Discrete varieties of care in the clinical pastoral tradition: continuing the dialogue

In the current cultural context, clinically trained ministers, lay and ordained, offer themselves to troubled souls through at least three distinct varieties of assistance: pastoral care, pastoral counseling, and pastoral psychotherapy. This essay delineates three accepted disciplines, emphasizing the importance of ascertaining, and perhaps re-evaluating, the particular needs and desires of persons who are in physical, mental, or spiritual distress. "Pastoral care," "pastoral counseling," and "pastoral psychotherapy" each play an important role in fulfilling the traditional mandate for "the cure of souls."     

Use of interreflection and shadow for surface contact

The interaction of light with surfaces results in a number of lighting effects that may serve as valuable visual cues. Previous research on shadows has shown them to be effective in determining the three-dimensional (3-D) layout of a scene, but interreflections have been ignored as cues for spatial layout. Interreflections as well as shadows may help to disambiguate the 3-D layout of objects by providing information about an object's contact with a surface. We generated computer images of a box on an extended textured ground plane that was either in contact with the ground or was slightly above the ground. Images were rendered for four conditions: (1) no shadow + no interreflection, (2) shadow only, (3) interreflection only, and (4) shadow + interreflection. A photometrically incorrect condition was also included. The participants rated the degree of contact for each image on a scale, which was used to generate receiver operating characteristic (ROC) curves and a measure of sensitivity. In the images with no shadows or interreflections, the participants performed at chance levels. Interreflections, shadows, and a combination of interreflections and shadows all resulted in high sensitivity for judging object contact. More important, information from shadows and interreflections can be combined, resulting in near-perfect judgment of surface contact. Interreflections and shadows can be effective cues for object contact.     

Cues trained apart compete for behavioral control in rats: convergence with the associative interference literature

Contemporary theories of associative learning require cues be trained in compound for cue competition (interference) to occur. That is, Cues A and X should compete for behavioral control only if training consists of AX-outcome (O) trials and not if each cue is separately paired with O (i.e., X-O and A-O). Research with humans challenges this view by showing that A-O trials interpolated between training and testing of a X-O association impair responding to X (i.e., retroactive interference). In six conditioned suppression studies with rats, the authors demonstrate that two cues trained apart can each interfere with the potential of the other to predict the outcome. The authors conclude that this type of interference (a) reflects a failure to retrieve the target association due to priming at test of the interfering association and (b) is attenuated if the outcome is of high biological significance. These findings parallel previous reports in verbal learning research and suggest that a similar associative structure underlies some types of associations in nonverbal subjects.     

The "prodromal" patient: both symptomatic and at-risk

This article discusses conceptual issues relevant to the prospective diagnosis of the schizophrenic prodrome. Recent efforts to diagnose these patients with operational criteria based on current symptoms are reviewed. Symptomatic patients so identified appear to be treatment-seeking and to have mild cognitive impairments. In addition to being currently symptomatic, these patients are imminently at risk for progression of illness and development of schizophrenia. Data from three international centers suggest that this risk is approximately 40% over the next year of follow-up if untreated. The implications of the reviewed data for the appropriateness of the term "prodromal" and for treatment/prevention research for these patients are discussed.     

Neural Recruitment and CognitiveAging: Two Hemispheres Are Better Than One, Especially as You Age

Several neuroimaging studies have reported that older adults show weaker activations in some brain areas together with stronger activations in other areas, compared with younger adults performing the same task. This pattern may reflect neural recruitment that compensates for age-related neural declines. The recruitment hypothesis was tested in a visual laterality study that investigated age differences in the efficiency of bihemispheric processing. Letter-matching tasks of varying complexity were performed under two conditions: (a) matching letters projected to the same visual field (hemisphere) and (b) matching letters projected to opposite visual fields (hemispheres). As predicted by the recruitment hypothesis, older adults generally performed better in the bilateral than unilateral condition, whereas younger adults showed this pattern onlyfor the most complex task. We discuss the relation between these results and neuroimaging evidence for recruitment, and the relevance of the present bihemispheric advantage to other evidence for age-related changes in interhemispheric transfer.     

Applying Utilization Management Principles to a Comprehensive Service System for Children with Emotional and Behavioral Disorders and Their Families: A Feasibility Study

The Comprehensive Services Act for At Risk Youth and Families of Virginia (CSA), is a service, funding, and organizational reform initiative designed to improve the provision of child centered and family focused services within a community setting. We conducted this study in order to assess the feasibility of applying utilization management principles to the CSA in order to improve the appropriateness, quality, and cost effectiveness of this service delivery system. Data were gathered through focus groups, surveys, clinical profiling, and analysis of costs, and service utilization. While overall program costs increased since inception of the program, the costs per child served rose less than the rate of inflation. CSA appeared to be serving children with a high degree of emotional and behavioral difficulties. There was considerable variation among localities in placement patterns. A majority of survey and focus group respondents were willing to consider the application of utilization management principles to the CSA as long as decision making remained within localities. We concluded that there is a constructive role for utilization management approaches to improve the appropriateness and quality of services as well as enhancing efficiency in child mental health.     

Racial socialization and racial identity: can they promote resiliency for African American adolescents?

Although there is a rich body of research on resiliency, much of the literature fails to include minority youths or does not take into consideration their distinctive racial and environmental circumstances. Additionally, limited attention has been given to protective factors that are unique to nonmajority populations. This article posits that racial socialization and racial identity protect urban African American adolescents against some of the harmful effects of a discriminatory environment. These factors are hypothesized to influence academic achievement-an indicator of resiliency that has been used in many studies. A theoretical framework is provided that combines character development in a hostile environment, bicultural identity, and urban stress models. Implications for practice and future research are discussed.     

The norm of self-interest

The self-interest motive is singularly powerful according to many of the most influential theories of human behavior and the layperson alike. In the present article the author examines the role the assumption of self-interest plays in its own confirmation. It is proposed that a norm exists in Western cultures that specifies self-interest both is and ought to be a powerful determinant of behavior. This norm influences people's actions and opinions as well as the accounts they give for their actions and opinions. In particular, it leads people to act and speak as though they care more about their material self-interest than they do. Consequences of misinterpreting the "fact" of self-interest are discussed.     

Counseling Women in Midlife: An Integrative Approach to Menopause

Menopause is a normative life transition that is experienced by virtually all women, yet remains poorly understood. The dominance of the biomedical model results in a unidimensional definition of menopause as a biological event, ignoring the influence of cultural and psychosocial factors. Counselors who use an integrative approach can not only provide accurate biomedical information but also conceptualize menopause as a normative midlife transition. The purpose of this article is to provide a foundation in biomedical issues and to consider how these independently, and in interaction with cultural and psychosocial factors, influence the experience of menopause.