Damage compounded: disparities, distrust, and disparate impact in end-of-life conflict resolution policies

For a little more than a decade, professional organizations and healthcare institutions have attempted to develop guidelines and policies to deal with seemingly intractable conflicts that arise between clinicians and patients (or their proxies) over appropriate use of aggressive life-sustaining therapies in the face of low expectations of medical benefit. This article suggests that, although such efforts at conflict resolution are commendable on many levels, inadequate attention has been given to their potential negative effects upon particular groups of patients/proxies. Based on the well-documented tendency among many African Americans to prefer more aggressive end-of-life medical interventions, it is proposed that the use of institutional policy to break decision making impasse in cases for which aggressive treatment is deemed "medically inappropriate" will fall disproportionately on that group. Finally, it is suggested that the development and application of institutional conflict-resolution policies should be evaluated in the context of historical and current experiences of marginalization and disempowerment, lest such policies exacerbate that experience.     

Perceived health: a test of incremental validity in relation to smoking outcome expectancies, motivation to smoke and desire to quit smoking

This study examined the role of perceived health in predicting theoretically-relevant aspects of smoking behavior among 161 young adult regular smokers (67 females; mean age = 21.9 years (SD = 7.2), cigarettes per day (M) = 12.2 (SD = 5.7)) recruited from the general community. Consistent with prediction, results indicated that relative to anxiety sensitivity, gender, number of cigarettes smoked per day and nicotine dependence, perceived physical health uniquely and significantly predicted expectancies for negative affect reduction and expectancies that smoking would lead to negative personal consequences. Additionally, perceived health incrementally predicted motivation to smoke to reduce negative affect. In contrast to expectation, perceived health was unrelated to motivation to quit smoking. Results are discussed in relation to the role of perceived health as a cognitive vulnerability factor for specific types of smoking patterns.     

Detection of feigned memory impairments using a Chinese word task

In this study the detection of feigned memory impairments was investigated using a forced-choice task with Chinese words as stimuli. Task difficulty on accuracy and response time and the faking strategies employed were examined for 85 participants, 42 men and 43 women, who were administered the experimental task. Following a simulation design, all participants performed under control and faking conditions. Their accuracy of performance and response times were measured. Analysis indicated significant differences on both outcome measures for the two conditions. Further, a significant difference in accuracy, but not in response time, among levels of task difficulty was observed. For classification accuracy, using the cut-off score criterion seemed more effective than using the below-chance criterion or response time. Implications for relying on chance criterion to identify deception are discussed.     

Causal ordering of academic self‐concept and achievement: Effects of type of achievement measure

Background. The relation between academic self‐concept and achievement has been examined in a large number of studies. The majority of these studies have found evidence for a reciprocal effects model. However, there is an ongoing debate on how students' achievement should be measured and whether the type of achievement indicator (grades, tests, teacher ratings) affects the causal pattern found in these studies. Aims. The study aims at clarifying how the types of achievement measures and the way they are modelled can affect the results of causal ordering studies. In that sense, the study will yield recommendations for researchers in this domain and also provide some direction for practitioners seeking ways to enhance their students' achievement and/or academic self‐concept. Sample. Repeated measures of academic self‐concept and achievement (standardized tests and teacher ratings) were examined in a sample of 1,753 students in Grades 7, 8, 10, and 12. Method. Structural equation modelling was used. Several models (with different types and numbers of achievement measures) were compared. Results. Only small differences were found between models using one or two indicators of achievement. All models generally supported the reciprocal effects model. However, the final model, wherein tests and teacher ratings were used as separate latent variables, showed different developmental patterns in the causal relation between academic self‐concept and achievement. Conclusions. Researchers should interpret the results of causal ordering studies discerningly because the type of measure chosen as an indicator of achievement might affect the causal pattern between academic self‐concept and achievement.     

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.     

Perchance to Sleep: Minding the Unworded Body in Psychoanalysis

In contemporary relational psychoanalysis, influenced by developmental/attachment theories, infant research, and neurobiology, the effectiveness and transformational potential of “the talking cure” can be thought of as, at times, located in areas of nonverbal engagement. It has become increasingly evident that human experience is born in the body and structured in body-based memory that informs us of what we “know in our gut” and contributes to our relating as embodied beings—experiences that as psychoanalysts we cannot or need not necessarily translate directly into declarative discourse. A detailed case presentation from work with a patient suffering from a severe sleep disorder and other forms of bodily dysregulation will be offered to illustrate and explore the affectively meaningful engagement between patient and analyst of somatically encoded, presymbolic memory within the context of a symbolically rich, verbal treatment relationship.     

Barriers and Supports to Substance Abuse Service Use Among Homeless Adults

Although there is a great need for substance abuse services among the homeless, many homeless individuals do not use those services. This study examined barriers and supports related to service use. Participants recognized a need for treatment and significant barriers to accessing care.     

Popular Versus Skinnerian Views on the Relation Between Human Freedom and Dignity

This study evaluated Skinner's (1971) contention that the function relating the degree to which a person's behavior is ascribed to voluntary choice and the level of dignity ascribed to that person originates at zero dignity for zero choice. In Study 1, 91 American college students answered questions about themselves, their beliefs about voluntary versus environmental control of behavior, and their bases for judging dignity. Then they attempted to describe their views of the functional relationship between perceived human dignity and perceived voluntary control of both prosocial and antisocial behaviors. Most indicated belief in voluntary choice, and some in intrinsic (unearned) dignity, but few could relate them quantitatively. A second study used 27 students in an advanced class, for whom the theoretical implications of various functional relationships were discussed before the functions were drawn. Both studies refuted Skinner's pragmatic argument against the concepts of freedom and intrinsic dignity.     

Engaging in Less Protective Self-Presentation: The Effects of a Friend's Presence on the Socially Anxious

To cope with their fear of negative evaluation, socially anxious people use protective self-presentation strategies. We hypothesized that the presence of a close friend (vs. being alone) would lead socially anxious people to engage in more acquisitive self-presentation tactics. Results supported the hypotheses. With a friend present versus not, socially anxious participants presented themselves more positively to and selected more self-disclosing topics to discuss with a stranger they believed they would meet face-to-face. Friendship strength moderated some of the effects. Results suggest that friends’ support may allow socially anxious people to satisfy safety needs while engaging in less protective self-presentation.