Coping with the Angry Patient

This patient is enacting two chronic maladaptive patterns. In one he alternates between the role of victim and abuser while inducing the therapist to play the counterrole. He tries to master the abuse he suffered passively as a child by becoming abusive with the therapist and having her experience what it feels like to be mistreated. My effort would be to interpret this pattern even while acknowledging and absorbing some degree of his anger. In a second pattern he acts like an angry, demanding child in an effort to extract nurturance and special treatment from the therapist. I would help him explore this posture in terms of his deprived background and its maladaptiveness in his current life. Finally, I present vignettes from my own practice to demonstrate how I work with patients' anger when it is expressed indirectly rather than in Mr. P's very direct manner.     

The Prevalence of Serious Emotional Disturbance: A Re-Analysis of Community Studies

The goal of these analyses was to use existing data to provide an empirically-based estimate of the prevalence in the population of Serious Emotional Disturbance (SED) in children and adolescents, to assist States in their task, required under PL 102-321, of including such estimates in their applications for Block Grant funds. Seven data sets were identified that could provide estimates of SED. The principal investigators agreed on common definitions of the key components of SED: a psychiatric diagnosis and significant functional impairment. Two definitions of impairment were used: domain-specific (impairment in one or more of three areas of functioning) and global (in the worst 10% over all). They also defined a set of correlates and risk factors for SED: age, gender, race/ethnicity, and poverty. Investigators then reanalyzed their own data, using these standard definitions, and calculated the proportion of SED youth who received mental health care. The median estimate of SED with global impairment was 5.4%, with a range from 4.3% to 7.4%. Estimates of SED with domain-specific impairment ranged from 5.5% to 16.9% (median 7.7%). Rates were slightly higher in boys. There were no clear ethnic differences. Poverty doubled the risk of SED. Only one SED child in four had recently received mental health care. Estimates of SED are critically dependent on the method used to define diagnosis and functional impairment. Using common definitions, seven studies produced fairly consistent estimates, which were similar to the estimate of prevalence of Serious Mental Illness (SMI) in adults. Implications for the estimate of State-by-State prevalence rates are discussed.     

Determinants of Participation in Multi-Family Recycling Programs1

The determinants of recycling in multi-family residences were investigated by administering a 50-item questionnaire to 230 residents of buildings where recycling collection systems had been installed. The level of tenant participation, defined by a composite index of self-reported usage, was positively associated with income, education, recycling motivation, and cleanliness of the recycling system. It was negatively associated with the number of different types of collection containers. At the aggregate level, participation varied considerably between the complexes. These differences were largely accounted for in terms of three system support variables, specified in terms of the “user friendliness” of the recycling system, its spatial location within the complex, and the degree to which the manager supported the program. Multiple regression analysis indicated that user friendliness and manager commitment together accounted for 85.3% of the variance in the aggregate participation index. These results suggested several experimental interventions designed to increase participation in multi-family recycling programs.     

The influence of negative advertising frames on political cynicism and politician accountability

This research examined the influence of negative political advertising frames on the thoughts and feelings people generate in response to campaign advertising. Preparing and conducting this investigation involved the use of a multiple‐method strategy. Content analysis identified two advertising frames (i.e., candidate theme and ad hoc issue advertisements) and two experiments separately induced political cynicism and politician accountability. Three hundred and sixty people participated in the experimental studies, in which they read and responded, using a thought‐listing technique, to candidate theme or ad hoc issue negative advertisements. Results demonstrated that participants were more likely to generate cynical comments and hold politicians accountable for the country's ills when reading candidate theme advertisements than ad hoc issue advertisements. The results indicate that this contributes to a political climate of cynicism and may function to erode the electorate's overall trust in government.