Engaging with the unknown: How Judaism enabled Freud's psychological discoveries.

A large literature has formed around the question of how Freud's Jewishness and/or Judaism influenced his psychological discoveries and development of psychoanalytic theory and methods. The article organizes the literature into several core theses but brings new clarity and insight by applying two essential criteria to demonstrate an impact of Judaism on Freud's thinking: direct content and historical timing. First, there should be evidence that Freud incorporated actual content from Jewish sources, and second, this incorporation must have occurred during the most crucial period of Freud's early discovery, conceptualization, and development of psychoanalysis, roughly 1893-1910. Thus, for example, Bakan's well-known theory that Freud studied Kabbala is completely negated by the absence of any evidence in the required time period. Part I reviews the literature on the influence of Freud's ethnic/cultural Jewish identity. Part II introduces the Judaic sacred literature, explores Freud's education in Judaism and Hebrew, and presents evidence that Freud had the motive, means, and resources to discover and draw from the "Dream Segment" of the Talmud-along with the traditional Judaic methods and techniques of textual exegesis. Freud then applied these same Judaic word-centered interpretive methods-used for revealing an invisible God-to revealing an invisible Unconscious in four successive books in 1900, 1901, and 1905.

Jail-based competency treatment comes of age: Multi-site outcomes and challenges to the implementation of an evidence-based forensic continuum.

The jail-based competency treatment (JBCT) model has become an established forensic practice across the country. From the perspective of implementation science and the three core elements of the Promoting Action on Research Implementation in Health Service (PARiHS) framework, the JBCT model is a remarkable example of how context (an unrelenting and overwhelmingly strong demand for forensic beds) has driven multiple state governments to facilitate implementation of a methodology in the absence of empirical evidence supporting its efficacy. This 7-year study of outcomes from four JBCT program sites provides this much-needed evidence by showing that JBCT restored 56% of 1553 male and 336 female patients over an average of 48.7 days. At the same time, the study highlights how variations in JBCT models, methods, and preadmission stabilization time present challenges to planned and effective implementation of evidence-based practice at the statewide system level. By identifying differential responsiveness to JBCT treatment by diagnosis and other factors, the study suggests preliminary implementation ideas for what types of patients are well served by the JBCT model as part of a continuum of restoration options that includes inpatient, outpatient and diversion. Significant findings showed that JBCT patients were restored at a higher rate and in a shorter time if they were female, < 20 years old (highest restoration rate; those < 60 years old also significantly better rates), free of co-occurring intellectual and cognitive deficits, and malingering. Of the major diagnoses, schizoaffective disorder required a significantly longer length of JBCT treatment for restoration, and lower restoration rates than schizophrenia and bipolar disorder, although this was moderated by a significant interaction with abuse of amphetamines.

The Absence of Evidence-Based Practices (EBPs) in the Treatment of Sexual Abusers: Recommendations for Moving Toward the Use of a True EBP Model.

Despite a continued evolution of the field of sexual abuser treatment toward a distinct professional discipline with clinicians using an increasing variety of treatment approaches, there is no consensus regarding the strength of our various clinical interventions as evidence-based practices (EBPs). This article provides a brief history of the development and goals of EBPs in medicine and mental health, and a review of the earnest efforts of researchers within the field to establish treatment approaches with sexual abusers as evidence-based. An appraisal of the current status of EBP's with sexual abusers is provided. Although there have been improvements in the methodological quality of treatment outcome research with sexual abusers, divergent opinions about treatment effectiveness remain, and the field has not yet agreed on a system or set of criteria for what constitutes "evidence." We contend that clinical practice has been influenced as much, or more, by new paradigms that are intuitively meaningful and perceived as needed than it has by what has been determined to be scientifically efficacious. This trend and other processes in our field that seem to be slowing the development of EBPs with sexual abusers are discussed. Recommendations for conducting evidence-based reviews and moving the field of sexual abuser treatment toward the use of a true EBP model are provided.

Review of the Empirical and Clinical Support for Group Therapy Specific to Sexual Abusers.

