Hugh Calkins, M.D.

• Director, Cardiac Arrhythmia Service
• Professor of Medicine

https://www.hopkinsmedicine.org/profiles/results/directory/profile/0001055/hugh-calkins

Describing the Transaction as an Adoption rather than a Sale Another misleading practice is labeling the for-profit consumer transaction as an "adoption" rather than a sale allergy testing winston salem nc purchase flonase 50 mcg with mastercard. The term "adoption" suggests that an animal has been orphaned or abandoned and is in need of a guardian allergy symptoms 5 month old purchase 50 mcg flonase mastercard. Animal shelters and rescues have commonly used the term adoption when referring to the process of placing unwanted animals in forever homes allergy treatment parasite cheap flonase 50mcg with visa. Breeders allergy medicine 18 months buy discount flonase 50 mcg, pet shops allergy testing vancouver island 50 mcg flonase for sale, and puppy mills fuel the companion animal overpopulation crisis by bringing more animals into a world that is already bursting at the seams with unwanted ones allergy medicine diphenhydramine generic flonase 50mcg overnight delivery. Many individuals looking to adopt a puppy to help reduce the shelter population allergy testing colorado cheap flonase 50 mcg amex, and to avoid supporting the industry that perpetuates the problem allergy report purchase 50 mcg flonase, find themselves misled and seduced by pet sellers into buying from puppy mills. Well-meaning people can often find themselves misled into purchasing a puppy even when they started out looking to adopt a pet. Pet sellers know that consumers want to support adoption, so some even mislead consumers into thinking that their business supports shelters through donations. As pet stores increasingly use the term adoption for the sale of a puppy, fake recues, like those who offer puppies for a hefty "adoption" fee, are harder to distinguish from legitimate shelters and rescues. New York recently passed a law in an attempt to help crack down on scam rescues after several consumers complained of shelters selling (or "adopting" for a high fee) sick puppies. For specific examples of how this deceptive practice is being implemented, refer to Appendix W. For examples of complaints relating to the practice of advertising puppies commercially raised for sale as up for adoption, see Appendix X, and also refer sale-of-sick-puppies-dogs-now-healthy-available-for-adoption/ (last visited June 7, 2018). Advertising Certain Breeds of Puppies as "Hypoallergenic" A hypoallergenic dog breed is supposedly one who has a predictably nonshedding coat that produces less dander, which is allegedly what causes most pet allergies in humans. Several companies market puppies to customers throughout the United States claiming to specialize in the sale of "teacup" puppies- puppies who are bred to be abnormally small. These teacup puppies are created by the unethical breeding practice of intentionally breeding runt after runt. Because these dogs are not naturally meant to be so small, they are highly susceptible to many illnesses and disorders such as poor bone density, major organ malfunctions, heart murmurs, liver shunts, and digestive issues. Sellers may even sell malnourished puppies in an effort to make them conform to their "micro" or "teacup" marketing. Failing to Deliver the Puppy Purchased As online puppy sales are becoming more prevalent, so are blatantly fraudulent scams that falsely advertise puppies for sale online but fail to deliver any puppy. These scams often involve advertising a puppy for sale(generally below market value), requesting payment by wire transfer, and then asking for additional payments to cover Importing puppies under six months of age for resale was banned in 2014. However, as explained in more detail below, some dealers have ignored this ban or asserted clever loopholes in the law to get around it. Furthermore, there is little evidence that this law has been much of a deterrent because there is no indication that enforcement actions have been taken against importers who bring in underage puppies for resale. Moreover, often these scams start out with an advertisement for a "free" puppy, and once a consumer accepts, the seller then tells the consumer she needs to pay for associated costs, like shipping insurance or a crate. Even if there was an actual puppy involved, these added costs make the representation that the puppy is "free" deceptive. As instructed, she purchased a pre-paid debit card and sent the information to the seller. Legal Actions and Publications Further Evidencing Widespread Deception in the Retail Puppy Sales Industry this section references many legal actions and other complaints brought about by the deceptive practices discussed in this Petition. These actions provide the Commission with empirical evidence regarding how consumers interpret the representations that this Petition argues warrant regulation by rulemaking. Many other consumers express the same misinterpretations and subsequent damage but do not have the resources to pursue timely and costly civil litigation. As such, this section also references a number of media stories about the misleading and deceptive conduct employed by pet sellers. Laymon inappropriately characterized her business as a "rescue" for French Bulldogs as a marketing technique, and to avoid some of the requirements of the Puppy Mill Cruelty Prevention Act, a state animal protection statute establishing a cap on the number of dogs used for breeding and requiring breeders to employ more humane methods. This case ultimately resulted in a settlement that was subsequently breached by the store owners. As a result, the owners were again brought to court for violating the terms of the settlement agreement and court order. Purebred Breeders advertised it only did business with reputable breeders and offered a comprehensive lifetime guarantee. However, as the lawsuit alleged, Purebred was linked to several puppy mills and failed to honor its health guarantee. The suit was dismissed on procedural grounds based on improper joinder, the court never reached the merits of the case, and it was impractical for each plaintiff to refile individually. These deceptive practices resulted in financial and emotional harm, as their beloved puppies have battled serious illness, behavioral issues, and in some cases even suffered premature death. These claims are enhanced by the allegation that PuppyFind has reason to know, through complaints submitted or its duty of ordinary care, that breeders on its website sell sick puppies, have criminal animal cruelty violations, and/or are running puppy mills. Many other consumer protection lawsuits have been brought by other organizations or individual consumers. The legal actions cited above and in the appendix all involve at least one or more of the deceptive practices outlined herein. The cases highlight how pervasive these practices truly are and that they have been utilized for decades. This sampling of lawsuits throughout the country demonstrates to the Commission the real world harms these practices actually or allegedly cause consumers. Despite these numerous individual actions, the deceptive practices pervasively continue. State Actions State consumer protection agencies have also exercised their powers to bring civil suits or take enforcement actions against actors engaging in the type of deception described in this petition. States are often empowered to bring lawsuits on behalf of a larger number of consumers and can obtain relief that is generally unavailable to individual plaintiffs. New Jersey In 2016, the New Jersey Division of Consumer Affairs cited 17 pet shops for violating the Pet Purchase Protection Act and issued nine executive conference letters to discuss inspection violations and impose civil penalties. Porrino and officials with the New Jersey Division of Consumer Affairs filed an action against one of those pet stores, Just Pups, and its owner, accusing the business of misleading customers about the health of puppies sold. The New Jersey Attorney General brought suit against a pet seller for violating the New Jersey Consumer Fraud Act and the Regulations Governing the Sale of Animals. The state alleged that the pet store engaged in unconscionable business practices to include failing to have the pets properly examined by a veterinarian prior Anthony G. Schneiderman Demands Pet Store Chain Stop Illegally Denying Reimbursement To Customers Sold Very Ill Dogs, (July 20, 2017), ag. Underwood Announces Lawsuit To Shut Down Pet Store Chain, Alleging Improper Care Of Puppies And Widespread Fraud And Deception, (May 16, 2018) ag. Despite these complaints, no known enforcement actions have been taken against these stores to date. Schneiderman Announces $20K Agreement With Pet Store Chain Owner Who Abused Animals And Falsified Documents To Make Them Appear Healthy Enough To Sell, (Jan. Pennsylvania Former Pennsylvania Attorney General Kathleen Kane brought a lawsuit against a dog breeder accused of selling sick dogs in violation of the Dog Purchaser Protection Act. For example, in 2016, the office entered into an amended consent judgment with the pet dealer, Wizard of Claws, obligating the pet store to , among other things, "not misrepresent the. Additionally, the office brought an action to stop the illegal importation, breeding, and sale of Bulldog puppies against sellers who falsely represented to consumers the health and age of hundreds of Bulldog puppies. In another