Towards an Italian model of therapeutic community

In this paper the author reflects on research undertaken by the Association Myth and Reality in the context of the psychiatric reforms in Italy which resulted in the closure of the asylums and the organisation, over the last 20?years, of a network of services in the community. These include thousands of residential units operating on a rehabilitative model. The focus of this paper is on the concept of the therapeutic community as a dynamic evolutionary path, individually tailored to people with different diagnoses and different ages – e.g. psychosis; borderline; adolescents and children. The therapeutic – and more specifically the environmental – factors are presented here. This includes the aesthetics of living and the sensory/emotional climate in relation to the care of the self and protection, regulation and safety, transitional playful climate, everyday life and the sharing implicit in relationships. The emotional climate is a fundamental component that transverses and intersects all the other factors. Treatment is central to the group with its potential for containment and dynamism in relation to relationships, cohesion, belonging, integration of the self in the community and connections with social networks outside the group aimed at reintegration into society of the resident as a citizen. A system of evaluation through peer reviews between therapeutic communities in Italy is being built in order to continuously improve the quality of service delivery.     

THE RELATIVE INFLUENCE OF MOTIVATING OPERATIONS FOR POSITIVE AND NEGATIVE REINFORCEMENT ON PROBLEM BEHAVIOR DURING DEMANDS

Research has demonstrated the feasibility of using positive reinforcement to treat problem behavior maintained by negative reinforcement. This line of research was extended in the current study. A functional analysis (FA) was conducted that suggested problem behavior was maintained by positive and negative reinforcement. Following the FA, a demand analysis was conducted with three demand conditions: one that replicated the demand condition from the FA, one that included presession exposure to a preferred item, and another that included presession exposure to preferred items and access to those items during breaks from demands. Although problem behavior occurred in all three demand conditions, within session analyses showed that problem behavior ceased during breaks from demands only when they included access to preferred items. This finding suggests that the motivating operation responsible for evoking problem behavior did not decrease when only a break was provided. Subsequent functional communication training and treatment analysis showed that treatments based on positive reinforcement were effective at reducing problem behavior, but those based on a negative reinforcement hypothesis were not. Copyright © 2013 John Wiley & Sons, Ltd.     

“Putting One Foot in Front of the Other”: A Qualitative Study of Emotional Experiences and Help-Seeking in Women with Multiple Sclerosis

Treatments for depression and anxiety in multiple sclerosis (MS) are effective but evidence suggests that individuals do not always seek help for emotional difficulties. This study explored how ten women with MS (aged 30–64), recruited via a hospital based MS clinic, coped with and understood their emotions. The semi-structured interviews were analysed using interpretative phenomenological analysis. Eight participants discussed the analytic process and themes. Four overarching themes emerged: Disclosure stress, Uncomfortable dependence, Facing deterioration and One step at a time. The women struggled emotionally with many aspects of living with MS yet coping alone provided a way of defying MS and maintaining independence and control. The women needed emotional support but reported thinking others either did not notice or understand; their emotions often felt invisible. More holistic care from services was desired. Non help-seeking for distress was partially influenced by a desire to keep things “normal” and a lack of knowledge regarding service provision.     

Women in the National Guard: Experiences with children during deployment

More women of the National Guard and Reserves have deployed to combat zones overseas than ever before. Upon reintegration, these soldiers often face a number of stressors related to their combat zone experiences and readjustment to civilian life. One of these stressors is the reintegration with family, partners, and children. This qualitative study involved interviews with 30 women from the National Guard regarding their reintegration experiences with their children. Four categories were revealed from the data: (a) Concerns for Children’s Well-being, (b) Sense of Loss (c) Reintegration: Personal Challenges, and (d) Reintegration: Children’s Reactions. Implications for clinical work with returning soldiers and further research are discussed.     

A Sandtray a Day Keeps the Doctor at Play: Using Sandtray for Personal and Professional Development

This article details a year-long project in which the author created a series of 365 sandtrays and journaled about them as a professional and personal growth project. The author shares professional and personal lessons learned from this experience and describes how reflective practices can be used as a method to improve clinical work.     

Religiosity and Self-Rated Health: A Longitudinal Examination of Their Reciprocal Effects

While religiosity tends to be favorably associated with physical health, further research is needed to assess the causal directions between religiosity and health. This study examined reciprocal pathways between them with a three-wave panel dataset (General Social Survey, 2006–2010). Among Christians (N = 585), religious activities were associated with improved self-rated health, while conservative religious beliefs were associated with worsened health over time. Additionally, worse health was associated with increased engagement in religious activities and greater endorsement of conservative religious beliefs over time. Results highlight the need for additional research and theory to map the complexity of the religion–health connection.     

A Presuppositional Account of Causal and Temporal Interpretations of <Emphasis Type="Italic">and</Emphasis>

Despite extensive studies, the issue concerning the pragmatic mechanisms leading to causal and temporal interpretations of and remains problematic and has not yet been addressed in its totality within one framework. This paper proposes a solution based on presuppositional mechanisms built into a comprehensive analysis that accounts for both the various interpretations of and-sentences as well as those of other types of sentences involving similar interpretations. This account is a specific part of a unified solution to the knotty problem of different manners of conveying causal and temporal relations both with connectives and also with juxtaposed sentences. It is formulated within the Relevance Nomological Model which provides a general framework for the analysis of causal constructions such as the connective because and why-questions.