What is a difficult mental health case? An empirical study of relationships among domain variables

A difficult case in psychotherapy can be defined in many ways. This study proposes a model for that definition, in which three domains (patient characteristics, case characteristics, and therapist characteristics) are considered to impact on that definition. A total of 264 professionals received a questionnaire to assess the relative importance of a series of variables within and across these domains. Wilcoxon Matched-Pairs Signed-Ranks tests indicated that patient characteristics were considered more important than therapist or case characteristics in defining a difficult case. Case characteristics were considered more important than therapist characteristics. Pearson correlations, however, suggested that the three domains in the model are related. Correlations (for years of experience) and Kruskal-Wallis one-way ANOVA for ranks (for professions) also indicated that participants were able to identify variables within domains as important in that definition regardless of years of experience or professions. Across domains, the most important variables included the motivation of the client (a patient characteristic), dropout/attrition and multiple diagnoses (case characteristics), and the degree of therapist-client racial similarity (a therapist characteristic).     

Sexual Attitudes of Males and Females as Predictors of Interpersonal Attraction and Marital Compatibility1

Two investigations examine the effect of similarity of sexual attitudes on (a) attraction to a stranger and (b) marital sexual satisfaction. In an experiment using undergraduates, manipulation of subject-stranger similarity in general affective orientation to sexuality affected attraction and other evaluative dependent variables. In the second investigation, married couples revealed sexual attitudes and sexual satisfaction. Husbands and wives were similar (r= 0.58, p < 0.001) in their affective orientations to sexuality. Discrepancy between the partners’ scores predicted sexual dissatisfaction in both partners. In addition, the wife's affective orientation to sexuality predicted more indices of sexual satisfaction and adjustment in both the wife and the husband than did the husband's affective orientation to sexuality. Finally, spouses with a positive affective orientation to sexuality were more accurate when judging their partner's sexual enjoyment, compared to spouses with a negative orientation. The findings have implications for the effects of similarity of attitudes on interpersonal attraction and on relationship quality.     

Chronic Stress as a Mediator of Acute Stress: The Case of Hurricane Hugo1

This study explored one mechanism through which acute disaster stress (injury, life threat, property damage, loss) may produce lasting psychological distress (depression, anxiety, somatization, hostility). More specifically, the study examined the mediating roles of seven domains of chronic stress (marital, parental, filial, financial, occupational, ecological, physical) within a sample of 930 disaster victims and controls. The results provided strong support for the hypothesis that chronic stress mediates the long-term effects of acute disaster stress on psychological distress. The main effects of loss, though limited in strength, were completely explained by victims’ higher financial, marital, filial, and physical stress. The effects of injury, though quite strong, were largely mediated by these same domains of chronic stress. Likewise, the effects of life threat were largely mediated by all these domains plus ecological stress. A mediational model was not appropriate for understanding the consequences of property damage because it did not exhibit a main effect on psychological distress.     

Adolescent Type A Characteristics and Socially Problematic Behaviors1

Researchers have increasingly advocated social and developmental psychology perspectives to studying Type A behavior to increase understanding of how it emerges and of how Type A individuals’ entry into different naturalistic social situations may exacerbate their stress reactions. As an initial step in these directions, we tested structural equation models relating components of Type A behavior in adolescents to childhood and adolescent socially problematic behaviors. Results from two high-school district cohorts (Ns = approximately 300 and 700) showed that impatience, hostility, and leadership all were related to childhood problems, but that only impatience predicted an adolescent problem (conflict with friends).     

Proximal and Distal Predictors of Homophobia: Framing the Multivariate Roots of Outgroup Rejection1

A proximal-distal theoretical framework was developed to examine the multivariate roots of homophobia. Using data from a sample of 288 undergraduates who had participated in a computer-assisted panel study over a three-year period, the effects on homophobia of distal and proximal family factors (e. g., parental education and family environment), distal and proximal individual factors (e. g., personality constructs and current beliefs), and proximal individual-situational factors (e. g., acquaintance with homosexuals) were tested in regression analyses. Both analyses employing sets of variables varying in proximity to the homophobic attitude and hierarchical regression employing variables contributing significantly in each set supported the proposed framework. All sets predicted significantly when regressed separately on homophobia; the sets containing the distal factors contributed most weakly, and the sets containing the proximal factors contributed most strongly. In hierarchical regression analysis, this pattern maintained such that the incremental increase in r² decreased with the addition of each more distal set, with the most distal factors failing to contribute significantly to the prediction. The importance of study findings for attitude change efforts is discussed.     

FUNCTIONAL COMMUNICATION TRAINING WITH AND WITHOUT EXTINCTION AND PUNISHMENT

Functional communication training has been reported to be a promising treatment for severe behavior problems. In this study, functional communication training alone and combined with extinction and/or punishment was evaluated for 4 clients with severe retardation, behavior problems, and communication deficits. The participants were inpatients on a hospital unit for treatment of severe behavior disorders. They received individualized interventions based on functional assessment that included reinforcement of a communication response with the same function as their destructive behavior. Results showed that for some patients, functional communication training was not sufficient to produce clinically significant reductions in destructive behavior, and the combination of training plus punishment produced the largest and most consistent reductions.     

VALIDATING PREDICTED ACTIVITY PREFERENCES OF INDIVIDUALS WITH SEVERE DISABILITIES

We examined the accuracy of 24 staff members' predictions of activities preferred by 14 individuals with severe disabilities. For each of 144 activities, staff members assigned a client preference rating of “likes a lot,” “likes,” or “dislikes.” Two activities from each category were randomly selected for each individual with disabilities. Pairs of selected activities were presented to the individuals, who were prompted to choose an activity. Staff members' activity preference ratings correctly predicted the choices made by the individuals with disabilities for 78% of the trials. The more divergent the preference ratings of the paired activities, the more likely staff members were to predict correctly the activity selected by a participant.