ABSTRACT
This article reviews, consolidates, and enhances current knowledge about the issues and problems child and adolescent psychiatry international medical graduates face. Their training, work force issues, and establishment and advancement of professional identity are presented. Acculturation and immigration dynamics include facing prejudice and discrimination, social mirroring, and difficulties with language. Treatment issues are discussed with a special focus on therapeutic alliance, resistance, transference, countertransference, and child rearing practices. Recommendations for training and future goals are considered.
Subject(s)
Adaptation, Psychological , Foreign Medical Graduates , Social Adjustment , Teaching , Acculturation , Adaptation, Psychological/ethics , Adolescent , Child , Child Psychiatry/education , Emigration and Immigration , Foreign Medical Graduates/ethics , Foreign Medical Graduates/psychology , Humans , Prejudice , Professional-Patient Relations , Psychotherapy/education , Psychotherapy/ethics , Social Support , United StatesABSTRACT
Abstract Combined therapy presents ethical quandaries that occur in individual psychotherapy and group psychotherapy, and dilemmas specifically associated with their integration. This paper examines two types of ethical frameworks (a classical principle-based framework and a set of context-based frameworks) for addressing the ethical hot spots of combined therapy: self-referral, transfer of information, and termination. The principle-based approach enables the practitioner to see what core values may be served or violated by different courses of action in combined therapy dilemmas. Yet, the therapist is more likely to do justice to the complexity and richness of the combined therapy situation by supplementing a principle analysis with three additional ethical frameworks. These approaches are: virtue ethics, feminist ethics, and casuistry. An analysis of three vignettes illustrates how these contrasting ethical models not only expand the range of features to which the therapist attends but also the array of solutions the therapist generates.
Subject(s)
Psychotherapy, Group/ethics , Psychotherapy/ethics , Combined Modality Therapy , Confidentiality , Female , Feminism , Humans , Physician Self-Referral , Psychotherapeutic Processes , Psychotherapy/methods , VirtuesABSTRACT
Endorsed as part of ethical practice in group psychotherapy by professional organizations, informed consent is a process of communicating essential information about group treatment to patients so that they can make rational decisions about treatment-whether to enter and how to participate. Its benefits as well as necessary precautions are discussed. The design and implementation of the informed consent process for group is discussed in terms of who should obtain it, when it should occur, how it should be communicated, and what information should be considered for inclusion. Specific suggestions are included as well as a discussion of some potential ethical dilemmas.
Subject(s)
Informed Consent , Psychotherapy, Group/ethics , Decision Making , HumansABSTRACT
The construction and initial psychometric evaluation of an interview assessment of clinically significant impulsivity (Lifetime History of Impulsive Behaviors; LHIB) is presented. Personality-disordered and control subjects participated by completing self-report measures of depression, anxiety and social desirability, along with self-report and laboratory analogue measures of impulsivity, and finally the LHIB. The LHIB demonstrated good to excellent internal consistency and test-retest reliability. Supporting concurrent construct validity, scores on the LHIB correlated with other self-report measures of impulsivity. Diagnostic group differences were obtained and the LHIB evidenced concurrent validity in its ability to classify subjects by scores. No relationship was obtained between the LHIB and laboratory analogue measures. While evidence of discriminant validity was mixed, these data suggest that the LHIB may be a useful instrument for the assessment of impulsive behavior.
