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.     

The psychiatric infant—family ward at Tampere University Hospital

This article describes a new integrated evaluation and intervention program for infants, small children and their families, a child psychiatric infant–family ward treatment model at Tampere University Hospital. A centerpiece of the model is a 3-week treatment period for the whole family at the infant–family day ward. The work of the multidisciplinary team on the ward focuses on family relationships, on representational level, and on the interactional behavior of the family. Interaction and relationships are used as tools, including a reflective working model and sharing concrete interaction with the family. Theoretically, the treatment is based on an integrative model where psychoanalytical and systems theories as well as a behavioral approach are applied in defining the strengths and problems of the family and of the infant and in choosing the best intervention techniques. The fact that the whole family is present at the ward creates a strong therapeutic holding relationship context and an open therapeutic reflection, which are the cornerstones of this new and encouraging treatment model. © 1998 Michigan Association for Infant Mental Health     

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.     

Hamburger Modell der integrierten Versorgung von schwer erkrankten Psychosepatienten

The Hamburg model designates an integrated care model for severely ill patients with psychotic disorders. Based on evidence-based knowledge it was developed in 2005 and implemented in 2006 and is financed since May 2007 via §140 SGB V (German Social Code, book V) as a yearly per patient rate by various health insurances. It comprises comprehensive and long-term treatment within a network of the University Medical Center Hamburg-Eppendorf and private psychiatrists. The treatment model consists of therapeutic assertive community treatment (ACT) and need-adapted inpatient and outpatient care. Since 2012 the model has been extended to the indications of first episode adolescent and young adult patients in the age range of 12–29 years. The present article summarizes the contents of the model, important patient characteristics and results of the long-term treatment.     

Multi-agency family systems

The term 'multi-agency' family is preferred to 'disorganized' family. Multi-agency family systems present special problems of the relationships (a) within the family, (b) between family and professional network, (c) among members of the professional network and (d) between family, network and treatment centre to whom the family is referred. Pressures on the family and professional workers can create a locked system which prevents natural development of the family or effective problem solving by the workers. A systems approach to such problems is presented which includes consultation to the family/professional network system.     

Research in Adolescent Suicide: Implications for Training,Service Delivery,and Public Policy

Four domains of research in adolescent suicide are reviewed: (1) the role of psychopathology, (2) family history of psychopathology, (3) mental health treatments, and (4) firearms in the home. Based on the extant literature, recommendations are made for changes in training, service delivery, and public policy. Among the recommendations for training professionals are: an emphasis on diagnostic proficiency, skill and attentiveness in the assessment of the entire family unit, and assessment of the availability of firearms in the home. With respect to changes in service delivery, we recommend treatment of the entire family system, and treatment of psychiatric and substance abuse problems in the same setting, and we show the need for a continuum of intensity of care from inpatient to outpatient. With respect to policy changes, we recommended parity of mental and physical health insurance coverage, screening for psychiatrically at-risk youngsters in schools and physicians' offices, providing funding to support a continuum of care between inpatient and outpatient, and gun control laws to restrict access to handguns. We believe that these changes can result in a substantial reduction in the adolescent suicide rate.     

Psychosomatische Rehabilitation

Besides inpatient and outpatient treatment, rehabilitation represents the third column of the German healthcare system. The goal for the persons concerned is the conservation of activity and participation in the professional and social life. This article shows the importance and development of German psychosomatic rehabilitation in contrast to regular inpatient treatment. It also explains its place in the whole healthcare concept of rehabilitation and the basic principles of sociomedical assessment, followed by practical advice for the indications and the rehabilitation application process. Compared with other countries Germany has a very well-established system of psychosomatic rehabilitation but this resource is often used too late in the course of treatment, mostly not until severe chronification has occurred and in addition there are also problems with points of interaction concerning the subsequent outpatient treatment. The aim of this article is therefore to contribute to an improved cross-linking of the different areas in the healthcare system.     

Ambulant oder stationär?

A central issue in psychosomatic-psychotherapeutic consultations is whether to recommend outpatient or inpatient psychotherapy. In a prospective field study at a psychosomatic outpatient unit sociodemographic and clinical variables were compared for patients for whom outpatient treatment (N = 129) or inpatient treatment (N = 112) had been recommended. The assessments of the therapeutic alliance were made by the referring therapist and the therapist who conducted the therapy. The main findings were: The decision about what type of treatment to recommend was based mainly on the type and severity of the disorder, including the patient's functional level and personality structure. There was no difference between the patient groups in how the referring therapists assessed the initial therapeutic alliance, but there was a difference in how the treating therapists did, the relationship to the inpatients being rated significantly less favorably. The importance of the different treatment settings in interaction with the severity of the disorder is discussed. The initial therapeutic alliance in the consultation did not enable a prognosis about the therapeutic alliance during therapy.     

