Fixing forensic patients: Psychiatric recommendations for treatment in pretrial settings

This article is concerned with psychiatric recommendations for treatment at the Metropolitan Toronto Forensic Service (METFORS), a clinical assessment agency providing both 1-day and 30-day evaluations of criminal defendants in Toronto, Canada. Analysis of both psychiatric reports and quantitative research instruments demonstrated the saliency of treatment as a central forensic issue at METFORS. Among a sample of 592 defendants, 134 were considered in need of outpatient care. Persons recommended for hospitalization were most likely to exhibit histories of mental health rather than criminal justice contacts; to be arrested for nonviolent offenses; to manifest psychotic behavior while at METFORS; to be found unfit for bail, incompetent to stand trial, in need of further assessment and dangerous to self; and to experience higher rates of hospitalization, but lower levels of criminalization during the two years following their initial forensic assessment. Psychiatric reports at METFORS tended to merge recommendations for treatment and assessment; to suggest prison or probation as means for securing clinical treatment; and to provide little written support for judgments about the need for intervention. Along with competency and dangerousness, treatment is a key issue in forensic practice, and warrants further attention in the psycholegal literature.     

Treatment recommendations for mentally disordered offenders: More than roulette?

Clinical judgments on the treatability and prognosis of mentally disordered offeenders (MDO) may strongly influence legal dispositions and the availability of treatment resources. This study examined 1,238 discharge summaries for MDOs referred for court assessments. Psychiatrists evidenced marked variability in how often they recommended treatment and how frequently they judged patients to have a poor prognosis. Two logit analyses suggested that diagnosis and consultation by other clinicians were associated with (a) treatment recommendations (i.e., Axis I diagnosis and social work consultations) and (b) prognosis (i.e., Axis II diagnosis and psychology consultations).     

Personal Versus Vocational Focus in Career Counseling: A Retrospective Outcome Study

In this archival study the authors sought to determine the relationship, if any, between counseling outcomes and the topical focus in career counseling. Twenty-two counselors saw 46 adult clients at a community-based clinic for an average of eight sessions. Counseling outcome and topical focus (the extent to which the actual content of counseling sessions reflected relatively more vocationally or personally focused topics) were assessed from follow-up questionnaires to former career clients and from trained raters' evaluations of the counselors' written progress notes. Results showed that, from the counselors' perspective, outcomes were better when the focus of the sessions was relatively more vocational than personal and when relatively more interviews were held. Client satisfaction, on the other hand, was predictable only from the counselor's level of experience. Satisfaction with occupational status was not associated with any of the client, counselor, or treatment factors. Discussion focuses on the contribution of the results to career counseling practice and on the feasibility and validity of retrospective, archival research.     

Menopause: Salient Issues for Counselors

Counselors are in ideal positions to help change attitudes toward viewing menopause as a time of positive change, rather than a time of psychological distress. Following definitions and a review of historical, sociological, psychological, and attitudinal factors that account for negative responses associated with menopause, recommendations for counselor interventions are proposed.     

A Gender Role Workshop Focused on Sexism,Gender Role Conflict,and the Gender Role Journey

A 6-day gender role workshop for adult men and women, using the phases of the gender role journey, is presented. The workshop's curriculum and process are described, including its assumptions, norms, and media. Movie clips, music, music videos, and academic content were used to promote participants' learning in both the cognitive and affective domains. Systematic follow-up evaluations of participants ( N =84) in three separate workshops are reported using Likert scaled questions. These evaluations assessed participants' personal learning, emotional reactions, and the workshop's overall impact over l-month and 1-and 2-year follow-up periods. Results indicate that participants were affected personally and professionally over the various time periods.     

Mass media treatment of violence in sports and its effects

There appears to be a strong relationship between mass media portrayals of violence and real-life violence itself. This article reviews the available literature on the effects of media treatment of sports violence; analyzes the theoretical explanations for this treatment; and makes proposals on how the problems of both sports violence and its media coverage may be remedied, with a particular focus on amateur hockey in Canada.     

Predicting diagnosis performance with measures of cognitive style

This study examines the relationship between performance on a context-independent fault diagnosis task and two dimensions of cognitive style: field dependence/independence (D-I) and focusing/scanning (F-S). The effects on diagnosis performance of training and the ability of both dimensions of style jointly to predict fault-finding ability were considered. The results showed that field independents and focusers were superior fault diagnosticians. Training, in the form of verbal feedback messages, was uniformly effective for the D-I dimension although field independents maintained a superior level of performance, over field dependents. In general, for the F-S dimension, training had little effect on either the focusers or scanners. A combination of scores on the F-S and D-I dimensions significantly enhanced the proportion of the variance in testing efficiency that could be accounted for during fault-finding. Finally it is argued that the F-S and D-I dimensions should be recognized as measures of ability, not style. Future research should be directed at identifying between subject differences on fault diagnosis tasks with reference to theories of information processing.     

Relaxation therapy for tension headache in the elderly: a prospective study

We evaluated the effects of an 8-week progressive muscle-relaxation therapy regimen on the headache activity of 10 elderly tension-headache subjects. Posttreatment assessment at 3 months revealed significant decreases in overall headache activity (50% or greater) in 7 subjects. Significant clinical or statistical prepost differences, or both, were also found for the number of headache-free days, peak headache activity, and medication index. This is the first prospective study of tension headache in an elderly population, and, unlike previous retrospective studies, it suggests that relaxation therapy may be an effective intervention in the treatment of such headaches.     

Daily stress and anxiety and their relation to daily fluctuations of symptoms in asthma and chronic obstructive pulmonary disease (COPD) patients

Although stress and anxiety have long been assumed to play an exacerbatory role in asthma, no study has systematically documented that daily exacerbations of asthma symptoms are related to stress and/or anxiety. In this study, 24 airways obstruction patients (12 asthmatics and 12 chronic obstructive pulmonary disease patients) were instructed to monitor the severity of daily respiratory symptoms. In addition, subjects recorded their daily anxiety level and the number and perceived impact of daily stressors. The results showed that although there were differences between high- and low-stress days for both groups, there were no differences between groups on symptom severity or between high- and low-anxiety days, as measured by the State-Trait Anxiety Inventory (STAI). Thus, although the number and impact of daily stressors were found to be directly associated with the severity of asthma symptoms, anxiety does not appear to have a direct role in the exacerbation of asthma. The findings failed to support the anxiety theory of asthma but provided an explanation for the poor results obtained in previous treatment studies which employed anxiety management with asthmatics.