Three Object Relations Models of Couple Treatment

This article describes three different approaches to the treatment of couples, all based on different versions of object relations theories. Object relations as a term has various meanings embodying different theoretical assumptions. It is used differentially to highlight certain aspects of clinical phenomena, to connote certain developmental paradigms, and to signal the importance of real, interactional aspects of human behavior. The three therapeutic approaches to work with couples illustrate some of the ways that the greater conceptual complexity of object relations theories affects how love is explained, couple conflicts defined, and what makes for change in couples treatment. Understanding the basic assumptions of a given theory will enable us to increase our informed consent to the use of theory in our practices.     

Ability, disability, and the oldest old

A measure of range of ability is used to profile the 85-years-old-and-older (oldest old) population, including the highly disabled institutional population. This new measure uses two new questions available in the 1990 Decennial Census concerning a self-care limitation and a mobility limitation as well as the usual question concerning a work limitation. In addition to examining the extent of disability among the oldest old, the article examines the extent of care potentially available in the household as well as the economic characteristics of this age group. It is also profiled in terms of relevant personal characteristics, including age, gender, marital status, race, ethnicity, rural residence, education, and employment. A key question addressed is the need for help or care among the oldest old and how various long-term care proposals would meet such needs. A careful analysis of this unique and growing population is necessary to both allay fears of the cost of care or help as well as to dispel stereotypes of this age group as frail and dependent, and in need of institutional care.     

Migration as a consumption activity

"While a generalized utility maximization approach to migration decisionmaking is not innovative, the principal extensions of this paper involve the search for an instrument capable of measuring changes in utility levels consistent with all preferences (i.e., with all forms of utility functions), requiring only data on observed behaviour. Our approach is to construct a Location-Specific Utility Index (LSUI), whose component variables serve as proxies for the arguments in [U.S.] households' utility functions.... The testable hypothesis is formulated as follows: Assuming constant household preferences and expansion of the household's feasible set over time, the household's utility level is greater following the migration decision.... The results are compared with the households' migration decisions. The empirical evidence shows that migration may reasonably be modelled as a consumption activity by households to maximize utility." (SUMMARY IN FRE AND SPA)     

Validating quality indicators. Quality as relationship between structure, process, and outcome

Theory and research have not kept pace with the growing interest in evaluating quality of mental health care, resulting in the use of unvalidated quality indicators. A framework for validating quality indicators is offered by which quality is viewed as the relationship between service structures, processes, and outcomes. Adoption of this framework will facilitate the measurement of quality using valid indicators and should be useful to agencies in their continuous quality improvement efforts. Valid information about the quality of mental health care services will help purchasers and consumers make more informed health care decisions.     

Implementation and process evaluation of a student "school-as-community" group. A component of a school-based drug abuse prevention program

Little documentation exists regarding the functioning of formalized adolescent groups as drug abuse prevention agents. Two studies are described that were conducted at high schools whose students are at high risk for drug abuse. Twenty-one schools were randomly assigned to one of three conditions: (a) standard care, (b) classroom drug abuse education only, or (c) classroom plus school-as-community. Results of the first study indicated that the school-as-community component--which involved weekly meetings and periodic events at seven schools--was implemented as planned, drug abused focused, and perceived as productive in discouraging drug abuse. In the second study, staff in the classroom plus school-as-community condition self-reported involvement in the greatest number of community activities across the school year, compared with staff from the other two conditions. These two studies support the feasibility of formalized groups of high-risk youth to promote drug-free events.     

Society's search for a legal and ethical basis of physician-assisted suicide

A review of the way physician-assisted suicide (PAS) is being addressed in the United States reveals three models, each functioning out of distinctive concepts of autonomy: (1) litigation, which utilizes philosophical autonomy; (2) legislation, which utilizes political autonomy; and (3) act of conscience by a physician, which utilizes consumer autonomy. Each model raises a correspondingly distinct set of ethical questions and challenges centered around their point of reference-the judicial system, voters, or the doctor-patient relationship. In the end, however, efforts to resolve the challenge of PAS will falter if they do not go beyond these models of autonomy. Religious institutions offer a more constructive setting for facing the life and death decisionmaking of PAS. The challenge for religion is to address PAS in solidarity with sufferers, physicians, and the community, rather than retreating into iconoclastic dogmas.     

The role of demographic and economic characteristics of twelve member states of the European Union in the diversity of state support for families

"This study is based upon an international dataset comparing state support for families in fifteen countries (of which twelve are member states of the European Union).... Using multiple regression analysis, the levels of state support are explained by the principal parameters used for setting the levels of benefit, and by the demographic and economic characteristics of the countries concerned....[Results suggest] that the economic convergence of the member states is likely to promote greater similarity in their systems of state welfare support for families." (EXCERPT)