TRANSITIONAL EMPLOYMENT PROJECT

McLean Hospital is a private, non-profit psychiatric hospital in Massachusetts. It is an extensive treatment facility providing outpatient care, patient hospitalization, and an inpatient bed capacity of 328. The psychiatric modalities used are traditional milieu structuring, individual and group psychotherapy, behavior therapy interventions, family and couples therapy, psychopharmacology, and rehabilitation treatment strategies. As in other psychiatric hospitals, vocational rehabilitation treatment strategies were severely challenged in the 1970s with the Supreme Court decision in the case of Souder versus Brennan. In essence, the findings in this class action suit construed traditional, clinical/vocational programs as forms of employment, not therapy. Thus, the issues of work adjustment and employment preparation for the psychiatrically disabled client needed to be creatively readdressed. Rehabilitation staff were called upon to redefine the activities presented to clients not only from the viewpoint of desired therapeutic interventions but also in terms of the new legal constraints. The shortened length of inpatient hospitalization also highlighted the need for aftercare rehabilitation opportunities. Responding to these needs, the Rehabilitation Services Department of McLean Hospital developed an independent transitional employment corporation called Everywhere Limited.     

Vocational Transition in Acute Care Psychiatry

The history of vocational rehabilitation in mental health occupational therapy is a sporadic one. Today, vocational integration is an essential part of holistic practice. The Vocational Transition group protocol identifies vocational services in acute care settings for psychiatric inpatients who are planning to return to work after discharge.     

出院精神病患者的职业康复

精神病患者出院后的职业康复研究是目前西方精神疾病康复研究的热点。通过帮助出院后症状稳定的精神病患者就业,来帮助患者获得技能,获取收入,增强自信和自我认同,提升生活质量,较好地回归社会。文章从总体上介绍了职业康复的研究现状与进展,并着重阐述了较新的支持性就业、个体支持性就业、工作社交技能训练和综合性支持性就业等方法,旨在为我国的相关研究提供参考     

Relationship of vocational maturity to work values

This study examined the relationship of vocational maturity to work values. Two hypotheses were tested: (1) Vocational maturity is positively related to differentiation of work values within subjects. (2) Vocational maturity is positively associated with intrinsic work values and negatively associated with extrinsic work values. Sixty-two subjects enrolled in remedial reading at a community college were administered the Vocational Development Inventory-Attitude Scale and the Work Values Inventory. Data analyses supported hypothesis 1 for females, but not for males, and partially supported hypothesis 2.     

John Rickman, Wilfred Ruprecht Bion, and the origins of the therapeutic community

The history of psychiatric therapeutic communities is complex and obscure. Nevertheless, one can make a reasonable case for saying that the first true therapeutic community was created at Northfield Military Hospital, Birmingham, England, in 1945. That community had its origins in the thought and practice of two British psychoanalysts, John Rickman and Wilfred Ruprecht Bion. Accordingly, in the present article their careers and the social and intellectual influences bearing on them are discussed. The article then continues by describing Rickman's work as a military psychiatrist, Bion's prototype of a therapeutic community, and the therapeutic community that was eventually created at Northfield. It is hoped that the article will provide some of the groundwork for an adequate history of the therapeutic community.     

Taxonomic implications of three prospective studies on the course and outcome of personality disorders

The Children in the Community (CIC) Study (Cohen, Crawford, Johnson, & Kasen, this issue), the McLean Study of Adult Development (MSAD; Zanarini, Frankenburg, Hennen, Reich, & Silk, this issue), and the Collaborative Longitudinal Personality Disorders Study (CLPS; Skodol et al., this issue) are three large prospective studies on the course and outcome of psychiatric disorders, borderline personality disorder, and personality disorders, respectively. These studies, involving approximately 2,000 subjects, have yielded an enormous amount of scientifically and clinically relevant information. In this commentary, I primarily aim to discuss the implications for future revisions to the DSM classification of personality disorders.     

Was William James a Patient at McLean Hospital for the Mentally Ill?

