Treating a Chronically Depressed Adolescent Female Using the Cognitive Behavioral Analysis System of Psychotherapy: A Case Study

A case is presented of an adolescent female with double depression who was treated using the Cognitive Behavioral Analysis System of Psychotherapy (CBASP). CBASP is designed to teach a social problem-solving procedure called Situational Analysis (SA). Generalized treatment effects were measured through monitoring of diagnostic status, two administrations of the Minnesota Multiphasic Personality Inventory-Adolescent, weekly administrations of the Child Depression Inventory, and acquisition performance ratings on the SA task. The results showed that CBASP appeared to be an effective treatment. The double depressive disorder remitted, and the patient learned to identify behavioral consequences as well as target and attain her interpersonal goals. CBASP can be effective for adolescents, although modifications of the adult form of the therapy may be necessary.     

Family Unification with Reactive Attachment Disorder Children: A Brief Treatment

This is a case study of a family with a child (age eight) with reactive attachment disorder and the subsequent individual and family therapy. Treatment of choice for the child was Eye Movement Desensitization and Reprocessing (EMDR) and supportive educational counseling for the parents and family. Qualitative evaluation of the process demonstrated that the parents observed an instant change in the child's attitude. The child reported that she felt better about family, school, and truthfulness, and stated about the therapy: It opened a window for me. A 12-month evaluation demonstrated continued positive effects.     

Ethical dilemmas in testing for late onset conditions: reactions to testing and perceived impact on other family members

This paper examines some of the ethical dilemmas that arise when testing for the late onset, untreatable condition of Huntington disease (HD) specifically now that technology allows us to test younger generations of the family for the mutant gene. Drawing on interview data from families with Huntington disease, the reactions to testing and perceived impact on other family members are considered. These are discussed in the light of the possible lowering of the age of test applicants. This potentially raises problems for a younger generation as they are confronted with reproductive decisions that the older generation did not have to face. It also means that individuals have the prospect of living with knowledge of a future illness for much longer.     

Fabry disease in genetic counseling practice: recommendations of the National Society of Genetic Counselors

The objective of this document is to provide health care professionals with recommendations for genetic counseling and testing of individuals with a suspected or confirmed diagnosis of Fabry disease, with a family history of Fabry disease, and those identified as female carriers of Fabry disease. These recommendations are the opinions of a multicenter working group of genetic counselors, medical geneticists, and other health professionals with expertise in Fabry disease counseling, as well as an individual with Fabry disease who is a founder of a Fabry disease patient advocacy group in the United States. The recommendations are U.S. Preventive Task Force Class III, and they are based on clinical experience, a review of pertinent English-language articles, and reports of expert committees. This document reviews the genetics of Fabry disease, the indications for genetic testing and interpretation of results, psychosocial considerations, and references for professional and patient resources. These recommendations should not be construed as dictating an exclusive course of management, nor does use of such recommendations guarantee a particular outcome. The professional judgment of a healthcare provider, familiar with the facts and circumstances of a specific case, will always supersede these recommendations.     

Beyond conflict of interest: the responsible conduct of research

This paper reports data and scholarly opinion that support the perception of systemic flaws in the management of scientific professions and the research enterprise; explores the responsibility that professional status places on the scientific professions, and elaborates the concept of the responsible conduct of research (RCR). Data are presented on research misconduct, availability of research guidelines, and perceived research quality. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland, 5–6 April, 2002. The opinions expressed herein are those of the author and do not necessarily represent the views of the Office of Research Integrity, the U.S. Department of Health and Human Services, or any other federal agency.     

Tyrannical omnipotence in the archetypal father

This paper sets the archetypal relationship between the tyrannical, devouring father and his sons in the context of a disjunction in the parental couple (syzygy) whereby the role of the maternal feminine is eclipsed and excluded. This is shown to originate in an omnipotent defence against infantile dependence on the mother. Successful liberation from the father's tyranny requires the restoration of mutuality between the internal couple. Although the main focus is on the internal world (and a detailed clinical illustration is given, showing the working out of this process in the analytical relationship), reference is also made to political tyranny, attitudes to the control of Nature by technological means and patriarchal forms of masculinity. The Chronos myth is amplified through the use of two modern variants in the films The Terminator and Star Wars.     

