Military Fitness-for-Duty Evaluations.

Article · January 2006with 990 Reads
Abstract
Fitness-for-duty evaluations make up a broad field because of the wide variety of duties, expectations, responsibilities, work environments, and skills needed by the many different types of jobs performed in the military. The most common fitness-for-duty evaluation will answer the following question: Are particular service members able to safely and effectively perform their jobs from a mental health or neuropsychological standpoint? Other, more focused evaluations may also be requested for the assessment of individuals to perform specialized duties or hold a particular status, as well as disability evaluations and forensic assessments secondary to court-ordered sanity boards. Although this chapter's primary focus is on traditional fitness-for-duty evaluations, a short discussion of several of these other forms of evaluation is also included. To provide some clarity about the fitness-for-duty evaluation process, this chapter discusses key issues that commonly arise in these types of evaluations. However, as there are some relatively minor idiosyncrasies among the services, it is recommended that the reader consult that service's regulations for specific guidance. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

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    Experimentally studied interpersonal dynamics in a prison environment by designing a functional simulation of a prison in which 21 male undergraduates role-played prisoners and guards over a 1-wk period. All Ss completed the Comrey Personality Inventory, the Mach IV Scale, and the California F Scale prior to the simulation, and there was no evidence of any pathology. 10 Ss played prisoners for the entire week and 11 played guards on a standard 8-hr shift. Neither group received any specific training. Continuous observation of the interactions was supplemented with videotapes, questionnaires, self-report scales, and interviews. All data lead to the conclusion that this simulated prison developed into a compelling prison environment, and as such, it elicited intense, realistic, and often pathological reactions from the participants. A loss of personal identity by the prisoners and the arbitrary control of their behavior resulted in a syndrome characterized by passivity, dependency, depression, and helplessness. Guards, however, experienced gains in social power, status, and group identification. The most dramatic coping behaviors used by 5 prisoners resulted in acute emotional disturbances which led to their early release. At least 1/3 of the guards were judged to have become more aggressive and dehumanizing than would have been predicted in a simulation study. Social implications are discussed in terms of the pathological prisoner syndrome. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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    In 1991, the Department of Defense (DoD) initiated a program designed to train doctoral-level psychologists to prescribe psychotropic medications. The program is housed in the psychology department at Walter Reed Army Medical Center (WRAMC); trainees receive didactic instruction at the Uniformed Services University of the Health Sciences and clinical training through the departments of psychology and psychiatry at WRAMC and Malcolm Grow Air Force Medical Center. Since its inception, the training curriculum has evolved from a standard medical school, basic sciences sequence to a tailored program designed specifically to meet the goal of training psychologists to become proficient in the independent use of psychopharmacological agents. To date, the program and its curriculum have not been described in detail in the literature. This article provides an archival reference of the DoD program by means of a review of successive versions of the curriculum and a comparison of these versions to other published models for training psychologists to this end. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
  • Article
    Military psychologists often find themselves in situations having the potential to compromise their professional ethics. Although conflicts in confidentiality are frequently the issue, multiple relationship development is also a significant concern. Case examples involving multiple relationship issues are presented, and the American Psychological Association's (APA's; 1992) guidelines concerning multiple relationship expectancies are considered. Decision-making frameworks are reviewed, and an adaptation of M. C. Gottlieb's (1993) model for multiple relationship resolution is proposed. The authors suggest recommendations for training and supervision, and they encourage continued collaboration between the APA and Department of Defense so that these dilemmas may be more adequately addressed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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    Proposes that the opening of the 1980's has produced serious socioeconomic strains on the profession of psychotherapy. Governmental support for the training and practice of psychotherapists has shrunk rapidly due to both the conservative philosophies of the party in power and the complexities of an