Information giving and involvement in treatment decisions: Is more really better? Psychological effects and relation with adherence

Objectives : The aim of this study is to improve our understanding of the ways in which a medical consultation style relates to satisfaction and adherence.

Design : Participants completed questionnaires about preferred and perceived consultation styles; psychological variables such as satisfaction, anxiety and depression; and questions about taking medication. Questionnaires were completed prior to the consultation, immediately after, three months later and one year later. Doctors also completed a scale on completion of the consultation. The decisions in question related to women seeking advice about Hormone Replacement Therapy (HRT) and decisions about pain management.

Results : Patients expressed preferences for information about the treatment options and for active involvement in the decision process. The extent to which patients perceived themselves as having received information about the treatment options was a particularly consistent predictor of satisfaction. The extent to which patients perceived themselves as having been prepared for the side effects of HRT was a consistent predictor of anxiety.

Conclusions : Perceptions of the amount of information received about medical options, including information preparing individuals for potential side effects of medication, appears to be more important to satisfaction and anxiety, than actual involvement in the decision.     

Developments in child psychotherapy in Australia: an introduction

This article describes a type of intervention with parents that attempts to stimulate and encourage empathic imagination in relation to their child's difficult behaviour. Some barriers to this process are explored in the context of wider cultural influences, particularly as they pertain to the USA. Basic cultural assumptions about children, their emotional life and development, are contrasted to basic assumptions in British Object Relations Theory. Examples of parent consultations are offered and theoretical reference points are suggested.     

The efficacy of conjoint behavioral consultation on parents and children in the home setting: Results of a randomized controlled trial

The present study is a large-scale randomized trial testing the effects of a family–school partnership model (i.e., Conjoint Behavioral Consultation, CBC) for promoting behavioral competence and decreasing problem behaviors of children identified by their teachers as disruptive. CBC is a structured approach to problem-solving that involves consultants, parents, and teachers. The effects of CBC on family variables that are commonly associated with important outcomes among school-aged children (i.e., family involvement and parent competence in problem solving), as well as child outcomes at home, were evaluated. Participants were 207 children with disruptive behaviors from 91 classrooms in 21 schools in kindergarten through grade 3 and their parents and teachers. Results indicated that there were significantly different increases in home–school communication and parent competence in problem solving for participants in the CBC relative to control group. Likewise, compared to children in the control group, children in the CBC group showed significantly greater decreases in arguing, defiance, noncompliance, and tantrums. The degree of family risk moderated parents' competence in problem solving and children's total problem behaviors, teasing, and tantrums.     

Cognitions associated with initial medical consultations concerning recurrent breathing difficulties: A community-based study

Abstract

A two-stage community survey identified 568 respondents reporting recurrent breathing difficulties over a one-year period. Subsequent interviews allowed comparison of (i) 21 respondents who had never consulted a doctor about frequent wheezing (i.e., on more than 30 days) or serious breathing difficulties (i.e., disrupting everyday activities) over the past year with (ii) a randomly selected group of 22 who had seen their doctor concerning breathing difficulties in the past year. These groups were found to be similar with respect to demographic and lung function measures. An extended health belief model framework including causal attributions for breathing difficulties and consulting self-efficacy was used to explore cognitions which might distinguish between the two groups. Logistic regression suggested that lower perceived relative severity of symptoms (in relation to other problems). attribution of wheezing to smoking and lower self-efficacy in relation to explaining breathing difficulties to a doctor distinguished between those who did and did not consult. Health education implications. including initiatives to encourage medical help-seeking amongst those with recurrent, frequent or serious breathing difficulties are discussed.     

Enhancing Adherence to a Problem-Solving Model for Middle-School Pre-Referral Teams

Abstract

Performance feedback and checklists were used to improve the degree to which middle-school teams adhered to elements of systematic problem solving as described in the Instructional Consultation literature (Bartels & Mortenson, 2002; Rosenfield, 1987). Direct observations of problem-solving meetings were conducted to determine levels of adherence to a problem-solving methodology. Performance feedback was provided to each participating school psychologist after a period of no feedback and was followed by the provision of a checklist of problem-solving steps to all team members. Visual analysis of the data indicated variable improvements in systematic problem solving following presentation of feedback and checklists. Feedback and prompts, while necessary, may not be sufficient to ensure adequate adherence to problem solving.     

