Working with the entitled patient

Entitled patients are described as those who derive gratification from indiscriminate and intense interpersonal relationships and who unconsciously do everything they can to resist the limits that psychoanalytic psychotherapy imposes on them. In this paper the dynamics of entitled patients are explained. Case histories illustrate the difficulties and significance of setting therapeutic limits on such patients.     

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.     

Symbiosis, the Family, and Natural Systems

Family systems theory, as developed by Murray Bowen, has its conceptual basis in natural systems. A basic premise is that emotional process is not unique to homo sapiens and that human behavior might better be understood by observing this process in the broader context of all natural systems. This essay discusses the phenomenon of symbiosis as it is used in the natural sciences and as it relates to the emergence of increasingly complex systems in nature. Finally, the emergence of the parent/offspring symbiosis from its possible origins to its development in the human family is discussed.     

The Anorectic Process in the Family: A Six-Stage Model as a Guide for Individual Therapy

This article presents a conceptual framework for individual treatment with chronic anorectic patients. In the first part of the article, the six-stage model for the anorectic process developed over the past years by M. Selvini-Palazzoli and her team is briefly explained. After presenting the model, we then discuss some related concepts, namely, "family game," "rule," and "strategy." Finally, the therapeutic technique in individual treatment is discussed. Two basic assumptions underlie this technique: first, the therapeutic relationship is instrumental, its main purpose being to improve the patient's personal relations outside therapy; second, the focus of the treatment is on the strategic incapacity of the patient who is caught up in and unable to cope with the "concealed family game."     

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.     

Systemic Optimism — Systemic Pessimism: Two Perspectives on Change

Therapists have a mandate to bring about change, and family therapists appear to have unusual leverage to fullfill such a mandate, that is, to facilitate changes rapidly and effectively. Because and in spite of this mandate, the very notion of change deserves critical reflection. The history of ideas and our clinical experience teach us that changes may be problematic. They may come too fast or too slowly, may endure or fade away, may turn out to be desirable or undesirable, equitable or inequitable, and may, when further consequences and larger systems levels are taken into account, be beneficial or disastrous. This essay examines some of the problematical and contradictory aspects of change and delineates two perspectives on change--systemic optimism and systemic pessimism.     

CHILD-REARING BELIEFS WITHIN DIVERSE SOCIAL STRUCTURES: MOTHERS AND DAY-CARE PROVIDERS IN MEXICO*

The child-rearing beliefs of 32 mothers and 36 day-care providers in Mexico were compared. Day-care providers expected children to master developmental skills at an earlier age than did mothers. Day-care providers more strongly valued the development of independent and cooperative behavior, and placed less importance on obedience. They also reported employing more flexible and nonauthoritarian discipline strategies than did mothers. Mothers and caregivers did not differ in the extent to which they attributed the success of their discipline strategies to their own actions rather than to external factors. Also examined was how mothers' beliefs differed in families characterized by interdependent versus individualistic social structures. In interdependent families, mothers were more likely to believe in later mastery of developmental skills and to make external attributions. These findings suggest that Mexican children experience incongruous social norms as they move between home and day care settings, and that these norms, at least within the home, are associated with the social structural features of the setting.