Death, bereavement and traumatic loss in Israel: a historical and cultural perspective.

In the present article, we focus on the experience of bereavement and traumatic loss in Israel and examine the main influences that continue to shape them. For the Jewish population the main features are: religious aspects stemming from Jewish tradition and its variants; the secular and contemporary traditions, the ethos of the Israeli state, and the influence of the struggle to reestablish the Jewish people in its homeland. In an increasingly multicultural society, significant changes are occurring. A series of vignettes of grief and mourning illustrate current issues and practices among religious, secular, kibbutz, Russian and Ethiopian segments of society. The remainder of the article discusses emerging patterns of response to bereavement that are socially constructed and historically situated. We follow the variations in these patterns, from shifting forms of memorialization on the collective level to changes in expressive mood on the individual level, which are mediated by the cultural mosaic of the society. Mental health professionals would benefit from an understanding of the multifaceted fabric of beliefs and cultural-specific customs that shape the mourning rituals and their meanings for the bereaved.

A new measure for assessing the physical activity behaviors of persons with disabilities and chronic health conditions: the Physical Activity and Disability Survey.

PURPOSE: Assess the psychometric properties of the Physical Activity and Disability Survey (PADS), a new physical activity measure for persons with disabilities and chronic health conditions. DESIGN: Cross-sectional and pre-post designs were employed. SETTING: A Midwestern university fitness center. SUBJECTS: Participants were 103 individuals with disabilities and/or chronic health conditions. MEASURES: The Physical Activity and Disability Survey (PADS), peak oxygen uptake (peak VO2), maximum workload (MW), and time to exhaustion (TE) during exercise. RESULTS: Factor analysis revealed a four-factor model that generally corresponded to PADS subscales. Cronbach alpha coefficients ranged from .67 (Exercise) to .77 (Time Indoors). Test-retest reliability (1-week interval) ranged from .78 (Time Indoors) to .95 (Leisure Time Physical Activity). Interrater reliability ranged from .92 (Household Activities) to .99 (Exercise, Leisure Time Physical Activity, Total Activity). Significant (p < .05) correlations were found between PADS subscales and absolute peak VO2 (Leisure Time Physical Activity, Household Activity, Total Activity), relative peak VO2 (Exercise, Time Indoors), MW (Time Indoors, Household Activity), and TE (Household Activity, Total Activity). Analyses of variance revealed that, unlike controls, health promotion program participants evidenced significant pre-post gains as measured by the Exercise subscale and Total Activity score. CONCLUSIONS: The findings lend support for the reliability and validity of the PADS as a measure of physical activity of groups who are sedentary and disabled.

Ethical dilemmas, good intentions, and the road to hell: a clinical-ethical perspective on Yalom's depiction of Trotter's therapy.

Fiction in literature can assist in the analysis of therapeutic and ethical dilemmas in psychotherapy. Lying on the Couch (Harper Collins, 1997), Yalom's account of Dr. Seymour Trotter and Mrs. Belle Felini's therapeutic encounter, describes a complex series of issues and dilemmas. In the present article a reanalysis of the case from the perspective of a clinical and ethical consultation is presented. The therapeutic crisis that preceded the sexual relationship and the initial presentation of the client are considered in detail. Following the discussion of each of these periods, alternative modes of understanding and intervening in the treatment are presented. The in-depth exploration of a fictional case such as this one allows therapists to critically evaluate the decisions that underlie problems in the therapeutic encounter. The article concludes with specific recommendations for clinical and ethical practice.

Barriers to exercise in African American women with physical disabilities.

OBJECTIVE: To examine what factors African American women with one or more physical disabilities perceive as barriers to exercise and how they rank them. SETTING: Department of Disability and Human Development at a major university. STUDY DESIGN: Data were collected through telephone interview using a newly developed instrument (Barriers to Physical Exercise and Disability [B-PED]) that addressed issues related to physical activity and the subjects' disability. SUBJECTS: Fifty subjects were asked questions about their participation and interest in structured exercise. RESULTS: The four major barriers were cost of the exercise program (84.2%), lack of energy (65.8%), transportation (60.5%), and not knowing where to exercise (57.9%). Barriers commonly reported in nondisabled persons (eg, lack of time, boredom, too lazy) were not observed in our sample. Only 11% of the subjects reported that they were not interested in starting an exercise program. The majority of subjects (81.5%) wanted to join an exercise program but were restricted by the barriers reported. CONCLUSION: African American women with a physical disability are interested in becoming more active but are limited in doing so because of their inability to overcome several barriers to increased physical activity participation.

When expertise and ethics diverge: lay and professional evaluation of psychotherapists in Israel.

