Clinical training: challenges for a new millennium.

It is a challenging and intimidating task to comment on the thoughts of several prominent leaders in the field of psychotherapy research and training. For many years I have turned to their scholarly writings for guidance, insight, and understanding. I have also urged my students to read their articles and books, to attend their presentations, and to listen carefully to the reports of these experts about the state of psychotherapy. In the present context Drs. Watkins and Guarnaccia have invited this impressive group of experts to offer their views on the direction in which psychotherapy training is moving and the particular implications of these trends for psychotherapy educators and training programs. To paraphrase the once popular television commercials about an American investment company, "When Levenson, Strupp, Mahrer, Boulet, and Beutler talk, people listen." When thinkers of this stature share their wisdom, I listen carefully, and I urge my colleagues who are involved in psychotherapy training to do the same. In my brief comments, I will discuss some of the challenges that we educators face and attempt to offer some recommendations that are based, in part, on the views of these contributors.

Therapists' attitudes about addressing the role of exercise in psychotherapy.

A questionnaire was mailed to 250 psychotherapists selected from the National Register of Health Providers in Psychology to assess attitudes regarding the discussion of exercise in psychotherapy. Responses were received from 110 (44%) of this group. The study focused on (1) reasons therapists do or do not address exercise in therapy; (2) beliefs about the efficacy of exercise; (3) the relationship between theoretical orientation and the likelihood of discussing exercise; and (4) the relationship between gender and the likelihood of discussing exercise. We found that exercising therapists are more likely to raise the issue and discuss exercise with their clients. In addition, male therapists are more likely to discuss exercise with their male clients than with their female clients. Although cognitive-behavioral therapists are more likely than psychodynamic therapists to use a cognitive-behavioral approach, no relationship was found between exercise variables and primary orientation.

Self- and other-directed aggression in child and adolescent psychiatric inpatients.

OBJECTIVE: To examine self- and other-directed aggression in 89 children and adolescents on a psychiatric inpatient unit to determine ways in which aggressive and nonaggressive patients differ and to discover those factors associated with self-directed versus other-directed aggression. METHOD: Three types of data were collected: ongoing observations of aggressive behavior during hospitalization, Child Behavior Checklists completed by a parent or guardian at admission, and patient and family history data gathered from a retrospective chart review. RESULTS: Compared with nonaggressive patients, aggressive patients were more likely to have a history of antisocial behavior, to be victims of abuse or neglect, to have lived in a foster home, and to have had several primary caretakers. Both groups of aggressive patients engaged in three types of aggressive behavior with equal frequency and were strikingly similar on a host of other variables. Only the number of primary caretakers with whom a patient had lived discriminated self- from other-directed aggressive patients; patients who experienced frequent disruptions in caretaking were likely to engage in acts of self-injury during hospitalization. CONCLUSIONS: Whether a particular patient will engage in aggressive behavior during hospitalization can be accurately predicted from preadmission characteristics; however, the manner in which a patient is likely to aggress, i.e., toward others or self, is difficult to predict because of striking similarities between types of aggressive patients. Further investigations are needed to determine how self- and other-directed aggressive patients differ and to elucidate relationships between disrupted, unstable, or inadequate caretaking and aggression, particularly self-injury, in children and adolescents.