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.     

Infertility treatment for postmenopausal patients: an equity-based approach

This article examines two questions pertaining to the extension of infertility treatment to postmenopausal women. First, what concepts and principles of infertility practice apply to assisted reproduction for the postmenopausal patient? Second, what role should these concepts play in the development of an ethical justification for extending women's reproductive lives past the menopausal boundary? The argument offered here supports their claim to infertility services on the basis of the formal principle of justice, which requires that similar cases be treated similarly. The cases of many postmenopausal patients are argued to be relevantly similar to classes of patients who already receive assistance in reproduction.     

Predictive testing and oncogenes

Case vignette: sharing unanticipated genetic information. The Questor family has experienced an unusual number of malignancies in the past two generations and has been advised by an oncologist that the p53 oncogene known as Li-Fraumeni Syndrome may be present in the family genome. The option of predictive genetic testing has been raised and several branches of the family have chosen to undergo screening to determine whether they are at risk for cancer because of the gene. Roger and Liz Questor have arranged for screening of themselves and their three children, ages 12, 10, and 7. The couple has, by all appearances, been happily married for 14 years. None of the family members are found to carry the oncogene; however, the geneticist conducting the analyses has made an interesting incidental discovery. The 10-year-old child is not the biological progeny of Roger Questor. Although the 12- and 7-year-olds are clearly the biological children of the couple, it is evident that the 10-year-old born to Liz Questor was fathered by a person other than Roger. What are the ethical obligations of the geneticist with respect to any sharing or disclosure of the information that has been discovered incidentally? What course of action, if any, do you recommend?     

Prenatal gender preference of mothers of feminine and masculine boys: Relation to sibling sex composition and birth order

A mother's (prenatal) wish for a girl has, at times, been implicated as an etiological factor for boyhood femininity or its DSM-III-R diagnostic equivalent, the Gender Identity Disorder of Childhood. In one sample of 52 feminine and 52 nonclinical control boys from Los Angeles, the proportion of mothers who recalled a wish for a girl during the pregnancy did not differ significantly between groups (26.9% vs. 19.2%, respectively); however, in both groups, the maternal wish for a girl was significantly more common in sibships in which all of the proband's older siblings were male. In a second sample of 103 feminine boys from Toronto, the maternal wish for a girl was significantly higher than that found in the Los Angeles sample (43.7% vs. 26.9%), but a control group was not available; as in the Los Angeles sample, the maternal wish for a girl was significantly more common in sibships in which all of the proband's older siblings were male. Implications of these findings for further study of maternal influences on boyhood femininity are discussed.     

Attentional bias to threat: Roles of trait anxiety, stressful events, and awareness

Attentional biases for threat stimuli were assessed in high and low trait anxious subjects (n = 66) using a probe detection task. To examine the effects of trait anxiety and situational stressors, each subject was tested three times: Under no stress, laboratory-induced stress, and examination-induced stress. To evaluate the role of awareness, half the word stimuli were presented very briefly (14 msec) and masked, and the other half were presented for 500 msec without a mask. Results showed that high trait anxious subjects under exam stress showed an attentional bias towards unmasked threat stimuli compared with low trait subjects. This effect was not found under lab-induced stress, suggesting that the attentional bias for unmasked threat in high trait subjects may be a function of a prolonged stressor, rather than a transient increase in state anxiety. The results from the masked exposure condition were not predicted; high trait anxious subjects shifted attention towards the spatial location of threat words despite lack of awareness of their lexical content, but this bias was only apparent in the no-stress condition. The results are discussed in relation to recent cognitive theories of anxiety.     

Does stimulus correspondence account for the Simon effect? Comments on Hasbroucq and Guiard (1991)

Summary In a recent paper analysing the Simon effect, Hasbroucq and Guiard (1991) concluded that stimulus congruence, a correspondence relationship between stimulus components, accounts for the Simon effect and explains its reversal in the Hedge and Marsh experiment (1975). We contend that their definition of stimulus congruence is applied inconsistently, which invalidates their conclusion. It is argued here that the effect of display-control arrangement correspondence (Simon, Sly, & Vilapakkam, 1981) is an alternative account that fits the presented data better. In a second experiment, Hasbroucq and Guiard (1991) claimed to have invalidated the suggestion that display-control arrangement correspondence could be considered to be an alternative account of the findings in their Experiment 1. However, we assert that the type of display-control arrangement employed in their second experiment was so unpredictable that no effect of display-control arrangement correspondence could occur.     

Indirect modes of aggression among women of Buenos Aires,Argentina

This study utilizes the construct indirect aggression to investigate aggressive behavior among middle class Argentine women and men by administering an attitude and self-report survey to 95 inhabitants of Buenos Aires and by analyzing ethnographic interviews and observations conducted over a nine month period in 1992. An examination of sex roles in Argentina, including machismo and marianismo, provide a cultural context for interpreting aggression. Factor analyses revealed the presence of indirect aggression (e.g., social manipulation, gossip, exclusion) in addition to verbal and physical aggression. Survey and ethnographic findings converge in suggesting that women employ more indirect aggression than men, while men utilize more physical aggression. While competition and aggression are salient elements of social life for both sexes, women and men tend to favor different approaches. The findings are compared with the literature on female aggression from other cultural settings. We conclude that cultural and evolutionary perspectives elucidate aspects of female aggression.We would like to thank the Ford Foundation for providing the financial support to make this research possible. We would also like to thank Patricia de Gyldenfeldt and Debbie Bandura for their endless contributions with translations, ideas, and help in general. Finally, we would like to thank Eckerd College, la Universidad del Salvador, and Michael Hobson for their base of support, all those in Argentina, especially Agueda, Andrea, Carmen, Cecilia, Claudio, Daniela, Heidi, Ingrid, Javier, Julio, María, Mariela, Roberto, and Victor, who offered their enthusiastic assistance and ideas, and Victoria Burbank, Ayala Gabriel, and the anonymous reviewer for their helpful suggestions.