A Comprehensive Model for Adolescent Chemical Dependency Treatment

Chemical dependency among adolescents continues to present significant challenges to helping professionals. This article discusses the variety of approaches used to treat chemical dependency. An adolescent program that integrates the strengths of different perspectives and techniques is described.     

The Bulimia Workshop: A Unique Integration of Group Treatment Approaches

The time constraints of weekly group therapy and the slow evolution of group cohesion attenuate the direct confrontation that is essential with bulimic patients. Consequently, a three-phase, multidimensional group program was devised to accelerate the treatment process. Treatment begins with an intensive weekend workshop during which members formulate contracts for interrupting the binge–purge cycle and changing symptomatic behavior. During a follow-up session problems in fulfilling the contracts are dealt with and successes are reinforced, in the final phase, group members convene without their therapists to provide peer support, reevaluate contracts, and share feelings regarding treatment progress. The unique implications for treatment process and therapist interventions prompted by this new format are discussed, and preliminary research findings are highlighted.     

Externalizing Metaphors Therapy and Innovative Moments: A Four-Session Treatment Group for Anxiety

The zeitgeist for brief services psychotherapy efficacy is well underway within the individual and family therapy treatment modalities. However, this paradigm shift, to produce clinically significant mental health outcomes in a much shorter time, has evolved to a much lesser degree within the treatment group format. Longer-term treatment group protocols typically do not match treatment-seeking behaviors with high dropout rates for clients. The current authors describe a structured, four-session treatment protocol that integrates the tenets of Externalizing Metaphors Therapy (EMT) with Innovative Moments (IMs) in addressing anxiety for children and youth. EMT is based upon the externalization of problems, transformation of metaphoric imagery, and the shifting of underlying maladaptive emotional schemas. It is suggested that treatment outcomes are enhanced through the integration of three IMs between-session exercises.     

Explicit Rejection of an Implicit Dichotomy: Integrating Two Approaches to Assessing Dependency

The field of personality theory and assessment is characterized by a long-standing divide between proponents of self-report and indirect approaches to assessment. This article reviews the increasing convergence between the two sides, using recent writings on interpersonal dependency as an example domain. The assumptions of the self-report approach to personality assessment are contrasted with those of the indirect, and research using both types of assessments is reviewed. Also considered is the importance of recognizing dissociations between a particular individual's scores on self-report and indirect measures of a given component of self-concept, and the possible implications of such dissociations. It is argued that the convergence between two traditionally disparate approaches is likely to develop, in light of hypotheses, data and conclusions that bear notable similarity.     

A Support Group for Women with Relationship Dependency

The author describes a support group for women with relationship dependency focusing on friendship, decision making, and feelings. Issues include loneliness, coping with loss, anger, and self-esteem. Guidelines for counselors are provided.     

Treatment of Excessive Interpersonal Dependency: A Cognitive-Behavioral Model

Clients with excessive dependency often seek treatment for an Axis I anxiety or mood disorder. Simply providing treatment for the Axis I disorder may fail to address the long-standing personality factors that may underlie the acute anxiety and depression. A four-stage model has been proposed for the treatment of excessive interpersonal dependency. This model describes strategic ways therapy content and style should change over the course of treatment. Despite the apparent utility of the four-stage treatment model, it may be difficult to apply in many sites that now emphasize short-term approaches to treatment. In many cases, therapy can be designed to address themes that are relevant to both dependency and the Axis I syndrome. Therapy can be focused around helping clients make improvements in stabilizing emotional reactions, enhancing views of the self, and improving social functioning. Treatment focused on stabilizing emotional reactions can help clients confront and develop tolerance for feelings of depression and anxiety. Treatment focused on enhancing views of the self can help clients improve their self-esteem, self-reinforcement and reduce self-criticism. Treatment focused on improving social functioning can enhance social skills, reduce social anxiety and challenge feelings of loneliness. In addition, treatment can focus on reducing specific aspects of interpersonal dependency and confronting developmental antecedents that may underlie the dependency.     

Alcoholism,Chemical Dependency and the Lesbian Client

No abstract available for this article.     

How to Begin A Therapy Group: Six Approaches

Japanese “groupism,” or the tendency to emphasize groups rather than individuals, often favors the use of group psychotherapy with Japanese patients. However, the author recommends that the clinician should be sensitive to other cultural phenomena, which are thought to be related to groupism that will influence the nature of group treatments. For example, the traditional Japanese relationship to authority may make it difficult for many patients to express negative attitudes and to share intimate material. Differences regarding confidentiality and gender, distinction between “miuchi” (families) and “tanin” (strangers), and attitudes toward silence may also influence the nature of group therapy. The author discusses these and related cultural differences and highlights implications for the therapist's style of intervention. Finally, the amount of influence that groupism has on group psychotherapy must be considered. The author suggests that it is greater for patients with mild neurosis than severe psychosis.     

A Cluster Analytic Study of Clinical Orientations Among Chemical Dependency Counselors

Three distinct clinical orientations were identified in a sample of chemical dependency counselors (N = 406). Based on cluster analysis, the largest group, identified and labeled as “uniform counselors,” endorsed a simple, moral‐disease model with little interest in psychosocial interventions. A 2nd group, identified as “multiform counselors,” embraced an incongruent moral‐disease‐psychosocial model, and valued a myriad of treatment approaches. The smallest group, labeled “client‐directed counselors,” did not fully endorse Alcoholics Anonymous (AA) principles, valued non‐coercive treatment, and recognized coexisting psychopathology in clients. Results from a discriminant function analysis provided evidence to support the 3‐group cluster solution.     

Meaning Coconstruction in Group Counseling: The Development of Innovative Moments

This study discusses a model of group counseling, the narrative mediation path (NMP), which is a unique narrative, multimodal approach that combines four narrative modes (metaphoric, iconographic, writing, and bodily) and the narrative group. The purpose of the NMP is to foster reflexive processes with underachieving university students and to improve their academic performance. The study analyzes a single case of group counseling for seven underachieving economics students at an Italian university and the process of meaning construction among NMP narrative modes and the follow-up session. It applies the innovative moments coding system, a reliable method for studying change by tracking narrative innovations in sessions. More specifically, we focus on how innovative moments (IMs: action, reflection, protest, and reconceptualization) evolve during the four different narrative modes and the follow-up session. The findings suggest that the NMP fosters narrative innovations, mainly of a reflexive nature (reflection and reconceptualization). Moreover, during counseling and the follow-up session, the pattern of change is primarily characterized by reconceptualization IMs, the most complex form of narrative innovation.     

Macrosystemic Approaches To Drug Treatment

Observations of methadone clinics show that the treatment system itself, following natal family dynamics, fosters addictive behavior. Changes within clinics and the macrosystem are recommended.     

Three Group Approaches with Socially Deprived Latency-Age Children

The significant benefit of experiential learning in group work presents ethical complexities that must be considered by students, faculty, and programs. This article explores the clinical and ethical intricacies of teaching a group counseling course while facilitating an experiential group as part of the course curriculum. Specifically, the framework presented examines the dual roles of facilitator and instructor as complementary versus adversarial functions while analyzing challenges to both teacher and students. Guidelines for effectively running an experiential group as part of a group counseling course are presented utilizing five ethical principles: fidelity, beneficence, nonmaleficence, autonomy, and justice. Finally, guidelines and practice considerations specifically tailored for the educative role as instructor and the process role as group facilitator are provided.