Outpatient group psychotherapy following day treatment for patients with personality disorders

This prospective, naturalistic study evaluated the practice and effectiveness of an outpatient group therapy program following day treatment for patients with personality disorders (PDs). One hundred and eighty-seven patients (86% patients with PDs and 14% with no PDs), were treated in outpatient psychodynamic group therapy. Outcome was assessed by Global Assessment of Functioning, Symptom Check List 90-R, and Inventory of Interpersonal Problems-Circumplex, short version, at admission and discharge from day treatment, and at the end of outpatient group therapy. Average length of outpatient therapy was 24 months. Forty-three percent terminated in an irregular manner. Outcome of the continuation therapy was satisfactory for patients without PDs. For PD patients, the improvement from the day treatment was maintained during outpatient therapy, but further improvements were modest for symptoms and interpersonal distress, somewhat better for global functioning. Implications for further treatment development are discussed.     

CHANGE IN SELF‐IMAGE AND PTSD SYMPTOMS IN SHORT‐TERM THERAPIES WITH TRAUMATIZED REFUGEES

In this study, an attempt was made to evaluate changes in the self‐image of traumatized refugees receiving short‐term psychotherapy. Fourteen clients with war and torture experiences were followed during and after trauma‐focused therapies with self‐rating instruments. Outcome was measured with SCL‐90, measuring overall psychiatric symptoms, and with PTSS‐10, measuring Post‐traumatic Stress Disorder (PTSD) symptoms. Self‐image was measured with Structural Analysis of Social Behavior (SASB). The analyses showed considerable remission of both general psychiatric and PTSD‐related symptoms, but more moderate changes in self‐image aspects. The positive aspect of the self‐image was virtually non‐related to the symptom measures and did not change after the termination of the therapy; the negative aspect of the self‐image was more strongly related to the symptoms and changed mainly on the last measurement occasion, 15 months after the therapy end. When clients with good and poor outcome were compared, it was found that those with good outcome had higher initial levels on both the positive and the negative aspects of the self‐images. This was tentatively interpreted as indicating that clients who had invested more energy in their self‐image were better able to utilize the therapy. Different development in the self‐image for these two groups indicated that for some clients, the treatment process might have entailed too much strain.     

Breaking the Rules When Others Do

People often speak as if the behaviour of others is relevant to the question of whether they are justified in violating a rule. This paper explores three lines of argument which might be used to justify rule violation on grounds appealing to what others do. The appeal to self-defence as a justification does not succeed, since it must expand the concept to involve a cumbersome weighing of harms. The argument that complying with a rule may involve too great a sacrifice in some cases needs to be developed by an account of when a sacrifice is morally significant. It is tempting, but problematic, to do this by weighing consequences of individual acts. An alternative approach is to argue that the behaviour of others is sometimes relevant to determining what rule is actually functioning in some context as a part of a particular moral system.