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 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.     

The effects of contextual information and gender on the prediction of hypnotic susceptibility

Council, Kirsch, and Hafner (1986) obtained empirical support for the hypothesis that significant correlations between questionnaire measures of absorption and hypnotic susceptibility are an artifact of subjects' beliefs about their own hypnotizability. We tested this hypothesis in a two-session experiment. During Session 1, subjects completed questionnaire measures of absorption, mystical experience, daydreaming frequency, and paranormal beliefs. During Session 2, subjects were tested for hypnotic susceptibility. Subjects were also exposed to one of three information manipulations: They were told about hypnotic testing either before or after filling out the questionnaires or were not told about hypnotic testing. The information manipulation moderated the prediction of susceptibility by the questionnaire measures for women, but not for men. For women, scores on the absorption questionnaire predicted susceptibility only when subjects were informed about hypnotic testing. In the told-after condition, this effect generalized to all of the remaining questionnaire measures. For men, none of the questionnaires was a reliable predictor of susceptibility.     

A COMPARISON OF PEER-DIRECTED AND TEACHER-DIRECTED EMPLOYMENT INTERVIEW TRAINING FOR MENTALLY RETARDED ADULTS

Interview skills deficits may limit employment prospects of mentally retarded adults. Although numerous papers highlight the importance of interview skills, few have validated effective strategies for use with mentally retarded persons. Further, there has been a lack of research contrasting rival interview skills training strategies. The present study was conducted with two mentally retarded young adults. It contrasted peer-directed instruction, in which both participants were equally deficient in the target skills, with teacher-directed instruction. Results of the investigation indicated that instruction, rehearsal, and feedback may be effective strategies regardless of who provides instruction. Comparisons of teacher-directed and peer-directed instruction indicated little or no difference in the effectiveness of the two procedures. However, the peer-directed procedure involved considerably less staff time than did the teacher-directed procedure.     

Processing resources and age differences in working memory

This study investigated the performance of young and old subjects on a modified version of the working memory task developed by Baddeley and Hitch (1974). Subjects were required to verify a set of sentences of varying complexity while they repeated aloud zero, two, or four words. The older subjects took longer to verify the sentences, especially when the sentences were grammatically complex, but the effect of concurrent memory load on verification latency was the same in both groups. These results cast doubt on the notion that there is an age-related decline in one general pool of processing resources. They also suggest that older people have greater difficulty with the active processing aspects, rather than with the passive holding aspects, of working memory tasks.     

Maternal depression and its relationship to life stress,perceptions of child behavior problems,parenting behaviors,and child conduct problems

This study examined the relationship of reported maternal depression to prior and current life stressors, and to mother perceptions of child adjustment, parenting behaviors, and child conduct problems. Forty-six depressed mothers and 49 nondepressed mothers and their clinic-referred children (aged 3-8 years) participated. Depressed mothers were more critical than nondepressed mothers, but the behavior of children of depressed and nondepressed mothers showed no significant differences. Depressed mothers were more likely to have experience child abuse, spouse abuse, or more negative life events than nondepressed mothers. Maternal reports of stress related to mother characteristics and to negative life events were the most potent variables discriminating depressed from nondepressed mother families.