TRAINING AND GENERALIZATION OF SEXUAL ABUSE PREVENTION SKILLS FOR WOMEN WITH MENTAL RETARDATION

Previous research has shown that behavioral skills training to teach sexual abuse prevention skills to women with mental retardation results in skill acquisition but poor generalization. In this investigation we evaluated procedures for enhancing generalization following training. Five women with mental retardation received 10 behavioral skills training sessions followed by in situ training when the skills did not fully generalize. Behavioral skills training resulted in skill acquisition and in situ training produced generalized responding during naturalistic assessments.     

The multiple self: working with dissociation and trauma

This paper describes a patient who appears to have a chronic dissociative personality disorder. Renewed clinical interest in dissociative disorders had arisen in North America in the 1980s, in part due to the influence of the Women's Movement which had highlighted the incidence of child sexual abuse. The early psychological observations of Janet, Freud and Jung on hysterical patients who displayed dissociative phenomena were similar to those displayed by the patient. consideration is given to theoretical understanding of the condition, taking into account the views of the earlier theorists and object-relations theory. The possibility of trauma, in particular childhood sexual abuse, as a causative factor in dissociative disorders is discussed.     

Differences in Parental Investment Contribute to Important Differences Between Men and Women

Parental investment theory addresses sex differences that result from the trade-off between parenting effort and mating effort. For example, relative to men, women spend more time caring for offspring, are more selective in assenting to sexual intercourse, are more upset by a partner's emotional infidelity than by a partner's sexual infidelity, and are better able to inhibit their behaviors in certain situations. These and other sex differences are attributable to evolved mechanisms that work in interaction with the physical and social environments.     

Risk of sexual revictimization: A theoretical model

Survivors of child sexual abuse suffer serious short- and long-term psychological consequences. Sexual revictimization as an adult is one of the consequences that has been reported. At present, there is no theoretical model identifying the risk factors that result in child sexual abuse survivors being at greater risk of experiencing an adult sexual assault. The proposed model is designed to integrate existing research, stimulate further empirical work, and eventually aid in the development of a program to prevent revictimization. The variables hypothesized to play a mediating role in the pathway to revictimization include: severe psychological symptoms as a consequence of the child sexual abuse, poor coping styles, an insecure attachment style, hyperfemininity, delinquent behavior, drug use, and high risk sexual behavior.     

Making Decisions About Life-Sustaining Medical Treatment in Patients With Dementia

The problem of decision-making capacity in patients with dementia, such as those with early stage Alzheimer's, can be vexing, especially when these patients refuse life-sustaining medical treatments. However, these patients should not be presumed to lack decision-making capacity. Instead, an analysis of the patient's decision-making capacity should be made. Patients who have some degree of decision-making capacity may be able to make a choice about life-sustaining medical treatment and may, in many cases, choose to forgo treatment.     

Evaluation of a sexual abuse prevention program for adults with mental retardation.

Programs to teach sexual abuse prevention skills to persons with mental retardation have rarely been evaluated empirically, and typical evaluations are limited to assessment of the participants' knowledge rather than their performance of specific skills. In the present study, 6 adult women with mental retardation were trained in sexual abuse prevention, and performance was assessed using four separate measures: pretests and posttests of knowledge, verbal report, role play, and naturalistic probes. All women learned the skills but failed to exhibit them to criterion during the probes. We discuss the implications for further training and assessment of sexual abuse prevention skills.     

What comes out of the consulting-room? The reporting of clinical material

The author addresses the difficulties inherent in reporting clinical material. These fall into two main categories, the ethical problem of upholding confidentiality, and the technical problems which include the definition of analytical data, and the numerous ways in which truth can be distorted in the analytic context. It is advocated that consent be obtained from patients before publishing their material. It is also suggested that clinical reports should contain enough detail of the analytic interaction, including the analyst's thoughts and feelings, to convey the analytic process, and to enable the listener/reader to consider the evidence for himself and to draw his own conclusions. It is concluded that an analyst's anxiety about exposing a patient might obscure an anxiety about exposing himself.     

Timing of HIV Interventions on Reductions in Sexual Risk Among Adolescents

Examined the effectiveness of an HIV intervention program among 151 adolescents ages 13 to 24 years who were randomly assigned to (a) seven sessions of 1.5 hr each (10.5 hr); (b) three sessions of 3.5 hr each (10.5 hr); or (c) a no-intervention condition. Using cognitive-behavioral intervention strategies, social skills and HIV-related beliefs, perceptions, and norms were targeted in both the three- and seven-session, small-group intervention conditions. Regression analysis indicated that over 3 months, the number of unprotected risk acts and the number of sexual partners were lower in the seven-session condition compared to the other conditions. Factors mediating risk acts changed in a complex manner: For example, perceived vulnerability increased for those with initially lower vulnerability scores among youths in the seven-session condition compared to others. Self-approval of condom use was also higher for those with initially low scores in the seven-session compared to the three-session condition. Self-efficacy for risk avoidance and condom use was significantly higher in the three-session condition for those with initially low scores compared to other groups. On the role-play measure, those with higher baseline scores in the low-pressure situation improved significantly only in the three-session intervention; in the high-pressure situation, the participants reported significantly higher scores in the seven-session intervention, and those with higher scores improved the most. Results suggest the importance of multisession HIV intervention programs to be delivered with fidelity in community settings.     

Association Between Employment and Sexual Risk-Taking Behaviors Among Public High School Adolescents

We examined the relationship between adolescent after school and weekend employment and sexual intercourse behavior in a cross-sectional sample of public high school students in South Carolina. The CDC Youth Risk Behavior Survey was used to secure usable data from 4,800 subjects. Thirty-nine percent of the sample worked at a job for pay during the academic year of the study. The majority of all race/gender groups reported having sexual intercourse in their lifetime and during the past 3 months prior, with the exception of Caucasian females. For Caucasian males employment ranging from 1-5 to 31+ hours per week was associated with sexual risk-taking. Caucasian female employment was associated with sexual risk-taking at 16-20 and 21-25 hours of work per week. For African American males, the relationship between employment and sexual risk-taking was evidenced at the 1-5 and 26-30 hours of work per week levels. Similar trends were determined for Caucasians (males and females) regarding sexual intercourse in the past 3 months prior and working for pay during the academic year. Youth working above 10 hours per week during high school may have an increased risk for unintended pregnancy and sexually transmitted infections, including HIV.     

A six-month follow-up of adolescents' sexual risk-taking,HIV/AIDS knowledge,and attitudes to condoms

A follow-up study was conducted to investigate change in sexual behaviour, knowledge about HIV/AIDS transmission, and attitudes to condoms over a 6-month period in a sample of late-adolescent students. The study also obtained subjective reports of HIV/AIDS-relevant change. Overall there was a decrease in sexual risk-taking behaviour with casual partners but no change occurred in sexual behaviour with regular partners, knowledge about HIV/AIDS, attitude towards condoms, or intention to use a condom on next sexual encounter. Examination of individual data revealed that, for some adolescents where behavioural change had occurred, this was in the direction of less safe sex. There were few self-reports of change in sexual behaviour, intention to take precautions against HIV/AIDS, or concern about HIV/AIDS over the preceding 6 months. Subjective reports of behaviour change did not correspond with reports of actual behaviour. Low rates of behaviour change are attributed to the failure of adolescents to personalize the threat of AIDS and to their trust in the safety of sex with a regular partner as well as to the lack of relevance of HIV/AIDS education campaigns to this group.