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Noninstitutional treatment for sex offenders in Florida.

The authors describe the availability and characteristics of noninstitutional treatment for sex offenders found in a survey of 63 community mental health providers in Florida. The results cover offense categories, referral sources, numbers in treatment, annual case load, and program characteristics. More sex offenders were being treated in the community than in state-operated residential programs, and 21% of the patients currently receiving community treatment were self-referred. The authors recommend that researchers and policy makers direct more attention to community treatment of sex offenders, its efficacy, and training for those delivering the treatment.

Community Mental Health Centers↗

Briquet's syndrome, dissociation, and abuse.

OBJECTIVE: To help clarify the complex association between childhood abuse and adult psychopathology, the authors examined the relationship among abuse, Briquet's syndrome (somatization disorder), and dissociative symptoms. METHOD: Ninety-nine female psychiatric clinic outpatients with a history of somatic complaints were assessed for Briquet's syndrome, dissociative symptoms, adult and childhood sexual abuse, childhood physical abuse, and childhood emotional abuse. RESULTS: Women with high dissociation scores and many somatic symptoms were more likely to report abuse than were subjects with low dissociation scores or with few somatic complaints. CONCLUSIONS: Briquet's syndrome, dissociation, and abuse are significantly associated. Awareness of this association may have a significant effect on the treatment of psychiatric patients.

Adult↗

Childhood abuse in patients with conversion disorder.

OBJECTIVE: Despite the fact that the assumption of a relationship between conversion disorder and childhood traumatization has a long history, there is little empirical evidence to support this premise. The present study examined this relation and investigated whether hypnotic susceptibility mediates the relation between trauma and conversion symptoms, as suggested by Janet's autohypnosis theory of conversion disorder. METHOD: A total of 54 patients with conversion disorder and 50 matched comparison patients with an affective disorder were administered the Structured Trauma Interview as well as measures of cognitive (Dissociative Experiences Scale) and somatoform (20-item Somatoform Dissociation Questionnaire) dissociative experiences. RESULTS: Patients with conversion disorder reported a higher incidence of physical/sexual abuse, a larger number of different types of physical abuse, sexual abuse of longer duration, and incestuous experiences more often than comparison patients. In addition, within the group of patients with conversion disorder, parental dysfunction by the mother-not the father-was associated with higher scores on the Dissociative Experiences Scale and the Somatoform Dissociation Questionnaire. Physical abuse was associated with a larger number of conversion symptoms (Structured Clinical Interview for DSM-IV Axis I Disorders). Hypnotic susceptibility proved to partially mediate the relation between physical abuse and conversion symptoms. CONCLUSIONS: The present results provide evidence of a relationship between childhood traumatization and conversion disorder.

Adult↗

Children who are victims of sexual assault and the psychology of offenders.

Psychiatrists and others have too often discounted reports of sexual attacks upon children and ascribed the incident to fantasy. The author's experience in private psychoanalytic practice and in Philadelphia's rape victim clinics indicates that these assaults occur frequently. If the sexual attack is dealt with improperly or repressed it may cause serious psychologic problems for the victim as an adult.

Adult↗

Theories of narcissism and trauma.

The more severe the pathology, the more one is likely to be dealing with sexual and aggressive fantasies and transferences based on actual traumas sustained by the child. Psychic trauma interferes with the normal structuring of experience. The psychotherapist needs to help transform traumatic registrations into more or less normal memories and tolerable affects. This organizing and structuring process, which brings with it increasing cohesion of self- and object-representations, corresponds to a crucial 'self-object' function of the therapist. The 'trauma paradigm' of psychopathology, with its implied organizational point of view, explains this structuring action of analytic therapy and bridges general psychoanalytic theory and special theories couched in object-relations language.

Denial, Psychological↗

Depression in abused and neglected children.

Depressive affect of continuing depression do occur in children. Behavioral symptoms can be described as masked depression. Deficient rearing, neglect, and physical and sexual abuse are most significant causes of childhood depression. Suicide and suicide attempts usually result from prolonged depression. Management must be multidisciplinary and aimed at rehabilitating child and family.

Adolescent↗

Elective brief psychotherapy with children.

There does not as yet exist a clearly unifying concept of brief psychotherapy with children. Various forms of shortened treatment have been reported as successful. The technique described in this paper is a form of individual therapy based on psychoanalytic principles, especially those of ego psychology. It is primarily recommended for children who have suffered a real of symbolic object loss. Distinctive features include the early definition of a focus, a predetermined time limit, and careful attention to termination issues. The goals are relatively ambitious. When successful the therapy results in persistent psychodynamic changes. Case examples are used to illustrate how these positive results may occur through the medium of identification with the therapist, which permits a resolution or lessening of ambivalent dependence. This in turn allows the treatment experience to act as a model for future relationships with limited givers.

Adolescent↗

Group therapy with sexually abused adolescent girls.

Clinical guidelines are presented for conducting group therapy with sexually abused adolescent girls, based on a literature review and the authors' clinical experience. Common treatment themes, pragmatic issues related to setting up a group treatment program, and group process issues are discussed.

Adolescent↗