STAGES OF FAMILY INVOLVEMENT IN THE RESIDENTIAL TREATMENT OF ADOLESCENTS

A strong case has been made in the literature that the effective treatment of adolescents in long-term psychiatric hospitals or residential treatment centers must include treatment of the family. This highlights the need for a family treatment model that integrates a long-term psychodynamically oriented residential treatment approach with family systems theory. Such a model must take into account the stages of inpatient treatment and must address therapeutic management of the physical, emotional and psychological aspects of separation between the adolescent and the family. A bridge between family systems theory and psychoanalytic theory can be found in object relations theory. A four-stage model for working with families having a hospitalized adolescent member is described in which each stage builds upon the previous one. Progress through the stages depends upon the establishment of a relationship in which the family perceives the hospital as supportive, nonjudgmental, helpful and trustworthy.     

“I Deserve a Family”: The Evolution of an Adolescent’s Behavior and Beliefs About Himself and Others When Treated with Theraplay in Residential Care

This article chronicles a seriously disturbed adopted adolescent’s experience in an attachment focused residential program at which the primary treatment was Theraplay^®. Adopted at age four following significant abuse and neglect, Tom lived in institutions for 5 years before participating in Chaddock’s Developmental Trauma and Attachment Program (DTAP). He now resides successfully in the home of therapeutic foster parents. Theraplay treatment directly meets attachment needs through adult-guided, highly positive, engaging and nurturing interactions to change the child’s working models of attachment and to develop affect regulation. Theraplay was especially useful with this adolescent who was born addicted and who had little ability to participate in insight oriented therapy. Topics include adolescence and attachment, Theraplay theory, process and applications, and the DTAP milieu and treatment program. This case study demonstrates that it is possible to improve the outcome for adolescent development by directly meeting the adolescent’s attachment needs through the Theraplay model.     

Pediatric Chronic Illness Management: A Qualitative Dyadic Analysis of Adolescent Patient and Parent Illness Narratives

In pediatric chronic illness, little is known about the relational interactions between adolescent patients, parents, and illnesses and how they influence self-management of illness. We conducted interviews with 32 individuals (16 dyads) representing adolescents diagnosed with a chronic illness and their primary parent who had been referred to a psychosocial treatment program for challenges with illness management. Interviews were conducted individually and analyzed dyadically using grounded theory to better understand the relational processes that may be contributing to illness management difficulties. Results include a theory of patient–parent illness responses and how parental illness meanings play a role in adolescent self-management. Results can be used to better understand and treat family relational patterns that may be influencing pediatric illness management challenges.     

Parental and peer characteristics as modifiers of the bond-behavior relationship: an elaboration of control theory.

Three bonds are at the core of Hirschi's control theory: attachment to parents, commitment to conventional activities, and belief in the conventional rules of society. Control theory does not include parental and peer attitudes and behaviors, variables that frequently are implicated in adolescent behavior. This study examines whether parental and peer behaviors and attitudes modify bond/behavior relationships. Adolescent cigarette smoking is the behavior of interest. Panel data from a probability sample of 685 adolescents shows that the relationship between attachment and adolescent smoking is modified by parental smoking; the relationship between commitment to conventional activities and adolescent smoking is modified by father's smoking; but the relationship between belief in conventional rules and adolescent smoking is not modified by parental or peer variables. We conclude that control theory needs to encompass parental behavior when considering adolescent smoking behavior.     

Adolescent substance use and family-based risk and protective factors: a literature review

Adolescent substance use has become a serious concern nationwide. Although there are many ways of viewing adolescent substance use, family influence has been established as one of the strongest sources of risk and protection. A review of the literature indicated relevant theories for understanding adolescent substance use and specific family-based variables influencing adolescent substance use. In general, there seems to be a relationship between adolescent substance use and family-based risk and protective factors. Relevant theories identified in the literature review include family systems theory, social cognitive theory, social control theory, and strain theory. Specific family-based risk and protective factors include family relationships such as with siblings and parents and family characteristics such as ethnicity and religious backgrounds. Future implications for research and prevention/intervention in relation to family-based risk and protective factors are discussed.     

Career Salience of Institutionalized Adolescent Offenders

This study investigated self-esteem and career salience of institutionalized adolescent offenders in the context of Super's (1980) lifespan career development theory. Participants were 185 male adolescents. Results indicated that participation, commitment, and values expectations in home-family roles contribute significantly to self-esteem in adolescent offenders. Additionally, adolescent offenders differ from adolescent non-offenders on home-family and work roles, with adolescent offenders scoring higher. Implications for career counseling of institutionalized adolescent offenders for transition into the community are discussed.     