economy plagued by both recession and inflation. At the same time, employers, unions, and insurance companies, eager to contain rapidly escalating premiums for group health insurance, are steadily eroding reimbursement funds available to patients who wish to enter psychotherapy. These social developments are likely to have far-reaching effects on the profession of psychology, creating irresistible imperatives for practitioners to develop more effective strategies for short-term psychotherapy. While behaviorally oriented psychotherapists should not find this challenge too difficult, those with other theoretical allegiances will be hard pressed. It is suggested that principles from psychoanalytic personality theory and from systems theory should be integrated. The new approach is illustrated with case examples. (14 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
  • Article
    Innovative programs in the Department of Defense have challenged health psychologists to broaden their scope of practice. To this end, health psychologists at Tripler Army Medical Center independently admit and discharge patients and serve as primary care managers during hospitalization and follow-up aftercare. A conceptual overview of the Tripler health psychology training philosophy and how the training model has guided Army health psychology in managing, rather than simply consulting, on the care of patients will be offered. Practical considerations and a training curriculum are provided. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
  • Article
    Malingering is of two types: the primary, premeditated, without underlying illness; and the secondary, in which a symptom is feigned under the pressure of a true anxiety state. The former is more difficult to uncover; the latter is readily given up, as less is to be gained. Supposed psychiatric syndromes are a particularly fertile field for the malingerer, as he believes that they cannot be detected by objective means. However, he overplays and does not show the acute distress and physical disturbances of the true battle neuroses. His fellow soldiers are usually aware of his designs. Diagnosis in suspected cases is simplified by sodium amytal narcosis. Malingerers of both types resist it and fail to show the productivity of the neurotic. Their overwhelming conscious effort to maintain their deception cannot be broken through by this method. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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    The U.S. Department of Defense Psychopharmacology Demonstration Project (PDP) to train military psychologists to prescribe psychotropic medications has been one of the most highly scrutinized programs of its kind. This article provides a retrospective analysis of the PDP by examining studies of the project by external sources, including Vector Research, Inc., the U.S. General Accounting Office, and the American College of Neuropsychopharmacology. The authors conclude that the PDP successfully achieved a primary objective for which it was established by demonstrating that licensed psychologists can be trained to provide safe, high-quality pharmacological care. As such, the project serves as a foundation for efforts to include prescription authority in state licensing laws and for the further development of a psychological model for prescribing. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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    Training in primary care medicine in the past decade has included more attention to the psychosocial issues of patients. With this shift, psychologists have new opportunities to collaborate with medical providers to provide comprehensive health care to medical patients and their families. Systems theory and biopsychosocial medicine provide compatible theories to underpin this collaboration. Suggestions are made for overcoming the considerable barriers to implementation of this model, and examples of creative collaboration are described. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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    Suicidal patients are difficult and challenging clinical problems. Conceptual tools aid the clinician in organizing and evaluating the clinical situation. The authors provide a framework for suicide risk assessment that emphasizes 2 domains–history of past attempt and the nature of current suicidal symptoms–that have emerged in suicide research as crucial variables. These domains, when combined with other categories of risk factors, produce a categorization of risk for the individual patient, leading, in turn, to relatively routinized clinical decision making and activity. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
  • Article
    This article identifies and clarifies some of the methodological issues responsible for inconsistencies in the literature regarding outcome of mild head injury. These issues include classification of head injury severity, biases in selection of patients with mild head injury, and use of controls to account for comorbidities related to other system injuries, preexisting conditions, and emotional reactions to and circumstances surrounding the accident. (C) Williams & Wilkins 1993. All Rights Reserved.
