ABSTRACTS

Maintaining Professionalism in the Face of Emotional Abuse From Clients

Cory F. Newman, , Ph.D.University of Pennsylvania, School of Medicine

The harmful effects of emotional abuse have been studied in children, romantic relationships, and families, but little work has explored the phenomenon of therapists experiencing emotional abuse from their clients. The current paper examines the characteristics of emotional abuse as experienced by therapists, and presents methods by which clinicians can best maintain their professional decorum, responsibilities, objectivity, conceptual skills, and overall effectiveness in spite of aversive interactions with clients. Therapists can facilitate their own staying on task, and can reduce their subjective levels of stress, by utilizing such self-help techniques as cognitive rehearsal, rational responding, assertiveness, and the use of social supports. These strategies help therapists to deal with patterns of hostile outbursts and boundary infringements from clients, without feeling helpless and burned out, and without resorting to terminating their clients prematurely out of desperation. Therapists also can remain suitably professional in managing the cases of emotionally abusive clients by making judicious use of documentation and supervisory consultations. Issues regarding appropriate termination of emotionally abusive clients are discussed, in light of the ethical obligation not to abandon clients. The principle of "therapist self-preservation," is addressed as well, which takes into account the therapist's need to consider his or her own well-being, along with the client's, is addressed as well.



Adapting Cognitive Processing Therapy for Child Sexual Abuse Survivors

Kathleen M. Chard, Terri L. Weaver, and Patricia A. Resick, University of Missouri-St. Louis

With the advent of managed care, there is an increasing need for short-term, empirically based treatments. This article presents a cognitive behavioral therapy protocol for the treatment of adult survivors of childhood sexual abuse, Cognitive Processing Therapy for Sexual Abuse (CPT-SA). Based on information processing, developmental and self-trauma theories, this 26- session model combines group and individual therapy over a 17-week period. Clients are asked to write about the trauma, and explore adaptive, schema congruent, and discrepant beliefs that developed during and after the abuse. Focus is placed on beliefs related to safety, trust, power/control, self-esteem, and intimacy, with individual modules for each of these areas. Initial pilot data (N = 15), clinical implications, and two client case studies are also discussed.



Beyond Parenting Skills: Battling Barriers and Building Bonds to Prevent Child Abuse and Neglect

Lizette Peterson, Sara Gable, Catherine Doyle, and Bernard Ewigman, University of Missouri-Columbia

The grave physical and emotional consequences of childhood abuse and neglect are undisputed. Although the risk factors for child maltreatment are well established, implementing effective treatment methods remains a challenge. This paper describes three treatment challenges and solutions for replacing potentially abusive or neglectful parenting with child-appropriate parenting. The treatment challenges include: (a) conflict between participants' cultural and religious beliefs and our treatment goals, (b) cognitive limitations including inaccurate developmental expectations for the child, and, (c) an excess of negative affect and a deficit of tender feelings for the child. Solutions for these challenges evolved from clinical investigation of participant barriers to treatment, and include Socratic dialogue during treatment regarding culture and religion, use of visual metaphor in explaining abstract parenting concepts, perspective-taking exercises, techniques for anger awareness and management, and activities to increase shared positive affect and maternal emotional awareness. Policy implications and caveats concerning the limited empirical support for these techniques are discussed.



Exposure-Based Treatment for Anger Problems: Focus on the Feeling

Elizabeth Brondolo, St. John's University, Raymond DiGiuseppe, St. John's University and Institute for Rational Emotive Therapy, and Raymond Chip Tafrate, Hofstra University

Excessive anger can foster health problems and damage relationships. Traditional methods for treating individuals with anger-related problems have employed skills training and relaxation methods. This paper proposes that anger and anxiety share many clinical features, and that intervention models that have been effectively employed in the treatment of anxiety disorders can also be used safely in the treatment of anger-related difficulties. Specifically, exposure and response prevention can be effectively integrated with other cognitive behavioral approaches in the treatment of anger problems. Procedures for conducting these treatments are described. Examples are drawn from clinical work with New York City traffic agents, dysfunctional couples, aggressive children, and outpatients self-referred for anger problems.



