Development of psychiatric comorbidity with substance abuse in adolescents: effects of timing and sex.

Examined the impact of childhood psychiatric disorders on the prevalence and timing of substance use and abuse and tested for sex differences. A representative population sample of 1,420 children, ages 9, 11, and 13 at intake, were interviewed annually. American Indians and youth with behavioral problems were oversampled; data were weighted back to population levels for analysis. By age 16, more than half the sample reported substance use, and 6% had abuse or dependence. Alcohol use began by age 9, and smoking in the 13th year. Mean onset of dependence was 14.8 years, and mean onset of abuse was 15.1 years. Substance use began earlier in boys, but not girls, who later developed abuse or dependence. Disruptive behavior disorders and depression were associated with a higher rate and earlier onset of substance use and abuse in both sexes, but anxiety predicted later onset of smoking. Family drug problems were the strongest correlate of early onset. Despite differences in prevalence of psychopathology, boys and girls showed more similarities than differences in the course of early substance use and abuse, and its associations with psychopathology.     

Group psychotherapy for adolescents comorbid for substance abuse and psychiatric problems: a relational constructionist approach

The group psychotherapy of adolescents comorbid for psychiatric and substance abuse problems is fraught with inconsistent attendance, frequent verbal and physical disruptions by the adolescents, and intense countertransference toward patients and their parents on the part of treating staff. A relational constructionist approach assists staff and patients in overcoming these obstacles and in focusing on the adolescents' search for personal meaning. Multiple group psychotherapy conducted in a combined day treatment and high school program is described and illustrated by case examples during the course of a year of treatment. These examples illustrate the importance of a relational non-hierarchical approach to adolescent patients by treating staff.     

A parenting group for women dealing with child sexual abuse and substance abuse

This article describes a group developed to address the parenting needs of women dealing with child sexual abuse and substance abuse. A solution-focused 12-week group intervention is described, and the results of an evaluation are presented. Participants included 29 women who attended seven parenting groups. The results suggest that the group was perceived as beneficial by the women, who reported an increase in self-esteem, parenting satisfaction, and parenting self-esteem and an improvement in their attitudes toward their children.     

A time-limited dynamic approach to adolescent inpatient group psychotherapy

In response to sharply curtailed lengths of stay of adolescents in an inpatient psychiatric program, new therapeutic modalities need to be implemented. A time-limited dynamic approach to adolescent inpatient group psychotherapy is presented. The model integrates psychoanalytic and crisis theory into a group format. The primary focus in this model is upon resolution of problematic interpersonal interactions as they are related to the current crisis state. The group process, as related to the adolescent, involves three phases. These include an initial intake phase, which incorporates an ego-functioning assessment; a second or middle phase which focuses on making actions ego-alien; and the termination phase, which incorporates the learning experience and how it relates to the resolution of precipitators of the admission.     

A group-centered object relations approach to group psychotherapy with severely disturbed patients

This paper discusses how the application of object relations theory to clinical intervention has extended the application of psychoanalytic group psychotherapy to more severely disturbed patients. The author suggests how to structure the group based on individual and group needs. Clinical issues are presented, including the group as a container, communication peculiarities, and psychotic response to separation, sexuality, and interpretation.     

A dynamic/expressive approach to brief inpatient group psychotherapy

Therapeutic action occurs in groups when patients simultaneously become more accepting of their own thoughts and feelings and increase their capacity to share more benign and mature interpersonal relationships with the therapist and other patients. This orientation can guide practitioners of brief inpatient group psychotherapy in choosing when to use interpersonal, problemsolving, or object relations techniques, or more traditional dynamic/expressive techniques. While the brief inpatient modality requires an increase in suppressive techniques compared to the longterm outpatient modality, suppression must be used judiciously, to facilitate rather than interfere with selfunderstanding and development of therapeutic relationships. Specific technical choices are derived from this principle and illustrated with a case example.     

Group psychotherapy with adolescents: An integrative approach

Conclusion This paper has attempted to convey a complex strategy and rationale for conducting group psychotherapy with a specific population. A variety of techniques have been integrated into an approach designed for adolescent groups. Modifications of this basic approach would be readily applicable in a variety of settings (e.g., school counseling programs, in-patient, facilities, private therapy).     

Cultural context and substance abuse in Hispanic adolescents

Much emphasis has been placed on the significant substance abuse problem being faced by Hispanic as well as other minority youth in the United States. However, little research has focused on the relative importance of culturally determined factors in the development of substance abuse in Hispanic youths. In this study, we propose an approach to measuring cultural factors through the activity orientations that youths endorse. We studied over 4000 Mexican-American and Mexican youths living along the U.S.-Mexico border with respect to their recent drug use, problem drug use, depressive symptomatology, and their activity orientation. While culturally related activity orientation does significantly increase risk for substance abuse, we found that symptoms of distress/depression and sociodemographic factors exerted a stronger effect on these youths.     

