Day treatment of patients with personality disorders: experiences from a Norwegian treatment research network

This study sought to investigate the following research questions: Are time-limited day treatment programs for patients with personality disorder (PD) effective outside resourceful university settings, and what are the overall treatment results when the program is implemented on a larger scale? Do all categories and subtypes of PDs respond favorably to such treatment? How intensive should such day treatment programs be? All patients (n = 1,244) were consecutively admitted to eight different treatment programs in the Norwegian Network of Psychotherapeutic Day Hospitals from 1993 to 2000. Altogether, 1,010 patients were diagnosed with PD. Avoidant, borderline, not otherwise specified (NOS), and paranoid PD were the most common conditions. SCID-II and MINI were used as diagnostic instruments. Outcome measures included GAF Global Assessment of Functioning, (GAF; American Psychiatric Association, 1994), SCL-90R, CIP, Quality of Life, work functioning and parasuicidal behavior, measured at admittance, discharge and 1-year follow up. The attrition rate was 24%. The number of dropouts did not improve over time. As a group, completers with PD improved significantly on all outcome variables from admittance to discharge and improvement was maintained or increased at follow up. Treatment results were best for borderline PD, cluster C patients, PD NOS and No PD, and poorer for cluster A patients. Units with a high treatment dosage did not experience better outcomes than those with a low treatment dosage (10 hours per week). Results from the University unit were not better than those from units at local hospitals or mental health centers.     

Justice and Game Advantage in Sporting Games

This paper is a case study of what Jon Elster calls "local justice"; particular schemes of justice which, on a relatively autonomous basis, are designed and implemented by institutions and practices to meet particular preferences and goals. The paper suggests an interpretation of the role of justice in sporting games. First, a framework for examinations of schemes of local justice is suggested. Second, norms are suggested that express the requirements that have to be met in order to consider a sporting game as just. The discussion shows that sports are characterized by a particular blend of meritocratic justice in which goods and burdens are distributed according to performance, and a non-meritocratic distribution through which goods and burdens arise as matters of chance. The essay concludes by arguing that the optimal blend of meritocratic justice and chance results in the realization of not merely fair sporting games, but of exciting and good games as well.     

Psychoanalyse und Verbrechen

Foulkes’ paper on “Psycho-Analysis and Crime” was first published in 1943. Today, only parts of this paper are published in the Selected Papers (1990). Foulkes’ paper is part of the tradition of psychoanalytic work and psychoanalytically inspired social research in delinquent behaviour. The paper is of special interest for the development of Foulkes’ works as it seems to mark the transition from a Freudian psychoanalyst to the founder of Group Analysis.     

Impacts of Home-Based Telework on Quality of Life for Employees and Their Partners. Quantitative and Qualitative Results From a European Survey

The study investigates the effects of home-based telework on quality of life (QoL). Four dimensions of QoL were analysed; overall satisfaction with life, sense of belonging, sense of becoming and sense of being. Through cross-national survey data (from 217 job holders and 112 partners) and by means of structural equation modeling, a positive association was found between home-based telework to a worker's sense of belonging (beta = 0.30, p < 0.001). On the other hand, a negative path was detected from the job holder's home-based telework to his or her partner's overall satisfaction with life (beta = –0.27, p < 0.05). After controlling for subdimensions of life quality, home-based work did not affect the job holder's overall life satisfaction. Moreover, the more concentration the job holder reported, the lower the sense of belonging was reported by his or her partner (beta = –0.28, p < 0.05). No simple explanation for the negative effects were found, but our interviews with the group of workers and their families leave us the impression that the problem of overworking and withdrawal was most relevant to the cases, in combination with negative spill-over effects and unclear boundary settings in the home.     

The design of the MBT‐G adherence and quality scale

Few group psychotherapy studies focus on therapists' interventions, and instruments that can measure group psychotherapy treatment fidelity are scarce. The aim of the present study was to evaluate the reliability of the Mentalization‐based Group Therapy Adherence and Quality Scale (MBT‐G‐AQS), which is a 19‐item scale developed to measure adherence and quality in mentalization‐based group therapy (MBT‐G). Eight MBT groups and eight psychodynamic groups (a total of 16 videotaped therapy sessions) were rated independently by five raters. All groups were long‐term, outpatient psychotherapy groups with 1.5 hours weekly sessions. Data were analysed by a Generalizability Study (G‐study and D‐study). The generalizability models included analyses of reliability for different numbers of raters. The global (overall) ratings for adherence and quality showed high to excellent reliability for all numbers of raters (the reliability by use of five raters was 0.97 for adherence and 0.96 for quality). The mean reliability for all 19 items for a single rater was 0.57 (item range 0.26–0.86) for adherence, and 0.62 (item range 0.26–0.83) for quality. The reliability for two raters obtained mean absolute G‐coefficients on 0.71 (item range 0.41–0.92 for the different items) for adherence and 0.76 (item range 0.42–0.91) for quality. With all five raters the mean absolute G‐coefficient for adherence was 0.86 (item range 0.63–0.97) and 0.88 for quality (item range 0.64–0.96). The study demonstrates high reliability of ratings of MBT‐G‐AQS. In models differentiating between different numbers of raters, reliability was particularly high when including several raters, but was also acceptable for two raters. For practical purposes, the MBT‐G‐AQS can be used for training, supervision and psychotherapy research.     

Videoconference to supervise early intensive behavioral intervention: A preliminary evaluation of acceptability

At present, early intensive behavioral intervention (EIBI) for children with autism spectrum disorders is the intervention that has the strongest empirical support. EIBI requires frequent supervision by qualified professionals. Norway, like many other countries, has a shortage of qualified supervisors, particularly in rural regions. This study used a reversal design to investigate how supervisors and supervisees perceive the quality of EIBI supervision and the local team's preparedness when supervision was provided either on-site or via videoconference. Calculations were made on how much time could be saved on travel when part of the supervision was provided via videoconference. There were no significant differences in the supervisors' and supervisees' ratings of on-site and videoconference supervision. Moreover, the supervisors found the local EIBI teams to be better prepared when supervision was provided via videoconference, and the videoconference supervision meetings were shorter. The study discusses the implications of these findings for the accessibility of EIBI and case capacity and proposes some areas for further research.     

Dreams as portraits of self and group interaction

Dreams presented in group psychotherapy portray different aspects of the dialectic between the group and the individual. A self psychology perspective emphasizes the interplay between the current self-state of the group-as-a-whole and the selfobject needs of the individual. With this focus in mind, the therapist should help the group to deepen its awareness and capacity to reflect on emerging new abilities ("forward edge") which dream imagery conveys and the needed human responsiveness that can actualize these abilities and thus help the individual and the group to break and transform chains of repetition compulsion. We illustrate this approach with two clinical examples.