Utilizing cognitive-behavioral techniques in psychodynamic practice with clients diagnosed as borderline

Many factors, including theoretical controversies, treatment constraints, and an increasing awareness of the high incidence of childhood trauma, compel practitioners to reevaluate both theory and practice in the treatment of clients diagnosed as borderline. Our purpose in this paper is to encourage clinicians who practice primarily from a psychodynamic perspective to reconsider the judicious use of relevant cognitive/behavioral techniques with this population. We focus on the rationale of utilizing relevant cognitive/behavioral techniques in out-patient settings, and discuss specific problem areas where these techniques might be useful. These problem areas include (1) cognitive and affective splitting, (2) affective dysregulation, and (3) faulty attributions. Each problem area is discussed with clinical illustrations of appropriate cognitive/behavioral interventions. The vignettes also illustrate the essential role the therapeutic relationship plays in order for cognitive/behavioral interventions to be effective.     

Long-Term Effects of Treatment for Gender Identity Disorder of Childhood

To evaluate the durability of behavioral treatment effects for gender identity disorder of childhood. 29 prepubescent boys aged 4 to 13 years at initial referral were assessed by an independent clinical psychologist before any treatment was offered and again for follow-up at a mean of 4 years and 3 months later. Initial and follow-up clinical ratings on severity of cross-gender behavior and cross-gender identity were transformed into scores representing percentage of potential improvement. Regression analysis indicated that completion of individualized behavioral treatment significantly accounted for long-term improvement in both gender behavior and gender identity. Age in months at initiation of treatment, number of months of treatment received, number of months from initial assessment to follow-up, and full scale I.Q. were additional independent variables considered as potentially important in regard to treatment outcome. Younger subjects received more severe initial diagnoses, were more likely to have completed treatment, and showed the greatest improvement. This study provides the longest independent follow-up assessment of the behavioral treatment of male children with gender identity disorder.     

What’s the Relationship Got to do with It? Understanding the Therapeutic Relationship in Therapeutic Foster Care

The therapeutic relationship is increasingly recognized as important to understanding how process variables contribute to treatment outcomes. In this paper, we examine the therapeutic relationship between children with serious emotional and behavioral disorders and their treatment providers in the context of an observational study of Therapeutic Foster Care (TFC). Our findings suggest that the quality of the relationship between the treatment parent and youth in a TFC setting is significantly associated with better emotional and behavioral functioning for the youth. It appears from these findings that the quality of the relationship between the youth and treatment parent in a TFC setting is at least one of the mechanism or process factors that contribute to improved functioning for the youth.     

Screening young people in the juvenile justice system for behavioral & substance abuse disorders

There is a wide variation in viewpoints regarding screening youth in the juvenile justice system for behavioral and substance abuse disorders. No consensus exists within and among local, state, and federal juvenile justice officials regarding the necessity of screening youth for behavioral and substance abuse disorders. Local, state, and federal juvenile justice officials voiced concern regarding screening young people for behavioral and substance abuse disorders without having available funding or facilities for diagnosis and treatment.     

Cognitive and behavioral therapies for pathological gambling

The purpose of this paper is to provide an overview of behavioral and cognitive treatment approaches in the management of pathological gambling disorders. Disappointingly, the literature to date contains only one controlled outcome study in which two differing behavioral techniques were compared. Although research in general has focussed on identifying the nature of cognitive distortions in gambling, findings from these studies have not been systematically translated into treatment programs. It is concluded that methodological limitations including small sample size, absence of control groups, multiple concurrent interventions and poorly defined outcome criteria preclude conclusive statements to be drawn regarding the active ingredient of either behavioral or cognitive strategies. The program offered within the Impulse Disorders Research Centre is outlined.The authors wish to gratefully acknowledge the assistance and contribution of Zachary Steel, Research Assistant, in the preparation of this paper.     

Behavioral Approaches to Marital Discord and Conflict*

This paper reviews the empirical research in behavioral approaches to marital therapy. The level of product of current research designs has not yet advanced significantly beyond the non-factorial single-group design, and the breadth of treatment populations employed thus far has been restricted. The power of the behavioral method is found in its theoretical base, observational and treatment-relevant assessment, procedural specificity, and quantification of outcome. The outcomes of treatment, though relatively small in number, thus far, have been almost universally positive and encouraging.     

