Group-as-a-whole concepts and the therapeutic milieu on the inpatient psychiatric unit

This paper focuses on large group process on the inpatient psychiatric unit. General systems theory and group-as-a-whole concepts are used to understand the dynamics of the therapeutic milieu. Using this information as a tool, the therapist can make various interventions on an individual and group level that will help patients understand and deal with their own psychopathology. Another benefit of this process is that it will develop a community on the psychiatric unit where patients help each other to get well. Three clinical examples are used to illustrate the relevance of this concept. With the advent of short-term psychiatric hospitalization, the therapeutic milieu has shown a drastic decline. Emphasis has been placed on the individual as opposed to the group and a valuable therapeutic tool has been lost. Using a group-as-a-whole concept can help reverse this trend and make the milieu on the inpatient psychiatric unit instrumental in the recovery of the patient.     

Therapeutic techniques vs therapeutic relationships in child behavior therapy

The parents of 56 children who had received behavior therapy rated a number of variables, including the degree to which they viewed the therapeutic relationship versus the specific techniques used in treatment as important, the extent to which the child improved in therapy, and the child's present functioning. Therapists also provided ratings of clinical improvement. Even though parents gave the highest ratings for the importance of the relationship in therapy, the correlation between technique and clinical outcome was statistically significant while the correlations between the relationship and outcome was not. These statistical associations also held when therapists rated improvement. Also, therapists saw greater improvement in children than did the parents. Over-all, the results support the view that the relationship and techniques are interwoven and are both perceived as important factors in treatment.     

Manic-depressive psychosis: Psychopathology and individual psychotherapy within a psychodynamic milieu

Manic-depressive patients are not usually regarded by psychiatrists as suitable subjects for psychotherapy, and there are many reasons for this view. Psychological support tends to take the form of helping the patient adjust to his disability, to become more aware of the life situations which may disturb him, of warning symptoms, of the need for appropriate medication, and perhaps to explore the most significant life conflicts. Psychoanalytic psychotherapy aimed at conflict resolution and personality development is widely regarded as impracticable, or ineffectual at best, or, at worst, as a potentially dangerous intervention. Considering the fact that the risk of suicide in the depressive phases may be so great, the problems of containing the disinhibited manic episode so serious, and the social consequences of such episodes so disastrous, it is not surprising that pharmacological control of pathological symptoms is so often regarded as the only therapeutic aim.

This paper is based on an account of a single patient suffering from a severe manic-depressive disorder with schizoid features, and a family history of manic-depressive illness, who was treated with individual intensive psychoanalytic psychotherapy in a context of a psychodynamic psychiatric ward, with encouraging results. Some implications of this experience will be discussed.     

In defense of experimental data in a relativistic milieu

The objectivity and utility of experimental data as evidential support for knowledge-claims may be found suspect when it is shown that (a) the interpretation of experimental data is inevitably complicated by social factors like experimenter effects, subject effects and demand characterics, (b) social factors which affect experimental data are themselves sensitive to societal conventions or cultural values, (c) all observations (including experimental observations) are necessarily theory-dependent, and (d) experimental data have limited generality because they are collected in artificial settings. These critiques of experimental data are answered by showing that (i) not all empirical studies are experiments, (ii) experimental methodology is developed to exclude alternate interpretations of data (including explanations in terms of social influences), (iii) theoretical disputes and their settlement take place in the context of a particular frame of reference, and (iv) objectivity can be achieved with observations neutral to the to-be-corroborated theory despite theory-dependent observations if distinctions are made (a) between prior observation and evidential observation and (b) between a to-be-corroborated theory and the theory underlying the identity of evidential response.     

The social milieu of dogmen and dogfights

This article examines the world of dogfighting. Our technique was to let the responses speak for themselves, thus presenting the world of dogfighting in full vivid detail and then to offer both summarization and interpretation. Our purpose was to capture the essence of dogfighting from those who have experienced it.     