Family Processes and Treatment Outcome in the MTA: Negative/Ineffective Parenting Practices in Relation to Multimodal Treatment

To elucidate processes underlying therapeutic change in a large-scale randomized clinical trial, we examined whether alterations in self-reported parenting practices were associated with the effects of behavioral, medication, or combination treatments on teacher-reported outcomes (disruptive behavior, social skills, internalizing symptoms) in children with attention-deficit hyperactivity disorder (ADHD). Participants were 579 children with Combined-type ADHD, aged 7–9.9 years, in the Multimodal Treatment Study of Children with ADHD (MTA). We uncovered 2 second-order factors of parenting practices, entitled Positive Involvement and Negative/Ineffective Discipline. Although Positive Involvement was not associated with amelioration of the school-based outcome measures, reductions in Negative/Ineffective Discipline mediated improvement in children's social skills at school. For families showing the greatest reductions in Negative/Ineffective Discipline, effects of combined medication plus behavioral treatment were pronounced in relation to regular community care. Furthermore, only in combination treatment (and not in behavioral treatment alone) was decreased Negative/Ineffective Discipline associated with reduction in children's disruptive behavior at school. Here, children in families receiving combination treatment who showed the greatest reductions in Negative/Ineffective Discipline had teacher-reported disruptive behavior that was essentially normalized. Overall, the success of combination treatment for important school-related outcomes appears related to reductions in negative and ineffective parenting practices at home; we discuss problems in interpreting the temporal sequencing of such process-outcome linkages and the means by which multimodal treatment may be mediated by psychosocial processes related to parenting.     

More than the Terrible Twos: The Nature and Severity of Behavior Problems in Clinic-Referred Preschool Children

The primary goals of this study are to describe the nature and severity of disruptive behavior problems in clinic-referred preschoolers from low-income environments and to explore the validity of DSM-IV disruptive disorders for young children. We examine the relation between DSM-IV symptoms, standardized behavior checklists, and observational ratings as a means of exploring measurement validity in this age group. Seventy-nine clinic-referred preschoolers (ages 2 through 5 years) from low-income environments were assessed. To examine whether clinic-referred preschool children have symptoms that are consistent with DSM-IV disruptive behavior disorders, parents were administered a semistructured diagnostic interview, modified for developmentally appropriate usage. In addition, parents completed the Child Behavior Checklist (CBCL) and children's behavior problems were assessed with observational ratings during parent–child interaction. Nearly half of the sample met criteria for conduct disorder, and three quarters met criteria for oppositional defiant disorder. Preliminary evidence for the validity of DSM-IV disruptive disorders in preschool children was demonstrated through association with CBCL scores, behavior ratings, and significant levels of impairment. Future efforts aimed at validating these diagnoses in preschoolers and implications for prevention are discussed.     

Perception of genetic risk among genetic counselors

A mailed survey of female prenatal genetic counselors, obstetric nurses, and high school biology teachers was conducted to determine if these groups hold different attitudes toward genetic risk and to investigate the extent to which any differences result from the effect of different professional experiences. In this study, the participants were 166 genetic counselors, 116 obstetric nurses, and 78 biology teachers (n = 360). Survey participants completed a written questionnaire designed to assess their numeric estimate of the empiric risk for birth defects/genetic problems, their subjective perception of this risk, and their personal use of prenatal diagnosis. Genetic counselors were found to be less likely than the other groups to consider the frequency of birth defects/genetic problems as rare and were 10 times more likely than nurses and 8 times more likely than teachers to have had prenatal diagnosis. Furthermore, more than half of the prenatal diagnosis procedures had by genetic counselors were not medically indicated. These results suggest that genetic counselors have an increased perception of genetic risks relative to nurses or teachers. Possible explanations for this finding are discussed, and the potential role of discordant risk perception in creating biases in the genetic counseling process is explored.