Quantifying the accuracy of forensic examiners in the absence of a "gold standard".

This study asked whether latent class modeling methods and multiple ratings of the same cases might permit quantification of the accuracy of forensic assessments. Five evaluators examined 156 redacted court reports concerning criminal defendants who had undergone hospitalization for evaluation or restoration of their adjudicative competence. Evaluators rated each defendant's Dusky-defined competence to stand trial on a five-point scale as well as each defendant's understanding of, appreciation of, and reasoning about criminal proceedings.

Issues of spirituality and religion in psychotherapy supervision.

Objective: We note gaps between the basic science of psychotherapy and the spiritual dimensions of religious life; between the beliefs and practices of patients and those of therapists; and between evidence for the influence of spirituality on health and the lack of its integration into psychotherapeutic training. We attempt to provide a framework to bridge this gap in supervision.

Method: We reviewed the literature on the roles of spirituality and religion in mental health and illness; on the place of religion in psychotherapy; and on the pedagogy of spirituality.

Delayed reaction to trauma in an aging woman.

Events of later life may awaken long-suppressed memories and feelings and yield emotional or behavioral problems that are evidence of an early traumatic experience. It is believed that posttraumatic stress disorder (PTSD)-like symptoms are more prevalent in the younger general population, but the lack of data supporting PTSD in the elderly may be due to the complicated presentation. The elderly often present to psychotherapy with comorbid diagnoses and may underreport their symptoms, or the symptoms may be masked by other diagnoses.

How competent are we to assess psychotherapeutic competence in psychiatric residents?

Background: The Residency Review Committee (RRC) for Psychiatry has mandated that training programs "must demonstrate that residents have achieved competency in at least the following forms of treatment: brief therapy, cognitive-behavioral therapy, combined psychotherapy and psychopharmacology, psychodynamic therapy, and supportive therapy."

Aim: To analyze the extent to which programs can realistically demonstrate that residents have achieved summative competency in these modalities.

Method: We briefly review methods from other fields for assuring procedural competence, review methods available to psychiatric educators for assuring competencies in psychotherapy, and assess these methods for their adequacy.

Closing the loop: assessing the effectiveness of psychiatric competency measures.

Background: During the past several years there has been a growing emphasis on competency assessment in graduate education in all specialties, including psychiatry. Methods of assessment are continuously being devised and refined.

Objective: To outline principles and methods of assessing the validity of competency measures and their relevance to trainees.