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The Heart of the Matter: An Essay about the Effects of Managed Care on Family Therapy with Children*
Ellen Pulleyblank Coffey Ph.d. Mary E. Olson Ph.d. Phebe Sessions Ph.d. 《Family process》2001,40(4):385-399
This essay is based on a pilot study that examined the effects of managed care on the treatment of children and families, with special attention to community mental health. We embarked on the pilot study to test the accuracy and generalizability of our impression that family therapy and other systemic practices have been marginalized in ordinary clinics and agencies, and to understand the reasons why. We interviewed managed care providers, researchers, family therapy trainers, and clinicians in the Northeast. Our findings led to seven themes that support our impression that, even though there is a consensus about the need for coordinated family-based services, there is a disconnection between state policies, contractual requirements and what is actually occurring at the implementation level. This study suggests that our knowledge of human systems may be in danger of being disqualified and lost, with damaging consequences for the care of children. Yet, as systemic thinkers and practitioners, it is our belief that ethical and effective treatment need not be at odds with care that is cost-efficient. The direction of our future research will be to study whether the involvement of all stakeholders at all levels of planning and training leads to systemic family-based practices that consistently save costs and provide high-quality care. 相似文献
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215.
The present study investigates the prevalence of adolescent eating disorders across gender, cultural groupings, and socioeconomic status. The Eating Attitudes Test, the Binge-Eating Questionnaire, and a demographic questionnaire were administered to students at two high schools. The results indicate a high rate of eating disorders in a nonclinical adolescent population. The rates for binge eating are comparable to those found in studies of college students--found at a younger age. With regard to SES, cross-cultural and gender findings, it is clear that eating disorders cross socioeconomic class and ethnic groups, and have a higher rate of occurrence in males than previously reported. Given such high rates of eating problems in a nonclinical population, the issue of prevention and early detection must be addressed. Additionally, more specific information on male eating disorders is needed. 相似文献
216.
T J McGuire 《Adolescence》1988,23(90):373-382
In response to sharply curtailed lengths of stay of adolescents in an inpatient psychiatric program, new therapeutic modalities need to be implemented. A time-limited dynamic approach to adolescent inpatient group psychotherapy is presented. The model integrates psychoanalytic and crisis theory into a group format. The primary focus in this model is upon resolution of problematic interpersonal interactions as they are related to the current crisis state. The group process, as related to the adolescent, involves three phases. These include an initial intake phase, which incorporates an ego-functioning assessment; a second or middle phase which focuses on making actions ego-alien; and the termination phase, which incorporates the learning experience and how it relates to the resolution of precipitators of the admission. 相似文献
217.
Perceived parental acceptance and female juvenile delinquency 总被引:1,自引:0,他引:1
S E Kroupa 《Adolescence》1988,23(89):171-185
The responses of 62 adolescent females residing at a state training school and 62 high school females on a measure of perceived parental acceptance were compared while statistically controlling for mental age, chronological age, socioeconomic status, social desirability, and family structure. Generally significant (p less than .05) results indicate that incarcerated females viewed their mothers and fathers more negatively than did nonincarcerated females. Slightly more ambivalent results were indicated in the mother-daughter relationship (delinquent girls reported mothers to be more rejecting/neglecting than did nondelinquents, but no significant differences were found between the groups on perceived mother acceptance) than in the father-daughter relationship. Results were discussed in terms of reported parental differences in acceptance-nonacceptance, providing limited support for Ausubel's satellization theory of child development, and the difficulty of inferring causality from retrospective self-report studies using "captive" subjects. 相似文献
218.
Four clinical examples of oedipal-based transference across gender lines are presented with the aim of illustrating (1) its existence, (2) the defenses against its emergence, and (3) the use of the analyst's gender as both an organizer of and resistance to certain transference manifestations. Factors that contribute to the availability for analysis of cross-gender transference are discussed, as are the resistances and other obstacles to its actualization. 相似文献
219.
J Schachter 《Journal of the American Psychoanalytic Association》1988,36(2):455-480
This paper's thesis is that concurrent individual-in-a-group and individual psychoanalytic psychotherapy can be conducted in conformance with psychoanalytic principles of treatment as well as can individual psychoanalytic psychotherapy alone. American psychoanalysts have shown little interest in group psychotherapy, probably because of earlier criticism that transference is diluted by the greater reality of the therapist in group psychotherapy. This is a misconception extrapolated from the mirror model of dyadic analytic technique. The criticism was formulated during a period when that model was prominent and there was little awareness that the actual personal relationship between patient and analyst played an important facilitating role in the dyadic analytic process, including providing a basis for investiture of transference. Also, the criticism was based on one-session-per-week group psychotherapy, whereas concurrent individual-in-a-group and individual psychoanalytic psychotherapy utilizes two group sessions plus one or two individual sessions per week, enabling a more intensive patient-therapist relationship. Concurrent group and individual psychoanalytic psychotherapy constitutes a contribution to the widening scope of application of psychoanalytic treatment. 相似文献
220.
Randy O. Frost Joan E. Morgenthau Catherine K. Riessman Margaret Whalen 《Behaviour research and therapy》1988,26(6):481-487
The study examined physical symptoms and health service utilization of subjects high or low on a measure of the tendency to experience stress somatically and high or low on a measure of current stress. High somatic responders reported greater numbers of symptoms than low somatic responders regardless of stress level. However, high somatic responders who were experiencing high levels of current stress reported significantly more symptoms than high somatic responders who were experiencing low levels of stress. These findings indicate that somatic response to stress reflects both a general tendency to focus on physical symptoms, and a specific tendency to focus more on physical symptoms when under stress. Analysis of health service records indicated that high somatic responders had more visits prompted by symptoms than low somatic responders, but did not differ in frequency of health service visits designed to maintain health. The findings further clarify the relationship between somatic response to stress, physical symptoms and health service use. 相似文献