  • Article
    ABSTRACT The first genuine psychobiography, Sigmund Freud's Leonardo da Vinci and a Memory of His Childhood (1910/1957b), presented several important guidelines for psychobiographical research Among them were the rejection both of pathography and of idealization, and the avoidance both of arguments built upon a single clue and of strong conclusions based upon inadequate data Though the guidelines are sound, Freud violated those guidelines in the very work where they first appeared Freud's methodological errors and his “obsession” with the Leonardo book are traced in part to his projective identification with Leonardo, incorporating aspects of his own sexual history and his anxieties about the future of the psychoanalytic movement
  • Article
    Suicide terrorism is rising around the world, but the most common explanations do not help us understand why. Religious fanaticism does not explain why the world leader in suicide terrorism is the Tamil Tigers in Sri Lanka, a group that adheres to a Marxist/Leninist ideology, while existing psychological explanations have been contradicted by the widening range of socio-economic backgrounds of suicide terrorists. To advance our understanding of this growing phenomenon, this study collects the universe of suicide terrorist attacks worldwide from 1980 to 2001, 188 in all. In contrast to the existing explanations, this study shows that suicide terrorism follows a strategic logic, one specifically designed to coerce modern liberal democracies to make significant territorial concessions. Moreover, over the past two decades, suicide terrorism has been rising largely because terrorists have learned that it pays. Suicide terrorists sought to compel American and French military forces to abandon Lebanon in 1983, Israeli forces to leave Lebanon in 1985, Israeli forces to quit the Gaza Strip and the West Bank in 1994 and 1995, the Sri Lankan government to create an independent Tamil state from 1990 on, and the Turkish government to grant autonomy to the Kurds in the late 1990s. In all but the case of Turkey, the terrorist political cause made more gains after the resort to suicide operations than it had before. Thus, Western democracies should pursue policies that teach terrorists that the lesson of the 1980s and 1990s no longer holds, policies which in practice may have more to do with improving homeland security than with offensive military action.
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    Multicultural competence can be defined as the ability, to understand and constructively relate to the uniqueness of each client in light of the diverse cultures that influence each person's perspective. Because the complexity, of culture is often overlooked, multicultural research often inadvertently strengthens the stereotypes that it is intended to thwart. To avoid stereotypic thinking, clinicians must critically evaluate cross-cultural research and be thoughtfully creative in applying it to clinical practice. Twelve suggestions are offered for the use of multicultural research as a source of questions that enhance. respect for clients' cultural identities rather than as answers that foreclose it.
  • Article
    This research relies on a useful focus for finding the contribution of the psychotherapist to the outcome of the treatment: the outcomes of each therapist's caseload. Our data consist of 22 therapists' caseloads within seven samples of drug-addicted and depressed patients. We concluded that (a) there were important differences in the improvement levels and post-treatment outcomes of patient caseloads among the therapists sampled, and (b) these differences in improvement could not be explained by differences in patient background or severity. Some of the differences appeared to reflect the therapists' efficacy with their patients because (a) a unique feature of the design was that three therapists took part in more than one study and therefore more than one caseload; these three therapists showed a similar efficacy in each new caseload, (b) At this time, it may be that the safest basis for choosing therapists for research studies or for clinical purposes is their “work sample” record of efficacy with their previous caseloads.
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    Although psychological debriefing (PD) represents the most common form of early intervention for recently traumatized people, there is little evidence supporting its continued use with individuals who experience severe trauma. This review identifies the core issues in early intervention that need to be addressed in resolving the debate over PD. It critiques the available evidence for PD and the early provision of cognitive-behavioral therapy (CBT). Based on available evidence, we propose that psychological first aid is an appropriate initial intervention, but that it does not serve a therapeutic or preventive function. When feasible, initial screening is required so that preventive interventions can be used for those individuals who may have difficulty recovering on their own. Evidence-based CBT approaches are indicated for people who are at risk of developing posttraumatic psychopathology. Guidelines for managing acutely traumatized people are suggested and standards are proposed to direct future research that may advance our understanding of the role of early intervention in facilitating adaptation to trauma.
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    ABSTRACT A method for the analysis of personal data is described Although primarily directed toward extracting recurring dynamic sequences, “scripts,”“themas,”“guiding messages,” the method can be utilized to assess a host of personality vanables Two major strategies are employed (a) letting the data set reveal itself, and (b) asking the data a question Rules for data extraction and data transformation are discussed Application of the method to work m psychobiography is indicated by example