The Decision-Making Process of Choosing a Treatment for Patients With Civilian Trauma–Related PTSD

Sherry A. Falsetti, Medical University of South Carolina

This article reviews the assessment and treatment of patients with civilian trauma–related posttraumatic stress disorder (PTSD) and presents a decision-making process for choosing treatment components that best meet each patient's needs, based on C. M. Nezu and Nezu's (1995) problem-solving model. Areas of importance for assessment include thorough trauma history, PTSD symptomatology, level of behavioral avoidance, comorbid disorders, coping skills, and distorted cognitions. Instruments available for assessment of these areas are reviewed. Three cognitive behavioral treatments for PTSD are presented: stress inoculation training, prolonged exposure, and cognitive processing therapy. Multiple channel exposure therapy, a treatment that combines PTSD and panic control treatment, is also briefly presented. As there are currently very few empirical studies that have investigated matching client' problems to treatments, particularly with regard to treatment of PTSD, the decision-making process of choosing treatment components from these treatments is discussed.



Stages and Processes of Change in Batterers' Treatment

Jill Walker Daniels and Christopher M. Murphy, University of Maryland–Baltimore County

The transtheoretical model of change (Prochaska & DiClemente, 1984) has been widely researched in the areas of substance abuse and health promotion. This model is applied to the problem of domestic violence, specifically to group treatment for abuse perpetrators. These interventions could benefit by incorporating the transtheoretical model's focus on motivational factors and stage-specific interventions. Clinical suggestions are provided that are appropriate to each stage of change (precontemplation, contemplation, preparation, action, and maintenance), and that correspond to the experiential and behavioral change processes identified by the transtheoretical model.



Cognitive behavioral Treatment of Men Who Batter Their Partners

L. Kevin Hamberger, Medical College of Wisconsin

Treatment of men who batter their partners has proliferated over the past 20 years. Cognitive behavioral treatment approaches are well-suited to violence abatement treatment applications. Such approaches provide both a philosophical and skills-based foundation for violence abatement. Philosophically, cognitive behavioral approaches place behavioral responsibility for violence and its cessation on the perpetrator. Cognitive behavioral approaches also provide systematic, empirically based methods to facilitate specific behavior change. Specific applications of cognitive behavioral methods to the treatment of partner violence are described and discussed. Finally, the community context of conducting partner violence treatment is discussed.



Contextual Factors in the Assessment and Management of Aggression in Dementia Patients

Jane E. Fisher and Diane N. Swingen, University of Nevada - Reno

Aggressive behaviors associated with dementia present serious problems for patients and caregivers. Aggression, which has often been assumed to be an inherent feature of dementia, may actually be adaptive for dementia patients who have limited skills available to manage an environment that becomes increasingly complex as cognitive deterioration progresses. When aggression in dementia patients is examined within a functional analytic framework, it emerges as an adaptive, albeit undesirable, means of communicating distress or discomfort. Idiographic assessment of the influence of setting events, environmental antecedents, and consequences associated with aggression may assist in the development of proactive interventions that modify environmental influences associated with aggressive behavior. Modifying environmental precipitants rather than relying on interventions that attempt to directly eliminate aggression from the patient's already impoverished behavioral repertoire is presumed to be more humane.



Generalization of Social Skills Training for Persons With Severe Mental Illness

Patrick W. Corrigan and Abdul Basit, University of Chicago Center for Psychiatric Rehabilitation

Even though social and coping skills training strategies have been shown to diminish symptoms, improve functioning, and enhance the quality of life for individuals with severe mental illness, research suggests that many of the positive effects do not generalize to other settings and responses. Some have argued that the lack of generalization represents a fundamental flaw in skills training. Others have countered that generalization is not a naturally occurring result of skills training. Rather, transfer training skills need to be strategically incorporated into the training program to facilitate generalization. Five sets of transfer training skills are reviewed here: fading reinforcers, self-management strategies, judicious use of homework, recruiting significant others to participate in the generalization program, and cognitive rehabilitation. The impact of these strategies is highlighted in this paper.