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.     

An Ecological Approach to Enhancing Parenting Skills in Family Therapy

To increase the effectiveness of parent education interventions, family therapists can address those factors that shape the way in which parents interact with their children. This article presents ecological theory as a framework that can help clinicians expand the range of their parent training efforts. In order to assess the utility of ecological theory for clinical practice, the present study empirically explored the ways in which selected characteristics of parents, children, and the family context related to mothers' parenting behavior. Specific recommendations for family therapists who employ parent training techniques are offered.     

AUGMENTING SIMPLIFIED HABIT REVERSAL WITH AN AWARENESS ENHANCEMENT DEVICE: PRELIMINARY FINDINGS

The chronic hair pulling of a 36-year-old woman with moderate mental retardation was initially treated with a simplified habit-reversal (SHR) procedure that consisted of awareness training, competing response training, and social support. When SHR did not produce large and sustained reductions in hair pulling, an awareness enhancement device was added, and it reduced hair pulling to near-zero levels in two settings. The results are discussed, and directions for future research with this device are provided.     

Understanding environments: The key to improving social processes and program outcomes

The contributions to this Special Issue illustrate research on several important types of environmental units, including psychiatric and substance abuse treatment programs, neighborhood block groups, and entire communities. They also exemplify alternative methodologies, such as assessing environments by relying on participants' appraisals, external observers' ratings, historical archives, and direct observation. I draw on these contributions and some of my own work to discuss four recurrent issues: (a) how to conceptualize environmental domains and dimensions; (b) how to understand environmental dynamics, that is, the interplay of environmental factors both within one setting and across settings; (c) how to comprehend the processes that link environmental factors to outcomes, especially with respect to the power and evanescence of environmental influence; and (d) how to use information about environments to monitor and improve them. Increased knowledge in these four areas is essential to help fulfill a major aim of community psychology: to understand social processes and improve intervention program outcomes.     

Boundary regulation in family and personal systems: Perceptions of late adolescents

Examination of boundary regulation can provide family therapists with a framework to describe both the functioning of family systems and personal systems (i.e., the intrapsychic functioning of individual family members). In the present study, late adolescents' perceptions of boundary regulation within their family systems (i.e., ratings of family health, communication, leadership, expressiveness, cohesion, and family conflict) were related to regulation of their personal boundaries (i.e., self-reported personal competence, distress, and patterns of defense mechanism use). In addition, personal system variables reliably discriminated between adolescents who described their families as psychologically healthy versus psychologically unhealthy.     

A case study of conflicting interests: Flemish engineers involved in environmental impact assessment

This article reports of the activities of the working group, Ethics & Engineers, of the Royal Flemish Society of Engineers. More particularly, the ethical problems that engineers face in the preparation of an environmental report are illuminated. Irrespective to which party the engineer belongs, he or she is confronted with the difficult weighting of his or her personal interest, the interests of private companies and last but not least the common good. It is argued that the implementation of a code of ethics and the introduction of courses on engineering ethics into the education of engineers would strengthen the engineer in the fulfilment of his vocation. Dirk Holemans is a bio-engineer preparing a doctoral thesis on the social responsibility of engineers, Herman Lodewyckx teaches ethics and has research interests in professional and applied ethics.     

Conversational skill and locus of perception

The present study attempted to identify behavioral skills associated with global perceptions of communication competence and to determine if the relationship between competence and skills varies as a function of perceptual locus. Fifteen dyadic conversations were videotaped. Each interactant rated self and partner and was rated by four observers who viewed each tape. Results indicated that subjects' perceptions of their partners' skills accounted for 87% of the variance in subjects' ratings of partners' competence and 80% of the variance in subjects'self-perceived confirmation. Observers' ratings of subjects' skills predicted 83% of the variance in observers' ratings of subjects' competence. Observers'ratings of subjects'skills were unrelated to subjects' self-rated competence.     

The Heterosocial Assessment Inventory for Women: A psychometric and behavioral evaluation

This paper presents a preliminary psychometric and behavioral evaluation of the Heterosocial Assessment Inventory for Women (HAI-W), a novel self-report instrument that evaluates five dimensions that may influence performance in 12 heterosocial situations: likelihood of initiation, anxiety, skillfulness, expectation of outcome, and influence of attractiveness. Study I obtained acceptable reliability and concurrent validity data and described the factor structure of the HAI-W with female college students. Study II found a significant relationship between the HAI-W factors and global ratings of the role-play performances of high- and low-heterosocially competent female college students as rendered by the male confederate, peer judges, and expert judges. The implications of these findings for the multidimensional assessment and facilitation of heterosocial competence are discussed.This study is part of a dissertation submitted to the Department of Psychology, Georgia State University, under the direction of Michael A. Milan. Portions of these data were presented at the Annual Meeting of the Association for Advancement of Behavior Therapy, Los Angeles, 1982.     

Sexual responding of “nonrapists” to aggressive sexual themes: Normative data

The present study presents data relevant to the sexual responding to aggressive cues of a large sample of nonrapist males recruited from the community. Two hundred three subjects received physiological assessment of sexual arousal to heterosexual and rape stimuli. Results indicated that under instructions not to interfere with sexual responding, approximately 80% of the nonrapists would be correctly classified, which was significantly different from chance. However, under instructions to suppress arousal, classification was no better than chance. The rape index was not related to age, socioeconomic status, sexual experience, or amount of arousal shown in the laboratory. However, there was a small but significant relationship to IQ. Overall, the data suggest that for instructions not to interfere with responding, the error rate seen in this larger-scale sample was equivalent to that in previous studies using smaller normative samples and that classification in general is not biased by the subject characteristics measured in this study.Portions of this project were supported by USPHS Grant MH-34030-02 from the Center for the Studies of Crime and Delinquency and by Tennessee Department of Mental Health and Mental Retardation Research Contract ID-0783 to the Department of Psychiatry.     

The pain behavior scale: Modification and validation for outpatient use

The present study investigated the validity of an inpatient pain behavior rating scale modified for outpatient use. A series of 43 consecutive outpatients referred for evaluation of chronic pain was examined using the Pain Behavior Scale (PBS) and other psychometric instruments. Analyses revealed significantly higher Pain Behavior Scale scores for low back and multiple pain-site groups. The results also indicated a high degree of internal consistency of the scale. A multiple regression analysis, predicting observed pain behavior from reported pain behavior, indicated that decreased activity accounted for 32% of the variance in the PBS score. A similar regression for pain experience found that the pain level and the sensory scale score on the McGill Pain Questionnaire accounted for 39% of the PBS variance. Psychological characteristics including disease conviction, self-control, depression, and anxiety explained 45% of the variability in the PBS score. Thus, the scale is related to pain intensity, interference with activities, and a variety of psychological characteristics. The scale provides a measure of observable pain behavior that is also relatively independent of these clinical data sources. The Pain Behavior Scale as modified for outpatient use provides a brief index of pain behavior with potential use in the comprehensive evaluation of the pain patient.