The Heart of the Matter: An Essay about the Effects of Managed Care on Family Therapy with Children*

This essay is based on a pilot study that examined the effects of managed care on the treatment of children and families, with special attention to community mental health. We embarked on the pilot study to test the accuracy and generalizability of our impression that family therapy and other systemic practices have been marginalized in ordinary clinics and agencies, and to understand the reasons why. We interviewed managed care providers, researchers, family therapy trainers, and clinicians in the Northeast. Our findings led to seven themes that support our impression that, even though there is a consensus about the need for coordinated family-based services, there is a disconnection between state policies, contractual requirements and what is actually occurring at the implementation level. This study suggests that our knowledge of human systems may be in danger of being disqualified and lost, with damaging consequences for the care of children. Yet, as systemic thinkers and practitioners, it is our belief that ethical and effective treatment need not be at odds with care that is cost-efficient. The direction of our future research will be to study whether the involvement of all stakeholders at all levels of planning and training leads to systemic family-based practices that consistently save costs and provide high-quality care.     

The long-term evaluation of a behavioral treatment program for child molesters

Recidivism data derived from various sources over a follow-up period of 1–11 yr, provided the basis for appraising the effectiveness of a comprehensive cognitive-behavioral treatment program for familial and nonfamilial child molesters. Unofficial records held by police and Children's Aid Societies proved to be the best data for estimating recidivism. These data revealed increases in recidivism with longer follow-up periods, but there were consistent advantages for the treated over the untreated patients. Men who had sexually abused the daughters of other people demonstrated the clearest treatment benefits. The younger offenders and those who had engaged in genital-genital contact with their victims were more likely to reoffend even if they were treated. Contrary to the expectations of behavior therapists, indices of deviant sexual preferences did not predict outcome.     

Temporal memory over the adult lifespan

Performances of noncollege student young adults, middle-aged adults, and elderly adults were contrasted on word temporal memory and paired-associate learning tasks. A comparison group of college-student subjects was also evaluated on each task. Significant effects for age variation were found for each task. The age sensitivity for temporal memory conflicts with one of the criteria commonly established for determining the automaticity of a memory task. In addition, moderately high positive correlations were found for each age group between word temporal memory scores and paired-associate learning scores, implying the involvement of effortful processes over the adult lifespan in word temporal memory.     

The Public and Private Use of Consensus-Raising Excuses

ABSTRACT Two experiments tested the proposition that people use consensus-raising excuses more in private than in public when the audience has information that could refute subjects' claims about others In Experiment 1, subjects received success or failure feedback and made public or private attributions to ability, effort, task difficulty, and luck In Experiment 2, subjects received positive or negative feedback and evaluated themselves and others on the trait Task difficulty attributions and evaluations of others are consensus-raising measures Consistent with our hypothesis, subjects receiving negative feedback in Experiment 1 claimed that the task was more difficult, and in Experiment 2 evaluated the other more negatively in private than in public.