action brought by the state, the Court ordered restitution in the amount of $59,700 to consumers who were deceived in connection with the sale of premium English French and Miniature Bulldog dogs and puppies. Additionally, the state attempted to bring charges against a pet seller and her generals-office-cracking-down-on-puppy-mills-and-pet-scams/ (last visited June 7, 2018). However, these cases were dismissed based on the unconstitutionality of the term "alter," which is undefined in the relevant law (Fla. The Court found the ambiguity of the term could lead to the potential for the arbitrary or discriminatory enforcement of the statute, particularly in conjunction with lack of a criminal intent element. Maurice Barrett and Michael Lamprea were charged with illegally selling puppies without the required veterinary inspection. Lamprea entered a plea of not guilty and the state declined to prosecute the case. Barrett eventually pled no contest to a second degree misdemeanor charge of disorderly conduct and mandatory court cost were imposed in the amount of $265. Purebred Breeders agreed to pay $200,000 and give a full refund in restitution to Illinois consumers who purchased a puppy within the last 5 years. Texas In Texas, former Attorney General Greg Abbott charged pet shop owners with making false pedigree claims and selling diseased puppies. News Reports and Other Consumer Complaints the deceptive acts or practices described above are often the subject of consumer reports, news stories, and are commonly described by harmed consumers on various online consumer complaint boards. These complaints vastly outnumber the legal actions described above in part because civil litigation is costly to pursue and many consumers lack the means to take their claims to court. Online platforms and news outlets provide an informal opportunity for these consumers to voice their stories, and their complaints further evidences the prevalence of the industry deception. For instance, over a three-year period, the national Better Business Bureau received over 2,000 complaints regarding pet shops. See Assurance of Voluntary Compliance between the Attorney General of Mississippi and Ashley Nicole Anderson d. Consumers complain about the deceptive or misleading practices they have encountered on dozens of online complaint or review boards such as Yelp! However, none of these laws will be detrimentally impacted, and all can run harmoniously with proposed federal rules. This section identifies those laws and provides an analysis of enforcement considerations. Existing State Consumer Protection Laws Several states, 23 at last count, have enacted Puppy Lemon Laws to protect Joe T. This is especially a concern given the limited remedies available to a consumer who may have already and unexpectedly spent a fortune treating a sick pet. For instance, the typical Puppy Lemon Law restricts the consumer to these common remedies: replacement of the animal, a refund of the purchase price, or reimbursement of veterinary expenses, generally up to the purchase price of the animal. These laws also confine consumers to strict timeframes to discover and report any issues with their pets. Furthermore, the average consumer is unaware of their rights under these laws and many times pet shops pick and choose their remedy of choice presenting it as the only option to the disgruntled customer. Most of the time the option the pet store gives the consumer is to return the dog for a full or partial refund knowing full well the average new pet parent is not going to return their dog. By that time, weeks had passed since Bernstein purchased the dog - too long for [the store] to be liable for covering medical expenses. New York Pet Lemon Law requires a customer to provide proof of medical bills and vet records within 14 days of purchase to receive reimbursement from a store. For example, Brianna Bryan purchased an English bulldog, Lilly, from Chelsea Kennel Club. Bryan "immediately called [the storeowner], who seemed skeptical and insisted Lilly was healthy when at the shop. Under the Lemon Law, [the store] would have to pay for any heart surgery, but Bryan seems unconvinced she will, given her dismissive and unsympathetic tone over the phone. Also, as discussed above, some states require pet sellers to disclose the meaning of pedigree registration. However, again, civil litigation is costly to pursue and many consumers lack the means to take their claims to court. In response to the deficiencies and obstacles just identified, and to provide better protection for consumers and eliminate the sale of puppy mill puppies, California236 and Maryland237 have passed statewide retail sales bans on commercially bred puppies. Local Ordinances and Actions Localities are starting to block the deceptive practices of pet sellers by enacting local ordinances that attempt to address many of the problems outlined in this petition, but they only work on a very local level. As California and Maryland have done, over 260 localities across 20 states in the U. By banning the sale of commercially bred dogs in a locality, the communities are shutting down the deceptive practices happening in those pet stores. See As selling pets online becomes normal, we need to regulate it, supra note 21; Baker, supra note 21. Industry Response Those who speak out against the retail pet industry are often labeled animal rights extremists by the industry and attacked in social media or even in the courtroom. It has become a trend and go-to tool of pet sellers across the nation to attack those who are speaking out against their deceptive practices. Increasingly, advocates are facing lawsuits filed by pet sellers alleging that they have been defamed. Mintz, a consumer who bought what he believed to be a healthy, purebred puppy only to find out he was sold a two-year old dog with several health conditions, was sued by the seller for libel when he published his story on a blog. This is to include, but not limited to the above mentioned, as well as other venues such as the Better Business Bureau and reports to the Attorney General. Local and state laws can function alongside this federal regulation, and each would ultimately strengthen protections for consumers and their pets. However, based on the evidence provided, the Commission can conclude, without conducting its own investigations, that the current acts, practices, and use of the terms at issue are misleading to consumers. Further, the Commission can conclude that these practices cause or are likely to cause substantial injury to consumers. Indeed, the Commission has previously issued alerts about scams relating to the advertisement of puppies that are never delivered. Dogs are intelligent, self-determining, emotional, and have distinct personalities. The rule simply would require pet sellers to disclose information to consumers prior to sale and refrain from engaging in deceptive acts or practices, most of which are already proscribed by general consumer protection laws but often go unfollowed and unenforced. As noted above, there are budgetary constraints to individual enforcement actions. X Definitions a) Adequate exercise and socialization means, for dogs other than puppies under eight weeks old and housed with their mother: (1. This term does not include any entity which is, or is housed on the premises of, a dog breeder or broker, obtains dogs from a dog breeder or broker in exchange for payment or compensation, or resells dogs obtained from a dog breeder or broker and provides payment or compensation to such dog breeder or broker. This term does not include any animal care facility, animal rescue organization, or hobby breeder. If you are covered by this regulation, breaking any of its rules is an unfair and deceptive act or practice or an unfair method of competition under section 5 of that Act. You can be fined heavily (up to $40,000 plus an adjustment for inflation, under §1. In connection with the sale or offering for sale of dogs to consumers in or affecting commerce, as "commerce" is defined in section 4 of the Federal Trade Commission Act, 15 U. The legal name, all registered business names, and physical address of the dog seller, breeder of the dog, and broker, if the dog seller obtained the dog from a broker; ii. The name and business address of the carrier of the dog; the United States Department of Agriculture license number(s) and any state or local license numbers, along with the name of the state or local licensing agency, for the dog seller, breeder of the dog, and broker, if the dog seller obtained the dog from a broker, or written verification that the 105 dog seller, breeder, or broker is not required to have a federal, state, or local license; iv. The number of adult dogs and puppies recorded on the past three state or federal inspection reports for the dog seller, breeder of the dog, and broker, if the dog seller obtained the dog from a broker; v. The breed, age, date of birth, sex, and color of the dog; the name and registration numbers of the sire or dam and the address where they are registered; ix. If the dog was purchased and then returned by a customer, along with the date and reason for the return. A notification that other documentation, including all applicable veterinary records and inspection reports, are available upon request and will be made available regardless of request, prior to completion of sale. For the three years prior to the sale of the dog, a copy of each and every Animal Welfare Act (7 U. For the previous