The assessment of adolescents: preconceptions and realizations

The paper explores, in detail, the process of a single assessment as it unfolds session by session. It draws attention to the inevitability of the clinician's harbouring preconceptions of all kinds - especially when working with adolescents. It focuses on the difficulty of withstanding those preconceptions and allowing the patient's true anxieties, conscious and unconscious, to emerge. The process is a complex one requiring close attention to transference and countertransference manifestations, to the central significance of observation, to Bion's notion of the opacity of memory and desire. The case, that of a hypochondriacal 17-year-old young woman, highlights some main concerns and defences of the age group, for example, somatization, separation, fears of madness, issues of identity and, most fundamental of all, sexuality.     

Serum Lipids in Suicide Attempters

As other studies have shown possible associations of low serum cholesterol concentrations as well as serotonin and corticosteroid deviances with suicide or depression, the present study was undertaken to investigate the serum lipid levels in subgroups of suicide attempters. Serum lipids were determined in 72 suicide attempters. Cerebrospinal fluid monoamine metabolites and plasma cortisol levels were measured, and dexamethasone suppression tests were performed. Hopelessness and suicidality were rated by the Hopelessness Scale (HS) and the Suicidal Intent Scales (SIS). The mean total serum cholesterol (TSC) level was 5.0 ± 1.2 mmol/L. We found no significant correlations between TSC and the monoamine metabolites. High-density lipoprotein cholesterol showed positive correlations with the dopamine metabolite homovanillic acid (r = 0.39, p = 0.04) and the serotonin metabolite 5-hydroxyindoleacetic acid (r = 0.34, p = 0.07). The SIS and HS scales did not correlate significantly with serum lipids. “Violent” attempters showed somewhat higher serum lipid levels than “nonviolent” attempters. We found no significant differences in serum lipid levels between the diagnostic subgroups. Hence, we could not find much support for the hypothesis of associations between low cholesterol levels and decreased serotonin activity in the brain. However, this field merits further investigation.     

Stepwise Latent Class Models for Explaining Group-Level Outcomes Using Discrete Individual-Level Predictors

Explaining group-level outcomes from individual-level predictors requires aggregating the individual-level scores to the group level and correcting the group-level estimates for measurement errors in the aggregated scores. However, for discrete variables it is not clear how to perform the aggregation and correction. It is shown how stepwise latent class analysis can be used to do this. First, a latent class model is estimated in which the scores on a discrete individual-level predictor are used to construct group-level latent classes. Second, this latent class model is used to aggregate the individual-level predictor by assigning the groups to the latent classes. Third, a group-level analysis is performed in which the aggregated measures are related to the remaining group-level variables while correcting for the measurement error in the class assignments. This stepwise approach is introduced in a multilevel mediation model with a single individual-level mediator, and compared to existing methods in a simulation study. We also show how a mediation model with multiple group-level latent variables can be used with multiple individual-level mediators and this model is applied to explain team productivity (group level) as a function of job control (individual level), job satisfaction (individual level), and enriched job design (group level).     

A longitudinal analysis of the course of depressive symptomatology in geriatric patients with cancer of the breast, colon, lung, or prostate.

This study mapped the trajectory of depression and its components (depressive mood, somatic expression of depression, and lack of positive affect) for 1 year after an initial cancer diagnosis, revealing the complex nature of the psychological response to the cancer experience. The analysis was based on 4 waves of panel data from 860 older patients with incident breast, colon, lung, or prostate cancer. Predictors of depressive symptoms included cancer site; stage; comorbidities; sociodemographic characteristics; and indicators of physical functioning, symptom severity, and treatment. Patients' overall depressive symptoms declined, especially depressive mood and somatic indicators. By contrast, the sense of well-being did not recover; in fact, it would have deteriorated without improvements in physical functioning and physical symptoms. The present findings show the importance of psychological assessments and symptom management during cancer treatment.     

Are we free to imagine what we choose?

It has long been recognized that we have a great deal of freedom to imagine what we choose. This paper explores a thesis—what we call “intentionalism (about the imagination)”—that provides a way of making this evident (if vague) truism precise. According to intentionalism, the contents of your imaginings are simply determined by whatever contents you intend to imagine. Thus, for example, when you visualize a building and intend it to be of King’s College rather than a replica of the college you have imagined the former rather than the latter because you intended to imagine King’s College. This is so even if the visual image you conjure up equally resembles either. This paper proposes two kinds of counterexamples to intentionalism and discusses their significance. In particular, it sketches a positive account of how many sensory imaginings get to be about what they are about, which explains how the causal history of our mental imagery can prevent us from succeeding in imagining what we intended.

     

Diversity: Clinical Pastoral Education (CPE) in the Hinterlands

The author claims that Clinical Pastoral Education (CPE) would be enriched if the notion of "diversity" were extended to program configurations, sites, and economic and occupational subgroups as well as to racial, ethnic, gender, and denominational groups as now tends to be the case. The author describes the settings and methodologies of a unique program that brings CPE to "natural caregivers" across the rural Midwest section of the United States.     

Does phonological recoding occur during silent reading, and is it necessary for orthographic learning?

Two studies were conducted to test the central claim of the self-teaching hypothesis (i.e., phonological recoding is necessary for orthographic learning) in silent reading. The first study aimed to demonstrate the use of phonological recoding during silent reading. Texts containing pseudowords were read silently or aloud. Two days later, target spellings were recognized more often than their homophone spellings. In both reading conditions, homophone alternatives were named faster than nonexposed pseudowords, suggesting that phonological recoding had occurred. The second study aimed to suppress phonological recoding to demonstrate its necessity for orthographic learning. Lexical decisions were performed in a standard condition, with concurrent articulation, or with tapping. One day later, target spellings were recognized less often after lexical decisions with concurrent articulation. Target and homophone naming speed was not affected by lexical decision condition. The results support the use of phonological recoding during silent reading and specify its role in orthographic learning.