Summary / Abstract

Title: Psychotherapy for delinquents?

Synopsis: The results of a psychotherapy consultation service for delinquents are presented. Based on the clinicalmaterial obtained from this programme, and a review of relevant delinquency and psychotherapy literature, a working model ofindividual psychotherapy related to attachment theory as it applies to this population is discussed. Developmental and existentialdifficulties that warrant resolution are included, as are issues with resistance and counter transference. delinquents, psychotherapy, adolescent, treatment, disorders, counter transference, Richards, effectiveness, review, attachment theory, Sullivan, psychiatry, patients, professionals, resistance, individual psychotherapy, psychotherapy literature, therapeutic alliance, psychotherapy consultation service, child adolescent, personality disorder, American Academy, manageable construct, warrant resolution, antisocial behaviours, Farrington, incarceration, secure base, responsibility, self observation,

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Additional keywords for: Psychotherapy for delinquents?

journal adolescence 1996 19 63 73 psychotherapy delinquents ian richards ann sullivan results psychotherapy consultation service delinquents presented based clinical material obtained programme review relevant delinquency psychotherapy literature working model individual psychotherapy related attachment theory applies population discussed developmental existential difficulties warrant resolution issues resistance counter transference 1996 association professionals services adolescents psychotherapy delinquents proposition psychotherapy delinquency questionable involve delivery psychotherapy treatment modality model psychotherapy effective far agreed practitioners tune work formulating manageable construct variety settings point fair say treatment major disorders commonly found delinquents conduct disorder anti social personality disorder synonyms psychopathy sociopathy regarded pessimism werry 1992 describes conduct disorder serious disorders children adolescents virtually untreatable kazdin 1987 result reviewing treatment modalities conduct disorder adolescents concluded particular approach shown ameliorate anti social behaviour lewis 1991 textbook chapter adolescent conduct anti social disorders supports family parent training reservations cognitive training community based interventions address psychotherapeutic options review literature quality assurance project 1991 stating conclusions made treatability anti social personality disorder based body controlled empirical research concludes demonstrably effective treatment disorder regard psychotherapy quote studies shown long term benefits treatment character disorder psychopathy easily understood rutter giller 1983 describe wellknown difficulties treatment delinquency conclude behavioural methods offer promise effective methods dealing reprint requests correspondence addressed i richards new south wales department juvenile justice rivendell adolescent services hospital road concord west 2138 new south wales australia 0140 1971 96 01006311 12 00 0 1996 association professionals services adolescents 64 i richards sullivan delinquent behaviour add claim works seriously misleading argument course place treatment disorders depression psychosis anxiety states frequently co morbid conduct antisocial personality disorders lie obviously domain psychiatry indicators justify psychotherapeutic energy applied management delinquents implications doing certainly questionable outcome adaption studies delinquent young people bleak lewis et al 1994 literature review follow studies concluded seriously delinquent aggressive juveniles likely continue antisocial behaviours adulthood reinforced review adaption approximately 9 years discharge juvenile detention centres 97 incarcerated male delinquents six adult criminal records particular researchers pointed group adequate support subsequent juvenile incarceration enabled function society zoccolillo rogers 1991 criteria weighted violence criminality dsm iii r followed 55 adolescent girls conduct disorder 2 4 years discharge locked adolescent unit found outcome poor subsequent violent death school drop pregnancy 17 years age arrest traumatic injury considerable psychological morbidity social maladaption associated delinquency issue perpetuation disorder farrington 1990 prospective longitudinal study 411 males period 24 years points typical offender tends provide kind deprived disrupted family background children experienced perpetuating generation range social problems offending element concludes major effort tackle problem anti social personality numerous manifestations urgently needed offered strategies early prevention based current empirical evidence link crime numerous social problems suggests measure successful reducing reduce alcohol abuse drunk driving drug abuse sexual promiscuity family violence school failure unemployment marital disharmony divorce imperative therapeutic action based dire consequences inaction studies generate proceed review fonagy target 1994 outcome end outpatient psychoanalytic treatment 135 children disruptive behaviour disorders average age 9 0 years found improved matched sample emotional disorders favourable result conduct disordered subjects 23 oppositional defiant disorder 56 particular authors suggest effectiveness treatment maximized offered relatively intensively initially 6 12 months prevent premature attrition proceed time consistent view conduct disorder chronic condition lewis 1991 aacap official action 1992 need therapy active order engage notoriously untrusting clientele described edelman goldstein 1984 demonstrated significantly