Do psychotherapists' unethical practices influence how they are perceived? The 202 Israeli lay and professional psychology participants rated systematically varied descriptions of effective therapists and potential clients under conditions of no difficulties (standard), practice without a license, and a previous sexual boundary violation on indexes of evaluation and willingness to refer. Participants completed a measure of important variables in therapist selection. Effective standard therapists were rated most favorably, unlicensed therapists were rated favorably, and therapists who violated sexual boundaries in the past were rated least favorably. When results were analyzed by respondent characteristics, laypersons rated unlicensed professionals (p < .01) and sexual boundary violators (p < .0001) more positively than did clinical psychologists. Men rated the violators more favorably than did women (p < .05). Factor analysis of therapist selection measures identified professional and personal factors, but only the former were associated with ratings of "problem" therapists. The results underscore the gap between ethical standards and applied decisions made by professionals and laypersons. Further investigation is needed to ensure quality care in both professional and consumer approaches to psychotherapy.

Physical activity patterns of African-American women with physical disabilities.

UNLABELLED: There is a dearth of research on the exercise and activity patterns of persons with disabilities, particularly minority women with disabilities. This lack of information makes it difficult for public health officials to set policy guidelines for this segment of the population. PURPOSE: The purpose of this study was to survey the exercise and activity patterns of African-American women with severe physical disabilities (N = 50). METHODS: The Physical Activity and Disability Survey (PADS) was created for subjects who have a severe limitation in movement and function (e.g., limited ability to stand or walk, needs an assistive aid to ambulate, needs assistance with activities of daily living). Reliability data were obtained on the PADS for interrater, test-retest, and internal consistency on the two subscales (Exercise and Activity). The Exercise subscale had an interrater reliability of 0.83 and test/retest reliability of 0.85. The Activity subscale had an interrater reliability of 0.68 and test/retest reliability of 0.66. Cronbach's alpha for internal consistency was 0.78 for the Exercise subscale and 0.68 for the Activity subscale. RESULTS: Results showed very low levels of exercise and general activity patterns in African-American women with physical disabilities. Only 8.2% of the sample participated in leisure-time physical activity, and only 10% engaged in aerobic exercise three or more days per week for at least 15 min. Unstructured physical activity (e.g., work-related activity, housework, gardening, shopping) was nearly absent. CONCLUSION: Our data suggest that the extremely low levels of self-reported physical activity in African-American women with severe physical disabilities expose them to a higher risk of secondary health conditions.

The two-track model of bereavement: overview, retrospect, and prospect.

Sustaining meaning in life, maintaining emotional well-being, and balancing attachments to the living and the deceased are features associated with the psychological (and often private) impact of loss. In the Two-Track Model of Bereavement, the loss process is conceptualized along two distinct but interactive axes that attend to these overt and covert aspects of the response to loss. Whereas Track I is concerned with biopsychosocial functioning in the wake of loss, it is Track II that focuses on the bereaved's ongoing emotional attachment and relationship to the deceased. The contributions of the model to theory and research can serve to clarify our thinking about bereavement as a process resonating throughout one's life. Initially, research and clinical findings from bereaved parents are presented to illustrate the Two-Track Model and its contribution to the deepening of our understanding of loss throughout the life cycle. The contributions of the model to clinical practice are then considered for their ability to clarify our thinking and interventions. Two clinical cases illustrate situations where a predominant focus is on one or the other of these tracks. Ultimately, the Two-Track Model of Bereavement's use extends to the organization and clarification of theory, research, and clinical work.

Reconsidering the transference paradigm in treatment with the bereaved.

What is to be expected of bereaved people years after a loss? How will life be lived following the conclusion of the mourning process? Answers to questions such as these are inherent in the use of terms such as recovery following loss or the resolution of bereavement. From the perspective of the Two-track Model of Bereavement, it should be clear that the outcome of loss needs to be examined along the dimension of functioning, where the term recovery might well be adequate, and along the dimension of the continuing relationship to the deceased, where resolution would be the more precise term. When one considers the impact of bereavement upon the individual years following the loss, it is well to keep in mind that both recovery and resolution range across the continuum, with varying degrees of adjustment, coping, and continued relationship to the representations of the deceased neither fixed nor static. In many ways, the continuing relationship to the deceased is similar to the relationships we have with living individuals. The more comfort and openness characterize the connection to memories and thoughts of a particular relationship, the greater the likelihood that the relationship is not a focus of conflict or difficulty requiring intervention. Changes in the relationship to the deceased will continue across the life-cycle. The presence of flexibility and resilience in the internal object world are important features of the individual's ability to deal with the ebb and flow of a life course.

Overweight prevalence in persons with Down syndrome.

Prevalence of overweight among the general population has been reported to be 33% for males and 36% for females. We undertook this study to establish overweight prevalence data in a cohort with Down syndrome and to stratify the incidence of overweight by living arrangement. We measured Body Mass Index (BMI) in 283 persons with Down syndrome and found a higher prevalence of overweight in this group compared to the general population. Individuals with Down syndrome living in a family setting had a higher incidence of overweight than did those living in a group home setting. Overweight prevalence among persons with Down syndrome should be considered a major public health concern that warrants further attention from researchers, practitioners, family members, and individuals with Down syndrome.

Residential independence of former special education high school students: a second look.

