Development of knowledge bases and the reliability of a decision support system for behavioral treatment consultation for persons with mental retardation: The Mental Retardation-Expert

The development of expert and decision support systems requires the collection, organization, codification, and storage of a body of specialized knowledge. The development, using reconstructive methods, of two such knowledge bases, the first containing the current scientific literature and the second containing an expert’s knowledge, is described for an automated decision support system, the Mental Retardation-Expert. This system provides practitioners with assistance in the treatment of aggressive, self-injurious, and destructive behaviors displayed by individuals with mental retardation or developmental disabilities. The average interobserver reliability of the expert knowledge base ranged from 92.5% to 95.0% when calculated across four clinicians’ assessments of 31 abstracted cases.     

Short-term psychodynamic intervention in an urban health clinic: A case report

This paper describes the application of short-term dynamic therapeutic techniques to treat both symptom disturbance and character pathology in an urban mental health clinic. Short-Term dynamic psychotherapy focuses extensively on the subjectivity and inner life of the patient with emphasis on repressed anger, sadness and desire. Methods to overcome patient ambivalence and resistance to psychotherapy are presented. The clinical psychodynamics associated with early life trauma are illustrated with a case of an African-American patient.Acknowledgments for support & critical feedback are expressed to Christine Baker, Ph.D., John Swanson, ACSW, Duncan Walton, Ph.D., and Isabelle Beveridge (Graphics).     

Child and adolescent psychopathology research: Problems and prospects for the 1990s

In November 1990 the National Institute of Mental Health (NIMH) convened a special conference of over 100 scientists and leaders to outline specific strategies and research initiatives that should be developed to implement the recently released National Plan for Research on Child and Adolescent Mental Disorders.Participants included journal editors, educators from psychology and psychiatry, representatives from private foundations, and leaders of research program areas in public funding agencies. Critical knowledge gaps were identified in five areas of child and adolescent psychopathology, including depression, attention deficit hyperactivity disorder, conduct disorder, the anxiety disorders, and the developmental disorders. For each of these areas, special emphasis was placed on developing new ideas and obtaining critical input from other areas of investigation. This report summarizes the identified research gaps and recommends research initiatives to implement the National Plan, as outlined by the conference participants.     

The collective past,group psychology and personal narrative: Shaping Jewish identity by memoirs of the Holocaust

Through honing its collective memory, especially after the Holocaust, the Jewish community has attempted to sustain its culture, bolster the Jewish identity of its members, and regain a resolute sense that its narrative is again proceeding. To some degree, all these aims are realized by instilling in its members the Jewish modal character structure: a psychological configuration with two contrastable entities. One chronically discomposed self-structure, defining itself as polluted and helpless, trembles with the appalling imagery of historical and imminent community disasters. The other entity believes in its unmatched capacity for reparative, socially beneficial actions. The paradigm of this psychological organization is found in many children of survivors. The memory of a tragic history abides alongside the community's hopes in the Jewish modal personality. The need to set forth and accommodate these two motifs imprints upon the Jewish "national" character many of its distinctive qualities. The designs of the Jewish community for this particularly Jewish twofold personality formation are augmented by the personal revelations of survivors. Therefore, Holocaustic testimonies are invested with a sacred aura. In measure, these recitals of the disaster with their stark images, plus the clashing affects aroused in the reader toward main characters of the narrative, dictate the way Jews define themselves in the world and the way they live. A confluence of being covertly commissioned by the Jewish community joins with the narrators' more idiosyncratic longings. Together they generate a steady stream of Holocaustic accounts. Complementary vectors drive the reader to peruse these records. The results therefrom, intimate knowledge of the disaster, plus the twofold personality motifs stamp many Jews as scions of the Holocaust.     

A Power Test of Conceptual Complexity: Textual Correlates1

Conceptual complexity is a personality characteristic that involves the individual's ability to differentiate and integrate aspects of information. It is usu ally measured with the Paragraph Completion Test (PCT), which requires the completion of six paragraphs, in response to standard stems, often with a time limit of 100-120 sec each. In order to eliminate time pressure, which may reduce complexity, the current study evaluated a revised format that used only two stems but allowed 8 minutes per response. As expected, this procedure resulted in higher scores and produced enough written output to allow analysis of particular test components. Complexity scores from 277 university students were related to total number of words written, sentence length, and number of words with more than three syllables, but not to standard formulae designed to measure readability, such as the Flesch, SMOG and FOG indices. The modest size of the obtained correlations suggests that the scoring of conceptual complexity on the basis of semantic content cannot be replaced by indices based on linguistic and textual components.     

Received and Perceived Social Support Following Natural Disaster1

Because they were participating in a concurrent panel study, 222 older adults had been asked how much help they would expect to receive in a hypothetical emergency before experiencing two separate floods. For the subsample suffering losses or injuries during the floods, Study 1 examined the accuracy of their expectations, as well as possible changes in them, as a result of help actually received. Generally, victims received much less help than they had expected to receive prior to the floods. Preflood expectation of support predicted help from kin, whereas loss and education predicted help from nonkin sources. However, subsequent expectations did not change as a result of the level of help received. Using the total sample, Study 2 examined the broader issue of whether the disaster itself affected subsequent perceptions of support. Flood exposure, as measured at both individual and community levels, was associated with declines in perceptions of support and social participation.     

Harming future people

Hanser examines Derek Parfit's contention in his treatise on rationalism, Reasons and Persons (Oxford University Press; 1984) that acts that are not reproductive in nature can nonetheless predictably affect the identities of future people, and that this fact has unexpected and important consequences for ethical theory. Hanser argues tht this fact is not as significant as Parfit believes it to be. The arguments of both scholars concern the morality of choices that, while causing future persons to be badly off, do not make them worse off than they would have been if the choices had not been made. Hanser concludes his essay with a discussion of responsibility for acts that will affect the health of future offspring.     

Do substance abuse and mental health clients prefer automated assessments?

In both psychiatric and substance-abuse services, clinicians have been concerned with the introduction of automated assessments and with their clients’ reactions toward those assessments. The positive reactions of psychiatric clients have been well documented, but little has been known about substance-abusing clients’ impressions of automated assessments. The impact of automated assessment on clients seeking substance-abuse services was evaluated and compared with a previously analyzed sample of clients seeking mental health services. On the whole, both groups responded similarly and positively to automated assessments. Factor analyses revealed three underlying dimensions in client attitudes toward automated assessment,Completeness and satisfaction,Ease of use and enjoyment, andNegative attitudes. In addition, statistically, though not clinically, significant differences in attitudes were found between various demographic groups. Overall, the results support the use of automated assessments with individuals seeking either substance-abuse or mental-health services.     

Clinical pragmatism: a method of moral problem solving

This paper presents a method of moral problem solving in clinical practice that is inspired by the philosophy of John Dewey. This method, called "clinical pragmatism," integrates clinical and ethical decision making. Clinical pragmatism focuses on the interpersonal processes of assessment and consensus formation as well as the ethical analysis of relevant moral considerations. The steps in this method are delineated and then illustrated through a detailed case study. The implications of clinical pragmatism for the use of principles in moral problem solving are discussed.