==================================HSR31================================== 31. Special problem in psychiatric treatment of wealthy, famous, or politically powerful patients, or the family members of such. Include 'social class' concept and both hospital psychiatric treatment and outpatient treatment. 1 UI - 87035604 AU - Friedman AS ; Glickman NW TI - Program characteristics for successful treatment of adolescent drug abuse. AB - The relationship to treatment outcome, as measured by reduction in drug use, of specific characteristics and elements of 30 drug-free outpatient programs for adolescents is reported. Admission and discharge data were obtained from National Institute on Drug Abuse-Client Oriented Data Acquisition Process on 5789 adolescents in the 30 programs. A partial cross-validation study was conducted by analyzing separately for two annual client subsamples. The program, not the individual clients, was the unit of analysis. While controlling for differences between programs on their client populations, multiple regression analysis indicated that the following characteristics of programs were found to predict the outcome criterion variable, to a statistically significant degree: treat a large number of adolescent clients; have a special school for school dropouts; have a relatively large budget; employ counselors or therapists who have at least 2 years' experience in working with adolescent drug abusers; provide special services such as vocational counseling, recreational services, and birth control services; use such therapy methods as crisis intervention, gestalt therapy, music/art therapy, and group confrontation; and be perceived by the clients as allowing and encouraging free expression and spontaneous action by clients. There was a high degree of replication of these findings across the two annual subsamples of clients; and the amount of variance in the treatment outcome criterion variable accounted for by the above-listed program characteristics was quite impressive. MH - Adolescence ; Ambulatory Care/*ORGANIZATION & ADMIN. ; Attitude to Health ; Community Mental Health Services/ORGANIZATION & ADMIN. ; Counseling ; Family Planning ; Female ; Human ; Male ; *Outcome and Process Assessment (Health Care) ; Probability ; Psychotherapy/METHODS ; Social Class ; Substance Abuse/PSYCHOLOGY/*THERAPY ; Support, U.S. Gov't, P.H.S. SO - J Nerv Ment Dis 1986 Nov;174(11):669-79 2 UI - 87025485 AU - Eisen P TI - Potential for psychiatric leadership in health care. AB - Some individual Australian psychiatrists have held influential positions in the administration of health care, academic institutions and medical research. It is timely to assess whether individual or group action best meets psychiatry's professional and service needs. Through an exploration of aspects of professionalism, power, leadership, change in the nature and control of health care, and psychiatry's political roles, a case is made for corporate action aimed at psychiatry establishing leadership roles in Australian health care. MH - Australia ; Ethics, Medical ; Family Practice/TRENDS ; Human ; Interprofessional Relations ; *Leadership ; Physician-Patient Relations ; Psychiatry/*TRENDS ; Referral and Consultation/*TRENDS SO - Aust NZ J Psychiatry 1986 Jun;20(2):107-11 3 UI - 86277218 AU - Dommisse J TI - The psychological effects of Apartheid psychoanalysis: social, moral and political influences. AB - The notorious governmental policy of Apartheid affects the people of that country psychologically, as well as politically, socially, economically and medically. It does so in a variety of ways, including: the humiliating effects on blacks and arrogance inducing effects on whites; the disruption of family-life by the enforced migrant labor system; the stunted brain-development and behavioral effects that result from the inexcusably widespread childhood malnutrition in that wealthy country, (the world's 6th-largest food-exporter); the distortions and alienations in personality development, on racial lines; the mental breakdowns and suicides that result from the physical and mental torture that unchanged security-police detainees are subjected to while under interrogation. In addition, when mental health services are required they are grossly inferior for blacks, especially in the rural areas and particularly in out-patient care. The white-doctor: black-patient relationship, perforce the rule, is distinctly problematic in this socio-political climate. The World Medical Association and the World Psychiatric Association have been supportive to the South African government and silent, respectively, in the face of all the documented information on this hazardous public health situation. The United Nations and its agencies, the World Health Organization and the Centre Against Apartheid, should be commended for their work and unequivocal stands on this issue and should be heeded in their calls for a