Startling affect in therapeutic relationships: Relational formulation of experience∗

Open internal boundaries allow therapists to receive patients’ unconscious communications and to hold disavowed affects and self states, thus making possible new relational and affective development. Such deep engagement with patients inevitably stirs intense feelings that may be difficult for therapists to bear. Unwanted affect and unconscious points of identification with patients may stimulate therapists’ shame and guilt leading to states of disequilibrium. A therapeutic stance which is fluid and open to intrapsychic and interpersonal influence, allows for the experience and elaboration of complex unconscious affects, points of identification and self‐other configurations. Clarity concerning intrapsychic and interpersonal boundaries in the therapeutic relationship is most helpful. Relational formulations of case material focusing on startling affects are offered.     

Beyond Simple Differences: Moderators of Gender Differences in Heteronormativity

ABSTRACT

Heteronormativity is a culturally embedded system defining acceptable identities and behaviors in romantic relationships. Recent literature has suggested that heteronormativity is strongly associated with political attitudes, personality characteristics such as tolerance of ambiguity, and key demographic variables such as gender and sexual orientation. However, interactions between gender and other factors have not been thoroughly explored as predictors of heteronormative attitude and beliefs. The current study (N = 306) expands the understanding of predictors of heteronormativity, particularly as they interact with gender. In the current study, higher education was associated with lower heteronormativity among women, but not among men, and expressiveness was associated with lower heteronormativity among men, but not among women. Finally, a 3-way interaction showed that the relationship between education and heteronormativity for men (but not women) depended on trait expressiveness. Future studies are recommended, including observation of changes in heteronormativity over time and exploration of mechanisms that reinforce or reduce heteronormativity.     

Direct and indirect effects of unionization on the wage levels of nurses: A case study of New Jersey hospitals

This study examines the determination of wage rates for nurses in hospital employment. Of particular concern is the effect of the recent increase in unionization by nurses on their wages, both directly and indirectly via threats from competing hospitals’ unionization. To improve on earlier work, the data are disaggregated and gathered from only one state to standardize for the legal, licensing, and reimbursement systems. We also look at the difference between highly skilled professional nurses, RN’s, and more general and less professional nurses, LPN’s. The results show that working conditions and competition in the market influence the wage rate as one would expect. The unionization of nurses, however, affects the wage levels differently for the two groups. We would like to thank Professors Robert Higgs and Alan Childs of Lafayette College, Professor David Fairris of Williams College, Professor James C. Luzier of Muhlenberg College, and an anonymous referee for their helpful comments and suggestions.     

Fill-in of missing data in univariate coastal data

An approach to fill-in of missing data where gaps exist within an otherwise continuous record is addressed. Ad hoc methods of past approaches are discussed and limitations noted. An approach for providing an estimate of data filling consistent with data having a correlation structure is presented. The method provided is an extension of parametric modelling along with additional constraints imposed via a linear filter to account for variance preservation. The method is applied and compared to real data in which a portion of the record has been removed to simulate missing data. Results show the method to provide realistic missing data that preserves the correlation structure and variance of the measured data.     

Children of problem gamblers

An anonymous 37-item Health Survey was administered to 844 randomly selected ninth- to twelfth-grade students in four Southern California public high schools. Systematic information was gathered about their general health, quality of life, school and work adjustment, involvement with a range of potentially addictive substances and activities, and indications of psychosocial maladjustment, including difficulties with the law and suicide attempts. A series of self-ratings of students who characterized one or both of their parents as having a compulsive gambling problem (N=52) were contrasted with those of their classmates who reported no gambling problem among their parents (N=792). Findings have been grouped into three major areas: (a) comparative levels and reported effects of involvement with health-threatening behaviors (i.e., smoking, drinking, drug use, overeating, and gambling); (b) comparative incidence of psychosocial risk indicators (i.e., broken home, unhappy childhood and teenage years, legal action pending, overall quality of youth rated as poor); and (c) comparative incidence of dysphoria, school and work problems, and suicide attempts. Across each of these areas children of parents said to gamble excessively were found to be at consistently greater risk than their classmates who did not describe their parents as having a problem with compulsive gambling. These findings strongly suggest that without early and competent intervention, children of parents who gamble excessively: (a) will be seriously disadvantaged when attempting to solve their present adolescent and future adult problems of living; and (b) as a consequence are, themselves, high-risk candidates for developing one or another form of dysfunctional adjustment, including an addictive pattern of behavior.     

A Methodology to Select a Wire Insulation for Use in Habitable Spacecraft

This paper investigates electrical overheating events aboard a habitable spacecraft. The wire insulation involved in these failures plays a major role in the entire event scenario from threat development to detection and damage assessment. Ideally, if models of wire overheating events in microgravity existed, the various wire insulations under consideration could be quantitatively compared. However, these models do not exist. In this paper, a methodology is developed that can be used to select a wire insulation that is best suited for use in a habitable spacecraft. The results of this study show that, based upon the Analytic Hierarchy Process and simplifying assumptions, the criteria selected, and data used in the analysis, Tefzel is better than Teflon for use in a habitable spacecraft.     

Bi‐Criteria Scheduling of Surgical Services for an Outpatient Procedure Center

Uncertainty in the duration of surgical procedures can cause long patient wait times, poor utilization of resources, and high overtime costs. We compare several heuristics for scheduling an Outpatient Procedure Center. First, a discrete event simulation model is used to evaluate how 12 different sequencing and patient appointment time‐setting heuristics perform with respect to the competing criteria of expected patient waiting time and expected surgical suite overtime for a single day compared with current practice. Second, a bi‐criteria genetic algorithm (GA) is used to determine if better solutions can be obtained for this single day scheduling problem. Third, we investigate the efficacy of the bi‐criteria GA when surgeries are allowed to be moved to other days. We present numerical experiments based on real data from a large health care provider. Our analysis provides insight into the best scheduling heuristics, and the trade‐off between patient and health care provider‐based criteria. Finally, we summarize several important managerial insights based on our findings.     

Social transformation,collective categories,and identity change

Changes in collective categories of identity are at the core of social transformation. The causal linkages among identity change, institutional change, and change in modes of practice are, however, complex. Developing and adapting ideas from Pierre Bourdieu's work, this article shows the coexistence in tension of a plurality of elements within each collective identity category. On this basis, it proposes a typology of responses at the level of identity to socio-political change. This allows an explanation of patterns of identity change in terms of wider social processes and resource distribution, while remaining open to the sense and complexity of the individual's experience and the moments of intentionality that arise when individuals face choices as to the direction of change. The worth of the model is shown by analysis of modes of identity change in a society now experiencing radical change in socio-political structures, namely post-1998 Northern Ireland.