A family-based, developmental-ecological preventive intervention for high-risk adolescents

Family-based preventive intervention has emerged as a promising modality for preventing antisocial behavior problems in youth. This article introduces an intensive, family-based preventive intervention for high-risk adolescents: Multidimensional Family Prevention. Multidimensional Family Prevention combines the advantages of standard prevention models (curriculum based and protection focused) with those of psychosocial treatment models (assessment based and problem focused). The model's main features are described: theoretical foundations (risk and protection theory, developmental psychopathology, ecological theory), guidelines for constructing a multidomain prevention program (family and peer relationships, school and prosocial activities, drug use and health issues, cultural themes), and strategies for tailoring and implementing five flexible intervention modules (adolescent, parent, interactional, extended family, extrafamilial). Implemented in the family's home, the intervention works to create a resilient family environment that supports the basic adolescent developmental goals of renegotiated attachment bonds within the family and durable connections with prosocial institutions.     

Videogame Assisted Emotional Regulation Training: An ACT with RAGE-Control Case Illustration

This paper describes the treatment of an adolescent girl (age 16) who received the ACT with RAGE-Control intervention during her treatment in an urban inpatient psychiatry unit. ACT with RAGE-Control utilizes five traditional Cognitive Behavioral techniques combined with an active biofeedback videogame designed to strengthen a patient’s self-regulatory capacities while facing simulated stress in a virtual environment. The treatment is delivered as daily individual psychotherapy sessions over five consecutive days of an inpatient psychiatric admission. The following case illustrates the theory and techniques of the ACT with RAGE-Control intervention.     

Adolescent development: A view from self psychology

Self psychology does not have a distinctive developmental theory. This paper discusses some of the methodological problems related to the articulation of such a theory, and goes on to outline a theory of adolescent development that is consistent with the tenets of self psychology. The major points made are: Adolescence does not represent a recapitulation of prior phase of development, the sense of self cohesion is fundamental to a healthy sense of self, and the culmination of the adolescent process is the formation of a nuclear sense of self.private practice     

Examining Outpatient Treatment Dropout in Adolescents: A Literature Review

This literature review explores the research to date on adolescent mental health treatment drop out. As many as one in five adolescents in the United States has been diagnosed with an Axis-I psychiatric disorder. Adolescents with Axis-I psychiatric disorders face significant short- and long-term consequences if they do not obtain mental health treatment. However, treatment dropout research has focused on child and adult populations with little focus on the unique issues that are likely to impact adolescents. The theoretical underpinnings for understanding adolescent mental health treatment are explored in relation to adolescent psychological development and the therapeutic alliance. The review concludes with suggestions for future research to extend our understanding of adolescent treatment drop out.     

Family Communication and Adolescent Alcohol Use in Nicaragua,Central America: A Test of Primary Socialization Theory

ABSTRACT

Applying primary socialization theory to a sample of early adolescents from Nicaragua, this study examines direct and indirect associations between family bonding and adolescent alcohol use via substance specific prevention communication (SSPC) and adolescent efficacy. Early adolescents in 7th and 8th grades completed a self-report, cross-sectional survey. Structural equation modeling revealed that family expressiveness was significantly indirectly related to adolescent lifetime alcohol use through SSPC. Results are discussed in relation to primary socialization theory, family communication, and international substance use prevention efforts. This study provides supportive evidence for the important role of positive family communication as a protective factor for early adolescents in Nicaragua.     

Substance use among adolescent mothers: A review

Maternal substance abuse is a critical problem, and adolescent mothers appear to be at high risk for such behaviors. We review studies on postpartum adolescent substance use to explore the extent of this problem and avenues for new research. Authors screened 1300 studies, identifying 12 articles on substance use among postpartum adolescent mothers for this review. Adolescent mothers reported greater substance use before pregnancy compared to other adolescent females. Although some adolescents continued substance use during pregnancy, most stopped using only to resume within six months after birth. Comparisons of use to national samples of nulliparous adolescent females showed a higher prevalence of substance use in this population. Substances used often varied by race/ethnicity, with white mothers more likely to smoke cigarettes and use marijuana, and Black mothers more likely than whites to drink and use drugs. Of all identified studies, only one focused on Hispanics. Beliefs about drug use grew less negative as girls transitioned from pregnancy to parenthood. As they transitioned to adulthood, substance use remained prevalent and stable. Psychological distress and low self-esteem appeared to influence continued use. Friends' cigarette smoking predicted early initiation of and persistent smoking, while increased education predicted quitting. Early initiation of substances often predicted problem behaviors. Adolescent mothers are a vulnerable population, implicating use of problem behavior theory or the self-medication hypothesis in future research. Multiple avenues for new studies are needed to help identify effective treatment and intervention for this understudied population.     

