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This case report illustrates the application of behavior modification techniques for managing children's misbehavior. The important elements of this report are the use of graduate students as co-therapists, the implementation of the program directly in the family's home, and the focus on shaping the mother's disciplinary behavior.
The study analyzes the treatment by copsychotherapy of 56 individual patients carried out by a male-female therapist pair. The therapeutic contributions of the female cotherapist are scored (from evidence in the process notes) in terms of thirteen factors, and are listed in order of importance. Her contributions are greatest in the treatment of borderline psychotic personality disorders.
Psychotherapy supervision offers an opportunity for examination of value differences between therapist and patient and therapist and supervisor. Effects of availability of female supervisors are discussed in relation to these value differences affecting referrals, therapeutic goals, assessment of psychopathology, termination, and supervision of cojoint therapy. Advocacy and ombudsman function of the female supervisor in a training program are emphasized.
The treatment of an "iatrogenically infantilized" patient by cotherapists using a dialectical approach is described. By focusing on the adult part of the patient, the here and now and on behavioral change rather than on the past, catharsis and insight, the development of dependency and regression were discouraged, while growth and independence were encouraged. The practice of providing further treatment to patients with poor responses to past psychotherapeutic aid is questioned and an alternate approach is suggested.
Although this paper has focussed on ways in which group-therapy experience differs from the experience of individual therapy for the beginning therapist, all of the differences discussed are only matters of degree and thus are important in both individual and group therapy. Group-therapy experience tends to enhance the visibility of important aspects of all forms of psychotherapy and therefore should be looked at as a useful tool in learning all forms of psychotherapy. Experience in group psychotherapy should ideally precede or occur simultaneously with initial exposure to individual therapy rather than following afterwards as an option, as is usually the case in current psychotherapy training programs. The most important skill to acquire in learning psychotherapy is the sophisticated ability to listen. To do so involves attending to content, affect, the patient's and one's own verbal language, body language, and meta-communications, conscious as well as unconscious. Group psychotherapy experience early in one's development as a psychotherapist can be a powerful tool in developing this ability to listen. Being part of the group process allows a unique level of intimacy that is probably more equal and vulnerable than in other forms of therapy. The use of the self, and the ability to trust in the process without using theory as a barrier between ourselves and our patients, but rather as a bridge to greater understanding, can all flow from the unique experience of leading a psychodynamic group.
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The authors have found small groups (called mini-groups) an effective way to work with patients who are too regressed or disturbed to benefit from individual psychotherapy and who find larger groups overwhelming and confusing. Mini-groups were formed in 1974 on a 20-bed acute inpatient service of a private psychiatric hospital, where traditional treatment approaches have been altered because of a more disturbed patient population and a shorter length of stay. A high staff-to-patient ratio, sometimes almost one to one, lends stability to the groups.
Puerto Ricans and other Hispanics have traditionally used the nuclear and extended family as vital support systems to deal with stress. Some Puerto Rican migrant families living in the United States have been suspected of being at high risk for mental health problems precisely because they lack extended family supports. Working together as bilingual co-therapists, the authors found that a systems-oriented family therapy approach is effective and syntonic with the culture of Hispanic migrants. They provide a clinical vignette and warn therapists about the potential problems in differentiating dysfunctional family patterns from culturally sanctioned behaviors.
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Explore the source record for details and available documents.
The long term management of chronic ambulatory schizophrenic patients represents a problem in spite of the advent of neuroleptics. The most appropriate regimen seems to be group therapy combined with pharmacotherapy. In this paper we suggest that the group is more easily managed by co-therapists (usually a psychiatric nurse and a psychiatrist). This permits a transference dilution and helps the therapist to maintain a constant motivation.
In the outpatient treatment of schizophrenia, the routine practice of providing each patient with two co-therapists results in several benefits: reduced dependency, increased expertise, objective monitoring, added support and morale for the therapists, more obvious and therefore more reversible countertransference, more obvious and therefore more treatable "splitting" and "projecting." Despite these benefits, problems arise in the two-therapist arrangement. They are discussed under the following headings: loyalty conflicts; limit setting; crisis management; family work. The authors report on techniques of co-therapy problem prevention and problem resolution. Though not always successful, co-therapy continues to be a useful model of service delivery to schizophrenic outpatients.
Therapists who are of the opinion that the cotherapy relationship has minimal therapeutic value, fail to understand the potential of this type of therapy. Cotherapy, in group psychotherapy, is a unique form of therapy with specific implications for therapeutic intervention. This paper will present three hypotheses developed from clinical observations which encourage a re-examination of traditional group perspectives. First, the authors believe that the development of the cotherapy relationship effects the development of group process. Second, the authors hypothesize that the pairing of the cotherapy relationship is paralleled by the pairing of group participants and finally that pairing in group psychotherapy is positive and can be utilized as an intervention technique. Although, traditionally, pairing has been viewed as an obstacle to group process, this paper presents the premise that pairing in group psychotherapy should be considered as a positive and necessary occurrence for cotherapy intervention. Six phases of cotherapy development are illustrated to show how the complex aspects of the cotherapy relationship impacts upon the developmental stages of group process. The clinical implications of this perspective may be the beginnings of new therapeutic horizons for cotherapists.
A randomized controlled study of 38 catchment unit psychiatric in-patients in a discussion group showed no significant additional benefit compared with 36 in-patients in an activity group. Symptom change scored by three rating groups agreed closely, average r = +0.64. Patients treated with ECT showed 2.6 times as much reduction in morbidity as those not so treated, but there was still no appreciable difference between discussion and activity groups when this was allowed for. Other treatment factors and the Hawthorne effect appeared to obscure any effect due to group therapy.