Sensitizing Medical Residents to Fantasies and Alignments in the Family: Mastering Psychosocial Skills in the Medical Encounter

In this paper, it is proposed that a) psychosocial medicine is best taught in a setting that provides technical and emotional support, while seizing for teaching only those moments when the learner is most receptive; and b) that the setting should avoid the development of a separate psychosocial skills curriculum, but should take the student where he or she is and integrate the psychosocial skills into his or her everyday biomedical practice. The paper gives specific case examples in which family based psychosocial issues were preeminent in the clinical problem-solving medical residents faced.     

Parallel lives: Community psychology in Latin America and the United States

Comparing the history of community psychology as it developed in the U.S. during the 1960s with the community psychology that developed 10 years later in Latin America, one is reminded of the title of Plutarch’s masterpice,Parallel Lives. Although there was very little contact or communication between the first community psychologists in these regions, very similar principles and orientations evolved. These similarities are particularly striking given the many ways in which the U.S. and Latin American contexts and histories differ. Since most readers are expected to be familiar with the history of community psychology as it developed in the U.S., this paper focuses primarily on the development of community psychology in Latin America in order to highlight areas of convergence as well as divergence from the U.S. experience. This paper is based on an address presented at the Fourth Biennial Conference, Society for Community Research and Action, Division 27 of the American Psychological Association, William and Mary College, Williamsburg, Virginia, 1993. The author acknowledges the valuable help received from J. R. Newbrough and from the referees in the revision of this paper.     

MFT trainee adjustment to program lifestyle stress: The TAPS scale

The 30-item Trainee Adjustment to Program Stress (TAPS) scale was developed to measure lifestyle stress of family therapy trainees. Initially, 70 items were generated from propositional statements based on four constructs. Following pilot testing, 329 out of 900 (37%) student members of the American Association for Mariage and Family Therapy (AAMFT) returned TAPS questionnaires. Internal consistency reliability analyses and principal components and factor analyses produced a final 30 item TAPS scale appropriate for use in family therapy training programs. Reliability and validity measures are reported.     

The effects of situational performance constraints on intrinsic motivation and satisfaction: The role of perceived competence and self-determination

Situational performance constraints, task interest, and pay contingencies were manipulated in a laboratory study in order to investigate the cognitive mechanisms associated with the previously observed detrimental effects of constraints on affective task reactions. It was hypothesized that feelings of task competence and self-determination would account for both the direct and the interactive effects of constraints on motivation and satisfaction. The results of the study indicated that despite the fact that participants' performance was being constrained and they were aware of these constraints, the mere presence of the constraints alone failed to result in lower levels of satisfaction or motivation on a proofreading task. Post hoc analyses suggested that the constraints, in fact, led to negative affective task reactions when they also reduced participants' feelings of competence and self-determination. Interestingly, participants' generalized locus of control was associated with such effects. Internals tended to maintain stronger feelings of competence and self-determination than externals in the presence of constraints, thereby also maintaining greater motivation and satisfaction.     

The effects of feedback consistency and feedback favorability on self-perceived task competence and perceived feedback accuracy

The present study, employing a 2 × 2 true-experimental design and regression analyses assessed the main and interactive effects of feedback consistency (consistent vs inconsistent), and feedback favorability (acceptable vs superior), for feedback given at two time periods on measures of perceived feedback accuracy and self-perceived task competence. Among the study's findings were that (a) the perceived accuracy of feedback at the second period was a function of the favorability of feedback received at the first time period, (b) the self-perceived task competence levels of subjects were jointly determined by the favorability of feedback received at both time periods, and (c) the perceived accuracy of feedback was a function of its consistency. Organizational implications of the study's results are offered.     

Individualized behavior therapy for alcoholics: a third year independent double-blind follow-up.

An independently conducted double-blind study providing third year follow-up data for 53 of 70 male alcoholics who served as subjects in an experiment evaluating “Individualized Behavior Therapy (IBT)” techniques is reported. In the original study, subjects were initially assigned to either a controlled drinking or non-drinking (abstinence) treatment goal, and were then randomly assigned to either an experimental group receiving IBT or a control group receiving conventional state hospital treatment oriented towards abstinence. Previously reported results showed that IBT subjects functioned significantly better than control subjects throughout the first year of follow-up. Second year follow-up results found that IBT subjects treated with a controlled drinking goal functioned significantly better than their respective control subjects on a variety of measures, including drinking behavior. Differences between IBT subjects treated with a non-drinking goal and their control subjects did not retain statistical significance during the second year of follow-up. The independently determined follow-up data showed that during the third post-treatment year, subjects in the experimental groups generally functioned better than their respective control subjects. Comparison of the controlled drinking experimental group with its control group showed the significantly better functioning of subjects in the experimental condition on a number of drinking and other life functioning measures. Comparison of the non-drinking groups indicated only one possible difference on the drinking related measures involving a trend for subjects in the experimental condition to abstain more than those in the non-drinker control group. On other life functioning measures, however, subjects in the non-drinking experimental condition showed consistent improvement over their respective control subjects. Both of the controlled drinking groups reported more controlled drinking days than the non-drinking groups throughout the third year follow-up period.     

THE BEHAVIOR OBSERVATION INSTRUMENT: A METHOD OF DIRECT OBSERVATION FOR PROGRAM EVALUATION1

The background and development of a multicategory direct observation system, the Behavior Observation Instrument (BOI), is described. This time-sampling procedure for recording the behavior of persons is demonstrated in several treatment settings and the results applied to issues of program evaluation. Elements that have prevented direct observation from being widely adopted, such as costs, manpower, and training requirements, are systematically analyzed. A basic psychometric analysis of the instrument is used to determine optimum frequency and duration of observation intervals as well as observer agreement. The results imply that direct observation methods, once assumed by some to belong to the special province of the single-subject design, can be used to assess the effects of programs on groups of psychiatric clients in an efficient and economic manner.     

SEVERE CLASSROOM BEHAVIOR PROBLEMS: TEACHERS OR COUNSELLORS

This experiment was designed to determine the relative effectiveness of teacher and counselling approaches in the reduction of disruptive or inappropriate classroom behavior. Inappropriate classroom behavior frequencies of 12 academically low achieving, seventh-grade, black male students, with a reported high rate of inappropriate classroom behavior, were recorded. Three groups, with nearly equal mean inappropriate behaviors, were randomly assigned to one of three treatment conditions: behavioral counselling, client-centered counselling, or no counselling. Each counselling group received fifteen 30-minute counselling sessions, at a rate of two to three times a week. In addition to counselling, all students subsequently received teacher approval within the classroom. Results indicated that the teacher was able to reduce inappropriate behavior more than any counselling group. There were also indications that behavioral counselling, but not client-centered counselling, was moderately helpful in reducing inappropriate classroom behavior.