three years, a copy of any and all State or local inspection reports for the dog seller, breeder of the dog, and broker, if the dog seller obtained the dog from a broker, and documentation of any violations of a state or local animal welfare law or regulation by the dog seller, breeder of the dog, or broker, if the dog seller obtained the dog from a broker; iii. A complete record of vaccinations and veterinary care and treatment of the dog, including the name of the person or licensed veterinarian who administered the vaccinations or veterinary care or treatment; iv. A list of known genetic and any related health problem that the breed and lineage may carry; ix. It shall be unlawful for any person to furnish, with respect to any dog, a false guaranty, and any person who violates the provisions of this subsection is guilty of an unfair method of competition, and an unfair or deceptive act or practice, in commerce within the meaning of the Federal Trade Commission Act. Any dog seller utilizing a rating system or consumer reviews or testimonials must a. A law is not in conflict with this Rule if it affords prospective purchasers equal or greater protection, such as more extensive disclosures. Conclusion the Humane Society of the United States respectfully requests the Commission to promulgate a Trade Regulation Rule to address the issues raised in this petition. Puppies are not like motor parts,272 they are unique and cherished members of many Inanimate used cars and contact lenses are more regulated. As such, puppies are in need and deserve well thought-out and specific rules to address the deceptive and misleading acts or practices that are unique to the retail pet sales industry. Centrally located on the home page of this website is a link to information about puppy mills and a claim that "[t]his website exists to connect caring families with healthy puppies. The report also listed a number of additional violations, three of which were "repeat" violations, including unsafe housing, dirty feeders, and dogs kept outside in the cold without adequate protection from the weather. It has also been cited repeatedly for filthy conditions, for keeping dogs in cages that were too small, for not making the facility accessible for inspection, and for numerous other problems. For example, in March 2016, the Campbells were cited for providing inadequate veterinary care, and in September 2016, housing violations were found. This was requested because the company engages in online pet sales and is required to be licensed. This complainant wrote, "I recently had the opportunity to speak with one of the new owners of this newest store. According to the complaint, All Pets Club advertises it "is the only one of its kind in the industry to be regulated and licensed to sell puppies.

An older acquaintance related how once in a gay bathhouse allergy testing for 1 year old safe 50 mcg flonase, he was on the verge of having sex with a very attractive and muscular stranger allergy symptoms phlegm in throat 50 mcg flonase amex, when the stranger spoke allergy testing infants order flonase 50mcg line. When I talk about this with other psychologists allergy medicine 12 hour discount flonase 50mcg fast delivery, the most common suggestion is internalized femiphobia-femininity has been punished so often by the straight world that gay men allergy testing jackson ms discount 50 mcg flonase free shipping, too gluten allergy symptoms in 3 year old flonase 50mcg lowest price, come to hate it allergy relief rexall flonase 50mcg without a prescription. If one is attracted to men allergy symptoms hearing loss purchase 50mcg flonase overnight delivery, then one will be attracted to those with masculine behavior. The second hypothesis implies that femiphobia is not due to societal intolerance but is intrinsic to male homosexuality and is not remediable even by reforming straight society to make it less homophobic. It suggests that across time and place, gay men will desire masculine men, and thus, acknowledging their own femininity makes them feel undesirable. Earlier in this chapter I suggested that having been mistreated as feminine boys is not the only reason gay men tend to react uncomfortably to the implication that they are, or used to be, feminine. It is certainly an unfortunate state of affairs that gay men tend to be feminine, tend to be less attracted to femininity, but tend to be stuck with each other. In those days, most psychologists thought it was an excellent test of mental health. In recent times, the Rorschach has fallen into increasing disfavor, and some of us think it is little better than reading tea leaves. During the past five years several studies have been conducted by giving large numbers of subjects standard psychiatric interviews, including questions about sexual behavior. In these studies, gay men have tended to have more of certain psychological problems than straight men. One study found that gay men were more likely to have a history of suicidal thoughts. One is that gay men have hard lives, particularly due to societal stigma, and this causes unhappiness and mental problems. This is the explanation that people tend to accept automatically, particularly pro-gay people. One of the studies that found higher rates of mental problems among gay men was conducted in the Netherlands. The Netherlands is probably the most tolerant country in the world toward homosexual people. But gay men there were still about three times as likely as straight men to have been depressed during the past year. The problems that gay men are most susceptible to-eating disorders, depression, and anxiety disorders-are the same problems that women also suffer from disproportionately. Alternatively, there may be innate sex differences that make women more susceptible. Part of the explanation for the sex difference in depression involves basic psychological traits. In particular, the personality trait, neuroticism, is one of the strongest predictors of depression. Gay men are also more neurotic than straight men, although they are slightly less neurotic than women. But genetic studies of twins suggest that it Copyright © National Academy of Sciences. Even identical twins separated at birth are similar in their degree of neuroticism. Learning why gay men are more easily depressed than straight men might tell us why women are also. This knowledge would also obviously take us closer to reducing depression among gay men. Therefore, we keep our minds open until science makes us certain we understand the sex and sexual orientation differences in depression. Men commit much more violent crime than women, but women are more depressed than men. Rather, the problems are being violent, depressed, delinquent, demented, or suicidal. One of the sex acts common between gay men is anal sex, and that act requires one man to be penetrated by another. This situation is analogous to that between heterosexual partners, in which a man is nearly always the penetrator, and the woman the receptive partner. Men possess a prostate gland, an erogenous zone which is often pleasurably stimulated during receptive anal sex. Bend Over Boyfriend, an instructional sex videotape showing straight couples how women can (with appropriate equipment) anally penetrate their male partners, was a bestseller. Among gay men, enjoyment of anal penetration might sometimes reflect only a desire to experience a particular type of sexual pleasure, rather than a Copyright © National Academy of Sciences. Similarly, our lab found that gay men who like to be penetrated describe themselves as more feminine than other gay men, although the association was not a strong one. In our analysis of personal advertisements, we also looked at whether advertisers requested or described a preferred sexual role. A slight majority of advertisers described themselves as "bottoms" and sought "tops. I have heard the complaint that at every gay bar there are "1,000 bottoms looking for a top" (though our results suggest that this is an exaggeration). One gay acquaintance related the following story, which is not unusual among gay men: "I met this cute guy at the bar. He seemed so butch and like such a stud, but when I got him home, the first thing he did was throw his legs in the air. The other major factor that has made them vulnerable, however, is their masculinity, and it is to gay masculinity that I now turn. Charlie had met a man at the party that he found attractive, and he was asking Ben whether it was okay if he went home with the man to have sex. Ben assured Charlie that this was fine, provided that he stayed within the bounds of their agreement: they had to use condoms, and the liaison must be exclusively sexual, and not romantic. A couple of years ago, Rick was the sole monogamous holdout I 85 Copyright © National Academy of Sciences. I later learned that the next weekend, Rick and his boyfriend had opened their relationship to include sex with other men in the form of threesomes. The idea of consensually nonmonogamous sexual relationships is, to say the least, challenging to the typical Northwestern University undergraduate. The panel is also asked about the number of sex partners they have had, and their answers always elicit gasps. Still, even using the broader definition of sex, the typical heterosexual Northwestern student finds it amazing that anyone has had so many partners. Although the straight men in my class have difficulty imagining the degree of cooperation necessary to have hundreds of sex partners, they