Individual versus family psychotherapy in managed care: comparing the costs of treatment by the mental health professions

In an effort to understand how psychotherapy is practiced in the "real world," outpatient claims data were examined to determine the cost of individual and family therapy provided by marital and family therapists, master's nurses, master's social workers, medical doctors, psychologists, or professional counselors. Claims for 490,000 unique persons over 4 years were obtained from CIGNA. Family therapy proved to be substantially more cost-effective than individual or "mixed" psychotherapy. Physicians provided care in the fewest sessions, marital and family therapists had the highest success (86.6%) and lowest recidivism rates (13.4%), and professional counselors were the least costly. Outcomes were overwhelmingly successful, with 85% of patients requiring only one episode of care.     

Supervision in the helping professions a practical approach

Abstract

This article is based on an ethnographic study undertaken to explore whether eight people diagnosed with terminal cancer and their families drew on aspects of their cultural identities to make sense of their journey towards death, and if so, how. Ethnographic methods were supplemented by semistructured interviews. Most participants received medical treatments until close to death and invested much effort, time, and hope in these. Consequently, they made little sense of their palliative referrals. Instead, they accommodated the biomedical cultures of treatment-oriented services, thus delaying their own and their family's preparation for death. Only three participants appeared well prepared one month prior to death. An ecological perspective helped to explain the systemic factors involved in this prioritisation. The authors make recommendations for greater involvement of social workers in palliative care, and for more attention to supporting dying people and their families to make culturally meaningful decisions in the journey toward death.     

Skills,control, and the mass professions

Since members of the mass professions are employed mainly by large organisations in the public sector, they are increasingly ‘managed’. What is happening to their skills, their control over their own work, and their professionalism, are matters of concern as revealed by recent disputes. These are precisely questions at the heart of the labour process debate relaunched by Braverman. The insights generated by this stream of writing, already profitably applied beyond blue collar work to clerical occupations may be extended to embrace elements of the service class. There the notion of indetermination goes beyond the notion of discretion. Changes in public ideology have effects analogous to those arising from technological innovation in manufacturing. Yet professionals, whilst attending to technological aspects of their work, typically ignore the wider social issues. In this respect they are vulnerable to deskilling and erosion of control over their work.     

Cultural diversity and school equality: Intercultural education in Spain from a European perspective

Formerly a country of emigrants, Spain has now become a receptor of immigrants from other countries. In spite of the great diversity that existed in our country's past, reflection, legislation and educational concern pertaining to cultural pluralism developed only after this phenomenon. In this paper we examine the adoption of the intercultural perspective in education in Spain, and the relationship between policy and practice. We first discuss the theoretical framework that we use. Second, we look at European policies in this area and finally we describe how cultural diversity is dealt with in Spain, both from a legislative and a practical point of view.     

Cultural diversity and the mistreatment of older people in black and minority ethnic communities: some implications for service provision

Previous research on mistreatment of older people in black and minority ethnic communities has identified limited service responses and the need to consider mistreatment as an issue not only for individuals but also for families, communities, and institutions. The impact of cultural factors on understandings, experiences, and remedies for mistreatment has been debated. Drawing on empirical research in the United Kingdom involving service providers and ethnically-diverse community members, the article explores implications of cultural variation for service provision. Clear gaps exist between service provision and people experiencing mistreatment due to structural and contextual factors; cultural factors have a relatively minor impact.     

Cultural diversity, democracy and the prospects of cosmopolitanism: a theory of cultural encounters

The most appropriate way of theorizing cultural diversity is to situate it in the context of a broader relational theory of culture in which the key dynamic is cultural encounters. The relational conception of culture places the emphasis on the relations between social actors and the processes by which some of these relations generate enduring cultural regularities and forms. This has important implications for political community and in particular for cosmopolitanism. It is in relationships that cultural phenomena are generated and become the basis of different kinds of political community. The paper outlines a typology of six kinds of cultural encounters and discusses four major cultural trends that variously emerge from these encounters. This approach with its emphasis on cultural encounters is the broad sociological context in which questions about cultural change and the prospects of cosmopolitanism should be discussed.     

Caring for Cultural Studies

This essay both inaugurates the editorship of Ted Striphas and reflects on the contributions of Cultural Studies’ longtime editor, Lawrence Grossberg. It opens by reflecting briefly on the journal's transformations over the last 28 years before taking stock of the wellbeing of Cultural Studies, the field. The claim here is that Cultural Studies devotes less time and attention than it used to in thinking through first principles, and thus that the future of the field hinges, in part, on asking whether core concepts are up to the task of answering to the urgent political questions of our time. The essay then recontextualizes the concept of culture, specifically with respect to the much-maligned (indeed, deservedly-maligned) ‘high culture’ tradition. In its recesses the author identifies a fugitive theoretical line in which culture signifies care, as opposed to subordination to patrician interests and aesthetic styles. This conceptual move sets the stage for the central argument of the essay, namely, that for Cultural Studies to live up to both its name and intellectual-political ambitions, it must devote significant time to caring for the infrastructure that sustains its body of ideas. The piece concludes by highlighting some of Lawrence Grossberg's efforts, as an infrastructuralist, to care for Cultural Studies and by observing how, moving forward, neither the field nor this journal will take care of itself.     

A Cultural Challenge for School Administrators

The job of a school administrator has changed over time from one of primarily administrative processes and functions to that of competencies and proficiencies. Incorporated within these competencies and proficiencies is the ability to understand the aspects of group dynamics, group and individual process skills, collaborative action, team building and, of course, cultural diversity. However, the understanding that cultural diversity exists at a school is not enough; the school administrator must understand the characteristics and expectations of the different cultural groups within the school community, including faculty, parents, and students. The Administrator must also develop a proactive strategy to address any potential "cultural" conflicts and misunderstanding that might arise. This paper reviews and introduces the reader to current research about individualism and collectivism as two important and diverse types of cultural characteristics through defining "culture", presenting the characteristics of individualistic and collectivist societies, addressing the importance of the school administrator understanding cultural differences, and presenting of effective tips for the school administrator to use in improving school-community understanding between cultures.