responsiveness low empathy high genuineness interviewer style delinquents sherwood 1990 describes unconventional approach challenging narcissism means overcoming early resistance treatment developmental pathway vaillant 1975 describes therapeutic strategies incarcerated psychopaths points controls cases 65 psychotherapy delinquency external containment established stigmata psychopathy disappear patients appear fully human indistinguishable patients personality disorders familiar psychiatric teaching units apparently immutable deficits emerging dynamic understandable defence mechanisms familiarity patients make difference consultation treatment programme offered central sydney health services rivendell child adolescent family services central sydney community health young offender population community detention developed scheme delivery individual psychotherapy delinquents preliminary results programme follows subjects results group 45 boys two girls seen psychotherapy 1990 1994 subjects referred regional juvenile justice services seen detention community progressed juvenile justice system essential criterion referral seriousness case difficulty management perception referring agent psychological factors needed addressed manifest antisocial behaviours covered spectrum adolescent offending violence murder armed robbery serious larceny car theft break enter drug possession distribution psychological profiles reflected consequences abuse abandonment neglect family violence substance abuse school failure major loss form hate rage mistrust revenge destructiveness restlessness hopelessness disparity sexes admission policy detention centres adult jails visited age range first seen 11 20 mean age 16 9 years recidivist offenders five subjects two episodes charged police courts incarcerated serious nature offence seen weekly initial phase contact reduced periods minimal contact eight seen period 3 months 10 3 6 months nine 6 months year 11 1 2 years nine 2 years impact outcome measured conjointly authors assessing changes improvements three levels parameters major changes indicated demonstrable absence problem behaviour ideation case attitudes significant growth positivism self observation interpersonal awareness recognition rights moderate changes defined demonstrated consistent improvements variables reaching level close extinction negative behaviours attitudes minimal change indicated little consistent observable improvements occurred ratings determined observations made treatment setting reports provided variety community detention settings school work place family parameters assessed follows i degree therapeutic alliance willingness enthusiasm psychotherapy tolerate obstacles distance commitments rivalries staff peers order attend ability work 66 i richards sullivan structural guidelines therapeutic process ii amounts psychological work carried covered willingness attempt put thoughts feelings words explore current past areas psychological conflict hurt acknowledge defensive attitudes develop better coping skills iii outcome attitude psychological self concept object relations control willingness take responsibility acknowledgement feelings ambivalence aspirations positivism vs destruction iv outcome behaviour amount antisocial behaviour violence theft coercion retribution subversion drug abuse manifest community detention centre behaviour known assessors legally sanctioned v offending determined receiving charges results preliminary based observations service developed clinical treatment opposed research purposes going evaluation proceeding strong therapeutic alliance achieved 12 25 6 subjects 22 46 8 moderate 13 27 6 minimal eleven 23 4 subjects processed intensive amount psychotherapeutic work moderate 14 29 8 limited 22 46 8 outcome regard attitude psychological factors major eight cases 17 0 moderate 13 cases 27 6 minimal 26 cases 55 4 behavioural improvement marked 13 cases 27 6 moderate 19 cases 40 5 minimal 15 cases 31 9 results regard offending difficult assess 20 subjects released custody released 27 average period 13 0 months 10 offences 15 showed reduction offending two showed change general subjects better outcome regard attitudinal behavioural changes stayed therapy longer period time greater 6 months developed stronger alliance done therapeutic work consistent dosage phase models psychotherapeutic effectiveness howard et al 1994 postulate degree complexity change psychotherapy result phases change period time allows dosage therapy impact conclusive picture outcome obtained recidivism rates 20 subjects remained incarcerated numbers assess adequate results hand improvement 25 27 released promising 89 subjects recidivist offenders bearing mind results integrated concepts relevant psychotherapeutic literature key issues psychotherapeutic model provided talk answering question asked sceptical delinquents psychotherapy negotiated avoided defining major areas therapeutic work outset provides basis contract clarifies delinquents intuitively understand needs happen remedy deficits straightforward structured addressing complex task clarifying interconnected themes 67 psychotherapy delinquency events past psychotherapeutic intervention delinquents needs target psychological consequences major developmental let degree trauma addressed considerable regard likened experience adult subjects engaged psychoanalytically orientated psychotherapy family factors contributing poor parental supervision harsh erratic child rearing parental conflict separation farrington 1990 parental psychopathology sociopathy alcoholism family violence abuse lewis et al 1989 luntz widom 1994 defiant antisocial siblings jones et al 1980 short background characterized disruption deprivation insecurity school