Profiles of youth in therapeutic group care: Associations with involuntary psychiatric examinations and readmissions.

The study aims were to identify distinct subgroups among youth placed in therapeutic group care (TGC) and to examine the effect of specific constellations of risk factors on readmission to residential mental health care and involuntary psychiatric examination among youth in TGC. Several administrative databases were merged to examine outcomes for youth placed in TGC during fiscal year FY04-05 through FY07-08 (N = 1,009). Latent class analysis (LCA) was conducted. Two classes were identified: youth with multiple needs (Class 1) and lower risk youth (Class 2). Class 1 represented 45% of youth in TGC. Compared with Class 2, these youth had a greater probability of having physical health problems, parents with substance abuse problems, and more extensive histories of maltreatment. Compared with Class 2, youth with multiple needs were almost twice more likely to exhibit self-injurious behavior leading to involuntary mental health examinations, but they were less likely to be readmitted to a residential mental health care of higher level of restrictiveness, such as state inpatient psychiatric programs (SIPPs). Youth placed in Florida TGC represent a heterogeneous population and services tailored to these youth's needs are important. Youth with multiple risk factors would benefit from interventions that would address multiple areas of risk. Lower risk youth (Class 2) would benefit from interventions that would focus on promoting mental health, especially among those who have experienced threatened harm, and providing services and supports necessary for stabilizing these youth in the community. (PsycINFO Database Record

Associations among self-concept, verbal behaviors, and group climate early in the group counseling process.

In this study, relations among group members' self-concept, verbal behaviors, and group climate early in the group counseling process were assessed for college students who were randomly assigned to four counseling groups. Based on measures from the hill interaction matrix, it was observed that family, social, and action self-concepts, as well as engagement, avoidance, and conflict group climate, were correlated with several verbal behaviors. Silence and quadrant 4 (Q4), which consists of speculative and confrontative verbal behaviors at personal and relationship levels, significantly predicted and explained 43% of the variance in engagement group climate. Silence and Q3, comprised of conventional and assertive verbal behaviors at personal and relationship levels, and Q1, conventional and assertive verbal behaviors at topic and group levels, explained 66% of variance in avoidance climate. Q4 and Silence explained 33% of conflict climate variance early in the group sessions. Implications for research and counseling practice are suggested.

[Do the New German OPS codes map the relevant therapeutic activities in psychiatric clinics?]. / Abbildung des psychiatrisch-psychotherapeutischen Leistungsspektrums durch die aktuellen OPS-Komplexcodes.

OBJECTIVE: Actual codes for operations and procedures (OPS) in psychiatry and psychosomatics should map cost separating therapeutic activities so far defined in Germany by the normative specifications of the psychiatry staff enactment (PsychPV). OPS codes should also allow re-estimating underlying therapy times. METHOD: Therapeutic activities of the PsychPV fulfilling the minimal criteria of the OPS definition were classified as multiples of a therapeutic 25 minute unit. RESULTS: Therapeutic activities of the PsychPV are mapped to OPS complex codes in a variable degree (psychiatrists 35 %, psychologists 42 %, nurses 43 %, special therapists 59 %). CONCLUSION: Actual OPS codes are inappropriate for identifying relevant cost-separating factors in the therapy of psychiatric in-patients. They cannot assure in their actual form the standards given by the PsychPV and need substantial revision.

Una experiencia de psicoterapia analítica de grupo en niños / Psychoanalytic psychotherapy with children

En la primera parte de este trabajo se hace una breve revisión acerca de la técnica de psicoterapia analítica de grupo en niños y se reseña el marco conceptual desde el cual se está trabajando. En la segunda parte se transcriben sesiones de un proceso analítico grupal con niños. Finalmente, se discuten algunas reflexiones con relación a la experiencia descrita.

