Impact of a preventive social problem solving intervention on children's coping with middle-school stressors

Children receiving 1 year or 1/2 year of a preventive social problem solving program in elementary school were compared with each other and with a no-treatment group upon entry into middle school. One year of training was significantly related to reductions in the severity of a variety of middle-school stressors. Most importantly, a clear mediating role for social problem solving (SPS) skills was found. Children lacking in SPS skills were more likely to experience intense stressors; however, possessing the skills was not necessarily predictive of adjustment to stressors. The results are discussed in terms of the implications of this asymmetry and the strong support given to the value of social problem solving as a preventive intervention for children.     

The interview for antisocial behavior: Psychometric characteristics and concurrent validity with child psychiatric inpatients

The present study evaluated psychometric features and correlates of the Interview for Antisocial Behavior (IAB), a new measure designed to assess antisocial child behavior. Parents of 264 psychiatric inpatients (ages 6–13 years) completed the measure to evaluate antisocial behavior of their children. The investigation evaluated the relation of IAB scores to clinically derived diagnoses and to aggression and externalizing behaviors, as measured by different raters (parents, teachers), across different settings (home, school, hospital), and with different assessment methods (rating scales, behavioral role-play test). The results indicated that the IAB showed acceptable levels of internal consistency. A priori scores (severity, duration, total antisocial behavior) and factor analytically derived scales (Arguing/Fighting, Covert Antisocial Behaviors, Self-Injury) distinguished children with a DSM III diagnosis of conduct disorder, and scores on the IAB were more consistently related to other measures of aggression and externalizing behavior than to measures of internalizing behavior or overall severity of dysfunction. The implications of the results for use of the measure, particularly in relation to evaluation of the overt-covert dimension of antisocial behavior, are discussed.Completion of this research was facilitated by a Research Scientist Development Award (MH00353) and by grants (MH35408, MH39642) from the National Institute of Mental Health and the Rivendell Foundation.     

The right to refuse treatment: Paradox,pendulum and the quality of care

This clinical and theoretical overview of the right to refuse treatment will address some of the themes that have dominated this area of interface between psychiatry and the law, and have, perhaps, obscured the real concern of the right to refuse treatment question; i.e., the issue of quality of care. Central themes include factors present in the medicolegal context and recent events, origin of the concept of the right to treatment, the separation of confinement from treatment, and the changing models of vicarious decision making. This review also addresses judicial conceptualizations of treatment, including the concept of quarantine, judicial risk-aversiveness, and judicial fantasies of drug action. Some possible directions for the future are also examined.     

Gender and sex role differences in the perception of social support

This study examined the relationships among support types (i.e., emotional, instrumental, and nonintimate social participation), gender, sex role orientation, and stress level among college undergraduates (N=253). Dependent variables included need, perceived availability, and satisfaction with support. Sex differences were found only in emotional support, with men reporting less need, perceived availability, and marginally less satisfaction than women. The only gender by sex role interaction was on need for emotional support. Traditional sex-typed men reported less need than traditional women, whereas there was no difference between androgynous men and women. While sex differences do exist for emotional support, the effects of sex role orientation on perceptions of social support appears to be somewhat circumscribed.     

Cast of characters work: Systemically exploring the naturally organized personality

Cast of Characters Work conceives of the personality as a naturally organized unique group of characters who, together, function in an internal system. All characters bring their own histories, perceptions, feelings, beliefs, and behaviors to life's situations. Their survival strategies and interrelationships are felt as anxiety, conflict, ambivalence, or confidence. Heightening awareness of these multiple, simultaneous events increases access to the actual living process. The complex inner world of individuals, couples, and families can be precisely explored by working directly with each character and their relationships. Objectives are accountability and more functional, flexible, and satisfactory arrangements among characters internally and in couples and families.Also in private practice at 2 Pine Circle, Urbana, IL 61801.     

Narrative unity and clinical judgment

Alasdair MacIntyre's recent thinking both about the concept of a practice and the existence of narrative unity in human life raises important questions about how we should view clinical medicine today. Is it possible for clinical medicine to pursue patient well-being in a society (allegedly) afflicted with what he calls ‘modernity’? Here it is argued that MacIntyre's pessimistic view of the individual in contemporary society makes his call for patient autonomy in the clinical setting pointless. Finally, recent work in gerontology is cited to make three points: first, MacIntyre's pessimism about us is too extreme; second, the concept of a ‘fictionalized’ personal history is closer to reality than either MacIntyre's notion of narrative unity or the ideas of his imagined opponent (Sartre); and finally, we should not expect clinical medicine to produce patient well-being, when this is understood narratively.     

The physician's influence on patients' choices

Although the traditional physician ethic sees nothing objectionable about the doctor's influence over patients, superficial conceptions of the patient's right to self-determination imply that this influence may be manipulative. On the contrary, there are several different lines of argument which can reconcile self-determination with the physician's influence. Nevertheless, drawing the boundaries between legitimate methods of persuasion, and manipulation or coercion sometimes proves difficult.     

Evidence for disparity change as the primary stimulus for stereoscopic processing

Subjects were able to respond to a lens-induced stereoscopic slant more quickly and more accurately when it was imposed on only part of a surface rather than on the whole surface. This shows that the presence of a stereoscopic boundary, where disparity is discontinuous, increases the efficiency of stereoscopic processing. This finding is not consistent with many current models of stereopsis.