Biofeedback, cognitive training and relaxation techniques as multimodal adjunct therapy for hospitalized adolescents: a pilot study

Modifications and adjuncts to traditional therapy techniques appear to be necessary for successfully treating hospitalized adolescents with impaired social and verbal skills, and a history of acting-out behavior. Modified therapy groups were combined with a structured biofeedback and cognitive training program to help these adolescents control anger and modify their behavior. Used in conjunction with training and practice in relaxation techniques, this multimodal treatment approach appeared to be helpful in both reducing incidents of acting out on residential units, and in reaching individualized therapeutic goals. The present paper describes use of this multimodal approach within selected residential settings, and outlines the structured materials developed by the authors.     

Adolescent eating disorder: bulimia

Bulimia, an eating disorder, recently has emerged as a major mental health problem, especially among adolescent females. The bulimic experiences periods of compulsive binge eating followed by purges to rid the body of unwanted calories. Binges are triggered by intense emotional experiences, such as loneliness, anger, rejection, or stress. Associated features of bulimia are secretiveness, depression, drug abuse, preoccupation with body image and sexual attractiveness, and an awareness that the behavior is abnormal. The physical side effects include dental problems, inflamed esophagus, EEG abnormalities, abdominal or urinary disturbances, and changes in blood sugar level. Cognitive disturbances related to binging and purging are perfectionistic, egocentric, and distorted thinking, misconceptions about nutritional requirements, unreasonable goals and expectations, and disturbed affect. Bulimics resist treatment; however, such methods as cognitive, group, family, behavior, and drug therapy, and hospitalization appear promising.     

A preliminary report on defenses and conflicts associated with borderline personality disorder

The authors present preliminary psychodynamic findings from a naturalistic study of borderline personality disorder compared to antisocial personality disorder and bipolar type II (depression with hypomania) affective disorder. An independent psychodynamic interview of each subject was videotaped from which ratings were made of the presence of 22 defense mechanisms and 11 psychodynamic conflicts. A factor analysis of ratings from 81 subjects supported the separation of borderline (splitting, projective identification) from narcissistic defenses (devaluation, omnipotence, idealization, mood-incongruent denial). While certain groups of defenses were associated with each diagnosis, defense ratings did not significantly discriminate the three diagnostic groups, suggesting a limit to their diagnostic value. Among 27 subjects rated, borderline personality was strongly associated with two conflicts: separation-abandonment, and a global conflict over the experience and expression of emotional needs and anger. Antisocial personality was psychodynamically distinct and more heterogeneous. Bipolar type II was associated with two hypothesized depressive conflicts: dominant other and dominant goal. Chronic depression, which was more common in both personality disorder groups than in bipolar type II, was associated with a third depressive conflict, overall gratification inhibition. Overall, conflicts were powerful discriminators of the three diagnostic groups. The heuristic value of these findings is discussed.     

Jamaican Family Structure: The Paradox of Normalcy

The relationship between basic research, theory, and clinical work with families is conceptualized during a discussion of Jamaican family structure and the application of change theory to a clinical case of depression in a Jamaican woman. It was found that three types of family structure are prevalent in Jamaica. The European ideal of a patriarchal-patrifocal structure creates problems for working-class Jamaicans. General system theory provides support for a different model. Change theory is applied to resolve the paradox created by the European model.     

Family therapy with delinquents: a critical review of the literature

A critical review of the theoretical and outcome studies on family therapy with delinquents is presented. Assessment of the theoretical developments reveals that families of delinquents may be distinguishable from other families by their interactional sequences and processes. The available outcome studies within the field indicate that family therapy is viable for interventions with this population, with behavioral, structural, strategic, and communication approaches receiving the most support, but more specific and robust evidence is still needed. Trends in the research and critical issues are identified and used to provide suggestions for future research and practice.     

Ineffability and intelligibility: Towards an understanding of the radical unlikeness of religious experience

