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     

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.     

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.     

DOUBLE DISSOCIATION BETWEEN MEMORY SYSTEMS UNDERLYING EXPLICIT AND IMPLICIT MEMORY IN THE HUMAN BRAIN

Abstract— Amnesic patients have impaired explicit memory that is evident in poor recall and recognition of words, yet can have intact implicit memory for words as measured by repetition priming, the enhanced efficiency for reprocessing those word's. The dissociation between explicit and implicit memory for words is a fundamental characteristic of normal cognition that could reflect two different functional architectures of the human brain two separate processing systems or two levels of operation of a single system with implicit memory less demanding of that system. We present a patient who has a lesion in the right occipital lobe and who showed intact explicit and impaired implicit memory for words. The deficit was specific to visual priming. The double dissociation between explicit and implicit visual memory for words indicates that separate processing systems mediate these two forms of memory, and that a memory system in right occipital cortex mediates implicit visual memory for words.     

Client and counsellor narrative accounts of congruence during the most helpful and hindering events of an initial counselling session

The role of congruence in establishing and maintaining a therapeutic alliance has been emphasized by theorists within the humanistic/person‐centred tradition. However, there appears to be a lack of research that explores the processes occurring during moments of congruence or incongruence. The main objective of the present study was to gather qualitative data about congruence based on both participants’ narrative accounts of their subjective reactions during the most helpful and the most hindering event of an initial counselling session. Client and counsellor recollections of their experiences during these two events were stimulated through the replay of a video‐tape after the session. The event identification came from the client through a Brief Structured Recall interview. During the hindering event, both participants were incongruent. There was a mismatch between what they were feeling and what they were expressing verbally and/or non‐verbally. At the same time the client was feeling criticised and offended by counsellor's confrontation. By contrast, during the helpful event both participants were congruent. The counsellor was experiencing empathic understanding toward his client and the client was feeling accepted and understood. The implication of these findings are discussed in terms of how congruence might affect the construction of significant events during the therapeutic hour.