What is a difficult mental health case? An empirical study of relationships among domain variables

A difficult case in psychotherapy can be defined in many ways. This study proposes a model for that definition, in which three domains (patient characteristics, case characteristics, and therapist characteristics) are considered to impact on that definition. A total of 264 professionals received a questionnaire to assess the relative importance of a series of variables within and across these domains. Wilcoxon Matched-Pairs Signed-Ranks tests indicated that patient characteristics were considered more important than therapist or case characteristics in defining a difficult case. Case characteristics were considered more important than therapist characteristics. Pearson correlations, however, suggested that the three domains in the model are related. Correlations (for years of experience) and Kruskal-Wallis one-way ANOVA for ranks (for professions) also indicated that participants were able to identify variables within domains as important in that definition regardless of years of experience or professions. Across domains, the most important variables included the motivation of the client (a patient characteristic), dropout/attrition and multiple diagnoses (case characteristics), and the degree of therapist-client racial similarity (a therapist characteristic).     

INCREASING CALORIE CONSUMPTION IN CHILDREN WITH CYSTIC FIBROSIS: REPLICATION WITH 2-YEAR FOLLOW-UP

Three mildly malnourished children with cystic fibrosis and their parents participated in a behavioral group-treatment program that focused on promoting and maintaining increased calorie consumption. Treatment included nutritional education, gradually increasing calorie goals, contingency management, and relaxation training, and was evaluated in a multiple baseline design across four meals. Children's calorie intake increased across meals, and total calorie intake was 32% to 60% above baseline at posttreatment. Increased calorie consumption was maintained at the 96-week follow-up (2 years posttreatment). The children's growth rates in weight and height were greater during the 2 years following treatment than the year prior to treatment. Increases in pace of eating and calories consumed per minute were also observed 1 year posttreatment. These findings replicated and extended earlier research supporting the efficacy of behavioral intervention in the treatment of malnutrition in children with cystic fibrosis.     

Child protection dilemmas in a 'not-existing' pattern of abuse

Three cases from a larger review of child abuse inquiry reports are discussed. The abuse the children suffered is termed 'not-existing' because they had been shut away until they perished. Interaction between the children's caretakers and the child protection professionals is examined within a revised framework of the double-bind.     

Grading the ‘cultural literacy’ project

The essay examines the argument advanced by E.D. Hirsch, Jr., for instituting ‘cultural literacy’ as a fundamental priority of schools. A number of confusions and equivocations in Hirsch's reasoning are identified, and the propensity of his project to indoctrinate is exposed. Among the features of Hirsch's argument shown to be troubling are his shifting construal of ‘language’, his inconsistency about the requirements of cultural literacy, and his uncritical relation to traditional images of the American past and present. The upshot is to raise the question why Hirsch's project has elicited wide support and praise.     

Interpersonal loss and self-mutilation

Self-mutilation was hypothesized to increase in frequency during periods of interpersonal loss in a treatment program for seriously disturbed adolescents. The study examined changes in the frequency of acts of self-mutilation, aggression, and running away for 32 teenagers who experienced interpersonal loss when staff members left employment. Data were collected for a 4-year period. Statistical findings indicated that the frequency of self-mutilation increased significantly during the time period of anticipated loss, 2 weeks prior to staff terminations. There was no significant increase in the frequency of self-mutilation immediately following the staff terminations. Also, there was no significant change in the rates of aggression or running away either before or after the loss events. It was concluded that the time of anticipated loss was the period of highest risk for these adolescents in terms of self-mutilative behavior.     

Referenzsemantik in der Partnermodellierung

How can we explain that an assertion on something perceived can be understood in the same manner by somebody who cannot perceive that scene? This problem bases the interest in computational linguistics in how listener modeling could possibly be harmonized with reference semantics. Mental images substituting real perception appear as a way out. The architecture of the listener model has to be adapted to the creation and use of such pictorial data structures. Furthermore, the relation between the latter and a verbal (i. e., propositional) representation must be understood. The resulting architecture of a listener model with reference semantics can be employed to solve communicational problems from three general classes in a better way, as is demonstrated by an example implementation.     

Stress and work performance: The role of trait anxiety

Employees high in Trait Anxiety (TA) were found to exert greater work effort than those low in TA, which resulted in better sales performance. There was no relation between TA and work efficiency, measured by sales performance relative to work effort. Employees high in TA also reported greater levels of stress and more adverse effects of work on non-work relationships. Using multiple regression, both stress and interference with relationships were found to be better predicted by TA than work effort. The results are discussed in terms of laboratory-based theories about relations between TA and efficiency and intervention strategies for managing stress at work.