experiences rarely better delinquent learning difficulties low intelligence attainment combined troublesomeness impulsiveness truancy farrington 1990 likely result poor achievement conflict school administrative hierarchy association friends delinquents result delinquent falls hands society minders werry 1992 alienation experienced family school likely compounded belongs racial ethnic minority events present delinquents seek minimize justify offending test therapist values manoeuvre needs negotiated order begin necessary process social relearning parallels drawn victimization present victimization delinquent egocentricity interpersonal disregard extends aspects functioning stealing violence affectional relationships attempt avoid processing material suggesting required fresh start unpleasantness put forgotten emotions defences extensive catalogue misfortune easily accessible psychotherapeutic context achieved defensive coping strategies delinquent need traversed vaillant 1975 describes development defences context sociopath offender describes apparent inability patient tolerate anxiety result learning postpone gratification treatment context transferring anxiety staff treating sociopaths feel feel fear lest feel staff working delinquents therapeutic context experience young person inability tolerate emotion characteristic projective identification splitting psychotherapist aware manage responses defensive manoeuvres clarify resultant apparently inexplicable emotions primary workers anger hopelessness fear consequences projective identification grandiosity devaluation peer conflict splitting vaillant likens depression patients bereaved 68 i richards sullivan children lieu depression exhibit intense persistent anger reproach objects self hardly surprising degree intensity emotion likely dealt externalizing responsibility immediate discharge behaviour intrapsychic defensive processes strategies delinquents adept quality assurance project 1991 describes patients antisocial personality disorder scolded parents teachers police jailers parole officers girl friends employers fact authority long remember deal continuum responses delinquent unconscious denial lying manipulation delinquent behaviours aimed achieving mastery dominance aggressive pre emptive strike safeguard attacks delinquent come believe inevitable polygamy promiscuity means dealing fear intimacy affectional betrayal crime means achieving excitement counter depressive boredom identification criminality adolescence ambivalent crime thing good means gaining quick rewards expression grievance society hand likely lead incarceration adult jail adolescents fear non productive marginal existence adolescents avoid summary looking constellation serious say profound personality deficits deviant coping strategies little wonder cambridgesomerville study mccord 1978 reported farrington 1985 average five years regular friendly attention counsellors ineffective preventing recorded offences combination major personality dysfunction failure simple helping approaches suggests psychotherapeutic work delinquents easy difficulties population problem major tool psychotherapist trade words result articulation experience hard technique delivery regular friendly attention constructive model particular assertion marmor 1980 first foremost basic matrix successful psychotherapy good patient therapist relationship rests largely trust rapport engendered therapist genuine interest respect empathy patient patient motivation helped applicable delinquents surface contradicted study edelman goldstein 1984 prescribes low empathy high genuineness therapeutic stance patients best explained related delinquent ability accurately assess interpersonal fraud regards therapist pseudo empathic genuine certainly counter transference engendered delinquents considerable likely make development marmor interest respect empathy problematic case therapist positivism diligent genuine sham issues countertransference adolescents general 69 psychotherapy delinquency applicable working delinquents laufer 1975 describes danger therapeutic omnipotence unconscious demand idealized adolescent voyeuristic interest adolescent sexual life need perfect parent delinquent discerns stance exploit withdraw therapy technical analysis therapeutic alliance adolescents made meeks 1971 emphasizes primary function alliance assist youngster understanding link feelings behaviour present context avoidance regression encourages self observation clarification connection feeling action interrupting adolescent propensity act order avoid feeling containment acting helps explain vaillant observation 1975 improvement psychological accessibility offenders closed setting provides rationale significant fundamental containment opposed unstructured indulgence therapeutic management patients spite caveats imposed problems countertransference centrality therapeutic alliance remains detailed elaboration context attachment theory described holmes 1993 view early work bowlby 1944 delineating connection delinquents parental deprivation fitting guidelines psychotherapy young people arisen theories empirical evidence instruments based attachment theory linking early childhood experience clinical status adults parker et al 1992 adolescents rey et al 1993 model operation holmes 1993 secure base components consistency regularity responsiveness reliability negotiated early follows order convinced security delinquent subject base appreciable testing easy acceptance altruism professionals major thrust testing boundary differentiation attempt discover influence therapist therapist need confrontation observed successful group patients vaillant 1975 define boundaries negotiation security facilitated explicit contracting