Complexity of ethical decision making in psychiatry

Psychiatric residents and psychiatrists have little difficulty in making judgments about a clinical course of action to take with patients. However, making ethical clinical decisions is more challenging, because psychiatric residents are usually provided little formal training in ethics. Further, many ethical dilemmas are complex, requiring knowledge of the psychiatric profession's ethics code, moral principles, law, and practice standards and of how they should be weighed in the decision-making process. The purpose of this article is to demonstrate this complexity in regard to the identification of potential ethical dilemmas, understanding the issues that these dilemmas raise, and formulating potential solutions to them. Two common but important areas of treatment in which ethical dilemmas arise (informed consent and competence of care) are used as examples for our presentation. The article demonstrates that to successfully engage in ethical analysis in psychiatry is impossible without substantial formal training in the process.     

Similarities and differences among three generations of women in attitudes toward the female role in contemporary society

A three-generational sample of 103 college women, 88 of their mothers, and 30 of their maternal grandmothers responded to questionnaires containing the Spence and Helmreich Attitudes Toward Women Scale (AWS). Intrafamily matched pair analysis tested hypotheses of intergenerational similarities and differences; and several potential correlates of attitudes toward female roles in contemporary society were investigated. Major intergenerational differences prevailed, with younger generations being more profeminist. The extent of difference varied by issue. Participation in the labor force was correlated with liberal views, but the degree of liberality seemed best interpreted in terms of enlightened self-interest.     

Perinatal positive parenting: Parent support groups

Parent-infant support groups offer first-time parents an opportunity to share their experiences and concerns with each other. This paper discusses the parent groups component of Perinatal Positive Parenting, a program for parents who deliver their first-born children at the William Beaumont Hospital in Royal Oak, Michigan. Formation of the support groups follows the program's hospital and in-home components. Group organization, structure, and meeting format are described and the volunteer group leader's role as facilitator is examined.     

EFFECTS OF CHOICE MAKING ON THE SERIOUS PROBLEM BEHAVIORS OF STUDENTS WITH SEVERE HANDICAPS

This study assessed the impact of choice making on the serious problem behaviors of 3 students with severe autism and/or mental retardation. In the context of within-subject reversal designs, the results showed consistently reduced levels of problem behaviors (e.g., aggression) when the students were given opportunities to make choices among instructional tasks and reinforcers. Additional data showed no systematic differences in the rate of correct responding between the two conditions. The results are discussed in relation to the continuing search for effective, nonintrusive solutions to the occurrence of serious problem behavior.     

The elegant solution to the problem of impotence

Although most therapists are committed to debunking the dual myths that sex requires an erection and that sex equals intercourse, sex researchers continue to use successful intercourse as a primary dependent variable. It is here asserted that RET therapists would do well to approach the problem of erectile dysfunction from a more elegant philosophical perspective. The treatment approach outlined here is aimed at reducing client disturbance as well as increasing sexual satisfaction rather than at simply helping the client to regain his potency.     

Considering methodological integrity in counselling and psychotherapy research

Within the field of counselling and psychotherapy research, qualitative methods have been a longstanding tradition of inquiry due to the mutual interest of therapists and researchers in both internal experiences and intersubjective processes. Methodological integrity is a conceptual framework that has been advanced to increase the rigor of these methods. In this paper, we consider the value of this concept for counselling and psychotherapy researchers and reviewers. This framework guides investigators and reviewers to consider how procedures can be adapted to meet the goals of specific studies, given their characteristics and approach to inquiry. In this brief article, we exemplify the relevance and application of this concept to this field by describing the decision‐making process within the designing of a qualitative research project to investigate clients' needs within rape crisis counselling. Through this exemplar, we also provide guidance to counselling and psychotherapy researchers on considerations during the process of research review and reporting.     

Clinical Judgment and Clinical Significance in Psychotherapy Practice

The use of outcome measurement in psychotherapy practice is briefly discussed, as is Jacobson and Truax’s (J Consult Clin Psychol 59:12–19, 1991) conception of clinically significant change. A more flexible and user friendly application of clinically significant change compatible with clinical judgment is proposed for psychotherapy practice. Examples are given and a free Windows program is described for computing RC and estimating the probability associated with it.     

Feature integration and spatial attention: common processes for endogenous and exogenous orienting

Briand (J Exp Psychol Hum Percept Perform 24:1243–1256, 1998) and Briand and Klein (J Exp Psychol Hum Percept Perform 13:228–241, 1987) demonstrated that spatial cueing effects are larger for detecting conjunction of features than for detecting simple features when spatial attention is oriented exogenously, and not when attention is oriented endogenously. Their results were interpreted as if only exogenous attention affects the posterior spatial attention system that performs the feature binding function attributed to spatial attention by Treisman’s feature integration theory (FIT; 1980). In a series of 6 experiments, we attempted to replicate Briand’s findings. Manipulations of distractor string size and symmetry of stimulus presentation left and right from fixation were implemented in Posner’s cueing paradigm. The data indicate that both exogenous and endogenous cueing address the same attentional mechanism needed for feature binding. The results also limit the generalisability of Briand’s proposal concerning the role of exogenous attention in feature integration. Furthermore, the importance to control the effect of unintended attentional capture in a cueing task is demonstrated.