Chinese and Vietnamese immigrant adolescents under pressure: Identifying stressors and interventions.

This article is directed at clinicians who want to increase their effectiveness in identifying and successfully intervening with psychological stressors faced by their Asian American adolescent clients. The myths that Asian American adolescents are universally academically successful and emotionally problem-free have eclipsed the true adaptive challenges faced by these young people. The authors underscore those difficulties faced by Chinese and Vietnamese adolescents in the areas of psychological distress, behavior problems, and academic performance. The article concludes with a number of recommendations to inform clinicians wishing to develop culturally competent clinical formulations and interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using the Nutrition Screening Initiative to survey the nutritional status of clients participating in a home delivered meals program

A large percentage of older Americans are at risk for malnutrition. This puts them at risk for premature institutionalization, creating a financial burden. The objective of this survey was to determine the nutritional health of clients receiving home delivered meals in Lake County, Indiana and the impact that home delivered meals had on them. Nutrition Screening Initiative (NSI) Determine Your Nutritional Health Checklists were mailed to recipients of meals; 58.3% were returned. Twenty-eight percent were found to be at no nutritional risk, 39% at moderate nutritional risk and 33% at high nutritional risk. One-hundred-thirty clients that scored three or more on the "Checklist" were visited by a Registered Dietitian for further screening using the NSI Level I Screen. This screen found many nutritional problems but the fact that the clients did receive home delivered meals decreased the risk. It was determined by the author that 68% of these clients could not function in their own homes without home delivered meals.     

The influence of general practitioner community hospitals on the place of death of cancer patients

A problem became apparent while analyzing intensive conversation between very "competent" elderly that a) were eye-witnesses of National Socialism in Germany as well as of wartime including the bombardment of larger cities, and b) volunteered to participate in the project as such witnesses. This problem seems worthy of being scrutinized in a sophisticated and systematic fashion: It is methodologically difficult to assess divergent--or even contradictory--information pertaining to the specific subjective foundations of an individual's competence and there are problems with integrating this information to a plausible and tenable statement about their action orientations. This holds especially for the assumptions related to the concept of "locus of control," since this concept could prove itself relevant in regard to a differential intervention strategy as well as for basic research on aging, in which the concept's potential for explaining aspects of the aging process remains to be further clarified. Finally, a possible solution to this assessment problem is presented.     

The general practice of psychology.

Psychology has developed a variety of specific techniques that are applicable to specific emotional problems, thus enabling brief psychotherapy to be particularly effective. In the past it was said that therapist and patient had only one chance to solve present and future emotional distress, a criterion applied to no other form of intervention. By combining dynamic and behavioral therapies into intervention designed to ameliorate the presenting life problem, using a multimodal group practice, professional psychology can define its own area practice. This general practice of psychology postulates that throughout the life span the client has brief, available, effective interventions designed to meet specific conditions as these may or may not arise. When such techniques are available, brief psychotherapy is the treatment of choice for about 85% of those seeking help, leaving long-term therapy for those clients who are best benefited by a protracted intervention. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The value of efficiency in psychotherapy.

While modern psychotherapies have often demonstrated a significant degree of effectiveness, in that they help clients overcome their presenting symptoms, their degree of "efficiency" may not measure up to their "effectiveness." Efficiency in psychotherapy includes several issues that are often neglected in research on "effectiveness." These criteria include such ingredients as depth-centeredness, pervasiveness, extensiveness, thoroughgoingness, maintenance of therapeutic progress, preventive psychotherapy, minimization of therapeutic harm, and encouragement of scientific flexibility. It is contended that these aspects of psychotherapy are of profound importance to therapists and clients and that such aspects should be consciously included as values in psychotherapy. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clients', therapists', and judges' evaluations of psychotherapy.

Asked 41 patients and their 17 therapists to complete a questionnaire indicating problem areas and their severity before and after the 1st and last therapy session. 2 clinical psychologists served as independent judges rating the client questionnaires. The clients' evaluations were unrelated to their therapists' evaluations, but were highly related to the evaluations made by independent judges. Further analyses suggest that the disagreements between clients and therapists stemmed from the therapists' inaccuracy in perceiving the clients' problems and the therapists' tendency to overestimate the progress of therapy relative to clients and independent judges. The results and the broader issue of client-therapist disagreements are discussed in terms of the client as a "consumer." (l6 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Counseling adolescents with problem pregnancies.

