The relative effectiveness of EMDR versus relaxation training with battered women prisoners.

Five women prisoners with a history of being battered and who met the DSM-IV criteria for post-traumatic stress disorder were assessed (A phase) and provided with structured relaxation training (RT) (B phase, or placebo treatment), followed by eye movement desensitization and reprocessing (EMDR) therapy (C phase). Using the Beck Anxiety Inventory and the Impact of Events Scale's avoidance behavior and intrusive thoughts subscales as outcome measures, RT alone did not result in any clinical improvements. The subsequent provision of EMDR did not improve upon this lack of success with 4 of the 5 participants; 1 did improve on anxiety and intrusive thoughts. The apparent ineffectiveness of EMDR with these participants may be attributed to several explanations. Foremost perhaps is the hypothesis that EMDR is not sufficient to ameliorate the effects of chronic abuse.

Social work early intervention for young children with developmental disabilities.

Social workers' awareness of and formal involvement in family-centered early intervention for infants and toddlers who are at risk of or who have developmental disabilities has increased considerably during the past 15 years. The functional role that social workers can play on early intervention teams and as coordinators of early intervention services is underscored by the formal recognition of the discipline in the Individuals with Disabilities Education Act. Despite the relevance of social work to early intervention, personnel often enter early intervention practice without the benefit of formal preparation related to very young children with developmental disabilities. This article provides an overview of the definition and identification of developmental disabilities, and discusses the role of and challenges to social work in early intervention.

Interrater reliability of the Brief Psychiatric Rating Scale used at a community-based inpatient crisis stabilization unit.

In 1993, the State of Georgia passed a law reforming the mental health system to include more consumers of services and their families on local boards, to provide services in the community, and to measure and report the outcomes of these services. As mental health services expanded in the community, it became necessary to extend the use of reliable and valid instruments appropriate to a brief treatment setting. This field study investigates the usefulness of the Brief Psychiatric Rating Scale (BPRS) using paired ratings to measure the level of psychiatric symptoms of clients treated in an urban community inpatient crisis stabilization unit. Interrater agreement for all paired assessments exceeded .85 comparing favorably with previous studies reported in the literature. The BPRS was found to be a useful and efficient instrument in this community setting.

Evaluating the effectiveness of short-term treatment at a university counseling center.

The effectiveness of short-term treatment provided to 55 students treated at a university counseling center was evaluated. The Symptom Checklist-90-R was administered at intake and at the termination of treatment for 41 clients, and at initial intake, again after a 6-week no-treatment waiting list period, and again at the termination of treatment, for 14 clients. Statistically and clinically significant improvements in SCL-90-R scores were obtained following counseling for those receiving immediate treatment. Clients in the waiting list condition did not improve until after receiving treatment. This study adds to the existing empirical literature suggesting that university counseling centers provide effective treatment. experience of caregiving. The measure is useful for understanding the close relationship between both the difficult and positive aspects of caregiving and also may be used to identify a caregiver's strengths in clinical and research settings.

Chalk eating in middle Georgia: a culture-bound syndrome of pica?

BACKGROUND: Although geophagia (earth eating) has been observed and documented in many areas of the world, the specific preference for consuming kaolin is less well known. The ingestion of kaolin, also known as white dirt, chalk, or white clay, is a relatively common type of pica found in the central Georgia Piedmont area. METHODS: We reviewed the literature, made informal contacts with Georgia physicians, and arranged semistructured interviews with 21 individuals with a history of chalk eating; we gathered both quantitative and qualitative information. RESULTS: Kaolin ingestion appears to be a culturally-transmitted form of pica, not selectively associated with other psychopathology. CONCLUSION: Kaolin ingestion appears to meet the DSM-IV criteria for a "culture-bound syndrome."

Clinical behavior analysis and clinical social work: A mutually reinforcing relationship.

Clinical behavior analysis (CBA) and clinical social work (CSW) have the potential to gain much from one another. The existing synergistic relation between the fields, however, is largely under-recognized, overwhelmed by the stronger disciplinary and historical associations among behavior analysis and psychology and education. This paper reviews the similarities and differences between CBA and CSW, how they have enriched each other, and the potential for greatly expanded relations between the two fields.

Evaluating outpatient behavior therapy of sex offenders. A pretest-posttest study.

This study compared the entrance and exit scores of 16 patients completing treatment at the Highland Institute for Behavioral Change (HIBC), an outpatient program specializing in the behavioral treatment of sex offenders. Outcome measures included the Minnesota Multiphasic Personality Inventory (MMPI), the Multiphasic Sexual Inventory, and recidivism (rearrest record) posttreatment. Statistically significant and clinical improvements were obtained on a number of these measures. One of the 16 graduates reoffended during the average follow-up period of 26 months (he is now incarcerated). These data are supportive of the contention that outpatient behavior therapy can be effective in reducing deviant sexual arousal and in enhancing appropriate consensual sexual behavior.

A preliminary evaluation of treatment outcomes at a veterans' hospital's inpatient psychiatry unit.

This article describes a preliminary effort to evaluate inpatient psychiatric services at the Carl Vinson DVA Medical Center in Dublin, Georgia. The facility annually treats a large number of veterans for a variety of psychiatric disorders. To determine whether these veterans improved following care, a simple pretest-posttest group design was employed, using the SCL-90-R, to assess psychiatric symptomatology before and after inpatient treatment. Both statistically significant and practically meaningful improvements in symptomatology were evident at discharge. While the research design does not permit causal inferences, low-cost evaluations such as this one simply demonstrating that patients get better are important first steps in empirically determining the efficacy of inpatient psychiatric services, and represent one means of demonstrating accountable practice.

