Integrating Art Therapy Methodology in Brief Inpatient Substance Abuse Treatment for Adults

ABSTRACT

Decades of drug addiction research and clinical work have underscored the need for multifaceted and comprehensive treatment responses in order to sufficiently address the varied needs of individuals struggling with addiction. One valuable treatment component that can be incorporated into traditional treatment protocols to expand the comprehensive nature of treatment response is art therapy. A conceptual framework is presented, detailing the integrative opportunities and benefits of including an art therapy component to short-term hospital-based inpatient substance abuse treatment programs. A creative arts component can be particularly beneficial for brief inpatient programs, where the client population is diverse, in crisis, and at high-risk for relapse; and where clinicians need to obtain comprehensive client information from multiple sources in a short amount of time. Art therapy methodology can provide a mechanism for collecting such collateral information for assessment purposes, can be employed to facilitate therapeutic change, and is used to track and document client progress and clinical change over time. Practice guidelines and specific treatment techniques are presented through short case examples.     

Explaining the Effects of Child Sexual Abuse: A Behavior Analytic Conceptualization

ABSTRACT

In the last two decades, several authors have proposed conceptual models to explain the adverse effects of child sexual abuse (CSA). Although conceptual models have been proposed from broadly behavioral perspectives (e.g., cognitive behavioral), as yet there is no comprehensive behavior analytic conceptualization of the effect of CSA. In this article, the behavior analytic mechanisms used to explain the development and maintenance of behavior are described, with specific reference to how the mechanisms provide a comprehensive means of accounting for adverse reactions following CSA.     

The effectiveness of creative bibliotherapy for internalizing,externalizing, and prosocial behaviors in children: A systematic review

IntroductionCreative bibliotherapy is the guided reading of fiction and poetry relevant to therapeutic needs. Experiencing stories is hypothesized to act on the same mechanisms as cognitive behavioral therapy (CBT). This systematic review assesses the efficacy and effectiveness of creative bibliotherapy for the prevention and treatment of internalizing and externalizing behaviors, and the strengthening of prosocial behaviors in children (aged 5–16).MethodAn electronic search in seven major databases was conducted along with hand searches of key journals and bibliographies. Only randomized or cluster-randomized trials were included. Primary outcomes: internalizing behavior (e.g., anxiety and depression), externalizing behavior (e.g., aggression), and prosocial behavior (e.g., behavioral intentions and attitudes towards others). Secondary outcomes: parent–child relationship, peer relationship, educational attainment and reading ability.Results9180 records were located after removing duplicates. 9134 were excluded prior to screening. Of the 46 full-text articles assessed for eligibility, eight met the inclusion criteria and 38 were excluded. Meta-analysis was inappropriate due to study heterogeneity. Overall results suggest that creative bibliotherapy has small to moderate effect for internalizing behavior (δ range: 0.48–1.28), externalizing behavior (δ range: 0.53–1.09), and prosocial behavior (δ range: 0–1.2).ConclusionCreative bibliotherapy can have a small to moderate positive effect on child behavior. Although no definitive model of creative bibliotherapy emerges from the included studies, to some extent all interventions reflected CBT mechanisms. Further research is required to: 1) model the change processes taking place when children experience stories; 2) develop and pilot an intervention; 3) assess subgroup effects by gender, age, modality and literacy.     

Clinical Results Using Virtual Reality

Abstract

Virtual Reality (VR) technology offers new opportunities for the development of innovative clinical research, assessment, and intervention tools. VR-based testing, training, teaching, and treatment approaches that would be difficult, if not impossible to deliver using traditional methods are now being developed that take advantage of the assets that are available with VR technology. As research evidence continues to indicate clinical efficacy, VR applications are being increasingly regarded as providing innovative options for targeting the cognitive, psychological, motor, and functional impairments that result from various clinical health conditions. VR allows for the precise presentation and control of stimuli within dynamic multisensory 3-D computer generated simulations as well as providing advanced methods for capturing and quantifying behavioral responses. These characteristics support the rationale for the use of VR applications in clinical assessment, intervention, and training. This article begins with a brief review of the history and rationale for the use of VR with clinical populations. We then detail one use-case for the clinical application of VR—the exposure therapy treatment of anxiety disorders and post-traumatic stress disorder. While significant work is cited in other areas of Clinical VR (e.g., pain management, cognitive/physical assessment/rehabilitation, eating disorders, social skills/clinical training, etc.), a full overview of such a broad literature is beyond the scope of this article. Thus, we have opted to provide more in-depth analysis of one specific clinical area that clearly illustrates how VR has been successfully applied and is supported by an encouraging and evolving scientific literature.     

