The effectiveness of a therapy group can be evaluated from a variety of perspectives. The opinions of therapists or blind raters are felt by some to be more valid than assessments made by the patients involved in the treatment. However, much can be gained by asking patients what qualities they found helpful in a therapy group. Yalom (1975} has developed a method of studying such qualities, which he calls curative factors, whereby patients rank order statements describing 12 potentially helpful attributes of a group from most to least helpful. The curative factors may be summarized as follows: altruism (helping others}; catharsis (expressing held-in feelings}; existential factors (facing the futility of life); family reenactment (reliving family issues}; group cohesivenes (feeling accepted by the group); guidance {receiving advice); identification (imitating attributes of others); insight or serf-understanding (discovering unconscious motivations); instillation of hope (feeling optimistic by watching others improve); interpersonal learning, input (receiving feedback on behavior); interpersonal learning, output (learning how to deal with others); and universality (feeling less isolated). Using a Q-sort procedure, Yalom had 20 psychiatric outpatients rank 60 statements, five describing each curative factor, after approximately 64 hourly sessions of interactional group therapy (Yalom, 1975).
The diagnosis and treatment of chemically dependent adolescents with a second diagnosis of learning disabilities (LD) or an attention-deficit hyperactivity disorder (ADHD) poses a challenge. Like other so-called dual diagnoses, these conditions must be assessed against the background "noise" of the adolescent chemical dependency syndrome. This syndrome is coincident with the onset and cessation of chemical dependence and abuse. A diagnostic framework for assessing chemically dependent adolescents is presented, with specific reference to the differential diagnosis of LD and ADHD from other conditions. The role of LD and ADHD is assessed with regard to being a risk factor for chemical dependence in adolescence. Treatment approaches, on both an inpatient and outpatient basis, with the chemically dependent adolescent who also has an LD or ADHD are discussed.
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