Client as colleague: Therapeutic contracting with the seriously mentally ill.

This article introduces the therapeutic contracting program as a comprehensive treatment system for persons with serious mental illness. Therapeutic contracting offers a promising framework for integrating medical, psychological, and social therapies in a manner that fosters clients' active involvement in treatment. This article outlines a multistage therapy program that mobilizes clients' adaptational resources through environmental interventions, structured goal-setting exercises, and skills-building experiences. Data illustrate the effectiveness of therapeutic contracting for (a) securing clients' treatment compliance, (b) promoting positive clinical outcomes, and (c) reducing overall treatment costs. The therapeutic contracting model is discussed as a potential vehicle for expanding the professional role of psychologists in psychiatric settings, particularly in areas of clinical and administrative decision making. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The seriously ill or dying analyst and the limits of neutrality.

Discusses a major dilemma that confronts the analyst who suffers from a prolonged or terminal illness. How much factual information should be revealed to patients concerning the illness and the prognosis? The impact of the illness on communications with the patient (e.g., how appointments are canceled) is explored. Discussion focuses on accounts by 4 analysts who suffered serious illnesses and wrote about their experiences. Transference and countertransference issues are considered, followed by relevant references to neutrality—its uses and abuses—when serious illness strikes. It is argued that the analyst cannot hide behind the concept of neutrality to avoid facing the demands of unusual situations in the analytic experience. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Task analysis training of case managers to assist seriously mentally ill patients find roommates and housing

This study examined the efficacy of task analysis training for case managers helping seriously mentally ill patients find roommates and housing. Behavioral objectives and task analysis were used to develop the task-oriented behavioral training program. Case managers were trained to use a checklist for every session with patients, which included the goal of the session, tasks required to accomplish that goal and lists of all the sub-tasks. The results of this study suggest that this methodology: (1) reduced the time required for patients to find roommates and housing; (2) increased the percentage of patients finding housing; and (3) decreased hospitalization rates occurring during the process of looking for roommates and housing.     

Race, resource use, and survival in seriously ill hospitalized adults. The SUPPORT Investigators

OBJECTIVE: To examine the association between patient race and hospital resource use. DESIGN: Prospective cohort study. SETTING: Five geographically diverse teaching hospitals. PATIENTS: Patients were 9,105 hospitalized adults with one of nine illnesses associated with an average 6-month mortality of 50%. MEASUREMENTS AND MAIN RESULTS: Measures of resource use included: a modified version of the Therapeutic Intervention Scoring System (TISS); performance of any of five procedures (operation, dialysis, pulmonary artery catheterization, endoscopy, and bronchoscopy); and hospital charges, adjusted by the Medicare cost-to-charge ratio per cost center at each participating hospital. The median patient age was 65; 79% were white, 16% African-American, 3% Hispanic, and 2% other races; 47% died within 6 months. After adjusting for other sociodemographic factors, severity of illness, functional status, and study site, African-Americans were less likely to receive any of five procedures on study day 1 and 3 (adjusted odds ratio [OR] 0.70; 95% confidence interval [CI] 0.60, 0.81). In addition, African-Americans had lower TISS scores on study day 1 and 3 (OR -1.8; 95% CI-1.3, -2.4) and lower estimated costs of hospitalization (OR (-)$2,805; 95% CI (-)$1,672, (-)$3,883). Results were similar after adjustment for patients' preferences and physicians' prognostic estimates. Differences in resource use were less marked after adjusting for the specialty of the attending physician but remained significant. In a subset analysis, cardiologists were less likely to care for African-Americans with congestive heart failure (p < .001), and cardiologists used more resources (p < .001). After adjustment for other sociodemographic factors, severity of illness, functional status, and study site, survival was slightly better for African-American patients (hazard ratio 0.91; 95% CI 0.84, 0.98) than for white or other race patients. CONCLUSIONS: Seriously ill African-Americans received less resource-intensive care than other patients after adjustment for other sociodemographic factors and for severity of illness. Some of these differences may be due to differential use of subspecialists. The observed differences in resource use were not associated with a survival advantage for white or other race patients.     

Prevalence of infection with HIV among the seriously mentally ill: Review of research and implications for practice.

