Clinical supervision: Its role in “Containing” countertransference responses to a filicidal patient

This paper illustrates the role of supervision in processing countertransference responses with might have disrupted the therapist's empathy with a patient who had killed her child. The clinical material demonstrates how the therapist's responses of initial denial and subsequent disgust and fear were dealt with in supervision. As a result, the treatment process led to genuine, albeit limited, therapeutic change in a patient with severe character pathology.This paper is developed from a presentation of the case of Mrs. Jay at Department of Psychiatry Grand Rounds, University of Cincinnati College of Medicine, on May 2, 1989.     

Net worth and the economic diversity of the elderly

Using data from the 1984 panel of the Survey of Income and Program Participation (SIPP), this article examines characteristics of the older population disaggregated by net-worth quintiles. The authors argue that income is not a sufficient measure of economic status for current policy discussions on issues such as changing Medicare co-payments, increasing the taxation of social security benefits, or means-testing under Medicaid. Net worth is a better measure of economic status, particularly for the elderly, because it represents the net value of assets accumulated over the life course. Their results indicate that there is considerable diversity in the economic status of the older population, which is masked by aggregate statistics (such as means and medians) typically used to summarize the economic status of population groups. Stereotypical views of the elderly based on such aggregates result in misdirected policy formulation. In the future, policymakers will need to formulate policies and programs using information on the distributions of income and assets among the older populations rather than relying on statistical aggregates.     

How well is debt managed by nonprofits?

Little is known about why nonprofits accrue debt, how much they owe, and whether the funds they borrow are used productively. This article distinguishes between productive, problematic, and deferred debt. Employing a data base representative of 114,726 tax-filing charitable nonprofits in the United States in 1986, it examines the pervasiveness of nonprofit debt and the relation between this debt and nonprofit financial health. The analysis finds that over 70 percent of the nonprofits hold debt, the distribution of this debt is highly concentrated, and the level of debt and leverage varies with asset size and type of activity. Nonprofits with higher leverage and absolute debt levels are financially healthier than those with lower levels. While the analysis does not determine whether financially stronger nonprofits are better able to borrow, the results support the view that borrowing in the nonprofit sector is economically efficient.     

Our bodies, our families. The family's role in organ donation

The 1968 Uniform Anatomical Gift Act--in keeping with a legal (and medical) concern for individual autonomy--bypassed the family in establishing the legal requirements for cadaveric organ donation, but current practice wisely recognizes a role for families in the decision making.     

Physician perceptions of medical malpractice and defensive medicine

Using judgments obtained in interviews with 33 Massachusetts physicians, the annual statewide volume of expenditures incurred for defensive medical reasons in 1982 was estimated to be $1.0 billion, 12% of all medical care expenditures. Estimates for the nation were $37 billion, 14% of expenditures. Nationally, 180,000 cesarean deliveries were thought to be performed for defensive motives. In their own institutions, respondents judged 43% of all skull x-rays following injury to be medically justified, 30% to be defensive medicine, 16% to be placebos, and 11% to be physician misjudgments. In considering the economic and noneconomic costs of medical malpractice procedures, the dollar costs of insurance were considered most serious, followed closely by defensive medicine, unfairness, and poorer relations with patients. Thirty-two percent of the responsibility for the negative aspects of malpractice processes was assigned to lawyers, 21% to physicians, 18% to legislatures and courts, 16% to patients, and 13% to insurance companies.     

Immigration reform in France and the United States: reflections and documentation

This paper analyzes similarities and dissimilarities in French and American efforts to come to grip with irregular migration. The symbolic importance of immigration reform is argued to be a key political concern in both nations, although the politics of immigration reform has assumed a more partisan flavor in France, particularly since the municipal elections of 1983. In France, the theme of control and security, associated with the notion of preventing "automatic" immigration which would endanger the cohesion of French society, was widely utilized for political ends prior to and after May 10, 1981 (the date of Francois Mitterand's investiture). The American government, on the other hand, is confronted with the unenviable task of obtaining a legislative consensus on legalization and employer sanctions through an approach seeking to harmonize and integrate the demands articulated by various groups: employers, unions, and alien and ethnic interest groups (principally Hispanic groups divided into a hierarchy along a recently arrived/established cleavage). The American situation most sharply differs from the French case in terms of the absence of a right/left political cleavage. The real effects of clandestine immigration are to be found at the local level. In France, as in the US, the ability of local actors to exert pressure raises the fear that legalization and sanctions will change little, except in terms of symbolic legitimacy.