The aggression-coercion cycle: Use of seclusion and restraint in a child psychiatric hospital

The widespread use of seclusion and restraint in child psychiatric hospitals to manage aggression and noncompliance is based on the assumption that coercive consequences reduce the frequency of undesirable behaviors exhibited by the patients. We report a study of the use of seclusion and restraint in a public child psychiatric hospital during a 3-year period. Twenty-eight percent of the patients had been secluded or restrained a total of 1670 times. About 25% of these patients had been secluded more than five times during their hospitalization, and 32% had been placed in restraints more than once. Behaviors that typically resulted in repeated seclusion included physical aggression toward staff, verbal aggression toward peers, non-compliant or oppositional behavior, and self-harm. Variables that predicted patients most at risk for repeated seclusion included age, gender, and psychiatric diagnosis. The predictor variables for those most at risk for repeated restraint included age, property destruction, and self-harm. The high rates of use of seclusion and restraint suggest that these methods for controlling the behavior of children and adolescents in this child psychiatric hospital may not have been therapeutic. We suggest that staff in such hospitals engage in a pattern of behavior characterized by an aggression-coercion cycle, in which increasingly aggressive and coercive behaviors are exhibited by both patients and staff.     

The place of words and numbers in psychiatric research

In recent decades, there has been widespread debate in the human and social sciences regarding the compatibility and the relative merits of quantitative and qualitative approaches in research. In psychiatry, depending on disciplines and traditions, objects of study can be represented either in words or using two types of mathematization. In the latter case, the use of mathematics in psychiatry is most often only local, as opposed to global as in the case of classical mechanics. Relationships between these objects of study can in turn be explored in three different ways: 1/ by a hermeneutic process, 2/ using statistics, the most frequent method in psychiatric research today, 3/ using equations, i.e. using mathematical relationships that are formal and deterministic. The 3 ways of representing entities (with language, locally with mathematics or globally with mathematics) and the 3 ways of expressing the relationships between entities (using hermeneutics, statistics or equations) can be combined in a cross-tabulation, and nearly all nine combinations can be described using examples. A typology of this nature may be useful in assessing which epistemological perspectives are currently dominant in a constantly evolving field such as psychiatry, and which other perspectives still need to be developed. It also contributes to undermining the overly simplistic and counterproductive beliefs that accompany the assumption of a Manichean “quantitative/qualitative” dichotomy. Systematic examination of this set of typologies could be useful in indicating new directions for future research beyond the quantitative/qualitative divide.     

From Copenhagen to the consulting room: Pauli and Jung in Copenhagen

In this paper the city of Copenhagen is used as a starting point to highlight some critical historical events, both concerning the exchange of ideas between the physicist Wolfgang Pauli and C.G. Jung and the history of psychotherapy in Scandinavia. Pauli's years in Copenhagen under the influence of Niels Bohr and his philosophy prepared him mentally to receiveC.G. Jung's ideas. The paper also recounts the one occasion that Jung was in Scandinavia, attending the 9th conference of the General Medical Society for Psychotherapy in Copenhagen, just before going to New York in 1937 to give his final seminars on Pauli's dreams. The reason for focusing on these particular events is that they also constitute part of the history of the reception of psychodynamic psychology in Sweden and Scandinavia.     

The Relation Between Cognitive Development and Anxiety Phenomena in Children

We examined the relation between cognitive development and fear, anxiety, and behavioral inhibition in a non-clinical sample of 226 Dutch children aged 4–9 years. To assess cognitive development, children were tested with Piagetian conservation tasks and a Theory-of-Mind (TOM) test. Fears were measured by means of a self-report scale completed by the children, while anxiety symptoms and behavioral inhibition were indexed by rating scales that were filled out by parents. Significant age trends were observed for some anxiety phenomena. For example, younger children displayed higher fear scores, whereas older children exhibited higher levels of generalized anxiety. Most importantly, results of regression analyses (in which we controlled for age) indicated that cognitive development, and in particular TOM ability, made a unique and significant contribution to various domains of behavioral inhibition. In all cases, higher levels of TOM were associated with lower levels of behavioral inhibition. In general, percentages of explained variance were rather small (i.e., <6%), indicating that the role of cognitive development in various anxiety phenomena is limited.     

Telephone-delivered psychotherapy for late-life anxiety

A randomized controlled trial (RCT) of telephone-delivered cognitive-behavioral therapy (CBT) was compared with usual care for late-life anxiety disorders. Client satisfaction, as assessed by the Client Satisfaction Questionnaire, was high (M = 27.4, range 8-32), and attrition rates were low (8.3%). Preliminary results suggest that participants receiving CBT, compared with usual care, experience declines in general anxiety, worry, anxiety sensitivity, and insomnia.     

