A Survey of Patients’ Experiences with the Cancer Genetic Counseling Process: Recommendations for Cancer Genetics Programs

In order to promote ongoing quality improvement of not only the Penn State Cancer Genetics Program, but also other cancer risk assessment programs throughout the country, we developed, piloted and conducted a survey to explore patient expectations, experiences, and satisfaction with the cancer genetic counseling process. The comprehensive survey was mailed to 340 eligible patients, 156 (45.9%) of whom returned the completed survey within the allotted time. Responses to closed-ended questions were tallied and open-ended questions were content analyzed. Major findings show that: (1) Patients were seeking cancer-related information and support throughout the cancer risk assessment process and were interested in participating in available research studies; (2) The setting in which patients are seen for cancer risk assessment may pose potential emotional ramifications; (3) Misperceptions regarding insurance discrimination and lack of insurance coverage persist; (4) Patients view the genetic counselor as responsible for updating them about new discoveries. Specific recommendations for cancer genetics programs are included.     

Factor structure of coping: two studies of mothers with high levels of life stress

Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to investigate the factor structure of coping in mothers with high levels of life stress. In Study 1, EFA of the Coping Orientation to Problems Experienced (C. S. Carver, M. F. Scheier, & J. K. Weintraub, 1989) in a sample of mothers of full-term or very low birth weight 2-year-old children yielded 7 reliable coping factors. Each factor accounted for significant variance in at least 1 of 6 outcomes measuring maternal-child well-being. In Study 2, CFA was used to cross-validate the EFA model on the basis of the responses of mothers of 2-year-old children with prenatal polysubstance exposure. CFA results revealed a moderately good fit, confirming the factor structure in a 2nd, independent sample of mothers with high levels of life stress.     

Possible knowledge of unknown truth

Fitch’s argument purports to show that for any unknown truth, p, there is an unknowable truth, namely, that p is true and unknown; for a contradiction follows from the assumption that it is possible to know that p is true and unknown. In earlier work I argued that there is a sense in which it is possible to know that p is true and unknown, from a counterfactual perspective; that is, there can be possible, non-actual knowledge, of the actual situation, that in that situation, p is true and unknown. Here I further elaborate that claim and respond to objections by Williamson, who argued that there cannot be non-trivial knowledge of this kind. I give conditions which suffice for such non-trivial counterfactual knowledge.     

The Dialectics of Relational Psychoanalysis and Group Psychotherapy: Commentary on Paper by Robert Grossmark

In this commentary, I address the question of why so few psychoanalysts become group therapists as I respond to the thoughtful and impressive paper written by Robert Grossmark on his work with a psychotherapy group, now in its 10th year of meeting. Prior to discussing the clinical material, and to set the stage for a discussion of Grossmark's work, I comment on my sense of the prevailing attitudes on group affiliations and group therapy within our culture and field as they have progressed over time. I then discuss my reactions to Grossmark's handling of his group session. Many of his conceptualizations of group treatment are in accordance with my own beliefs. There are some differences, however, in how I view my role as a leader and some ideas I have about group treatment that Grossmark did not address.     

The Relation between Individual and Group Conflicts in Psychotherapy

Abstract

I describe three constellations of group life and group process: resistance, rebellion, and refusal. In resistance, an individual or group remains antagonistic to conscious but not unconscious thinking, the latter manifested in derivatives, including symbol and symptom formation, transference–countertransference, and enactment. Rebellion functions on the level of conscious thinking, manifested in challenge, defiance, and the possibility of sociopolitical action. The basic premises and values of the group and/or leader are at the center of the controversy, to be addressed on that level. Refusal establishes a mental boundary between what is considered appropriate and inappropriate. Unconsciousaswellasconscious processes of feeling, thinking, and meaning making are refused entry, left undeveloped, rejected, or obstructed. Working with refusal requires appreciating how and why the mind and its thinking operations are being suspended. The theoretical framework is applied to a case example.     

Childhood Abuse,Head Injuries,and Use of Medical Emergency Services in People with Severe Mental Illness

People with severe mental illness (SMI) report high rates of traumatic experiences. This study analyzes data collected from 183 people diagnosed with SMI on reports of childhood trauma, head injuries, and emergency room (ER) services. More than half the cohort (56.7%) reported 3 to 7 cooccurring categories of childhood abuse (CAB). People who reported 6 and 7 categories of CAB had a 5-fold risk of experiencing a head injury. If they have used the ER for reasons other than psychiatric illness they endorse more traumatic experiences in their childhood when compared to those who did not. People with SMI and cooccurring CAB experiences might be predisposed to a higher risk of head injuries and more frequent use of the ER.     

The sources of skill in seriating cups in children,monkeys and apes

Is a concept of either reversibility or of hierarchical forms of combination necessary for skilled seriation? We examined this question by presenting seriating cups to adult capuchin monkeys and chimpanzees and to 11‐, 16‐ and 21‐month‐old children. Capuchins and chimpanzees consistently created seriated sets with five cups, and placed a sixth cup into a previously seriated set. Children of all three ages created seriated five‐cup sets less consistently than the capuchins and chimpanzees, and were rarely able to place a sixth cup into a seriated set. Twenty‐one‐month‐olds produced more structures containing three or more cups than did the younger age groups, and these children also achieved seriated sets more frequently. Within all participant groups, success at seriating five cups was associated with the frequency of combining three or more cups, regardless of form. The ability to integrate multiple elements in persistent combinatorial activity is sufficient for the emergence of seriation in young children, monkeys and apes. Reliance on particular methods of combination and a concept of reversibility are later refinements that can enhance skilled seriation.