Barriers to treatment participation and therapeutic change among children referred for conduct disorder.

Examined predictors of therapeutic change among children seen in outpatient therapy. Children (N = 200) referred for oppositional, aggressive, and antisocial behavior and their families participated. The major findings were that (a) socioeconomic disadvantage, parent psychopathology and stress, and child dysfunction predicted therapeutic change from pretreatment to posttreatment; (b) barriers to participation in treatment also were significantly associated with therapeutic change and this effect was not explained by the other family, parent, and child predictors; (c) as the level of perceived barriers to participation in treatment increased among families, the amount of therapeutic change decreased; and (d) among children at risk for relatively little therapeutic change, the perception of few barriers to treatment increased the degree of child improvement. The implications for further work on predictors of therapeutic change and the role of barriers in the treatment process are discussed.     

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.     

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.     

OPEN DIALOGUE IN PSYCHOSIS I: AN INTRODUCTION AND CASE ILLUSTRATION

As a social construct, our approach to work with severely disturbed psychiatric patients in crisis, termed Open Dialogue (OD), begins treatment within 24 hours of referral and includes the family and social network of the patient in discussions of all issues throughout treatment. Treatment is adapted to the specific and varying needs of patients and takes place at home, if possible. Psychological continuity and trust are emphasized by constructing integrated teams that include both inpatient and outpatient staff who focus on generating dialogue with the family and patients instead rapid removal of psychotic symptoms. The main principles are described, and a case is analyzed to illustrate these.     

Systemische Therapien bei Menschen mit psychotischen Verhaltens- und Erlebnisweisen

Systemic therapy for persons who have been diagnosed as having schizophrenic or schizoaffective psychosis has been practiced since the 1950s, not everywhere and routinely but in many psychiatric hospitals and outpatient clinics with a strong psychosocial orientation. Evidence of the effectiveness is well documented in randomized controlled studies. This article describes three systemic approaches in which the authors are actively involved: (1) systemic constructivist family therapy developed in Heidelberg for outpatient contexts, (2) need-adapted treatment and open dialogue developed in northern Europe that has gained access to psychiatric clinics through regional training within integrated care projects and (3) the concept of systemic therapeutic methods of acute psychiatric treatment (SYMPA) a systemic family-oriented inpatient treatment.     

Psychoanalytic aspects of inpatient treatment

This paper looks at the experience of inpatient hospital treatment at the Cassel Hospital and how formal psychoanalytic psychotherapy, with its emphasis on the transference and the inner world, fits into that context and orientates itself to some of the realities of the setting. It outlines how psychotherapy and nursing can work to inform and enrich each other, and what is psychoanalytic about the overall work. A bridge of understanding is built using the patients' perceptions of, adjustment to and conflict about the inpatient setting, and the affective impact of the processes on patients and staff alike. Two clinical examples of severe child abuse family cases are given, the first of Munchhausen syndrome by proxy, the second in which a baby sibling had been killed. They show how in-depth psychoanalytic work with mother and child and individual psychotherapy of the child can be combined with psychotherapy of the parents and intensive work in the therapeutic community. Such a combination can contribute, even in cases of severe pathology, to the development of the relationship between mother and child and promote successful rehabilitation in the outside community.     

Rorschach Depression indices with children and adolescents: concurrent validity findings.

Exner (1983, 1986) developed and recently revised (1990b) a Rorschach Depression Index based on scores from variables in the Comprehensive System. This study evaluated both the original and the revised DEPIs for child and adolescent outpatient (n = 67) and inpatient (n = 99) samples in order to assess the diagnostic utility of these indices. There were no significant relationships between the original form and the revised form of the DEPI and clinical elevations on the Depression scale of the Personality Inventory for Children in the outpatient sample or treatment team diagnostic judgments in the inpatient sample. These findings sound a strong cautionary note for using only Rorschach Depression indices to diagnose depression in children and adolescents.     

