Countertransference,resistance and frame management in the psychotherapy of a 15 year old anorexic and her mother

Countertransference is a rich source of understanding of client dynamics but can be difficult to detect. A case vignette is used to illustrate how changes in the arrangements of therapy should be viewed as red flags alerting the therapist to possible countertransference. By paying careful attention to the client's derivative response to the therapist's agreeing to a request for a change in appointment times, the therapist was able to understand the unconscious motive behind the request, as well as her own countertransference reasons for participating in the resistance expressed in the request. When, based on this under-standing, the therapist was then able to hold to the framework and maintain the previous appointment schedule, this furthered the treatment by providing a model for introjection and by promoting understanding rather than acting out. In complicated therapy situations where treatment of more than one family member by a single therapist is indicated, such careful attention to the framework and to the client's derivative response to the therapist's interventions is particularly important.An earlier version of this paper was presented before the Annual Conference of the Washington State Society for Clinical Social Work on May 14, 1984.     

Effective child welfare practice with immigrant and refugee children and their families

This article presents a multistage migration framework to broaden the lens through which child welfare personnel can view immigrant and refugee families and their children. By better understanding the family's experiences in both emigration and immigration, including reasons for leaving their home country, experiences in transit, and reception and resettlement experiences in the United States, child welfare personnel are better equipped to assess their needs and provide effective prevention, protection, permanency, and family preservation services. Case examples illustrating the application of the framework and guidelines for program and practice are included.     

THE LAWYER-THERAPIST CONSULTATION TEAM*

This paper discusses a six-month pilot study done at The Ackerman Institute for Family Therapy. Joint consultations with a Family Therapist and a Matrimonial Attorney were offered to ten couples and one woman contemplating divorce. Sessions were videotaped. A project addendum was done with telephone interviews. The authors were interested in determining whether joint consultations would be useful to help couples understand the psychological and legal implications of conflicts expressed during the separation process.     

Casino gambling in private school and adjudicated youngsters: A survey of practices and related variables

This study provides additional information about casino gambling practices in two adolescent samples. Specifically, 109 adolescents from a religious high school and 84 adolescents from a juvenile detention facility in Las Vegas, Nevada were surveyed. Of these, 71 (36.8%) were found to gamble regularly (58 males, 13 females, mean age 15.9 years). Results indicated many similarities among the two groups. The overall sample appeared to have a strong affinity for casino gambling, were diverse in their practices and reasons for gambling, reported a variety of emotional and physiological behaviors when gambling, occasionally experienced problems from casino gambling, and had parents who generally approved and were aware of their children's gambling behavior. The accessibility and family-oriented nature of many new casinos may be responsible for these effects.The authors thank Nicole Giangregorio and Ned C. Silver for their assistance. Portions of this paper were presented at the meeting of the Rocky Mountain Psychological Association, Boulder, CO.     

Prevalence and Diagnostic Correlates of DSM-IV Pathological Gambling in Psychiatric Outpatients

Studies of the prevalence of pathological gambling (PG) in psychiatric and substance abusing patients suggest that the disorder is not rare. Most studies have been of substance abusers in treatment, and the rate of PG has been found to be several times higher than the rate found in community based epidemiological surveys. However, only one study has examined the prevalence of PG in a heterogeneous sample of patients, and this was a study of psychiatric inpatients. We are not aware of any prior study of the prevalence of PG in a psychiatric outpatient sample. In the present report from the Rhode Island Methods to Improve Diagnosis and Services (MIDAS) project we examined the current and lifetime prevalence of PG in 1,709 psychiatric outpatients interviewed with a semi-structured diagnostic interview that included a module to diagnose DSM-IV PG. Forty (2.3%) patients had a lifetime history of DSM-IV PG, all of whom had at least one other DSM-IV axis I disorder. Patients with PG had significantly more axis I disorders than patients without PG, and had significantly higher rates of bipolar disorder, social phobia, panic disorder with agoraphobia, alcohol use disorder, and other impulse control disorders. Possible reasons for the low prevalence of PG in our sample are discussed.