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.     

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.     

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.     

Do tough-minded people hold tough-minded attitudes?

Eysenck originally postulated that extraverts would adopt tough-minded social attitudes, although psychoticism is now considered to be of greater importance than extraversion. Previous research has attempted to relate psychoticism to realism-idealism, a principal factor of the Wilson-Patterson Conservatism Scale, and a measure of tough-mindedness acceptable to Eysenck. Results have proved discrepant; authors have used psychoticism scales of uncertain item content and length. The present study examines the relationship between psychoticism, extraversion and realism-idealism, using the Eysenck Personality Questionnaire and the Wilson-Patterson Attitude Inventory. The results provide only weak support for Eysenck’s theory. A more significant relationship was obtained between psychoticism and conservatism, and extraversion and conservatism, although a theoretical rationale for these relationships is lacking.     

Behavioral assessment of imipramine effects in a depressed child

A 7-year-old boy was diagnosed as suffering from childhood depression by two independent psychiatric evaluators who employed the Research Diagnostic Criteria. Multifaceted behavioral observations were performed on target behaviors which were identified as major problematic areas of functioning related to the child's depression. The behavioral assessment strategy included daily monitoring of on-task and disruptive behavior in the classroom, enuresis, and overall hygienic, social, and compliance behaviors as a means of identifying the specific drug-induced effects of an anti-depressant, imipramine. The assimilation and application of behavioral assessment strategies within child psychiatry have been slow and tenuous. Reasons for the resistance include theoretical differences and misconceptions among psychiatric personnel, who, although open to objective evaluations, may wish to employ nonbehavioral treatments such as pharmacologic agents. The primary purpose of this study was to demonstrate the viability of behavioral assessment as an integral adjunct to pharmacologic treatment in a psychiatric setting as a means of gauging the efficacy of a psychiatric intervention. Issues regarding the role of behavioral assessment in psychiatry and, in particular, pharmacologic interventions with depressed children are examined and discussed.This study was supported, in part, by NIMH Grant MH 30915.