Learning multiple family therapy through simulated workshops.

Multiple Family Therapy (MFT) can be learned more rapidly through simulated workshops. A chronological approach to a simulated workshop is outlined describing mechanics and techniques. The hardest parts of simulated and real MFT are taking off and landing. Specific exercises are detailed to facilitate the early phases when professionals tend to simulate excessive psychopathology. However, recovery is usually rapid and dramatic in simulations; thus, the workshop leaders appear impressive. How to end "healthily" is the final challenge. Group input for assessment of simulated and real MFT is essential. From this feedback, subassertives and schizophrenics may be at the highest risk for deleterious effects from real MFT.

Intra-hospital transfer: effects on chronically ill psychogeriatric patients.

Since the Vermont State Hospital was approaching a major transition period, it was decided to study systematically the effects of intra-unit and inter-unit transfer on its psychogeriatric patients. Ten patients were assessed by means of four standardized measures in the intra-unit study, specifically investigating the effects of integrating wards previously devoted either to chronic or to acute psychiatric illness. Twenty-five patients from a specialized geriatric unit were evaluated, by separate investigators, with respect to changes occuring as a result of their transfer to regional mixed units. The critical incident log, the problem classification form, and the clinical global impression showed some changes, for which there were several possible explanations. None of the changes was as dramatic as predicted by staff members holding divergent views prior to the study. The optimists predicted a "blossoming" of the psychogeriatric patients in the mixed, regional units, whereas the pessimists prophesied dire consequences. The group of patients studied was not completely homogeneous with respect to the effect to transfer. Clinical assessment after transfer could be relied on to detect improvement in some of these psychogeriatric patients and deterioration in others. Some understanding of the complexity of the multifactor determinants of change developed along with increased cooperation among the investigators and the nursing staff. A middle ground of mutual respect for fresh ideas and an appreciation for years of experience was reached.