A test of behavioral family therapy to augment exposure for combat-related posttraumatic stress disorder.

This study tested a family-based skills-building intervention in veterans with chronic combat-related posttraumatic stress disorder (PTSD). Veterans and a family member were randomly assigned to 1 of 3 conditions: (a) waiting list, (b) 18 sessions of twice-weekly exposure therapy, or (c) 18 sessions of twice-weekly exposure therapy followed by 16 sessions of behavioral family therapy (BFT). Participation in exposure therapy reduced PTSD positive symptoms (e.g., reexperiencing and hyperarousal) but not PTSD negative symptoms. Positive symptom gains were maintained at 6-month follow-up. However, participation in BFT had no additional impact on PTSD symptoms.

Behavioral family therapy for Vietnam combat veterans with posttraumatic stress disorder.

Severe interpersonal problems are common in veterans with combat-related posttraumatic stress disorder (PTSD) and their families. The authors first detail the rationale and use of behaviorally based family therapy to help reduce avoidance and withdrawal symptoms of PTSD and improve the active coping capacities of both veterans and their loved ones, then present a case example of the model, and finally discuss the clinical application of behavioral family therapy to the unique concerns of veterans with combat-related PTSD.

Ostensible agency: another malpractice hazard.

Under the tort doctrine of ostensible (apparent) agency, a psychiatrist was named as a codefendant in a psychiatric malpractice suit against a nonmedical psychotherapist employed in his medical group, who had treated the plaintiff in her private practice in the same offices. The psychiatrist was later dismissed as a defendant, but to avoid being sued in such a case, a psychiatrist contemplating an association with another professional should 1) check the professional's record with the appropriate licensing agency, 2) require proof of licensure and malpractice insurance, 3) require that the professional's private patients sign disclosure statements, and 4) assure that names on written materials are kept separate.

The future of chiropractic: a psychosocial view.

As the total health-care delivery system in the United States has come under increasing public scrutiny, the role of chiropractic has become of interest. An overview of chiropractic, with an analysis of its social functions and a projection of its future indicates that chiropractic is more congruent with the values of its lower-middle-class clientele than is orthodox medicine. Chiropractors function adquately to legitimize their patients' entrance into the "sick role" and to provide an alternative channel to therapy. The marginal role of the chiropractor in the health-care system, as compared to that of the physician, is stable and functional for the chiropractors thenselves, as well as for their patients. Chiropractic likewise serves the physician, both as a boundary-defining mechanism and as a means of disengagement from troublesome patients. For these reasons, we believe that the role of chiropractic within the health-care system will remain stable in the future.