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.     

Morale and Job Satisfaction Among Nurses: What Can Hospitals Do?

In an attempt to account for morale and job satisfaction among 314 nurses, this study investigated the influence of work-related and interpersonal variables. Morale on the unit was directly related to supervisor support, co-worker relationships, and work recognition. Personal morale was accounted for by recognition, physical environment, the job itself, and pay. Job satisfaction was predicted by personal morale, work commitment, job clarity, work pressure, and innovation. Suggestions for improving nurse morale and job satisfaction are made.     

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).     

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.     

Effect of Server Posture on Restaurant Tipping1

The effect of server posture (standing vs. squatting) on the size of tip left by restaurant customers was examined in two naturalistic experiments. In these studies, squatting down next to the tables increased servers’ tips from those tables. Both the practical implications of this effect and its similarity to other nonverbal effects on tipping are discussed.     

How much can people really change?

The basic purpose of pastoral counseling, and counseling in general, is to help people change. Therefore, it's critically important to understand the nature of change and to have realistic expectations with respect to how much people can change. To expect too little change can lead to underachievement and despair, whereas to expect too much change can cause needless frustration and an abiding sense of failure. This article discusses behavioral change, its potential and its limits, from the point of view of genetic potential and offers some specific pastoral implications.     

The effect of maternal depression on maternal ratings of child behavior

There have been continuing concerns about the extent to which maternal depression may influence maternal reports of child behavior. To examine this issue, a series of structural equation models of the relationships between maternal depression and errors in maternal reports of child behavior was proposed and tested. These models assumed that (a) maternal depression was unrelated to maternal reporting behavior; (b) maternal depression causally influenced maternal reporting accuracy; (c) maternal depression was correlated with reporting accuracy. These models were fitted to data on maternal depression and multipleinformant (mother, teacher, child) reports of conduct disorder and attention deficit behaviors for a birth cohort of 12 and 13yearold New Zealand children. The results of model fitting suggested the presence of small to moderate correlations (@#@ r=+.13 to+.40) between maternal depression and maternal reporting errors, indicating the presence of a tendency for increasing maternal depression to be associated with a tendency for mothers to overreport child behavior problems. However, independently of any effects of maternal depression on maternal reporting errors there was evidence of small but significant associations (r=.10 to .17; p<.05)between maternal depression and child conduct disorder and attention deficit behaviors.This research was funded by grants from the Health Research Council of New Zealand.     

Book reviews

The Popularization of Medicine 1650–1850 Roy Porter (ed.), 1992 London, Routledge pp. x + 296, £50 (hardback) ISBN 0415 07217 4

Quantum Mechanics: An Empiricist View Bas Van Fraassen, 1991 Clarendon Press, Oxford pp. 558, £17.50 (paperback), ISBN 019 8239807