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.     

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.     

Book reviews

Current Psychology -     

Effective functioning in dual-career families: an investigation

This study is concerned with the commonalities inherent in diverse psychotherapeutic strategies, despite seemingly discontinuous theoretical stances. Two approaches were evaluated with respect to effective family functioning, viz. Analytical Psychology and Systems Theory. Analytical Psychology posits the growth of conscious awareness in the individual as the source of therapeutic change. Problem centred systems therapy of the family emphasizes the importance of teaching clinically presenting families to negotiate collectively family rules and expectations and thus to allocate and monitor roles via clear and direct verbal communication. Both positions thus stress the reflective mode as a pivotal factor in effective problem solving. Analytical psychology maintains that conscious awareness expands to the extent that the individual integrates the contrasexual aspect of the personality, that is, the affective, expressive mode or 'feminine principle' in the male, or the instrumental, assertive 'masculine principle' in the female. Such individuals are said to be 'androgenous'. It was therefore hypothesized that such individuals would more readily be able to negotiate family rules and expectations in a manner consistent with a major therapeutic thrust of family therapy. These clinically derived hypotheses were subjected to an empirical test by assessing twenty, non-clinical, dual-career families where both parents pursued careers and were therefore presumably both required to share instrumental and affective roles on the basis of mutual agreement. Results indicated that negotiation contributed significantly to successful role fulfilment and effective family functioning, thus substantiating the focus of family therapy strategies upon clear and direct communication and role allocation.     

The co-therapy relationship: Mutuality,agreement and client outcome

This project, utilizing a pretest and posttest design, studied interactions between co-therapists and the relationships of their interactions to client outcome. Six co-therapist pairs at a counseling center saw two clients in multiple treatments yielding twelve cases. The study investigated co-therapist relationships in regard to: (a) their level of mutuality or caring for their partners, (b) their ratings of the quality of their relationships, and (c) their agreement as to perceptions and behavior during sessions. Also investigated were: the relation of co-therapist interaction to client outcome and the personal growth of the therapists over the course of therapy. Results supported success claims of the literature concerning co-therapy.     

Logic of paradox revisited

Conclusion If, to return to the image with which I started this paper we consider the path of papers written on the logical paradoxes, then there is much to be learnt from the more recent additions, those by Chihara, Dowden and Woodruff included. However, the case for the paraconsistent approach to the paradoxes has not been weakened. In fact, it seems to me to have been strengthened. If we consider the path of papers, not as a signle line, but branching according to the approach to the paradoxes advocated, then the Logic of Paradox would, I still submit, be on the right track.