Integrating individual and family treatment for outpatients vulnerable to psychosis

Article Abstract:

Traditionally, outpatient psychiatric patients who are subject to psychotic episodes are treated with individual therapy in conjunction with psychotropic drugs. However, when living with parents or a spouse, such patients may require a form of treatment involving his or her family members as well. A set of principles and techniques for the management of potentially psychotic patients who live with family members is presented. The family members, first of all, may be able to provide the therapist with information about the patient that the patient cannot or does not provide. The therapist should deal with the patient in terms of his present state of mental health, and show respect for his autonomy; this will help to prevent the perception that the therapist is allied with the family. The family should participate in the therapeutic process on a regular basis, which at first will involve interviews concerning the background of the patient and acquainting the family members with the therapeutic situation; later, the family should be invited to deal with specific problems, both with and without the patient present. In case of crises, the therapist should be available to the family on short notice. The therapist must remember that the focus for the patient is still on individual therapy, which should be continued. Meanwhile, the relatives should be encouraged to communicate their feelings and complaints to the therapist, usually in the presence of the patient, so that the entire group will learn to solve their problems together. It is suggested that the therapist and patient prepare for the eventuality of a relapse by providing a protocol for communication with family members in case of a recurrence; this will reduce concerns about violations of confidentiality, while providing a mechanism for protecting the patient from harm. Finally, the therapist should work with the family closely to help them deal with the consequences of any major changes in the patient. It is concluded that this model addresses the needs of both the patient and family, and provides a framework for responding to the various demands placed upon patients and their families by major mental illness. (Consumer Summary produced by Reliance Medical Information, Inc.)

Mentally ill persons, Telecommunications systems, Mentally ill, Family, Therapist-patient relations, Schizophrenics, Home care, Psychotherapist and patient

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Drug therapy in mental retardation: 'artificial hibernation' evolved

Article Abstract:

''Psychopharmacology of the Developmental Disabilities,'' (1988) edited by Michael G. Aman and Nirbhay N. Singh, provides an overview of the past 35 years of research on the curative effects of psychotropic drugs among mentally retarded patients with destructive behavior problems. Overall, the research findings have proved to be extremely disappointing. Drug therapy remains the prevalent form of treatment for problem behavior, but has become progressively difficult to justify empirically. This book integrates contributions of researchers in developmental disabilities and psychopharmacology, and includes a comprehensive summary of the clinical research literature on the behavioral effects of various drugs. Issues such as the prevalence of drug therapy, drug blood-levels and behavioral response, antipsychotic and anti-epileptic medications, vitamin therapy, and pharmacological side effects are also discussed. The limited benefits of drug therapy on developmental disabilities are related to the reliance on the medical model in clinical psychopharmacology. For example, a retarded person who becomes violent is often assumed to have an illness which can be treated neurochemically. However, research does not justify this model and instead indicates that in most instances disturbed behavior is motivated by the intention to create a desired change (the same intention which motivates adaptive behavior). The point is made that drug effects will remain unpredictable until we have a thorough understanding of all the environmental variables which influence and regulate behavior. In general, this book does an excellent job of summarizing many aspects of the field, and provides tactical ideas for treatment approaches and future research. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Drug therapy, Behavior disorders in children, Childhood mental disorders, Mental retardation, Psychopharmacology

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'Thinking gender' in therapy

Article Abstract:

''The Invisible Web: Gender Patterns in Family Relationships,'' by Marianne Walters, Betty Carter, Peggy Papp and Olga Silverstein (1988), presents a feminist view of family relationships and dynamics. Feminism is defined as a 'framework ... concerned with the roles, rules and functions that organize female-male relations,' and 'seeks to include the experience of women in all formulations of human experience, and to eliminate the dominance of male assumptions.' Guidelines to assist therapists who wish to work towards a feminist approach in family therapy are offered, including: the identification of gender issues that condition behavior and sex roles; limitations in female access to social and economic resources; sexist thinking; the social forces that have forced women to assume the primary responsibility for family relations; problems related to child rearing; and the positive values and behaviors of women. The point is made that no therapeutic intervention can be gender-free. Sections of the book are devoted to particular family relationships (such as mothers and daughters, fathers and daughters, mothers and sons, single mothers, etc.). While Carter focuses on how women tend to over-idealize their fathers and devalue their mothers and themselves, Papp writes about the difficulties a mother in a sexist society has in bestowing a feeling of self-confidence in a daughter when she, herself, has lived her life in a subservient position to her husband. The book is also sensitive to the emotional development of males in therapy. Since it does not present an anti-male feminist approach, it provides a revolutionary work in family therapy with a 'kinder, gentler' feministic view of how gender-roles affect family system dynamics. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Feminist therapy, Feminism

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