Fertility Behavior and Interspousal Authority Relationships

Abstract

The most important issue which surrounds attitude theory today is the so called “consistency issue.” It is an issue which focuses on the failure of attitude theory and research to demonstrate the kind of causal relationship between attitudes and behavior which has been traditionally asserted in the logical underpinnings of that theory.

For some time, the critics of attitude theory and research have suggested that the inconsistency between attitudes and acts would not be reduced until attitudes were rooted in the social process within which human behavior occurs. This criticism has been responded to by contemporary attitude specialists who have made notable modifications in theory and research to take account of social variables which influence the assumed relationship between attitudes and behavior.

However, some of the criticisms of attitude theory have gone beyond pointing out the lack of a “socialized” conception of the problem to attack the logical underpinnings of the entire enterprise. While this paper is not a renewal of these criticisms of attitude theory, it is an attempt to identify and explicate a conception of attitudes which is a true sociological alternative to more traditional psychological conceptions.     

How parents suspected of child maltreatment change their cognition and behavior: A process model of outreach and child protection,generated via grounded theory

AimAlthough considerable efforts have been made to improve relationships between professionals and parents suspected of child maltreatment, little research has been conducted to examine the ways in which parents escalate their negative cognition and behavior involving professionals. This study developed a model of parents' negative reinforcement of their cognitive behavior and the factors influencing reductions in this reinforcement.MethodInterview data were collected from 21 parents, who had experienced outreach and child protection issues, and analyzed using the grounded theory approach.ResultIn the outreach phase, the analysis initially produced the negative image of help-seeking behavior category, followed by the dissatisfaction with outreach and reinforcement of negative cognition categories. In this phase, the analysis also identified the social support and support groups step as a means of reducing negative cognition. In contrast, in the child protection phase, the analysis produced the anger and psychological conflict with child protection services and unwilling consent categories. In this phase, the analysis also identified the psychoeducation and timely feedback step as an acceptable means of minimizing the escalation of negative cognition.ConclusionThe hypothetical model revealed the ways in which parents changed their cognition and behavior and demonstrated the factors influencing reductions in the reinforcement of negative cognition and behavior. These results could be useful for practice in child maltreatment cases.     

Collaborative Treatment for Sexual Behavior Problems in an Adolescent Residential Center

Abstract

Many residential treatment and sex offender programs for adolescents historically have used coercion-based interventions. Treatment programs employing coercive techniques often replicate the same destructive and intrusive behaviors they seek to eliminate. Tension between departments coupled with poor communication and discomfort around sexual behavior issues within the staff of residential treatment centers are more likely to inhibit the progress of the youths they serve.

Collaboration among residential, educational, and clinical components enables staff to work in a direct, genuine, and respectful fashion with students who have histories of sexually abusive behavior. It further assists in maintaining a safe and predictable environment for these students. Finally, it helps students eliminate destructive behaviors by directly and consistently addressing four key areas: sexually abusive behavior, antisocial attitudes, social/emotional functioning, and overall self-care. It is not the author's intention to hold Bennington School, Inc.up as a model residential treatment program or to criticize other residential facilities. Rather, it is hoped that what is working in Bennington may be helpful to others.

Many who have worked on the front lines of residential treatment with sexually abusive adolescents have received training in elements specific to sexually abusive behavior. The origins of treatment for youth who have sexually abused were noteworthy for their lack of offense-specific interventions (National Adolescent Perpetration Network, 1993). However, a wealth of literature soon emerged addressing the need for assessment and treatment techniques specific to this population (Perry & Orchard, 1992; Barbaree, Marshall & Hudson, 1993). Much of this literature made assumptions regarding high levels of chronicity (Perry & Orchard,1992) while other contributions stressed the role of denial and minimization (Barbaree & Cortoni, 1993). As a result, while many issue-specific forms of assessment and treatment were developed, they often did not take into account other developmental needs and issues in the lives of sexually abusive youths (Lane, 1997).

Concurrent with this emerging research was a substantial increase in the number of treatment programs for juvenile sex offenders (National Adolescent Perpetration Network, 1993). In this context, it is not surprising that many treatment programs relied heavily on treatment targeting denial, minimization, and perceived sexual deviance without taking into account other treatment needs of youths. Although a recent literature review of adolescent residential programs (Curwen, 2000) notes a trend away from shame-based approaches, there appears to be less clarity on specific criteria on which to base residential treatment of adolescents who have sexually abused (Curwen, 2000).

