Experimentation with Group Techniques with Ego-Disturbed Mothers

Abstract

Psycho–educational groups (PEGs) have been shown to be a particularly effective form of treatment for patients classified under the rubric of severely and persistently mentally ill (SPMI). However, recent surveys suggest that certain professionals, such as nurses and clinical psychologists, called on to conduct these groups may have limited to no training. This study tested three methods (self–instructional, workshop, and workshop plus clinical supervision) designed to provide on-the-job training to practicing clinicians. Specifically, training was based on two manuals; one that operationalized the basic knowledge and skills needed to run an effective PEG and the second being a commonly used PEG program for symptom management targeted at SPMI patients. Eight nurses from four adult units at a state psychiatric hospital initially received self–instructional or workshop training and then conducted a 12–session symptom management PEG composed of four to five SPMI patients (e.g., schizophrenia, schizoaffective or major depression disorders). In a second wave of additional training, nurses received workshop training or clinical supervision and then conducted a second PEG. Differences between training methods were assessed by nurse– and patient–completed measures that tapped the knowledge and skills emphasized in the symptom management and PEG (nurses only) manuals. Results indicated limited support for the superiority of the workshop method on the nurse measures alone. Implications for training working professionals in group treatments and assessing outcomes with chronic SPMI patients are discussed.     

Factors associated with respite care use by families with a child with disabilities

This paper reviews the literature on respite care utilization, describes a respite care program in Arkansas, and reports on a study of utilization initiated by the Arkansas Division of Mental Health Services (DMHS). Among the 89 families qualifying for respite services, 70 consented to participate, and 66 were surveyed in a phone interview. Users (n=54) and non-users (n=12) were compared relative to a variety of staff, child, geographic, and budget differences. Also, respite use was examined relative, to the aforementioned variables based on level of use, (i.e., none, low, moderate, high). There were no differences in use according to age, the number of family members, family income, or needs of the child. A larger percentage of non-use and low use of respite care was evident among those families receiving Tax Equity Fiscal Responsibility Act (TEFRA) benefits. There were no significant differences between races related to perceived barriers to care. Differences in expectations/experiences with respite care among rural and urban groups were limited with rural respondents expressing, concern about travel/distance issues. Overall, the program as a whole received positive ratings by parents, and no clear factors were found to be related to non-use in the small sample (n=12) who did not take advantage of respite services.     

Go/no‐go procedure with compound stimuli with children with autism

The go/no‐go with compound stimuli is an alternative to matching‐to‐sample to produce conditional and emergent relations in adults. The aim of this study was to evaluate the effectiveness of this procedure with two children diagnosed with autism. We trained and tested participants to respond to conditional relations among arbitrary stimuli using the go/no‐go procedure. Both learned all the trained conditional relations without developing response bias or responding to no‐go trials. Participants demonstrated performance consistent with symmetry, but not equivalence.     

Working with families of adults with anorexia nervosa

The aim of this paper is to describe working with the carers (families) of adults with anorexia nervosa (AN), which is different from working with families of younger adolescents. The main difference is in the area of rights and responsibilities of both parties. Moreover, as AN in adults is often a chronic condition, the treatment goal may not focus on recovery, but instead on improvement in quality of life. Thus the spectrum of nature and degree of parental involvement in the treatment of adults with AN is much broader than in children and adolescents. Our framework for intervention is based on a clear model of carer distress, from which targets for intervention follow. The paper outlines some of the core components of this work.     

Using Relaxation Techniques with Individuals and with Groups

The use of biofeedback, meditation, deep breathing relaxation, and imagery relaxation with individuals and with groups is described. The physical and mental well-being of people depends on learning ways to relax. Relaxation techniques reduce high levels of stress by facilitating the mind to switch from dwelling on day-to-day concerns to instead dwcll on relaxing themes. The body always responds to thinking processes; when the mind switches from dwellir~g on distressing thoughts to relaxing thoughts, the body becomes more relaxed.     

The Therapeutic Process with Children with Learning Disorders

Abstract

Clinicians who work with children and adolescents with learning disorders must be aware of the relationship between the learning disorder and the psychopathology the children present. This article offers a conceptual framework, based on psychoanalytic self psychology, to understand the modifications that are necessary in the treatment of this population. The author suggests that, in contrast to other approaches, it is not possible to conceptualize the treatment of these children as having a beginning, a middle, and an end. Rather, the therapeutic process is open-ended and conceived as occurring during a series of moments. The moments may be categorized as concordant, complementary, or disjunctive. During concordant moments a holding environment is created; during complementary moments the transference and countertransference is addressed; and during disjunctive moments the ruptures that inevitably occur during treatment are dealt with.     

Group intervention with children of parents with aids

This paper describes a format for group intervention with children of parents with AIDS. Therapeutic factors specific to group work with these children and special issues regarding AIDS are discussed. The stages of development of such groups are outlined, with particular attention paid to themes of grief and loss. Suggestions for future work in this area are given.     