have less difficulty understanding the desire to do so. Many of these experiences were anonymous-some took place in gay bathhouses, for example. Surveys have found approximately 30 to 50 percent of gay men to be attached at any one time, compared to approximately 75 percent of lesbians and even higher percentages of heterosexuals. Social conservatives have taken facts like these as evidence for the decadent and perverse nature of gay men. The currency of evolution-what determines how successful one has been, evolutionarily speaking-is the number of offspring one leaves. If a man had the universal cooperation of women, he could leave thousands of offspring in his lifetime. But women do not, in general, benefit at all from having more than one sex partner. A single man with average sexual ability can impregnate a woman often enough to guarantee that she will have as many children as she can have. Thus, we would expect evolution to have made men much more interested than women in sexual variety and casual sex. Casual sex with a variety of women is potentially a reproductive bonanza for a man, because it means that many more children carrying his genes will be out in the world. In contrast, unless there is something very special about a casual Copyright © National Academy of Sciences. That is, they risk losing the chance for commitment from and investment by other men. However, many of the adaptations that evolved due to heterosexuality are also found in gay men. Regardless of whether one buys the evolutionary story, anyone who has been out of the house, much less to a singles bar, knows that men and women differ considerably in their approach to casual sex. Not all men want casual sex, and some women do, but the average difference is large. The problem with this approach is that casual sex accomplishments are constrained by opportunity. In order for a heterosexual man to have casual sex, he has to have a willing female partner. This is not true of gay men, who do not need to negotiate with women in order to have sex. These inclinations include interest in sexual variety, and in having sex without commitment. I devised a questionnaire that tapped interest in casual sex and sexual variety without asking for numbers of sex partners. The items in the questionnaire were written so that either straight or gay men or women could answer them. I would consider having sex with a stranger, if I could be assured that it was safe and s/he was attractive to me. I do not need to respect or love someone in order to enjoy having sex with him/her. I believe in taking sexual opportunities when I find them, as long as no one gets hurt. I could easily imagine myself enjoying one night of sex with someone I would never see again. If an attractive person (of my preferred sex) approached me sexually, it would be hard to resist, no matter how well I knew him/her. I gave the questionnaire to both gay and straight men, as well as to lesbians and straight women. Although gay men had had far more sex partners than straight men, they scored nearly identically on the questionnaire measuring interest. The number of partners of straight men was similar to those of straight women and lesbians. I think it is instructive to think about how many opportunities the typical heterosexual man gets to have uncommitted sex with attractive strangers. The evolutionary anthropologist, Donald Symons, who first used the example of gay men to draw inferences about the male psyche wrote, "I am suggesting that heterosexual men would be as likely as homosexual men to have sex most often with strangers, to participate in anonymous orgies in public baths, and to stop off in public restrooms for five minutes of fellatio on the way home from work if women were interested in these activities. At first, when the relationship is new, sex is hot and heavy, and the couple is happy being sexually exclusive with each other. But with most couples, as the newness wanes so does the sexual excitement, and eventually one or both partners seek sex elsewhere. This pattern often occurs even as partners become increasingly committed to each other in other ways-emotionally and financially, for example. The opening of gay relationships to outside sex partners undoubtedly reflects the compromises necessary for two men to fulfill their masculine desire for sexual variety. But it may also represent a feminine characteristic that I have neglected to mention. Many straight men admit that they would love to have many more sex partners than they do. One way to show this is to have people imagine their partner both having sex with someone else and falling in love with someone else, and then to choose which scenario is more disturbing. It may simply be the compromise they have to make in order to have as many sex partners as they like. Perhaps both women and gay men recognize that their male sex partners are capable of having meaningless sex with others. Although this might not make either women or gay men happy, it is preferable to their partners having meaningful sex, because meaningful sex can more effectively end relationships. When straight men learn that their wives are unfaithful, they often become violent. Sexual jealousy is a major cause of domestic abuse and spousal homicide, committed most often by men. If sexual jealousy and physical violence are intertwined, this could explain why gay men are less sexually jealous. The gay men at the latter are distinguishable from the mostly straight male students at the former. When they leave the gym, they are wearing tighter clothing, which reveals their honed bodies. Most of my female friends insist that gay men are better Copyright © National Academy of Sciences. When I gave that questionnaire to straight and gay men and women, the women scored lower than the men. It is easy to imagine becoming romantically involved with someone I initially felt was physically unattractive, as I grew to know her/his personality. It is more important to me how nice a potential romantic partner is than how good looking he/she is. It would be hard for me to get involved with someone with a noticeable skin problem. I like my romantic partner to dress attractively, even if it requires some effort on her/his part. I would be upset if my partner did not try to maintain her/his physical appearance. If my partner became much less physically attractive, it would be difficult for me to stay with her/him. I have known few straight men who openly worried that they were not good looking enough for a successful dating career. In contrast, I know gay men who do worry, despite the fact that (in my opinion) they look fine. Gay men are markedly over represented among men diagnosed with eating disorders, comprising 20 percent to 50 percent of male cases. Gay men also tend much more than straight men to pay attention to fashion, such as designer clothes and trendy shoes. I doubt that gay men care all that much whether a potential sex partner is stylishly dressed, as long as he is otherwise attractive. Gay men who are most interested in fashion tend to have other feminine interests as well. Both gay and straight men enjoy looking at naked people (of their preferred sex) a lot more than women do. The questionnaire that asked about interest in visual sexual stimuli got results that differed markedly between men and women, with men scoring higher. This is one of the largest sex differences in human mating psychology (although it is much smaller than the answer to the Copyright © National Academy of Sciences. A naked woman is potentially a sexual opportunity, and so straight men should have evolved to seek them out and to become sexually excited in their presence. In contrast, women have nothing to gain by becoming easily aroused at the sight of a naked man. Otherwise, men would be constantly exposing themselves to women and preventing women from using their good cautious judgment. Although difficult to document, consumers of pornography are certainly disproportionately male. Even visual erotica that is targeted at straight women is disproportionately consumed by men-gay men. Playgirl magazine, which was intended to let women share in the objectification of the nude body, probably has as many gay men as women readers. Gay men also respond to pornography very much as straight men do, and very differently from how women do. Show men two erotic video clips: one showing only men and the other showing only women. If they are straight, they become much more sexually aroused by the clip showing women than by the one showing men. This is true whether you measure sexual arousal by asking them (subjective arousal) or by using a penile plethysmograph, which measures the degree of penile erection (genital arousal). Gay men show exactly the opposite pattern: they are much more strongly aroused by video clips of men than by those showing women. The experience of intense sexual arousal to one sex or the other, but not to both, is a powerful source of information. Seeing attractive people (of my preferred sex) in skimpy clothing such as lingerie or tight briefs is very sexually exciting to me. I find photographs of attractive naked bodies (of my preferred sex) sexually exciting. Being around a group of attractive naked people (of my preferred sex) does not sound very sexually arousing to me. When I meet someone I find attractive, I fantasize about what they would look like without clothes on. Seeing the genitals of an attractive person (of my preferred sex) would be extremely sexually arousing.

