Effects of diagnostic classification systems on clinical hypothesis-generation

In this study it was determined whether (a) classification as opposed to absence of classification has an effect on the quality of clinical hypotheses (b) the DSM-III-R and the CBCL have a different effect on the quality of clinical hypotheses, and (c) the potential difference between the DSM-III-R and the CBCL is moderated by the different number of syndromes identified by these systems. To investigate these questions, an experiment was conducted in which 86 clinicians generated hypotheses for six cases. The clinicians were divided into a DSM-III-R, a CBCL, and a control group. Of the six cases, two were classified by both classification systems as one syndrome, two were classified as one syndrome by the DSM-III-R but as two syndromes by the CBCL, and two were classified as two syndromes by the DSM-III-R but as one syndrome by the CBCL. The quality of the hypotheses was determined by means of four dependent variables selected from an overview of qualitative criteria: explanatory value, redundancy, possibility of operationalization, and specificity. No differences between the CBCL and the control groups were found. The DSM group performed better than the control group regarding explanatory value and redundancy. The DSM-III-R group also scored better than the CBCL group regarding explanatory value, particularly when the number of identified syndromes was two for the CBCL and one for the DSM-III-R.     

Improving our understanding of therapeutic failure: A review

This paper argues the need to consider carefully the phenomenon of therapeutic failure in counselling and psychotherapy. The scant literature on therapeutic failure is reviewed, this literature suggests that there are large individual differences in therapists' overall effectiveness. A conceptual model of therapeutic failure is proposed, organized around the assumption that failure results from a therapist's inability to meet the needs of a particular client. Suggestions aimed at reducing the likelihood of therapeutic failure are offered.     

Development of lateral asymmetry in the perception of sequentially touched fingers

In order to investigate lateral asymmetry in tactile perception, two or four fingers of normal primary school children were touched sequentially. Stimulation was either unimanual or bimanual and either verbal or nonverbal responses were required. Right hand advantage was demonstrated subsequent to uni- and bimanual stimulation in both the verbal and nonverbal response conditions. Neither an age nor a sex effect on laterality was found. Right hand advantage was affected by direction of stimulation in the bimanual condition. Left hemispheric dominance was argued to be related to the temporal nature of the tasks.     

On various causes of improper solutions in maximum likelihood factor analysis

In the applications of maximum likelihood factor analysis the occurrence of boundary minima instead of proper minima is no exception at all. In the past the causes of such improper solutions could not be detected. This was impossible because the matrices containing the parameters of the factor analysis model were kept positive definite. By dropping these constraints, it becomes possible to distinguish between the different causes of improper solutions. In this paper some of the most important causes are discussed and illustrated by means of artificial and empirical data.The author is indebted to H. J. Prins for stimulating and encouraging discussions.     

Treatment of obsessive-compulsive patients: The contribution of self-instructional training to the effectiveness of exposure

Fifteen obsessive-compulsive patients were given treatment consisting of ten sessions of gradual exposure in vivo. For half of the patients gradual exposure in vivo was preceded by self-instructional training.Treatment resulted in significant improvement on anxiety and avoidance scales, Leyton Obsessional Inventory, Self-rating Depression Scale and on ratings for anxious mood and depression. Neither the post-test nor the follow-ups 1 month and 6 months later indicated a difference between the effects of the two conditions. Self-instructional training did not enhance the effectiveness of gradual exposure in vivo.     

TEACHING THE HANDICAPPED TO EAT IN PUBLIC PLACES: ACQUISITION,GENERALIZATION AND MAINTENANCE OF RESTAURANT SKILLS

This study examined classroom-based instruction in restauranting skills for handicapped persons. Three male students were taught each of four skill components in sequential order: locating, ordering, paying, and eating and exiting. Training was implemented in a multiple baseline design across subjects and consisted of modeling and role playing in conjunction with photo slide sequences and a simulated ordering counter. The use of a menu containing general item classes and a finger matching procedure for identifying errors in the delivery of change greatly reduced the reading and math skills necessary to enter and complete the program. Periodic probes were conducted in a McDonald's restaurant prior to, during, and up to one-year following the termination of training. In addition, two probes (overt and covert observation) were conducted in a Burger King restaurant to assess further generalization to a location different from the one depicted throughout training. Results showed that students' performance on restaurant probes improved as a result of training, generalized to novel settings, maintained over an extended period of time, and was comparable to that of a normative sample of nonretarded persons.