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.     

Attitudes Toward Male Oral Contraceptives: Implications for Models of the Relationship Between Beliefs and Attitudes1

Four factors (effectiveness, health risks, cost, and convenience) were orthogonally manipulated in a 3 × 2 × 2 × 2 factorial design to determine their relative importance in influencing attitudes toward and intentions to use male oral contraceptives. The experimental design also permitted a test of the assumption of additivity underlying expectancy-value models of attitude and the assumption of absence of context effects. Results were consistent with expectancy-value models of the relationship between beliefs and attitudes. In addition, it was found that health risks and effedtiveness, in that order, were the most important factors influencing receptivity to male oral contraceptives, with the effects of cost and convenience being mediated by these two factors. Sex differences in attitudes toward male oral contraceptives were also observed.     

Septal correlates of conditioned inhibition and excitation in rats

Multiple-unit activity was recorded in the lateral septum of rats during Pavlovian differential conditioning. In Experiment 1, one group of animals received a classical aversive discrimination paradigm, while another group was presented with a control procedure in which the unconditioned stimuli (shocks) were administered randomly with regard to the conditioned stimuli. Septal unit activity increased during presentations of the conditioned inhibitor and was markedly suppressed during presentations of the conditioned excitor in the conditioning-group animals and not in the control animals. Baseline activity remained unchanged in the conditioning group but was suppressed in the random control group. Furthermore, termination of the aversive stimuli was marked by a burst of firing in the conditioning group, but no such rebound was seen in the control group. In Experiment 2, a classical appetitive discrimination paradigm was given, in which septal unit activity was found to increase in the presence of the conditioned excitor and was suppressed in the presence of the conditioned inhibitor. The results are interpreted as indicating a role for the septum in the relief of aversive states.     

Performance of dyslexic children on speech perception tests

Several researchers who have compared the performance of dyslexic and normal-reading children on a variety of different tasks have suggested that dyslexic children may have subtle deficits in the phonemic analysis of spoken as well as written language. Thus it is of interest to know how children who have extraordinary difficulty learning to read can perform explicity auditory-phonetic tasks. Seventeen dyslexic children (10 years of age) and a group of 17 controls were administered tests of identification and discrimination of synthesized voiced stop consonants differing in place of articulation. These were tests of the type used to study categorical perception in adults, adapted for use with young children. Significant differences between dyslexics and controls were found in both kinds of tasks; the pattern of identification and discrimination differences suggests an inconsistency in the dyslexics' phonetic classification of auditory cues. A significant relationship was found between reading level and speech discrimination.     

An information processing system for the psychiatric emergency room

An information processing system for a psychiatric emergency room is described. Several studies are presented that show the utility of the system. In the first study, variables involved in diagnosis are explicated. The second study attempts to determine the characteristics that distinguish recidivists from nonrecidivists at an emergency room. The third study attempts to find patient variables related to success in short-term treatment programs. The final study is aimed at discovering whether there are psychopathological effects related to the use of inhalants. Together, these studies show the potential of a mental health information system for learning more about the nature of mental disorders and their treatment.     

Behavior of depressed subjects in problem solving groups

This study investigated leadership selection in groups in relation to level of depression of group members. On the basis of MMPI-D and DACL scores 66 subjects were organized into groups of six to eight people consisting of all depressed, all nondepressed, or half depressed and half nondepressed subjects. Subjects performed a problem solving task alone and in groups and completed a questionnaire on leadership choice and group performance. Results indicate that nondepressed group members talked more frequently, were rated as more important contributors, and were selected as leaders more frequently than depressed members. In addition, mixed groups were perceived as more efficient and enjoyable by group members than the unmixed groups. There were no significant differences between depressed and nondepressed subjects on performance of the problem solving task whether working alone or in groups. Results were discussed in relation to other literature on the interpersonal behavior of depressed persons.