Ask students to help you design an observational measure of whether students were killed in the experiment allergy forecast last week buy flonase 50mcg low cost. Now conduct your observation of subjects and record the number alive in each condition allergy testing renton wa discount 50 mcg flonase otc. Collect the questionnaires and report to the class the number of subjects in each condition allergy testing yarmouth ns order flonase 50 mcg otc, the number of subjects in each condition reporting themselves alive in the pretreatment questionnaire spring allergy symptoms 2013 order flonase 50mcg without a prescription, the number of subjects in each condition Copyright © Houghton Mifflin Company allergy shots guelph generic 50 mcg flonase with visa. Chapter 4: the Scientific Method in Abnormal Psychology 63 reporting themselves alive in the posttreatment questionnaire allergy symptoms lilies order 50 mcg flonase visa, and the number observed to be alive allergy symptoms without runny nose 50 mcg flonase overnight delivery. Results should show that class participation did not kill more participants than nonparticipants allergy forecast galveston discount 50mcg flonase otc. If some students, trying to be funny, indicated they were dead, you can emphasize the point about the reliability of self-reports and the value of multiple measures. Be sure to explain the importance of random selection if you have not already done so. If you are at all concerned with using the words kill or dead as part of the activity, you could substitute other hypotheses, such as class participation will not cause students to spontaneously combust or be laughed out of the class room. This activity shows students how to think scientifically about common psychological concepts that are the focus of abnormal psychology research. Distribute the handout and have students record individually how they think each concept can be defined operationally. That is, require them to define each term that could be tested in a research study. Emphasize that there are multiple ways of defining each of the terms and that after they are finished working alone, they will be able to see the range and originality of definitions. If you wish, you can review the material from Chapter 2 on different perspectives and assign certain groups in the class to define terms from a particular perspective. For example, one group of students might be assigned the biological perspective and they would be expected to define anxiety in terms of heart rate, perspiration, or muscle tension. Those assigned to a cognitive perspective would be expected to define the same term as, for example, "frequency of thoughts about threatening events. This demonstration can introduce your students to the concept of validity in testing. If these tests were not used for college admission, what method or methods should be used instead? Ask the students to imagine that they have been diagnosed with one of these disordersor any other, for that matterand think about the implications such a diagnosis might have for other areas of their lives, such as finding jobs, insurance coverage, and relationships. Now have students develop a method to tell their best friend that they have a diagnosable mental disorder. Would they be treated the same or differently by their friends after this revelation? All the research is aimed at answering some aspect of this problem: Does stress cause alcohol consumption? Please recognize that stress can be defined in many ways and that alcohol consumption can range from light, social drinking to heavy, daily use. Be sure to give operational definitions for all the variables you use when describing your proposed studies. The first proposal should be in the form of an experiment that could be performed within the walls of the psychology department at your college or university. Remember that in all experiments the researcher manipulates the existence or absence of an independent variable and randomly assigns subjects to experimental and control groups. In longitudinal studies, you collect data on the same group of people several times over a span of time. Please consider the type of people and the amount of time necessary so that stress and drinking are likely to occur. In field studies you must leave the laboratory and collect data about behaviors and events as they are happening "in the wild. Also consider a way of collecting data that will not disturb the behavior you want to study. A psychologist did in-depth interviews with this person and linked the area of brain damage from the shooting with obsessions and compulsions. It is discovered that subjects with highest frequency and intensity of pain reports have families in which illness is common and family members engage in behaviors that encourage pain expression. Thirty phobic and thirty nonphobic individuals are shown slides of either fear-inducing scenes or non-fear-inducing scenes. Control Alive Treatment Dead Posttreatment Questionnaire To which condition were you assigned? Furthermore, it should be defined so that it can be observed by someone other than the subject experiencing it. Anger: Sociability: Anxiety: Addiction: Depression: Copyright © Houghton Mifflin Company. Forty studies that changed psychology: Explorations into the history of psychological research. Uses humorous sketches to illustrate hypothesis testing, random assignment, control and experimental conditions, and statistical inference. Terms such as independent variable and dependent variable and concepts such as control, replication, and random assignment are nicely illustrated. This program describes different types of experimental designs and when they would be appropriate. It shows the seven steps of the scientific method and conveys both the practice and ethical issues in experimentation. This five-part series covers sampling, data collection, descriptive statistics, sampling distributions and the normal curve, standard deviation, central limit theorem, and inferential statistics. Very useful if you are assigning a term paper or research report, this video illustrates the key points in writing for the social sciences. Chapter 4: the Scientific Method in Abnormal Psychology 69 Good sites for discussions of casual relationships and experimental research, including online demonstrations (as well as experiments your students may wish to participate in) are: -psych. Five groups of anxiety disorders: panic disorder, generalized anxiety disorder, phobias, obsessive-compulsive disorder, acute and posttraumatic stress disorders F. Panic attacks: intense fear with somatic symptoms; can occur in all anxiety disorders 1. Panic disorder: severe apprehension and feelings of impending doom lasting minutes to hours; recurrent unexpected attacks and at least one month worry about another attack 1. Generalized anxiety disorder: persistent anxiety and worry, hypervigilance, physiological symptoms (but less reactive than panic disorder) lasting six months or more 1. Lifetime prevalence 5 percent of adult population; two times as likely for women 2. Psychodynamic perspective: stresses internal conflict originating in sexual and aggressive impulses 2. Cognitive behavioral: negative thoughts or overattention to bodily sensations serve as internal triggers for panic attacks; sets up feedback loop 3. Agoraphobia: fear of being in public places where escape or help may not be readily available; fear of panic symptoms 1. Three subcategories: performance (such as public speaking), limited interactional (such as going out on a date), and generalized (extreme anxiety in most social situations) 2. Two times more prevalent in women than in men; men may lie about fears more than women 4. Behavioral perspective a) Classical conditioning perspective: conditioned emotional responses; some research and clinical support b) Observational learning perspective: negative information and modeling are major factors accounting for childhood fears c) Negative information perspective: negative information acquired largely from television d) Cognitive behavioral: negative thoughts and overestimates of unpleasant future events in those with phobias 3. Biochemical treatments a) Drugs used typically affect neurotransmitters and/or reduce depression b) Methodological flaws hamper evaluation research on effectiveness 2. Obsessive-compulsive disorder: intrusive repetitive thoughts and need to perform ritual acts A. Obsessions: most common are bodily wastes, germs, and environmental contamination Copyright © Houghton Mifflin Company. Compulsions: need to perform an act to reduce anxiety; if severe must be performed perfectly E. Psychoanalytic perspective: obsessive-compulsive behaviors are attempts to fend off sexual urges 2. Behavioral and cognitive perspectives a) Obsessive-compulsive behaviors reduce anxiety b) Obsessions are the result of a "catastrophic misinterpretation" of intrusive thoughts or images 3. Biological perspective: relate to brain structure, genes, and biochemical abnormalities F. Behavioral treatments: a) Exposure (continued actual or imagined exposure to fear-arousing stimuli) b) Response prevention (prevented from performing rituals) c) Cognitive component (identify and modify irrational thoughts) Acute and posttraumatic stress disorder A. Prevalence for Americans between ages 15 and 54 is 8 percent; twice as many women as