According to current estimates, 40% of young women will get pregnant while they are teenagers. Most teenage pregnancies are unintended, and thus, they often precipitate a personal crisis. This article discusses the psychosocial context of such pregnancies, including emotional and cognitive development during adolescence, family and peer relations, and norms for gender-appropriate sexual expression. In counseling teenagers with problem pregnancies, the main goal is to help clients reach and implement an informed and fully integrated decision about the pregnancy. Ethical conflicts arise when counselors impose their religious or moral beliefs on their clients, or when the confidentiality and privacy of the counseling relationship is limited by an external authority. In addition, it may sometimes be difficult to reconcile clients' right to self-determination with the responsibility to promote their best interests. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cost savings from home and community-based services: Arizona's capitated Medicaid long-term care program

The Arizona Long-Term Care System is the first capitated, long-term care Medicaid program in the nation to operate statewide. It promotes an extensive home and community-based services program intended to lower long-term care costs by substituting home care for institutional care. Because the program is statewide, finding a suitable control group to evaluate it was a serious problem. A substitute strategy was chosen that compares actual costs incurred to an estimate of what costs would have been in the absence of home and community-based (HCB) services. To estimate the likelihood of institutionalizing clients in the absence of HCB services, coefficients for institutionalization risk factors were estimated in a logistic regression model developed using national data. These were applied to characteristics of Arizona clients. The model assigned approximately 75 percent of the program's clients to a category with traits that were determined to resemble nursing home residents' traits. A similar methodology was used to estimate lengths of nursing home stays. Lengths of stay by the program's nursing home patients were regressed on their characteristics using an event history analysis model. Coefficients for these characteristics from the regression analysis were then applied to HCB services clients to estimate how long their nursing home stays would have lasted, had they been institutionalized. These estimated nursing home stays were generally shorter than these same patients' observed home and community stays. Risk of institutionalization was then multiplied by estimated length of stay and by monthly nursing home costs to estimate what costs would have been without the HCB services option. The expected costs were compared to actual costs to judge cost savings. Home and community-based services appeared to save substantial amounts on costs of nursing home care. Estimates of savings were very robust and did not appear to be declining as the program matured. Savings probably came from several sources: the assessment teams that judged client eligibility were employed by a state agency and thus were independent from the program contractors; clients were required to be in need of at least a three-month nursing home stay; a cap was placed on the number of HCB services clients contractors were allowed to serve each month; the capitated payment methodology forced managed care contractors to hold down average HCB services costs or lose money; and the HCB services and nursing home costs were blended in the capitated rate, so that plans that failed to place clients in HCB services would lose money by using more nursing home days than their monthly capitated rate allowed.     

Therapist qualities preferred by sexual-minority individuals.

Psychotherapy research concerning lesbian, gay, and bisexual (LGB) individuals has focused on matching clients on gender and sexual orientation, yet has not considered how factors such as therapeutic skill, presenting problem, and cohort membership may influence preference for therapists. This study was designed to identify those therapist qualities that sexual-minority individuals prefer and to determine how the presenting problem influences therapist choice. Forty-two nonheterosexual adults between 18 and 29 years old ranked 63 therapist characteristics from "Extremely Uncharacteristic" to "Extremely Characteristic" when seeking treatment for a problem in which their sexual orientation was salient and one in which it was not. The analyses of both conditions yielded clusters of items reflecting therapist characteristics that participants considered unfavorable, neutral, beneficial, and essential. Participants valued therapists who had LGB-specific knowledge as well as general therapeutic skills, whereas they indicated that they would avoid therapists who held heterocentric views. Application of these findings to clinical practice and future directions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The shape of change in psychotherapy: Longitudinal assessment of personal problems.

