Typical-Atypical Interactions: One Patient’s Experience of Weight Bias in an Inpatient Eating Disorder Treatment Setting

Abstract

This article examines one patient’s experiences with weigh bias in an inpatient eating disorder treatment setting with a focus on interactions between the patient and her primary therapist. These therapeutic interactions had multiple unintended consequences, including bolstering feelings of denial, modeling of disordered behaviors, and disrupting the therapeutic alliance. Additional instances of weight bias with other treatment professionals, including an inpatient nutritionist and psychiatrist, are briefly discussed. The article ends with several brief recommendations for how clinicians can more skillfully approach issues of weight and size in the therapeutic alliance in order to resist size-related oppressions rather than reinforce them.     

Tobacco Use Predicts Treatment Dropout and Outcome in an Acute,Transdiagnostic Psychiatric Treatment Setting

Tobacco use is consistently associated with greater levels of depression and anxiety, broadly, and preliminary evidence suggests that current tobacco use is a significant predictor of dropout from psychiatric treatment. The current study extends past work to examine the impact of tobacco use on treatment dropout and outcomes in an acute psychiatric treatment setting. Upon intake to a partial hospitalization program (PHP), patients completed a battery of measures assessing sociodemographic characteristics, current tobacco use, depression and generalized anxiety, and substance use. Patients at the PHP also completed measures assessing levels of depression and generalized anxiety again upon discharge from the program. In line with hypotheses, current tobacco use was a significant predictor of dropout from treatment at the PHP. Importantly, this relationship remained significant when statistically controlling for demographic variables and psychiatric and substance use severity (such as number of previous inpatient psychiatric hospitalizations and degree of alcohol or drug problems). Results from the current study indicate that tobacco use is a significant risk factor for treatment dropout. Further research is needed to replicate these findings and to determine the mechanism underlying this link between tobacco use and treatment dropout for people receiving intensive psychiatric care.     

Use of the Everyday Memory Questionnaire With Children

The Everyday Memory Questionnaire (EMQ; Sunderland, Harris, & Baddeley, 1983) was examined for its suitability to assess children's memory. The parents of 226 school children (6-12 years) completed the EMQ in relation to their own children. A subset of these children (N=101), in 6, 8 and 10 years age groups, completed subtests of the Wide Range Assessment of Memory and Learning (WRAML; Sheslow & Adams, 1990). Comparison of EMQ and WRAML data found aspects of verbal memory correlated moderately with the EMQ in the 10 years age group. There were no meaningful correlations in the 8 years age group. In the 6 years age group aspects of visual memory correlated moderately with the EMQ. The diagnostic utility of the EMQ for children was assessed by comparing the school group to children diagnosed with ADHD and/or learning disorders. Diagnostic indicators revealed the EMQ to have high sensitivity (89%) but poor positive predictive power, identifying 40% of the school group as having memory deficits. Negative predictive power (confirming a negative diagnosis) was high. Validity data suggested that the EMQ could be useful with children at least as young as 10 years and further research needs to be conducted to establish the utility of the EMQ in clinical groups with primary memory deficits.     

Couples Therapy for Drug Abusing Women in an Inpatient Setting: A Pilot Study

This article describes a pilot study to examine the usefulness of adding a couples therapy component to inpatient drug and alcohol treatment for women. The treatment model was modified from a 12-week integrative systems model that has been empirically supported in outpatient treatment settings. A team of student-therapists received intensive training and supervision in the modified version. This article discusses the ability of chemical dependency counselors to implement this model, includes pre and post treatment comparisons, and qualitative findings regarding the efficacy of the project. The treatment model promises to be usable, safe, and practical in inpatient settings, and merits a more thoroughgoing clinical trial.     

Extratest Validity of Selected Personality Assessment Inventory Scales and Indicators in an Inpatient Substance Abuse Setting

Sixty college students were selected on the basis of their performance on an unstructured personality measure, Rokeach's Interrelations Task. Interrelatedness of ideas was significantly related to resistance to the influence of peer norms and to performance on a comprehensive, college-level examination. These findings extend the construct validity of interrelatedness and join other studies to demonstrate the importance and scope of this personality variable. A test construction strategy is discussed which would change the assessment of interrelatedness from a dichotomous classification to a continuum.     

Characteristics of Dieting and Nondieting Adolescents in a Psychiatric Inpatient Setting

  The clinical and psychosocial characteristics of 239 dieting and nondieting adolescents (61% female; mean age=15.3) recruited from an inpatient psychiatric setting were examined. Dieting adolescents were compared to nondieting adolescents on exercise frequency, weight control behaviors, risky behaviors, psychiatric comorbidity and distress, eating disorder symptomatology, smoking, coping, and family factors. While dieters did not statistically differ from nondieters on scores of body mass index, dieting youth reported greater levels of self-reported distress, poorer coping, greater eating disorder symptomatology, and were more likely to engage in extreme weight control behaviors. In addition, dieting was associated with higher rates of major depression (58% vs 34%) and eating disorders (14% vs 1%). Among adolescent smokers, dieters endorsed smoking as a weight control behavior. Engaging in risky behaviors or familial factors did not differentiate dieters from nondieters. Given the number of negative correlates associated with dieting in adolescents, identifying dieting and weight control behaviors in clinical settings may prove to be an effective strategy in the development of prevention and intervention efforts for youth.     

