Premature twins on a neonatal intensive care unit

This paper presents observations of boy and girl twins on a neonatal intensive care unit, following them through from 10 days old to return home. The observer hypothesizes about the experience of the twins as they progress, based on detailed notes of their actions. The preoccupations of the parents are incorporated, as are reactions and interventions of staff. The place and possible functions of such observation by a child psychotherapist attached to such a unit are elaborated in the concluding section.     

A DBT Skills training group for family caregivers of persons with dementia

A Dialectical Behavior Therapy Skills training manual (DBT Skills) was adapted for use with caregivers of individuals with dementia. Implementation occurred in a community clinic with a heterogeneous caregiver group at risk for elder abuse. Sixteen caregivers completed the 9-week group. The results point to improved psychosocial adjustment, particularly increased problem-focused coping, enhanced emotional well-being, and less fatigue. Caregivers tended to utilize individual therapeutic services at a higher rate during the period of group attendance, indicative of appropriate help-seeking behavior in highly demanding situations. Six of the 16 caregivers repeated the training sequence in “booster” groups. Follow-up data from the booster groups suggest that high-risk caregivers may require continuing support to maintain treatment gains. In addition to demonstrating the feasibility of DBT Skills with caregivers, the results warrant a controlled outcome evaluation.     

The case of Peter: reflections on applied ethics in a neonatal intensive care unit

The case of Peter is reflected upon in order to highlight some of the moral theorising that could be brought to bear in the process of providing palliative care for sick neonates. The situation will be discussed using the theoretical lenses of deontological and virtue ethics. Nursing practice is considered as engaged moral reasoning where the nurse brings his/her beliefs, knowledge and experience into the situation and engages in reflexivity to provide appropriate ongoing patient care. The care should be provided in culturally sensitive manner and tailored to the needs of the newborn and their family. Nurses should initiate early consultations with colleagues, medical staff and families to address concerns about patient well-being in order to enhance the well-being of patients and families and to improve the work environment making it more conducive to care.     

Correlates of parenting on a neonatal intensive care unit: maternal characteristics and family resources

The association of maternal characteristics, family resources, and receipt of prenatal care with parenting behaviors observed in a neonatal intensive care unit (NICU; n = 383) was assessed. The parenting behavior of mothers not receiving prenatal care (n = 128) was compared to that of mothers of the preceding and subsequent admissions (n = 256) by retrospective chart review. Parenting variables included frequency of visits to the NICU and evaluative ratings of parents' involvement with their infant. Parenting of the no-prenatal-care group was significantly less favorable than the control on all comparisons. Factor analysis supported a priori grouping of parenting variables. A stepwise multiple regression of maternal and family characteristics to the factor-derived variable, parenting, showed significant contributions for prenatal drug use and father involvement. Pediatric interventions assessing maternal social and behavioral characteristics are proposed.     

Group climate and group development in a community meeting on a short-term inpatient psychiatric unit

Group climate and group development of the community meeting on a short-term inpatient psychiatric unit are examined. The Group Climate Questionnaire (GCQ) was administered to all staff and patients present at the weekly community meeting on an acute treatment unit in a teaching hospital over a 12-week period. Results show that staff and patients perceive the community meetings in relatively similar ways, that the group climate of a community meeting can attain a positive working state, and that, at times, the meeting can progress through developmental stages of group process. Behavioral observations support the GCQ as a measure of group interaction.The authors gratefully acknowledge the assistance of Mary Pat Donnelly with the statistical analyses and the cooperation of all staff and patients who participated in this study.     

Sequential cotherapy of groups for training and clinical care

Cotherapy has often been used as the leadership model in group therapy. The literature is full of contradictory data and impressions as to the efficacy of this model. In this article a new form of cotherapy is presented which may offer some of the assets attributed to the cotherapy leadership model while at the same time reducing some of the liabilities. Sequential cotherapy refers to cotherapy when each of the therapists leads sequentially rather than at the same time. The pros and cons of such an approach are discussed from both the perspectives of training new group therapists and of service to patients in groups.Dr. Rutan and Mrs. Alonso are members of the faculty of Harvard University Medical School and share responsibility for training psychiatric residents in group therapy at Massachusetts General Hospital, Boston, Massachusetts.     

A survey of groups within a psychiatric hospital

Summary

The findings of a survey of the involvement of staff in group activities within a large psychiatric hospital are presented. Over two hundred regular group meetings were being held, excluding ward-rounds and business meetings. There was a wide variation in the type and structure of the groups, the purpose and theoretical underpinning of many of which were unclear to the participants. It is suggested that this lack of clarity reflects the fact that the original therapeutic aims have been subverted in the service of institutionalised defences against anxiety. To be therapeutically effective, groups need clear leadership, good supervision and well-defined aims.     

Family therapy in primary health care: Skills training and outcome evaluation

Some of the theoretical tenets of family therapy such as emphasis on the activation and utilization of existing family resources and the importance it accords to context appear to have a good fit with primary health care's commitment to empowering individuals in their struggle against ill health and the circumstances in which it occurs. This paper explores the possibility of teaching a problem-solving approach to family therapy to nurses in a South African primary health care system. Training consisted of conceptual, pragmatic, and self-growth exercises, and trainees' conceptual and performance skills were compared to the skills of a group of untrained nurses.We thank Bukelwa Selema, co-trainer on the program, for her contributions to joining effectively with the nurses and enriching the experiential process. We also thank Dr. P.J. Beukes, Dr. J.H. Olivier, Dr. G.M. Louw, Matron L.C. Langley and other staff in the Soweto primary health care system for their support. In particular, we are grateful to nursing sisters Martha Nkoane and Millicent Matomela, who roleplayed clients on the videotaped training modules. We are also grateful to Edcent Williams, who was one of the videotape raters, and Mike Spruce, Ricky Snyders, Nico Cloete, Ricky Mauer, and Brenda Radebe for their inputs at various stages of designing and implementing the programme.     

T groups: An essential model in the training of group therapists

This paper argues for the T group (training group) model as the preferred experiential aspect of training in group psychotherapy. The rationale for preferring the T group model centers around aspects of: 1) contractual clarity; 2) the management of the learning regression; 3) the effectiveness of the T group as a professional holding environment; and 4) the development of a professional identity as a group therapist. Some difficulties with the model are also noted, and some case examples are offered to illustrate various aspects of the work within the T group model.