Ethical Considerations of Multiple Roles in Forensic Services

Attorneys increasingly rely on the services of mental health practitioners. Although some practitioners lack training, the promise of professional rewards lead some to accept opportunities with resulting ethical quandaries. Due to significant differences between the objectives of traditional mental health services and expert testimony, problems occur when clinicians venture into forensic services. Attorneys and judges, unfamiliar with mental health specialties, may seek to press a mental health practitioner into multiple roles. Although not all multiple roles are ethically inappropriate, caution demands careful parsing of particular roles: (a) academic/behavioral science expert; (b) fact witness as a treating therapist; (c) expert witness based on a clinically oriented assessment; (d) pretrial and/or trial consultant; and (e) professional critic of other experts. Possible ethical issues and risks associated with accepting multiple roles are identified and strategies for avoiding or minimizing harm or exploitation are discussed.     

Developing the Sense of Agency Rating Scale (SOARS): An empirical measure of agency disruption in hypnosis

Two experiments report on the construction of the Sense of Agency Rating Scale (SOARS), a new measure for quantifying alterations to agency. In Experiment 1, 370 participants completed a preliminary version of the scale following hypnosis. Factor analysis revealed two underlying factors: Involuntariness and Effortlessness. In Experiment 2, this two factor structure was confirmed in a sample of 113 low, medium and high hypnotisable participants. The two factors, Involuntariness and Effortlessness, correlated significantly with hypnotisability and pass rates for ideomotor, challenge and cognitive items. Twelve week test–retest correlations showed that Involuntariness was highly stable, but Effortlessness only moderately stable. Analysis of the combined datasets from Experiments 1 and 2 showed both SOARS scores were significantly related to the derived factors of Woody, Barnier, and McConkey’s (2005) 4-factor model of hypnotisability. This scale clarifies conceptual confusion around agentive action and provides empirical support for a multifactorial account of sense of agency.     

Reviews

Abstract

The sixth annual banff conference on behavior modification looks at families: Perspectives, polemics, and promises, Cole Barton, James F. Alexander

Behavior Modification and Families. Mash, E.J., Hammerlynck, L.A., and Handy, L.C. (Eds.), New York: Brunner/Mazel Publishers, 1976, $13.50, 362 pages.

Behavior Modification Approaches to Parenting. Mash, E.J. Hammerlynck, L.A., and Handy, L.C. (Eds.), New York: Brunner/Mazel Publishers, 1976, $13.50, 254 pages.

The abusing family, Blair, Rita Justice, William Friedrich, Human Sciences Press, 1976, $14.95, 288 pages     

Clinical strategies to promote compliance

Abstract

This article focuses on the need for effective client management throughout the therapeutic process. The appropriate and astute use of clinical strategies can promote client compliance with treatment and counteract the possibility of client dissatisfactions and ethical/legal complaints. This article offers a systemic explanation of compliance, identifies five major clinical strategies to foster treatment adherence, and discusses the need for clinical judgments that fulfill ethical/legal obligations while promoting quality care.     

Treatment of obsessions: A randomized controlled trial

This study tested Rachman's cognitive behavioral method for treating obsessions not accompanied by prominent overt compulsions. The cognitive behavioral treatment was compared to waitlist control and an active and credible comparison of stress management training (SMT). Of the 73 adults who were randomized, 67 completed treatment, and 58 were available for one-year follow-up. The active treatments, compared to waitlist, resulted in substantially lower YBOCS scores, OCD-related cognitions and depression as well as improved social functioning. Overall, CBT and SMT showed large and similar reductions in symptoms. Pre-post effect sizes on YBOCS Obsessions for CBT and SMT completers was d = 2.34 and 1.90, respectively. Although CBT showed small advantages over SMT on some symptom measures immediately after treatment, these differences were no longer apparent in the follow-up period. CBT resulted in larger changes on most OCD-related cognitions compared to SMT. The cognitive changes were stable at 12 months follow-up, but the differences in the cognitive measures faded. The robust and enduring effects of both treatments contradict the long-standing belief that obsessions are resistant to treatment.     

Black women in the emerging services economy

In the current debate about low-wage work and poverty, little attention has been paid to causes of basic structural change in the economy with the shift from a manufacturing to a services economy. Black women, a key segment of the low-wage work force, have gained and lost in this change. As the lowest paid, lowest status work force in the economy, black women benefited by a move out of domestic services employment where they had been restricted for more than a century. But static wages, high rates of part-time work, and a continuing overconcentration in new but marginal services job systems have created a crisis for personal income and black family support. The growing feminization of poverty is the product of growth of a subculture of low-wage work. Only through serious attention to the use of collective bargaining and equal opportunity regulation on behalf of this work force are these trends likely to be reversed in the 1990s.Support for this research was provided by grants from the NAACP Legal Defense and Educational Fund, the William Monroe Trotter Institute, The Ford Foundation, and the Woman's Bureau of the U.S. Department of Labor.     

Influence of maternal depression on children's brooding rumination: Moderation by CRHR1 TAT haplotype

There is growing evidence that brooding rumination plays a key role in the intergenerational transmission of major depressive disorder (MDD) and may be an endophenotype for depression risk. However, less is known about the mechanisms underlying this role. Therefore, the goal of the current study was to examine levels of brooding in children of mothers with a history of MDD (n = 129) compared to children of never depressed mothers (n = 126) and to determine whether the variation in a gene known to influence hypothalamic-pituitary-adrenal axis functioning—corticotropin-releasing hormone receptor 1 (CRHR1) —would moderate the link between maternal MDD and children's levels of brooding. We predicted children of mothers with a history of MDD would exhibit higher levels of brooding than children of mothers with no lifetime depression history but that this link would be stronger among children carrying no copies of the protective CRHR1 TAT haplotype. Our results supported these hypotheses and suggest that the development of brooding among children of depressed mothers, particularly children without the protective CRHR1 haplotype, may serve as an important mechanism of risk for the intergenerational transmission of depression.