SEX ROLE CONSIDERATIONS AND BEHAVIORAL MARITAL THERAPY: EQUAL DOES NOT MEAN IDENTICAL*

Despite the egalitarian position espoused in behavioral marital therapy, little attention has been paid to sex role issues and female-male differences. This paper explores advantages and disadvantages of behavioral marital therapy vis à vis the treatment of women and men. Features of behavioral marital therapy implicated as important in the consideration of sex role issues include underlying assumptions of egalitarianism, assumptions of external causality, and orientation toward action, as well as specific procedures such as goal setting, behavioral exchange and training in communication and problem-solving skills. Each of these features is evaluated with respect to clinical considerations as well as to research findings on female-male differences in marriage. The paper concludes with recommendations as to how behavioral marital therapy could become more sensitive to sex role issues.     

The Effective Social Worker

Abstract

Client and worker interchange is at the core of the social work effort. The practitioner, in using the self as a tool, must manifest a fundamental grasp of the treatment configuration that is empirically based, relevant, and guided by a professional code of ethics. Successful therapeutic outcomes in psychosocial treatment depend on a number of variables, such as, client and worker characteristics, worker efficacy regarding the structure of treatment, length of therapy, behavior acquisition procedures, treatment technologies, and level of intervention. Behavioral therapy is a proven valuable interventive tool. A profile of the relevant skills along with a brief aggregation of empirical support provides the behavioral social worker with an understanding of the essential elements of the behavioral treatment structure in addition to empirically appropriate interventive methods.     

Borderline personality disorder: nursing interventions using dialectical behavioral therapy

Psychotherapeutic treatment of people with borderline personality disorder (BPD) is one of the greatest challenges confronting mental health professionals today. Clients with BPD are often difficult for nurses to work with, perhaps due to a lack of understanding of the underlying dynamics of the disorder. This article describes effective treatment strategies for BPD with a central focus on dialectical behavioral therapy (DBT). In typical mental health settings, nurses can effectively implement interventions using the concepts of DBT to help people with BPD build effective coping strategies and skillful behavioral responses for improved quality of life.     

Computerized Behavioral Interventions: Current Products and Recommendations for Substance Use Disorder Treatment

Unlike traditional methods of delivering substance use disorder (SUD) and mental health treatment, computerized behavioral interventions deliver services via computers, smartphones, and other electronic devices. In recent years, there has been a proliferation of Web-based treatment programs designed for certain target populations. Studies have shown that many of these programs are evidence-based, and some are just as effective as traditional in-person interventions. This article reviews current computerized behavioral interventions and makes recommendations for how these tools can be incorporated into SUD treatment services.     

自闭症儿童家庭干预方法的研究

对自闭症儿童家庭的调查发现，自闭症儿童的家长获得干预方法的途径主要来源于咨询机构的老师；家长熟悉的干预方法包括行为治疗法、感统训练法、药物治疗法、游戏疗法等：家长认为有效的干预方法是行为治疗法与感统训练法，认为无效的干预方法为药物治疗法与功能分析法。建议家长在选择干预方法时综合考虑家庭环境、儿童的特点、自身的学历水平和职业特点等多方面因素；干预方法的使用要立足于自闭症儿童的实际感受，服务于儿童生活质量的提高．注意干预的生态效度以及学科跨领域的合作。     

Psychiatric Symptomatology in a Deaf College Population Affecting Diagnosis and Treatment

Abstract

As the mental health needs of the deaf receive increased recognition, issues of diagnosis and treatment become vital. Several characteristic behavioral patterns are frequently encountered which often confuse diagnosis, particularly in clinicians inexperienced with hearing-impaired individuals. These behavioral characteristics of suspiciousness, the use of odd or idiosyncratic language, difficulties in expression of affects, and acting out behaviors may create a tendency to overdiagnose serious mental illness. In addition, an understanding of the impact of deafness on an individual's personality development is crucial to an intelligent choice of treatment approach. These difficult issues of differential diagnosis and treatment are discussed in the context of the psychotherapeutic experiences of a hearing and nonsigning clinician working with deaf college students.     

