Risky assessments: participant suicidality and distress associated with research assessments in a treatment study of suicidal behavior

The purpose of this study was to examine patterns of self-reported suicidality and distress during research assessments in a sample of 63 women meeting criteria for borderline personality disorder and current and chronic suicidality. The risk management protocol we used during the two-year study period (University of Washington Risk Assessment Protocol; UWRAP) is described. Results indicated that changes in suicidality following assessments were small and relatively infrequent, and were just as likely to reflect decreases in suicidality as increases (17.5% versus 16.4% of sessions, respectively). Further, longitudinal analyses indicated that changes in suicidality became increasingly rare over the course of the 2-year study. Ratings of distress were more changeable than suicidality, underscoring the need for separate measurement of these constructs when assessing risk. With the aid of the UWRAP, our assessors judged 15 participants as high-risk status in 28 assessment sessions (3.7% of all sessions). In comparison to the rest of the sample, these individuals were of significantly greater clinical severity as measured by the HRSD 17-item, GAF scores, number and severity of previous suicide attempts, and number of previous psychiatric hospitalizations. Low-intensity risk intervention strategies (e.g., validating participant's feelings) were typically sufficient to reduce risk in these participants. Overall, our findings indicate that research with highly suicidal individuals can be done safely with the use of well-trained assessors and an appropriate crisis management protocol.     

Child care effects in context: quality, stability, and multiplicity in non-maternal child care arrangements during the first 15 months of life

Main and interactive effects of child care quality, stability, and multiplicity on infants' attachment security, language comprehension, language production, and cognitive development at 15 months were examined using data from the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care. Thirty-nine percent of the infants in this sample experienced arrangement change, and 46% experienced multiple concurrent arrangements during the first 15 months. As in previous studies, concurrent quality, average quality, and quality slope significantly predicted cognitive and language development. There was some evidence that certain forms of unstable child care--including nonfamilial change, familial to nonfamilial change, and within-home to out-of-home change--were associated with poorer language development. Multiple child care arrangements involving family members positively predicted language comprehension; multiple care involving a mix of family and non-relative caregivers negatively predicted language comprehension. Interactions among variables exhibited "effects in context." That is, under conditions of low or moderate quality in the primary care arrangement, the use of fewer multiple arrangements was associated with higher language scores; under conditions of high primary care quality, the use of more multiple arrangements was associated with higher language scores.     

The brief Reasons for Living Inventory for adolescents (BRFL-A)

This study modified and evaluated the psychometric properties of the Reasons for Living Inventory (RFL) in samples of adolescents. Internal consistency reliability, corrected item-total scale correlation, and exploratory factor analysis procedures were used with a mixed sample of 260 adolescents to identify 14 items for the brief version of the RFL (BRFL-A). Confirmatory factor analyses provided support for the five-factor oblique structure of the BRFL-A in a psychiatric inpatient sample with a range of suicidal behaviors. Reliabilities of the BRFL-A subscales were satisfactory. Four of the five subscales differentiated between suicidal and nonsuicidal adolescents. Significant correlations were found between three BRFL-A subscales and several suicide indices. Convergent-discriminant validity was examined by correlating the BRFL-A subscales with the Minnesota Multiphasic Personality Inventory—Adolescents (MMPI-A) Content Scales. Limitations of the study are discussed.This study was supported in part by a Project Grant from the Graduate College, The University of Northern Iowa.     

The role of religion in heart-transplant recipients' long-term health and well-being

While religion has long been recognized clinically to provide important coping strategies in the face of serious health problems, there has been little systematic consideration of its role in organ transplant recipients' long-term reactions and adjustment to this experience. This study examines these issues through qualitative and quantitative evaluation of longitudinal data collected from 40 adult heart recipients followed during their first year post-transplant. Large proportions of recipients expressed strong beliefs and were able to increase religious participation over the 12-month study period. They delineated specific ways in which their faith had provided them support, as well as ways in which the transplant experience itself further strengthened their beliefs. We found empirical evidence that recipients with strong beliefs who participated in religious activities had better physical and emotional well-being, fewer health worries, and better medical compliance by the final 12-month assessment. The findings suggest the development of specific nursing, social-service, or pastoral-involvement strategies, continuing staff education about the role of religion in patient care. The implications of such interventions for maximizing quality of life in transplant recipients are discussed.This study was funded by grants from the National Institute of Mental Health.     

