Recent developments in psychiatric malpractice

Common issues of mental health liability are examined in relationship to recent legislative and case law. Matters of practical importance to practitioners including the applicability insurance coverage to punitive damage awards of arising from malpractice are addressed. Specific legal doctrines involving proof of liability, proximate cause and the standard of care are explored as they relate to mental health malpractice cases.     

The use of family myths as an aid to strategic therapy

The concept of family myth can be used by the therapist to help organize the wealth of information provided by a family in therapy. Rituals, symbols and metaphors can be viewed as structurally related components within the family myth system which enable the therapist to interpret non-literal, analogic communications as a coherent yet primarily symbolic, narrative about the family's shared perceptions of its functioning. The concept of myth is explored in relation to mythology, the family therapy literature, and a case study. Several strategic intervention strategies are proposed which utilize the family's own metaphors, symbols and rituals to re-edit the family myth. Re-editing the myth on a symbolic level should be associated with improved system functioning, including more concrete areas of the family's life.     

Multifactorial assessment of bulimia nervosa

We investigated a multifactorial approach to the assessment of bulimia nervosa by means of hierarchical factor analysis. Two hundred forty-five bulimia nervosa patients and 68 patients with either anorexia nervosa or eating disorders not otherwise specified were administered a self-report battery that was organized into 21 dimensions relevant to eating disorder patients. When dimensions from this battery were subjected to hierarchical factor analysis, support for bulimia nervosa as a unique diagnostic category was obtained. However, the emergence of 3 secondary factors and 6 primary factors suggests that bulimia nervosa can also be described more complexly. The emergence of a multifactorial model of bulimia nervosa that incorporates several existing undimensional models suggests the potential for both divergent and complicated clinical presentation in bulimia nervosa patients.     

Making choice a routine part of mealtimes for persons with profound mental retardation

Despite increased recognition of the importance of providing routine choice opportunities for persons with severe handicaps, this population continues to experience a typical lack of such opportunities. We evaluated a program for increasing the amount of choices made during routine mealtimes by persons with profound mental retardation and minimal communication skills. The choice provision program, involving systematic presentation of alternative food and drink items in a step-wise fashion during the course of the meal, was implemented with three persons in a residential facility. Results indicated that after implementation of the choice program, all three participants made consistently more choices concerning the foods and beverages they consumed relative to baseline. The choice provision program was conducted without extending the amount of time typically allotted to mealtime within the residential setting. Results are discussed in regard to additional research needed to continue developing means of assisting persons with profound mental retardation to exert control over meaningful events in their lives.     

Cognitions, affect, and behavior following uncontrollable outcomes: A response to current human helplessness research

A series of articles in the Journal of Personality challenge several central assumptions of the reformulated learned helplessness model: that perceptions of uncontrollability, awareness of noncontingency between responses and outcomes, and attributions made about the outcome are necessary to explain learned helplessness effects. The present article addresses the validity of this challenge through a consideration of the methodology employed in these and other traditional studies of human helplessness conducted in the laboratory. We maintain that although performance deficits can be demonstrated reliably following exposure to uncontrollable outcomes, a number of factors other than expectations of future uncontrollability (i.e., learned helplessness) may be responsible for these effects. In addition, demands of the experimental situation may prevent subjects from admitting their true underlying thoughts and feelings regarding the manipulations employed. Finally, the current use of artificial laboratory paradigms may unnecessarily restrict the study of a complex psychological phenomenon such as learned helplessness. We suggest that future researchers employ paradigms that more closely parallel real world situations to which they hope to generalize, or utilize naturally occurring uncontrollable life events to study the problem. In addition, we argue that future research should broaden its focus beyond attributions to explore other mediators of human helplessness.     

USE OF A SELF-RECORDING AND SUPERVISION PROGRAM TO CHANGE INSTITUTIONAL STAFF BEHAVIOR

The use of a self-recording and supervision program to increase interactions between direct care staff and profoundly retarded persons in a state residential facility was investigated. Following baseline, staff were provided with instructions regarding what to self-record, criteria for how many interactions to record, and a prepared card on which to make the recordings. Throughout the study, the staff supervisor monitored intermittently staff-client interactions. Observations indicated that when the staff recorded their interactions with clients in a loosely structured dayroom setting, the rate of interactions increased noticeably for each staff person. Behavioral ecology measures indicated that other staff responsibilities, such as maintaining the cleanliness of residents and the physical area, were not affected detrimentally when social interactions increased and actually showed small improvements. Additionally, small decreases in resident self-stimulatory and disruptive/aggressive behaviors occurred when the rate of social interactions from staff persons increased. Follow-up measures indicated that the rate of staff self-recording was variable, but when staff did self-record, the increased rate of staff-client interactions maintained.     

Children at risk for delinquency: A follow-up comparison of aggressive children and children who steal

This study compared the follow-up incidence of court-recorded nonstatus offenses for three groups of adolescent children. These children had been seen 2 to 9 years earlier for problems with aggression in the home (N = 21), for stealing problems (N = 25), or for normative comparisons (N = 14). The results showed that 77% of the children with stealing problems had court-recorded offenses. This was significantly higher than the aggressive children, whose rate did not differ from the normative sample. These findings suggested that young aggressive children were not at risk for adolescent court contact. Instead, it was the young child with identified stealing problems who was highly likely to become an official delinquent. It also appeared that parental reports of stealing events constituted a predictive measure of later criminal acts.