Report from the National Society of Genetic Counselors Service Delivery Model Task Force: A Proposal to Define Models, Components, and Modes of Referral

The Service Delivery Model Task Force (SDMTF) was appointed in 2009 by the leadership of the National Society of Genetic Counselors (NSGC) with a charge to research and assess the capacity of all existing service delivery models to improve access to genetic counseling services in the context of increasing demand for genetic testing and counseling. In approaching this charge, the SDMTF found that there were varying interpretations of what was meant by "service delivery models" and the group held extensive discussions about current practices to arrive at consensus of proposed definitions for current genetic service delivery models, modes of referral and components of service delivery. The major goal of these proposed definitions is to allow for conversations to begin to address the charge to the committee. We propose that current models of service delivery can be defined by: 1) the methods in which genetic counseling services are delivered (In-person, Telephone, Group and Telegenetics), 2) the way they are accessed by patients (Traditional referral, Tandem, Triage, Rescue and Self-referral) and 3) the variable components that depend upon multiple factors unique to each service setting. This report by the SDMTF provides a starting point whereby standardized terminology can be used in future studies that assess the effectiveness of these described models to overcome barriers to access to genetic counseling services.     

Identification with the aggressor and the ‘normal traumas’: clinical implications

Ferenczi's (1933) surprisingly unknown concept of identification with the aggressor – an abuse victim's ‘eliminating’ her own subjectivity and ‘becoming’ precisely what an attacker needs her to be – has radical implications for our understanding of analytic technique. Its very frequent occurrence also forces us to broaden our understanding of what constitutes trauma. Ferenczi saw the experience of ‘traumatic aloneness’ or ‘emotional abandonment’ as the key element of trauma, since this is what enforces the traumatic responses of dissociation and identification with the aggressor. Identification with the aggressor operates in the analytic relationship in both patient and analyst. This has various consequences, including the structuring of the relationship through unconscious collusions – mutually coordinated, defensive identifications designed to help both participants feel secure. This view of the analytic relationship has clinical implications in at least four areas: the understanding of the patient's free associations, which may reflect the patient's compliance with the analyst's wishes rather than the contents of the patient's own unconscious; the need for some kind of mutuality of analysis; the traumatizing potential of the analyst's authority; and the tendency of some patients to take blame and responsibility reflexively, as a way of protecting the analyst.     

The Effects of Type and Amount of Pretraining on Transfer in Concept Formation

Two experiments were conducted to investigate the effects of 2 types of directed attention pretraining, a form of stimulus predifferentiation, on immediate- and delayed-transfer tasks in concept identification. In both experiments, the participants received either the “seeing-and-discriminating” or “seeing” technique of pretraining, except for those assigned to the control group. The participants received different amounts of pretraining. In the first experiment, participants were required to learn new concepts from the same category for the delayed-transfer task, whereas in the second experiment, the delayed-transfer task involved concepts from a different category. Among the major findings in both experiments are that the pretraining methods resulted in positive transfer on all transfer tasks. In general, the seeing-and-discriminating method yielded a more positive transfer than the seeing technique. Maximal positive transfer effects were found with a small number of trials. The implications of the findings for understanding the effectiveness of various training methods used for problem solving are discussed.     

Memory for Intratrial Events in Learning Disjunctive Concepts: Implications for Hypothesis-Testing Models

The present experiment was designed to further investigate the adequacy of hypothesis-testing models to account for how concepts are acquired. Disjunctive concept formation tasks were administered to 75 college students to examine predictions of hypothesis-testing theory concerning memory for intratrial events. The different events explored were hypotheses, responses, feedback, and stimuli. A 4 × 4 × 3 within-subjects design was employed in which question type, number of intratrial events recalled, and percentage of trials with memory probe were the factors. A major finding was the failure of students to recall the hypothesis stated on previous trials, under certain conditions, which contradicts predictions based on hypothesis-testing theories. Implications for opposing frequency theory are discussed.     

A Human Modification of the Children's Apperception Test (CAT-H)

Since the creation of the CAT fifteen years ago, first introduced in the pages of this Journal, many studies have been published comparing the stimulus value of animal versus human figures. Some outcomes favored the animal figures, while an even larger number favored the human stimuli. It appears that some children respond better to animal stimuli, and some to human figures, depending on particular characteristics of the child. A human modification of the CAT was therefore developed by Bellak and Bellak. It is hoped this version will be useful with older children, especially those with an M.A. beyond ten years, and will thus bridge the gap between the animal CAT and the TAT. The human CAT may also elicit more information from children with particular personality characteristics.     

On the Dissemination of Clinical Experiences in Using Empirically Supported Treatments

This article addresses the long-standing gap that has existed between psychotherapy research and practice and the efforts that have been made to bridge it. It also introduces one such effort, which has consisted of 3 clinical surveys on the experiences of practitioners in using empirically supported treatments for panic disorder, social anxiety, and OCD. In contrast to attempts to close the gap by disseminating research findings to the clinician, the clinical surveys are intended to allow for practitioners to disseminate their clinical experiences to the researcher—and also to other clinicians. What we view as a “two-way bridge” initiative is a collaboration between the Society of Clinical Psychology, Division 12 of the APA, and the Psychotherapy Division of the APA—Division 29. The mechanism that has been established provides a way for clinicians to be a part of the research process, which we hope will provide evidence that can help to enhance our clinical effectiveness.     

Relational Psychoanalysis: A Review

Relational psychoanalysis, a relatively new and evolving school of psychoanalytic thought, is considered by its founders to represent a “paradigm shift” in psychoanalysis. The relational approach, initiated by the publication of Jay Greenberg and Stephen Mitchell's book, Object Relations in Psychoanalytic Theory in 1983, has developed into a movement with its own substantially separate literature. This paper reviews both the history and theoretical origins of the relational movement, as well as important theoretical premises and viewpoints now associated with the relational school.     

Just a Game? Unjustified Virtual Violence Produces Guilt in Empathetic Players

Many avid gamers discount violent conduct in video games as morally insignificant as “it is just a game.” However, recent debates among users, regarding video games featuring inappropriate forms of virtual violence, suggest a more complex truth. Two experiments (N₁ = 49, N₂ = 80) examined users' guilt responses in order to explore the moral significance of virtual violence. In both studies, justification of virtual violence and users' trait empathy determined guilt in a structurally similar way to real-world scenarios: People felt guiltier if they engaged in unjustified virtual violence, especially if they were empathetic players. These results show that video games are capable of inducing affective moral responses in users. Accordingly, virtual violence may be considered morally significant action.