The "REST" program: a new treatment system for the oppositional defiant adolescent

This study compared the REST (Real Economy System for Teens) program with traditional talk therapy in the treatment of oppositional defiant adolescents. The REST program uses rules for five target behaviors: room care, personal hygiene, completion of chores, abusiveness, and safety violations. Objective measures and subjective parental ratings were taken. Twenty-five adolescents were assigned to each therapy group. In the REST program the adolescent was provided with only food and shelter. The adolescent had to earn money through the REST allowance program to pay for everything else. Earning the allowance was made contingent upon compliance with all rules for the five target behaviors. The results showed significantly greater improvement on all target behaviors for the REST program than for traditional therapy. In addition, parents of adolescents in the REST group reported that their adolescents seemed happier, more relaxed, and closer to them.     

"A war that had come right to them": group work with traumatized adolescents following September 11

This paper describes therapeutic foci for group intervention with traumatized adolescents. These include targeting the symptoms of trauma, helping members to weave a coherent, temporally ordered narrative of the event, providing psycho-education, and addressing bereavement issues and secondary adversities, all ultimately aimed at helping the adolescents proceed with development. The particular benefits of group are highlighted and clinical vignettes, drawn from the aftermath of September 11, are presented to illustrate these concepts.     

Verhaltenstherapie bei Kindern und Jugendlichen mit Angststörungen

Research into anxiety disorders of children and adolescents have been neglected for a long time. Current work on the prevalence and on the course of anxiety disorders of children and adolescents impressively substantiates that (1) anxiety disturbances are the most frequent mental disorders of children and adolescents and, (2) represent important factors of risk for the development of anxiety disorders, depression and substance dependence/abuse in adulthood. The recent developments in behavior therapy on anxiety disorders with children and adolescents are presented first and the results of a meta-analysis of behavior therapy studies are summarized. The results of the meta-analysis show that anxiety disorders can be treated successfully in children and adolescents with behavior therapy. The follow up data show that therapy successes remain stable over a timespan of several years. In comparison of individual and group therapy as well as child and family-based therapy, there are no important differences with regard to therapy success.     

Quality of Relationship with Parents and Emotional Autonomy as Predictors of Self Concept and Loneliness in Adolescents with Learning Disabilities: The Moderating Role of the Relationship with Teachers

The present study aims to investigate the impact of family-level variables (emotional autonomy and the quality of the parents-adolescent relationship) on socio-emotional adjustment (loneliness and self-esteem) in adolescents with learning disabilities (LDs) and the role of the quality of the teacher-adolescent relationship in moderating the effects of these impacts. The participants are 293 typically developing adolescents (TD group) and 50 adolescents with learning disabilities (LD group), aged between 13 and 20. The following measures were administered: the Emotional Autonomy Scale (EAS), the Loneliness and Aloneness Scale for Children and Adolescents (LACA), the Assessment of Interpersonal Relations (AIR), and the Multidimensional Self Concept Scale (MSCS). The data showed that adolescents with LDs display significantly higher levels of peer-related loneliness, and lower levels of self-concept and perceived quality of relationships with parents and teachers. No significant differences emerged between the groups in emotional autonomy and in parent-related loneliness. Path analysis indicated that, in adolescents with LDs, emotional autonomy was more closely related to self-concept than in typically developing adolescents. A positive teacher-adolescent relationship could have a moderating effect on the relationships between the dimension considered only in the LD group. The findings have important implications for the implementation of intervention programs focused on social and emotional competences in young people with LDs.     

Confrontation and support in group therapy in the residential treatment of severely disturbed adolescents

This paper focuses on the use of various forms of group therapy for severely emotionally and behaviorally disturbed adolescents. Group therapy is considered to be subordinate to a total systemic approach which includes individual, family, group, and milieu therapy. The author uses an eclectic theoretical frame of reference which includes some elements of psychodynamic, object relations, and structural and strategic family therapy theory. Precedents for the confrontational-supportive approach include encounter group and residential drug addiction programs, psychodynamic short-term individual therapy, and dynamic group therapy.     

