The evolution of a therapy group for vietnam veterans on a general psychiatry unit

The evolution of a therapy group for hospitalized Vietnam veterans with post-traumatic stress disorder (PTSD) and related symptomatology is described. The literature on group treatment for this population is briefly reviewed and discussed in relation to an inpatient psychiatry setting. The prevailing conditions at the time of group inception are recalled along with the initial goals of the therapeutic intervention. Problems encountered are also discussed, along with the changes made in response to these identified difficulties. The results of three and one-half years of experience with this group are described in detail.The authors would like to thank Cynthia Sturm, Ph.D. for her helpful editorial assistance.     

SERIOUS DELINQUENT BEHAVIOR AS PART OF A SIGNIFICANTLY HANDICAPPING CONDITION: CURES AND SUPPORTIVE ENVIRONMENTS

The past 20 years have been productive ones for the field of applied behavior analysis. A brief review of our own efforts during this period reveals that we have accomplished several but not all of our goals for the Teaching-Family approach. In this context, we note that the setting of realistic and appropriate goals is important for the field and for society. Moreover, we suggest that the realistic goal for some persons with serious delinquent behavior may be extended supportive and socializing treatment rather than permanent cure from conventional short-term treatment programs. We base this suggestion on the accumulating evidence that serious delinquent behavior may often be part of a significantly disabling and durable condition that consists of multiple antisocial and dysfunctional behaviors, often runs in families, and robustly eludes effective short-term treatment. Like other significant disabilities such as retardation, autism, and blindness, the effects of this condition may be a function of an interaction of environmental and constitutional variables. We argue that our field has the wherewithal to construct effective and humane long-term supportive environments for seriously delinquent youths. In this regard, we explore the dimensions, rationales, logistics, and beginnings of a new treatment direction that involves long-term supportive family treatment. We contend that such supportive families may be able to provide long, perhaps even lifetime, socializing influences through models, values, and contingencies that seem essential for developing and maintaining prosocial behavior in these high-risk youths.     

USE OF ESCAPE AND REWARD IN THE MANAGEMENT OF YOUNG CHILDREN DURING DENTAL TREATMENT

A reinforced practice procedure was used to facilitate cooperative behavior in five children, aged 3 to 6 years, during dental treatment. In a multiple baseline design across subjects, the children were rewarded with escape, inexpensive stickers, and praise for cooperative behavior in the presence of the sights, sounds, and some sensations of the dental instruments prior to actual dental treatment. Direct observations of disruptive behavior via a 15-s interval recording system indicated baseline levels as high as 90% were reduced to less than 15% by the final treatment visit. In addition, the procedure was effective in reducing overall heart rate and blood pressure reactivity to dental treatment. All children were rated by the involved dental professionals as more cooperative and relaxed following exposure to reinforced practice.     

PROMOTING AUTOMOBILE SAFETY BELT USE BY YOUNG CHILDREN

A program using behavioral practice, assertiveness training, and social and contrived reinforcers was developed to establish and maintain automobile safety belt use by young children. Sixteen children (ages 4.8 to 7 years) who never used their safety belts during a 5-day preexperimental observation period were randomly assigned to two groups of eight each. A multiple baseline design across groups was used to evaluate the effectiveness of the training program. During the 8-day baseline period for Group 1, no children used their safety belts when unobtrusively observed while being driven from school. During the 26-day intervention period, the children were buckled up on 96% of the observations. Follow-up probes conducted 2–3 months after program discontinuance found safety belt use to range from 86% to 100%. For Group 2, the 14-day baseline safety belt use averaged 6% and increased to a mean of 81% during the 20-day training and maintenance program. Follow-up probes 2–3 months later found safety belt use to occur during 75% to 96% of the observations. Parent questionnaires indicated the generalizability and social validity of the program.     

Unprogrammed effects of training high-status peers to interact with severely handicapped children.