The residential independence of postsecondary students was assessed in 5,462 parents or surrogate parents of students with disabilities from the National Longitudinal Transition Study who had left United States high schools between 1985 and the time of the questionnaire in 1990. An index of residential placement independence served as the dependent variable in a hierarchical regression analysis that featured 43 community, family, student, and school program characteristics entered as block-wise predictors (i.e., entered in a controlled order). This analysis produced a multiple R2 of .376: missing data, youths' daily living skills, youths' social skills, youths' maladaptive ("problem") behaviors, and community characteristics all contributed significantly to the prediction of the postschool residential independence of former special education students during the first 5 years after they had left secondary school.

Exploring the social construction of bereavement: perceptions of adjustment and recovery in bereaved men.

The general public's view of bereavement in Israel was studied by means of a series of vignettes describing various reactions of a man at mid-life alternately to the death of an adult son and then to the death of a spouse. Respondents believed that the bereaved were particularly affected when the deceased was an adult child; functioning was impaired; and the relationship to the deceased was conflictual. A continuing relationship to the deceased was considered normative five years after death. Implications for theory and clinical practice are offered.

Electrophysiological indices of lexical processing: the effects of verb complexity and age.

To further investigate the effects that argument structure can have on language processing, reaction-time (RT) and event-related potential (ERP) data were collected for 14 younger subjects (M = 23 years) and 13 older subjects (M = 66 years). A cross-modal lexical decision (CMLD) task, involving online processing of high- and low-complexity verbs embedded in sentences, was used. Results of a baseline nonlinguistic visual ERP task indicated that the older group of subjects demonstrated significantly longer P300 latencies and significantly lower P300 amplitudes than the younger subjects. In the sentence task, younger subjects exhibited significantly higher P300 amplitudes when processing high- versus low-complexity verbs, with a similar pattern noted for the older subjects. P300 latencies were significantly shorter for the older group than the younger group. Neither P300 latencies nor RTs were significantly related to verb complexity, although medium to large effect sizes were present. Overall, these findings support earlier notions of argument structure effects.

Psychotherapy and supervision with a bereaved Moslem family: an intervention that almost failed.

Families responding to loss are units that function and are embedded in particular cultural frameworks. The adequate clinician learns to work with different individuals and problems over time, and in this process he or she learns about the importance of a range of variables including sex roles, age, socioeconomic circumstance, and the like. In parallel fashion, the developing clinician also learns to work with different cultural and religious contexts as they affect and frame the client's experiences.

Parental and relationship representations and experiences of depression in college students.

Young adults' descriptions of their parents and their relationships with their parents were used to reexamine the relations between object representation and depressive experience. One hundred eight students completed (a) four open-ended descriptions, including two written descriptions of the parents (mother and father, separately), and two written descriptions of the relationships with the parents; and (b) the Depressive Experience Questionnaire. Each of the four open-ended descriptions was rated on seven scales. Factor analysis yielded four distinct factors from the 28 dimensions of the descriptions. These factors were related to: (a) the degree of elaboration and investment, (b) the structural level of the descriptions, (c) the affective tone of the description of the father, and (d) the affective tone of the description of the mother. Significant differences and interactions were found regarding the interplay between the specific significant other represented (father or mother) and the specific framework of representation (parent description or relationship description). Measures derived from parents' and relationship descriptions significantly predicted depressive experiences of self-criticism and dependency. The results indicate the advantages of a joint exploration of the representation of distinct significant others (mother and father) and the use of two modes of relatedness (describe parent and describe relationship with parent) in the process of personality assessment.

At the border of supervision: critical moments in psychotherapists' development.

Supervision in psychotherapy is a complex series of tasks for both supervisor and supervise/therapist. At times, the anxiety experienced by the supervises within a highly charged supervision can signal critical opportunities for their professional development. At these junctures, the supervisor's understanding and interventions are not always sharply distinguished from the skills of the psychotherapist. Three cases of supervisory intervention into learning impasse are presented to illustrate the resemblance between the practice of psychotherapy and supervision. While supervision is not psychotherapy, a subset of listening and intervention skills are common to both.

Using computerized testing in the psychiatric hospital.

This article addresses the uses of the computer in psychological testing and particularly in reference to its use in psychiatric hospitals. Psychologists have received the training necessary to administer and interpret psychological tests. Psychological tests have been used for assessing the patient's level of intellectual functioning, for a better understanding of personality dynamics, for the recognition of organic factors affecting patients' behavior, and for making differential diagnoses. At present there have been numerous attempts to computerize the administration, scoring, and interpretation of standardized psychological tests, but the reliability and validity of these programs is still in question. There exists a tremendous variation in the quality of the software products available. Other issues are who takes responsibility for the statements made in the computerized report, and who administers the tests and under what conditions.

Mourning distinct from melancholia: the resolution of bereavement.

The premise that mourning has been satisfactorily completed when symptoms associated with the response to loss subside is rejected. The emphasis on the bereaved's behavioural functioning in adjustment to loss has tended to overshadow the recollected relationship to the deceased as a major dimension in the resolution of loss. Elaborating the two-track model of bereavement (Rubin, 1981), the author focuses upon the relationship to the representations of the deceased from the object relations point of view. The active relationship between representations of the deceased and the bereaved's self-representations define resolution of loss. Two cases are presented to illustrate the thesis.