Managed Care: Ethical Considerations for Counselors

Key factors and trends in health care will have an impact on the ethical practice of counselors. Ethical challenges to clinical practice presented by trends in managed care are discussed in relation to the American Counseling Association (1995) Code of Ethics and Standards of Practice. Recommendations for practice are also included.     

A Multicultural Perspective in an Undergraduate Human Services Program

This article describes the undergraduate human services program at California State University, Fullerton, which is designed to integrate theory and practice as a foundation for training human service workers. The article focuses on a course in cultural diversity that is taught from a multicultural perspective. The course is designed to help students understand and value diversity based on the nature of the clients they will be working with in the future. Because a single course is not sufficient to provide students with the necessary knowledge and skills needed for effective practice in a multicultural society, the article also describes the program's attempt to weave a multicultural perspective throughout the curriculum. We believe a multicultural curriculum improves both the academic achievement of our students and their success as future human service workers in the community because they will be able to adapt intervention strategies to meet the needs of a diverse client population. Este articulo describe el programa de estudios de Asistencia Social en California State University, Fullerton, el cual se ha diseñado para intregar la teoría y la practica como un base para entrenar a los Asistentes Sociales. El artículo se centra en un curso de diversidad cultural, enseñado desde una perspectiva multicultural. Se ha diseñado el curso para ayudar a los estudiantes a entender y evaluar la diversidad de clientes con quienes trabajarán. Porque sólo un curso no es suficiente para dar a los estudientes el conocimiento y capacidades necesarios para la práctica eficaz en una sociedad multicultural, el artículo tambien describe el intento del programa de incorporar al programa una perspectiva multicultural. Nosotros creemos que un programa multicultural mejora a la vez los resultados académicos de nuestros estudiantes y su éxito como futuros Asistentes Sociales en la comunidad, porque de esta manera podrán adaptar estrategias de intervención para una población variada de clientes.     

Vicissitudes in adult life resulting from traumatic experiences in adolescence1

The author deals with the diffi culties in combining the concepts of trauma and phantasy. He evaluates Freudian observations relating to chance and trauma. He considers traumatic effects of chance in relation to the rupture of a narcissistic phantasy of invulnerability. The narrating of traumatic events may awaken in the analyst tendencies to repeat the aggression of these traumatic events towards the subject. The accusatory interpretation can be one of the means by which this repetition is established. The author explores a type of trauma which is essentially related to the disturbance of the structure which contains the ideals of the subject. This disturbance is a consequence of disillusionment resulting from the loss of an object who was the depository of these ideals. Trauma generates a state of mourning for lost ideals. The author describes traumatic events which occurred in a patient's life at puberty; paradoxical behaviours in the patient's parents caused the patient to have new traumas. The reluctance to explore the derivatives of the unconscious, and to investigate possible meaning in symbols, was a central problem in this patient's analysis. The author discusses disturbances in symbolization, and he examines the subject of projective identifi cations that were received by patients from their primary objects.     

Perceptions of Women Condom Proposers Among Chinese Americans,Japanese Americans,and European Americans1

This study was a comparison of the judgments made about a sexually active female condom proposer by men and women of 3 ethnic groups: Chinese Americans, European Americans, and Japanese Americans. Results indicate that Chinese Americans reacted more negatively to the female condom proposer than did European Americans. Japanese Americans could not be distinguished between either of the groups on most measures. However, Japanese Americans did perceive the female condom proposer to be less sexually attractive than did the other 2 groups. These findings underscore the importance of distinguishing among subgroups of Asian Americans, especially when considering issues related to gender and sexuality.     

A disturbance of interpreting,of symbolisation and of curiosity in the analyst‐analysand relationship: (The patient without insight)1

The author examines the function of the analyst who may distort the unconscious communication with the patient by means of the expression of his countertransference. He studies a disturbance in curiosity and in symbolisation in a patient with a narcissistic pathology. Both problems were related to this failure in interpreting. The curiosity of the patient, which initially seemed to be non‐existent, was found to be directed towards investigating the mind of the analyst, this being his sole purpose. The disturbance in symbolisation was manifested as a constant verbal acting out, which was expressed as verbal communication empty of meaning. A change in the interpretative attitude enabled a modifi cation in the objective of the curiosity, which became focused on investigating his own inner world, and the emptiness of the verbal communication was replaced by representations. This change in communication allowed the analyst to relate the facts of the psychoanalytic relationship both with the patient's phantasy and with the events in his history. An idealised identifi cation with destructive aspects of the mother towards the father was discovered. This idealisation had been sustained by the analyst by means of his errors in interpreting. The author explores disturbances in symbol formation and in the use of symbols, and he considers the different states of emptiness.     

A COMPARISON OF TECHNIQUES WHICH TEST FOR JOB DIFFERENCES

There has been a recent trend in research seeking the most appropriate statistical technique for determining job similarities/differences. Monte Carlo methods were used to analyze more closely the repeated measures analysis of variance and the multivariate analysis of variance in order to add further insight into the viability of these techniques for this purpose. The conventional univariate analysis of variance, the ε-adjusted univariate F test, and the ε-adjusted univariate F test were compared to three multivariate tests (Roy's largest-root criterion, Wilk's likelihood ratio, and the Pillai-Barlett trace) in terms of power and control for Type I error when (1) circularity and homogeneity were met, (2) homogeneity was met but circularity was violated, (3) homogeneity was violated but circularity was met, and (4) both homogeneity and circularity were violated. The efficacy of the techniques was shown to be contingent upon whether the assumptions were met or not. The univariate test proved to be the better technique when circularity was met. The multivariate technique proved to be the better test when homogeneity was met while circularity was violated. The results were mixed when both circularity and homogeneity were violated. Guidelines for selecting a statistical technique which tests for job differences are offered.     

Ethnic Intermarriage

Americans are marrying out of their ethnic groups at an ever-increasing rate, reflecting the expectation that people in this country will assimilate into what has been termed the "melting pot." We know, however, that not all ingredients in the pot have melted and that ethnic values and identification remain with us for generations. The difficulties inherent in intermarriage then become intensified by being unanticipated. We confuse the idea that we are all created equal with the belief that we are all the same.
This paper presents a paradigm for understanding the family patterns and typical problems of intermarried couples, and offers suggestions for clinical intervention. We will present a framework for helping spouses to recognize, understand, and negotiate their differences. We are keenly aware of the perniciousness of negative stereotyping in our culture and in no way wish to contribute to that tendency. We wish instead to provide a map that, although covering only limited aspects of the terrain, may nevertheless provide a guide to explorers seeking a path to expand our clinical sensitivity and effectiveness.     

Dilution of Family Process in Social Services: Implications for Treatment of Neglectful Families

Families identified as neglectful pose a special challenge to family therapists and other practitioners, not only because they are usually involuntary clients but also because of the relative weakness of their internal process, which often becomes "diluted" into the system of providers. Current social services practices that exacerbate the dilution of family process are hard to eradicate because they are rooted in a culture that promotes the transfer of functions from families to social agencies; families, immersed in the same culture, often collude with the agencies in their own dilution. The treatment of neglect in families calls for the nurturance of the family's process and the disruption of the complementary pattern between family and regulatory agencies.