“现代性”视域下的社会心理服务——基于齐美尔的理论——

社会心理服务受到的广泛关注体现了现代生活中的心理需求。齐美尔的“现代性”哲学理论指出, 理智功能、客观文化取得优势地位、社会关系弱化是“现代性”心性结构的三个主要特征。心理健康服务接纳“感性”,关注个体的“完整性”和重视人与人之间的关系,能够帮助现代人避免被技术、商品、劳动淹没,从而缓解现代社会生活引发的焦虑。同时,心理健康服务又必然受到现代社会的影响,故其所展现出的“批判性”又是有限的。

     

Consultation in adolescence: Hurried,terminable, interminable1

The physiological ambivalence displayed by adolescents towards dependence on adults is an obstacle, at least initially, to a course of psychotherapy. A consultation is often the only thing that can be offered to start with, and constitutes an essential stage even for those teenagers who go on to prove themselves able to benefi t from therapy or analysis. The way this fi rst meeting is handled is therefore crucial. The author investigates the diffi culties and paradoxes of this consultation, the particular nature of the ‘time’ of the consultation compared to that of therapy, and the different internal attitude this requires of the analyst. She thus identifi es two separate confi gurations‐a hurried consultation and an interminable consultation‐which can result when the consultation fails in its primary objectives. Both are connected with possible collusive elements in the professional linked to specifi c adolescent angst. The very detailed account of a consultation shows the ‘journey’ made by a 14 year‐old starting from her urgent request to be freed from a symptom experienced as an incomprehensible obstacle, to her gradual development of curiosity towards herself and towards her own mental and emotional make‐up, resulting in her acceptance of therapeutic treatment, which would initially have been impossible.     

The Lawyer in the Dutch Interrogation Room: Influence on Police and Suspect

In many European countries, providing a suspect in custody with legal aid before the first police interrogation is a heavily debated issue. In this paper, we report on an exploratory study on the use of coercion by the police and the use of the right to silence by suspects in 70 Dutch homicide cases and their relation to prior consultation and presence of a lawyer. Analysis of the data indicates that there is a relation between the presence of a lawyer in the interrogation room and the way in which police interrogators use coercion. To gain insight into whether the police use coercion and how this is achieved, we looked at the extent to which the interrogators make use of certain interrogation techniques and how the interrogation techniques are used to exert coercion. We found that legal advice from a lawyer before and during the interrogation corresponds with suspects more often using their right to silence. It also appears that the police are inclined to use ‘hard coercion’ when confronted with a silent suspect. The research thus raises the question as to whether the presence of a lawyer is an adequate way to prevent false confessions. Copyright © 2012 John Wiley & Sons, Ltd.     

The Positive Plus Program: Affirmative classroom management to improve student behavior

This study describes the Positive Plus Program, a multicomponent intervention combining behavior‐specific praise with an interdependent group contingency and teacher feedback. An elementary school teacher wanting to improve her classroom management skills implemented the Positive Plus Program. Four second‐grade students participated in the study, and each of the students emitted disruptive behavior in class previously. This study, using an ABAB design, indicated that when the teacher reliably delivered high levels of behavior‐specific praise and awarded points, disruptive behavior was less likely. Student outcomes showed increased academic engagement and decreased off‐task motor and verbal behavior from pre‐ to post‐intervention. Teacher ratings indicated high levels of social validity. In light of these findings, implications for future research and implementation are discussed.     

Reflections of a reluctant clinical ethicist: Ethics consultation and the collapse of critical distance

The obvious appeal and growing momentum of clinical ethics in academic medical centers should not blind us to a potential danger: the collapse of critical distance. The very integration into the clinical milieu and the processes of clinical decision making, that clinical ethics claims as its greatest success, carries the seeds of a dilution of ethics' critical stance toward medicine and medical education. The purpose of this paper is to suggest how this might occur, and what potential contributions of ethics to medicine might be sacrificed as a result. Medical sociology will be used for comparison. Sociologists have found that they may function either as students and critics of established medical practices and educational philosophies, or as collaborative participants in them — but rarely both. It may be that professional ethics is most effective when it plays the role of stranger rather than insider, and is continually able to question the most basic assumptions and values of the enterprise with which it is associated. As with medical sociology, ethics and humanities must ask to what extent their desire for acceptance in the clinic requires their acceptance of the clinic: specifically, acceptance of basic assumptions about optimal ways of organizing medical education, socializing physicians-in-training, providing care, and even of defining medical ethics itself. The paper concludes by recommending that ethics reassert its strangeness in the medical milieu even as it assumes a more prominent role within the medical center.