Connecting the disconnected: Preliminary results and lessons learned from a telepsychology initiative with special management inmates.

The use of telepsychology, such as videoconferencing (VC) systems, has been rapidly increasing as a tool for the provision of mental health services to underserved clients in difficult to access settings. Inmates detained in restrictive housing appear to be at an increased risk of experiencing emotional and behavioral disturbances compared to their general population counterparts, yet they are less likely to receive appropriate treatment due to security constraints. The primary purpose of this article is to describe the process of implementing a novel telepsychology intervention specifically designed to offer group therapy to high-security, administratively segregated inmates. In addition, preliminary results on treatment and therapeutic process outcomes in a sample of 49 participants are reported. Although some evidence indicated that telepsychology was less preferred than in-person sessions, group differences on measures of psychological functioning and criminal thinking were not found across 3 conditions (telepsychology, in-person, and a no-treatment control). Furthermore, a number of limitations associated with program implementation and study design suggest that results be interpreted with caution and should not be used to discount the use of telepsychology as a viable treatment delivery option. Recommendations for future development and evaluation of telepsychological programs are discussed within the context of correctional settings and beyond. (PsycINFO Database Record

[Health and justice coordination in prisons]. / Articulation santé et justice en milieu carcéral.

The question of health-justice coordination has been present since the law of 18th January 1994. Since then, professional relations between prison staff and health carers have been regularly questioned in terms of their aims. The texts structuring this interinstitutional health-justice coordination constitutes a framework which the various professionals must appropriate and implement by drawing on specific knowledge and skills. It is an invitation to work together around the same population, on their respective and different missions. The implementation of a structured therapeutic group with sex offenders constitutes a positive experience.

Group Psychotherapy in the United Kingdom.

In the United Kingdom (U.K.), group therapy is one of the most widely practiced methods, with a broad range of applications and an extensive literature. The terminology used here is based on the author's chapter in The New Oxford Textbook of Psychiatry (Schlapobersky & Pines, 2008). We used two factors-therapeutic goals and group leadership-to provide a classification of different models and applications. We described group therapy as a method, group analysis (for example) as a model, and an in-patient or weekly group as an application of a model.

A randomized clinical trial of family therapy in juvenile drug court.

The objective of this article is to examine the effectiveness of 2 theoretically different treatments delivered in juvenile drug court--family therapy represented by multidimensional family therapy (MDFT) and group-based treatment represented by adolescent group therapy (AGT)--on offending and substance use. Intent-to-treat sample included 112 youth enrolled in juvenile drug court (primarily male [88%], and Hispanic [59%] or African American [35%]), average age 16.1 years, randomly assigned to either family therapy (n = 55) or group therapy (n = 57). Participants were assessed at baseline and 6, 12, 18 and 24 months following baseline. During the drug court phase, youth in both treatments showed significant reduction in delinquency (average d = .51), externalizing symptoms (average d = 2.32), rearrests (average d = 1.22), and substance use (average d = 4.42). During the 24-month follow-up, family therapy evidenced greater maintenance of treatment gains than group-based treatment for externalizing symptoms (d = 0.39), commission of serious crimes (d = .38), and felony arrests (d = .96). There was no significant difference between the treatments with respect to substance use or misdemeanor arrests. The results suggest that family therapy enhances juvenile drug court outcomes beyond what can be achieved with a nonfamily based treatment, especially with respect to what is arguably the primary objective of juvenile drug courts: reducing criminal behavior and rearrests. More research is needed on the effectiveness of juvenile drug courts generally and on whether treatment type and family involvement influence outcomes. TRIAL REGISTRY NAME: Clinical Trials.gov, Identified NCT01668303.

Sex offender treatment: consumer satisfaction and engagement in therapy.

Convicted sex offenders attending an outpatient treatment program in Connecticut were surveyed about their experiences in therapy, their perceived importance of treatment content, their satisfaction with the help they receive, and their engagement in therapeutic services. There were strong correlations between perceived importance of content items and satisfaction with services. A robust correlation was also found between engagement and satisfaction. Clients rated accountability and victim empathy as the most important components of treatment. Other popular content areas were thinking errors, relapse prevention concepts, uncovering motivations to offend, and controlling deviant arousal. Most sex offenders valued the peer support and confrontation offered by group therapy. Though reduced recidivism is clearly the crucial measure of treatment success, clients who are engaged in the treatment process and develop healthy interpersonal skills by participating in therapy may be less likely to engage in abusive behavior. Implications for practitioners are discussed.

Examining the impact of mixing child molesters and rapists in group-based cognitive-behavioral treatment for sexual offenders.

This study examines the relationship between recidivism rates, therapeutic climate, and composition of offenders in group-based cognitive-behavioral treatment (CBT) for sexual offenders. The Group Environment Scale (GES) is employed to measure social climate. The GES is administered to 73 male sexual offenders in groups of those who only victimized adults or children (five groups) or men who both victimized adults and those who victimized children (five groups). Group environment is not found to differ significantly as a function of group composition. Group member's ratings on the GES are in the medium to high range, indicating a generally positive group environment. Although the group environment overall does not differ between groups, groups do differ significantly in terms of expressiveness. There are no differences in recidivism rates between groups as a function of group composition. The results are discussed in the light of mixing child molesters and rapists in group-based CBT.

Predicting restorability of incompetent criminal defendants.

