The rapid development of managed mental health care systems has created serious problems for psychology. This article addresses several issues that are inherent in the manner in which psychology responds to the development of these systems, particularly whether effective psychological treatment must be compromised in such systems. One model of managed mental health care is described.By 1992, 70% of the American population might well receive health care through a managed care system (Ginsberg et al., 1985). This growth of managed health care is in response to the need for cost containment-a concept which has become the sine qua non for corporations, unions, and the health industry in a time when the cost of health care approaches 11 % of the gross national product. The urgent need for cost containment in health care has created a new marketplace for enterprising health care entrepreneurs, established insurance companies, and Fortune 500 corporations. The proliferating development of an alphabet soup of managed health care systems (HMOs, PPOs, PPAs, IP As, TPAs, and EPOs) has been in response to the need to contain health care costs. This need to contain costs has also provided an opportunity for entrepreneurs to turn a handsome profit. Managed health care is fast becoming big business.Initially, these new health care organizations were not necessarily concerned with quality of
An etiology of maladaptive coping in Chronic Obstructive Pulmonary Disease is proposed and a model for psychotherapeutic intervention with poorly coping COPD patients is presented. Failure in mourning, manifested by a lack of shift in patient's expectations and goals leads to: 1) difficulty in accepting illness related feelings of loss; 2) chronic anxiety; 3) attribution of responsibility for feelings and behavior to external factors; and 4) poor compliance with medical regime. Recommendations for establishing a therapeutic alliance with the poorly coping patient are discussed. Psychotherapeutic intervention aims at: 1) facilitating acceptance of losses and restructuring of life goals; 2) interrupting the cycle of alienation and social withdrawal; and 3) increasing patient's control over affective arousal and respiratory functioning. Utilization of supportive individual psychotherapy, family or marital therapy, and specific behavioral techniques is discussed. Family or marital therapy is seen as the treatment of choice. The psychotherapeutic model proposed is useful in promoting more adaptive coping in the COPD patient.
The purpose of this study was to develop a survey instrument to measure coping responses in working mothers. Coping responses were defined as efforts to prevent, avoid, or control emotional distress. Based on interviews, literature review, and a survey of existing instruments, items were developed to measure these three functions of coping behaviors. The instrument was distributed to 133 married mothers who worked at least 15 hours per week outside the home; response rate was 93%. Nine subscales to measure coping responses in working mothers were identified. Alpha reliability coefficients for the subscales range from .65-.90. Construct validity of the subscales was investigated by examining specified relationships between subscale scores and role strain measures. All but one of the subscales were significantly correlated in the predicted direction with at least one of the role strain measures. The final instrument, the Coping Responses Inventory (CRI), is comprised of 59 Likert format items from which nine subscale scores can be calculated. Some aspects of the reliability and validity of this instrument have been investigated, but confirmation of the findings await further study. Potential uses of the CRI are as an instrument in survey research and as an exploratory tool in counseling interventions with employed women with children.
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