Countertransference,resistance and frame management in the psychotherapy of a 15 year old anorexic and her mother

Countertransference is a rich source of understanding of client dynamics but can be difficult to detect. A case vignette is used to illustrate how changes in the arrangements of therapy should be viewed as red flags alerting the therapist to possible countertransference. By paying careful attention to the client's derivative response to the therapist's agreeing to a request for a change in appointment times, the therapist was able to understand the unconscious motive behind the request, as well as her own countertransference reasons for participating in the resistance expressed in the request. When, based on this under-standing, the therapist was then able to hold to the framework and maintain the previous appointment schedule, this furthered the treatment by providing a model for introjection and by promoting understanding rather than acting out. In complicated therapy situations where treatment of more than one family member by a single therapist is indicated, such careful attention to the framework and to the client's derivative response to the therapist's interventions is particularly important.An earlier version of this paper was presented before the Annual Conference of the Washington State Society for Clinical Social Work on May 14, 1984.     

Lifestyles and identity maintenance among gay Japanese-American males

An exploratory study of thirteen Japanese-American gay men residing in the Los Angeles area found that those men who had disclosed their sexual orientation to family members were more likely to express more positive attitudes concerning a variety of issues. Detailed personal accounts of these patterns are presented along with discussions of how Asian homosexuals maintain their “double-minority” identities as both Japanese and gay.     

The Functional Substitutability of Blacks and Females in the Labor Market: a Closer Look*

The interrelationship between labor market discrimination against black males and white females—as reflected in the respective size distributions of their full-time income—is examined for states in the U. S. Employing previously used data, conclusions opposite those of other researchers are reached. The hypothesis of a simple negative association between the two forms of discrimination is rejected, along with the implication of that association that blacks and females are functional substitutes in a capitalist economy. More adequate measurement and analysis shows that the presumed relationship is largely spurious, and caused primarily by the sexual specificity of labor demand as well as supply.     

Estimation of Dietary Exposure to Chemicals: A Case Study Illustrating Methods of Distributional Analyses for Food Consumption Data

There are a number of sources of variability in food consumption patterns and residue levels of a particular chemical (e.g., pesticide, food additive) in commodities that lead to an expected high level of variability in dietary exposures across a population. This paper focuses on examples of consumption pattern survey data for specific commodities, namely that for wine and grape juice, and demonstrates how such data might be analyzed in preparation for performing stochastic analyses of dietary exposure. Data from the NIAAA/NHIS wine consumption survey were subset for gender and age group and, with matched body weight data from the survey database, were used to define empirically-based percentile estimates for wine intake (μl wine/kg body weight) for the strata of interest. The data for these two subpopulations were analyzed to estimate 14-day consumption distributional statistics and distributions for only those days on which wine was consumed. Data subsets for all wine-consuming adults and wine-consuming females ages 18 through 45, were determined to fit a lognormal distribution ( R ²= 0.99 for both datasets). Market share data were incorporated into estimation of chronic exposures to hypothetical chemical residues in imported table wine. As a separate example, treatment of grape juice consumption data for females, ages 18–40, as a simple lognormal distribution resulted in a significant underestimation of intake, and thus exposure, because the actual distribution is a mixture (i.e., multiple subpopulations of grape juice consumers exist in the parent distribution). Thus, deriving dietary intake statistics from food consumption survey data requires careful analysis of the underlying empirical distributions.     

Consideration of Background Exposures in the Management of Hazardous Waste Sites: A New Approach to Risk Assessment

The current approach to health risk assessment of toxic waste sites in the U.S. may lead to considerable expenditure of resources without any meaningful reduction in population exposure. Risk assessment methods used generally ignore background exposures and consider only incremental risk estimates for maximally exposed individuals. Such risk estimates do not address true public health risks to which background exposures also contribute. The purpose of this paper is to recommend a new approach to risk assessment and risk management concerning toxic waste sites. Under this new approach, which we have called public health risk assessment, chemical substances would be classified into a level of concern based on the potential health risks associated with typical national and regional background exposures. Site assessment would then be based on the level of concern for the particular pollutants involved and the potential contribution of site contaminants to typical background human exposures. While various problems can be foreseen with this approach, the key advantage is that resources would be allocated to reduce the most important sources of human exposure, and site remediation decisions could be simplified by focussing on exposure assessment rather than questionable risk extrapolations.     

Families and donor insemination: the views of semen donors

One of the consequences of donor insemination for the semen donor is that he becomes a member of two families: his own family in which he has a genetic and social connection with his offspring; and the family of the recipient couple, in which he has a genetic connection to the offspring, but usually no social connection with either the offspring or the recipient couple. This article challenges the dominant view that donor insemination as a practice of mainly medical or legal importance by looking at the attitudes of donors to both their own family and the family to which they have contributed their genetic material. Results are presented concerning who donors have told about their donation, who they think should be told, whether they think recipient couples should tell their donor insemination offspring about their conception, and concerning their opinions about factors that are considered in matching donors with recipient fathers.     

Least restrictive alternative: ethical considerations

Potential ethical dilemmas occur between rights and needs within the context of least restrictive alternative for psychiatric patients. This concept has been viewed primarily as a mechanism for limiting paternalistic interference and promoting individual dignity and autonomy. In addition, it has implied some possible conflicts in supporting such a well intentioned concept as least restrictive alternative without more reflection on the complexities involved.