Physicians' values and physician-value neutrality

For years articles have decried the lack of empathy in physicians' relationships with patients. In addition to being empathetic, physicians are called upon to assume the posture of value neutrality, i.e., not imposing one's values when dealing with patients. Empathy is clearly an expression of deeply held values; even the language used to define it is value-laden. Physicians are consistently called upon to exhibit traits which are expressions of their underlying values. However, if proponents of value-neutrality are to be taken literally one must not impose any of one's values on one's patients. But then one wonders how empathy could ever be expressed; further, it is hard to imagine what a truly value neutral physician would be like. It is time we recognize that any relationship between two persons requires the expression of values from both parties. These values help shape that relationship and define its further history. Physicians are not excluded from this process just because they consider themselves professionals. Divulging personal values to patients is both more honest and more in keeping with the concepts of justice, beneficence, non maleficence, and autonomy than to feign value-neutrality. A presentation of some type statement of values is timely and would give patients an idea of where a physician stands on a myriad of issues. Rather than being value-neutral, value non-neutrality seems a more right and reasonable posture for physicians to assume.     

A behavioral assessment scale for attention deficit disorder in brazilian children based on DSM-IIIR criteria

A teacher scale based on DSM-III-R diagnostic criteria for attention deficit hyperactivity disorder (ADHD) was developed for the behavioral assessment of children in Brazil. A total of 2, 082 children (782 males and 1,300 females) with a mean age of 11.2 years who were attending a public school in the greater Rio de Janeiro area were the subjects of this study. Two factors (Hyperactivity-Impulsivity and Inattention) were extracted from a principal-factor analysis conducted on the data, and the factor structure of the scale was found to be stable. Ratings of boys were higher than ratings of girls, and younger children had higher ratings than older children for both factors. Test-retest reliability for each item of the scale ranged from .56 to .70. The data are discussed in view of current controversies in the factor structure of teacher ratings of DSM-III-R ADHD symptoms.This research was supported by FINEP (42.88.0138.00) and FUNPENE. GNOB is the recipient of a CNPq Research Career Development Award (30.0197/82). RCAP was supported by a CNPq fellowship (82.2151/87). The authors are grateful to Rosely V. Magalhaes and Angela S. Guedes for assistance in data analysis with the SAS and SPSS packages. The authors wish to thank the school staff and teachers who participated in the study. This work was presented at the Fifteenth European Conference of the International Neuropsychological Society, Portugal, 1993.     

School Counseling: An Evolving Specialty

This article provides a review of school counseling as a specialty area of the counseling profession, including attention to historical development, training standards and accreditation, certification, and future trends and issues.     

Marital attributions in spouses of depressed patients

Causal attributions (i.e., locus, stability, globality) and responsibility attributions (i.e., bad intent, selfish motivation, blame) were assessed in the spouses of 27 depressed psychiatric inpatients and 30 nondepressed dyads to test predictions derived from Hooley's (1987) symptom-controllability model of marital distress. Results indicated that (1) depressed patients and their spouses were less dyadically adjusted than nondepressed spouses, (2) causal and responsibility attributions about depressive behaviors predicted lower dyadic adjustment, and (3) attributions of causality mediated the relationship between group status (depressed or nondepressed) and dyadic adjustment among spouses who had higher expectations for their partner to change. Results suggest that among spouses with a high expectancy for change, depression may be a risk factor for marital distress.     

An investigation of the effects of comorbid Axis II pathology on outcome of inpatient treatment for unipolar depression

DSM-based research on comorbidity has suggested thatdepression andpersonality disorder frequently occur together and that the combination of syndromes is associated with a poor response to treatment for depression. The present study was designed to explore the effect of comorbid Axis II pathology for a sample of 45 inpatients who received treatment for major depression. Both categorical and dimensional ratings of personality disorder were used in the statistical analysis. Positive categorical diagnosis of Cluster C (anxious-avoidant) disorder, as well as higher dimensional rating of Cluster A (odd-eccentric) pathology, was predictive of a poor response to treatment (p<.05), as measured by change in pre-post clinical ratings on the Montgomery-Asberg Depression Rating Scale. These results were construed as indicative of a significant Axis II comorbidity effect in the context of an inpatient, multimodal treatment setting for depression. The results also spotlight the influence of techniques of measurement in determining the outcome of statistical analysis.     

Use of a computer-controlled firearms training simulator in perception response time experiments

This paper describes the use of a custom-configured computer-controlled firearms training simulator to measure perception response (reaction) time (RT) to a stimulus in which the degree of threat presented is a manipulable variable across trials. The computer records the number of frames of videotape traversed between the point of presentation of the threat in the video stimulus and the point at which the subject responds by drawing the firearm. For the purposes of data analysis, these frame-count measures are converted to RT measurements. Example data are presented that capture perception RT at both thedraw-stimulus and thefire-stimulus points in situations for which either only one threat or more than one threat exists. Other elements, such as degree of threat and accuracy of response, provide additional data.     

Mindless reading: Eye-movement characteristics are similar in scanning letter strings and reading texts

The purpose of the present study was to compare the oculomotor behavior of readers scanning meaningful and meaningless materials. Four conditions were used—a normal-text-reading control condition, and three experimental conditions in which the amount of linguistic processing was reduced, either by presenting the subjects with repeated letter strings or by asking the subjects to search for a target letter in texts or letter strings. The results show that global eye-movement characteristics (such as saccade size and fixation duration), as well as local characteristics (such as word-skipping rate, landing site, refixation probability, and refixation position), are very similar in the four conditions. The finding that the eyes are capable of generating an autonomous oculomotor scanning strategy in the absence of any linguistic information to process argues in favor of the idea that such predetermined oculomotor strategies might be an important determinant of eye movements in reading.     

Thinking About “Tests and Assessment” and the Career Beliefs Inventory

The author (a) comments briefly on the “Tests and Assessment” section of the Journal of Counseling & Development (JCD)—what it has covered and has not covered in recent years—and (b) introduces a set of articles that discuss a new career-oriented inventory of potential interest to counselors.