Personality scales on the Millon Clinical Multiaxial Inventory-II (MCMI-II) for 195 psychiatric inpatients (93 men and 102 women) in a public facility were cluster analyzed to develop an empirical subtyping according to personality traits. Subjects also completed the Brief Symptom Inventory (BSI), Methods of Coping Scale (MOC), and the Level of Expressed Emotion Scale (LEE). The five personality subtypes that emerged were consistent across two clustering methods (K-means and complete linkage). Subtypes members differed on subscales of the BSI, MOC, and LEE. Results support the relevance of personality traits and disorders in assessing psychopathology in psychiatric patients. Results also support the relevance of subtyping these patients according to MCMI-II results.
Psychology as a discipline has contributed significantly to the development of new treatment methods for severe behavior problems such as those found in the chronically mentally ill. Nevertheless, there are relatively few psychologists practicing in state mental hospitals, and it is difficult to attract and retain young qualified psychologists in these settings. The current article examines some of the more common problems that psychologists face in state facilities, with specific focus on organizational, physician-related, and staff-related issues. Recommendations are provided on ways to cope with problems in these three areas.
Psychiatric inpatients with severe character pathology have been identified as among the most difficult and frustrating to treat by the staff o f long-term care hospitals. While behavioral methods have been demon strated to be effective for behavior problems associated with many person ality disorders, they are seldom used in most inpatient psychiatric settings. This manuscript outlines the development and implementation o f a treat ment approach, based on behavioral methods, for two patients with con current borderline and dependent personality features. In each case, initial failures to recognize and implement indicated behavioral interventions resulted in a protracted series o f behavior management failures to the detri ment o f both patients and staff members. The behavioral methods that proved effective, along with issues encountered in implementing the plans, are discussed.Psychiatric patients with personality pathology, particularly those with bor derline features, are notoriously difficult to treat in inpatient settings (Beard, Marlowe, & Ryle, 1990;Miller, 1989;Peters, 1990). Such patients often express powerful and poorly controlled emotions, have a propensity for self-injury, and are considered to be interpersonally manipulative by treatment staff members (Adler, 1990;Drum & Lavigne, 1987). Conse quently, such patients are identified as among the most difficult and frus trating to treat by the staff of long term care hospitals (Colson et al., 1985).The disruption that such patients can generate, along with the modest impact of medications in producing and maintaining consistent behavior change (Ellison & Adler, 1990), has led some to suggest that hospitalization This document is copyrighted by the American Psychological Association or one of its allied publishers.This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Ideological bias is a worsening but often neglected concern for social and psychological sciences, affecting a range of professional activities and relationships, from self-reported willingness to discriminate to the promotion of ideologically saturated and scientifically questionable research constructs. Though clinical psychologists co-produce and apply social psychological research, little is known about its impact on the profession of clinical psychology. Following a brief review of relevant topics, such as “concept creep” and the significance of the psychotherapeutic relationship, the relevance of ideological bias to clinical psychology, counterarguments and a rebuttal, clinical applications, and potential solutions are presented. For providing empathic and multiculturally competent clinical services, in accordance with professional ethics, psychologists would benefit from treating ideological diversity as another professionally recognized diversity area.
Group psychotherapy with chronically mentally ill patients on psychiatric admission units can be a complex and challenging endeavor. Besides a varied and unmotivated population, numerous other factors that are specific to the admission units of state-supported mental hospitals impinge on the therapeutic process. These factors need to be taken into consideration in conducting group psychotherapy. The current article delineates some of the problems that can affect group therapy in state-supported psychiatric facilities, and some of the techniques that the authors found efficacious in conducting group psychotherapy are discussed.
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