The autistic moment in psychotherapy

This is a report on the author's experience in treating four autistic children and their families. The importance of making available the therapist's own autism is stressed. The difficulty in doing this and reverting defensively to an administrative approach is described. A previous paper discussed the corrective autistic experience with a focus on the autistic person. This follow-up describes the autistic moment which is a relational experience between the therapist and both the autistic person and the autistic family. The family needs to have an experience of its own autism as a continuum of normal before it can relate to an autistic child. To the extent that the therapist can bring his own autism into the therapy can the family experience its own. The patients are the person, the relationships, the family, and the therapist.The author would like to thank Richard B. Anderson, MD, Lindy T. Barnett, MSW, David V. Keith, MD, JoEllen Barnett Smith, MA, and Orion Smith for their participation as cotherapists. The comments made on an earlier draft of this paper by the members of the Atlantic Psychiatric Clinic are warmly acknowledged. Valuable editorial assistance has been extended by Robert Garfield, MD, and Stuart Sugarman, MD. Lastly, the author would like to extend his appreciation to Robert R. Haubrich, PhD, for stimulating his interest in the field of comparative ethology.Presented at the Conference Honoring the Retirement of Carl A. Whitaker, MD, in Madison, Wisconsin, June 25, 1982.     

Forced migration and resettlement: Its impact on families and individuals

An increasing number of families are forced to migrate as a result of political turmoil, civil wars, and ethnic cleansing. This paper describes the impact of forced migration on individuals and their families. We suggest that forced migrants reject the new culture while their children are likely to embrace it. This discrepancy between the old values of the migrants and the values to the new culture espoused by their children is a frequent source of intrafamilial tension. We also describe a second acculturation process that takes place when forced migrants return to their country of origin. Families who migrate back to the country of origin realize, often to their surprise, that both they and their country of origin have changed significantly.     

The AIDS Risk Reduction Model: Examining Intentions to Use Condoms Among Injection Drug Users1

This paper uses the AIDS Risk Reduction Model (ARRM) to examine psychosocial factors involved in adopting safer sex practices in a sample of Los Angeles injection drug users (IDUs; n= 161) who reported having more than one sex partner in the year preceding the interview. The ARRM hypothesizes that behavior change is a process occurring in three stages: (a) labeling one's behavior as problematic, (b) making a commitment to behavior change, and (c) taking action to accomplish that change. We test the first two stages of the model using a measure of perceived risk of HIV infection (Stage I), and intentions to use condoms always during vaginal or anal sex in the next year (Stage 2). We examine differences in the predictive value of the ARM between IDUs who reported using condoms in the year prior to the interview and those who reported not using them. We identify leverage points in the model-factors which appear to have a major influence on intentions to use condoms and which may be amenable to change through educational or other types of intervention. For both condom users and non-users, susceptibility to AIDS predicted perceived infection risk (Stage I). For condom users, knowledge about AIDS also predicted perceived risk. For both groups, self efficacy, peer norms concerning condom use, and the perceived pleasure of using condoms predicted intentions to use condoms (Stage 2). Our findings do not support either direct or indirect relationships between the Stage 1 and Stage 2 outcome variables for either group.     

The logic of delusion

Piagetian concepts explaining normal mental development are applied to delusion, a major psychiatric disorder of thought which can result in bizarre conduct. Piaget constructed problems in which the errors of six to eight year old children fit the standard textbook definition of delusion surprisingly well. When we examined cases of delusional individuals, we concluded that their apparent irrational and bizarre conduct could be explained as problem-solving errors like those of Piaget's young children. In contradistinction to existing theories, we define delusion as a regression under stress to the logic of children of a particular age range, and that what appears bizarre and irrational is the result of an adult attempting to filter experience through a child's logic.Under a different title this paper was presented at the Biennial Congress of the World Federation for Mental Health in Mexico City in August, 1991.