Malpractice in clinical social work: A perspective on civil liability in the 1980's

Recently reported cases involving the malpractice of psychiatrists have also focused attention on the potential liability for similar acts by clinical social workers. While there is no appellate case authority holding social work clinicians liable for malpractice at this time, the potential for such litigation is enormous. This article explores some of the more common areas of concern and suggests several prophylactic measures that clinicians may employ to safeguard both their professional career and their continued financial independence.     

Do Patients With Psychosis Experience Loss and Grief As a Result of Their Illness?

BACKGROUND: Depression and suicidality are frequently reported in patients with psychosis and schizophrenia, but the grief process that may be associated with this illness has not been systematically studied. In this study, we examined whether patients diagnosed with psychosis identify, grieve, and mourn losses engendered by the illness. METHOD: 24 patients diagnosed with psychosis in the past five years were surveyed to indicate whether their illness led to losses, and to describe their responses to the losses. Psychosis-related perceived losses were surveyed using three subscales of a loss and grief questionnaire (loss of self, self-care, and roles). Their relationship with beliefs about the illness, symptomatology, coping style, and self-efficacy and insight was studied. RESULTS: 23 (96%) patients named specific losses, and 16 patients (67%) reported feelings associated with grief and mourning. More than half reported loss of self-esteem at the onset of illness and only half saw themselves as having improved in the past month. Patients reported more loss within the past month than at the onset of illness. In the past month, patients with an intact sense of self experienced greater self-efficacy (r = .568, p < .004) while those with loss of self reported feelings of shame (r = ?.582, p < .003). Only patients with insight associated the onset of illness with loss. In the past month, most patients saw themselves as experiencing loss. DISCUSSION: The study results suggest that at some distance from diagnosis, patients still experience themselves as having much loss due to their illness. These unresolved feelings may indicate complicated mourning. Insight appears to be associated with the ability to look back at the onset of the illness and recognize that it engendered losses. Further study of the process of and barriers to grief and mourning is recommended. In clinical practice, the assessment of grief as a part of post-psychotic recovery could lead to providing more appropriate treatment and lead to a positive outcome.     

Comorbid Substance Use and Anxiety Disorders in Adolescents

To explore the coexistence of substance use disorders and anxiety disorders in adolescents, we assessed adolescents presenting for treatment to an inpatient substance abuse treatment facility (SUH), an inpatient psychiatric treatment facility (IPH), and a community-based psychiatric facility (CMHC) for comorbid substance use and psychiatric diagnoses. Thirty subjects from each facility (N=90) were interviewed using the revised Child Schedule for Affective Disorders and Schizophrenia (K-SADS) and the Structured Clinical Interview DSM-III-R (SCID-R) for substance use diagnoses. Overall, comorbidity (anxiety and substance use disorders) prevalence was 67% (20/30) of adolescents in the SUH group, 33% (10/30) of the CMHC adolescents, and 33% (10/30) of the IPH adolescents. Alcohol and marijuana were the most frequently abused substances. Anxiety disorders commonly coexist with substance use disorders in adolescents. Early identification and treatment of anxiety disorders may in fact prevent substance abuse in this population.     

A community mental health clinic's infant-toddler services

A community mental health clinic study of 20 infants for psychological risk status combined with a group of mother (200) and infant-toddler visits (450) over 1-year period is described as a program for providing services to the 0 to 3 age group. Recent studies in the development of human competence emphasize the importance of these years in obtaining various social and nonsocial abilities that are crucial to life and/or work satisfaction. The community mental health clinic has the knowledge, expertise, and mandate to provide services to this age group.     

AN ENGAGED BUDDHIST RESPONSE TO JOHN RAWLS'S THE LAW OF PEOPLES

In The Law of Peoples, John Rawls proposes a set of principles for international relations, his “Law of Peoples.” He calls this Law a “realistic utopia,” and invites consideration of this Law from the perspectives of non‐Western cultures. This paper considers Rawls's Law from the perspective of Engaged Buddhism, the contemporary form of socially and politically activist Buddhism. We find that Engaged Buddhists would be largely in sympathy with Rawls's proposals. There are differences, however: Rawls builds his view from the idea of independent nation–states, while the Buddhists see the world more in terms of a single humankind, the members being highly interdependent with one another, and also with the physical world. The Buddhists would also push harder than Rawls for global structures building multilateralism, restrict more severely justifications for war and behavior in war, stress economic justice more heavily, and insist on all the human rights in the Universal Declaration of Human Rights.     

Perseveration of the partial reinforcement effect in extinction with rats over two phases of extinction and two stages of continuous reinforcement

One group of 10 male albino rats was given partial reinforcement while the other 10 rats received continuous reinforcement in a straight alley. Subjects then experienced five consecutive stages of Extinction 1, Continuous Reinforcement 1, Extinction 2, Continuous Reinforcement 2, and finally, Extinction 3. Analysis showed the partial reinforcement effect in extinction was sustained over two stages of extinction and two stages of continuous reinforcement, since subjects receiving partial reinforcement ran faster than rats given continuous reinforcement throughout all three of the extinction periods. The results seem to support those of Amsel's (1967) and Cabpaldi's (1967) theoretical formulations of the partial reinforcement effect in extinction.     

The Wisdom of the Fool

The First Beginnings

Moorings: The People, The Place, The Event