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.     

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.     

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.     

Further Labeling Within the Category of Disability Due to Chemical Dependency Disorder

This paper raises issues of validity and consequences of appending the label Borderline Personality Disorder to chemically dependent women who are adult survivors of child sexual abuse. Parallels between documented sequelae of childhood sexual abuse and DSM-III-R delineated characteristics of Borderline Personality Disorder are noted as is the DSM-III-R insertion of "No information" with respect to Predisposing factors. This clinician suggests that the label Borderline Personality Disorder and its accompanying assumptions function to generate negative expectations regarding both the course and direction of the therapy process. By failing to consider the impact of childhood abuse this label provides neither appropriate diagnosis nor therapeutic directionfor women with a diagnosis of chemical dependency who are adult survivors of childhood sexual abuse.     

Child Abuse: Group Treatment for Parents

Group counseling, structured to maximize peer support and to reduce social isolation, provides a context in which parents can make changes in cognition and behavior.     

A Multimethod Approach to Assessing Dependency: The Early Memory Dependency Probe

The construct validity and clinical utility of the early memory probe assessing aspects of dependency was investigated. Clinical patients' responses to the feeding, being fed, or eating probe were compared with Rorschach Oral Dependency (ROD) scale scores (Masling, Rabie, & Blondheim, 1967), as well as theoretically and empirically derived behavioral ratings. Sixty-five psychiatric patients and their therapists participated in the study. Results demonstrated moderate to strong correlations between the early memory scores and the ROD scores, thus demonstrating good concurrent validity. A moderate correlation between the early memory scores and therapists' ratings of key behavioral patterns in therapy support the predictive validity of the early memory probes. The earn memory scores also demonstrated discriminant validity when compared with Rorschach object-relational content scales.     

Innovative Approaches to Child Custody and Domestic Violence in New Zealand

Summary

In 1995, as part of a major review of domestic violence law, the New Zealand Parliament amended the legislation under which disputes about custody of and access to children are determined by the Court. Specifically, the amendment introduced a rebuttable presumption that a parent who had used violence against a child or against the other parent would not have custody of, or unsupervised access to the child unless the Court could be satisfied that the child would be safe during visitation arrangements. Three years after the implementation of this legislation, it is timely to reflect on the impact of this major domestic violence law reform initiative. Our findings indicate that there are indeed advances. Psychological violence is now clearly being considered when Courts are assessing the issue of children's safety. As well, the delineation of mandatory risk assessment factors has led many judges to see a continuum of power and control tactics as relevant in domestic violence related visitation proceedings; the previous emphasis on physical violence has given way to an analysis which more closely reflects accords with women's and children's realities of the abuse they are exposed to. Some of the old problems continue to exist despite the law changes. There are still recent cases where perpetrators of serious violence are awarded unsupervised access and where their violence continues to be construed as “out of character,” arising because of the perpetrator's “despair” about the breakdown of his relationship. These and other issues are discussed.     

Multifaceted Approaches in Spouse Abuse Treatment

SUMMARY

The understanding of spouse abuse has changed considerably in the last 30 years, shifting from a perspective based on individual psychopathology to that of a pervasive social problem. Current treatment solutions for stopping violence are limited to those that address resocializing the batterer. Several states often restrict the use of state funds for batterers' groups and forbid couples treatment as a primary treatment option in spite of the fact that most couples choose to remain in their relationships in the presence of repeated violence. This article argues for broadening options to include a specific type of couples treatment as a part of a coordinated community response to remediate domestic violence. Solution-focused therapy is described as an example of treatment of relationships that makes safety a priority and is not victim-blaming. It is suitable treatment both for couples who wish to stay together and those seeking a safe way to separate.