The impact of the therapeutic environment

This paper emphasizes the impact of the setting, space, and general physical properties of the clinic upon the difficult patient's profound neediness and absence of inner regulatory structure. Moreover, the clinic's administrative style and requirements often related to fiscal restraints, demands for accountability for both how funds are spent and treatment outcome, all impinge upon the patient. Humanizing clinics so they have the capacity for psychotherapeutic holding and provision of safety for difficult patients are discussed in detail in this contribution.     

Systemic crisis intervention as a response to adolescent crises: an outcome study

The present study demonstrates the safety and effectiveness of an outpatient program designed to respond to adolescent-precipitated crises by mobilizing and restructuring the family's kinship system. Families of 75 adolescents at risk for hospitalization were followed up to 24 months after treatment with Systemic Crisis Intervention. Measures of offspring and family functioning, suicidal behavior, institutional use, and treatment costs are presented. Results clearly demonstrate the safety, effectiveness, and economic viability of Systemic Crisis Intervention.     

CHILD-REARING BELIEFS WITHIN DIVERSE SOCIAL STRUCTURES: MOTHERS AND DAY-CARE PROVIDERS IN MEXICO*

The child-rearing beliefs of 32 mothers and 36 day-care providers in Mexico were compared. Day-care providers expected children to master developmental skills at an earlier age than did mothers. Day-care providers more strongly valued the development of independent and cooperative behavior, and placed less importance on obedience. They also reported employing more flexible and nonauthoritarian discipline strategies than did mothers. Mothers and caregivers did not differ in the extent to which they attributed the success of their discipline strategies to their own actions rather than to external factors. Also examined was how mothers' beliefs differed in families characterized by interdependent versus individualistic social structures. In interdependent families, mothers were more likely to believe in later mastery of developmental skills and to make external attributions. These findings suggest that Mexican children experience incongruous social norms as they move between home and day care settings, and that these norms, at least within the home, are associated with the social structural features of the setting.