The Loneliness of the Therapist in the Public Outpatient Clinic

The therapist's work in a public outpatient clinic is a unique combination as an individual and as a team member. Although the therapist may enjoy working within a team framework, sharing common goals and providing support and supervision, when he feels this environment failing to help or becoming critical, he may begin to experience loneliness. Individual psychotherapy occasionally evinces feelings of loneliness. The therapist has to contend with his patient's powerful feelings and try to contain them. We examined issues of loneliness, teamwork, and burnout during open meetings with the staff of three outpatient clinics. In addition, 50 questionnaires were sent to the therapists. Thirty-one were answered anonymously. Most of the therapists (80%) reported interest and enjoyment in their work with only 15% reporting tension and feelings of burnout. In the Pearson statistic correlation, there was a significant relationship between satisfaction at work and the lack of loneliness (p < 0.01). There was an inverse statistical correlation between satisfaction and burnout (p < 0.01) and a connection between staff meetings and not feeling lonely (p < 0.05). We found that the therapist in the outpatient clinic does not feel lonely. The staff meetings and consultations support him as a team member. A disparity was found between feelings felt at the open meetings and those in the questionnaires. Although the therapist is satisfied with his work, problems of overload and the danger of burnout are always present. It should be noted that clinic administrators should pay close attention to the entire picture.     

An Open Trial of Acceptance and Commitment Therapy With Exposure and Response Prevention in an Intensive Outpatient Setting for Adults With OCD

Intensive outpatient treatment settings for adults with obsessive-compulsive disorder (OCD) are common, but data on their effectiveness are limited. The effectiveness of IOP treatment for adults with OCD using combined acceptance and commitment therapy (ACT) and exposure and response prevention (ERP) was studied with eight adults. The intervention was 15 hours per week for 3 weeks. Measures were collected at pretreatment, 1-week, 2-weeks, posttreatment, and at 1-month follow-up. At the end of treatment, all participants were in the mild range of OCD symptom severity with a mean symptom decrease of 58%. Psychological inflexibility, depression, anxiety, and stress significantly decreased through treatment and participants ended treatment below clinical range for psychological inflexibility and nonclinical to mild range for depression, anxiety, and stress. The results of this study provide preliminary support for the effectiveness of ACT and ERP in an intensive outpatient setting for adults with OCD. The focus of this paper is on the clinical application of this treatment.     

Initial hospitalization and community tenure outcomes of intensive case management for children and youth with serious emotional disturbance

Since 1988 New York State's Children and Youth Intensive Camse Management (CYICM) program has enrolled more than 1,700 children. The program goal is to maintain children in the least restrictive environment approriate to their needs. This linkagke and advocacy focussed program uses a small caseload and flexible service money to meet its goal. We review the program model, describe the enrolled children, highlight some of the problems associated with determining program outcomes, and present the outcomes related to hospitalization and community tenure. Using two analytic techniques, CYICM was shown to be associated with fewer hospital admissions and fewer days in the hospital over a two-year period following the intervention of CYICM than prior to enrollment.     

关于儿童内包量概念发展的研究

自从Piaget等人提出对时概念的守恒性进行研究以来,对儿童比例概念形成的研究就成了儿童概念形成研究的一个热点,并积累了比较丰富的实验成果,提出了许多新的研究课题。近来,国外一些研究者又提出了对内包量概念进行研究。本文试就国内外关于内包量概念研究的主要取向、研究的一些新进展、内包量概念形成的实质等作一综合的介绍。     

Changes in behavioral problems and prosocial functioning in child treatment

Decreasing emotional and behavioral problems and increasing prosocial functioning are two ares of interest in child treatment. The present study examined the extent to which changes in deviant behavior were associated with changes in prosocial functioning. Three separate samples of children (N = 393, ages 6–13) referred to inpatient or outpatient services were evaluated by parents and teachers on three separate assessment occasions spanning 1–2 years. The major findings indicated that behavioral problems and prosocial functioning and changes in behavioral problems and prosocial functioning over time showed low to moderate negative correlations for parent and teacher evaluations. These relations were consistent across separate time periods, samples of children, and parent and teacher ratings. The magnitude of the correlations between behavioral problems and prosocial functioning indicated that these domains are related but represent relatively independent spheres of child functioning. The importance of assessing both domains of functioning in evaluating children and treatment outcome is discussed.     

The effects of a vitamin supplement on the pica of a child with severe mental retardation

The effects of a common multiple vitamin on the pica of a child with severe mental retardation and anemia were evaluated. A BAB design revealed that pica was decreased by the vitamin. The results suggest that pica can be effectively treated by implementation of a simple nutritional or biological intervention. Further research investigating the generality of this finding and the effects of combining biological and behavioral interventions are discussed.     

知情权与新生儿重症监护病房(NICU)患儿父母的信息交流技巧

在新生儿重症监护病房(neonatal intensive care unit,NICU)中接受治疗的危重新生儿约90%结果良好,而这些患儿的父母100%都在此过程中遭受不同程度的心理创伤.患儿父母及其家人应被充分告知患儿的病情、治疗方案及可能的预后,这是他们拥有的知情权.在临床工作中,怎样运用良好的信息交流技巧让患儿父母充分理解病情、配合治疗又不过分紧张这对患儿的康复比对患儿实施具体的诊疗方案更重要.从患儿父母、医护人员、人文关怀的角度探讨NICU医护人员与患儿父母之间信息交流的技巧.     

How to grow up or (nearly) die trying: developing trust in one’s own capacity for growth

This paper is a single case study describing intensive psychoanalytic psychotherapy with an adolescent girl, an apparently bright and capable girl who was struck down at 15 by a double blow of trauma and loss. She cracked along her fault lines which, it is argued, were created during the ordeal of her psychic birth in the first year of life. It is proposed that ordinary Oedipal humiliations precipitated anxiety about dependency. While any adolescent is likely to have to grapple with these difficulties, the terrible life events that befell this girl compounded her dependency just when she might have been moving towards independence. In addition, the ordinary task of mourning childhood and familiar family relationships was obscured by the new and devastating losses that needed to be mourned. Unable to face this task, she spurned the support of her loving family and any potential good object and instead became dependent on manic over-achievement and grievance. The paper traces how the intricacies of the patient’s internal world slowly unfurled through the transference and countertransference and through her story as she told it to her therapist. The therapist describes the slow and difficult process of making links between that story and their experiences together in the consulting room. The theoretical concepts that enabled these links to be made are outlined and the ways in which they guided the therapist’s technique are discussed.     

Patterns of Response and Remission Following a One-Session Treatment for Blood-Injection-Injury Phobia in Youth

Blood-Injection-Injury (BII) Phobia is a severe and impairing disorder that has been understudied in youth. The present study aimed to define patterns of response and remission following a modified One-Session Treatment (OST) including an e-therapy maintenance program for children and adolescents with BII Phobia. Moreover, characteristics of different responder groups were examined in order to determine correlates of a poorer response. Youth (n?=?20; 8–18 years) were categorized into four responder groups (e.g., immediate remitter, delayed remitter, partial responder, and nonresponder) based upon defined criteria for remission. Immediate remitters to treatment were more likely to have a primary diagnosis of injection phobia, rather than a combined blood and injection phobia. Nonresponders reported significantly greater disgust sensitivity at pretreatment and were more likely to have a comorbid diagnosis of Social Phobia. In regards to within session change, youth who achieved the exposure goal of having a blood test during treatment had a significantly stronger treatment response. These preliminary findings may assist clinicians in the planning and delivering of intensive Cognitive Behavioral Treatment (CBT) approaches for BII Phobia in youth.