Sherwyn M. Woods

Litigation in Residency Training Programs and Suggested Due Process Guidelines for “Residents in Trouble”

Litigation involving the dismissal of residents has increased in the past decades. A review of relevant court decisions and their implications for residency training programs is provided. To assure due process in such cases and to help programs deal fairly with situations involving problem residents that may never come to frank dismissal, a set of guidelines to assist training programs in dealing ivith residents “in trouble” is presented. The guidelines were developed collaboratively at University of California at Los Angeles (UCLA) and the University of Southern California (USC) and were reviewed and approved by the local hospital, university, and Veterans Affairs counsels to assure compliance with institutional policies and procedures regulating due process for employees and students. The guidelines were also reviewed and approved by an American Association of Directors of Psychiatric Residency Training (AADPRT) task force, but they were never published or widely distributed. Although modifications of these guidelines may be required to meet local educational or institutional variations, or to meet variations in state law or precedent, these suggestions provide a useful template with which to develop adequate and effective due process procedures.

Observed psychotherapy: What the patients say about it.

While educators generally consider demonstration psychotherapy to be useful, its effect on patients has been insufficiently studied. Several years of experience suggests that observation through a one-way mirror only minimally influences the process of dynamic, insight-oriented psychotherapy. This was confirmed by a survey of the attitudes and evaluations of 18 former demonstration patients obtained by semistructured follow-up interviews. Seventeen of these 18 neurotic or character-disordered patients believed their observed therapy had been valuable. Five thought observation significantly altered therapy, one negatively. Questions of treatment outcome, alteration of process, projection, elaboration of affect-laden material, withholding, exhibitionism, and other related topics were surveyed and are discussed as they relate to observed psychotherapy. Precautions regarding structure and professionalism are recommended for implementing this effective teaching method. Therapists and observers are more concerned about the negative effects of observation than are patients, and, in general, more than is warranted.

Unusual Sexual Syndromes

Sexual behaviors differ from society to society and from individual to individual. Beliefs about which sexual practices are good, moral, and natural and which are wrong, immoral, and unnatural are mutable. Certain types of sexual behaviors are thought to be exhibited by only a small portion of the people of our society. Because of the presumed rarity and because of the difference between these practices and accepted sexual norms, these sexual behaviors are of interest to those who study human behavior. In this chapter we will attempt to review objectively the information available on the syndromes of necrophilia, vampirism, zoophilia, autoerotic asphyxia, coprophilia, rare types of incest, and hypersexuality. The intention is to provide the reader with a clear and objective view of the range of human sexual behavior.