Rumors that William James was a patient at McLean Asylum near Boston have persisted for several decades. I focus on the reasons why the question has been so difficult to answer in any definitive way; assess the evidence presented in support of the rumors; note that two different periods in James’s life (late twenties and early sixties) have been judged the most likely; and explore the diagnostic question as well: If he was in fact a patient, for what was he being treated? I also discuss evidence that his younger brother Robertson was a patient at McLean and consider the bearing of this evidence on the question of whether William James was a patient at McLean and on the diagnostic issue.     

New Maps for Old: Guidance and the Reform of Vocational Qualifications

The reform of occupational qualifications in England and Wales being undertaken by the National Council for Vocational Qualifications will affect the qualifications of those who work in guidance and counselling, and the opportunities open to their clients. While early development work concentrated on lower-level qualifications, attention is now turning to higher levels, including occupations like guidance and counselling where interpersonal skills play a major part. The principles underpinning the reform of qualifications are outlined; the project work carried out up to the end of 1991 is described; and some of the implications and issues arising from this work are identified, both for the professional qualifications available, and for the map of the broad fields of guidance and counselling.     

Dual diagnosis in an Australian forensic psychiatric hospital: prevalence and implications for services

Despite a growing awareness of the unique needs of psychiatric patients with co-occurring substance abuse and dependence disorders (i.e. dual diagnosis), there is a dearth of research investigating the prevalence of dual diagnosis in forensic psychiatric populations. Similarly, little work has been done to determine the implications of dual diagnosis for forensic psychiatric patients. Patients at the Thomas Embling Hospital in Victoria, Australia, were assessed to determine the prevalence of substance abuse disorders and mental illnesses within this population. Results reveal that the majority of patients (approximately 74%) have a lifetime substance abuse or dependence disorder. Information was collected concerning patients' criminal histories and the Level of Service Inventory, Revised, was completed for each patient who participated. Results suggest that patients with both major mental illnesses and substance abuse disorders have more extensive criminal histories and demonstrate a higher level of risks and needs when compared with patients with major mental illness alone. The implications for the development and delivery of effective forensic mental health services that address both co-occurring disorders are also discussed.     

Family Therapy in Norway: Past and Present

This article will describe the development of family therapy in Norway. First, this article will review the main theoretical influences on Norwegian family therapy, followed by a discussion about its international influence in the field. The second section of this article will address psychiatric health care, family counselling, and how systemic thinking and systemic practice have spread to other areas in the fields of health, social work, and pedagogy. Particularly, a special emphasis will be placed on child protection work in Norway. Then, the family therapy union and Norwegian and Scandinavian congresses will be presented. This article will then describe family therapy education and research in Norway. Finally, future developments in the field will be discussed.     

Minimal brain dysfunction in adolescent and young adult psychiatric inpatients

This paper presents data on a study of 100 consecutive young adult psychiatric admissions to Horsham Hospital, to determine the incidence of minimal brain dysfunction in this population, to define the subcategories of common psychiatric presentation, and to compare these data with those from the companion study conducted by our research group of fifty consecutive adolescent psychiatric admissions, reported by Horowitz, 1981.     

Futility in Chronic Anorexia Nervosa: A Concept Whose Time Has Not Yet Come

Comparatively little scholarly attention has been given to the question of futility in chronic psychiatric disorders, with the exception of a small body of work on so-called end-stage anorexia nervosa (AN). A review of this literature provides the background for a critical examination of whether the concept of futility has any clinically meaningful, ethically justifiable, and legally defensible application to AN. In this article, the arguments for and against futility judgments in AN are analyzed with special emphasis on determinations of capacity in this serious mental illness. Parallels between the futility disputes in medical and psychiatric disorders, where applicable, will be drawn to further illuminate whether or not the concept that continued psychiatric treatment for AN is ever truly futile.     

Skinner boxes for psychotics: operant conditioning at Metropolitan State Hospital

Between 1953 and 1965, Ogden Lindsley and his associates conducted free-operant research with psychiatric inpatients and normal volunteers at Metropolitan State Hospital in Waltham, Massachusetts. Their project, originally named "Studies in Behavior Therapy," was renamed "Harvard Medical School Behavior Research Laboratory" in 1955. This name change and its implications were significant. The role of the laboratory in the history of the relationship between the experimental analysis of behavior and applied behavior analysis is discussed. A case is made for viewing Lindsley's early work as foundational for the subfield of the experimental analysis of human behavior that formally coalesced in the early 1980s. The laboratory's work is also contextualized with reference to the psychopharmacological revolution of the 1950s. Finally, a four-stage framework for studying the historical and conceptual development of behavior analysis is proposed.     