Should social work clients have the right to effective treatment?

Currently, the codes of ethics developed for social workers by NASW and other professional associations do not suggest that clients have the right to receive effective, empirically validated treatment. In addition, the codes place no explicit emphasis on empirically validated treatments when referring to social work competence, education, research, supervision, or the profession as a whole. Does the social work client have the right to receive effective treatment when such interventions are known to be available? Should the NASW Code of Ethics include such requirements to encourage more responsible behavior on the part of social work practitioners? This article considers some of the issues involved in this debate and offers suggestions as to how codes of ethics could be modified to include clients' right to receive effective treatment and social workers' obligation to be educated about and to provide such treatment.

Social work practice with deaf clients: issues in culturally competent assessment.

Persons with severe hearing loss live in a unique cultural context with which social workers may not be familiar. This paper reviews the skills needed for the culturally competent social work assessment with deaf clients, including communication skills, interviewing methods, taking case and family histories and behavioral observation.

Evaluating improvement over the course of adult psychiatric hospitalization.

This paper describes an evaluation of the potential efficacy of adult in-patient psychiatric treatment provided at a private general hospital. Using a simple pretest-posttest group design, 78 consecutively admitted patients, and a valid measure of psychiatric symptomatology (Symptom Checklist-90-R), it was found that the diverse group of patients were statistically significantly improved at discharge, relative to their admission status. This study illustrates a practical effort by social workers to integrate simple evaluative efforts into routine clinical services provided by mental health facilities, efforts consistent with managed care, the demands of third-party-payers, and the profession's initiatives in the direction of empirically-based practice.

Exposure therapy in the treatment of vaginal penetration phobia: a single-case evaluation.

A 25-year-old woman with a specific phobia related to vaginal penetration fears was effectively treated with graduated exposure therapy involving self-conducted and partner-assisted homework exercises. Treatment produced a complete resolution of the problem within 12 sessions. This behavior therapy regimen followed the client having received several periods of psychodynamic therapy which did not yield symptomatic improvement.

Promoting an empiricist agenda within the human services: an ethical and humanistic imperative.

Various meta-contingencies inadvertently promote the perpetuation of bogus psychotherapies and other human service interventions. This article outlines some of these perverse incentives and describes counter-controls which could be adopted by the various professional associations, state licensing boards, accreditation bodies, and service providers. These counter-controls have the potential to move human services in the direction of becoming a truly empirical clinical science. This would directly enhance the ethical appropriateness and humanistic goals of the human service professions.

The X club and the secret ring: lessons on how behavior analysis can take over psychology.

In 1864 Thomas Huxley and eight fellow scientists formed a secret organization called the X Club, dedicated to the promotion of Darwinian theory and naturalistic science. Its members active for almost 40 years, the X Club acted as the "power behind the throne" with respect to the governance of the Royal Society and other British scientific groups. In 1914 Sigmund Freud formed the Secret Ring with six other psychoanalysts, dedicated to the covert promotion of their field and to the removal of impediments (persons and policies) to the acceptance of psychoanalysis. After over 20 years of existence, the Secret Ring disbanded, having succeeded in its mission. It is suggested that behavior analysis should adopt a similar arrangement, whereby a group of distinguished scholars quietly but systematically promotes the persons and practices of our field within psychology, with respect to awards, elected and appointed office, and governance.

The reported prevalence of physical and sexual abuse among a sample of children and adolescents at a public psychiatric hospital.

In this retrospective analysis of inpatient charts, a total of 298 children and adolescents admitted to a public psychiatric hospital over a 1-year period were examined for the prevalence of reported histories of physical or sexual abuse. Physical abuse was reported in 15% of the cases, while sexual abuse occurred in 13%. A variety of comparisons were made examining possible differences in gender, age, race, diagnosis, and personality trait disturbance among the abused and nonabused patients. Relative to known prevalence rates as reported to child protective agencies, physical or sexual abuse occurred much more frequently among our sample of patients, suggesting the need for careful assessment of such histories upon admission and during treatment.

Feather picking disorder and trichotillomania: an avian model of human psychopathology.

Animal models of psychopathology have been extremely valuable in conceptualizing various human disorders. The human condition known as trichotillomania (compulsive hair pulling) has considerable similarities with an avian disorder called feather picking, with respect to analogous behavior, proposed etiologies, evoking cues, response to behavior therapy, and response to pharmacological treatments based on serotonin re-uptake inhibitors. We suggest that feather picking disorder has the potential to be a useful animal model of trichotillomania, and lends itself to studies on the experimental psychopathology of compulsive hair pulling.

Reports of childhood incest by adults with panic disorder or agoraphobia.

A convenience sample of 94 members of an agoraphobia self-help group responded to an anonymous survey on their possible histories of childhood incest. 12 (13%) respondents reported such a history. These results are discussed in terms of hypothesized etiologies of panic disorder and agoraphobia.

Extinction and DRO in the treatment of aggression in a boy with severe mental retardation.

A novel use of extinction was applied in combination with differential reinforcement of other behavior to reduce dangerous levels of aggression displayed by an 11-year-old boy with severe mental retardation and cerebral palsy. Data taken during actual treatment sessions and in the client's "natural" environment (classroom and dormitory) suggest that the intervention was immediately effective and that the improvements were maintained and generalized.