FACTORS THAT INFLUENCE DEPRESSIVE SYMPTOMS IN MOTHERS OF INFANT

This study explored the association between interpersonal factors and depressive symptoms in first-time mothers over the first two years of parenthood. An interpersonal style characterized by dependency, recollections of rejection in childhood, and current relationship characteristics was assessed in a nonclinical sample of 133 women. The final model explained 52% of the variance in depressive symptoms at 24 months. Controlling for initial symptom levels, interpersonal variables explained 24% of the outcome variance. The findings suggest that two interpersonal attributes, peer rejection in childhood and a dependent interpersonal style, are particularly important to our understanding of depressive symptomatology.     

The Heart of the Matter: An Essay about the Effects of Managed Care on Family Therapy with Children*

This essay is based on a pilot study that examined the effects of managed care on the treatment of children and families, with special attention to community mental health. We embarked on the pilot study to test the accuracy and generalizability of our impression that family therapy and other systemic practices have been marginalized in ordinary clinics and agencies, and to understand the reasons why. We interviewed managed care providers, researchers, family therapy trainers, and clinicians in the Northeast. Our findings led to seven themes that support our impression that, even though there is a consensus about the need for coordinated family-based services, there is a disconnection between state policies, contractual requirements and what is actually occurring at the implementation level. This study suggests that our knowledge of human systems may be in danger of being disqualified and lost, with damaging consequences for the care of children. Yet, as systemic thinkers and practitioners, it is our belief that ethical and effective treatment need not be at odds with care that is cost-efficient. The direction of our future research will be to study whether the involvement of all stakeholders at all levels of planning and training leads to systemic family-based practices that consistently save costs and provide high-quality care.     

The MMPI and clinical diagnosis: a comparison of classification system outcomes with discharge diagnoses

This study examined the agreement or congruence rate between clinical-discharge diagnoses rendered by a psychiatrist, and admission and discharge MMPI-derived diagnoses from four diagnostic classification systems that have been developed for the MMPI. The four classification systems included a simple high-point code based on the most elevated clinical scale in the profile, the Henrichs revision of the Meehl-Dahlstrom rules, the Goldberg equations, and a system developed by Lachar. Subjects consisted of 150 patients selected from a larger pool of patients who had completed a 9-week adult residential treatment program. Overall, this study yielded modest hit rates between 26% and 34% for MMPI-derived diagnoses and psychiatric diagnoses across the various classification systems. In addition, stability of MMPI-based diagnoses from admission to discharge assessments ranged from 48% to 51% depending on the classification system employed. Findings are discussed in terms of their implications for the use of the MMPI in patient diagnosis. It is recommended that the MMPI be used in conjunction with other sources of clinical and test information in deriving clinical diagnoses.     

A COMPARISON OF PEER-DIRECTED AND TEACHER-DIRECTED EMPLOYMENT INTERVIEW TRAINING FOR MENTALLY RETARDED ADULTS

Interview skills deficits may limit employment prospects of mentally retarded adults. Although numerous papers highlight the importance of interview skills, few have validated effective strategies for use with mentally retarded persons. Further, there has been a lack of research contrasting rival interview skills training strategies. The present study was conducted with two mentally retarded young adults. It contrasted peer-directed instruction, in which both participants were equally deficient in the target skills, with teacher-directed instruction. Results of the investigation indicated that instruction, rehearsal, and feedback may be effective strategies regardless of who provides instruction. Comparisons of teacher-directed and peer-directed instruction indicated little or no difference in the effectiveness of the two procedures. However, the peer-directed procedure involved considerably less staff time than did the teacher-directed procedure.