men D. Biological perspective and treatment a) Hypersensitivity to stimuli similar to traumatic event b) Neurochemical and neuroanatomical circuitry in amygdala 1. Describe the nature and cognitive, behavioral, and somatic manifestations of anxiety in anxiety disorders and list the five major groups of anxiety disorders. Discuss the psychodynamic, behavioral, and biological theories of the cause of obsessivecompulsive disorder. Describe and discuss the biological, behavioral, and cognitive treatment of obsessive-compulsive disorder. Panic attacks appear to be rather common, but it is possible that some "panic attacks" are not psychologically induced at all. It is increasingly clear that another common problem having to do with the heart may be the cause of some panic attacks. This heart defect, which is rarely life endangering or severe, is called mitral valve prolapse. The mitral valve of the heart usually closes flush with the wall that separates the atrium from the ventricle. In mitral valve prolapse, for reasons that are not well understood, the valve folds in on itself when it closes. The effect is to produce a racing heart, fainting, profuse sweating, and dizziness-many of the signs of a panic attack. These episodes occur randomly, and not all attacks are a result of psychological panic. The wise clinician would encourage a client to have a physical examination to rule out such physical causes as mitral valve prolapse. Chapter 5: Anxiety Disorders the world seems to be a more and more dangerous place. The problem of posttraumatic stress disorder and its prevention should be mentioned in this section of the course. Whether natural or caused by human agency, the disasters people suffer need not lead to long-lasting and disabling conditions. One description of such a prevention effort was a response to the 1981 Hyatt Regency Hotel disaster in Kansas City, Missouri. The survivors had significant psychological aftereffects, as did the rescue workers. Grist and Stolz (1982) describe what mental health professionals in the region did to prevent posttraumatic stress disorder. A good discussion question is, "Should local or state governments provide funds and facilities so that citizens who are victims of such disasters are assured of psychological services? The textbook does not give a clear indication of the scenes that are used in flooding therapy. A good discussion topic is the need for truly graphic imagery and the ethical considerations for both client and therapist. The intense anxiety that the client with spider phobia will feel is exactly what must occur, but explain to students that this therapy is done only after the client is informed of what will happen and the reasons for it. Stopping the presentation of fear-inducing scenes before there has been an extinction of anxious responses will reinforce avoidance. Students may want to discuss whether the slower, more comfortable (but often less effective) process of systematic desensitization is preferable to the distressing (but effective) method of flooding. A new theory of anxiety and depression (Higgins, 1987) proposes that people define themselves in terms of an actual self (the attributes that describe how they actually are), an ideal self (the way they aspire to be), and an ought self (the way they are morally obligated to be). The latter two are considered "self guides" and may be based on a personal standpoint or the standpoints of important others such as parents or teachers. Higgins argues that depressive emotions are related to discrepancy between the actual and the ideal self. Anxiety is related to discrepancy between the actual and the ought self, particularly the ought self as defined by others. As predicted, depressed students showed greater actual-ideal self-discrepancy than anxious or normal students showed. Anxious students showed greater actual-ought self (other-defined) than depressed or normal students showed. Self-concept discrepancy theory: A psychological model for distinguishing among different aspects of depression and anxiety. Self-guides, autobiographical memory, and anxiety and dysphoria: Toward a cognitive model of vulnerability to emotional distress. The Velten method of inducing mood (Velten, 1968) has been successfully applied to a range of emotional states including anxiety. The method uses a stack of cards that contain statements associated with a particular emotion. Subjects first read the cards silently, then aloud, and finally spend five or so minutes concentrating on a time in their life when they experienced the same emotional state. In the first case, statements focus on cognitive concerns: "I am plagued by my racing mind" or "I am so worried that I cannot concentrate on anything. You could either make a set of such cards or present the statements to the class via overhead transparencies or verbally. Further, the public nature of the classroom may work against the "suspension of disbelief" necessary for such statements to induce mood. However, the fact that such statements are often made by clients with anxiety disorders can be a point of departure for discussion of the cognitive cause or maintenance of such problems as panic disorder, generalized anxiety disorder, phobias, and obsessive-compulsive disorder. A laboratory task for the induction of mood states, Behavior Research and Therapy, 6, 473­482. Effects of worry and somatic anxiety induction on thoughts, emotion, and physiological activity. You can make this exercise even more relevant and useful by applying it to test anxiety, a problem in any class. You can either read it to the class or distribute the handout and instruct students to practice on their own time. Make it clear to students that each person has his or her own anxiety hierarchy; those in the class who suffer from test anxiety will relate to the listing on the next page but will undoubtedly apply different numbers to the test-related situations in their own lives. When anxiety is felt, the client "turns off" the scene, becomes relaxed again, and imagines the scene again. People are rarely able to imagine highly stressful scenes while completely relaxed, but reducing anxiety to manageable levels usually improves performance. The cognitive component in anxiety disorders is receiving considerable research attention. Ever alert to even small body changes, people with this anxiety sensitivity interpret a skipped heart beat to be a sign of a heart attack. Fearful of the consequences of anxiety symptoms, they even worry about becoming anxious. The demonstration will show students a research instrument and allow class members to compare their scores with those of other college students and two samples of patients with anxiety disorders. The findings give support to the idea that agoraphobia is associated with a fear of fear. Chapter 5: Anxiety Disorders 77 Preface this demonstration with some cautionary statements. Make it clear that scores on the index diagnose no condition and that the completion of the index is for educational purposes-to see how researchers in the field measure concern about anxiety symptoms. Scoring is straightforward: "Very little" scores 0 points; "a little" scores 1 point; "some" scores 2 points; "much" scores 3 points; and "very much" scores 4 points. Wolpe (1973) suggests that the Willoughby Personality Schedule can be used prior to beginning systematic desensitization. This questionnaire identifies interpersonal situations that elicit anxiety, presumably more important for those with social phobias. Have your students fill it out, but caution them that the purpose of the exercise is to better appreciate what goes on in behavioral assessment and treatment; it is not designed for self-diagnosis. Another useful questionnaire is the Wolpe-Lang Inventory (Wolpe & Lang, 1969), which assesses sources of more specific fears than the Willoughby Personality Schedule. Ask your students to generate a longer list on their own or have them make suggestions in class to gain a more complete understanding of the exercise. Items in the Wolpe-Lang Inventory questionnaire refer to things and experiences that may cause fear or other unpleasant feelings. Students should indicate how much each item disturbs them, using the following categories: Not at All, A Little, A Fair Amount, Much, and Very Much. People who are high in trait anxiety (generalized anxiety disorder) seem to interpret life as more threatening than it needs to be. Presented with alternative interpretations of situations, anxious people disproportionately endorse dangerous ones (Butler & Mathews, 1983). Anxious individuals tend to write down more threatening meanings to words that sound alike but have different meanings (homophones) (Mathews et al. Chapter 5: Anxiety Disorders Since panic attacks are so common, students will want to know the symptoms that accompany them. This chapter represents the first of the chapters devoted to clinical disorders, and you need to remind students to "take with a grain of salt" any concern they may have that they have a disorder. This demonstration is best done with a class with which you have developed a positive rapport. Assign some outside reading, and the publications put on reserve in the library several weeks prior to this demonstration. Ask the students to complete these readings by the date of this demonstration for discussion in class.

