Effects of psychotherapy in schizophrenia: I. Design and implementation of a controlled study.

This article describes a 2-year, multi-hospital study on the effects of psychotherapy for nonchronic schizophrenic patients. The design and methods used to evaluate the relative benefits of exploratory, insight-oriented (EIO) psychotherapy and reality-adaptive, supportive (RAS) psychotherapy when both are provided by experienced therapists against the backdrop of good hospital and psychopharmacological management are presented. Similarities and differences between the two therapies and the therapists are outlined. Special attention is given to the problems in implementing research on long-term psychotherapy. Finally, the strengths and limitations of the present study are discussed.

Effects of psychotherapy in schizophrenia: II. Comparative outcome of two forms of treatment.

This study compares the effects of exploratory, insight-oriented (EIO) and reality-adaptive, supportive (RAS) forms of psychotherapy on a sample of 95 schizophrenic patients. Analyses of 2-year outcomes revealed a complex interaction between the type of psychotherapy provided and the domain of psychopathology affected. RAS psychotherapy exerted clear preferential effects in the areas of recidivism and role performance. The EIO psychotherapy exerted preferential, albeit more modest, action in the areas of ego functioning and cognition. Overall, however, the magnitude of the differences was low. The results highlighted the need for more focused studies of subgroups, and of process and contextual influences on outcome.

Impact of aftercare in the treatment of alcoholics: a cross-lagged panel analysis.

Participation in aftercare activities during the first 3 months following discharge from inpatient treatment had a positive effect on outcome at 3 months and 6 months, but participation decreased between 3 and 6 months as patients who were doing best began to drop out of the aftercare system.

Data attrition in follow-up studies of alcoholics.

Alcoholics who responded to posttreatment follow-up evaluation showed more improvement than those wh did not respond. Thus nonresponders may bias follow-up research tht does not account for missing data. Several procedures are outlined to increase follow-up return.

Leader dilemmas and countertransference considerations in group psychotherapy with substance abusers.

Leader issues and countertransference dilemmas that emerge in psychotherapy groups for substance abusers will be examined along with strategies to extricate the therapist from the impasses that emerge. Specific issues include feelings of helplessness and inadequacy when a patient relapses and resumes substance use, countertransference reactions emanating from an overlapping personal or family history of substance abuse, countertransference helplessness when the therapist is more invested in the treatment than the patient, feelings of incompetence related to partial familiarity with 12-step culture and lingo, and countertransference devaluation fostered by systemic issues in substance abuse settings.

Dilemmas and countertransference considerations in group psychotherapy with adult children of alcoholics.

This article will explore special leader issues that emerge in psychodynamically oriented therapy groups with adult children of alcoholics. Particular focus will be on countertransference feelings that get stirred up in group leaders and techniques for dealing with some of these special dilemmas. Specific issues include (a) assumption of sameness between the therapist and the patient (the therapist assuming that he or she "understands" because of having also grown up in an alcoholic family); (b) the "will to restore," which may be destructive when the therapist, whose own self-esteem is dependent on the patient's progress in therapy, forces a "rush to recovery" on the patient; (c) other personal issues in the life of the therapist that may also resonate with experiences of the patient; (d) "countertransference goodness and availability" as it affects therapists' abilities to set reasonable limits on their patients, as well as reasonable expectations for themselves; and (e) special issues regarding therapist transparency and self-disclosure.

Barriers to treatment of alcoholic women.

Three barriers to effective treatment for alcoholic women are described: 1) the impact of negative myths and expectancies (in particular, the myth that women do worse); 2) the impact of stereotyped sex-role expectancies which may limit and constrict women's potential for growth; and 3) the impact of the knowledge gap. The impact of each kind of barrier is elaborated as data are presented from: a clinical field experiment; a meta-analysis of a decade of research studies; and clinical experience.

Sex-role values and bias in alcohol treatment personnel.

During a two day training workshop with 45 alcohol treatment agency personnel, the impact of sex-role bias on clinical practice with alcoholic clients was examined. More specifically, data were gathered on: 1) client comfort level of surrogate clients as related to perceived sex-role values of treatment personnel; and 2) the impact of patient sex and sex-linked characteristics of presenting problems (whether problems are "typically" male or female, and whether "sex-appropriate") on each of the following: perceived importance of client's presenting problems, specificity of the treatment plan to problems presented, and clinician's estimate of client prognosis. The results suggest that sex-role values of treatment personnel influence client comfort, that female clients are seen as having a poorer prognosis than males, and that presenting problems are perceived to be more important if they are sex-appropriate than if they are not sex-appropriate (the least important problems being female problems in a male client).

Effect of sex bias on women's studies on alcoholism.

Women alcoholics have historically been underrepresented in research studies far out of proportion to the difference in male female prevalence rates. This study examined disparities in the ways in which male and female alcoholics have been studied in the treatment outcome literature and examined the role of sex bias (author sex) as a contributing factor. Two hundred fifty-nine studies published between 1972 and 1980 were reviewed that reported drinking-related outcome of subjects treated with psychological intervention or medication. Only 7.8% of subjects sampled in these studies were women. Of greater interest, female authors sampled nearly 3 times as many women in proportion to the number of people they studied as did male authors; women subjects were more than one and one-half times as likely to be followed up by female than by male authors; and 3 times as many female as male authors presented data examining sex differences. The same kind of differences between male and female authors occurred with respect to specifying precise numbers of male and female subjects studied and followed up, and with respect to examining prognostic variables related to women's outcome. The data suggest that subtle sex bias contributes to inadequate studying of women alcoholics.

The influence of instructional set on schizophrenic vs. organic concreteness.

36 male patients (12 schizophrenic, 12 organic, and 12 neurotic), age 19-57, each took two forms of the Gorham Proverbs test under two different instructional sets. It was hypothesized that for schizophrenics, a higher level of abstraction would be obtained on the proverbs task when the instructions required less personal involvement of the patient than when a more personalized set was used; whereas the performance of organic and neurotic patients would not be affected by the variation in instructional set. The results indicate that instructional set does significantly alter the concreteness of the schizophrenic's response to proverbs, but has little effect on the responses of the other two groups.