The authors review the research literature for estimates of the prevalence of HIV infection among the seriously mentally ill. Data from nine studies suggest that 4%–23% of the seriously mentally ill have been infected with the virus that causes AIDS. Men have been infected at a higher rate than have women, but this gender difference is less pronounced than that found in the general population. Because most of these blinded seroprevalence studies have been conducted in New York City, the representativeness of these results remains unknown. Nonetheless, the findings call attention to the need for enhanced HIV-related services for the seriously mentally ill. The authors provide screening and counseling guidelines for practitioners who work with seriously mentally ill clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient empowerment and feedback did not decrease pain in seriously ill hospitalized adults

We tested a nurse clinician-mediated intervention to relieve pain in a group of seriously ill hospitalized adults using a randomized controlled trial at five tertiary care academic centers in the US. The study included 4804 patients admitted between January 1992 and January 1994 with one or more of nine high mortality diagnoses; 2652 were allocated to the intervention and 2152 to usual care. Specially-trained nurse clinicians assessed patients' pain, educated them and their families about pain control, empowered patients to expect pain relief, informed patients' nurses and physicians about level of pain and suggested or used other pain management resources. Patients' pain was determined from hospital interviews with patients and surrogates. Pain 2 and 6 months later or after death and satisfaction with its control at all time periods were also assessed. All analyses were adjusted for baseline risk of being in pain and propensity to be in the intervention group. Overall, 50.9% of patients reported some pain. After adjustment for other variables associated with pain, comparing the intervention to the control group, there was not a statistically significant difference in level of pain (OR for higher levels of pain 1.15; CI 1.00-1.32) or satisfaction with control of pain during the hospitalization (OR for higher levels of pain 1.12; CI 0.91-1.39), 2 or 6 months after discharge, or during the last 3 days of life. A multifaceted intervention using information, empowerment, advocacy, counseling and feedback was ineffective in ameliorating pain in seriously ill patients. Control of pain in these patients remains an important problem. More intensive pain treatment strategies addressing the needs of seriously ill hospitalized adults must be evaluated.     

Emotional adjustment in terminal patients: A quantitative approach.

Used a quantitative approach to identify factors relating to emotional adjustment in 84 13-82 yr old dying patients. 11 hospital chaplains collected data by interviewing the patients. Results indicate that emotional adjustment to the awareness of a limited life expectancy was not related principally to religious orientation, although this was an important factor. Emotional adjustment was influenced more by the patient's physical condition (level of discomfort), by previous experiences with dying persons, and by interpersonal relationships. The most important aspect of the religious variable was the quality of religious orientation rather than mere religious affiliation or verbal acceptance of religious beliefs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Men's and women's participation in domestic roles: Impact on quality of life and marital adjustment.

Interviewed 82 couples in which the wife was employed (EP) or not employed (NEP) outside the home on their use of time in the 24 hrs prior to the interview. Results suggest that women were primarily responsible for housework and childcare, regardless of employment status. However, husbands of EP women had higher rates of involvement with housework and childcare than husbands of NEP women. Full-time EP women and husbands of NEP homemakers spent the least time in leisure activities. Part-time EP women had the lowest level of marital adjustment, whereas husbands with part-time EP wives had the highest. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personal adjustment as a determinant of aggressive behavior toward the mentally ill.

36 undergraduates acted as teachers whose job was to enable a person whom they believed to be an exmental patient to learn an arbitrarily correct series of button presses. Ss could only communicate with the learner by shocking him when he was incorrect and could vary both the intensity and duration of the shock. It was found, using mean shock duration as an index of punitiveness, that the more emotionally unstable (and thus similar to the learner) an S believed himself to be, the less punitive he was toward the learner. The surprising utility of the shock duration measure as an index of aggression against a stigmatized person is discussed. (18 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The cultural context of interventions for family members with a seriously mentally ill relative

This chapter provides an overview of interventions for relatives of severely mentally ill individuals. The author discusses the design and use of these interventions in the context of the cultural characteristics of families and providers, as well as the culture of the interventions themselves.     

Taking the theorizing in personality theories seriously: Comment.

Comments on "A tale of two visions: Can a new view of personality help integrate psychology?" by J. D. Mayer (see record 2005-05480-001). Mayer's attempt to find ways to use personality emphases as integrative tendencies in psychology is welcome. Certainly, it would help if the research and practice efforts of psychologists were coordinated more clearly than they are now. The comment author finds Mayer's rather ambiguous and scattered suggestions to be disconcerting. The comment author proposes alternatives he hopes will further Mayer's goals. He believes that emphasizing core, developmental, and peripheral statements is important in envisioning the personality system. The comment author does not agree with Mayer's (2005) assertion that emphasizing existing personality theories is necessarily damaging because of their specific content disagreements. There are, of course, many personality theories, but their diversity can be reduced to a more manageable level by inducing from them the basic models of personality theorizing. When the comment author engages in this process, what emerges is the conflict, fulfillment, and consistency models, each with two subtypes. Psychologists need to collaborate with each other in formulating comparative analytic research that can resolve the fundamental issues arising from the differences between these three models. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapist self-care: Practitioner-tested, research-informed strategies.

