Child abuse and the limits of confidentiality: forewarning practices

Confidentiality is widely considered to be of great importance in psychotherapy. With few exceptions, the breaching of confidentiality is an ethical violation and grounds for litigation. One such exception is the mandated reporting of known or suspected child abuse, representing a legally sanctioned limitation of confidentiality. Because clients generally expect unlimited confidentiality in therapeutic relationships, many therapists have begun to "forewarn" clients as a matter of informed consent. This research report: (a) briefly reviews issues surrounding mandatory reporting and confidentiality as they relate to forewarning, (b) defines and discusses forewarning as contrasted with "informing," (c) examines state statutes, case law and ethical guidelines relevant to forewarning, and (d) presents a survey of 428 mental health providers (MHPs) on their forewarning practices in which 36.9% forewarned all clients, 36.4% informed clients only upon suspicion of abuse, and 20.6% informed only after receiving a disclosure of abuse. The implications of these findings are discussed.     

Efficacy of a Train-the-Trainer Curriculum for Increasing Occupational Therapists’ Mental Health Knowledge

The marked prevalence and under detection of affective disorders including depression in older adults is associated with poor functional outcomes and patient mortality. Although occupational therapists are trained in mental health assessment and intervention, these skills are underutilized in practice. A two-group wait-list control design was used to test a DVD-based educational curriculum to increase knowledge about depression in a sample of occupational therapists. The educational intervention was delivered using a train-the-trainer model. The train-the-trainer model was found to be effective and study results showed that knowledge increased significantly after the DVD training.     

Clinical Utility of the Mattis Dementia Rating Scale in Older,Urban Medical Patients: An Expanded Study

This study investigated the clinical utility of the Mattis Dementia Rating Scale (DRS), using a sample of 138 cognitively intact and 151 cognitively impaired patients at an urban medical center. The 172 young-old patients (ages 60-79) and the 117 older-old patients (ages 80 and above) were predominantly African American elders who had completed significantly less education than had Mattis’s normative samples. Results show that, despite lower mean scores in our sample versus Mattis’s normative samples, the best cut-off score is nearly identical to Mattis’s in the young-old patients, while a lower cut score provided optimal classification for the older-old patients.     

Values,Consciousness, and Language

Two seminal thinkers, Edelman and Damasio, offer neurophysiological models of brain development and functioning that correspond with a contemporary psychoanalytic focus on dynamic experiential intersubjective systems. I describe their respective contributions under three headings derived from Edelman: values, consciousness, and language. I consider the scope of each of these topics as it abuts related psychoanalytic concepts.     

Motivational Systems and Model Scenes with Special References to Bodily Experience

The motivational systems underlying the behavior of recalcitrant and verbally uncommunicative patients are viewed and discussed in terms of emerging self with other. The painful sensations and misperceptions of bodily experience in infancy can reoccur during treatment or have become a habitual way of being in the world. They must be understood and worked through in order to facilitate symbolization and sufficient distance from bodily sensations to allow renewed psychological growth. Five motivational systems are said to aid and express needs such as help in sustaining physiologic requirements, need for attachment, assertion of preferences, development of healthy assertion, and the need for sensual enjoyment. Affective experiences associated with each system in infancy set the pattern for later behavior. It becomes clear that during treatment patients reclaim and begin to understand such “sensation” language. The therapist is then called upon to translate the arising metaphors.

Ten “principles of psychoanalytic technique” are then offered. Every effort is made to comprehend the patient's affective experience, either during recall of experiences or in the present. Of particular interest is the stance of the therapist during such therapeutic encounters. Rather than adopting the traditional position of interpreting the present in terms of the past, empathic attention is given to affect and emotion in the here and now.     

A Clinician's View of Attachment Theory and Research: A Discussion of the Papers in Three Issues of Psychoanalytic Inquiry

In this essay, I take up concepts raised in papers in the three issues of Psychoanalytic Inquiry edited by Diana Diamond and Sidney Blatt. To give coherence to my discussion, I consider the many subjects covered (often several in one paper) under the headings of Mothering, Representation, Trauma and Pathology, and Therapeutic Change and Its Measurement. I focus throughout on the relevance of findings to the outlook of a clinician, at times providing examples based on my experience as an analyst to further elucidate my conceptualizations.     

Demographic variables and microCog performance: relationships for VA patients under treatment for substance abuse

The associations of demographic variables with cognitive performance, as measured by the MicroCog ability domain scores, were assessed with 222 substance abusers who were patients in a VA medical center. Analysis indicated that age was negatively related to all five outcomes scores, and education was positively related to measures assessing Attention/Mental Control and Reasoning/Calculation. These findings are consistent with past theoretical and applied research. The demographic variables, as a group, accounted for a total of 17% to 37% of the variance in the five domain scores.     

Reasons for Leaving: Causes and Initial Triggers for Disaffiliation from Orthodox Judaism

Investigating both the causes and initial triggers for disaffiliation from Orthodox Judaism is an important part of understanding the complex lived experiences of exiters. This study documents an extensive number of causes for leaving Orthodox Judaism, as well as initial triggers, a less-often investigated, yet important component of disaffiliation. Using an online survey, over 700 open-ended responses were collected from 303 participants who self-identified as having grown up practicing Orthodox Judaism but had since stopped practicing. Content analysis was used to organize responses, resulting in distinct categories that fit into two themes: intellectual and social-emotional, the former more often reported by males and the latter by females. The most commonly reported causes and initial triggers, respectively, were issues with the community and lack of belief in Torah and Orthodoxy. Our results give voice to exiters by documenting nuanced accounts of the full disaffiliation journey, beginning with the initial trigger.     

Much Ado About Nothing?

Mary Lee Smith. Sex bias in counseling and psychotherapy Bernard E. Whitley, Jr. Sex roles and psychotherapy: A current appraisal