Conclusion I do not for a moment question the fact that many people have experiences of a special type which may be termed religious, that such experiences often involve reference to something which appears to display a radical unlikeness to all else and that they are therefore in some sense inexpressible. Doubtless the ideas I have put forward about the possible source of such unlikeness and ineffability might suggest models of God which would not find much theological approval, at least within any mainstream theistic tradition, since some sort of pantheism seems inevitably to be implied. But however this might be, the concept of radical unlikeness as it has been analyzed here can, I think, help us towards understanding certain problematic areas in religion quite apart from the issue of intelligibility, which has been the focus of this discussion.To begin with, radical unlikeness suggests a way in which the historical continuity of concepts of the transcendent might be upheld against the discontinuity suggested by the diversity of interpretations through which they have moved. Ancient and modern outlooks on, say, God differ enormously, as indeed do the range of co-temporal accounts at many particular moments. But, by and large, theologians firmly maintain that it is a single and unchanging phenomenon which is being dealt with. Unless we can point to some common element which is both specific enough to create a binding sense of common tradition, yet never completely expressed by any attempt at understanding it within that tradition (thus persistently demanding new attempts to apprehend it), then given the widely differing views of God within, for example, the Christian community, it is difficult to see how we could assume that in fact they all stemmed from the same source and were talking about the same thing. The idea of radical unlikeness could provide an element with just these required characteristics: it could be seen as what all the accounts attempt to net, with varying degrees of adequacy, within their offered interpretations. It could be seen as what remains constant, constantly elusive yet constantly generative of fresh attempts to apprehend it, throughout a history of intra-religious diversity. Secondly, radical unlikeness might suggest a possible way of understanding inter-religious diversity in a way which allows that whilst such diversity exists, whilst the differences between religions are real, they are grounded in a similar root-experience. It may, at first sight, seem difficult to continue thinking of the various religious traditions as truly separate phenomena if they are taken as being grounded on experiences whose ineffability stems from the unlikeness of experiencing things as a whole. Here we must stress again that if they are to be considered intelligible, radically unlike experiences cannot be considered completely so - or putting this another way, we cannot more than approach experience of totality. Sense can be given to religious claims of ineffability by suggesting experience of near totality, where we reach the last point on the scale of inclusiveness which complies with the logical criteria demanded of something for it to be possible for us to be aware of it. We might thus attempt an explanation of inter-religious diversity based on the view that Hinduism, Buddhism, Christianity, Islam etc. acquire their differences from the different elements included in their experience of near totality. Taking totality to be represented by the scale of one to ten, Hinduism might be seen as grounded on experience of 1-2-3-4-5-6-7-9-10, Buddhism on experience of 1-3-4-5-6-7-8-9-10 and so on. The resulting dissimilarities are thus centred not on different types of experience, but on different areas of inclusiveness. This is, of course, to suppose that the various religious traditions are all based on the same degree (as opposed to the same elements) of inclusiveness, but it is by no means clear that such a supposition is justified. Continuing with our decimal analogy, might it not be suggested that whilst Christianity stemmed from experience of 2-3-4-5-6-7-8-9-10, Jainism was founded on a less extensive encounter with the divine (say 4-5-6-7-8-9-10)? It is, however, uncertain how we can compare and evaluate different religious traditions in such a way as to be able to comment on such claims. The analysis of radical unlikeness and ineffability which has been advanced might also suggest a way in which certain passages in religious writings could be understood, passages which at first sight can be seriously perplexing. If, for example, to return to the quotation given in the introductory section of this paper, we continue to think of accounts of the nature of Shiva as being attempts to describe some discrete, objective entity, then it is inevitable that either we will share the Puranic writer's puzzlement or that much of what we read about Shiva will appear as the muddled and extravagant thinking thrown up by an uncritical and over-fertile mythological imagination, consisting of little more than a hotch-potch of contradictory elements. But if we see such accounts as attempting to say something about everything, as symbols of near totality stemming from experiences which verge on the holistic, then what we read - with all its ambiguities - may become somewhat more meaningful. This analysis of ineffability and intelligibility seeks to introduce for debate a possible way of understanding the radical unlikeness which accounts of religious experience apparently attempt to speak about. It does not, however, claim to present an exhaustive treatment of the issues raised, on the contrary, I am conscious of many shortcomings and omissions. For instance, it remains to be seen under precisely what conditions something counts as being an elucidating likeness (presumably all experiences are, for example, temporal, yet temporality alone would not seem to offer a particularly elucidating comparison). Moreover, the degree to which appeal to likeness is allowed operation in actual accounts of religious experience needs to be explored. In addition, the notion of categorizing experiences according to the extent to which they approach a point of total inclusion requires careful clarification. To begin with, according to what criteria could we establish that one experience was more inclusive than another? However, such issues can only be mentioned here, any adequate consideration of them would require a separate paper.In conclusion, I would suggest that to use radical unlikeness and/or ineffability simply as devices by which to halt any process of investigation, proclaiming that the thing in question is not like anything and so is beyond all words, risks making unintelligible and placing beyond all further inquiry an important and extensive area of human experience. As William Alston put it, to label something ineffable in an unqualified way is to shirk the job of making explicit the ways in which it can be talked about. It is surely more accurate to take ineffability as a qualifier which multiplies models without end than as an absolute which prevents the construction of any elucidating models.An early draft of this paper was read to a seminar group at the University of St. Andrews during Martinmas term 1984. I am grateful to Dr. Gordon Graham & Mr. Tony Ellis, both of the Department of Moral Philosophy, and to Dr. George Hall, of the Department of Divinity, for remarks which stimulated some subsequent revisions of the argument.

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