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.     

Parent and child MMPI responses: Characteristics among families with adolescents in inpatient and outpatient settings

The relationship of parent personality to child psychopathology has been investigated in numerous MMPI studies over the past three decades. Very few of these studies, however, have directly analyzed MMPI response patterns of both parents and offspring. The current study included the MMPI responses of 199 families with adolescents entering inpatient and outpatient psychiatric setting (N = 542). Inpatient parents and adolescents had significantly higher mean scores across a variety of MMPI scales than did their outpatient counterparts. The linear combination of adolescent and maternal MMPI scale data, in a stepwise discriminative function analysis, resulted in accurate classification of 75% of all children in inpatient treatment and 74% of all children assigned to outpatient treatment. Findings were discussed in terms of salient MMPI differences between inpatient and outpatient families and shared psychopathological characteristics among family members with offspring in psychiatric treatment settings.     

Integrated,Family‐based,Partial Hospital Treatment for Complex Pediatric Illness

This paper describes a unique treatment program for complex pediatric illness. The Hasbro Children's Partial Hospital Program uses a family systems orientation, integrated care, and a partial hospital setting to treat children with a wide range of pediatric illnesses that have failed outpatient and inpatient treatments. We have treated more than 2000 children with at least 80 different ICD‐9 diagnoses. The multidisciplinary treatment team functions as a meta‐family for children and their families who present with illness and family beliefs that impede successful outcomes with standard care. The three features: family systems orientation, integrated care, and partial hospital setting, hopefully interact to create an environment that helps families expand and modify their explanatory models regarding participating in effective medical care. The goal of treatment is for both children and their parents to feel empowered to take control of the illness. Parents completing standardized measures at intake describe their children and families as experiencing significant emotional distress, low levels of general family functioning, and poor quality of life. Although the children are described as having distinct behavioral differences, the families are described as responding to the experience of a seriously ill child in similar ways. A treatment program that addresses the noncategorical aspects of how families respond to illness while addressing the specific diseases of the children can allow children and their families to respond favorably to treatment.     

卒中单元——中国未来卒中医疗的起点

卒中单元是脑血管病管理的新模式,是目前脑血管病临床治疗最为有效的方法。研究证明：卒中单元能有效地降低急性卒中患者的病死率,减少并发症,提高卒中后生活质量,缩短住院时间。而我国脑血管病的主要医疗模式是以药物为主的治疗方式,建立有中国特色的卒中单元是目前脑血管病临床实践的当务之急。     

Inpatient group processes parallel unit dynamics.

The authors conducted a quantitative examination of parallels between milieu and therapy group dynamics on a short-term inpatient unit. The Ward Atmosphere Scale was used to assess the milieu, and the Group Climate Questionnaire-S to measure processes in key groups. Assessments were made by patients and staff once each week for 10 months. The authors found clear parallels between ward and therapy group processes. The parallels reflected the impact of patterns utilization of the unit, its treatment philosophy, and the emotional dynamics of its constituents. Examination of these associations also revealed limitations of the treatment setting, clarified the potential impact of particular staff interventions, and demonstrated biases in the rating methods. Study of parallel process on the psychiatric unit is a rich source of information on the nature of inpatient treatment.     

T-Group Theory and Laboratory Method: Innovation in Re-Education Edited by Leland P. Bradford,Jack R. Gibb,and Kenneth D. Benne

The authors conducted a quantitative examination of parallels between milieu and therapy group dynamics on a short-term inpatient unit. The Ward Atmosphere Scale was used to assess the milieu, and the Group Climate Questionnaire-S to measure processes in key groups. Assessments were made by patients and staff once each week for 10 months. The authors found clear parallels between ward and therapy group processes. The parallels reflected the impact of patterns utilization of the unit, its treatment philosophy, and the emotional dynamics of its constituents. Examination of these associations also revealed limitations of the treatment setting, clarified the potential impact of particular staff interventions, and demonstrated biases in the rating methods. Study of parallel process on the psychiatric unit is a rich source of information on the nature of inpatient treatment.     

Written Exposure Therapy for Suicide in a Psychiatric Inpatient Unit: A Case Series

Patients with posttraumatic stress disorder (PTSD) are at an elevated risk of suicide. For patients hospitalized for suicide risk, psychosocial treatment and stabilization are routinely offered; however, the availability of evidence-based, manualized therapeutic interventions for PTSD is sparse. Typically, the short duration of hospitalization makes it difficult to accommodate evidence-based, trauma-focused treatments. This article presents the clinical course of four active-duty service members with PTSD who were hospitalized in a psychiatric inpatient unit for acute suicide risk and treated with Written Exposure Therapy for Suicide (WET-S). WET-S is a brief, five-session therapy based upon Written Exposure Therapy and augmented with Crisis Response Planning for Suicide Prevention. Both posttraumatic stress symptoms and suicidal ideation were reduced from pre- to posttreatment for three of the four patients treated. WET-S shows promise as a manualized therapeutic intervention that can be delivered on an inpatient psychiatric unit.     

The Use of Play in Child Psychiatry

The Model of Human Occupation is used as a theoretical framework to evaluate a preschool child on an inpatient psychiatry unit, and as a guide for designing treatment. The therapeutic environment is reframed through the use of play to facilitate competent functioning. Literature on play and play environments is reviewed to highlight the success of this approach.     

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.     

Analytic Group Psychotherapy with Children,Adolescents and Adults by S. R. Slavson

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.     