Proposed 4 parameters that describe the course of change in the subjective intensity of personal problems during psychotherapy: (1) the problem's initial severity; (2) its rate of change (deterioration or improvement); (3) its instability (day-to-day variability in intensity); and (4) its curve (change in the rate of change during treatment). The authors constructed indexes of these parameters for 10 individualized personal problems rated 3 times per week by each of 40 clients (most were diagnosed as depressed) over the course of their 16-session treatment and associated assessment periods. Initial severity predicted problems' reported salience to clients. The rate of change parameter was correlated (across clients) with traditional pretreatment to postreatment outcome measures. Instability was high, and problems dealing with tension symptoms and mood were more unstable than were problems dealing with relationships or self-esteem. Cutting across problem content were large individual differences among clients in the patterns of change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A "thinking-in-action" approach to teaching clinical judgment: a classroom innovation for acute care advanced practice nurses

The complexity of the evolving advanced practice nurse (APN) role demands new teaching strategies. Based on the challenges that clinicians face daily, we have developed a teaching-learning strategy that addresses five central issues: (a) learning to perceive or identify relevant clinical problems; (b) learning to address the limits of formalism by situating clinical problem solving according to the most relevant goals and intents; (c) learning to reason in transition about the particular clinical situation; (d) learning the ethical skill of problem engagement and interpersonal involvement; and (e) learning to take a stand as a responsible agent by making clinical judgments, acting on them, and advocating for the patient/family. Although these five central issues are typically excluded from classic academic approaches, they are addressed in the "Thinking-in-Action" approach. This teaching-learning strategy offers a different way of teaching clinical judgment that closely resembles the way in which expert nurses actually think and reason in patient situations as they unfold.     

Cognitive benefits and costs of bilingualism in elementary school students: The case of mathematical word problems.

Previous research has emphasized the importance of language for learning mathematics. This is especially true when mathematical problems have to be extracted from a meaningful context, as in arithmetic word problems. Bilingual learners with a low command of the instructional language thus may face challenges when dealing with mathematical concepts. At the same time, speaking two languages can be associated with cognitive benefits with regard to attentional control processes, although such benefits have only been found in highly proficient bilinguals. In the present study, we attempted to disentangle the effects of bilingual proficiency on mathematical problem solving in Turkish–German bilingual elementary school students. We examined whether the positive cognitive effects of bilingualism could be found not only in highly proficient bilinguals but also in students with an immigrant background and a low command of the instructional or native language. Our findings emphasize the importance of language proficiency for mathematics problem solving, as shown by the predictive value of students' proficiency in the language of testing (German/Turkish) for their performance on mathematical word problems. No additional effect of the language of instruction (German) was found for problem solving in the bilingual students' native language (Turkish). Furthermore, bilinguals gained scores comparable to those of their monolingual peers on word problems that required attentional control skills although performing significantly below their monolingual classmates on ordinary word problems, suggesting that bilinguals have an advantage when it comes to attentional control. Finally, bilingual students with a relatively high command of the instructional language performed better on word problems presented in German than on those presented in Turkish, thus facing cognitive costs when transferring knowledge from one language to the other. Implications of our findings for bilingual education are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Perspectives of probabilistic inferences: Reinforcement learning and an adaptive network compared.

The assumption that people possess a strategy repertoire for inferences has been raised repeatedly. The strategy selection learning theory specifies how people select strategies from this repertoire. The theory assumes that individuals select strategies proportional to their subjective expectations of how well the strategies solve particular problems; such expectations are assumed to be updated by reinforcement learning. The theory is compared with an adaptive network model that assumes people make inferences by integrating information according to a connectionist network. The network's weights are modified by error correction learning. The theories were tested against each other in 2 experimental studies. Study 1 showed that people substantially improved their inferences through feedback, which was appropriately predicted by the strategy selection learning theory. Study 2 examined a dynamic environment in which the strategies' performances changed. In this situation a quick adaptation to the new situation was not observed; rather, individuals got stuck on the strategy they had successfully applied previously. This "inertia effect" was most strongly predicted by the strategy selection learning theory. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lay epistemo-logic—process and contents: Another look at attribution theory.

Outlines a theory of the lay epistemic process. According to this theory knowledge-seeking behavior is initiated by a purpose that a person has for reaching a given inference and consists of the stages of problem formulation and of problem resolution, the latter stage being governed by the principle of logical consistency. Major attributional formulations are interpreted within the lay epistemic framework. It is concluded that such formulations have typically addressed particular instances of epistemic (inferential) behavior rather than the underlying epistemic process. In this sense, the attributional formulations may be considered special cases of the present model applied to specific contents of knowledge. The present lay epistemic paradigm thus provides an integrative framework that allows for the consideration of diverse attributional models in common theoretical terms and for the derivation of the necessary applicability conditions of different such models. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Detecting malingering and deception: Forensic distortion analysis.