An Island in a Sea of Madness: The Uses of Theory for In-Patient Adolescent Treatment

This paper explores the ways an integrated psychodynamic theory helps practitioners to maintain their therapeutic equilibrium. I discuss adolescent treatment at Chestnut Lodge Hospital, using case examples of projective identification and splitting on the milieu. I argue that theory helps the therapist to contain his own reactions to the intense, evocative work, which in turn helps him to contain the patient. I also discuss the ways theory can help us to make therapeutic use of countertransference enactments, allowing us to use discursive language to understand previously wordless experience. An integrated psychodynamic theory allows us to bridge the intrapsychic and intersubjective realms. It both facilitates, and helps us to understand, the novel attachment the patient forms in psychotherapy. Theory guides us regarding what psychological skills the patient has failed to master and organizes our efforts to impart these skills to him.     

Parent-adolescent relationship quality as a link in adolescent and maternal depression

Guided by family systems theory and the depression-distortion hypothesis, the purpose of this study was to test the extent to which mother-adolescent relationship quality linked the known associations between maternal depression and adolescent depression. Data from the Longitudinal Study of Child and Adolescent Well-being were used to test hypotheses with a sample of 267 mother-adolescent dyads. Findings demonstrated the longitudinal associations between perceptions of mother-adolescent relationship quality and adolescent and maternal depression. Specifically, maternal depression symptoms were negatively correlated with adolescent perceptions of the relationship at age 12 and 14, which were positively correlated with adolescent depression at age 14. Additionally, youth depression at age 8 was positively correlated with maternal depression at adolescent ages 12 and 14. A significant association was found between youth depression and adolescent perception of the parent-adolescent relationship quality, such that higher youth depression scores were moderately linked with lower adolescent report of quality of the relationship at age 12. Further, higher levels of youth depressive symptoms were associated with lower maternal perception of the parent-adolescent relationship quality at youth age 12. Implications for clinical intervention and research are discussed.     

Rethinking Girls “At-Risk”

Abstract

This conceptual article critically analyzes influential theoretical frameworks concerning adolescent female development, including psychosocial identity stage theory, person-in-environment theory, and feminist psychology. Based on the strengths and limitations of these approaches, the author introduces social workers to an emerging framework that addresses the gender, race, and class intersections that contextualize adolescent girls' developmental experiences. This perspective also discusses young women's capacity to resist norms and stereotypes in their search for an authentic identity. This innovative theory complements a strengths-based approach to social work and can be used to guide research andpractice with this population.     

Working with parents of spinal cord injured adolescents: A family systems perspective

Concepts from family systems theory are used to facilitate understanding of the needs of families coping with the spinal cord injury of an adolescent. Five assumptions derived from systemic principles are discussed as related to assessment and family functioning. Related suggestions are given for assisting parents in dealing with this non-normative stressor and its long-range effects on the adolescent and family.     

Exploring Gender and Racial/Ethnic Differences in the Effects of Child Sexual Abuse

Child sexual abuse (CSA) has been linked to a number of adverse effects including hypersexuality (HYP), substance use (SUB), suicidality (SUI), and depression (DEP). Despite a plethora of research on CSA, little is known about how it affects adolescents and the cultural factors that influence their coping styles. This study was founded on social-cultural coping theory and the model of traumagenic dynamics of sexual abuse, suggesting that CSA consequences lead to maladaptive coping mechanisms influenced by sociocultural factors. Using archival data, loglinear analysis was conducted to examine gender differences within racial/ethnic groups in HYP, SUI, DEP, and SUB among adolescent survivors of CSA in a National sample of 13,583 male and female high school students. The purpose of the study was to identify differences in the effects of CSA as manifested by variations of maladaptive coping across racial/ethnic groups and gender. Boys were significantly more likely to use substances, while girls were more likely to experience depressive symptoms and suicidality. Notably, this study did not reveal any significant racial/ethnic differences in adolescent coping. These findings can inform treatment planning and interventions for adolescents who may present with DEP, SUI, SUB, or risky sexual behaviors, but may have underlying trauma from CSA. This study contributes to the knowledge base about the processes that take place within adolescent CSA survivors, shedding light on cultural nuances among adolescent coping and informing culturally competent practice.     

Preparation for residential treatment: An anticipatory mourning process

This paper discusses the intense emotional bonding between parent and adolescent as it interferes with the adolescent and family's ability to tolerate the physical separation inherent in long-term residential treatment. It describes the mourning process through which both adolescent and parent experience and partially relinquish their attachment to one another in anticipation of the separation. The process is completed when both parent and child accept the need for placement and are ready to accept the possibility of new relationships in the residential treatment setting.     

Adolescent crisis and suicidal behavior: Dynamics and treatment

Suicide among adolescents is increasing. Three interacting factors—the crisis of adolescent development, family dysfunctioning, and social factors—create vulnerability to feelings of rejection and worthlessness among suicidal adolescents. Long-term family problems that are not openly acknowledged but for which the adolescent feels responsible are particularly relevant. The authors recommend a multiple approach to assessment and treatment in which crisis intervention is employed initially; and individual treatment for the adolescent and family therapy are utilized concurrently on a long-term basis.