We examined the effects of a peer initiation intervention with high- and low-status nonhandicapped students on the behavior of untrained peers toward handicapped students. In the context of a counterbalanced withdrawal design, high- and low-status nonhandicapped students were taught to direct social initiations to eight severely handicapped students during recess activities. The interactions of the high-status students resulted in higher levels of initiations by untrained peers toward the handicapped students than did the interactions of the low-status students. Social response levels were also differentially affected by the status of the peer initiator.     

The fundamental rule: a study of current usage

Members of the editorial boards of the Journal of the American Psychoanalytic Association, Psychoanalytic Quarterly, and Psychoanalytic Inquiry, plus selected analysts from Canada, France, and England, were asked how they presented the fundamental rule to their analysands and what considerations led to their choice of initial guidelines. Forty-nine of eight-three analysts responded to the survey. The respondents described diversity in phrasing of the fundamental rule, the time in analysis when the guidelines are given, and the reasons for the practice they follow. The method each chose appears to reflect the differing conceptions analysts have of the analytic process. Two major trends emerged: either our respondents emphasized delineating a work or functional framework or contract, or they emphasized establishing an attitude or spirit of cooperation, mutuality and work sharing. In each group respondents differed as to whether they favored minimal or more lengthy instructions. They also differed as to whether they followed a consistent approach or one tailored to the needs of the individual analysand. A source of tension lay in an inclination either to remain in the tradition set by Freud or to experiment with different phrasings and timings. The authors give their reasons for choosing to give explicit instructions, requesting associational material beyond thoughts and feelings, and describing resistance as inevitable and a potential source of insight.     

Changes in the level and quality of object relations in psychoanalysis: followup of a longitudinal, prospective study

As part of a prospective, longitudinal study of suitability for and outcome of psychoanalysis, 22 patients were evaluated for changes in the level and quality of their object relations. These patients had been accepted for supervised analysis with candidates in training by senior analysts who had diagnosed them as neurotic. The majority of these patients reported difficulties in relationships as at least one of their reasons for originally seeking psychoanalytic treatment. Prior to beginning analysis, each patient was given a battery of psychological tests. One year after the termination of analysis, the test battery was readministered and a followup interview was conducted separately with each patient and analyst. Ratings of change based on patient and analyst interviews and comparisons of psychological tests before and after treatment all showed statistically significant improvement in the level and quality of object relations for this patient group. The results of this study support what is often observed in clinical practice, that psychoanalysis has a positive effect on the level and quality of a patient's object relations.     

Histories of sexual abuse in adolescent male runaways

In this study, data on sexual victimization in the histories of 89 Canadian male runaways as well as information on physical victimization, family structure, family financial stability, delinquent and criminal activities, and reasons for running away from home were evaluated. The population of male runaways evidenced dramatically higher rates of sexual and physical abuse than did randomly sampled populations. Sexually abused and nonsexually abused male runaways shared characteristics noted in the literature as common to runaways: problem families, high rates of delinquency, depression, tension, low self-image, and history of physical abuse. Sexually abused male runaways differed from nonsexually abused runaways in their reactions to their runaway event, with sexually abused male runaways responding in highly avoidant patterns coupled with extreme withdrawal from all types of interpersonal relationships. These differences are explained as consistent with known sequelae of sexual abuse, and the implications for treatment by runaway shelters and for further research are suggested.     

How adolescents perceive their relationships

In order to determine how adolescents perceive their relationships, a set of eight drawings representing one, two or three characters, whose sex and relationships where not clearly defined, were shown to 403 Parisian adolescents (227 girls and 176 boys) aged 15 to 19. The majority of data converge for all subjects, regardless of the sex, curriculum or socioeconomic factors. The subjects consistently identify more mixed-sex dyads and triads than same-sex in all pictures. This predominance does not imply that the adolescents perceived all relationships as having a romantic connotation. Some data seem consistent with the traditional sex role stereotypes. The subjects' responses do not seem to reflect the reality of their own peer relationships.