Triangular empathy: “The other” in psychotherapy with individuals

This paper seeks to explore triangular dimensions in individual psychotherapy. In addition to serving as the dyadic object of transference projection and/or as selfobject for a person in psychotherapy, the therapist may be called upon to help the patient work on relationships with certain early, important people or their representations and on the interplay between such relationships and the therapeutic one, that is, in a triangular configuration. Because patients' attempts to introduce others into individual psychotherapy are sometimes experienced by therapists as resistant rather than as integral to the therapeutic process, I propose an empathic reconsideration of such patient efforts to get us to help with the complicated dimensions of human relatedness.     

How to fight the regulator glut: the role of the HCFA-type survey

More and more hospitals in this country are being threatened by the removal of their Health Care Financing Authority (HCFA) Medicare Certification. A perception of competitiveness among HCFA, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and other organizations has heightened this concern. This unpleasant situation has provoked many hospitals to prevent any type of regulator decertification. One of the practical methods of prevention is the use of a HCFA-type survey. These surveys prepare institutions for unexpected, unarmored review by regulators and should be part of the quality improvement (QI) process even in institutions with limited resources. This article discusses the means to accomplish the HCFA-type survey. The development of the survey process involves institutional commitment, hospital policy and procedures, a department review schedule, selection of review personnel, preparation of review personnel, record keeping, and department education.     

The ethics of health care system reform

The United States is now engaged in a momentous national debate about health care. How can we provide the best care possible while simultaneously containing cost (to promote the general economic integrity of society) and somehow maintain a semblance of a free health care marketplace. This is not just a political question; it is also a question of ethics. It is an ethical consideration because the current debate is not just about designing or promoting health care systems that can best address our concerns for costs, quality, and accessibility. It appears that at least some participants in the debate would not stop at arguing their beliefs as valid; they would make their beliefs law. Some urge the creation of the right to health care as a matter of law. There are significant differences between beliefs and rights, however, and they need to be considered carefully in the ongoing debate over the future of this country's health care delivery and financing system.     

Meeting the change challenge: managing growth in the nonprofit and public human services sectors

The current economic climate has been particularly hard on non-profit and public human services organizations, frequently resulting in managing organizational decline. The authors believe that the dominant concern should be with fostering organizational growth. To this end, they suggest that nonprofit board members and executives, as well as public sector leaders, need to concern themselves with the concurrent management of two agendas: Running the Shop and Meeting the Change Challenge. This can be done effectively through the use of strategic issue management, which is a set of techniques that represents a blend of traditional strategic management and change management approaches.     

Demographic changes in East European countries and Russia

The authors outline demographic trends in Eastern Europe and Russia since 1970. Aspects considered include population size, birth rate and number of births, marriage and divorce, death rate, infant mortality, natural increase, sex ratio, and life expectancy.     

The print media and aging policy: how differential coverage of Medicare Catastrophic led congress astray

This article examines the role of the print media in covering complex policy issues. Two models of journalism are considered. "Pack journalism" predicts that print media coverage will be highly consistent in content due to the reliance by those in the media on the same sources of information. In this article, another model--"Beltway journalism"--is proposed. It implies that coverage by the print media indigenous to the Washington, D.C. area (inside the Beltway) will diverge from that of other print media, presenting a potentially distorted view of the world to policymakers in Washington. Using the Washington Post and the Los Angeles Times as possible indicators of the two models, aging policy is addressed through a case study of newspaper coverage during passage and repeal of the Medicare Catastrophic Coverage Act of 1988. Findings suggest that Congress was unduly influenced by the way that Medicare Catastrophic was framed in the Washington Post, lending credence to the Beltway journalism model. By paying insufficient attention to the way Medicare Catastrophic was being framed by sources of print outside the Beltway area, lawmakers allowed themselves to assume a grassroots-level understanding of the issue and support for the bill, both of which turned out to be illusory.     

The household structure of second-generation children: an exploratory study of extended family arrangements

"Using data from the Children of Immigrants Survey, the antecedents of extended family arrangements among [U.S.] immigrant households with children are examined. The incidence and form of such arrangements, especially the presence of grandparents, are analyzed in relation to single parenthood, national origin, cultural assimilation, and socioeconomic variables. The findings serve to underscore the complexity of the correlates of extended family arrangements. While there is a relationship with single parenthood, more research is needed on the economic basis for the presence of relatives in the household. The analysis uncovered the need to also treat presence of grandparents as an independent variable, especially in the cultural assimilation of children of immigrants."     

Today's second generation: evidence from the 1990 U.S. census

"The prospects for today's second generation will be considerably shaped by their current social, economic and demographic status. This article provides a statistical portrait of children of immigrants by analyzing data from the 1990 U.S. Census of Population and Housing. With the second generation defined as children under age 18 with at least one foreign-born parent, the study describes place of residence; household demographic, social and economic circumstances; household head's socioeconomic status; and characteristics of children themselves. Data on second-generation children are broken down by year of immigration of parents and child's nativity. Data for children with native-born parents are provided for comparison."     

The model of place utility revisited

"The purpose of this paper...is twofold: first, to specify a way of calculating place utility so that potential migrants could move to the place where overall place utility is maximized; and second, which is more important, to reveal how decision-makers in the real world, who are acting within 'bounded rationalities'...,make their decisions on where to migrate. This study is supported by an empirical survey of recent Chinese immigrants to Edmonton [Canada].... The findings reveal that when people evaluate different places, they do not necessarily look for the one that generates the highest overall value or utility across all properties.... The study further indicates that the assumption underlying most microeconomic models (that maximizing utility or benefit is the ultimate rule for choosing one location out of several) has not been verified." (SUMMARY IN FRE AND SPA)