The demand to initiate medical care: A morbidity specific analysis

The dependence of the one year probability of utilizing preventive services and the one year probability of utilizing visits for acute micro-organism disease in the Kaiser-Oregon Prepaid Medical Care System on ten (10) explanatory factors has been investigated using a multiple logistic function analysis.Our results demonstrate the importance of disaggregating the population and the type of medical care when investigating the determinants of utilizing service. This is especially important for understanding the underlying structure of medical care utilization decisions.The study also illustrates a potentially fruitful application of the multivariate logistic analysis to the fields of health care planning and policy analysis. The use of specific types of medical care in the short-term is probabilistic and depends on many factors. For most groups, the multivariate logistic approach produces an analysis reasonably consistent with the actual data.Further research is needed to test the predictive ability of these types of utilization models and to investigate the determinants of other morbidity specific types of medical care utilization. The problem will then be to develop a model of the quantity of alternative types of services utilized-conditioned on the number of persons initiating service for alternative health reasons.     

Some theoretical considerations on confidential adoption part IV: Countertransference

Psychological self-awareness is as essential to the maturation of one's professional self as is the development of theoretical and clinical expertise in child placement. This paper represents a first published attempt at examining countertransference in adoption. The focus is within the context of confidential adoptions, which the authors believe is more child-focused and intrapsychically based than the current experimentation with open adoptions. A distinction is made between countertransference and non-countertransference issues. Countertransference responses are divided into Racker's three categories: the concordant; the complementary; and the disjunctive. Clinical data illustrates these responses in actual practice from the perspective of confidential adoptions.This paper was presented in 1985 before the Illinois Infant Mental Health Association, National Society of Clinical Social Workers, and the National Association of Social Workers National Professional Symposium.This is the last of a series. Parts I, II, and III were published in Vol. 2, Nos. 1, 2, and 3.     

Perceptual deficits and self-esteem in adolescence

This paper attempts to conceptualize the dynamics of selfesteem in an adolescent suffering from a perceptual deficit. The interrelationship between the deficit and the development of self-esteem is discussed from two points of view, that of traditional ego psychology and that of the psychology of the self. In the case illustration given, the treatment methods were heavily influenced by the work of Heinz Kohut and by the insights provided by his psychology of the self.     

The accomplishment of intimacy in the jail visiting room

An essential feature, and perhaps the harshest reality, of incarceration is the physical separation of the prisoner from those with whom he or she would ordinarily interact—a separation which often puts familial and friendship ties in jeopardy. In light of this, prison administrators, citizens' advisory commissions and government agencies have become aware of the rehabilitative benefits of prisoner contact with outsiders. Despite such thinking and the institution of various forms of visitation, effective procedures are difficult to attain in large metropolitan jails. This paper, based on observations in a county jail located in a large, western city, argues that the desired level of intimacy exhibited during a visitor-prisoner conversation is directly related to the importance of the visitor-prisoner relationship as a topic of conversation. Furthermore, the conversation itself becomes an effective experience for those visitors and prisoners for whom their sexual relationship becomes a topic of high priority. The author wishes to thank Murray Davis, Bennett Berger and Fred Davis for helpful comments on an earlier draft of this paper.     

Success and interpersonal touch in a competitive setting

Early observations of interpersonal touch among American adults have revealed rates of touch well below that of many European and Latin American countries. Conclusions drawn from these results, however, mandate caution since touch has been shown to be affected by age, gender, race, and setting. Observation of mens' televised sports has revealed that high rates of touch often follow a successful performance. The present study attempted to quantify touch within a mixed-gender, competitive setting in both black and white subcultures. Interpersonal touch following a success and otherwise occurring was observed among bowlers during league play. Overall rates of touch were much higher than those reported for other public settings. High rates of touch following a success were reported only for blacks. Unlike previous studies females initiated cross-gender touch as often as did males.     

Summative scales for measuring community satisfaction

Results of this study indicate that pen and paper questionnaire procedures can be successfully adapted to random digit dialing telephone interview methods. Further, the study produced a reliable instrument for measuring attitudes about how residents perceive their communities as a place to live.     

HISTORICAL AND CURRENT FACTORS DISCRIMINATING SEXUALLY FUNCTIONAL FROM SEXUALLY DYSFUNCTIONAL MARRIED COUPLES*

Clinical literature has noted numerous past and current psychosocial factors characteristicof sexually dysfunctional individuals. However, there is almost no empirical documentation of factorsdiscriminating sexually functional from dysfunctional couples. The present study compared the responses of 94 clinical couples accepted for sex therapy with 110 nonclinical couples, selected from the same community. The couples were in their mid-30s, married an average of 12 years, middle income, rather well educated, and over 75% had at least one child. Individuals completed a 517-question Personal History Questionnaire (PHQ), and sex and marital defensiveness scales. The PHQ wasclinically and empirically developed, resulting in 54 internally consistent scales. Major analyses tested the discriminating power of past and current PHQ scales. The best discriminators were sexual functioning scales, historical and affective scales for women, and current and fantasy scales for men. Several surprising results appeared, including the importance of first coitus and the lack of importance of marital satisfaction, communication and sexual history scales. Four conclusionswere discussed relevant to the separation of sex and relationship satisfaction, the separation of sexualfunctioning and sexual satisfaction, and the differential impact of sexual problems on men and women.