require definition delinquent need contribute work b therapist responsibility attendance absences questioning reflection meaning confidentiality duration contract c anticipated gains adjustment awareness affective state d potential limitations therapist contribute legal process possibility periods negative transference talking exploration achievement secure base enables patient begin tell story emergence coherent autobiographical narrative integrated 70 i richards sullivan resonant story loss pain opposed dismissal enmeshment holmes 1993 delinquents need tested questioning relevance talk educational experience verbal skills compromised developmental deficits environment families promises broken lying adaptive result words little value action mode communication need experience verbal material listened worthwhile require reflections meaning validate reports happened lives clarify confused contradictory opinions hold experiences non verbal therapies adjunct development skills words music art sport valued delinquents source competence admiration means expression particular worth interactions care providers peers therapist young person reports experiences expand exploration feeling therapist needs engage play unresolved delinquents report play therapy demeaning age inappropriate irrational value closeness opportunity expression understanding affords words elicit resistance talking unpleasant deviant material socially personally tabled listener experience deal delinquent feel great shame result closely scrutinize effect words therapist patient material gradually processed new cognitive schemata evolved internal representational models heard lake 1986 personal interaction developed support mechanisms achieved relationship therapist affect problematic delinquents processing emotion central practice dynamic psychotherapy unmanageable directed delinquent therapist view patients emotional release effective associated circumstances past let abuse abandonment betrayal transferential mode difficult delinquent associate origins old trauma finish clear patients going review considerable past present dysfunction require option extended therapeutic contract open allow consultation professionals alliance delinquent easily transferable secure bases easy precious jealously guarded hand base allow possibility exploration return allow achievement developmental growth safeguards adolescent feeling clung worthwhile principle maintain treatment delinquent patient working terms agreed contract extending inevitable periods therapeutic inactivity long 71 psychotherapy delinquency ill advised consideration break treatment available option re engaging adjuncts relationship models models containing essentials practice brevity convey story discernable experience familiarity client group essential functioning model provision supervision therapeutic alliance conceptualized core variable regard outcome prescription inherent risk development perverse alliance sexual dependent narcissistic voyeuristic variants contained detailed supervision case monitoring understanding counter transference psychotherapy severely disturbed adolescents essential ability cause helper relive adolescence particular painful unresolved aspects acting far alliance extend therapeutic session delinquents forsaken families perceiving family inadequacies holding families responsible parlous situation ask therapist attend significant events particular major court cases attempt churlish viewed lack commitment young person therapist need act delinquents behalf areas police notoriously provocative repeat young offenders supervisory staff detention community lovers family needed fight young person battles encourage dealing listen respond positive new behaviours initiatives therapeutic models argued therapeutic models best operate practised pure form family therapy diluted concurrent individual therapy model based attachment theory preclude treatments particular cognitive behavioural techniques population blakely davidson 1984 varley 1984 anger management control feindler ecton 1986 work effectively instituted acknowledgement therapy violence conflictual issue imposed treatment violence denied rationalized egosyntonic experience cognitive schemata underpin model internalized young person describe situations obviously calculated provide narcisstic gratification therapist usefulness talking value human relationships need control boundaries rewards perseverance work 72 i richards sullivan differences analytic model therapies delineate major task reviewing resolving developmental experience extended time frame model active neutral regard encouragement young persons volition choices therapist figure projected delinquent life story vehicle understanding transference interpretation major trauma interpersonal catastrophe found delinquent past procedure fraught difficulty danger experienced clinician say distortions alliance based transference occur recognized clarified processed therapeutic paradox summary model offered psychotherapeutic treatment delinquency embodied paradox young people oppressed wounded victimized family society course development warrants diminution responsibility actions helping strategies based appear change group patients improved giving external locus control working coming terms developmental vicissitudes process facilitated therapeutic alliance supported active direct communication stance boundary differentiation counter transferential probity ability withstand testing emphasis converting action words secure base provided embarkation adaptive development continuation considerable period acknowledgements professor m bashir professor j rey comments earlier drafts paper references 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