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.     

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.     

Resiliency in Families with a Member with a Psychological Disorder

The aim of this study was to identify resiliency factors in families with a mentally ill family member. The study population was composed of 30 families, where questionnaires were independently completed by both a parent and a child. The results indicate that family hardiness was an important resilience factor for both the parents and the children. According to the parents the passive evaluation of a crisis situation, or the use of avoidance strategies, was also helpful for the family to adapt. For the children, the extent to which they found support from within the community and the extent to which they experienced emotional support, self-worth, and community support were linked to their view on family adaptation to stressful situations.     

Coping with disturbances

Motion systems must cope with internal and external disturbances affecting the envisioned movement program. In science responses to disturbances are used to characterize system properties. Recently, evidence has been collected that self-stability due to the mechanical response of a system can greatly contribute to safe guarding proper operation of the system and to follow up an envisioned task. Here we review research in our laboratory on the kinematic response of standing subjects to sudden pulls inflicted by a motor, and the kinetics of runners crossing a track with a bump. We find that in both cases the first responses are dominated by system compliance. Thereby damage is avoided and the tasks are secured. Preparation to the observed disturbance does not seem to have the goal to compensate quickly but to enhance the scope of the reaction and its economy.     

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     

Working with Psychosis

This is the first of four papers about working with psychosis in a newly established post of psycho-analytic psychotherapist in an acute psychiatric unit in Australia. In this paper the author gives an account of some early impressions and experiences with staff and patients, particularly connected with an unacknowledged grief in the aftermath of psychosis. The author next discusses some of the psycho-analytic theory about psychosis which he found containing and helped make some sense of his experiences. He then introduces a case study of an exploratory psycho-analytic psychotherapy with a 40-year-old man suffering from a bi-polar disorder. The beginning of the therapy is described when this man revealed feelings of grief and despair about his illness. Being able to face and bear these feelings enabled him to begin to mourn what was irretrievably lost because of his illness and to contemplate what might still be possible. The author describes some of the early themes and one session in detail, and discusses how fluctuations in contact with the client reflect his retreat to a pathological organization in the mind. This psychic retreat was dominated by a psychotic process, and the retreat offered refuge from a dread of fragmentation and the pain of mourning and loss.     

Leashing God with Levinas: Tracing a Trinity with Levinas

Levinas' ethical metaphysics opens up a nexus of relationships, in the midst of which God becomes accessible as the counterpart of the justice I render to others. Although Levinas refuses a theorising theology which does violence to God, we attempt in this article nonetheless to glimpse the possibility of a divine threesome (leash) which can be articulated in the language of ethical metaphysics. We seek to trace a Trinity, not in Levinas, but with Levinas. We seek to 'leash God with Levinas.'
Thus, we argue the liturgical nature of God . God is utterly 'for-the-other.' The Father, as utterly self-diffusive, is 'for-the-Son', and the Son, as utterly responsive, is 'for-the-Father.' The divine nature ( ousia ) is the ethical reality of 'for-the-other.' Secondly, this one nature ( ousia ) has three distinct hypostases , which need to be understood ethically. The relationship between Father and Son is not the same as the relationship between the Son and the Father. The Father and the Son are the same in that they are essentially 'for-the-other,' bound by a bond or a Spirit of responsibility . Yet, the Son's relation to the Father is responsive, whereas the Father's relation to the Son is initiative or originary. Thus, there is both an identity yet a non-identification of Father and Son. Again, since responsibility is the ethical hypostasis of 'the-other-person-in me,' we might say that the Father is in the Son and the Son is in the Father (cf. John 14:10,11), in a non-identical way, and that it is precisely this perichoresis of the one in the Other which constitutes the hypostasis of each.     

More rapid associative change with retraining than with initial training

Retraining was compared with initial acquisition in 4 magazine approach experiments with rats and 1 autoshaping experiment with pigeons. The levels of performance were matched prior to reinforcement and nonreinforcement for stimuli with a history of both training and extinction and stimuli with only a minimal history of training. Under these conditions, a previously extinguished stimulus was more vulnerable both to the incremental effects of reinforcement and to the decremental effects of nonreinforcement compared with a stimulus that had only been minimally trained.     