Un modelo de grupos psicoeducativos para la prevención de las recaídas en esquizofrenia / A Psychoeducational group model for the prevention of relapse in schizophrenia

La alta prevalencia de la esquizofrenia a lo largo de todo el mundo provoca grandes gastos en los servicios de salud que soportan los costes derivados de esta enfermedad. Varios estudios avalan la hipótesis de que el cumplimiento de la medicación y la aplicación de programas preventivos que favorezcan el uso correcto de estos fármacos reducen el número de recaídas y en consecuencia su elevado gasto. En este artículo exponemos las líneas básicas de los grupos psicoeducativos para pacientes esquizofrénicos, que desde hace años venimos aplicando. No sólo se incide en el manejo correcto de la medicación, también se ayuda al paciente a afrontar sus síntomas, se discuten conductas y conflictos y se favorecen las interacciones sociofamiliares fuera y dentro del grupo. Todo ello repercute en la mejora del pronóstico de su enfermedad (AU)

Análisis comparativo de los factores terapéuticos grupales en la esquizofrenia. Parte II. Resultados y discusión / Comparative analysis of group therapeutic Factoes in schizophrenia. Part II. Results and discussion

Los resultados obtenidos muestran que la mayoría de Factores Terapéuticos Grupales (FTG) son valorados por los tres grupos de forma similar (La Cohesión Grupal y El Aprendizaje interpersonal (AIP) "Output" han sido los más valorados por los pacientes), mientras que otros parecen tener alguna especificidad respecto al pronóstico del paciente o el contexto donde se realizan los grupos. Encontramos algunos predictores "débiles" de dos FTG: La Identificación y el Insight.Tanto la Cohesión Grupal como los aspectos más conductuales del Aprendizaje Interpersonal son Factores Terapéuticos que trascienden las diferencias de contexto, duración de la terapia, gravedad clínica ... etc. La Identificación, como expresión de un mecanismo primario de defensa es comparativamente, mucho más valorada por los pacientes en crisis . La Instalación de Esperanza es un Factor muy importante para los dos grupos de mal pronóstico, probablemente con connotaciones diferentes en cada uno de ellos. Y finalmente, en los enfermos más estables, con mejor pronóstico clínico y en tratamiento ambulatorio la Comprensión de Sí mismo es tan importante como para los grupos de pacientes no esquizofrénicos (AU)

Rehabilitation needs psychotherapy.

The rehabilitation patient by his permanent disablement comes into an important crisis which makes psychotherapy as reasonable and necessary as other human crisis situations do. Especially the more senior patient must be regarded within this rank. There is a broad rank of known psychotherapeutic methods which however we propose to classify in six groups with the following main factors: Verbal communication Sociodynamics Representational means The hypnoid Behaviouristic means Physical means as entrance to psychotherapy We recommend 'renaissance of conversation culture' and give further hints on conversion therapy. The hypnoid can by no means only act in functional disturbances, however, its action is directly somatotropic. We could show this in paralysed patients. Conversation with the uncurably ill needs special emphasis schooling, and mainly taking the caregivers into the conversation (systemic approach). We have with good success used a combination model, combining autogenic training with analytically orientated group psychotherapy.

The advanced-stage therapy group.

Many authors describe a stage of maturity in the development of groups, but each highlights a different dimension. This article describes the characteristics of the advanced stage and the main axes along which it develops (internalization and containment, symbolization, self and self-other development, differentiation and individuation). It also offers a conceptual explanation for these developments and attempts to identify the conditions necessary for the emergence of this stage of maturity. An understanding of this stage and the conditions required for its development can be used by the group leader as a compass to help him or her navigate the group toward this objective.

Group psychological therapy for cancer patients: a point of view, and discussion of the hierarchy of options.

OBJECTIVE: We present here a point of view about the logical role of group psychological therapies in the care of cancer patients, and propose a comprehensive, four-stage program that could be implemented at any large cancer treatment center. METHOD: Our proposals rest on a review of the literature, and on our own experience with various kinds of psychological help for cancer patients, some of which is described. RESULTS: It is clear that group psychological therapies improve the quality of life of many participating cancer patients, and there is preliminary evidence that it may prolong life in some cases. We describe five main kinds of adjuvant psychological therapy, arranging them on a hierarchy of increasingly active participation by the recipient, and noting the status of evidence for their efficacy. They are: providing information, emotional support, behavioral training in coping skills, psychotherapy (of various kinds), and more speculatively, spiritual/existential therapy. CONCLUSIONS: We propose that it is time to consider psychological therapy as an adjuvant in cancer management, analogous to adjuvant chemotherapy. The main indication for advocating group psychological therapy to patients should, we argue, be an expert assessment that the patient is likely to benefit, and should not (as is usual at present) be restricted to either 1) those patients with overt psychopathology, or 2) those few who specifically request it.

