Engaging “Resistant” Families in Treatment

Many families, when presented with the option of family therapy, are less than eager to participate. This paper comprises the second and third parts of a series on engaging “resistant” families. ¹ 1 The first paper in this series, authored by J. M. Van Deusen, M. D. Stanton, S. M. Scott, and T. C. Todd, is entitled “Engaging “Resistant” Families in Treatment: I. Getting the Drug Addict to Recruit His Family Members” and appeared in the International Journal of the Addictions 15 (7): 1069–1089, 1980. A revised and expanded version of Part II is presented in M.D. Stanton, T. C. Todd, and Associates, The Family Therapy of Drug Abuse and Addictions New York, Guilford, in press.
Part II presents 21 principles and a number of techniques and strategies that have been developed for successfuly recruiting such families. These techniques should be applicable for engaging resistant families with all types of presenting problems. Part III provides an analysis of the important variables involved, along with data on cost efficiency and administrative costs. It was found that when therapists had administrative control of their cases, serving in dual roles as both therapists and drug counselors, the recruitment effort was (a) more effective (i.e., complete families, including both parents or parent surrogates, were recruited in 77 per cent of the cases), and (b) twice as cost efficient. Two-thirds of the non-engaged families were not recruited because the index patient would not allow family members to be contacted. Black families were more difficult to recruit than whites. Data on cost efficiency and on the actual administrative costs of recruiting families are also provided. We conclude that the engagement process requires a revision in therapeutic philosophy, since such families are often desperately in need of help but are unavailable unless therapists make a special effort to reach them.     

The rotating square illusion

Twenty subjects viewed displays of square and trapezoidal luminous dot figures rotating about a vertical axis in both polar and parallel projections. The frequency of reported oscillation of the rotating figures was as high for the squares as for the trapezoids, provided that the squares contained static slant information in the form of internal texture gradients. Previously reported oscillation effects using shapes other than trapezoids have generally been unreliable, with a subject as likely to see rotation as oscillation for a given cycle, and then only in parallel projection. As a consequence, linear perspective information in trapezoidal shape has been taken to be the indispensable element for obtaining a strong oscillation effect. The authors argue that in the construction of the rotating object, a required condition for reliably producing the effect is a violation ofsome optical constraint regarding slant information, not necessarily one involving linear perspective.     

The effect of phonemic processing on the retention of graphemic representations for words and nonwords

The three experiments reported in this study were each conducted in two phases. The first phase of Experiment 1 involved a same-different comparison task requiring “same” responses for both mixed-case (e.g., MAIN main) and pure-case (e.g., near near) pairs. This was followed by Phase 2, a surprise recognition test in which a graphemic effect on word retention was indicated by the superior recognition accuracy obtained for pure-case compared with mixed-case pairs. The first phases of Experiments 2 and 3 involved pronounceability and imageability judgment tasks, respectively. Graphemic retention was assessed by contrasting recognition accuracy for letter strings presented, during Phase 2, in their original Phase 1 case, with letter strings presented, during Phase 2, in. a graphemically dissimilar new case. The experiments provided evidence that there was minimal retention of the graphemic representations from which the phonemic representations of words are generated and, further, that the locus of this effect is probably postlexical. Nonwords were recognized more accurately than words in all three experiments. The latter result was attributed to differences between nonwords and words in both graphemic retention and semantic distinctiveness.     

The EPPI family therapy outcome study

Information was evaluated from 1014 families seen in an eight-year period by therapists connected with the Department of Family Psychiatry at Eastern Pennsylvania Psychiatric Institute in Philadelphia. Statistical analysis revealed several factors that had some predictive value in relation to outcome of therapy; these were race, past psychiatric hospitalization, type of presenting family problem, and number of sessions held. There was a rather good chance of improvement being noted by the therapist if the family stayed in treatment for eight or more sessions. About 90% of the cases were seen for less than 20 interviews. Only about 3% were seen for longer than 35 interviews. The vast majority of EPPI cases were short-term. Black families tended to present different problems from white, and therapy was terminated with blacks sooner than for whites. About 35% of families terminated after one to two interviews, and another 30% after three to seven sessions. Since families tended to benefit most after eight or more sessions, the need for better methods or techniques to engage families is highlighted.The research was supported in part by a Career Development Award from the University of California, San Francisco, to the first author.     

Alcoholics in inpatient,short-term interactional group psychotherapy: an outcome study

The differential outcome of 100 psychiatric inpatients distinguished by the presence/absence of secondary alcoholism was examined in shortterm closed group psychotherapy. Alcoholics did not differ from the general sample in outcome, but displayed distinct active/aggressive personality features. Group outcome was not affected by the presence/absence of alcoholic members.     

Perception of surface curvature and direction of illumination from patterns of shading

Three experiments examine the perceptual salience of shading information for the visual specification of three-dimensional form. The observers in these experiments were required to estimate the surface curvature and direction of illumination depicted in computer-synthesized images of cylindrical surfaces, both with and without texture. The results indicate that the shininess of a surface enhances the perception of curvature, but has no effect on perceived direction of illumination; and that shading is generally less effective than texture for depicting surfaces in three dimensions. These and other findings are used to evaluate the psychological validity of several mathematical analyses of shading information that have recently been proposed in the literature.     

Adolescent Smoking Behavior and the Recognition of Cigarette Advertisements1

In a study designed to assess the relationship between smoking status and correct identification of cigarette brands, junior high school students from two schools viewed cigarette and automobile advertisements with brand and model identification deleted. Results showed that adolescents with higher ad recognition scores were more likely to smoke cigarettes. In addition, a relationship was found between age and correct identification of cigarette advertisements, with older students identifying more ads correctly than younger students. No significant effects emerged for identification of automobile advertisements except for sex, with boys identifying more advertisements than girls. Additional findings indicated that even “experimental” smokers, who smoked as little as once per year, recognized significantly more cigarette advertisements than nonsmokers. These and other results are discussed in terms of their implications for prevention and policy issues. It is argued that society's allowance of printed cigarette advertising overlooks adolescents' heightened vulnerability to the kinds of appeals used in cigarette advertisements. Present policy also overlooks adolescents' relative unresponsiveness to the health risk information required in cigarette advertisements.