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.     

Predictors of Depression Among Caregivers of Older Adults With Severe Mental Illness

Caregivers of older persons with severe mental illness (SMI) contend with the double challenge of providing assistance related to both the psychiatric condition and older age of their family member. Study explored factors influencing negative psychological outcomes experienced by caregivers (n = 96) of older adults with SMI. One-quarter of caregivers scored at or above the clinical point for depression. Low income, care recipient gender, poor health, problems dealing with care recipient’s symptoms and the interaction of health and problems dealing with symptoms were associated with higher rates of depression. Implications for service provision and future research are discussed.     

Roles of the institute of medicine in providing health science policy advice

Studies conducted by the Institute of Medicine (IOM) are one way that government agencies can get presumably neutral advice on health science policy issues. The traditional IOM study is undertaken using a committee of experts supported by professional staff on issues of particular importance related to health policy. The report is usually a consensus document from the group of experts who have various points of view on the topic. After a report is prepared, it undergoes an independent review process to assure that the conclusions are based on the best available science and vigorous analysis of the data. IOM reports make recommendations for further actions that could be undertaken by a diverse audience, and do not just provide a series of options as is done in reports from the Office of Technology Assessment.     

HIV and PTSD: A Confirmatory Factor Analysis of the PCL Screening Instrument

ABSTRACT

The findings are reported from a confirmatory factor analysis (CFA) of the posttraumatic screening checklist (PCL) created by Weathers et al. (1993) Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A. and Keane, T. M. 1993. The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility, Presented at Annual Meeting of the International Society for Traumatic Stress Studies, San Antonio, TX. [Google Scholar]. One hundred and eighty-six individuals receiving either preventive HIV information or ongoing HIV counseling from community-based AIDS organizations in the New York City area completed the PCL checklist. To identify a model relevant to screening posttraumatic stress disorder (PTSD) within the HIV/AIDS community, six CFAs were conducted. Results indicated that the PTSD scale should include attention to four general areas: a) reexperiencing the traumatic event; b) avoidance of anything associated with the traumatic event; c) a sense of numbing; and d) a hyperarousal state. The CFA produced a more concise model of 12 items, relevant to the HIV community. Future research suggests that the relationships between different components of trauma exposure and different manifestations of PTSD should be examined further.     

Assessment of the Refined Aging Semantic Differential: Recommendations for Enhancing Validity

The US population is aging. Traditional perspectives have emphasized that a substantial increase in the number of gerontological social workers is needed to care for this population. However, published evidence demonstrates that, along with population growth, economic and social factors must be taken into account before predicting future gerontological social work demand. Structural lag theory is introduced to explain how these factors affect the profession and may limit its presence in gerontological work settings. Recommendations are made to correct the lag, allowing the social work profession a more substantive voice in the aging enterprise.     

Lesbian and Gay Elders and Long-Term Care: Identifying the Unique Psychosocial Perspectives and Challenges

This qualitative study of lesbian and gay elders seeks to identify the psychosocial challenges this community faces regarding long-term care. Two focus groups were conducted among 16 gay elders in community and long-term care settings. Participants reported fear of being rejected or neglected by healthcare providers, particularly personal care aides; fear of not being accepted and respected by other residents; fear of having to go back into the closet if placed in long-term care; and a preference for gay-friendly care. Participants suggested staff training to promote acceptance and respect for gay people, and favorably perceived gay-specific and gay-friendly living arrangements.     

Interview group therapy: Process and effects 1

Abstract

This article identifies major forms of institutional racism in the United States today. It considers how taken together they form a web of oppression which obstructs economic, social, and political mobility for people of color while white people are issued passports of privilege. The implications of this enduring form of social inequality for social workers and other helping professionals are considered.     

Staying Strong: Gender Ideologies among African-American Adolescents and the Implications for HIV/STI Prevention

This paper explores adolescents' definitions of what it means to be a man and a woman, the psycho-social context surrounding the formation of gender ideologies and their relationship to HIV/STI prevention. Semi-structured, in-depth interviews were conducted with 50 African-American adolescents living in Baltimore, Maryland. Female gender ideologies included economic independence, emotional strength and caretaking. Male gender ideologies emphasized financial responsibility, toughness and sexual prowess. Findings suggest that stronger adherence to male gender ideologies related to toughness and sexual prowess is influenced by male participants' perceived inability to fulfill their primary gender role as economic providers and the importance of gaining approval from male peers in the absence of adult male role models. Stronger adherence to female gender ideologies related to emotional strength and caretaking may be linked to a heightened desire for male intimacy and tolerance of male sexual risk behavior. Implications of the gender ideologies documented and their commonalities are discussed in terms of HIV/STI prevention.