This is the first in a series of reports on an experimental, small-sample study of systemic/strategic team consultations. This report describes a "Milan-informed" method of team consultation for resolving therapy impasses. It then focuses on the initial one-month outcomes from the larger 3-year project. Eleven therapists were asked to select two ongoing cases matched for difficulty. While all cases continued in regular therapy, one of each therapist's cases was also selected at random to participate in a systemic/strategic, five-part team consultation. Analyses of one-month follow-up data showed that clients who participated in the team consultation were more likely to achieve their main and overall treatment goals than clients who received only regular therapy (p's less than .05, eta2 as a measure of effect size ranging from 32% to 41%). The strong findings of this initial study encourage more widespread use of team consultations as a context for treatment, training, and research.
This is the third in a series of reports on a small-sample study of systemic/strategic team consultations. It sheds new light on aspects of the therapeutic alliance in Milan-informed therapy. Ratings of the end-of-session interventions and ratings of the therapist's relationship skills (warmth, active structuring) significantly predicted client improvement at 1-month and 3-year followups. These results dispute the Milan team's idea that an intervention's effects are unpredictable. Also, our findings challenge the way some teams have adopted an impersonal, emotionally unresponsive style under the guise of "neutrality." In view of this and other recent studies, we conclude that systemic/strategic therapists should devote more attention to collaborative and affective qualities of the therapeutic alliance.
This is the second in a series of articles on an experimental, small-sample study of systemic/strategic team consultations. It presents the 3-year outcomes of clients whose 1-month progress was described in an earlier report (12). The 8 therapists in the current study originally were asked to select two ongoing cases matched for difficulty (N = 16). While all cases continued their regular therapy sessions, one of each therapist's two cases were selected at random to participate in a "Milan-informed," five-part team consultation. At 3-year followup, clients who participated in team consultations had maintained significantly higher levels of goal attainment than nonteam clients (p less than .05). For interpreting these results, we propose a developmental theory ("emergent design") to explain therapy impasses, team effects, the impact of termination, and long-range outcomes of therapy.
OBJECTIVE: To determine the rates of various types of infections on an Alzheimer's special care unit (ASCU) compared with the rates found on traditional nursing home units. Because patients on the ASCUs are allowed to wander throughout the unit and typically come into contact with each other more frequently, we hypothesized that the rate of communicable infections such as upper respiratory infections are significantly higher than on other units where patients are more easily isolated when sick. METHODS: A 4‐year retrospective case control study, 1990–1993. SETTING: A metropolitan long‐term care skilled nursing facility. Three floors are traditional nursing care units (123 beds), and one floor is the ASCU (41 beds). PRIMARY OUTCOME: Annual nosocomial infection rates per 10,000 patient days were measured for six types of infection during the 1990–1993 study period. Data were segregated by location of infection, either the traditional nursing units or the ASCU. In 1992, patients on the Alzheimer's unit were placed in smaller activity groups, and an education program for the control of infectious agents was provided to the unit's staff. RESULTS: The relative order of prevalence for the different infection types remained constant during the 4 years. The most common type of infection for all 4 years of the study period was urinary tract infection (UTI), followed by upper respiratory infection (URI), Lower respiratory tract infection (LRI), cutaneous infection, gastrointestinal (GI) infection, and eye infection. Of these various infections, only URI rates remained consistently higher on the ASCU versus the traditional nursing unit over the 4‐year study period (in years 1990, 1991, and 1993; these differences were statistically significant, P < .05). In 1992, the year in which nursing interventions to curb the relatively high rates of URI on the ASCU took place, the rates of URI on the two unit types were not statistically different. CONCLUSIONS: This study suggests that an inherent risk of ASCUs is an increased exposure to highly contagious infections such as upper respiratory infections. An intervention program effective in decreasing this risk to the level of traditional nursing units is proposed. A prospective study is needed to confirm these findings.
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