The Trouble with Harrison's 'The Trouble with Tarski'

In 'The Trouble with Tarski', The Philosophical Quarterly , 48 (1998), pp. 1–22, Jonathan Harrison attacks 'Tarski-style' truth theories for both formalized and natural languages, on the grounds that (1) truth cannot be a property of sentences; (2) if it could be, T-sentences would have to be necessary truths, which they are not; and (3) T-sentences are not necessarily true and can even can be false. I reply that (1) cannot be an objection to Tarskian truth theories, since these can be formulated in terms of whatever truth bearers might be. Thesis (2) is unjustified: Harrison's argument for it depends on an equivocation. Thesis (3) is false, since the right-hand side of a T-sentence is a meta-language translation of the object-language sentence described on the left-hand side, and this guarantees its truth.
email: boisvert@phil.ufl.edu     

HIV prevention with persons with mental health problems

The HIV seroprevalence rate among persons with mental health problems (PMHP) is substantially higher than that of the general population in the United States. This study examines the efficacy over 12 months of an HIV prevention program with 99 individuals attending outpatient mental health clinics who were randomly assigned to receive either: (a) a seven-session, small-group intervention of Project LIGHT (Living in Good Health Together); or (b) a one-session video intervention. Regression analyses of data from 87% of the sample interviewed at 1-year follow-up revealed that intervention group membership was associated with significantly fewer sexual risk acts. A significant intervention effect for condom use was found for 72% of the sample who were African American, but not for Latino or Caucasian participants. Results from this study suggest that HIV risk reduction groups such as Project LIGHT may have utility in public mental health care settings.     

Womanist Therapy with African American Women with Disabilities

Abstract

African American women are at increased risk for disabilities. There is very little information available, however, regarding psychological interventions with African American women with disabilities. The purpose of this article is to discuss psychological intervention in working with African American women with acquired disabilities from a womanist perspective. Themes and interventions will be discussed. Recommendations for working with African American women with disabilities in a therapeutic context will be offered.     

Psychiatric Comorbidity in Children with Autism Spectrum Disorders: A Comparison with Children with ADHD

The present study was conducted with the aim to identify comorbid psychiatric disorders in children with autism spectrum disorders (ASD) (n = 40) and to compare those comorbidity rates to those in children with attention deficit hyperactivity disorder (ADHD) (n = 40). Participants were clinically referred children aged 7–18 years. DSM-IV classifications were used for the primary diagnosis (ASD/ADHD), while comorbid psychiatric disorders were assessed using a structured diagnostic interview, the structured clinical interview for DSM-IV, childhood diagnoses (KID-SCID). Twenty-three children with ASD (57.5 %) had at least one comorbid disorder, whereas 16 children with ADHD (40.0 %) were classified as having at least one comorbid disorder. No group differences were found with respect to this comorbidity rate or for the rate of comorbid externalizing disorders (ODD and/or CD). However, children with ASD had more comorbid internalizing disorders compared to children with ADHD. More specifically, children with ASD had higher rates of anxiety disorders, but not mood disorders. No associations between comorbidity and age or between comorbidity and the intelligence quotient was found. It is important for clinicians to always be aware of, and screen for, comorbidity, and to consider treatment for these comorbid disorders. In addition, research should focus on establishing valid and reliable screening tools as well as effective treatment options for these comorbid disorders.     

Computer-Facilitated Therapy: Reality-Based Dialogue with People with Schizophrenia

Schizophrenia is often characterized by deficits in information processing, attention, and memory that profoundly disrupt communication. Two vignettes are presented to illustrate how computer word-processing technique can be used with people with schizophrenia to facilitate reality-based conversation, to help them remember or remain focused in therapy session, and to participate with them in the development of cognitive-behavioral statements in managing their psychiatric symptoms. By visually representing the spoken words on the computer screen, the author hypothesizes that people with schizophrenia can partially compensate for the difficulties in remaining focused in a typically auditory-based conversational mode. Print-outs given from the conversational sessions can also be helpful as a memory aid.     

Psychodynamic counselling with parents of children with developmental disabilities

A joint treatment of parents and child can be the treatment of choice when dealing with developmental disabilities. In our clinical experience, we have observed that psychoanalytically oriented support (developmental guidance), which involves the child and the parents together, answers the needs and addresses the difficult dynamics that are characteristic of developmental disabilities.     

Group psychotherapy with alcoholics: Interface with self-help groups

This paper addresses recovering alcoholics' concurrent involvement in psychotherapy groups and self-help groups. A developmental model of alcoholism group psychotherapy is presented, differentiating between early and advanced sobriety. Psychotherapy and self-help groups are compared and contrasted. Multiple group membership entails various areas of compatibility. Divergence and conflict result from differences in underlying conceptual framework and approach. Clinical implications of members' involvement in partially discrepant group settings are explored with an emphasis on transference and countertransference reactions. Multiple group membership is identified as a salient factor in alcoholism group psychotherapy at all levels of recovery.She is also in private practice.This paper was presented at the American Group Psychotherapy Association Annual Conference, Boston, February 1990.