Leader dilemmas and countertransference considerations in group psychotherapy with substance abusers

Leader issues and countertransference dilemmas that emerge in psychotherapy groups for substance abusers will be examined along with strategies to extricate the therapist from the impasses that emerge. Specific issues include feelings of helplessness and inadequacy when a patient relapses and resumes substance use, countertransference reactions emanating from an overlapping personal or family history of substance abuse, countertransference helplessness when the therapist is more invested in the treatment than the patient, feelings of incompetence related to partial familiarity with 12-step culture and lingo, and countertransference devaluation fostered by systemic issues in substance abuse settings.     

Medicine as metaphor and medium in group psychotherapy with psychiatric patients

A conceptualization is presented which encourages a renewed exploration of the way in which psychiatric patients discuss their medications in the group therapy setting. It is suggested that process-oriented group therapists tend to harbor subtle prejudices which may inhibit examination of this material. If we listen to medication-related discourse more carefully, we find that patients disclose important information about hopes and fears about treatment, self-efficacy, attitudes about control and authority, and other sensitive or disowned parts of experience. The process of interactions about medicines often reveals interpersonal difficulties, particularly around intimacy. Suggestions for intervening more effectively with this type of material are presented. The importance of medication attributions in revealing curative fantasies is discussed.     

Subgrouping with psychiatric inpatients in group psychotherapy: linking dependency and counterdependency

Abstract A model of inpatient group psychotherapy that focuses on two frequently observed patient subgroups reflecting contrasting attitudes toward authority is presented. The counterdependent subgroup overly values autonomy, opposes unit restrictions, and rejects treatment. The dependent subgroup tends to accept the unit's treatment and structure but is overly passive. In this model these attitudes are addressed in order to help patients adapt to the unit and to facilitate discharge. The author describes a three-stage group designed to help patients achieve these goals.     

Video self-portraits: a novel approach to group psychotherapy with young adults

A group therapy model was formulated for exploring the intersubjective processes of adolescents and young adults whose group bonds had been fragmented by their severe emotional illnesses. The model involved having adolescents and young adults who were psychiatric inpatients make video self-portraits; that is, videotapes which focused on various aspects of their emotional pathology. These tapes were then presented before a larger group of nine patients for discussion. The video team method is shown to aid in self-disclosure and facilitate the working through of severe emotional conflicts in this age group. It is an especially useful method with more severely disturbed patients for whom narcissistic self pathology is a prominent feature.     

A behavioral approach to substance abuse prevention in the correctional setting: A preliminary report

This study evaluated the effectiveness of a substance abuse program in a correctional institution using social skills training for secondary prevention. Forty-four male inmates with a history of substance use participated in the pilot program. Program topics included drug, alcohol, and substance abuse treatment knowledge and development of anger and stress management skills. A pretest-posttest analysis revealed significant improvement in overall knowledge of program topics and within specific areas. Areas of greatest improvement were drugs and alcohol. Clients and group leaders reported that the program was effective in facilitating attitude and behavior change regarding substance abuse. Results suggest a social competence approach to substance abuse rehabilitation in correctional institutions holds promise for both increasing knowledge and teaching effective skills to resist future substance abuse.     

Contemporary theories of group psychotherapy: a systems approach to the group-as-a-whole.

The author discusses how subgroups represent the basic focus of the systems-centered group therapist. Particular attention is given to boundary issues and to how therapy takes place by facilitating the process of discriminating, communicating, and integrating perception of differences in the apparently similar and similarities in the seemingly different. Communication occurs at the boundaries between systems at all levels of the hierarchy: the group, the subgroup, and its members. Clinical vignettes are provided to illustrate important process issues, such as work with difficult patients, levels of intervention, and group resistance and defense.     

Cotherapy in psychodynamic group psychotherapy: An approach to training

Cotherapy in a training relationship with a senior therapist/supervisor and a trainee/junior leader is presented. A structured training year with planned sessions for the junior leader to lead the group alone, as well as intensive supervision, is described. The training relationship is seen as evolving into an egalitarian, collegial working relationship. An incidental benefit of this cotherapy approach is that additional opportunities are provided for group members to work through attitudes, feelings, and behaviors associated with attachment, interpersonal relationship (autonomy and affiliation), separation, and loss. Potential drawbacks and applications are also noted.The authors express their appreciation to the many group members and cotherapists whose experiences provided the stimulation and clinical material for the present formulation.