Commentary: Writing About Clients: Ethical and Professional Issues in Clinical Case Reports

From the standpoint of a former journal editor and long‐time professional, this commentary challenges the direction of the profession as demonstrated in this special section. The ongoing creation of more and more ethical constraints not only harms the profession but also loses sight of fundamental ethical principles.     

Self-Knowledge of Personality: Do People Know Themselves?

The intuition that we have privileged and unrestricted access to ourselves – that we inevitably know who we are, how we feel, what we do, and what we think – is very compelling. Here, we review three types of evidence about the accuracy of self-perceptions of personality and conclude that the glass is neither full nor empty. First, studies comparing self-perceptions of personality to objective criteria suggest that self-perceptions are at least tethered to reality – people are not completely clueless about how they behave, but they are also far from perfect. Second, studies examining how well people’s self-perceptions agree with others’ perceptions of them suggest that people’s self-views are not completely out of synch with how they are seen by those who know them best, but they are also far from identical. Third, studies examining whether people know the impressions they make on others suggest that people do have some glimmer of insight into the fact that others see them differently than they see themselves but there is still a great deal people do not know about how others see them. The findings from all three approaches point to the conclusion that self-knowledge exists but leaves something to be desired. The status of people’s self-knowledge about their own personality has vast implications both for our conception of ourselves as rational agents and for the methods of psychological inquiry.     

Single and combined effects of methylphenidate and behavior therapy on the classroom performance of children with attention-deficit hyperactivity disorder

Twenty-four boys with attention deficit-hyperactivity disorder (ADHD) participating in an intensive summer treatment program each received b.i.d. placebo and two doses of methylphenidate (MPH, 0.3 mg/kg and 0.6 mg/kg) crossed with two classroom settings: a behavior modification classroom including a token economy system, time out and daily home report card, and a regular classroom setting not using these procedures. Dependent variables included classroom observations of on-task and disruptive behavior, academic work completion and accuracy, and daily self-ratings of performance. Both MPH and behavior modification alone significantly improved children's classroom behavior, but only MPH improved children's academic productivity and accuracy. Singly, behavior therapy and 0.3 mg/kg PMH produced roughly equivalent improvements in classroom behavior. Further, the combination of behavior therapy and 0.3 mg/kg MPH resulted in maximal behavioral improvements, which were nearly identical to those obtained with 0.6 mg/kg MPH alone.The authors gratefully acknowledge the assistance of Patricia Donovan, Michelle Berry, Mary Ingram, Patricia Wells, Beth Gnagy, Karen Greenslade, Mary Hamilton, and the entire staff of the Western Psychiatric Institute and Clinic ADHD Summer Treatment Program.     

Cardiovascular reactivity and interpersonal influence: active coping in a social context

Previous studies have demonstrated that effortful attempts to secure positive outcomes or avoid negative outcomes produce significant increases in systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR). Although these effects of active coping on cardiovascular reactivity are central in current psychosomatic theories, virtually all of the research to date has used impersonal, asocial tasks. Our two studies examined the cardiovascular effects of effortful attempts to influence other people. In Study 1, male subjects attempting to influence the opinions of their discussion partner to improve their own chances of winning money displayed significantly greater SBP, DBP, and HR reactivity. In Study 2, we obtained similar effects on SBP and DBP reactivity in men and women, while both preparing an influence attempt and making that attempt. Furthermore, reactivity levels were larger as the magnitude of incentive for successful persuasion increased. Implications of this interpersonal equivalent of active coping for the development of cardiovascular disease are discussed.     

Children's affective,behavioral, and cognitive responses to social comparison

Relative outcomes in social commerce with peers are potent determinants of cognitions and behavior in young children. Although there has been considerable attention given to the behavioral consequences of social comparisons following the receipt of rewards, there has been less concern with cognitive or affective consequences. Additionally, little is known about the accrued effects of multiple social comparison experiences that may be consistent or inconsistent with one another. In the present study, young children received a constant level of reward but the amount they saw a peer receive was varied. There were two sequences of reward distribution, and in a given sequence children received either the same number of rewards as the peer (=), more (+), or fewer (?). In a 3 × 3 factorial design all possible combinations occurred. A negative inequality in reward distribution, no matter where it fell in a sequence, made children sad and inclined children to distribute fewer rewards to peers. When a sequence contained an initial experience of positive inequality, children decreased subsequent levels of self-reward. Experiencing a comparison that revealed a negative inequality in reward distribution also disrupted children's accuracy in appraising the overall distribution of rewards: even when an initial negative inequality was completely offset by an equivalent experience of positive inequality, children inaccurately concluded that they had received fewer rewards than their peers.     

