The current environment for medical decision making: Alternative efficiency concepts and decision motivation

Health services delivery is rapidly changing in the U.S. and along with it the incentives and motives for making decisions about the use of services. This paper discusses the economic criteria for making good decisions from both individual and social perspectives. The position is taken that individual criteria for decision-making efficiency in health services is quite different from social efficiency criteria but the two perspectives can be viewed as complementary. These criteria are used to examine current developments in health services, including aggressively competitive managed care. The analysis concludes that current directions may be in conflict with both social and individual efficiency. Alternative public policies are required to alter motives and incentives such that decisions better meet the complementary efficiency criteria.Originally prepared for presentation at the Annual Meeting of the American Association for the Advancement of Science, Atlanta, Georgia, February 17, 1995, as part of the symposium Cognitive Interpersonal, and Societal Influences on Medical Decision Making (A. M. Isen and B. S. Moore, Chairs).     

Book reviews

Science as Salvation: a Modern Myth and its Meaning, Mary Midgley, 1994. London, Routledge x +256pp., Hb 04 15062713, £35; Pb 04 15107733, £8.99

Philosophical Naturalism, David Papineau, 1993 Oxford, Basil Blackwell xii +219pp., Hb 0631189025, £40; Pb 0631189033, £14.99

F. H. Bradley, Writings on Logic and Metaphysics, James W. Allard & Guy Stock (Eds), 1994. Oxford, Clarendon Press xv+357pp, Hb 0–198–24445–2, £40.00; Pb 0–198–24438‐X, £14.95

Invariance and Heuristics: Essays in Honour of Heinz Post, Steven French & Harmke Kamminga (Eds), 1993 Boston Studies in the Philosophy of Science, Vol. 148 Kluwer Academic Publishers, Dordrecht

Beyond Reason: Essays on the Philosophy of Paul Feyerabend, GONZALO MUNÉVAR (Ed.), 1991. Dordrecht, Kluwer Academic Publishers xxi + 535pp., hb, ISBN 0–7923–1272–4, £104.20

World Changes: Thomas Kuhn and the Nature of Science, Paul Horwich (Ed.), 1993. Cambridge, MA, Bradford Books/MIT Press vi + 356pp., pb, ISBN 0262581388, £14.95

Realism Rescued: How Scientific Progress is Possible, Jerold L. Aronson, Rom Harré & Eileen Cornell Way, 1994 London, Duckworth vii +213pp., Hb 0715624768, £30.00

Scientific Nihilism: On the Loss and Recovery of Physical Explanation, Daniel Athearn, 1994. State University of New York Press, Albany ix + 387pp., Hb ISBN 0–7914–1807–3, £52

Theism, Atheism, and Big Bang Cosmology, William Lane Craig & Quentin Smith, 1993. Oxford, Clarendon Press x +342pp., Hb 0198263481, £35; Pb 019826383X, £13.95     

Construction and validation of the Gender Attitude Inventory,a structured inventory to assess multiple dimensions of gender attitudes

Three studies describe the development and initial validation of the Gender Attitude Inventory (GAI), a structured inventory that assesses attitudes toward the multiple objects that organize college students' thoughts and feelings about sex and gender. An intergroup relations perspective was used to specify the universe of gender-related targets and to construct a preliminary instrument. Factor analyses of the results of two sequential studies yielded a 109-item inventory with 14 content-specific attitude areas and three second-order factors. In Study 3 GAI scales were shown to have acceptable internal consistency and temporal stability, as well as convergent and discriminant validity. In terms of race/ethnicity, most respondents were white (ranging from 69% to 82% across the three studies).     

Outcomes of inpatient group psychotherapy associated with dispositional and situational affiliativeness

Before and after participating in an intensive three-week program of group psychotherapy, 33 recently rehospitalized male veterans (mean age=42) completed the Symptom Check List-90R and the Profile of Mood States. Prior to this program they also completed a trait affiliativeness measure and later rated their subsequent group therapy sessions for situational affiliativeness. The outcome measures indicated medium to large effect size benefits, which consistently associated positively with both separate and joint measures of trait and situational affiliativeness. The results encourage greater clinical attention to affiliativeness, a construct central to interpersonal theories of personality.This article is based upon a dissertation submitted to the Department of Psychology, Michigan State University, in partial fulfillment of the requirements for the Ph.D. by the senior author.The authors express appreciation for the interest and cooperation of Drs. Bruce Vreeland, Larry Schwartz, Robert Munley, and Hope Conte and the patients of the Veterans Administration Medical Center, Battle Creek, Michigan.     

Testing Two Theoretical Explanations for the Attraction-Enhancing Effects of Self-Disclosure

The study investigated the differential ability of similarity theory and social exchange theory to predict the effects of self-disclosure in a counseling versus a friendship encounter The participants were 80 undergraduates. A 2 (counseling or friendship) × 2 (positive or negative disclosure) × 2 (relevant or irrelevant disclosure) design was used in which participants rated the videotaped self-disclosure of an individual in an initial dyadic encounter. Unequivocal support was not obtained for either of the theories, but relationship context (counselor vs. peer) influenced the effects of disclosure as measured on counselor-peer and relationship characteristics. A unique feature of the study was the use of the Client Reactions System (CRS) to measure participants' immediate reactions to self-disclosure. The CRS demonstrated both relationship context and valence of disclosure (positive or negative) effects.     

Assessment of Supervisee Developmental Level and Supervision Environment Across Supervisor Experience

Supervisors representing different levels of experience viewed videotape vignettes of counselors demonstrating the first three developmental levels of Stoltenberg's (1981) Counselor Complexity Model. Supervisors assessed each counselor on his or her developmental level and on the supervision environment he or she would provide for the trainee. Results indicated that supervisor experience did not influence the assessment of developmental level or the ability to make accurate environmental matches. Nevertheless, supervisors had the most difficulty accurately assessing counselors representing Level 2 in Stoltenberg's model and tended to make relative judgments about counselor developmental level. Implications for training and further research are discussed.     

The Cost of Client Transfer

Clients undergoing transfer from one counselor to another were compared on the Generalized Contentment Scale and a DSM-III-R measure with clients staying with the same counselor over the same length of treatment. In three 12-week blocks, the clients with the same counselor made the greatest progress in the first 12 weeks, making less progress in each successive block. The clients who were transferred in the middle of the second 12-week block also made the greatest progress in the first time block, lost some of the progress in the transfer block, and made significant progress with the new counselor in the third time block, ending with no significant differences in either generalized contentment or DSM-III-R outcome from clients who had not been transferred.     

The Doctoral Degree in Counselor Education and Supervision

The doctoral degree in Counselor Education and Supervision (CES) is a terminal or final degree in the field of counseling. This article, provides an abbreviated look at the development of the CES doctoral degree, reviews the development of accreditation standards, reports on current status of the doctoral degree, and comments on the possible future of the CES doctoral degree.     

Marital attributions in spouses of depressed patients

Causal attributions (i.e., locus, stability, globality) and responsibility attributions (i.e., bad intent, selfish motivation, blame) were assessed in the spouses of 27 depressed psychiatric inpatients and 30 nondepressed dyads to test predictions derived from Hooley's (1987) symptom-controllability model of marital distress. Results indicated that (1) depressed patients and their spouses were less dyadically adjusted than nondepressed spouses, (2) causal and responsibility attributions about depressive behaviors predicted lower dyadic adjustment, and (3) attributions of causality mediated the relationship between group status (depressed or nondepressed) and dyadic adjustment among spouses who had higher expectations for their partner to change. Results suggest that among spouses with a high expectancy for change, depression may be a risk factor for marital distress.