The factor structure of ADHD items in DSM-III-R: Internal consistency and external validation

Previous research employing factor-analytic procedures to study the underlying dimensions of DSM-III attention deficit disorder with hyperactivity (ADDH) symptoms have consistently supported a two-factor model. Revision of the structure of the ADHD diagnosis in DSM-HI-R, as well as inclusion of new items, has raised the question of comparability of the two diagnoses. To explore the significance of these changes, teacher ratings of DSM-III ADDH items and DSM-III-R ADHD items of 85 nonreferred school children were factor-analyzed to determine their underlying factor structures. A similar two-factor solution was obtained for each diagnostic scale. The factors consisted of items believed to reflect inattention and hyperactivity-impulsivity constructs. These factors were further evaluated against results of a cognitive test battery to ascertain whether objective, external validation could be demonstrated. The hyperactivity-impulsivity factor scores were related to continuous performance test measures of response inhibition, while inattention-disorganization factor scores were related to measures of attention and visual search. Implications for assessment and diagnosis of ADHD are discussed.The authors gratefully acknowledge the assistance of Sister Hildegarde Koger, the St. Francis de Sales School, and the parents and children who participated in this study.     

Small and unfilled psychotherapy groups: Understanding and using them effectively

Many open-ended psychotherapy groups have fewer than five members, and fewer than the number the therapist considers necessary for the group to be filled. This paper discusses the rationale for starting such groups and the special dynamics of running them. It then suggests strategies for the therapist to use in maximizing their therapeutic effectiveness. Suggestions are made for further research into the demographic and dynamic aspects of such groups.     

Medication dynamics in group psychotherapy

The use of medications in insight-oriented groups has not been adequately investigated. We report a group in which the anxiolytic buspirone appeared to be associated with attractiveness to the group in the face of impending therapists' termination. We feel that in this group, medications became a variable associated with group cohesiveness, served as a vehicle for the expression of group dynamics, and as an indicator of regression within the group. These observations suggest that, under certain circumstances, medications may become an important variable in the process and expression of group dynamics.They would like to thank Myron Pisetsky, M.D., for reading the original draft of this paper, and are also indebted to Daniel O'Neil, Ph.D., for his input.     

The capacity to join in the group process

This paper explores the difficulties certain individuals have in joining the interactional processes that make a group work. It explores the sequelea of traumatic early failures in need mediation, notably the encapsulation that renders them unresponsive to efforts by fellow group members to engage them. An uncanny similarity to holocaust victims is observed. Illustrative case examples are cited and suggestions for treatment offered.This paper was part of a symposium entitled Love and Hate in Group Therapy presented at The 11th International Congress of Group Psychotherapy, Montréal, Quebec, Canada, August 1992.     

Brief report: On becoming a group therapist

Clinicians have become group therapists via many routes, either voluntarily or not. Group psychotherapy itself has had a checkered history, in that it has often been seen as an ancillary or a second choice form of treatment. Indeed, we know that there is a growing number of well-respected clinicians who are not only not ambivalent about being seen as group clinicians, but embrace this reality as a primary clinical identity. It has occurred to us that no one has looked deeply at this developmental path or what facilitates or inhibits movement along this path. This article is a preliminary attempt to initiate this line of study.     

Dream appreciation group: A model of stress prevention for medical students

This paper describes a pilot study in stress prevention for medical students, utilizing Montegue Ullman's process in a dream appreciation group. Relevant literature on the use of dreams in a group is reviewed. In this model, group dynamics and interaction are not analyzed, rather the dream holds center stage. The technique of working with dreams in a group is described, and selected vignettes are presented to document the process. This study suggests that in the presence of a supportive group atmosphere, unconscious conflicts can be alleviated or resolved so as to enhance medical students' evolving personal and professional identity.This paper is based on a presentation at the thirty-first winter meeting of the American Academy of Psychoanalysis, Scottsdale, Arizona, December 11, 1987.     

A critique of Kellehear's transcendent society

Allan Kellehear argued that the otherworld society envisioned in near-death experiences (NDEs) is similar to utopian societies. However, his cultural analysis, based on 9 Mormon NDEs, did not reflect the diversity of near-death visions from other cultures. I suggest that these Mormon NDEs were neither as utopian as Kellehear assumed nor representative of contemporary NDE reports, and that a more complete analysis would reveal a variety of NDEs and otherworld visions reflecting the experiencers' sociocultural back-ground. Robert Bellah's model of religious evolution provides a model for charting the NDE's change over time and cultures, and allows us to differentiate the perennial features of the NDE from the transient culturally-determined ones — a first step in understanding the role of NDEs in the quest for an ideal society.Howard Mickel, Ph.D., formerly Chairman of the Department of Religion at Wichita State University, is currently Director of the Theta Project, an educational and research effort focusing on near-death and related experiences.     

Designing an effective worksite smoking cessation program using self-help manuals,incentives, groups and media

Pilot studies indicate that the workplace is a successful site for the implementation of smoking cessation programs (Jason et al., 1987a; 1987b;). Cessation efforts using monetary incentives have had yielded increased success in abstinence (Kleges & Cigrang, 1989). This article provides an overview of previous efforts at worksite cessation programs and outlines a new study that will use self help manuals, incentives, and group support sessions in a multilevel intervention in an attempt to identify successful components of worksite programs. The four year project will attempt to develop a comprehensive worksite program that is capable of being implemented by individual companies. To this end, sixty corporations will receive one of three programs and a week long television newscast on WGN-TV will be aired to accompany the interventions. An overview of the project is presented.The authors appreciate the financial support from the National Heart, Lung and Blood Institute (Grant Number 42987).     

Curriculum reform in death education: The modern resurrection ofArs Moriendi

... The purpose of death education, therefore, must be to teach medical personnel how to assist their patients to achieve their private needs. Philosophically and religiously, the good death is purposeful and meaningful. It may or may not entail relief of suffering. Medically, the experience of death may be manipulated in a number of different directions. Whether sentience is worth preserving at the expense of pain, or vice versa, for example, is not the physician's decision: it is the patient's. One cannot guarantee that death will be easy for anyone: but because medical personnel must generally turn from the dying to attend to the living, thoughtful educational curricula can improve the lot of all three.