Multiple Microswitches for Multiple Responses with Children with Profound Disabilities

Abstract

Several components of motivation for exercise were investigated in a sample of 51 subjects who participated in a five-month exercise program designed for people with back pain. Assessment of motivation was made prior to the program using a self-report questionnaire. Tests were made of the motivational factors' ability to classify subjects as higher or lower adherers. A combination of age, perceived lack of time to exercise, expected consequences of not taking action to relieve the back pain, and adherence self-efficacy, resulted in a logistic regression model that correctly identified 96% of the higher adherers and 84% of the lower adherers after five months of participation. The present pilot study offers preliminary data on potentially influential motivational components. In addition, the results clearly support the notion that motivation is best viewed as a complex psychological construct, thus indicating that assessments of motivation should be multifactorial.     

Matrix training of preliteracy skills with preschoolers with autism

Matrix training is a generative approach to instruction in which words are arranged in a matrix so that some multiword phrases are taught and others emerge without direct teaching. We taught 4 preschoolers with autism to follow instructions to perform action-picture combinations (e.g., circle the pepper, underline the deer). Each matrix contained 6 actions on 1 axis and 6 pictures on the other axis. We used most-to-least prompting to train the instructions along the diagonal of each matrix and probed the untrained combinations. For 2 participants, untrained responding emerged after the minimum amount of training. The other 2 participants required further training before untrained combinations emerged. At the end of the study, 3 of the 4 participants performed the trained actions with previously known pictures, letters, and numbers. This study demonstrated that matrix training is an efficient approach to teaching language and literacy skills to children with autism.     

Reasoning with quantifiers

In the semantics of natural language, quantification may have received more attention than any other subject, and one of the main topics in psychological studies on deductive reasoning is syllogistic inference, which is just a restricted form of reasoning with quantifiers. But thus far the semantical and psychological enterprises have remained disconnected. This paper aims to show how our understanding of syllogistic reasoning may benefit from semantical research on quantification. I present a very simple logic that pivots on the monotonicity properties of quantified statements--properties that are known to be crucial not only to quantification but to a much wider range of semantical phenomena. This logic is shown to account for the experimental evidence available in the literature as well as for the data from a new experiment with cardinal quantifiers ("at least n" and "at most n"), which cannot be explained by any other theory of syllogistic reasoning.     

Factors associated with self-efficacy in persons with chronic illness

Change of lifestyle may be necessary for persons with chronic illnesses in order to manage their health situation and reduce symptom distress. Success in changing lifestyle partly depends on a person's self-efficacy beliefs. This cross-sectional study explores social support, physical activity, and illness perceptions in relation to self-efficacy in a sample with morbid obesity and in a sample with chronic obstructive pulmonary disease (COPD). The linear regression analyses showed that higher physical activity and less emotional response to illness were directly associated with higher self-efficacy among persons with obesity, while more social support; fewer perceived consequences from illness; and more understanding of the illness were directly associated with higher self-efficacy among persons with COPD. The results indicate that obese persons are likely to benefit from increasing physical activity and from receiving emotional support. Persons with COPD may be empowered by being able to utilize cognitive coping strategies and by receiving social support.     

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.     

Teaching children with autism to request help with difficult tasks

We taught three children diagnosed with autism spectrum disorder to request help using an interrupted chain procedure during which we manipulated task materials such that the child was either incapable or capable of independently completing a link of a behavior chain. We initially observed undesirable generalization of requests for help during capable trials when teaching was introduced during incapable trials for two participants and to a lesser extent for the third participant. However, with repeated exposure to differential prompting and reinforcement across incapable and capable trials, differential responding was observed across EO‐present and EO‐absent trials for all three participants during both teaching sets and one generalization set that was never exposed to teaching procedures. These findings suggest that it is important to consider the antecedent conditions under which the response should occur when teaching children to request help.     

Speaking with Frankenstein

This collaborative essay experimentally applies the insights of Mary Shelley's 1818 gothic fantasy Frankenstein to clinical interactions between present-day physicians and the patients they, akin to Shelley's human protagonist, so often seem to bring (back) to life. Because that process is frequently fraught with unspoken elements of ambivalence, disappointment, frustration, and failure, we find in Shelley's speculative fiction less a cautionary tale of overreach than a dynamic parable of the role that the unspoken, the invisible, and the unknown might play in contemporary physician/patient relationships. Playing with that parable, we consider its relevance to four often unacknowledged dynamics that shape physician/patient interaction: commitment to a false binary of life and death; the tyranny of normative aesthetics; shared negative affect; and the ethics of care and care-denial. To "speak with Frankenstein" is, we show, to make space for the otherwise unspeakable. The result is a more complete model of narrative medicine that accommodates to its ideal of open communication and full attention the persistence of what cannot be said, seen, or known--only imagined and approximated.

     

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.