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.     

Verbal conditioning of stimulus significance in the orienting response context

The manipulation of stimulus significance, by instructions from the experimenter, may be taken as an example of verbal conditioning. Consideration of such a mechanism suggested that personality effects previously found in conditioning studies should be apparent in instructional manipulations of significance in a study of the orienting response (OR) to words. Because of recent changes in dimensioning of the personality structure, some of the items originally used to define Eysenck’s extraversion (E) dimension are now used to assess the new dimension of psychoticism (P), suggesting that at least some of the established effects of E upon conditioning may be associated now with P. Hence the P scale was focused on in this study. Words differing on the evaluative dimension of the semantic differential were presented in three blocks, the first under indifferent instructions, the second under instructions to rate the words for their affective impact, and the third under indifferent instructions again. These blocks correspond to baseline, conditioning, and extinction conditions respectively. Electrodermal activity indicated enhanced conditioning, together with greater carry-over effects in the extinction phase, for low-P compared with high-P subjects. The results indicate the importance of personality effects in studies of stimulus significance and illustrate the value of the verbal conditioning mechanism in this area of the OR field. They also suggest the need to re-examine previously obtained E-effects in conditioning studies in light of changing personality tests.     

Solving the rod-and-frame test in a tachistoscopic presentation: Effects of stimulus size and perceptual style

This research was undertaken to demonstrate, with correlational evidence, that presenting the rod-and-frame test (RIT) with either limited (tachistoscopic) or unlimited (Oltman’s, 1968, portable RFT) exposure time does not significantly affect the ranking of subjects. The underlying hypothesis is that the intersubject variability of performance on the portable RFT is due essentially to differences in sensitivity to the optostatic vection that appears automatically and almost immediately. Results of the tachistoscopic test show that the effect of angular size of the stimulus is similar to that described in the literature for unlimited time situations, and that subjects’ ranking is very similar regardless of the exposure time (W = .80). However, although a difference is observed between the means of low and high achievers in both types of RFT, intraindividual intertask homogeneity (correlation coefficient) is not verified in each of these subgroups. From these results, one can distinguish two processes in the RFT: the first, vections, has to do with the subject’s postural orientation and seems to playa great role in organizing interindividual differences. The second process, a more cognitive one, has a less striking effect and has to do with the selection of reference frames in perceptual organization.     

Neighborhood frequency effects and letter visibility in visual word recognition

Two experiments are described that measured lexical decision latencies and errors to five-letter French words with a single higher frequency orthographic neighbor and control words with no higher frequency neighbors. The higher frequency neighbor differed from the stimulus word by either the second letter (e.g.,astre-autre) or the fourth letter (chope-chose). Neighborhood frequency effects were found to interact with this factor, and significant interference was observed only tochope-type words. The effects of neighborhood frequency were also found to interact with the position of initial fixation in the stimulus word (either the second letter or the fourth letter). Interference was greatly reduced when the initial fixation was on the critical disambiguating letter (i.e., the letterp inchope). Moreover, word recognition was improved when subjects initially fixated the second letter relative to when they initially fixated the fourth letter of a five-letter word, but this second-letter advantage practically disappeared when the stimulus differed from a more frequent word by its fourth letter. The results are interpreted in terms of the interaction between visual and lexical factors in visual word recognition.     

Follow-up of a full-scale network assembly

The authors conducted two full-scale network assemblies for the family network of a suicidal adolescent. Findings from the clinical follow-up and telephone interviews with 21 of 65 participants revealed benefits for the index family and the network members who participated in the meetings. A ripple effect in which the participants' own personal networks improved was also demonstrated. Benefits included resolution of a suicidal crisis, better understanding of depression and family stress, more adaptive responses to depression and suicidal risk, and improved personal relationships. No casualties from this intervention were discovered. This report is intended to stimulate future, more systematic outcome studies.