This study was an attempt to replicate the findings of earlier research in which conclusions were based on a questionable interpretation of statistical results. A 2 × 2 repeated-measures analysis of covariance did not confirm, as had been previously reported, greater heart-rate recovery for 20 aerobically fit subjects as opposed to 20 unfit subjects following psychosocial stress. Two indices of electrodermal activity and State-Trait Anxiety Inventory responses also were utilized. Only the comparison between groups for Trait Anxiety was statistically significant.
Although alcoholism is often regarded as an intractable disorder that requires intensive treatment, studies of the natural history of alcoholism indicate that unaided, spontaneous recovery may be the most common pathway to remission from alcoholism. Negative environmental consequences of alcoholic drinking have been invoked to explain spontaneous recovery, but a more compelling reason for sudden changes in drinking behavior concerns shifts in the personal meanings surrounding alcohol use. Extensive interviews in a multimodal format were conducted with two groups of alcoholics: one group comprised of 7 subjects who spontaneously recovered without treatment and the other group comprised of 9 people who believed formal treatment was necessary to abstain from drinking. Spontaneously recovered alcoholics reported experiencing vivid sensations and images at the time they decided to quit drinking, and they reported subsequent transformations of their personal identities. Active alcoholics reported no comparable experiences in imaginal, sensory, and cognitive modalities. Implications of the results for current alcoholism treatments are discussed.
Jamieson, Evans, and Cox discuss several issues regarding our previous attempt to replicate their work. Three aspects of their reply are addressed as they relate to our research.
Receiving a subpoena or court order are among the most stressful and potentially confusing events for mental health practitioners. This chapter explains the private practitioner’s obligations when receiving a subpoena, important steps to take before releasing client records or answering questions about a client’s treatment, and how to respond in a manner that does not jeopardize the client’s rights or welfare. The various types of subpoenas are explained, the practitioner’s actual obligations and options for responding are reviewed, and the steps to take to incorporate the client’s wishes and best interests are addressed. Recommendations are provided for how to prepare for the possibility of receiving a subpoena regarding any current or former client, the role of legal and risk-management consultation in these matters, and how consultants may assist clinicians to protect themselves and their clients’ interests while complying with legal obligations.
Knowing what to do with client records can be a challenge for mental health practitioners. Those in private practice will need to make these decisions themselves given that they cannot rely on a records office or some other entity found in many agencies and hospitals. This chapter addresses each mental health practitioner’s ethical, legal, and clinical obligations with regard to assessment and treatment records when the professional relationship ends. How to store records, when and how to destroy them, confidentiality requirements, and legal obligations are each addressed. Further, the role of treatment records beyond one’s work with clients is explained to assist clinicians in best meeting former clients’ ongoing mental health treatment needs. The importance of maintaining treatment records as a risk management strategy should complaints be received at a later date is explained.
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