Howard B. Roback

Problematic physicians: A comparison of personality profiles by offence type

Objective: This exploratory study compares objective personality test findings among physicians exhibiting different forms of misconduct. The importance of delineating distinctive personality characteristics by type of offence is that such characterizations can direct therapy and prognosis for remediation. Method: Eighty-eight physicians referred to the Vanderbilt Comprehensive Assessment Program for Professionals (V-CAP) completed the Minnesota Multiphasic Personality Inventory-2, the Personality Assessment Inventory, or both, as part of their evaluation. On the basis of referral information, physicians were partitioned into 3 groups of offenders: “sexual boundary violators,” “behaviourally disruptive,” and “other misconduct.” Results: On both personality measures, the sexual boundary violators generated the greatest percentage of profiles indicative of character pathology. Conclusions: Although all 3 groups exhibited unacceptable behaviours, the pervasive personality features of the sexual boundary violators are associated with greater therapeutic challenge, and these individuals likely pose the greater risk of reoffending.

Group Therapy for Depressed Elderly Women

Abstract We describe and evaluate a group therapy program targeting depression among elderly residents (N=303) of subsidized high-rise apartments in Nashville, TN. This eclectic program was comprised of 12 sessions (a total of 24 hours) that included modules on exercise and preventive health behaviors, cognitive and re-motivation therapy, reminiscence and grief therapy, and social skills development. Our multivariate regression analyses of pre-post measures using the Geriatric Depression Scale (GDS) showed that the effects of the group therapy varied by race, age, and level of initial depression among the participants. The program was effective in reducing depression, but only among Caucasian women who reported at least moderate depression prior to the program, and it yielded greater benefits for women between 55 and 75 years of age.

Insight and hospital adjustment.

The relationship between insight and adjustment in schizophrenics was examined. Subjects who scored higher on a paper-and-pencil insight test were rated by hospital staff as better adjusted behaviourally but described themselves as more psychologically distressed than presumably less insightful subjects. Results were discussed in relation to the notion that insight in schizophrenics may intensify subjective distress while conducing to behavioural adaptation.

Guarding confidentiality in clinical groups : the therapist's dilemma

This study examines the confidentiality practices of highly experienced, well-trained group psychotherapists. A provocative finding was that practitioners rarely inform prospective clients of confidentiality limitations. Their reluctance to do so appears to be based upon the belief that it might discourage persons from entering treatment, as well as having negative ramifications for the therapeutic process (e.g., members may be less likely to talk about unprotected topics). The prevalence and content of breaches in confidentiality are explored. Ethical, legal, clinical, and educational implications of these and other findings are addressed. Research recommendations are offered.

Restoring professionalism: the physician fitness-for-duty evaluation.

OBJECTIVES We compare findings from 10 years of experience evaluating physicians referred for fitness-to-practice assessment to determine whether those referred for disruptive behavior are more or less likely to be declared fit for duty than those referred for mental health, substance abuse or sexual misconduct. METHOD Deidentified data from 381 physicians evaluated by the Vanderbilt Comprehensive Assessment Program (2001-2012) were analyzed and compared to general physician population data and also to previous reports of physician psychiatric diagnosis found by MEDLINE search. RESULTS Compared to the physicians referred for disruptive behavior (37.5% of evaluations), each of the other groups was statistically significantly less likely to be assessed as fit for practice [substance use, %: odds ratio (OR)=0.22, 95% confidence interval (CI)=0.10-0.47, P<.001; mental health, %: OR=0.14, 95% CI=0.06-0.31, P<.001; sexual boundaries, %: OR=0.27, 95% CI=0.13-0.58, P=.001]. CONCLUSIONS The number of referrals to evaluate physicians presenting with behavior alleged to be disruptive to clinical care increased following the 2008 Joint Commission guidelines that extended responsibility for professional conduct outside the profession itself to the institutions wherein physicians work. Better strategies to identify and manage disruptive physician behavior may allow those physicians to return to practice safely in the workplace.

Negative Treatment Effects in Dyadic Psychotherapy: A Focus on Prevention and Intervention Strategies

Therapy holds the potential to harm as well as help. This paper highlights approaches that may help prevent or decrease the incidence of negative effects in psychotherapy. These approaches include supervision, peer consultation, ongoing assessment of the therapeutic process, therapist-client matching, and referrals and transfers. We hope that this paper will serve as a stimulus for clinicians, psychotherapy researchers, and educators to put forth collabo-rative effort into identifying variables directly associated with adverse treat- ment outcomes and determining appropriate prevention and intervention strategies.

The Mid-Life Male Sex-Change Applicant: A Multiclinic Survey

Directors of coordinators of a cross-section of North American Gender Identity Clinics provided descriptive information on 1,637 sex-change applicants and psychosocial, psychosexual, and psychiatric data on 21 middleaged male candidates. To determine the age relatedness of the findings, the mid-life male candidates were then compared on selected characteristics with a random sample of younger biological males seeking sexual reassignment at the Vanderbilt Gender Identity Clinic. The results are consistent with previous findings highlighting the factors at mid-life that intensify the male transsexuals desire for sexual transformation. Viewing the aging gender dysphoria patients surgical request from a developmental perspective promotes appreciation of his predicament and informed consideration of his treatment options.

Feminine gender identity and psychological adjustment of male transsexuals and male homosexuals

Abstract Previously, researchers have compared homosexuals with transsexuals as if these were two homogenous groups. In the present study male to female transsexuals who had applied for sex reassignment surgery were divided into two groups: (a) those who reported either no history or irregular history of cross‐sex dressing initiating after age 20 and (b) those who reported regular cross‐sex dressing since early childhood or adulthood. Homosexuals were divided into masculine and effeminate groups, based on the behavioral Effeminacy Rating Scale. These four groups were then compared on the Feminine Gender Identity Scale (part A) and the Tennessee Self‐Concept Scale (TSCS). Results indicated that transsexuals report preferring more female activities and desiring to be female significantly more since age 6 than did homosexuals. Effeminate homosexuals wished, since age 13, that they had been born female significantly more often than did masculine homosexuals. On the TSCS, none of the group means differed signi...

On the Ethical Group Psychotherapist

This two-part special section is an important effort to frame ethical dilemmas that occur in group psychotherapy and to offer methods of resolution. The invited contributors, who are generally well–known in the group therapy field, note that ethical problems are often complex and that there are times when it is difficult to make ethical and clinical goals fully compatible. For the most part, the contributors confront problematic issues by relying on traditional Western ethical principles; however, due to their working with a diverse, multicultural clientele, we believe that readers would also benefit from exposure to other decision making models. Our commentary concludes with a case example that illustrates this point. In her introductory article, Brabender (2006) presents several ethical principles pertinent to the group psychotherapist. She properly points out, “Guidelines occur in relation to common rather than unusual situations therapists commonly encounter. . . . Guidelines also tend to be generic and fail to capture the nuances of situations in which ethical problems emerge. . . . Because every therapist’s practice has unique aspects, he or she will face circum-

Confidentiality Dilemmas in Group Psychotherapy: Management Strategies and Utility of Guidelines

This article examines how 100 experienced group psychotherapists report that they would manage problematic ethical incidents related to confidentiality. Findings suggest a relation between therapist gender, office location (private practice, public outpatient, hospital), degree of societal threat explicit in the incident (e.g., threats ofphysical endangerment), and management strategies. There is also some indication that psychoanalytically oriented group therapists are less likely than non-analytically oriented clinicians to contact authorities when confronted with psycholegal issues. Limitations in the study and directions for future research are discussed.