Spirituality and Multimodal Therapy: A Practical Approach to Incorporating Spirituality in Counseling

The purpose of this article is to describe how the dimension of spirituality can be added to an existing counseling theory, multimodal therapy (MMT; A. A. Lazarus, 1984), to provide counselors with a practical approach to incorporating clients' religious and spiritual beliefs in the counseling process. An explanation of MMT is given, as well as its supporting research. The context of spirituality in counseling is discussed, and the process by which it can be integrated into the MMT model is explained. Two case studies are described to demonstrate how spiritual issues can be assessed and used to strengthen the counseling process. Finally, implications for counseling are discussed.     

Freedom, Preference and Autonomy

Philosophers have advocated different kinds of freedom, but each has value and none should be neglected in a complete theory of freedom and responsibility. There are three kinds of freedom of preference and action that should be distinguished. A person S may fully prefer to do A at every level, and that is one kind of freedom. A person S may autonomously prefer to do A when S has the preference structure concerning doing A because S prefers to have that very preference structure, and that is a second kind of freedom. A person S may prefer to do A when S could have preferred otherwise, and that is a third kind of freedom. These forms of freedom may be combined, but they are valuable and essentially independent. They all involve the metamental ascendence of preference over desire, but it is autonomous preference that makes a person the author of his or her preference. The responsibility a person has for what he or she does out of a preference for doing it depends on the kinds of freedom of preference the person has and must be ranked in terms of them.     

The Problem with Contemporary Moral Theory

Feminists, especially radical feminists, have reason to be dissatisfied with contemporary moral theory, but they are understandably reluctant to abandon the theoretical project until it is seen as unsalvageable. The problem is not, however, as Margaret Urban Walker claims, that theory is abstract, that it seeks to guide conduct, or that it postulates moral knowledge. The problem is that contemporary moral theory is foundational.     

The Case of Helen D.: A Woman Who Learned to Suffer

Despite our earnest wish to be useful to patients, we sometimes fail. Part of the difficulty often has to do with the expectations that the patient brings to therapy. Another contribution to an impasse may be the psychiatrist's theoretical orientation. This review illustrates a playful distortion of the doctor-patient relationship so as to develop an alliance with a difficult patient. The involvement of part of her family in the long-term treatment facilitated her growth out of a biopsychosocial swamp.     

The Career Concept Scale: An Assessment of Career Judgment

An assessment scale of career concepts found to be reliably related with vocational sophistication is developed. With the renewed emphasis in CETA programs for youth-employment counseling efforts, the relative prevocational maturity of those seeking our services can be an element in deriving baseline data from which the efficacy of vocational counseling services can be judged.     

Rowland Universal Dementia Assessment Scale,Mini‐Mental State Examination and General Practitioner Assessment of Cognition in a multicultural cohort of community‐dwelling older persons with early dementia

Early dementia can be difficult to diagnose in older persons from culturally and linguistically diverse (CALD) backgrounds. The Folstein Mini‐Mental State Examination (MMSE), the General Practitioner Assessment of Cognition (GPCOG) and the Rowland Universal Dementia Assessment Scale (RUDAS) were compared in 151 older, community‐dwelling persons. Receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic accuracy, while logistic regression was used to evaluate the influence of age, gender, CALD status and years of education. All three instruments were equally accurate in predicting dementia (ROC area under curve 0.92–0.97, p > 0.05 for all comparisons). At the recommended cut‐offs, the RUDAS was best for ruling in dementia (positive LR = 8.77), while the GPCOG was best for ruling out dementia (negative LR = 0.03). All three instruments were influenced by concomitant depression. Whereas the MMSE was influenced by CALD status, the RUDAS and GPCOG were not. While the GPCOG combines participant and informant data, the RUDAS is a stand‐alone measure specifically designed for, and validated in, multicultural populations.     

Do Health Care Workplaces Affect Treatment Environments?

Previous research has demonstrated that characteristics of the health care workplace influence staff outcomes such as morale and burnout, but the potential effect of health care workplaces on the treatment environment has been little studied. Building on a model proposed by Schaefer and Moos (1993), we propose that the workplace factors of supervisory work environment (e.g. support from supervisors, managerial control) and programme philosophical orientation (e.g. disease model of addiction, psychosocial learning model of addiction) predict four treatment environment elements: patient autonomy, staff control, staff sensitivity, and patient alienation. Multiple regression analysis of data drawn from a survey (response rate = 86%) of 327 staff members at 15 Veterans Affairs (VA) inpatient substance abuse treatment programmes revealed that greater managerial control over staff predicted greater patient alienation, lower staff sensitivity towards patients, and greater staff control over patients. Stronger disease model programme orientations predicted less patient alienation and greater staff sensitivity, whereas stronger psychosocial model programme orientations predicted less staff control. These results suggest that health care workplaces may influence treatment environments. Implications for further research and practice are discussed. © 1997 John Wiley & Sons, Ltd.     

INTEGRATING ERRORS INTO THE TRAINING PROCESS: THE FUNCTION OF ERROR MANAGEMENT INSTRUCTIONS AND THE ROLE OF GOAL ORIENTATION

Error management training explicitly allows participants to make errors. We examined the effects of error management instructions ("rules of thumb" designed to reduce the negative emotional effects of errors), goal orientation (learning goal, prove goal, and avoidance goal orientations) and attribute x treatment interactions on performance. A randomized experiment with 87 participants consisting of 3 training procedures for learning to work with a computer program was conducted: (a) error training with error management instructions, (b) error training without error management instructions; and (c) a group that was prevented from making errors. Results showed that short-and medium-term performance (near and far transfer) was superior for participants of the error training that included error management instructions, compared with the two other training conditions. Thus, error management instructions were crucial for the high performance effects of error training. Prove and avoidance goal orientation interacted with training conditions.