Finally, recent research shows that among adult populations, accepting responsibility for abusive behavior in treatment is more likely to result from a warm, genuine, and empathic treatment style (Marshall, Fernandez, & Anderson, 1999). Group therapy participation, similarly, results from encouragement, open questions, and nonconfrontational challenge. The emerging themes of recent trends and research should inspire those at the front lines of residential treatment to reconsider not just basic treatment approaches, but the most minute elements of their interactions with youths.     

Best Practices in Online Therapy

ABSTRACT

This article discusses important issues in delivery of best practice Internet-based therapy (etherapy). Etherapy is first defined as the interaction between a consumer and a therapist via the Internet (commonly via e-mail) in association with the use of a structured web-based clinical treatment program. A summary of the professional and ethical issues is provided, along with illustrated examples of best-practice principles experienced in clinical and research work by members of the Swinburne University of Technology Etherapy Unit (formerly the Etherapy Research, Education, and Training Unit in the Department of General Practice at Monash University). Etherapy has been found to be effective in treating a range of psychological disorders. Future research investigating methods of enhancing consumers' ability to engage in etherapy should further increase the effectiveness of this type of therapy.     

New Drugs and HIV Risk Taking

Abstract

Many workers in HIV-prevention and mental health have feared that publicity surrounding new drugs for treating HIV would cause HIV-negative gay men to lapse from safer sex. However, a recent informal survey of health workers and therapists in New York City suggests that although information about the new drugs has shifted the thinking of many negative men, it hasn't changed their behavior a great deal as yet. Anecdotal evidence of minor behavior change is described, along with medical data concerning how dangerous unsafe sex with an infected person undergoing combination drug therapy may be.     

Interviewing Strategies with Sexually Abusive Youth

SUMMARY

Adolescents who have sexually abused may pose a serious problem for both the community and the treatment provider concerning the management of risk and the application of effective intervention strategies. Fundamental to providing good clinical treatment is an assessment that results in an individualized treatment plan specifically tailored to the young person's needs. An integral but often overlooked part of this involves interviewing clients in a way that elicits accurate information and facilitates the development of a therapeutic relationship upon which effective therapy can be undertaken. This article will describe interviewing strategies and highlight the importance of the client-therapist relationship in providing effective therapeutic interventions.     

Structuring Home-Based Therapy: Four Phases to Effective Treatment

ABSTRACT

Home-based services are gaining more popularity than in years past. Therapists going into the home are exposed to various treatment issues that differ from those in a clinic or office setting. One of these issues is that of structuring the therapeutic process. Much has been written about the structure and stages of clinic-based therapy; however, little is known about the process of home-based therapy. This paper will delineate four phases of home-based therapy which the in-home therapist can use as a guide to provide faster and more effective services.     

An Evaluation of a Group Treatment for Sexually Abused Young Children

ABSTRACT

The present study measured outcomes of a group treatment for five-to eight-year-old sexually abused children. Although research completed in the last 10 years has produced some outcome studies on the effectiveness of group treatment for this population, no previous research has measured the effectiveness of psychoeducational interventions, such as the teaching of sexual information and abuse prevention strategies which are often included in this type of treatment. Also, the effects of different lengths of treatment have not been studied. The results of the current study found that children improved significantly from pre-treatment to mid-treatment on measures of problematic behavior, sexual information and abuse prevention. The children also made significant improvements from mid-treatment to post-treatment and from pre-treatment to post-treatment on all of the outcome measures with the exception of mid-treatment to post-treatment changes on the maternal acceptance self-esteem subscale. These results suggest that young children do benefit from a sexual abuse group treatment and that a longer treatment may be more beneficial.     

A Comprehensive Review and a Meta-Analysis of the Effectiveness of Internet-Based Psychotherapeutic Interventions

ABSTRACT

Internet-based psychotherapeutic interventions have been used for more than a decade, but no comprehensive review and no extensive meta-analysis of their effectiveness have been conducted. We have collected all of the empirical articles published up to March 2006 (n = 64) that examine the effectiveness of online therapy of different forms and performed a meta-analysis of all the studies reported in them (n = 92). These studies involved a total of 9,764 clients who were treated through various Internet-based psychological interventions for a variety of problems, whose effectiveness was assessed by different types of measures. The overall mean weighted effect size was found to be 0.53 (medium effect), which is quite similar to the average effect size of traditional, face-to-face therapy. Next, we examined interacting effects of various possible relevant moderators of the effects of online therapy, including type of therapy (self-help web-based therapy versus online communication-based etherapy), type of outcome measure, time of measurement of outcome (post-therapy or follow-up), type of problem treated, therapeutic approach, and communication modality, among others. A comparison between face-to-face and Internet intervention as reported on in 14 of the studies revealed no differences in effectiveness. The findings of this meta-analysis, and review of additional Internet therapy studies not included in the meta-analysis, provide strong support for the adoption of online psychological interventions as a legitimate therapeutic activity and suggest several insights in regard to its application. Limitations of the findings and recommendations concerning Internet-based therapy and future research are discussed.     