Effectiveness of inpatient treatment programs for mentally ill adults in public psychiatric facilities

This article updates the current state of knowledge and research on the effectiveness of inpatient treatment programs for mentally ill adults in the public sector to provide guidance for improving both research and services. National figures show inpatient facilities to still be predominant in the U.S. public mental health system; the populations and programs in these facilities are in serious need of science-based assistance. We summarize the major conceptual factors that influence the conduct and interpretation of inpatient outcome studies, clinical trials, or program evaluations (relevant domains and classes of variables, unit of analysis and effectiveness criteria, empirical findings on moderator variables). The major inpatient treatment approaches are described, and the empirical literature on effectiveness is reviewed. We conclude with a summary of the substantial accumulated evidence and recommendations for use of new assessment technology to assist with implementation of effective approaches and for advancing promising lines of research. The time seems ripe for exciting science-based advances in research and services.     

Therapeutic Assessment With Child Inpatients

Growing evidence supports Therapeutic Assessment (TA), a collaborative and therapeutic approach to psychological assessment, as an effective method for enhancing motivation for and engagement with psychotherapy across a variety of clinical populations and treatment settings. However, to date there are no known studies assessing the use of TA in child psychiatric inpatient settings. This article briefly reviews the structure of child and family TA, enumerates the challenges and risks associated with short-term inpatient stays, and proposes a path for integrating TA into these units as a way to enhance the quality of care and reduce the risk of rapid rehospitalization. The authors provide three case examples from a child psychiatric inpatient unit, each using a modified version of TA and each integrating assessments into brief family interventions. The authors conclude with suggestions for best practice for child psychiatric inpatient TAs.     

A model for group therapy with latency-age boys

This paper describes a model of group therapy with latency-age boys 9 through 12 years old. Usually parents and families are involved in family therapy while a boy is in group therapy. The model described here is appropriate for outpatient or inpatient treatment and has been used extensively by the author in a variety of settings.     

Reducing assaults on an acute psychiatric unit using a token economy: a 2‐year follow‐up

Token economies are an effective way of changing various behaviors including acquiring new skills, reducing undesired behaviors, reducing aggression, increasing treatment compliance, and improving psychiatric unit management. This study examines the long‐term effect of a token economy on an acute care, inpatient psychiatric unit. The two years following the implementation of a unit based token economy are compared with the 12 months prior to implementation. The results show a significant reduction in total assaults as well as fewer staff injuries resulting in loss of time from work. Copyright © 2003 John Wiley & Sons, Ltd.     

The de facto national system of psychiatric inpatient care. Piecing together the national puzzle

National data regarding psychiatric inpatient episodes can be viewed in 2 ways. The normative method surveys the "specialty mental health sector." A more inclusive method includes smaller sites (e.g., the military), all of general hospital treatment (rather than only the psychiatric unit), residential treatment centers, and other residential care. The difference between the 2 methods represents approximately 725,000 episodes, at a direct cost of more than $6 billion. The more inclusive analysis of the years 1980 and 1985 reveals a strong shift to the private sector and an increase in inpatient care of children and youth that might be obscured by limiting national treatment statistics to the specialty mental health sector.     

Inpatient adolescent group therapy as a social system

This paper describes a method of group therapy that 1) utilizes open systems theory to describe the social structure of group therapy, and 2)presents interventions drawn from Masterson's ideas for treating borderline personality disorders. Illustrations from a group therapy program for chemically dependent adolescents in a short-term, inpatient treatment unit of a general hospital are offered. It is proposed that under constrained conditions of treatment, such as those described, group therapy can be effective if there is precision about the system boundaries of task, role, time and place, and if group interventions are based upon a theoretically and clinically consistent model such as Masterson's.     

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.     

The Therapeutic Community Sing: Music Therapy Inpatient Group Process

Early psychoanalytic authors and music educators in both Europe and the United States pointed to the contemporary use of music therapy as a powerful modality in an inpatient psychiatric unit. The inpatient community sing is discussed in its capacity to address both individual and group goals. A clinical vignette from such a group is presented and discussed.     

Establishing family inclusive acute inpatient mental health services: a staff training programme in Somerset

In spite of policies advocating the involvement of families in the care of mental health service users in the UK there are few examples of training initiatives to bring this about. This article describes the delivery of a whole-team training initiative to promote family inclusive working in all acute inpatient units in Somerset. The three-day staff-training programme is described and training outcomes are reported. Staff reported a significant increase in confidence in their skills for working with families, and a pre- and post-training case note audit showed an increased consideration of the needs of families. This was accompanied by a modest increase in the average number of family meetings. Obstacles to family inclusive ways of working on inpatient units are described, and strategies to overcome these are discussed.     

Systemic-motivational therapy for substance abuse disorders: an integrative model

Although recent reviews of the literature on families and substance misuse offer compelling evidence that inclusion of families significantly improves treatment engagement, retention and outcome, family therapy remains peripheral in most substance abuse treatment programmes. Furthermore, many of the treatment approaches that have been included under the term 'family therapy' continue to focus on the substance abuser as the sole target of treatment. Still conspicuously absent are treatment models based on family systems approaches, with outcomes targeted at non-abusing family members as well. This article presents an overview of one such family-focused substance abuse treatment model – systemic-motivational therapy – that combines a family systems approach with techniques derived from motivational interviewing, but this time is applied to work with the family as a unit. The background for the development of the model will be described, as well as the assessment/consultation, family-level action plan, and aftercare/relapse prevention phases of the treatment approach.