The Roosevelt years: crucial milieu for Carl Rogers' innovation

This study explores broad features of political culture and event of the 1930s and World War 2 years, viewed in relation to the emergence and rapid early growth of the new therapy of Carl Rogers. The paper traces Rogers' early professional life and examines distinctive emphases in sociopolitical thought and development during Franklin D. Roosevelt's leadership as President over the prolonged emergency of the Great Depression and the crisis of the War. The study includes a focus on the President's own outlook and style, pertinent New Deal innovations, and wartime needs. Twelve features of this larger context are discriminated as together having vital importance for the new therapy and its founder. The congruent courses of the macrocontext and of Rogers' innovation are followed to the ending of Roosevelt's life. Direct causation is not attributed, but the evidence adduced newly points to particular contours of a larger environment favorable for the expression of Rogers' values and rare ability. In sum, the author concludes that a synergy of highly conducive historical circumstance and individual exceptionality contributed to the philosophical underpinnings, attitudinal values and early momentum of Rogers' client-centered therapy.     

Progressive relaxation and meditation : A study of psychophysiological and therapeutic differences between two techniques

Physiological and self-report data were collected on anxious subjects who participated in a study comparing progressive relaxation, meditation and a waiting-list control. The data provide some support for the Schwartz, Davidson and Goleman (1978) hypothesis of specific effects for different relaxation procedures, superimposed upon a generalized relaxation response. The similarities between techniques, however, were greater than the differences, both on physiological and self-report measures. Both techniques generated positive expectancies and produced decreases in a variety of self-reported symptoms and on EMG: but no skin conductance or frontal EEG effects were observed. Progressive relaxation produced bigger decreases in forearm EMG responsiveness to stressful stimulation and a generally more powerful therapeutic effect than meditation. Meditation produced greater cardiac orienting responses to stressful stimuli, greater absorption in the task and better motivation to practice than progressive relaxation; but it also produced more reports of increased transient anxiety. We found no significant differences between conditions in the therapeutic expectancies they generated. The clinical implications of these findings are discussed.     

Money: a therapeutic tool for couples therapy

This article addresses the therapeutic importance of discussing money at every stage of a couple's relationship, both as a concrete reality and as a metaphor for security, adequacy, competence, commitment, acceptance, and acknowledgment in a relationship. I will present a developmental schema looking at financial issues that couples confront at various stages in the adult life cycle and how these affect and reflect relationship problems. The article also presents a money questionnaire as a useful tool for exploring family-of-origin financial history, affect, and behavior.     

Resistance as a Problem for Practice and Theory

Resistance is one of the most problematic and potentially counterproductive concepts in the entire field of psychotherapy. It is at the same time one of the most crucial, pointing toward perhaps the single most important factor—or, more accurately, set of factors—in determining the success or failure of the therapeutic enterprise. Drawing on the articles by Davis and Hollon, Prochaska and Prochaska, Reid, and Eagle in this issue, as well as on the author's own perspective, this paper explores this seeming contradiction in order to point toward an integrative resolution of the differing perspectives on resistance and related phenomena.     

Ward assessment questionnaire--a further possibility for objectively evaluating therapeutically significant milieu conditions

Ways of evaluating the therapeutic environment in psychiatry and psychotherapy are discussed, and an account of work with Engels Ward Assessment Form is given.     

No Work for a Theory of Grounding

It has recently been suggested that a distinctive metaphysical relation— ‘Grounding’—is ultimately at issue in contexts in which some goings-on are said to hold ‘in virtue of’’, be (constitutively) ‘metaphysically dependent on’, or be ‘nothing over and above’ some others. Grounding is supposed to do good work (better than merely modal notions, in particular) in illuminating metaphysical dependence. I argue that Grounding is also unsuited to do this work. To start, Grounding alone cannot do this work, for bare claims of Grounding leave open such basic questions as whether Grounded goings-on exist, whether they are reducible to or rather distinct from Grounding goings-on, whether they are efficacious, and so on; but in the absence of answers to such basic questions, we are not in position to assess the associated claim or theses concerning metaphysical dependence. There is no avoiding appeal to the specific metaphysical relations typically at issue in investigations into dependence—for example, type or token identity, functional realization, classical mereological parthood, the set membership relation, the proper subset relation, the determinable/determinate relation, and so on—which are capable of answering these questions. But, I argue, once the specific relations are on the scene, there is no need for Grounding.