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The sudden withdrawal of this privilege had confused and angered Steve allergy shots injection sites cheap flonase 50 mcg on line, who was not certain what he had done wrong allergy symptoms kids generic flonase 50mcg mastercard. He knew allergy treatment epipen buy flonase 50mcg cheap, though allergy treatment side effects buy flonase 50mcg, that his mother had been quite upset when she awoke one night to find him masturbating next to her allergy discount flonase 50 mcg on-line. His birthdays were celebrated with a cake and candles allergy medicine zyrtec vs claritin generic flonase 50 mcg on line, but the only celebrants were Steve and his mother allergy treatment pollen order flonase 50mcg overnight delivery. By age ten allergy ears buy cheap flonase 50 mcg online, Steven had learned to keep himself occupied by playing "mind games," letting his imagination carry him off on flights of fantasy. His fantasies were often extremely violent, and his foes were vanquished only after much blood had been spilled. As Steve grew older, his fantasies and heroes became increasingly menacing and evil. When he was fifteen, he obtained a pornographic videotape that he viewed repeatedly on a video player in his room. Often, Steve would masturbate as he watched scenes of women being sexually violated. He was addicted to the Nightmare on Elm Street films, in which the villain, Freddie Kruger, disemboweled or slashed his victims to death with his razor-sharp glove. Steve now recalls that he spent much of his spare time between the ages of fifteen and seventeen watching X-rated videotapes or violent movies, his favorite being the Texas Chainsaw Massacre, in which a madman saws and hacks women to pieces. Steve always identified with the character perpetrating the outrage; at times, he imagined his parents as the victims. At about age sixteen, Steven became convinced that external forces were controlling his mind and behavior and were drawing him into his fantasies. Although he was strongly attracted to his fantasy world, he also felt that something was wrong with it and with him. After seeing the movie the Exorcist, he became convinced that he was possessed by the devil. In kindergarten the school psychologist had described his condition as autisticlike because Steve seldom spoke, seemed unresponsive to the environment, and was socially isolated. His parents had immediately hired a prominent child psychiatrist to work with Steve. The psychiatrist had assured them that Steve was not autistic but would need intensive treatment for several years. And throughout these years of treatment, Steve never acted out any of his fantasies. With the development of his interest in the occult and in demonic possession, however, he became outgoing, flamboyant, and even exhibitionistic. He read extensively about Satanism, joined a "Church of Satan" in San Francisco, and took to wearing a black cape on weekend journeys into that city. Against his will, he was hospitalized twice by his parents with diagnoses of, respectively, bipolar affective disorder and schizophrenia in remission. Steve was twenty-one years old when he met Linda at an orientation session for first-year university students. Linda struck him as different from other women students: unpretentious, open, and friendly. But although Linda dated Steve frequently over the next few months, she did not seem to reciprocate his intense feelings. She took part in several extracurricular activities, including the student newspaper and student government, and her willingness to be apart from him confused and frustrated Steve. She would not allow sexual intercourse, but she and Steve did engage in heavy petting. Even while he and Linda were dating, Steve grew increasingly insecure about their relationship. Several times he accused her of plotting against him and deliberately making him feel inadequate. Finally (on one occasion), feeling frightened and intimidated by Steve, she acquiesced to having sex with him. When he blamed her for this "failure" and became verbally and physically abusive, Linda put an end to their relationship and refused to see him again. During the next year and a half, Steve suffered from severe bouts of depression and twice attempted suicide by drug overdose. How would a psychologist oriented toward biogenic explanations view the case of Steven V.? I do accept the importance of environmental influences, but in my view, the biological bases of abnormality are too often overlooked by psychologists. We do not have the data necessary to chart a family tree, which would show whether other members of his family have suffered from a similar disorder. At age fifteen, Steve was given a diagnosis of bipolar affective disorder (formerly called manicdepressive psychosis). Unfortunately, Steve apparently disliked taking medication and did so only sporadically. In any case, evidence documents and supports a diagnosis of bipolar affective disorder. Steve displays the behaviors associated with this disorder, ranging from manic episodes (elevated mood characterized by expansiveness, hyperactivity, flight of ideas, and inflated self-esteem) to depressive episodes (depressed mood characterized by loss of interest, feelings of worthlessness, and thoughts of death or suicide). These symptoms are not of recent origin but probably were evident very early in his life. The chief symptoms described in his early years, which appeared to indicate autism (social isolation and unresponsiveness), are similar to those of depression. I suspect Steve was experiencing a major depressive episode as early as kindergarten, and it may not have been his first. What we do have, however, are several statements from his parents indicating that "even at birth, Steve did not respond in the normal way. Heredity seems to have played a part; we have some evidence that relatives may have suffered a similar disorder. The precise biological mechanism that triggered the disorder is probably within one of the two major classes of neurotransmitters (catecholamines and indoleamines). And they will probably continue to occur unless Steve controls his biological problem with medication. Steve did not receive the love and care, at crucial psychosexual stages, that a child needs to develop into a healthy adult. We have evidence that he was prone to "accidents"-being hit on the head by a swing, burning himself severely on an electric range, numerous falls. Furthermore, I believe that his proneness to accidents was the forerunner of his attempts at suicide, a reflection of the death instinct and a desire to punish himself. It must be an awful experience for a young child to believe that he or she is unloved. For many of us, it is easier to deny or repress this belief than to face up to it. Steve may have been the victim of marital unhappiness between his mother and father. Apparently she was fearful of his dominating and abusive manner at home, and she avoided potential conflicts by playing a passive role. Unable to form an intimate relationship with her husband, she became physically seductive toward Steve. To a youngster still groping his way through oedipal conflicts, nothing could have been more damaging. His continued feelings of inadequacy and anger, and his sexual drives as well, have remained repressed and are expressed symbolically. His frequent accidents, his episodic depression, and his attempts at suicide are classic manifestations of the death instinct. Linda is described as being active in student affairs; Copyright © Houghton Mifflin Company. Linda was "warm, affectionate, and intimate" in private; the mother, when "alone with Steve," was quite affectionate. Linda would consent to "heavy petting" but drew the line short of intercourse; the mother suddenly withdrew "bed privileges" when Steve showed incestuous sexual interest. It is clear that Steve continues to search for a "mother figure" and unconsciously selected a woman who is most like his mother. His impotence with Linda is additional evidence that Steve unconsciously views her as his mother. Resolving past traumas, overcoming resistance, and working through a transference relationship with the therapist will be crucial components of his therapy. A therapist who strongly endorses the humanistic or existential approach would see Steven V. I must begin by stressing a point that is