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.     

The role of self-esteem in the experience of envy

It is the thesis of this paper that although analysts have always recognized that narcissistic injury may trigger envious feelings, the significance of self-esteem as both a motivator and response to envious feelings has not yet been sufficiently explored. Traditional drive-defense or object instinctual explanations tend to diminish awareness of the importance of self-esteem in the experience of envy. The focus on drives or repetition of early patterns of object relations does not always take into account the significance of the cycle in which damaged self-esteem leads to envy, the component parts of which may cause further damage to self-esteem, leading to more envy, and so on. I am suggesting that it is often an attempt to avoid painful injury to one's self-esteem, as well as the related attempt to maintain a positively colored sense of self, and not a repression of drives or a repetition of some aspect of early object relationships which must be understood in order to fully comprehend both feelings of envy and the need to keep such feelings out of conscious awareness.     

EFFECTS OF SELF-EVALUATION ON PRESCHOOL CHILDREN'S USE OF SOCIAL INTERACTION STRATEGIES WITH THEIR CLASSMATES WITH AUTISM

This study investigated effects of a self-evaluation procedure on preschool children's use of social interaction strategies among their classmates with autism. Three triads of children (comprised of 1 trained normally developing peer, 1 untrained peer, and 1 child with autism) participated. A multiple baseline design across subjects was used to demonstrate that peers who were taught facilitative strategies increased their use of strategies only after the self-evaluation intervention was introduced. Improvements in social behavior of children with autism was associated with peers' increased strategy use. Untrained peers demonstrated little change in their social behavior. Treatment effects were replicated when trained peers were asked to use self-evaluation with other children with autism during other play times. Self-evaluation procedures enhanced the use of social interaction strategies on the part of normally developing peers during social skills interventions.     

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.     

An intergenerational analysis of expectations for women's career and family roles

This study examined the career and family role expectations and attitudes of women university students and both of their parents. Data collected from 292 families revealed that most daughters and their parents were traditional in their attitudes toward mothering, held somewhat egalitarian attitudes toward marital roles, and generally expected daughters to experience little frustration regarding future career and family roles. Differences and similarities among daughters, mothers, and fathers as well as between intact and dissolved families of various SES were examined. Implications of findings and suggestions for future research were discussed.This research was supported by grants from the University of Rhode Island Council on Research and from the College of Human Science and Services. Portions of this paper were presented at the National Council on Family Relations annual meeting, New Orleans, Lousiana, November, 1989 and at the Eastern Sociological Society annual meeting, Providence, Rhode Island, April, 1991. The authors thank Mary Ellen Reilly for her encouragement and assistance.     

The utilization of genetic counselors within a newborn screening program

Genetic counselors have participated in the Michigan Newborn Screening Program on a contractual basis since 1988. Their role includes newborn screening education and training, newborn nursery site visits, and monitoring newborn screening in hospitals. Their impact has been to improve the quality of newborn screening services by reducing errors and increasing completion of data fields on newborn screening cards, improving hospital nursery cooperation and problem solving, and enhancing health department response to specific problems.     

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.     

Predicting Contraceptive Efficacy: A Discriminant Analysis of Three Groups of Adolescent Women1

The relationship of knowledge and attitudes to adolescent contraceptive efficacy was investigated in a multivariate study, with demographic and sexual history variables covaried. Subjects were unmarried, sexually active 15- to 19-year-old women. Two studies were conducted: one using a large and representative sample and the second using a smaller, high socioeconomic status sample that is more typical of samples generally used in earlier research. Subjects were classified as effective, ineffective, or nonusers of contraception, based on both frequency of use and effectiveness of the method(s) they used. Two discriminant function analyses were performed to determine (a) whether knowledge and attitudes contributed to discrimination among the groups over and above discrimination attributable to demographic and sexual history variables, and (b) which variables distinguished ineffective users from both other groups. The results of both studies indicate that attitudes, particularly attitudes toward contraception, are strong predictors of patterns of contraceptive use. Ineffective users were distinguished from nonusers by their greater knowledge of contraception, and from both other groups by their greater sexual activity and more positive attitudes toward intercourse. The discussion focuses on the theoretical implications of the results, the usefulness of the effective/ineffective/nonuser categorization, and applications of these findings to design of interventions.