Innovative uses of psychodynamic group psychotherapy.

Psychodynamic group psychotherapy is gaining renewed attention as an effective form of treatment, due in part to increasing economic constraints that make other forms of treatment less accessible. The author highlights some innovative applications of both extended and time-limited groups. She also describes specific issues that can be addressed effectively in homogeneous time-limited group therapy.

The role of evaluation in clinical practice: overview and group treatment illustration.

A variety of intrinsic and extrinsic factors exert pressure on clinicians and researchers to forge a more effective alliance in their mutual efforts to understand treatment process and outcome. The authors provide a general framework and a specific group-therapy model to demonstrate how research measures can facilitate this integration and thereby improve the quality of service delivery. We divide treatment into four phases: negotiation, retention, enhancement, and evaluation, and illustrate how psychotherapists can use research instruments to overcome problems at each stage of intervention.

Aproximaciones téoricas a la familia del farmacodependiente / Theorical approaches to the family of the drugdependant

El documento aborda, partiendo de la bibliografía basada en S. Freud el "¿Por qué de la psicoterapia familiar?", reflexionando acerca de lo que son la psicoterapia y la familia; y sobre todo en el ¿por qué de la psicoterapia familiar donde se detectan casos de farmacodependencia?. Reflexionando también que la demanda de atención no parte del farmacodependiente; generalmente aunque, aclaro, no siempre, viene de uno de los miembros de la familia y por lo general de la madre o de la que hace las veces de madre; de igual modo cabe la reflexión a lo que respecta del grupo familiar ¿qué significa que uno de ellos sea farmacodependiente?; y la reacción de los padres al darse cuenta que el tratamiento no es una cura milagrosa

La psicoterapia familiar en el tratamiento de la farmacodependencia / Family psycotherapy in the treatment of drugdependency

El autor anota: "La psicoterapia familiar es una técnica terapéutica, cada día más utilizada como respuesta a diversos problemas psicosociales. En lo que se refiere al tratamiento de enfermos farmacodependientes, durante los últimos años se ha evidenciado un creciente interés en el papel de la familia en la génesis y mantenimiento del problema del uso y abuso de drogas, así como en el tratamiento del mismo. Por ejemplo, en ciertos programas para el abatimiento del uso y abuso del alcohol se han empleado, con resultados efectivos, estrategias que incluyen la orientación y/o el tratamiento del núcleo familiar del enfermo alcoholico. Sin embargo, aun cuando en el tratamiento del alcoholismo se ha manejado desde hace algún tiempo la psicoterapia familiar, la intervención de la familia en el tratamiento del enfermo farmacodependiente es relativamente nueva, debido, probablemente, a que el problema del uso y abuso de drogas a nivel social puede considerarse, también, como relativamente nuevo" más adelante anota: "La terapia familiar puede ser una ayuda importante en el tratamiento de algunos tipos de desórdenes que se presentan en la adolescencia, siempre y cuando no se le considere como una terapia total. Los problemas de trastornos en la formación de la identidad; conflictos con los padres; cambios relacionados con las normas morales; y las dificultades para el `acting out', son algunos de los que pueden ser tratados con éxito mediante la terapia familiar; asimismo, ésta resulta útil en conflictos que tienen que ver con la imagen del `self' y la imagen de la familia y puede modelar al adolescente, permitiendole que cambie y crezca a su propio ritmo y de acuerdo con sus propios intereses. Cuando, como sucede con frecuencia, se utiliza el recurso del `chivo expiatorio' para mantener el precario equilibrio familiar, tal vez la única vía de acceso al adolescente sea el tratamiento del grupo familiar"

La psicoterapia familiar con pacientes farmacodependientes / The family psycotherapy with drugdependent patients

El trabajo señala las características y actitudes del paciente farmacodependiente y su familia al acudir al Centro de Integración Juvenil, para la psicoterapia familiar, esto en la ciudad de León Guanjuato, México; inicia con el marco téorico referencial de psicoterapia familiar -función de roles básicos, comunicación y tipo de salud mental; a continuación presenta el abordaje terapéutico de la familia, basándose en los diagnósticos de Bleger; describe también algunas características familiares de los pacientes tratados,la iniciación del tratamiento, el desarrollo de las sesiones subsecuentes y la evolución y terminación del tratamiento