likely to be underemphasized by many other psychologists. Steve is a flesh-andblood person, alive, organic, and moving, with thoughts, feelings, and emotions. How could anyone hope to understand Steve by reading a pile of material that is static and inorganic and occasionally seeks to pigeonhole him into diagnostic categories? To classify Steve as schizophrenic, manicdepressive, or suicidal does not help me understand him. Indeed, such labels might serve as barriers to the development of a therapeutic relationship with him. I intend to develop such a relationship with Steve, to engage him in a dialogue that will require no pretenses or self-justifications, and to travel with him on a journey whose destination neither of us will know until we get there. Steve is deeply hurt by his father, he is angry at his father, and he seems to be seeking approval and validation from his father; he is also grappling with identity issues. He clings to this perception of himself because he is afraid that without it he would not know who he is. Now here is another diary entry, this one during his senior year in high school: Copyright © Houghton Mifflin Company. In this way Steve evades responsibility for choosing and protects himself by staying in the safe, known environment of his room. Steve needs to realize that he is responsible for his own actions, that he cannot find his identity in others. He needs to get in touch with, and express directly, his feelings of anxiety, guilt, shame, and anger. All this can be accomplished through a free, open, and unstructured client-therapist relationship. Many of the behaviors he has learned are inappropriate (much like songs that nobody wants to hear), and his repertoire lacks useful, productive behaviors. He has had little practice in social relationships, and so has difficulty distinguishing between appropriate and inappropriate behavior. While others seem to have no difficulty making "small talk," Steve remains silent. When he does speak, his statements are usually perfunctory, brief, and inappropriate. If we are to help Steve change his behavior, we must know what behavior we are talking about. Too often terms such as depression, passivity, and anxiety are used without a common referent. For example, when a client calls himself "shy," we must be sure that both therapist and client understand the term in the same way. Steve may be able to master such situations by developing more effective behaviors. I believe that Steve has a conditioned or learned anxiety toward women and especially toward sexual intercourse. This anxiety not only blocks his ability to relate to members of the opposite sex but also directly affects his autonomic nervous system, so that his sexual arousal is impaired. We must teach Steve through classical conditioning how to subtract anxiety from the sexual encounter. Many people display inappropriate behaviors that are considered aversive, odd, or unusual but that may be somehow reinforced. But the people who call him crazy and are occasionally frightened by him may actually be reinforcing these behaviors. When Steve behaves in this way, he garners much attention from his parents, peers, and onlookers. I am not the only behaviorist who contends that psychoanalytically oriented therapists make this mistake. Many behavioral therapists believe, for example, that psychoanalysts elicit so much sexual material from their clients precisely because they unwittingly reinforce this concentration on sex. I would use cognitive strategies and teach him behaviors through which he may more adequately control his environment to combat his depression. His heterosexual anxiety and impotence would be treated via counterconditioning methods and relaxation training. Finally, the use of extinction strategies might reduce his excessive concern with Satanism. In essence, it is important to show Steve that the psychological problems he is experiencing derive from the many irrational beliefs that he uses to judge himself and others. First, it is very easy for us to conclude that the problems he now encounters are a function of unrealistic and illogical standards that he learned from his family and significant others in his life. This would be simplistic, however, because the real problem is not the learned values in his childhood, but rather the many dogmatic, rigid "musts," "shoulds," and "oughts" that he has creatively constructed around these standards and around the unfortunate events that occur in his life. As you recall, Steve first came to the attention of the university therapist after a breakup with his woman friend, Linda. Initially, he became severely depressed and withdrew from almost all social activities. Most of us, including Steve, could easily conclude that the reason he became depressed was because of the breakup of a valued relationship. Most people do not feel good about such an event, and the negative reactions we experience might even be normal and expected. The breakup with Linda must have other personal significance and meaning to him, contained in irrational beliefs he holds. It is quite clear that Steve has irrational beliefs about himself and others that are the basis of his problems. He must be helped to distinguish between the real event and the unrealistic assumptions he makes about its consequences. The Family Systems Model of Psychopathology What if Steve were working with a family systems oriented therapist? Although Steve is manifesting the disorders, his father and mother are also suffering, and their pathological symptoms are reflected in Steve. It is obvious that the relationships between Steve and his father, between Steve and his mother, and between his father and mother are unhealthy. Each seems to live a separate life, even when they are together in the same house. Each has unfulfilled needs, and each denies and avoids interactions and conflicts with the other. He is a European American of Scottish descent, born to an extremely wealthy family in the upper socioeconomic class. All of these characteristics mean that many of his experiences are likely to be very different from those of a person who is a member of a minority group, economically indigent, or of female gender. He has succeeded by his own efforts but, unfortunately, his success has come at the emotional cost of his family. To truly understand Steve, we must recognize that the many multicultural variables-race, culture, ethnicity, gender, religion, sexual orientation, and so on-are powerful factors. As such, they influence the types of social-psychological stressors Steve is likely to experience, the ways he will manifest disorders, and the types of therapeutic approaches most likely to be effective. I believe strongly that therapy should involve a blend of techniques aimed at recognizing that each client is a whole human being. Many current schools of psychotherapy are one-dimensional; they concentrate only on feelings, or only on cognitions, or only on behaviors. I also believe that no single theory or approach to therapy is appropriate for all populations and all problems. To recognize this difference means to use different strategies and techniques for each individual. A very "unstable" relationship with Linda, his woman friend, had just ended, and he seemed quite disturbed by it. As I found out later, his own private therapist was on vacation, and he did Copyright © Houghton Mifflin Company. As a result, he contacted the university psychological services center and was assigned to me. During our initial contact, Steve appeared extremely suspicious, withdrawn, and reluctant to disclose his thoughts or feelings. I can recall the long periods of silence following my questions and his short but sarcastic responses. It was almost as though he were testing me to see what kind of therapist I was, to see whether he could trust me. Usually I try to be less active at first and to encourage the client to tell his or her own story. Therapist: It must be hard to begin a new therapy relationship again-to start all over. I took on an active and directive manner characteristic of the behavioral therapies. As I look back, I believe this brief but heated exchange represented the beginning of our relationship. I think Steve realized that I was an authentic person who could get angry but would not let the anger become destructive.

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