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.     

Lateralized Changes in Regional Cerebral Blood Flow during Performance of Verbal and Facial Recognition Tasks: Correlations with Performance and “Effort”

Functional neuroimaging has been used to investigate neural substrates of mnemonic processes, and cerebral blood flow (CBF) measures have been sensitive to activation with memory tasks. Studies of memory with two-dimensional¹³³Xenon clearance techniques found that word and face recognition tasks produced contralateral CBF changes in mid-temporal cortical regions. This study replicated the activation paradigm, expanding to the three-dimensional resolution of positron emission tomography (PET). Word and face recognition, and a control baseline task were administered to 19 healthy right-handed volunteers (11 men, 8 women) during successive 10 min PET¹⁵O-water measures of CBF. Quantitative CBF rates were calculated with the arterial input function and the equilibrium model. Redistributions of blood flow were compared across tasks using both absolute and relative (region/whole brain) CBF.Replicating the¹³³Xenon clearance findings, CBF was “appropriately” lateralized during task performance (left–right for words > left–right for faces) in the mid-temporal region. Contrary to predictions, the recognition tasks did not activate expected mesolimbic or prefrontal areas. The task-induced CBF changes also correlated with performance. Bilateral CBF in mid-temporal and parahippocampal gyrus regions of interest correlated with the ability to correctly identify word targets (sensitivity). Left-lateralized CBF in the amygdala and hippocampus correlated with better word sensitivity as well as specificity (ability to correctly reject foils). Complementally, right-lateralized CBF in the parahippocampal gyrus correlated with better face specificity performance. In addition, left-lateralized CBF in the amygdala and right-lateralized CBF in the parahippocampal gyrus and hippocampus correlated with “mental effort” indices (task performance relative to basal ability) for word and face memory tasks, respectively. Thus, whereas this recognition task showed the expected lateralized increase in the mid-temporal region and not in frontal and limbic areas, lateralized activation in some of these areas was associated with better performance. Exploratory analyses on other regions showed lateralized changes in one additional temporal region, the occipital-temporal, and several limbic regions.     

The specific action of different personality risk factors on cancer of the breast, cervix, corpus uteri and other types of cancer: A prospective investigation

We report the results of a prospective study of a random sample of 1353 elderly but healthy men and women who were followed up for a period of 10 yr, when mortality and cause of death were ascertained. Overall results have been reported elsewhere for mortality from cancer, coronary heart disease and other causes; here we are concerned with the personality factors predicting breast cancer, cervical cancer, cancer of the corpus uteri specifically, as well as other types of cancer in women. Ten specific hypotheses were tested, using specially constructed questionnaires for the purpose, and for most of these statistically significant support was obtained. The results justify belief that specific types of cancer may be related to specific stress/personality factors.     

Power and Personality: An Analysis of Gay Male Intimate Abuse

A study was conducted to investigate the issue of gay male intimate abuse in a sample of 52 couples. The objective of the study was to explore the association between relationship power dynamics and the perpetration of psychological abuse, and to investigate the correspondence between intimate abuse and factors associated with the Abusive Personality [D. G. Dutton and A. J. Starzomski (1993) Borderline Personality in Perpetrators of Psychological and Physical Abuse, Violence and Victims, Vol. 8, pp. 327–337; D. G. Dutton (1994a) Behavioral and Affective Correlates of Borderline Personality Organization in Wife Assaulters, International Journal of Law and Psychiatry, Vol. 17, pp. 265–279.] The majority of participants were middle to upper class and their ethnic/racial breakdown is as follows: White (86%), Native American (7%), Asian (4%), and Other (3%). In terms of power, results indicated that the more frequent form of psychological abuse was significantly higher in relationships characterized by divided power (i.e., partners sharing decision-making authority by the partners each making decisions in different domains). This finding supports the supposition that abuse can occur in relatively egalitarian relationships. An association between intimate abuse and the Abusive Personality was also clearly observed and this personality profile seemed to characterize both members of abusive dyads. Conclusions are drawn regarding the generalizability of intimate abuse across lines of sexual orientation.     

