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.     

The air gap phenomenon in children's landscape drawings

The “air gap” phenomenon was found to be very common in the free landscape drawings of middle and later childhood. Three experiments are reported in which the contextual cues for such drawings were systematically manipulated. When subjects were supplied with drawing sheets constructed to imply the absence of the air gap, the phenomenon was eliminated in most of their drawings. When supplied with sheets constructed to imply its presence, most subjects produced air gap drawings using contextually provided reference lines. There were no consistent transfer effects across different cuing orders. The susceptibility of the air gap phenomenon to modification by task manipulation suggests that it results from problems of production rather than from defects in the child's internal representation of the world.     

The rotating square illusion

Twenty subjects viewed displays of square and trapezoidal luminous dot figures rotating about a vertical axis in both polar and parallel projections. The frequency of reported oscillation of the rotating figures was as high for the squares as for the trapezoids, provided that the squares contained static slant information in the form of internal texture gradients. Previously reported oscillation effects using shapes other than trapezoids have generally been unreliable, with a subject as likely to see rotation as oscillation for a given cycle, and then only in parallel projection. As a consequence, linear perspective information in trapezoidal shape has been taken to be the indispensable element for obtaining a strong oscillation effect. The authors argue that in the construction of the rotating object, a required condition for reliably producing the effect is a violation ofsome optical constraint regarding slant information, not necessarily one involving linear perspective.     

Personality and the topography of the conditioned eyelid response

One-hundred and four women were tested on an eyelid conditioning paradigm in a 2 x 2 x 2 factorial design where two levels of US intensity (1 vs 3 p.s.i.) were balanced against two rest pause interpolations (after 25 and after 50 trials), and the presence or absence of a warning stimulus prior to CS-US presentation. Subjects were later classified as high, low or intermediate extraverts on the basis of a personality questionnaire. A very detailed analysis of conditioned responses was carried out, using both simple and composite measures including work-ratio, utility-ratio, CR frequency, peak latency, peak amplitude, response area and effective response area, degree of avoidance amplitude and latency, etc. Major findings related to similar effects of high intensity US vs low intensity US, and introversion vs extraversion; introverts react as if they were responding to more intense stimuli than extraverts. This finding cuts across other parameter variables, and supports Eysenck's formulation of personality-conditioning relationships in terms of higher cortical arousal in introverts as compared with extraverts.     

The importance of inhalation volume when measuring smoking behavior

Theoretical and technical considerations of measuring puff and inhalation volumes during cigarette smoking are reviewed. Measures of smoking behavior using a flowmeter and inductance plethysmography are described and demonstrated with seven subjects smoking over a 3-to 4-h period. Puff volume and duration, inhaled volume and duration, interpuff and intercigarette interval, and number of puffs varied for each individual over the session. The ratio of puff volume to inhaled volume changed with successive cigarettes. Smokers adjust the concentration of smoke by blending air with the smoke. Thus, to completely characterize smoking behavior, the volume of smoke and air inhaled into the lungs must be measured directly.     

Perception of surface curvature and direction of illumination from patterns of shading

Three experiments examine the perceptual salience of shading information for the visual specification of three-dimensional form. The observers in these experiments were required to estimate the surface curvature and direction of illumination depicted in computer-synthesized images of cylindrical surfaces, both with and without texture. The results indicate that the shininess of a surface enhances the perception of curvature, but has no effect on perceived direction of illumination; and that shading is generally less effective than texture for depicting surfaces in three dimensions. These and other findings are used to evaluate the psychological validity of several mathematical analyses of shading information that have recently been proposed in the literature.     

Mechanisms of attentional selection: temporally modulated priority tags

When a single abrupt onset appears in a multielement display, it captures attention. When multiple onset elements occur, they have conditional priority over no-onset elements such that a limited number of onsets can be serviced with high priority in visual search (Yantis & Johnson, 1990). We report three experiments in which we assess two possible mechanisms for attentional prioritization: a priority queue into which a fixed number of high-priority elements are placed for early servicing during search, and a mechanism that temporarily tags all high-priority elements for early servicing or more frequent sampling. We manipulated the visual quality or inter-letter confusability of the stimuli to prolong encoding and/or comparison operations; this manipulation led to a decrease in the estimated number of elements serviced with high priority. We conclude that a mechanism incorporating temporally decaying priority tags is implicated in servicing multiple abrupt onsets in visual search.     

The Reasons for Living Inventory: psychometric properties

The test-retest reliability, internal consistency reliability, normative, and item analysis data of the Reasons for Living Inventory were investigated in a sample of 116 college students. The inventory has six subscales, each of which assesses a category of adaptive beliefs and expectations considered reasons for not committing suicide. The inventory was administered twice, with a 3-week interval between testings. Test-retest coefficients for the men, women, and total sample were moderate to high. The alpha coefficients and item-total correlations for the subscales and the total inventory provided strong support for internal consistency. 26 items were consistently endorsed by 30% or more of our total sample as "extremely important," while only four were suggested as "not at all important" reasons for not committing suicide.