Empirical derivation of SVIB-Holland scales: A brief report

The Strong Vocational Interest Blank responses of 93 students were used to construct six empirical scales similar to the scales of Holland's Vocational Preference Inventory. Scores on the empirical scales were correlated with actual VPI scores. The resulting correlations were compared to coefficients obtained from correlating the intuitive scales designed by Campbell with actual VPI scores. It was concluded that (1) meaningful estimates of VPI profiles can be obtained by scoring selected items from the SVIB and (2) further work with the empirical scales is needed prior to settling on a SVIB scoring procedure for estimating VPI profiles.     

Meditation—Psychologically and theologically considered

Considerable recent research on the psychology of meditation provides valuable guidance to religious meditators and pastoral counselors. The present paper summarizes this research under six topic headings, moving from the most common effects of regular meditation to the most subtle and rare: inducement of relaxation, gradual alleviation of anxieties, release of repressed psychic material, spontaneous physical adjustments, dissolution of habitual patterns of perception and cognition, and the attainment of an abiding state of altered consciousness. Contemporary research confirms traditional wisdom and suggests that meditation is recommended under ordinary circumstances only for those who have a stable personality and a supportive social environment. Such psychological material represents an initial, viable understanding of mysticism. Theological considerations do not invalidate psychological conclusions. Rather, the faith-filled appropriation of scientific findings draws them into a broader context that highlights their full significance.Dr. Helminiak pursues research in spirituality through study of psychology at Boston University and in-patient service at McLean Hospital. His address is 2 Mt. Vernon Street, Dorchester, Massachusetts 02125.     

The Vocational Exploration Group and minority youth: An experimental outcome study

This study was designed to investigate experimentally the effectiveness of the Vocational Exploration Group in assisting students to become more aware of the world of work and its relevance for them. Sixty male, Mexican-American, junior high students were randomly assigned to one of three groups: (1) Vocational Exploration Group, (2) VEG without interaction, or (3) Control. Upon completion of treatments subjects were post-tested with an instrument designed to assess knowledge of factors such as differing functions of jobs, interests and skills needed in different jobs and satisfactions available from work. Analyses revealed no statistically significant differences (a = .05) among groups.     

The psychodynamic psychiatry service of the University of Alberta Hospital: a thirty year history

This paper describes the Psychodynamic Psychiatry Service (PPS) of the University of Alberta Hospital over its 30 years of development. This psychiatric organization consists of three clinical programs-an outpatient clinic and intensive day and evening programs-and an integral evaluation and research unit. The PPS is unique in its group therapy clinical orientation, its psychodynamic theoretical orientation, and its integration of an ongoing research program that establishes empirical validation of its clinical work. The productivity and longevity of this psychiatric organization appear to derive from several strengths, including cooperation between leaders of the clinical and research programs; the institution of staff relations groups in the three clinical programs; the operation of the fully integrated evaluation and research program that serves to provide empirical support for the treatments offered; and a unifying ideology characterized by the valuing of both psychodynamic and group oriented work. Other important factors to the success of the PPS include the strengths of the founder of the service and financial and other support of the academic department in which it is housed. This paper describes the historical development and present structure and functioning of the PPS, the challenges it has been confronted with, and the responses to those challenges. We conclude with factors contributing to its survival and productivity and with thoughts about the future.     

Therapeutic approaches to families of young Israeli soldiers

This paper presents a set of family interventions performed in a civilian psychiatric unit with patients who were young Israeli soldiers. The work was done with a psychoanalytic orientation coupled with special attention to the general cultural characteristics of the surrounding society as well as to the particular ones of the families themselves. An experience of group therapy with the soldiers' parents will also be described in detail.     

Nursing and psychoanalysis — Uneasy alliances?

This paper examines the emergence of psychoanalytic ideas in nursing, tracing the history of these ideas, in particular the history of psychiatric nursing at the Maudsley Hospital since the 1950s. The development of psychoanalytically-informed nursing in the UK is compared with the developments in this field in the US. The future of psychoanalytically-informed psychiatric nursing is considered.