Abuse of persons with mental retardation: A literature review

The literature reports a number of reasons why abuse of people with mental retardation occurs. These causes of abusive behavior can be divided into three categories: organizational variables, staff characteristics, and client characteristics. The author examines each of the variables and presents recommendations for reducing their contributions to abusive behavior.     

Teaching dancercise to persons who are mentally handicapped: Programming transfer of stimulus control to a community setting

This study demonstrated procedures to promote the acquisition and transfer of stimulus control of an age-appropriate exercise skill. Three young adults diagnosed as mentally handicapped in a residential setting were taught a commercial dancercise routine during individual training sessions using a package of instructional procedures. A combination of a multiple baseline across subjects and a multiple baseline across response groups design showed that skill acquisition occurred only after each subject received training, and that performance did not generalize across exercise response groups. Training progressively incorporated more participants, new teachers, and new settings. Ultimately, subjects performed in a community dancercise class attended by 100 nonhandicapped persons.     

A controlled comparative investigation of psychological treatments for chronic sleep-onset insomnia

A sample of physician-referred chronic insomniacs was randomly allocated to either progressive relaxation, stimulus control, paradoxical intention, placebo or no treatment conditions. Treatment process and outcome were investigated in terms of mean and standard deviation (night to night variability) measures of sleep pattern and sleep quality. Only active treatments were associated with significant improvement, but the nature of treatment gains varied. In particular, stimulus control improved sleep pattern, whereas relaxation affected perception of sleep quality. All improvements were maintained at 17 month follow-up. Results are discussed with reference to previous research and guidelines are given for clinical practice.     

Adolescent suicide attempters presenting to a pediatric facility

This study profiles the characteristics of adolescent suicide attempters and the treatment they received in a pediatric emergency room (ER). A retrospective chart review of 4,072 adolescents seen in the ER at a children's hospital (CH) from July 1984 to June 1985 was undertaken. Twenty-seven adolescents who had deliberately injured themselves were identified. The average age was 14 years 7 months (range 11-19 years). Fifty-two percent of the patients were white and 78% were female. Ingestion was the most common method (78%), followed by attempted hanging (11%), and wrist laceration (7%). After evaluation by a pediatrician in the ER, 30% of the patients were treated and released, 11% were transferred directly to a psychiatric hospital, and 59% were admitted to the CH, with an average hospital stay of 1.88 days. Once hospitalized, consultations from psychiatry (81%), social service (50%), psychology (19%), and neurology (6%) were obtained. At the time of discharge from either the ER or CH, the patients had a variety of plans for ongoing care, with 52% being referred to outpatient counseling, 37% being transferred to a psychiatric hospital, and 11% having no documented plan for ongoing care. These results demonstrate that the evaluation of suicidal adolescents cared for in a pediatric facility may be episodic and suggest the need for a comprehensive program to approach the problem.     

Students' preferences for male or female counselors for social and educational problems

Fifty-eight male and 66 female junior high school students were examined to determine their preferences for sex of counselor under personal/social and educational hypothetical counseling situations. Girls demonstrated a definite same-sex preference for both counseling situations, while boys preferred male counselors for personal/social counseling and had opposite-sex preferences for educational counseling. Implications of the findings are discussed in light of earlier contradictory results from research on college students.     

Affective quality of family relations and adolescent identity exploration

The purpose of this study was to examine the relationship between adolescent pubertal status, the affective quality of family relations, and the early adolescent's exploration of a sense of ego identity. Fifty-one intact families with adolescents in the seventh grade agreed to participate. Each family member completed a battery of questionnaires designed to assess familial adaptation to pubertal growth and identity exploration. The results reveal that the affective quality of parent-adolescent relationships and the pubertal status of the adolescent appear to influence the adolescent's exploration of ego identity. The need to establish the functional significance of familial adaptation to adolescent pubertal growth for identity development is discussed.     

Pains and gains: a study of forced terminations

The forced termination of psychoanalysis, such as occurs when the analyst makes a geographic move, uniquely disrupts the analytic setting. This paper recounts the author's experience of terminating a full-time private practice of psychoanalysis and psychoanalytic therapy for such a move. The limited literature on the subject is reviewed with a focus on the use of technical variation in the forced termination situation. The author delineates three areas of interaction with patients where technical variation proved in her experience to be of value: dealing with countertransference and counter-reaction, providing information about the move, and the consideration and process of referral for continued therapy. As opposed to what would be predicted from a classical psychoanalytic perspective, the use of such technical maneuvers seemed to facilitate rather than impede analytic work. These variations in technique served at crucial times to maintain the analytic alliance, to preserve the patient's capacity to recognize and make use of transference, and to provide avenues for resolving past traumas in the transference and the actual loss of the analyst. The concept of the analyst as a new or useable object is proposed as providing a theoretical framework for understanding these observations.     

How dreams are told: secondary revision--the critic, the editor, and the plagiarist

Secondary revision is a highly provocative concept arising out of Freud's attempts to explain the construction of dreams, but it remains relatively ill-defined. It includes three related, yet by no means identical aspects of the process by which the dream acquires its more or less final form during the experiencing, the remembering, and the telling. It represents one of the most interesting hypotheses dealing with the fluid world between sleeping and waking, a field which still presents us with a host of unanswered questions. Secondary revision not only reflects the higher levels of the dreamer's mental functioning superimposed on his biological substructure, but it also operates as a sensitive indicator of the cultural factors which have helped mold his personality. These factors include both the subculture of the analytic situation and the impact of society in the larger sense. I make reference to individual dreamers in analysis and to the world of dreams recorded in the past from our own and other cultures.