Multiple family therapy for anorexia nervosa: concepts, experiences and results

Multiple family therapy (MFT) is an increasingly popular treatment approach for adolescents suffering from anorexia nervosa and their families. This paper describes the ingredients and different phases of this treatment, and outlines its indications and contra‐indications. Relationship patterns in families containing anorectic teenagers are examined, with a special emphasis on identifying areas for change in family relationships. Results with regard to the overall acceptability of the approach are presented.     

Stopping the Nonadherence Cycle: The Clinical and Theoretical Basis for Dialectical Behavior Therapy Adapted for Adolescents With Chronic Medical Illness (DBT-CMI)

Most adolescents with chronic illness do not adhere to their regimen. A novel transdiagnostic adaptation of dialectical behavior therapy (dialectical behavior therapy for chronic medical conditions; DBT-CMI) is presented to improve medical adherence in adolescents. The authors describe the approach of DBT-CMI and the model’s conceptualization of nonadherence, with specific focus on the core concepts of non-adherence across illness in adolescence.DBT-CMI has been piloted in two disease groups with preliminary benefit. DBT-CMI lends itself theoretically as a transdiagnostic approach due to specific skills that target core concepts of nonadherence in adolescence. Future research is warranted on the applicability of DBT-CMI across other pediatric medical conditions to replicate findings and examine long-term outcomes.     

Collaborative Home-Based Therapy (CHBT): A Culturally Responsive Model for Treating Children and Adolescents Involved in Child Protective Service Systems

Mental Health professionals are challenged with utilizing innovative treatment models to meet the needs of diverse communities. Enhancements in interventions have led to a reconceptualization of the role of mental health professionals, specifically, family therapists. This paper presents a collaborative, home-based model for working with children and adolescents involved in foster care. We begin by examining literature on home-based therapy. This review provides a framework to understand the need for a culturally responsive approach. A collaborative, home-based approach is presented along with unique issues and guidelines for practice. A clinical case is presented to illustrate implications for treatment.     

Therapeutic group approaches in an inpatient facility for children and adolescents: A 15-year perspective

Inner city, psychiatrically hospitalized adolescents are accessible to group therapy intervention. We developed a unique approach combining Slavson's theories with principles of family treatment and psychoanalytic theory. The group was conceptualized as a corrective family experience with the therapists functioning as model parents. Our model relies on a four-phase process, which is discussed.     

Are critical items "critical" for the MMPI-A

This article examines one aspect of the potential usefulness of critical items to the: Minnesota Multiphasic Personality Inventory -Adolescent (MMPI-A). Endorsement frequency data are presented on the Koss-Butcher (1973) and the Lachar-Wrobeli (1979) critical items for Minnesota Multiphasic Personality Inventory-2 (MMPI-2) adult normative and clinical samples and for MMPI-A adolescent normative and clinical samples. Adolescents in both normal and clinical samples endorse critical items with a higher frequency than do normal adults. Further, results demonstrated that significant differences were uniformly found between the endorsement frequencies for normative versus clinical subjects for the MMPI-2 samples, whereas similar comparisons for the MMPI-A samples typically showed that adolescents in clinical setting did not endorse critical items more frequently than normal adolescents. These findings indicate that it may be difficult to construct critical item lists for adolescents based on the type of empirical methodology used with adults in which items are selected based on endorsement frequency differences found between comparison group. Beyond the issue of the technical difficulty in creating a critical item list for adolescents, several conceptual concerns are raised regarding the application of critical items to the MMPI-A. It was noted that the concept of "critical items" has not been we11 defined, and both the reliability and validity of critical items may be limited in adolescent populations.     