Therapeutic alliance and progress in couple therapy: multiple perspectives

Therapeutic alliance research in couple therapy using multiple perspectives and longitudinal data has been sparse. This study used structural equation modelling to explore relationships between changes in alliance and in progress from clients' and therapists' perspective in a fairly large sample of couples (N=195) during the initial stage of therapy at an on‐campus training clinic. Self‐rated alliance was measured after sessions 2 through 4 with the Working Alliance Inventory. There was very little change in alliance over the early sessions of therapy, and changes in alliance did not always account for changes in relationship satisfaction. Husbands' perceptions of satisfaction and alliance seem to play an important role in the dynamics of the therapeutic process. Findings suggest a reciprocal relationship between perceptions of alliance and progress in therapy when combining perceptions of therapists and couple clients. Clinical implications and future research are discussed.     

Effects of normal aging and Alzheimer's disease on emotional memory

Recall is typically better for emotional than for neutral stimuli. This enhancement is believed to rely on limbic regions. Memory is also better for neutral stimuli embedded in an emotional context. The neural substrate supporting this effect has not been thoroughly investigated but may include frontal lobe, as well as limbic circuits. Alzheimer's disease (AD) results in atrophy of limbic structures, whereas normal aging relatively spares limbic regions but affects prefrontal areas. The authors hypothesized that AD would reduce all enhancement effects, whereas aging would disproportionately affect enhancement based on emotional context. The results confirmed the authors' hypotheses: Young and older adults, but not AD patients, showed better memory for emotional versus neutral pictures and words. Older adults and AD patients showed no benefit from emotional context, whereas young adults remembered more items embedded in an emotional versus neutral context.     

“Paramount reality” in Schutz and Gurwitsch

Conclusion Both Schutz and Gurwitsch describe reality as having a manifold character: Schutz speaks of multiple realities and Gurwitsch of orders of existence. Both hold that one realm of reality has a privileged status compared to the others: common everyday experience. However, in spite of this apparent convergence in their views, a closer reading of their various works reveal the important difference in what they understand under common everyday experience.For Schutz, it is the world of social action, characterized by him as paramount reality because of the constitutive processes of the experiences of time, space, sociality and meaning involved in action. For Gurwitsch, the realm of common everyday experience represents the counterpart and the origin of the constructed realm of science: therein lies its status of paramount reality. But what it really refers to is not ordinary experience, as most of his statements suggest, but pre-predicative experience, wherefrom the categories of the natural sciences, namely space and time, originate. Gurwitsch speaks of this pre-predicative experience, which he also calls primordial experience, as being essentially perceptual experience. However, he limits perceptual experience to sensory perception, leaving out the symbolic, social and action-related components of perception and becomes thus inconsistent with his adherence to the dismissal of the constancy hypothesis in his field theory of consciousness. The dismissal of the constancy hypothesis implies the recognition of the appresentational structures involving symbols, action and Others as inherent components of every perception. Schutz disagrees with Gurwitsch's reduction of the life-world Erlebnisse to sensory perception and this issue becomes the core of their debate on the phenomenon of paramount reality.     

Overt and covert parental conflict and adolescent problems: observed marital interaction in clinic and nonclinic families.

When adolescents behave in socially unacceptable ways, overt interparental conflict is widely held to be the cause. Empirical studies, however, have been inconsistent in supporting this assumption. Some researchers therefore have speculated that covert conflict also plays a role. In the current observational study, evidence was found that both overt parental conflict and some forms of covert conflict play roles. During problem-solving family discussions, parents of adolescents whom they had brought into an outpatient clinic for treatment overtly disagreed with each other significantly more often than did parents with adolescents who did not require treatment. Families of clinic adolescents also exhibited significantly more silence during their discussions, and mothers spent significantly less time talking than did their nonclinic counterparts. The implications that both the overt and covert conflict may have for adolescent behavior are discussed.     

Gender Role Beliefs and Attitudes toward Lesbians and Gay Men in Chile and the U.S.

We compared the relationship between gender role beliefs and antigay prejudice in Chile and the United States. Participants were Chilean and American university students. In Study 1, Chileans were more prejudiced than Americans, and men were more prejudiced than women. In Study 2, gender role beliefs mediated cultural and sex differences in prejudice. Chileans held more traditional gender role beliefs and were more antigay than Americans. Men were more prejudiced than women, particularly in their attitudes toward gay men. Further, sex differences in attitudes toward lesbians and gay men were completely mediated by gender role beliefs. Nationality differences in attitudes toward lesbians were completely mediated, and nationality differences in attitudes toward gay men were partially mediated, by gender role beliefs.