Sexuality education and young people's sexual behavior: a review of studies

Sexuality education for children and young adults is one of the most heavily debated issues facing policy-makers, national AIDS program planners, and educators, provoking arguments over how explicit education materials should be, how much of it there should be, how often it should be given, and at what age instruction should commence. In this context, the World Health Organization's Global Program on AIDS' Office of Intervention Development and Support commissioned a comprehensive literature review to assess the effects of HIV/AIDS and sexuality education upon young people's sexual behavior. 52 reports culled from a search of 12 literature databases were reviewed. The main purpose of the review is to inform policy-makers, program planners, and educators about the impact of HIV and/or sexuality education upon the sexual behavior of youth as described in the published literature. Of 47 studies which evaluated interventions, 25 reported that HIV/AIDS and sexuality education neither increased nor decreased sexual activity and attendant rates of pregnancy and sexually transmitted diseases (STDs). 17 reported that HIV and/or sexuality education delayed the onset of sexual activity, reduced the number of sex partners, or reduced unplanned pregnancy and STD rates Only 3 studies found increases in sexual behavior associated with sexuality education. Inadequacies in study design, analytic techniques, outcome indicators, and the reporting of statistics are discussed.     

The U.S. Supreme Court Decision in Jaffee v. Redmond: Implications for Counselors

In 1996, the U.S. Supreme Court held that communications between licensed psychotherapists and their patients are privileged under the Federal Rules of Evidence. The nature of privileged communication, the history of this Supreme Court decision, and implications of the decision for counselors are discussed.     

TIME COURSE OF ACTIVATING BRAIN AREAS IN GENERATING VERBAL ASSOCIATIONS

Abstract— Generating a use far a visual word in comparison with reading the word aloud activates frontal attention areas first (170 MS), a left lateral frontal area next (250 ms), and then a left temporoparietal (Wernicke's) area (650 ms). A brief period of practice reduces these activations. If subjects are asked to respond to a word from the same practiced list by giving a novel use, the original activations reappear and are joined by activity similar in location and time to Wernicke's activation but in the right hemisphere. These findings demonstrate the time course of activations of neuroanatomical areas in word processing and indicate a role for the right hemisphere when semantic processing is more difficult, such as in generating a less frequent association in the presence of a highly practiced one.     

Changes in Newcomers' Person–Climate Fit following the First Stage of Socialization

The development of attitudes and activities of newcomers in the 18 months following the first period of socialization was investigated. At two points in time, persons' preferences for seven work climates were compared with perceived climate. Changes in person-climate fit were assessed, using a squared difference index, after alternative fit-indices were tested with hierarchical regression analysis. Person-climate fit and work attitudes at T1 (eight to ten months after entry) were examined by comparing three groups of respondents who did not change jobs, changed jobs within the organization or changed organizations. Results showed no alpha, beta or gamma changes for the total group of 108 respondents. Alpha changes were only found for respondents who changed jobs. They showed higher ratings for job satisfaction at T2. Finally, work attitudes at T1 were related to turnover. Organizational changers showed higher turnover intentions and higher discrepancies between preferred and perceived risk orientation and work pressure at T1.     

Confirmatory Factor Analysis of U.S. Merit Systems Protection Board's Survey of Sexual Harassment: The Fit of a Three-Factor Model

Research over the past decade and a half exploring the psychological dimensions of the definition of sexual harassment has converged on a three-factor model: gender harassment, unwanted sexual attention, and sexual coercion. The current study used confirmatory factor analysis to determine whether the most widely used sexual harassment survey, the U.S. Merit Systems Protection Board (USMSPB; 1981) survey, measures this three-factor structure. Data from a sample of the USMSPB's 1988 survey of Federal employees (n= 1070) and from a midwestern university's survey of undergraduates (n= 572) and graduate students, faculty, and staff (n= 575) were analyzed. The three-factor model fit reasonably well in all samples, but two survey items, measuring sexual assault and sexual favors, were weakly related to their respective factors. This model, however, was only marginally stable across female and male subsamples, and gender harassment and unwanted sexual attention had low discriminant validity. Both practical and theoretical implications are discussed.