An “outside-in” processing strategy in the perception of form

The discriminability of line segments in a number of different geometric forms was examined. The procedure used was to have one of the lines within a given form drawn thinner than the other lines. The location of the thin line varied randomly within the form, and subjects were required to detect its location. Three observations were made. First, outer line elements were discriminated more accurately than inner line elements. Second, the outer line advantage appeared to reflect an attentional strategy: By presenting inner and outer lines independently, and informing subjects in advance as to whether target lines would be in the inner or outer area of the form, the outer line advantage could be eliminated. Third, consonant with a global attentional strategy, and in opposition to any retinally tied, peripheral-to-central scanning process, an outer-line advantage was evident regardless of whether the fixation point was positioned within or outside the forms, or whether outer lines were more peripheral than inner lines.     

Sensitivity to lexical denotation and connotation in brain-damaged patients: A double dissociation?

Sets of words can be grouped in terms of their denotation (cold and warm both refer literally to temperature) or in terms of their connotation (cold and warm connote remoteness and intimacy, respectively). To assess whether these two facets of meaning are dissociable, unilaterally left- and right-hemisphere-damaged patients were presented with word triads and asked to group together the two words that were closest in meaning. Right-hemisphere-damaged patients showed a preserved sensitivity to denotation, and a selective insensitivity to connotative facets of meanings. In contrast, left-hemisphere-damaged patients exhibited a preserved sensitivity to connotation as well as a selective insensitivity to denotative aspects of meanings. Inasmuch as normal control subjects displayed a flexible sensitivity to both denotative and connotative aspects of meaning, the results suggest that unilateral brain damage selectively curtails use of one or the other major aspect of word meaning.     

Response mode and choice consistency: A test of unfolding theory

Coombs, Donnell, and Kirk (1978. Journal of Experimental Psychology, 4, 497–512), in a study of risk preferences, collected data using both pick $\text{1}\text{3}$ and reject $\text{1}\text{3}$ response modes. Although the preference orders derived from the two response modes were identical, the pick data contained a greater number of inconsistencies than the reject data. In the present study, predictions were derived from unfolding theory (Coombs, 1964. A theory of data. New York: Wiley) regarding the relative consistency of pick and reject response modes. An experiment performed as a test of these predictions supported the unfolding model suggesting that differences in inconsistency between response modes could be attributed to the fineness of the grid of working midpoints imposed upon the choice process by the response mode.     

Evaluating public posting,goal setting,and rewards to increase physical activity in children

In this study, we evaluated several components of a pedometer-based intervention with children in an elementary-school-aged classroom, across 24-h sessions. The intervention included combinations of self-monitoring, goal setting, feedback, and reinforcement, and data were analyzed at both the classroom level (i.e., average daily step totals) and the individual level (i.e., daily step totals), across phases. The highest levels of physical activity were observed when components of self-monitoring, public posting, goal setting, and feedback with reward were applied concurrently.     

People who help people: A needs assessment of those who provide interpersonal support to individuals with chronic illnesses

Social support during an ongoing illness has been shown to be beneficial for both the provider and the receiver, but people often struggle with offering effective, appropriate support. There is a lack of communication-focused training not specifically tied to caregiving or training that is designed for all social network members of a person experiencing a chronic illness, which we call interpersonal support providers (ISPs). We conducted a concurrent mixed-methods needs assessment, surveying both ISPs and support receivers, to understand communicative challenges and inform an evidence-based intervention. Analysis of results from an online survey (N_providers = 91, N_receivers = 97), consisting of five open-ended and 15 quantitative items, suggests that ISPs have difficulty managing their worries and emotions while providing comfort to others, which may impact support quality. In addition, ISPs and receivers both identify “listening” as a key skill for ISPs to hone, though ISPs feel they are more skilled at listening than receivers say they are. Lastly, ISPs feel they are good at sharing information and advice, but receivers often perceive it as patronizing or unhelpful. These results will inform the creation of an intervention for everyone offering emotional, esteem, and informational support to individuals with chronic illnesses.