Although there has been considerable accumulation of knowledge in psychosomatic obstetrics during the past few decades, the critical level of psychosocial stress above which sub-optimal pregnancy outcome can be said to occur remains indeterminate. Consequently, it is virtually impossible on the basis of psychosocial stress inventory for a prenatal care provider to accurately identify those women who are truly at the risk of stress-related poor pregnancy outcome.In our recent study of 185 primigravidas selected for their low baseline medical risk factors, the inability to cope (which we defined operationally as psychosocial distress and determined clinically from the participants' scores on the Hope Index Scale) was found to be highly predictive of pregnancy outcome with a positive predictive value of 0.8 1. The 3-year prospective study also suggests that lower socioeconomic status may not be a true risk factor in an otherwise low medical risk pregnancy.We conclude that in screening for the pregnant woman at risk, even in the absence of apparent biomedical risk factors, a determination of the ability or inability to cope is essential for an accurate prediction of pregnancy outcome. 0167-482X/84/$03.00 0 1984 Elsevier Science Publishers B.V. J Psychosom Obstet Gynaecol Downloaded from informahealthcare.com by Chinese University of Hong Kong on 12/26/14 For personal use only.

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Today is thefirst day ofthe rest of your lfe - What are you going to do about it?Most people have probably heard that very positive and challenging statement many times before. When we in the helping professions hear that statement, what specific encouragements, insights, and challenges does it present for us? What does it say to us about our future and the futures of those we counsel? In this article, some issues of the future as they relate to counseling, with specific implications for Black professions, will be examined.When one hears that statement-Today is the first day of the rest of your life-it tends to bring to mind that the future starts now, at this very moment, and extends forever. Now when one says that the future extends forever, it is an understatement to say that's a long, long time. Thus, it is necessary to make the future more manageable. Joseph (1974) states that the future, as viewed from today, is composed of a multiplicity of possible alternative futures, which one can move toward-with or without control. These alternative futures can be considered as planning horizons from which one can select and expand one's control over those futures one brings into fruition. Therefore, it is expedient to divide the future into five basic periods: ( a) immediate future; (b) near or shortterm futures: (c) middle-range futures: ( d) long-range futures; and (e) far futures (see Table I) .Thus, from Table 1, it is obvious that the portion of the futures over which one has the most control is in the middle-range periodsthose futures 5 to 20 years from the present. This is not to say that one should avoid striving to improve the day-today and short-term quality of life, but that it is more fruitful to invest one's energies where they will have a more meaningful yield. This is why it is often said that the future is that which has already happened. This article will focus on the middle-range future.