Treatment for Juveniles Who Sexually Offend in a Southwestern State

A 25-item questionnaire was mailed to sex offender treatment providers from counties with 60 or more reported juvenile sex offenders in a Southwestern state to determine the most effective treatment for juvenile sex offenders. Results indicated that cognitive behavioral therapy was the most successful reported approach to treatment with an average success rate of 87%. The most commonly used approach was cognitive behavioral therapy with relapse prevention. The most common sexual offense was indecency with a child involving sexual contact, contrary to studies that found that in the Probation Commission data, aggravated sexual offense was the most common. These results have ramifications for state policies on treatment for juvenile sex offenders.     

Retail point-of-sale guardianship and juvenile tobacco purchases: assessing the prevention capabilities of undergraduate college students

This randomized experiment evaluates the attitudes and behavioral intentions of 458 undergraduate college students about intervening with the intent of preventing an illegal retail purchase of tobacco products by a minor after exposure to a factorial combination of three pieces of information. MANOVA results show that none of the treatment conditions, considered alone, are correlated with increased attitudes or behavioral intentions; however, there is a significant interaction effect on attitudes when information portraying a potentially annoying situation is combined with information about the costs associated with youth tobacco use. Post-hoc t tests suggest that this effect is concentrated among non-tobacco using respondents.     

The interruption and resumption phases of milieu treatment with children and adolescents

This article addresses the special issues of the interruption and resumption of ten-month day treatment with children. It reviews behavioral and dynamic responses to their changes of treatment status, and the use of positive reframing, as a technique useful to minimize regression and maximize consolidation of treatment gains.     

Game-Based Cognitive-Behavioral Therapy (GB-CBT) Group Program for Children Who Have Experienced Sexual Abuse: A Three-Month Follow-Up Investigation

This study examined the efficacy of a game-based cognitive-behavioral group therapy program for addressing problems typically found among elementary school-aged victims of child sexual abuse immediately after treatment and at three months following treatment. It was hypothesized that positive gains would be observed among the following domains: (a) internalizing symptoms (e.g., anxiety, depression, and trauma); (b) externalizing behaviors (e.g., oppositional behavior, disobedience, and conduct disordered behavior); and (c) sexually inappropriate behaviors. Improved knowledge of abuse and personal safety skills was also predicted. Results indicated that game-based cognitive-behavioral group therapy resulted in improvements in internalizing symptoms, externalizing behavioral problems, total behavioral problems, and personal safety skills both immediately after treatment and at three-month follow-up.     

The queer youth cultural competency (QYCC) scale: Measuring competency in direct-care behavioral health workers

Sexual and gender minority (SGM) youths are disproportionately represented in behavioral health treatment settings, and face disparities in outcomes when compared to their non-SGM peers. These youths need workers who are culturally competent in addressing their specific needs. This article presents a scale to measure the SGM-related cultural competence of direct care workers. The scale, named the Queer Youth Cultural Competency (QYCC) scale, fills a gap in the measurement literature and enables social workers to more robustly address the cultural competency of service providers as it relates to lesbian, gay, bisexual, transgender, queer, and questioning youths receiving behavioral health treatment.     

Children’s Psychosocial Rehabilitation: Clinical Outcomes for Youth with Serious Emotional Disturbance Living in Foster Care

Children living in foster care are an especially vulnerable population who often come to the attention of Medicaid mental health providers. These children experience a high incidence of emotional and behavioral disorders and may have specialized treatment needs related to their living arrangement status. This study assessed whether Children’s Psychosocial Rehabilitation could effectively treat youth with severe emotional and behavioral disorders who live in foster care. Analysis of data from an open trial of 218 clinically-impaired youth, aged 3–18 years, revealed no reliable differences in treatment outcome between foster versus non-foster children, with a trend toward more favorable outcomes for foster youth. Findings justify further study of the effectiveness of this Medicaid-funded service for the treatment of youth in care.     

Tourette's syndrome

1. Tourette's syndrome is a disorder with a multitude of complex behavioral problems with major implications for social impairment and emotional pain. 2. The generic care plan anticipates the predictable management problems in adolescent patients. It offers nursing interventions, particularly structure, which is important in managing symptoms. 3. The treatment process is slow. The successful implementation requires consistent efforts from the nursing staff, treatment team, and family.