Assessment of Psychotic Disorders in Inpatient Children and Adolescents: Use of the Devereux Scales of Mental Disorders

The Devereux Scales of Mental Disorders (DSMD), with its 3-factor model of measurement (i.e., Internalizing, Externalizing, and Critical Pathology), may be useful in screening for psychotic disorders in children. This study assessed the ability of the DSMD to differentiate between inpatient children and adolescents with psychotic disorders (n = 18) and those with other clinical syndromes (n = 71). Results of ANCOVAs indicated that the psychotic group scored significantly higher on most DSMD scales and composites than the nonpsychotic clinical group. However estimates of effect size were particularly large for the Critical Pathology Composite and the Autism and Acute Problems Scales. Diagnostic efficiency statistics revealed that the DSMD's Critical Pathology Composite was highly accurate in differentiating between the 2 clinical groups. These findings support the utility of the DSMD in identifying children and adolescents with psychotic disorders.     

The Importance of Group Cohesion in Inpatient Treatment of Combat-Related PTSD

Abstract

Post-traumatic stress disorder (PTSD) is the most widespread mental illness resulting from exposure to combat, necessitating an increase in the provision of group therapy. This pilot study examined the efficacy of, and treatment outcome predictors associated with, group inpatient treatment of combat-related PTSD. Participants included 38 active duty military personnel deployed during Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), diagnosed with PTSD, and consecutive admissions to an inpatient PTSD treatment facility. A paired samples t-test revealed significant change in symptom severity and global functioning between pre- and post-treatment. Multiple regression analyses supported the predictive utility of baseline symptomatology and group cohesion (> 50% of the variance in treatment outcome), highlighting the importance of group cohesion in the efficacy of group treatment for combat-related PTSD.     

Comparing Television Use and Reading in Children With ADHD and Non-Referred Children Across Two Age Groups

There has been abundant speculation, but very little research, concerning the role of television in the lives of children with attention deficit hyperactivity disorder (ADHD). This study compared the use of television and other media in samples of children with ADHD and nonreferred children. Children with ADHD were reported to watch more television, a difference partially accounted for by demographic and environmental characteristics. Children with ADHD were also reported to enjoy television more and have greater involvement in television-related activities, and to enjoy reading less and be less involved in reading-related activities. However, there were no diagnostic group differences in reports of weekly reading, and weekly reading was unrelated to television viewing in children with ADHD. Results suggest a complex relation between television viewing and ADHD not recognized in previous research and popular commentary, and suggest that research on children with ADHD's television use should consider environmental and developmental contexts.     

Emotion Socialization in Families of Children With an Anxiety Disorder

Compared emotion socialization in 26 children with anxiety disorders ages 8–12 years and their mothers to 26 nonclinical counterparts without psychopathology. Children and their mothers participated in an emotion interaction task in which they discussed occasions when the child felt worry, sadness, and anger. Responses were coded for length of discussion, proportion of words spoken by child vs. mother, frequency of positive and negative emotion words, explanatory discussion of emotion, and maternal facilitation of emotion discussion. Children and their mothers also completed the Expressiveness and Control scales of the Family Environment Scale. Results indicated that mothers of children with an anxiety disorder spoke less frequently than their child, used significantly fewer positive emotion words, and discouraged their childrens emotion discussions more than did mothers of nonclinical children. Nonclinical children and their mothers indicated significantly more emotional expressiveness in their families than did children with an anxiety disorder and their mothers. These results highlight the potential role of truncated family emotional expressivity in the emotional development and functioning of children with an anxiety disorder.     

On the Boundary: Family Therapy in a Long-Term Inpatient Setting

This paper presents a paradigm of family therapy in a long-term inpatient setting. After reviewing literature commenting on the necessity of attending to the needs of families of inpatients, the essential functions of inpatient treatment are discussed and an approach to family therapy, related to and reflecting those functions, is developed. Four functions of inpatient family therapy are delineated: joining, support, intervention, and validation. What distinguishes these from similar functions in outpatient treatment is the family therapist's position on the hospital-family boundary.     

