Reflections on group psychotherapy with eating-disordered patients

This paper addresses some of the dynamics, resistances, and transference and countertransference considerations in group psychotherapy with eating disordered patients. Several resistances are delineated, including guilt over being helped, the recreation of early problems around control and forced feeding, and withdrawal as a defensive operation. A brief vignette is presented which highlights the demand on the part of the therapist as well as the patient to contain and manage feelings rather than acting on them. Lastly, the author argues that group participation helps the patient to identify, articulate, and accept feelings and to promote assertiveness.This paper is based on a presentation given at the Training Institute for Mental Health on May 11, 1991.     

An exploratory study of videotapes of long-term group psychotherapy of outpatients with major and chronic mental illness

This study explored patterns emerging in videotaped sessions of group psychotherapy with seven outpatients of a large mental health facility. The 22 sessions spanned the 12th to 27th months of the group's existence. Group members had long histories (25–50 years) of symptoms characteristic of schizophrenia. Each session was rated on the Group Environment Scale. One session from a group in its earlier stages was also rated on the same instrument to give some indication of baseline patterns. Analyses of changes across the 15 months were not statistically significant. However, some GES subscales, including Cohesion, Independence, and Self-Discovery, showed relatively high mean levels across the 15-month period. These elevations are discussed as suggesting the codevelopment of orientations that have sometimes been viewed as incompatible and unattainable for schizophrenics. Interpreted clinically, the GES patterns help to elaborate recent findings about the relatively good success of long-term group therapy with such populations. The study, although merely suggestive, illustrates the potential for gleaning solid and clinically useful data from group psychotherapy research.The authors would like to thank Drs. Jill Rierdan, Nina Fieldsteel, Joseph Christy, and an anonymous reviewer for their suggestions, Kendra Bryant for serving as the reliability rater, and Janet Eltinge for her skilled videotaping.     

Perception of complex geometric figures in chimpanzees (Pan troglodytes) and humans (Homo sapiens): analyses of visual similarity on the basis of choice reaction time.

In a conditional-discrimination task (matching-to-sample), we assessed similarities among figures consisting of 2 elemental figures through the choice reaction time, nonmetric multidimensional scaling, and hierarchical cluster analysis data from chimpanzees (Pan troglodytes) and humans (Homo sapiens). Humans also rated similarities among figures. The results of the 3 experiments clearly indicated that the reaction time data obtained from chimpanzees' performances were useful measures of the similarities among figures. The results suggested that chimpanzees and humans perceived the complex figures similarly. The outer-contour elements were perceived most dominantly by both species, and the straight-line elements were perceived least dominantly. Both species showed the same perceptual hierarchy or dominance among perceptual categories, as determined by the similarity of simple elements, on the basis of transformational invariances.     

Simultaneous conditioning in honeybees (Apis mellifera).

Honeybees (Apis mellifera) were classically conditioned with odor as conditioned stimulus (CS), sucrose as unconditioned stimulus (US), and proboscis extension as response. The purpose of Experiment 1 (Ns = 26 and 27) was to look for facilitation of forward conditioning by CS-US overlap, but rapid conditioning without overlap left little room for improvement. In 2 further experiments, CS and US were simultaneous, and response to odor alone was measured in subsequent tests. In Experiment 2, a Simultaneous group (N = 25) responded more to the training odor than did an Unpaired control group (N = 25). In Experiment 3, a differentially conditioned Simultaneous group (N = 29) responded more to an odor paired with sucrose in training (S+) than to an odor presented alone (S-). The implications of the results for the problem of the role of amount of reward in honeybee learning are considered.     

Gender and temporal differences in identifying sources of stress

Much of the methodology in stress research focuses on stress manifestation and organismic reactions to life’s crises. In contrast, the present study sought to identify the major sources of stress and the nature of those sources. The results revealed a consistent pattern in high and low stressors throughout the 3-year period of the study, and differences only of intensity between males and females, not type of stress. Except for individuals’ temporal variations in critical events, the highest stressors for the groups were external, primarily financial and time management. Internal sources, such as personal relationships and self-absorption, were typically the lowest concerns. Everyday problems arising from current life styles seem to be significant sources of stress.     

Recidivism of disordered offenders who were conditionally vs. unconditionally released

Postinstitutional arrests and state hospitalizations of 191 patients placed on conditional release (CONREP group) were compared to those of 44 patients released from the same California state hospital with no aftercare due to expiration of commitment terms (MAXOUT group). The two groups were not randomly determined but were comparable in demographic characteristics and rates of preprogram arrest. The CONREP group had a significantly lower community-period arrest rate than did the MAXOUT group (p <.001). Survival rate analyses, using time until arrest and time until revocation as dependent variables, suggested that revocations during the first 240 days of community re-entry reduced the potential arrest rate within the CONREP group. Results were discussed in terms of the “criminalization hypothesis” as well as the crime-preventive possibilities of the conditional release mechanism.     

Representation by counsel: Right or obligation?

Since the Supreme Court's decision in Faretta v. California (1975), courts have generally permitted defendants to represent themselves, as long as they are competent to do so. The problem lies in the definition of competency to waive counsel, which has been vaguely defined by the courts. Little is known about the frequency of, or reasons for, attempts to waive counsel, about the process of forensic evaluation of such competency, and about the success of such attempts. The authors briefly review the case law on competency to waive representation, report on a longitudinal prospective study of these issues in a population of defendants referred to an inpatient forensic facility for evaluation of all types of competency related to their criminal prosecutions, and discuss the significance of the issue for forensic clinicians. A key question for courts, lawyers, and clinicians is whether a competency evaluation can be invoked to overcome a defendant's constitutional rights to self-representation and bail.