Alkoholabhängigkeit in der psychiatrischen Klinik

In Germany 2.4?% of the population suffer from alcohol dependency and 3.8?% of adults from alcohol abuse. Despite an extensive number of options available for addiction therapy only a minority of affected persons receive addiction-specific therapy. This results in a chronification of the disease and a reduction of approximately 15 years in life expectancy. Background knowledge of the foundations of alcohol addiction leads to a new understanding of the processual course of the disease as well as to new therapy interventions. Individualized treatment includes a combination of outpatient, partial inpatient or inpatient therapeutic measures and range from medical advice for reduction of alcohol consumption, to qualified withdrawal treatment up to pharmacological relapse prophylaxis and long-term weaning treatment. Under current therapeutic conditions abstinence quotas of 50-70?% over 1 year can be achieved. Treating physicians must have sufficient diagnostic certainty and furthermore must be in command of motivating discourse techniques, knowledge on the therapeutic options of outpatient and inpatient withdrawal treatment, pharmaceutical relapse prophylaxis and mediation in rehabilitation measures.     

Patienten- und Elternzufriedenheit bei intensiver,klinikvernetzter Zu-Hause-Behandlung

Background

Due to the increasing importance of effective, patient-oriented treatment options for mentally ill children and adolescents, new alternatives to established inpatient and outpatient care in child and adolescent psychiatry have to be found. Intensive cross-sectoral treatment settings may be an alternative but have not yet been evaluated or implemented in routine care.

Aim

The objective of this randomized study was to compare and assess satisfaction with a new model of care within the underlying BeZuHG (“behandelt zu Hause gesund werden”, treated at home become healthy) study with regular inpatient care (TAU). Patients in BeZuHG received early discharge from inpatient care followed by 3 months of intensive home treatment enhanced by clinical elements.

Material and methods

Youths and parents were asked to fill in a patient satisfaction questionnaire (BesT) at completion of treatment. Participants in the study were evaluated between April 2012 and January 2013.

Results

Neither BeZuHG nor inpatient care was clearly superior. Youths in the control group stated a higher satisfaction with the overall treatment than youths in the BeZuHG group (p?=?0.031), while youths in the BeZuHG group named a significantly higher satisfaction with the home treatment component than with the inpatient component of treatment (p?=?0.007).

Conclusion

Patient satisfaction could be shown for inpatient and BeZuHG treatment at discharge. Data may change at follow-up. A long-term follow-up should be implemented to confirm these results or to allow other conclusions.     

Intregrating family therapy into in-patient paediatric settings: a model

This paper describes the integration of structural family therapy and systemic consultation into an in-patient paediatric unit. Two case examples illustrate the approach used. It is concluded that six stages are involved in the successful integration of a systemic approach: planning and convening an initial staff meeting, developing a structural hypothesis, enlisting hierarchical support in the ward system, holding the family meeting, reconvening the professional team and disengaging the family and ward system.     

Inpatient cognitive therapy: Detours,potholes, and roadblocks along the routes of progress

Developing innovative treatment approaches for psychiatric inpatient settings is an emerging area of interest. This paper delineates the detours and circuitous paths treatment with difficult patients often takes. Differences between typical outpatient and inpatient care are described and the obstacles to cognitive therapy that inpatients present are discussed. The role of case conceptualization is emphasized as a way to promote increased effectiveness. Finally, methods for maximizing therapeutic opportunities with inpatients are suggested.Robert D. Friedberg, Ph.D. is a staff psychologist on the Cognitive Therapy Unit at Mesa Vista Hospital and is an adjunct faculty member at the California School of Professional Psychology.Raymond A. Fidaleo, M.D. is the Clinical Director of the Cognitive Therapy Unit at Mesa Vista Hospital. He is also the Medical Director of the Cognitive Therapy Institute as well as an Associate Professor of Psychiatry at the University of California-San Diego School of Medicine. Dr. Fidaleo engages in private practice in San Diego, CA.Michele M. Mikules, M.A. is a predoctoral psychology intern with the United States Navy at Balboa Hospital, San Diego, CA.     

Like a phoenix: the journey toward core-self restoration following paediatric skin-burn injury: a psychoanalytic perspective

Severe and sudden injury to the skin during childhood may damage both the child’s outer appearance and mental state. Such a trauma can provoke a complete and utter breakdown of the core-self and regression to an ‘unintegrated’ state. We present the case of 11-year-old Michael, who played with matches, set a fire and sustained severe burn trauma. Michael was treated in our rehabilitation ward over several months and received skin treatment, physical therapy and psychotherapy. Paediatric burn injury is not only a physical struggle but is often accompanied by intense emotional distress of the child and his family. In describing Michael’s therapeutic process, we show how the restoration of the core-self, alongside the healing of the outer skin, provoke issues concerning early infantile skin formation, normative age-related conflicts and vulnerabilities specific to the child. By integrating psychoanalytic thinking into the clinical work of skin rehabilitation, following burn injury, we demonstrate how the significant relationship between the skin and the self manifest in different practice.