Treatment Outcome Studies With Children: Principles of Proper Practice

This article addresses ethical issues in conducting randomized clinical trials (RCTs) with youth. Ethical considerations that occur prior to treatment (matters of research design, the risk–benefit ratio, issues concerning assent/consent, the influence of payment for participation), during treatment (issues of privacy, protocol adherence, premature termination), and following treatment (needs for posttreatment referrals and/or follow-up contacts, archiving of treatment data) are reviewed. Recommendations, based on empirical evidence and clinical experience, are offered for conducting ethical treatment research with youth and future directions for carrying out research on the ethics of conducting RCTs with youth are offered.     

Goal Setting by Groups Performing an Additive Task: A Comparison With Individual Goal Setting1

This article compares goal levels and task performance of groups and individuals that are assigned or self-set goals. Groups performed an additive task that allowed for direct comparison with individuals' i]ndependent performance of the task. Consistent with predictions, groups and individuals selected goals that were less difficult than assigned goals which required only a modest increase in performance. Group members and individuals who were assigned goals attained higher levels of performance than self-set or no goal condition subjects. The prediction that group members and individuals who self-set their goals would have more positive affective reactions to the goal-setting situation than participants in assigned condition was supported. The results of this study are consistent with the existing literature on groups and individuals regarding effects of goals, performance, and affective reactions. Analyses also indicate that the group goal decision process involves a compensatory strategy in which an average of group member preferences for the goal was used to reach a group goal decision. Discussion focuses on the similarities and differences between the findings of self-set and assigned goal-setting situations for groups and individuals, with particular reference to goal choice strategies, goal expectancies, and efficacy.     

New and Familiar Roles for Clinical Psychologists in the Effective Treatment for Children With an Autism Spectrum Disorder

Alongside the increased prevalence of autism spectrum disorders (ASD), there is a greater likelihood of clinical psychologists having a role in the treatment of children with these disorders. Population heterogeneity with respect to ASD-specific symptomatology, comorbid medical and psychiatric issues, level of cognitive functioning, and presence of adaptive behaviors, all add to the complexity of providing treatment to this population. Consequently, psychologists often find themselves in multiple roles in order to effectively manage treatment for children with ASD and their families. The purpose of this article is to increase awareness of three major roles for clinical psychologists working with this population: assisting families with treatment coordination, identifying and treating comorbid psychopathology, and addressing parental stress.     

Development of a Reinforcement Survey for Inpatient Psychiatric Children

A reinforcement survey for use with inpatient psychiatric children is described. The survey provides a quick means of identifying reinforcers for use in motivational programs. Sample data from a child psychiatric population are included.     

The Rehabilitation Counselor in an Educational Setting

The role of the rehabilitation counselor in a high school Work Experience and Study Program for the Educationally Mentally Handicapped is delineated. The most common problems in placement, and the manifest vocational needs that these students exhibit are examined.     

The Happiness-Energy Paradox: Energy Use is Unrelated to Subjective Well-Being

Applied Research in Quality of Life - Earth’s per capita energy use continues to grow, despite technological advances and widespread calls for reduction in energy consumption. The negative...     

Expanding Treatment Options for Children With Selective Mutism: Rationale,Principles, and Procedures for an Intensive Group Behavioral Treatment

Children with selective mutism (SM) experience significant challenges in a variety of social situations, leading to difficulties with academics, peers, and family functioning. Despite the extensive evidence base for cognitive-behavioral interventions for youth anxiety, the literature has seen relatively limited advancement in specialized treatment methods for SM. In addition, geographic disparities in SM treatment expertise and the roughly 6-month duration of some of the supported SM treatment protocols can further restrict the accessibility and acceptability of quality SM care. Intensive group behavioral treatment (IGBT) for SM was developed to expand the portfolio of evidence-based SM treatment options by offering brief, but high-dose, expert SM intervention in a group format for youth ages 3–10 years that can be completed in 1 week. In this article, we outline IGBT for SM program, which has already received initial support in a waitlist-controlled trial. Our presentation is organized around the five main components of the treatment model: (1) individual “lead-in” sessions, (2) camp (i.e., all-day group sessions for children held in a simulated classroom setting, with an emphasis on graduated exposures and structured reinforcement), (3) parent training, (4) school outreach, and (5) booster treatment, as needed. We conclude with a discussion of clinical considerations and future directions for further IGBT refinement and evaluation.     

The Use of Empirically Supported Strategies for Building a Therapeutic Relationship With an Adolescent With Oppositional-Defiant Disorder

Manualized evidence-based treatments, particularly behavioral and cognitive-behavioral interventions, have been found efficacious for the treatment of adolescents with oppositional-defiant disorder (ODD). However, despite research that underscores the importance of the therapeutic relationship for the success of treatment, manuals do not adequately address how a therapist should engage an adolescent and his/her family in treatment. This paper demonstrates how to utilize findings from the empirical literature on youth and parent engagement when delivering evidence-based treatment to an adolescent diagnosed with ODD. Examples of strategies for engaging adolescents and parents in treatment are provided.