The impact of the therapeutic environment

This paper emphasizes the impact of the setting, space, and general physical properties of the clinic upon the difficult patient's profound neediness and absence of inner regulatory structure. Moreover, the clinic's administrative style and requirements often related to fiscal restraints, demands for accountability for both how funds are spent and treatment outcome, all impinge upon the patient. Humanizing clinics so they have the capacity for psychotherapeutic holding and provision of safety for difficult patients are discussed in detail in this contribution.     

Preventing Substance Abuse Among American-Indian Adolescents: A Bicultural Competence Skills Approach

Tobacco, alcohol, and drug use are problems for American-Indian people. We reviewed these problems and the explanations for them and described a bicultural competence skills approach for preventing substance abuse with American-Indian adolescents. Data from a study of that approach suggest its efficacy with American-Indian youth. At posttest and a 6-month follow-up, American-Indian subjects who received preventive intervention based on bicultural competence skills concepts improved more than did American-Indian subjects in a no-intervention control condition on measures of substance-use knowledge, attitudes, and interactive skills, and on self-reported rates of tobacco, alcohol, and drug use. Our findings have implications for future substance-abuse prevention research with American-Indian people.     

Systemic crisis intervention as a response to adolescent crises: an outcome study

The present study demonstrates the safety and effectiveness of an outpatient program designed to respond to adolescent-precipitated crises by mobilizing and restructuring the family's kinship system. Families of 75 adolescents at risk for hospitalization were followed up to 24 months after treatment with Systemic Crisis Intervention. Measures of offspring and family functioning, suicidal behavior, institutional use, and treatment costs are presented. Results clearly demonstrate the safety, effectiveness, and economic viability of Systemic Crisis Intervention.