New directions for the education of clinical psychologists: The primary care setting,the VA's PRIME program,and the in-depth generalist model

As part of this special issue on psychology in primary care settings, we describe the Department of Veterans Affairs' (VA's) new approach to education for practice in the primary care setting and we concurrently address some general issues related to the education of clinical psychologists for practice in this setting. In this article we argue that the primary care psychologist, in parallel with the generalist in medicine, must have a strong generic background in clinical psychology in order to gain the broad range of clinical skills necessary to function effectively as an in-depth generalist (IDG) who is capable of addressing the variety of psychological issues that emerge in the primary care setting. The IDG model of professional practice, which we believe is best suited for primary care/managed care settings, requires extensive training in generic clinical skills and increased time devoted to its implementation at both the predoctoral and the postdoctoral levels.     

Philosophy of medicine and other humanities: Toward a wholistic view

A less analytic and more wholistic approach to philosophy, described as ‘best overall fit’ or ‘seeing how things all hang together,’ is defended in recent works by John Rawls and Richard Rorty and can usefully be applied to problems in philosophy of medicine. Looking at sickness and its impact upon the person as a central problem for philosophy of medicine, this approach discourages a search for necessary and sufficient conditions for being sick, and instead encourages a listing of “true and interesting observations” about sickness which reflect the convergence of a number of different viewpoints. Among the relevant viewpoints are other humanities disciplines besides philosophy and the social sciences. Literature, in particular, provides insights into the meaning and the uniqueness of episodes of sickness in a way that philosophers may otherwise fail to grasp.     

TRANSITIONS IN CHILDREN'S ROLES AND CAPABILITIES*

Stage theories and empirical studies have concentrated on a few periods of childhood (e.g., age 5 to 7 years) as important times of transition. On the basis of ethnographic suggestions that the age period 8 to 10 years also involves interesting changes, the authors carried out a search of published empirical studies for findings of transitions in capabilities at 8 to 10 years. An annotated bibliography is provided summarizing the studies found in a 5-year period in three journals. The authors discuss possibilities for characterizing the transition at age 8 to 10, as well as how such a transition meshes with the concept of stage.     

The indirect impact of child-oriented advertisements : On mother-child interactions

The Federal Trade Commission (1978) has expressed concern about the direct and indirect effects that commercial food advertisements have on children and families. Based on these concerns, they suggested banning all advertising aimed at young children. The present experiment was designed within the context of concern about the influence of television food advertising on parent-child interactions. It was predicted that mothers whose children viewed a television program with embedded food advertisements would display more control strategies and more power assertion while grocery shopping than mothers of children who were not exposed to advertisements. The results corroborated this hypothesis and, in addition, revealed that children who viewed the food advertisements attempted to influence their mothers' consumerism more than children who did not view the food advertisements. These results were discussed in terms of the importance of considering how television-viewing indirectly influences the quality of parent-child interactions.     

Schreber'sMemoirs: Myth or personal lamentation

Lucy Bregman's approach to Schreber'sMemoirs is scrutinized and found to be based on a number of fallacious and contradictory assumptions that call her interpretation of the book as personal religious myth into question. A social constructionist approach to mythology maintained by Berger and Luckmann is advanced, suggesting that at best Schreber's work qualifies as a quasi-mythical attempt to explain the source of his personal sociopsychic suffering. The family and interpersonal dynamics of Schreber's quasi-myth are investigated. Similarities to other cases of psychotic quasi-myths are noted and a general relationship between oppressive socialization and psychotic communications is advanced, as well as a specific alternative interpretation of Schreber's work to that proposed by Bregman.Nathan Church, M.S., is currently teaching at Douglass College of Rutgers University, where he is nearing completion of his Ph.D. in sociology.     

Effects of a token reinforcement system on journal reshelving

A token reinforcement program involving two levels of token value and backup reinforcers to increase journal reshelving behavior in a large university library was experimentally evaluated. Results showed that instructions (in which signs asked users to reshelve journals) had no impact. By contrast, token reinforcement contingent on reshelving behavior led to a marked increase in journals reshelved. A return to instructions-only conditions, when data were corrected for library usage, showed an increase in unreshelved journals over the token reinforcement period, though the increase was not to baseline levels. For the next 11 months, library staff maintained a modified token program. Follow-up data collected after that interval showed that number of unreshelved journals remained markedly lower than levels at baseline and the first instructions-only period, though they were slightly higher than at the token reinforcement period. Token reinforcement of the variety employed in this study constitutes an efficient, economical means of changing the behavior of library users who fail to reshelve books and journals.