principled response by more of the world's psychiatric, psychological and medical communities. MH - Blacks/PSYCHOLOGY ; Human ; *Mental Health ; Mental Health Services ; Morals ; Nutrition Disorders/PSYCHOLOGY ; Personality Development ; *Political Systems ; Politics ; *Psychiatry ; Race Relations ; Social Control, Formal ; Social Identification ; South Africa ; Sports ; Torture ; Whites/PSYCHOLOGY SO - Int J Soc Psychiatry 1986 Summer;32(2):51-63 4 UI - 86275227 AU - Dechesnay M TI - Jamaican family structure: the paradox of normalcy. AB - The relationship between basic research, theory, and clinical work with families is conceptualized during a discussion of Jamaican family structure and the application of change theory to a clinical case of depression in a Jamaican woman. It was found that three types of family structure are prevalent in Jamaica. The European ideal of a patriarchal-patrifocal structure creates problems for working-class Jamaicans. General system theory provides support for a different model. Change theory is applied to resolve the paradox created by the European model. MH - Adjustment Disorders/THERAPY ; Case Report ; *Culture ; Dominance-Subordination ; *Family ; Family Therapy ; Female ; Gender Identity ; Human ; Jamaica ; Male ; Models, Psychological ; Social Class SO - Fam Process 1986 Jun;25(2):293-300 5 UI - 86260375 AU - Mu:noz JA TI - Countertransference and its implementation in the treatment of a Hispanic adolescent boy. AB - The literature on the psychotherapeutic treatment of Puerto Rican and Hispanic Americans primarily focuses on unique cultural characteristics that may affect the initial transference reaction. Cultural values and beliefs related to authoritarianism (Mu:noz 1981), dependency (Bluestone and Vela 1982), espiritismo (Comas-Diaz 1981), etc., have been identified as important in shaping initial expectations and attitudes toward psychotherapy. Therapists have been advised to become familiar with and sensitive to such characteristics and their manifestations and to be honest with themselves and patients about their prejudices (Sue et al. 1981). Otherwise countertransference is not discussed in depth. The following case presentation of an intellectually gifted Puerto Rican boy, Regalado, will illustrate some of the countertransference problems, such as overidentification, class differences, and unresolved conflicts about minority group membership, which have been identified as disruptive to the therapeutic process (Griffith 1977). It is generally agreed that one must be more active in the treatment of minorities or poor people. Maduro (1982) recommends that in working with Latinos, dream analysis be consistently related to sociocultural issues and that the healthy or creative aspects of the unconscious be emphasized. He also recommends a warm and personal attitude and active participation in communicating and interacting with the patient. MH - Adolescence ; Case Report ; *Countertransference (Psychology) ; Culture ; Dreams ; Fantasy ; Hispanic Americans/*PSYCHOLOGY ; Human ; Intelligence ; Male ; Professional-Patient Relations ; Puerto Rico/ETHNOLOGY ; Social Class ; United States ; Violence SO - Psychiatry 1986 May;49(2):169-79 6 UI - 86260374 AU - Phillips J TI - Sartre and psychoanalysis. AB - Why read Sartre? Such is the question which is addressed in this article. In a series of publications, principally his monumental Being and Nothingness (1943), the French philosopher of existentialism challenged traditional psychoanalysis with his "existential psychoanalysis.: It has remained a matter of debate whether Sartre's alternative approach to the analysis of human motivation and behavior has any value for the psychoanalytic therapist or theorist. In recent publications two clinicians, Charles Hanly (1979) and Richard Chessick (1984), who have read Sartre extensively, respond negatively, arguing that there is nothing productive in Sartre's challenge to Freudian psychoanalysis. In this article I would like to take issue with that point of view and argue that there is indeed much to be gained from reading Sartre, that the challenge which he poses to traditional psychoanalytic thinking with his "existential psychoanalysis: is in fact a productive one for the contemporary clinician and theorist. MH - Austria ; Awareness ; Conflict (Psychology) ; Ego ; *Existentialism/ HISTORY ; *Famous Persons ; France ; Historical Article ; Historical Biography ; History of Medicine, 20th Cent. ; Human ; Literature, Modern/ *HISTORY ; *Psychoanalysis/HISTORY ; Unconscious (Psychology) SO - Psychiatry 1986 May;49(2):158-68 7 UI - 86240973 AU - Taitz LS ; Wales JK ; Urwin OM ; Molnar D TI - Factors associated with outcome in management of defecation disorders. AB - Simple, incentive based behaviour modification, with or without a modest programme of psychotherapy involving outpatient visits every four to six weeks, seems to be associated