Building and Maintaining Clinical Programs

This paper describes the basic elements of practice development and management within the academic medical setting. These include assessment of the market environment, both in the community and within the medical setting, product development, marketing, budget basics, quality, managed care negotiations, and finding time to do research in a financially-driven health care system.     

Termination of Mental Health Services for Children

In this paper, we examine the termination of children's mental health services. Analyses were based on the 901 families in the Fort Bragg Evaluation Project who participated at Wave 1 and Wave 2 six months later. The project compared a full continuum of care provided at a demonstration site with traditional care at two comparison sites. The results showed that in most cases families and providers were partners in decisions to terminate treatment. About half of the clients self-terminated or were terminated solely at the discretion of the provider. Providers tended to play a more dominant role in terminating restrictive services; families played a more central role in terminating outpatient care. Regardless of initial psychopathology, children in single-headed households, whose parents were dissatisfied with services, did not expect their child to cooperate with treatment and did not expect treatment to help their child, were more likely to terminate care than others. While the Demonstration site had significantly fewer terminations, the sites did not differ with regard to the reasons for termination, who participated in termination decisions, or the factors that affected the likelihood to terminate care. Of most interest, mental health outcomes among children who had terminated all care did not vary by reasons for termination or by who participated in the termination decision.     

The Future of Psychology in Departments of Psychiatry

Health care reform has put increasing pressure on faculty of medical schools to become self-supporting. Opportunities for clinical revenue will decrease, but psychologists who are able to generate research funding will become increasingly competitive, albeit as mercenaries, i.e., capable of paying their own way plus generating a profit to support departmental operations and educational programs. Changes in the health care system signal an end to psychiatry's paternalistic relationship to psychology and present opportunities for psychology proactively to influence its future role in health care. Research, political action, and revised scientific mission, models, and roles represent important strategies in the redefining of psychology as a basic science and major profession in health care.     

Flexibility of Labor, Well-Being, and Stress

After a short introduction into the changing nature of our society and organizations, we outline two kinds of flexibility of labor: qualitative flexibility, that is the degree to which people who work in or for a certain organization can and do perform different tasks, and quantitative flexibility, that is, varying the quantity of personnel and their working hours. Then, the different ways in which we organize our work and organizations are dealt with in terms of quantitative and qualitative flexibility. Next, we survey these ways of organizing on the degree to which they moderate the positive individual outcomes, or individual goals, of work. It can be concluded that quantitatively flexible work, besides some minor positive consequences, may have serious negative consequences for one's well-being, health, and personal development, while qualitative flexibility may have many more advantages, though it may lead to a devastating task overload. Last, we explore some ways to alleviate these negative effects.     

The use of the occupational stress indicator (OSI) in factory workers in China

The purpose of the study was to investigate occupational stress among Chinese factory workers (N=342), from three cities of South East China, using the shortened version of the Occupational Stress Indicator (OSI)-2. The results showed that the reliabilities and predictive validity of the OSI-2 subscales and other subscales used for the study were reasonably high. Quite a high percentage of workers perceived high work pressure. The main sources of stress were intrinsic to the job; and the coping strategies that were most frequently used to tackle stress were “control” methods. In addition, “satisfaction on environmental condition” seemed to be a common predictor for job satisfaction, and mental and physical well-being. The logical relationships between job satisfaction, mental well-being and physical well-being in Chinese workers have provided support to the findings obtained in Western countries.     

On the dynamics of dying

This study is concerned with dynamic processes that underly the rapid, degenerative changes associated with the “dying” stage of the multicellular organism's life cycle. The interaction between negative and positive feedback cycles is discussed: negative feedback cycles underly the superstability characteristic of health and illness. When negative feedback cycles fade in the dying phase of life, positive feedback cycles, previously held in check by the negative feedback cycles to which they had been coupled, rise explosively, driving physiologic variables from their normal values towards extremes. This results in the rapid downturn that we associate with dying—an accelerating disintegration terminating in death. A medical case history is analyzed.     

Latinas with Arthritis: Effects of Illness, Role Identity, and Competence on Psychological Well-Being

Tested a theoretical model on the effects of social role identity, illness intrusion, and competence on psychological well-being among 109 low-income Latinas with arthritis. All six roles studied were rated as highly important identities. Sex-role nontraditionalism was associated with less importance of the homemaker, mother, and grandmother roles. Negative affect increased as a function of intrusions into valued identities. Having important role identities contributed to feelings of competence (i.e., self-esteem and self-efficacy), which in turn, contributed to psychological well-being. Competence also mediated the effects of pain, identity, and illness intrusions on psychological well-being. Results suggest competence processes play an important role in well-being.     

Self as the feminine principle

In analytical psychology, ego is associated with consciousness and the masculine principle. Although die feminine principle generally characterizes the unconscious, it was not assigned a psychic structure equivalent to the ego. This paper proposes a model of the psyche where self and ego are the major modes of psychic experience. The self as the 'being' mode represents the feminine principle and functions according to primary process; the ego represents 'doing', the masculine principle and secondary process. Feminine and masculine principles are considered to be of equal significance in both men and women and are not limited to gender.
Jung's concept of the self is related to the Hindu metaphysical concepts of Atman and Brahman, whose source was the older Aryan nature-oriented, pagan religion. The prominence of self in analytical psychology and its predominantly 'feminine' symbolism can be understood as Jung's reaction to the psychoanalytic emphasis on ego and to Freud's 'patriarchal' orientation. In Kabbalah, a similar development took place when the feminine principle of the Shekinah emerged in a central, redemptive role, as a mythic compensation to the overtly patriarchal Judaic religion.
In the proposed model of the psyche neither ego nor self represents the psychic totality. The interplay of both psychic modes/principles constitutes the psyche and the individuation process.     

Cultural orientation and psychological well-being in Chinese Americans

Examined cultural orientation in the domains of language proficiency, cultural activity, and social relationship, and its relationship with psychological well-being in a group of 143 Chinese Americans in San Francisco. Four indicators of psychological well-being were utilized, two assessing the experience of distress (depression level and negative affect) and two assessing positive well-being (positive affect and life satisfaction). Domain-specific cultural orientations were found to hold differential relationships with psychological well-being. For instance, bicultural activity orientation predicted the best psychological well-being (regardless as to how it was assessed), but socially separatist individuals experienced less negative affect than assimilated and bicultural respondents. Findings were discussed in the context of the multicultural setting of San Francisco. It is suggested that future research retain separate assessments of domain-specific cultural orientation, examine the contribution of the community's ethnic/cultural composition to its members' cultural orientations (i.e., address the role of person-environment fit) and study their impact on psychological well-being. The data reported here were collected as part of the author's doctoral dissertation. Ricardo F. Munoz and Guillermo Bernal guided and supported the implementation of this study; Sunwoo Lee assisted with the data analysis; and Edison J. Trickett and the anonymous reviewers offered helpful suggestions.     

Primary health care for women: What is it and who provides it?

Recent federal policy has highlighted historically underrecognized women's health issues. Women comprise the majority of the population, especially the elderly. Women's health care needs, utilization patterns, and outcomes vary from those of men, and often among each other. Primary health care services for women are multidisciplinary and emphasize prevention, education, and early intervention as well as treatment. Psychologists and other primary health care providers can collaborate to provide their services in a cost-effective manner that optimizes quality of care and comprehensive health care.