U.S. courts frequently require forensic examiners to offer opinions concerning the likelihood that criminal defendants found incompetent to stand trial can have their competence "restored" through treatment. Yet no jurisdiction has established legal guidelines for testimony concerning restorability, and several authors have suggested that mental health professionals cannot accurately predict whether treatment to restore competence will succeed. This study asked whether reliable information that is consistently available at the time of examination might support empirically grounded opinions about the likelihood of restoration. Using records from all 351 inpatient pretrial defendants who underwent competence restoration at a state psychiatric hospital from 1995 through 1999, I evaluated whether several types of information that are reliable and that could consistently be made available to forensic examiners--including evaluees' demographic characteristics, diagnoses, symptom patterns, criminal charges, number of prior public sector hospitalizations, and cumulative prior length of stay (LOS)--would predict outcome of restoration efforts. I modeled the probability of successful restoration using logistic regression equations, and evaluated the equations' predictive accuracy using k-fold cross-validation and receiver operating characteristic (ROC) analysis. Lower probability of restoration was associated with having a misdemeanor charge, longer cumulative LOS, older age, and diagnoses of mental retardation, schizophrenia, and schizoaffective disorder. Although the overall rate of successful restoration for felony defendants was 75 percent, logistic equations allowed selection of subgroups with high predicted probabilities of restoration (>90%) and low probabilities of restoration (<35%). In cross-validation simulations, predictive equations had ROC areas of 0.727 for all defendants, and 0.735 for felony defendants. These findings provide scientific support for testimony that two types of incompetent evaluees have well-below-average probabilities of being restored: chronically psychotic defendants with histories of lengthy inpatient hospitalizations and defendants whose incompetence stems from irremediable cognitive disorders (such as mental retardation). Nonetheless, courts may still deem low probabilities of success to be "substantial" enough to warrant attempts at restoration.

Survivors of sexual abuse allege therapist negligence.

In two recent litigation cases, adult survivors of sexual abuse claimed that their current symptomology was linked to the failure of mental health professionals to provide appropriate treatment. If mental health practitioners are to be held accountable for providing acceptable standards of treatment, these standards must be based on empirical evidence of the efficacy of treatment methodologies. This article provides a review of the professional literature and determines that with the exception of time-limited group treatment, which appears to reduce symptoms in some survivors of sexual abuse, there is an absence of clear evidence of treatment efficacy. Other data point to low consumer satisfaction with treatment, the absence of evidence for a consistent symptom presentation in survivors of sexual abuse that confounds standardizing treatment approaches, and iatrogenic effects of some forms of treatment. The authors conclude that, at this time, there is little empirical data to support the development of standards of practice for treating women who have been sexually abused as children.

Confidentiality dilemmas in group psychotherapy with substance-dependent physicians.

OBJECTIVE: The purposes of this article are 1) to review federal and state laws relevant to confidentiality in group therapy with impaired physicians and 2) to provide empirical data concerning the actual confidentiality practices and experiences of group therapists treating chemically impaired physicians. METHOD: In the clinical research phase, 25 state medical societies identified 45 rehabilitation centers as those to which the societies preferentially referred chemically impaired physicians. Fifty-one group leaders from 33 of these rehabilitation centers completed the survey questionnaire employed in this project. RESULTS: Because of the risk of potentially irreversible social and professional injury, physician patients were exceedingly concerned about breaches of confidentiality. Co-members' infractions most often involved the violator sharing with close friends and family members the name and abuse history of a fellow physician. In contrast, transgressors rarely leaked information about a co-member's drug-related illegal behaviour. CONCLUSIONS: Chemically impaired physicians would feel safer in sharing secrets in group therapy if more jurisdictions adopted legislation making co-members liable for violating confidentiality. Currently the pertinent body of law is confusing and inconsistent and provides little protection to impaired physicians who enter group therapy. The authors propose ideas for model legislation.

Confidentiality in group psychotherapy: empirical findings and the law.

Empirical research suggests that group therapists generally discuss with prospective clients the importance of maintaining confidentiality, but are unlikely to inform them of the significant potential for violations of confidentiality. Therapists believe information about the risk of unauthorized disclosures will reduce the number of patients willing to enter group therapy and will inhibit the therapeutic dialogue. Therapists' failure to provide information sufficient to obtain informed consent, however, produces serious ethical problems and potential legal problems as well. The law of informed consent varies in different jurisdictions such that identical factual scenarios could produce different legal outcomes depending on the jurisdiction in which the case occurs. In spite of the proliferation of group interventions, empirical studies of confidentiality in group therapy have lagged behind similar research in individual psychotherapy.

[Alcohol impaired drivers after completion of a long-term model IVT-Hö rehabilitation]. / Alkoholauffällige Kraftfahrer nach Abschluss einer Langzeitrehabilitation Modell IVT-Hö.

The "Individualpsychologische Verkehrstherapie (IVT-Hö)" is a psychotherapeutic long-term rehabilitation for alcohol impaired drivers. The therapy is mainly for the benefit of people for whom re-training (BASt model) is unsuitable because of their extreme alcohol problems. 3 years after having completed the treatment and after having been re-granted their driving licences, 3.6% of the drivers had a relapse.

Effects of professional affiliation on group therapists' confidentiality attitudes and behaviors.

This study examines the influence of group therapists' professional characteristics on their attitudes and practices regarding confidentiality. Eighty-three highly experienced and well-trained group therapy providers representing the fields of psychiatry, psychology, and social work completed a survey questionnaire inquiring into their confidentiality practices. Although there is considerable consensus between medical and nonmedical practitioners on the issues addressed, there are also interesting differences and trends. Implications of the findings for clinical practice, ethics training, and confidentiality legislation are addressed.