You are not alone – adolescents’ experiences of participation in a structured skills training group for ADHD

Little is known about how adolescents with attention deficit/hyperactivity disorder (ADHD) experience participating in group therapy, an important factor to consider when developing treatment methods for this age group. This study aimed to explore how adolescents with ADHD experience participating in a structured skills training group program based on dialectical behavioral therapy. Semi-structured interviews were conducted with 20 adolescents (15–18 years of age) with ADHD after participating in a structured skills training group. The interviews were transcribed verbatim and qualitative content analysis were used to analyze the text. The participants emphasized the value of meeting other adolescents with ADHD and the opportunity to exchange experiences, strategies and tips. Participating in the group treatment made the adolescents realize that they were not alone, and feelings of togetherness and an increased acceptance of themselves were described. The participants associated the treatment with elevated knowledge and understanding, for example, about ADHD, their own functioning and helpful strategies. They also described emotional and behavioral changes, such as higher self-esteem, fewer inter-personal conflicts and improved concentration. Activating and experiential exercises were considered important elements of the treatment, and the participants expressed a need for a variation of exercises, as well as more time for practicing skills, discussions and breaks. The results indicate that the group format add an extra value to the treatment and that the use of an active approach throughout the treatment is of importance for this group of patients.     

The Prevention of Rehospitalization of Adolescents and Young Adults

This paper presents a family-oriented therapy approach for the prevention of rehospitalization of adolescents and young adults with diverse diagnoses. The dilemma of the family is presented in terms of the incongruities evident in the organizational hierarchy of these families. The main premise is that if the hierarchy is corrected so that the parents are jointly in charge of the youth and the extended kin cooperate, rehospitalization can be prevented. A therapeutic strategy is presented with the emphasis on overcoming the family's attempt to avoid a hierarchy in which the parents are in charge of the family.     

Learning Disabilities and Delinquent Behaviors among Adolescents: A Comparison of Those with and without Comorbidity

Research is inconclusive on whether adolescents with learning disabilities (LD) engage in more delinquency than adolescents without such deficits. Mixed results may result from a failure to account for the effects of co-occurring disabilities. Using the National Longitudinal Study of Adolescent Health, this study examines delinquency among adolescents without disabilities to youth with LD, Attention Disorder Symptoms (ADS), and comorbid LD/ADS. Results indicate no significant differences in property offenses, or alcohol, tobacco, and marijuana use; however, youth with LD reported significantly more violence than non-disabled youth. Findings illustrate the heterogeneous effects various disabilities have on delinquent behavior. Future research and policy implications will be discussed.     

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.     

Learning Disabilities and Psychosocial Adjustment: A Critical Review

Research is reviewed that assesses the extent to which difficulties in psychosocial adjustment are characteristic of broadly defined learning disabilities (LD) and of specific patterns of academic and neuropsychological assets and deficits (Rourke & Fuerst, 1991; Spreen, 1989). Overall, a majority of children and adolescents with LD are in the normal range of peer acceptance and socially competent behaviour. Some measure of difficulty in these social assessments is observed in approximately one third of children and adolescents with LD, compared with 10 to 15% of non-LD controls. Similarly, internalized emotional symptoms of depression and anxiety are assessed as somewhat higher for individuals with LD than for non-LD controls but are within the normal range of scores. Externalized emotional behaviours, specifically aggression, delinquency, and hyperactivity, are problematic but these too are at subclinical levels. In the few studies that examine psychosocial adjustment for subtypes of LD, there is some evidence that individuals with nonverbal learning disabilities (NLD) are at much greater risk for personality disturbance and behaviour problems. That the psychosocial adjustment of individuals with reading disabilities is within the range of non-LD controls remains to be convincingly demonstrated.     