Provides a compilation of consensual self-care strategies for psychotherapists that is clinician recommended, research informed, and practitioner tested. Illustrative examples from the author's own practice and life are included. The self-care strategies are as follows: (1) Recognize the hazards of psychological practice; (2) think strategies, as opposed to techniques or methods; (3) begin with self-awareness and self-liberation; (4) embrace multiple strategies traditionally associated with diverse theoretical orientations; (5) employ stimulus control and counterconditioning when possible; (6) emphasize the human element; (7) seek personal therapy; (8) avoid wishful thinking and self-blame; (9) diversify, diversify, diversify; and (10) appreciate the rewards. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Taking time seriously: A theory of socioemotional selectivity.

Socioemotional selectivity theory claims that the perception of time plays a fundamental role in the selection and pursuit of social goals. According to the theory, social motives fall into 1 of 2 general categories–those related to the acquisition of knowledge and those related to the regulation of emotion. When time is perceived as open-ended, knowledge-related goals are prioritized. In contrast, when time is perceived as limited, emotional goals assume primacy. The inextricable association between time left in life and chronological age ensures age-related differences in social goals. Nonetheless, the authors show that the perception of time is malleable, and social goals change in 20–83 yr olds when time constraints are imposed. The authors argue that time perception is integral to human motivation and suggest potential implications for multiple subdisciplines and research interests in social, developmental, cultural, cognitive, and clinical psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of work adjustment in bipolar I patients: A naturalistic longitudinal follow-up.

This study explored the clinical and psychosocial predictors of work adjustment in 52 Bipolar I patients over a 2-year longitudinal period and examined associations between work functioning and social relationships, personality features, stressful life events, and clinical variables. Analyses indicated that psychosocial variables (personality disorder symptoms and social functioning) added significantly to prediction of work functioning after clinical variables were entered. Stressful life events were not associated with work adjustment. Overall, presence of a good quality supportive relationship was the strongest unique predictor of work. The results highlight the need to study functional outcomes in patients, especially because they appear only modestly associated with clinical status. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Minnesota Multiphasic Personality Inventory (MMPI) cluster groups among chronically ill patients: relationship to illness adjustment and treatment outcome

Cluster analysis of the MMPI has been utilized widely in the chronic low back pain literature to try to identify reliable patient subtypes predictive of treatment outcome. We extended this methodology to patients with heterogeneous chronic medical conditions by replicating prototypic MMPI cluster group profiles and by relating cluster groups to clinical baseline and outcome data. Subjects were two independent samples (n = 254 and n = 263) of chronically ill patients admitted to an inpatient medicine/psychiatry unit. Using a four-cluster solution, similar cluster profile groups were replicated in both samples. Consistent differences emerged between cluster groups on functional impairment, psychiatric diagnoses, depression, and psychosomatic symptoms. Cluster group membership also predicted changes in functional impairment and depression six months after treatment. Results are discussed in terms of similarities between chronic low back pain and chronic illness and tailoring treatment to different patient types.     

In pursuit of wellness: The self-care imperative.

The practice of psychology can be demanding, challenging, and emotionally taxing. Failure to adequately attend to one's own psychological wellness and self-care can place the psychologist at risk for impaired professional functioning. An ongoing focus on self-care is essential for the prevention of burnout and for maintaining one's own psychological wellness. Salient aspects of self-care are discussed, including the ethical imperative of addressing self-care throughout one's career. Three invited expert commentaries provide additional insights and recommendations on positive actions, preventive strategies, and steps to be taken by individual psychologists, by those training the next generation of psychologists, and by professional associations. Realities of the current state of psychology and a clear call for action are highlighted, with the overarching goal being the ethical and effective treatment of clients and the successful management of the challenges and stresses faced by practicing psychologists. Baker, Elman, and Schoener provide commentaries on the initial article by Barnett. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral suppression of seriously disruptive behavior in psychotic and retarded patients: A review of punishment and its alternatives.

Reviews the use of punishment procedures to suppress seriously disruptive behavior. Although differential reinforcement of behaviors incompatible with disruptive behavior is attractive to many because it does not involve aversive procedures, it has shown mixed results and may be effective only when combined with other procedures. Contingent removal of reinforcement (timeout) has been found moderately effective for dealing with self-stimulation and aggression but is of more limited value in treating severe self-injury. Overcorrection also has a beneficial effect on a variety of serious management problems. It is suggested that although electric shock has been the focus of considerable debate, it may have value under certain conditions. Research on generalization, maintenance, and side effects of these procedures is reviewed, and ethical issues are examined. (188 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)