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Ideally, programs for adolescents in psychiatric hospitals should be based on empirical studies of long‐term effectiveness of different treatment techniques. This paper reviews the literature and isolates six variables significantly related to long‐term outcome. Components of the process‐reactive variable are examined separately for predictive ability, and other variables that suggest directions for research are presented. Multivariate research designs examining combinations of refined outcome predictors are suggested.
The processes that augment the continued development of psychotherapeutic competence are little understood. One readily available source of learning is the life experiences of the therapist, particularly those situations which invoke intense affects and may increase empathic capacity. Some life experiences, however, lead to defenses against affect. In particular, situations in which the therapist feels helpless and those which confront the therapist with his or her own death may precipitate intense defenses. Several periods of such defensiveness resulting from discussions with four dying friends are explored and their implications for psychotherapeutic competence are analyzed.
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