Clinical,Studies in Psychiatry by H. S. Sullivan

A structured group therapy approach for psychiatric inpatients is presented. After reviewing the literature indicating that insight-oriented approaches are not effective with severely disturbed patients, the data supporting an interpersonal, cognitive, problem-solving approach with such patients is reviewed. A rationale for combining this cognitive problem-solving approach and Yalom's interpersonal approach with psychiatric inpatients is then presented. This structured group therapy approach, called the problem-solving support group (PSSG) is discussed, defining the nature and composition, screening procedures, methods, and techniques of the PSSG. Its use with psychiatric patients is illustrated by therapy protocols depicting the nature of the therapeutic interactions during the group, while also demonstrating what the group appears to be accomplishing for its members.     

An Experiment in the Prevention of Delinquency by Edwin Powers and Helen Witmer

A longitudinal clinical outcome study based primarily on a questionnaire method is the purpose of this two part paper. Techniques and approaches honed from fifteen years of para-analytic experience with one continuous Saturday morning group (seventy-five adolescents and young adults) are highlighted in this first part. Attention is focused on such pertinent issues as: lateness, selection, duration, individual sessions, physical setting, outside contacts, decreasing anxiety, parents and the important involvement of a female cotherapist. Catalyzing agents in the form of art therapy and mini-silent groups are described. The psychological position is presented for an age-mixed group (adolescents and young adults—age range twenty to thirty) to facilitate a natural flow of topics in the group dialogue rather than a “topic” format.     

Metaphors and Stories in Cognitive Behavioral Therapy with Children

Despite the recent proliferation of material on cognitive behavioral approaches with children and adolescents and the call for these approaches to be more child-friendly, there is scant attention paid to the use of metaphors with youngsters. This paper emphasizes the value metaphors add to cognitive behavioral therapy with children and adolescents. The advantages which recommend metaphor use for cognitive behavioral therapy with children are delineated. Further, seven guidelines for clinical practice are outlined. Examples of both clinician-generated and patient-generated metaphors are also presented.     

Father absence and adolescent "problem behaviors": alcohol consumption, drug use and sexual activity

Among the issues faced by adolescents are problems relating to alcohol consumption, drug use, and sexual behavior. A survey of 813 adolescents found that adolescents are most likely to discuss these problems with peers and least likely to discuss them with parents, especially fathers. However, father absence from the home resulted in greater use of and problems with alcohol, marijuana, and sexual activity. This was the case especially for boys. The results obtained underscore the significance of the father as a key figure in the transmission of values and as a deterrent to certain behaviors. The results point to adolescents from fatherless homes, especially boys, as being at risk for problems in the areas noted. This suggests that community agencies providing services to adolescents should make special efforts to incorporate into their programs specially designed services to meet the particular needs of this group. Aspects of such programs are discussed.     

Processing of Ambiguous Facial Affect in Adolescents with Depressive Symptoms Prior to and Following Social Exclusion: The Role of Perceptual Sensitivity and Response Bias

Depressive symptoms in adolescents are an important mental health issue and are associated with adverse developmental outcomes. Impairments in facial affect processing are considered an important factor in the etiology of depression. However, studies on facial affect processing in youth with depressive symptoms are lacking. This study investigated alterations in facial affect processing and the underlying mechanisms (perceptual sensitivity vs. response bias) related to adolescent depression, as well as the potential impact of negative social experiences. Sixty adolescents (M age?=?13.24, SD?=?1.03, 66.7 % female) with high (HD) and low (LD) depressive symptoms rated the predominant affective expression in ambiguous stimuli with varying intensity (happy-sad, happy-angry, sad-angry) prior to and following a negative (social rejection), positive (social inclusion), or no social experience with the depicted model identities. There were no baseline differences between groups. The LD group exhibited an increased perceptual sensitivity to happy expressions depicted by benevolent and stranger models, whereas the HD exhibited a higher sensitivity toward happy expressions depicted by rejecting social partners. The results suggest that depressive symptoms in adolescents may be associated with an altered processing of facial affect for partners who had previously rejected them. Implications of these findings for development and maintenance of adolescent depression are discussed.