Personality Adjustment in College Students With a Parent Perceived as Alcoholic or Nonalcoholic

Adjustment of 547 college students was examined by the variables of alcoholic parentage and participant gender. Results from a multivariate analysis of variance, using the Diagnostic Inventory of Personality and Symptoms, indicated significant main effects for gender but not for alcoholic parentage. Significant gender differences occurred for alcohol abuse, drug abuse, paranoid psychosis, affective depression, anxiety disorders, psychological factors affecting physical condition, immature character, and neurotic character. Findings suggest that college students from alcoholic homes should not be distinguished from the general population in terms of their adjustment.     

Once a princess,always a princess: A strategy for therapy with families of rape victims

Reconstitutive interventions for victims of rape involve more than discussion of cognitive and emotional responses to the traumatic events of the rape and the post-traumatic anxiety and depression. Many victims and families of victims are not able to reconstruct a supportive functional system after they have been violated by rape. This paper presents a strategic ritual which can be used with the raped family to facilitate this reorganization and restitution of their integrity.Through the use of a short metaphorical story and symbolic ritual, each individual member and the family as a whole can experience, reexperience, and redecide how they will respond to this traumatic event through open expression of their emotions and responses. Reintegration of their responses and shared life crisis enable them to respond to one another in ways not open to them previously.     

Preparing direct service staff to teach people with severe disabilities: A comprehensive evalution of an effective and acceptable training program

In light of the continuing need for residential, direct service staff to be able to teach people with severe disabilities, we comprehensively evaluated a program to train staff in behavioral teaching strategies. The program was developed and evaluated with attention given to recent concerns in the staff management literature regarding shortcomings with staff training research. The training program, involving a maximum of four, 2-hr classroom instruction sessions and three in vivo observation and feedback sessions, was evaluated in four studies. In Study 1, the program was shown to improve verbal skills of 13 direct service staff regarding behavioral teaching principles and terminology. In Study 2, the program was demonstrated to improve performance based teaching skills of nine staff and four staff supervisors. In Study 3, the program was shown to result in improvements in adaptive skills of three clients with severe disabilities when direct care staff used their newly acquired teaching skills with the clients. In Study 4, the training program was shown to be well received among 17 staff trainees, although the trainees were more accepting of some program components than others. Results of the studies are discussed in regard to the importance of agencies providing effective and acceptable staff training programs. Future research areas also are noted, focusing on the need to determine, and minimize where possible, the amount of time required to conduct successful staff training.     

Co-leader termination in an outpatient alcohol treatment group

The termination of a co-leader from a long-term therapy group for alcoholic outpatients is described over a seven-week period from the initial termination announcement to the first week following the co-leader's departure. The authors highlight salient themes and defensive maneuvers that appear as the group struggles with the difficult task of termination. Attempting initially to flee from the impending loss, the group defends with pseudomature responses and veiled hostility. These are followed by themes of abandonment and loss. The group leaders' initial collusion with the group's denial of loss is described, along with leader tactics to facilitate the group's termination work. Finally, the meaning of a group farewell gift is discussed in terms of both its implicit communications and as a form of resistance.     

Treatment contracts in long-term groups with alcoholic outpatients: A group case study

This paper describes the process of treatment contracting in a long-term group with alcoholic outpatients — relating the contracting process to the dynamics of the group and to the total treatment context. The material presented highlights the ways in which the contracting process (in particular, grappling with the issue of who should set the terms of the contract) may serve as a model for helping group members better understand and cope with problems in assertiueness and limit setting.