Multiple-family group treatment of outpatients with schizophrenia: impact on service utilization

The impact of multiple-family group treatment (MFGT) on outpatient and inpatient mental health service utilization of 97 persons with schizophrenia was investigated. Participants were randomly assigned to standard care (n = 44) or standard care plus MFGT (n = 53). Service use for a year prior to randomization, the 2-year study period, and a 1-year follow-up were examined. Relative to standard care participants, the MFGT group had reduced community hospitalization during year 1 of the intervention and reduced state hospitalization at follow-up. During the intervention period, MFGT participants demonstrated a significant increase in outpatient utilization as a direct consequence of the intervention. However, when service use was summed across 3 years post-randomization, no group differences were observed. Results suggest that implementation of MFGT in a community mental health setting reduces inpatient service at specific time periods, without significantly increasing outpatient service utilization. These findings add to other outcomes from this study that demonstrate decreased psychiatric symptoms and caregiver distress.     

Ethical Issues in Cancer Genetics: 1) Whose Information Is It?

This article presents and discusses four clinical cases that exemplify the complexity of ethical dilemmas concerning the provider's obligation to disclose or withhold genetic information from patients. Case 1: What is the responsibility of the cancer genetics provider to ensure that a positive test results is shared with distant relatives? Case 2: To ensure that results go to at-risk relatives, do we have the right to ignore the wishes of the designated next-of-kin? Case 3: Do we have the right to reveal a familial BRCA1 mutation to a patient's relative, who is at 50% risk? Case 4: Do we have an obligation to reveal that a patient is not a blood relative and therefore, not at risk to have inherited a familial mutation? These cases form the basis for discussing the provider's dual obligations to keeping patient confidentiality and informing patients and families about risk (i.e. duty to warn). We also provide a summary of consensus points and additional discussion questions for each case.     

Place matters: consensual features and regional variation in American well-being and self

Consensual and regionally distinct features of well-being and self were examined in a nationally representative survey of midlife Americans (ages 25-75). Consistent with key American ideology, Study 1 found that a majority of Americans believe they have high levels of mastery, purpose, life satisfaction, overall health, family and work obligation, and partner and family support. Study 2 found distinct regional well-being profiles (e.g., New England reflected concern with not being constrained by others; Mountain showed concern with environmental mastery; West South Central with personal growth and feeling cheerful and happy; West North Central with feeling calm, peaceful, and satisfied; and East South Central with contributing to others' well-being). Study 3 found regional self profiles consistent with the well-being profiles.     

Science and Human Behavior at fifty

The golden anniversary of Science and Human Behavior is cause for celebration. Toward that end, the present paper is largely an historical consideration of the book, its inception and reception, both at the time of its publication and in subsequent years. The range and intensity of reactions to S&HB mark its impact and show it to be among Skinner's most important works, if not the most important. S&HB was written as an introductory psychology text--a vigorous use of the book in our teaching could do much to benefit the dissemination of behavior analysis.     

Interrogative suggestibility: The effects of sleep deprivation and relationship with field dependence

Suggestibility (yield) scores on the first Gudjonsson Suggestibility Scale were found to correlate significantly with field dependence, as measured by the Finding Embedded Figures Test. Sleep-deprived subjects, while scoring worse on story memory, reaction time, POMS vigour–energetic and POMS confusion than controls, did not show any increase in yielding to suggestive questions. Upon answering the questions again after negative feedback, however, sleep-deprived subjects shifted their responses to questions significantly more than did controls. The results are interpreted in terms of sleep loss increasing the variability of performance.     

Barriers to inclusion for the disaffected: Implications for 'preventive' careers guidance work with the under-16 age-group

Issues arising from Careers Service refocusing its work with the 'disaffected' in the UK are examined, with particular attention to preventive work with the under 16s as a new direction for careers practitioners. The extent to which 'inclusion' is likely to be achieved via enhanced guidance is discussed. The benefits of such intervention are questioned. It is suggested that guidance is ineffective if it fails to consider social difference, and that it must pay adequate attention to the social and personal context within which the individual operates. Assumptions behind individualistic 'lifelong learning' policies are called into question.     

Self-knowledge: An expanded view

This paper argues for a more extensive study of self-knowledge. From the cognitive perspective, self-knowedge is a critical component of personality. Until quite recently, however, the study of self-knowledge has been narrowly conceived, focusing primarily on how individuals describe their roles and characteristic behaviors. Yet individuals also have knowledge about their preferences and values, their goals and motives, and their rules and strategies for regulating behavior. These dynamic aspects of self-knowledge are significant because they can be importantly revealing of future behavior. The content and organization of self-knowledge is important first because it indicates which domains of behavior are regarded as the most self-relevant. It is in these domains that the strongest links between personality and behavior will be observed. Second, self-knowledge cognitively represents desired and undesired states for the self, as well as specific ideas about how to realize or avoid these states. It thus indicates the likely course of behavior in self-relevant domains. A number of recent research efforts can be intepreted as explorations of self-knowledge. These are briefly reviewed and integrated to provide a general outline for an expanded view of self-knowledge.     

Negotiating professional and personal biographies in a liquid world: creating space for reflexive innovation in career counselling

This paper explores the constraints to innovative, creative and reflexive careers counselling in an uncertain neo-liberal world. We draw on previously reported research into practitioners’ use of a narrative model for career counselling interviews in England and a Europe-wide auto/biographical narrative study of non-traditional learners in universities. The latter draws on a number of narrative interviews with an asylum seeker, to debate whether such a way of working with people, ‘in a clinical style’, offers contextualised insight into people's struggles to construct a career and a methodology for doing so. The paper also examines the difficulties of creating a ‘good enough’ professional, psychosocial space for experimentation with creative approaches in a marketised guidance world, where more is expected from less.