with a useful cure rate in children with lower bowel function disorders. Appreciable social disadvantage seems to be the most important factor mitigating against a successful outcome, associated with non-compliance with treatment. Failure to respond to treatment was associated with important psychological problems. These were more common in the socially disadvantaged groups. Children from satisfactory social backgrounds who have lower bowl disturbances can be effectively treated by fairly simple programmes. More elaborate and expensive strategies should be reserved for those whose psychosocial circumstances make it possible to predict a less satisfactory outcome. MH - Adolescence ; Age Factors ; *Behavior Therapy ; Child ; Child, Preschool ; Encopresis/PSYCHOLOGY/*THERAPY ; Female ; Human ; Male ; Patient Compliance ; Prognosis ; Psychotherapy ; Social Class ; Support, Non-U.S. Gov't SO - Arch Dis Child 1986 May;61(5):472-7 8 UI - 86197005 AU - May JM TI - Cognitive processes and violent behaviour in young people. AB - Forty-three subjects from secondary school took part in a correlation study investigating the nature of cognitive processes involved in the presentation of violent behaviour. Measures of violence were scores on "aggression items: of a self-report questionnaire. The experimental procedure involved binocular tachistoscopic presentation of neutral and violent slide pairs. Descriptions of the composite stimuli were scored for violent content. The main finding was that subjects who had reported more involvement in violent acts also reported seeing more violence in the stimulus array. This association held irrespective of age, IQ, socio-economic status and starting mood. It is argued that these findings indicate a perceptual, rather than a response, bias. A role for this bias as a possible maintaining condition in the presentation of aggressive behaviour is presented. The implications of the present findings for interventions with young people are discussed. It is suggested that cognitive techniques may prove more effective than traditional behavioural programmes. MH - Adolescence ; Behavior Therapy ; *Cognition ; Emotions ; Human ; Intelligence ; Male ; Physical Stimulation ; Social Class ; *Violence ; Visual Perception SO - J Adolesc 1986 Mar;9(1):17-27 9 UI - 86140788 AU - Evans LA ; Acosta FX ; Yamamoto J ; Hurwicz ML TI - Patient requests: correlates and therapeutic implications for Hispanic, black, and Caucasian patients. AB - A patient's reason for coming to a psychiatric outpatient clinic (his/her request for service) should be the focal point as a therapist develops an appropriate therapeutic plan for that patient. Data have been collected on 173 Hispanic, Black and Caucasian patients with regard to their reasons for coming to the clinic and selected demographic and process/outcome variables. A factor analysis of the patient request data generated three conceptual factors, which account for 13 reasons for coming to the clinic. The relationship of these factors with selected demographic and therapy outcome variables was tested statistically, and implications for therapy with low income and minority patients are discussed. MH - Adult ; Blacks/PSYCHOLOGY ; Factor Analysis, Statistical ; Female ; Hispanic Americans/PSYCHOLOGY ; Human ; Male ; *Patient Acceptance of Health Care ; Patient Dropouts/PSYCHOLOGY ; *Psychotherapy ; Social Class ; Support, U.S. Gov't, P.H.S. ; United States ; Whites/PSYCHOLOGY SO - J Clin Psychol 1986 Jan;42(1):213-21 10 UI - 86100896 AU - Mollica RF ; Milic M TI - Social class and psychiatric practice: a revision of the Hollingshead and Redlich model. AB - In 1958, Hollingshead and Redlich demonstrated that there were major differences in mental health care for lower-class patients: they primarily received low-intervention treatments from nonprofessional staff. The authors report a follow-up study initiated by F.C. Redlich that reveals new trends at the community mental health center (CMHC) serving the region studied by Hollingshead and Redlich. More than half of the lower-class patients who sought evaluation at this CMHC were discharged without a treatment assignment. Many lower-class patients, however, gained access to the CMHC's psychotherapy unit. Most of these patients were women, employed, and diagnosed as psychoneurotic. The authors conclude that the effect of social class on psychiatric care is less complete than Hollingshead and Redlich originally demonstrated. MH - Adult ; Ambulatory Care/UTILIZATION ; Blacks ; Community Mental Health Centers/TRENDS/*UTILIZATION ; Employment ; Female ; Follow-Up Studies ; Hispanic Americans ; Human ; Male ; Mental Disorders/*THERAPY ; Neurotic Disorders/THERAPY ; Patient Dropouts ; Psychotherapy/METHODS ; Referral and Consultation ; Sex Factors ; *Social Class ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, P.H.S. ; United States SO - Am J Psychiatry 1986 Jan;143(1):12-7