Reviews the book, Detecting malingering and deception: Forensic distortion analysis by Harold V. Hall and Joseph G. Poirer (see record 2001-18575-000). Therapists who often see clients presenting with posttraumatic stress disorder, memory difficulties, substance abuse questions, and "potential-for-harm" (to self or others) problems can benefit from this text. It is interesting, given their orientation to the field of malingering and deception, that the authors do not dwell specifically on the issues of treatment as such. Instead, they address the concerns of therapists genetically at first, remarking on the assumptions often made about clients by clinicians, and then more specifically, in the context of various forensic topics. Hall and Poirier unfold their approach without rancor toward other clinicians or toward clients, and they do much to rectify the stuffy, over litigious image of forensic psychology in their humane and sensible stance. They do a marked service by reassuring therapists generally that forensic science need not mean decimation of the patient or the therapeutic relationship; in the process of seeking the truth, forensic specialists do not have to abandon decency. The reviewer recommends this carefully written and thorough text to all therapists who may themselves be drawn, or see clients who may be drawn, into the forensic arena. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of the reluctant client.

"This paper proposes to consider some theoretical and practical considerations concerning persons who do not enter psychotherapy willingly." A tentative behavioral continuum at the onset of treatment is proposed. This proceeds from "active hostility" at one extreme to "negativism" to "passive resistance" to "neutrality" to "admission of a problem" to "recognition of personal problem and desire for help in working it out." Pretherapy designates any work with reluctant clients with the object of raising them up the continuum to full therapy-client status. Ethical considerations, the role of anxiety, and treatment possibilities are discussed. Brief vignettes of reluctant clients are provided. "They are human beings who are not getting nearly enough peace and happiness out of life—and they are making others miserable in the process. They need help; but many are not getting it. Graduate schools do not offer courses on the treatment of the reluctant client, probably because little study has gone into the problem." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reactions to impaired fertility: the vicissitudes of primary and secondary control appraisals

Recent formulations about how perceived control influences adaptation to chronic medical conditions suggest that although a sense of personal (primary) control may decline over time, there are ample opportunities for individuals to make other adaptation-enhancing "secondary control" appraisals such as construing benefits or finding meaning in their threatening circumstance. We describe a longitudinal study of men and women with impaired fertility that evaluates a dynamic relation between primary and secondary control--one in which anticipated benefits increase over time as failed efforts to achieve a desired pregnancy lead to declines in primary control. Forty-six men and women with impaired fertility rated their sense of personal control over fertility outcomes, the extent to which they anticipated benefits in this situation and their outcome expectancy on two occasions separated by 14 months. As predicted, perceived control diminished over time. Changes in anticipated benefits were unrelated to changes in personal control. Anticipating benefits, however, was inversely related to changes in outcome expectancy, such that a more pessimistic expectancy over time was associated with an increase in anticipated benefits. This relation was independent of perceived control and was not mood dependent. We discuss these findings in terms of current theories of control, the need for further longitudinal investigations to evaluate the temporal relations between primary and secondary control appraisals, and implications for infertility research.     

The psychotherapist and one-way intimacy.

Several prominent psychotherapists have asserted that many therapists use their relationships with clients to gratify desires for controlled, "one-way" intimacy in which they are less vulnerable than the clients. The present experiment tested the hypotheses that (1) therapists have higher needs for control and intimacy than the normative population; (2) need for control is negatively related to quantity and quality of family involvement; and (3) therapists categorized as pseudo-intimate have higher need for control than those categorized as intimate. The FIRO-B and assessments of structured interviews by blind raters provided data on 26 male practicing psychotherapists (aged 29–61 yrs) and 28 male doctoral students (aged 24–48 yrs). None of the hypotheses were supported. Therapist and trainee need scores were similar, and both groups had lower needs for inclusion and needs to be influenced by others than are the norm. Roughly two-thirds of the therapists were categorized as intimate and one-third as pseudo-intimate. Results do not support the idea that therapists gratify their neurotic needs through working with clients. Implications for future research and for therapist selection and training are discussed. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)