Problems in Measuring the Effectiveness of Cognitive Therapy for Pathological Gambling

Cognitive therapy is a relatively new approach to the treatment of pathological gambling. Theoretically, there are strong grounds for believing that cognitive treatments will be effective in helping individuals cut back and stop excessive levels of gambling. However, there is evidence that cognitive therapy for pathological gambling is being confused with cognitive-behaviour therapy. In this paper, the distinction between treatments that are cognitive and those that are cognitive-behavioural is highlighted. Such a distinction has strong implications for the manualisation of therapy. Additionally, a range of problems that confront the evaluation of all therapies for pathological gambling is considered. Spontaneous recovery without therapeutic intervention has been documented in both field studies of both problem and non-problem players and controlled trials of cognitive therapy compared to a waiting list control group. The implications of the phenomenon of spontaneous recovery for the evaluation of cognitive therapy are described. Other problems common to all evaluations of psychotherapies are considered in relation to gambling and recommendations made for outcome study designs.     

Emotionally Focused Family Therapy and Play Therapy for Young Children Whose Parents Are Divorced

ABSTRACT

Divorce is common and can pose risks to those involved. Although divorce affects all parts of the family system, young children face extraneous challenges due to their unique developmental stage and limited cognitive ability. Emotionally focused family therapy (EFFT) works to enhance attachment bonds by restructuring a family’s negative interaction cycle and can be useful for repairing relationships between parents and their children who are suffering negative effects of parental divorce. Whereas adults have the skills to express themselves verbally, young children often use imaginary play to convey their emotional experiences and unmet attachment needs. By using play therapy techniques within an EFFT framework, adults and children can better communicate their perspectives concerning difficult life events such as parental divorce.     

Development of a New Approach to Guided Self-Help via the Internet: The Swedish Experience

ABSTRACT

This article describes the development and empirical status of guided Internet-delivered self-help. The treatment approach combines the benefits of bibliotherapy with book-length text materials and the support given online via web pages and e-mail. Interactive features such as online registrations, tests, and online discussion forums are also included. Cognitive behavior therapy (CBT) guided the research and clinical implementations of this approach, as it lends itself more easily to the self-help format compared with other presently available psychotherapy approaches. We include an overview of the research, current issues and research in service delivery, lessons learned through a program of research, and directions for future investigations.     

The Nature and Dimensions of the Grandparent Role

Abstract

Grandparenting is a fundamental personal and social role. Despite its importance, the nature and dimensions of the grandparent role and its relevance to developmental theory is not well understood. Recently, grandparenthood has been conceptualised as a highly generative activity, thus involving developmental work that previously was attributed to middle adulthood. However, the importance of generativity as a means of avoiding a sense of stagnation in older adults has yet to be thoroughly investigated. Not surprisingly, most studies have concluded that grandmothers and grandfathers find the role to be very satisfying. Nevertheless, the psychological factors that influence this satisfaction remain unclear. Future research is required to examine grandparent satisfaction in terms of grandparents' attitudes and expectations, grandparent behaviours (e.g., child care provision) and the derived meaning of grandparenthood. This research needs to follow an integrated, theoretical approach.     

A Pilot Study of 2 Brief Forms of Dialectical Behavior Therapy Skills Training for Emotion Dysregulation in College Students

Abstract

Objective: To examine the feasibility and initial efficacy of 2 abbreviated dialectical behavior therapy (DBT) skills training groups: emotion regulation skills only and emotion regulation with mindfulness skills. Participants: Participants were 24 undergraduates (aged 18–29) with significant emotion dysregulation who participated between February and May of 2010, 2011, and 2012. Methods: Participants participated in 2-hour weekly group sessions for 8 weeks and completed outcome measures at baseline, midtreatment, posttreatment, and 4-week follow-up. Results: Participants in both conditions made significant gains, with large effect sizes, across measures of emotion regulation, affect, skills use, and functioning. There were no differences between the 2 groups, suggesting no additive benefit of mindfulness skills. Conclusions: This pilot study provides support for the acceptability and efficacy of abbreviated DBT skills training in colleges, given significant improvements, positive feedback, and low attrition. Impediments to feasibility included recruitment difficulties, particularly due to scheduling constraints.