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Objectives. Factors affecting ethnic differences in the use of out-patient mental health services are analyzed in an insured, nonpoor population to determine if lower use by Blacks and Hispanics persists when socioeconomic and other factors are controlled. Methods. To identify significant predictors of the probability and amount of use, insurance claims data for a population of 1.2 million federal employees insured by Blue Cross/ Blue Shield in 1983 were analyzed with the Andersen and Newman model of health service utilization. Logistic and ordinary least squares regression models were estimated for each ethnic group. Results. Blacks and Hispanics had lower probabilities and amounts of use when compared with Whites after controlling for a number of variables. Conclusions. Since ethnic differences in the use of outpatient mental health services exist even in an insured, nonpoor population, factors other than lower socioeconomic status or insurance coverage - for example, cultural or attitudinal factors and service system barriers - are likely responsible. Such findings have policy implications in the current climate of health care reform to increase access to care for the underserved. (Am J Public Health. 1994;84: 222-226), Whites tend to use outpatient mental health services more than other ethnic groups even when insurance coverage is similar among groups. Information from insurance claims filed by 1.2 million federal employees and their families was analyzed. Two options for mental health coverage were available through the health insurance plan. The high-option plan had a lower deductible, a higher copayment and a maximum of 50 mental health visits per year. The low-option plan had a slightly higher deductible, a lower copayment and a maximum of 25 mental health visits. Fifty-eight percent of whites and approximately 75% of blacks and Hispanics chose the high-option plan. Fewer blacks used outpatient mental health services than any other group. Hispanics used outpatient mental health services slightly more often than blacks but had a lower average number of visits. Whites used the mental health services most frequently and had the highest average number of visits. Of women, those on the high-option plan, the more educated and those between 18 and 45 years old had higher rates of mental health service use.

Abstract: Charges for medical services of persons covered by the Blue Cross/Blue Shield Federal Employees Program from 1974 through 1978 who were first diagnosed as having one of four chronic diseases in 1975 and within one year began mental health treatment (MHT) were compared with persons who also were firm diagnosed as having one of these diseases in 1975 but had no subsequent MHT. In the third year following the diagnosis, those having seven to 20 MHT visits had medical charges $309 lower and those having over 21 MHT visits had medical charges $284 lower than the comparison group. The savings in medical charges over three years of the group having seven to 20 MHT visits were a function of lower use of inpatient services and roughly equaled the cost of 20 MHT visits. Outpatient mental health treatment can be included in a fee-for-service medical care system to improve the quality and appropriateness of care and, if not extensive, may also serve to lower medical care costs. (Am J Public Health 1983: 73:422-429.) [ABSTRACT FROM AUTHOR]

A quantitative review of 34 controlled studies demonstrates that, on the average, surgical or coronary patients who are provided information or emotional support to help them master the medical crisis do better than patients who receive only ordinary care. A review of 13 studies that used hospital days post-surgery or post-heart attack as outcome indicators showed that on the average psychological intervention reduced hospitalization approximately two days below the control group's average of 9.92 days. Most of the interventions were modest and, in most studies, were not matched in any way to the needs of particular patients or their coping styles. Beyond the intrinsic value of offering humane and considerate care, the evidence is that psychological care can be cost-effective. [ABSTRACT FROM AUTHOR]

Studies the fears of borderline patients in mid-recovery. Complaints in the termination of psychoanalysis or psychotherapy; Case studies of borderline patients; Expression of sense of uneasiness; Resistance of patients to change.

Focuses on the role of language skills in serving defensive functions. Isolation as a defense mechanism; Expressions of isolation; Importance of listening to the patient; Recognition of defensive operations.

Analyzes the meanings of the term character as used in psychoanalysis. Character as enduring aspect of personality; Character and fate; Description of characteristic ways of behaving; Moral dependability; Compromise formation; Lack of a theory of character in psychoanalysis.

The effectiveness of analytic Interpretation is conditioned by a number of factors within the patient. within the analyst, and within the analytic situation. I will focus on one of these factors, part of the technical activity of the analyst that I will call follow-up interpretation, one which omitted, or even slighted, sharply diminishes the effectiveness of interpretation. [ABSTRACT FROM PUBLISHER]

The article focuses on cognitive attitudes in relation to susceptibility to interference. Many studies have documented the growing conviction that perception in general can be influenced by motivational and situational factors. It is the primary purpose of the paper to show that the search for such generalized relationships bypasses an important source of variables, which condition these relationships. This source is the person himself and the way he is organized to perceive or, more generally, his cognitive organization. A second purpose is to demonstrate the operation of one such variable, which has direct significance for the study of values and needs as they affect perception. Judging sizes, a representative perceptual task, involves not merely the simple matter of comparing retinal-image sizes but is a complex affair in which the entire person can be expected to participate and upon which such extraneous matters as value, need, reward and punishment, may, but need not intrude. This is not to say that the necessary relationship between motivational or personality variables and perception is one of interference, but in the context of most studies in this area and in the investigation to be described, only this aspect of all the possible relationships has been considered.

The widespread acceptance of the Rorschach test introduced by psychologist H. Rorschach as a diagnostic instrument is something of an anomaly in clinical science, for so little is known of the mechanisms or processes that underlie responses to it. The vast bulk of Rorschach research has taken the method itself for granted and has been contented with wide-spanning correlations of Rorschach responses with nosological groupings or with personality traits. Rorschach interpretation has been little affected by these correlations because they tell nothing of "why" in terms of psychological processes. Interpretations have therefore remained curiously frozen and the test has, for the most part, been in research a validating rather than validated instrument. The simplest assumption in approaching processes underlying Rorschach responses is that they do not require a psychology of their own, that Rorschach responses reveal ego processes no different in kind from those appearing in other, apparently quite different, situations which require adaptive response.

A previous study demonstrated that subjects consistently differed in their willingness to experience perceptual organizations contradicting what they knew to be true. Subsequent work has suggested that these individual differences reflect the operation of more general 'cognitive controls'. Results of the previous study, originally described in terms of 'tolerance' and 'intolerance' for one form of instability, are here conceived as representing a cognitive control more aptly described as 'tolerance for unrealistic experiences'. In an attempt to discover the range of applicability of this hypothesized control principle, and to gain further knowledge about it, 30 subjects were tested in a series of laboratory experiments. The Rorschach test was administered to 27 of these subjects. The tests were chosen to bring about unconformable, i.e. unrealistic, experiences by two general means: ( a) by manipulating the physical stimulation so that reality is altered; and ( b) by presenting subjects with relatively ambiguous stimuli for which 'reality' provides no clear-cut confirmation, so that subjects are free to organize them in a number of ways. The results generally support those of the original study and extend the range of situations in which the control principle can account for individual differences. [ABSTRACT FROM AUTHOR]

Presents an obituary for psychologist Philip S. Holzman who died on June 1, 2004, in Boston, Massachusetts, at the age of 82.