This review compiles 48 empirical studies and 55 clinical/practice articles specific to group therapy with sex offenders. Historically, group therapy has always been the predominant modality in sex offender-specific treatment. In the first decades of the field, treatment applied a psychoanalytic methodology that, although not empirically supported, fully appreciated the primary therapeutic importance of the group modality. Conversely, since the early 1980s, treatment has applied a cognitive behavioral method, but the field has largely neglected the therapeutic value of interpersonal group dynamics. The past decade has seen a growing re-appreciation of general therapeutic processes and more holistic approaches in sex offender treatment, and there is an emerging body of empirical research which, although often indirectly concerned with group, has yielded three definitive conclusions. First, the therapeutic qualities of the group therapist-specifically warmth, empathy, encouragement, and guidance-can strongly affect outcomes. Second, the quality of group cohesion can profoundly affect the effectiveness of treatment. Third, confrontational approaches in group therapy are ineffective, if not counter-therapeutic, and overwhelmingly rated as not helpful by sex offenders themselves. Additional conclusions are less strongly supported, but include compelling evidence that sex offenders generally prefer group therapy over individual therapy, that group therapy appears equally effective to individual therapy, and that mixing or separating groups by offense type is not important to therapeutic climate. Other group techniques and approaches specific to sexual abuse treatment are also summarized.

The ROC program: accelerated restoration of competency in a jail setting.

In 29 months of operation, the restoration of competency (ROC) program provided treatment services to 192 incompetent to stand trial patients in a jail setting. The ROC restored competency for 55% of the patients in an average of 57 days compared to the state hospital average of 180 days. The average cost of treatment/restoration per admission was $15,568 compared to the state hospital average of $81,000. The ROC model accelerates needed treatment for mentally ill defendants, cuts demand for costly state hospital forensic beds, and assists jails in better managing inmates with severe psychiatric disorders--yielding major cost savings and improved care. In addition to preventing readmissions and negative behavioral episodes, the ROC improved the broader forensic system by eliminating the state hospital waiting list, accelerating access to psychiatric services, promoting local access for lawyers and family, and gaining stakeholder satisfaction.

Using the Malcolm Baldrige "are we making progress" survey for organizational self-assessment and performance improvement.

A national healthcare company applied the Malcolm Baldrige Criteria for Performance Excellence and its "Are We Making Progress?" survey as an annual organizational self-assessment to identify areas for improvement. For 6 years, Liberty Healthcare Corporation reviewed the survey results on an annual basis to analyze positive and negative trends, monitor company progress toward targeted goals and develop new initiatives to address emerging areas for improvement. As such, the survey provided a simple and inexpensive methodology to gain useful information from employees at all levels and from multiple service sites and business sectors. In particular, it provided a valuable framework for assessing and improving the employees' commitment to the company's mission and values, high standards and ethics, quality of work, and customer satisfaction. The methodology also helped the company to incorporate the philosophy and principles of continuous quality improvement in a unified fashion. Corporate and local leadership used the same measure to evaluate the performance of individual programs relative to each other, to the company as a whole, and to the "best practices" standard of highly successful companies that received the Malcolm Baldrige National Quality Award.

Forensic continuum of care with Assertive Community Treatment (ACT) for persons recovering from co-occurring disabilities: long-term outcomes.

This study presents the long-term outcomes of a continuum of care program for co-occurring psychiatric disabilities and chemical dependency that has been recognized as a best practice model by the American Psychological Association's Committee for the Advancement of Professional Practice's Task Force on Serious Mental Illness and Severe Emotional Disturbance (APA/CAPP, 2007). Since publication of the initial positive outcomes for 18 men in 2002, this innovative recovery program continued to successfully reintegrate a total of 91 men and women with severe co-occurring disabilities who had been acquitted of violent crimes by reason of insanity (NGRI). This follow-up study showed continued positive outcomes for an additional 73 program graduates in terms of non-reoffending, psychiatric stability, substance abuse abstinence, stable housing and meaningful activity. In contrast to other studies that have applied Assertive Community Treatment and Intensive Case Management to populations with forensic issues and failed to reduce criminal recidivism, this continuum of care recovery model had strong results in preventing criminal recidivism in addition to achieving improved mental health, abstinence and quality of life.

Principles and techniques for maximizing the effectiveness of group therapy with sex offenders.

Group-based interventions are widely used as the preferred method for the treatment of sexual offenders. However, little attention has been given to the vital interpersonal processes within groups, which contribute to their therapeutic effect. This paper describes specific principles and techniques of group therapy that will help sex offender treatment practitioners take full advantage of this unique modality and thereby maximize the positive impact of treatment. In contrast to an individual-focused style that characterizes many sex offender treatment groups, group-focused interventions involve all group members and use the social/relational energy that is essential to the group modality.