Psychological Disorders:
Traditional psychological treatment suffers two major liabilities...
OUTREACH AND PREVENTION: THE HOPES OF COMMUNITY PSYCHOLOGY
Traditional psychological treatment suffers two major liabilities. First, as we
have seen, it arrives only after a problem has entailed untold misery for the
client. And second, there are simply not enough professional therapists to
treat all those who are in need. As a result, psychologists and psychiatrists
have become increasingly involved in community efforts to prevent and
contain psychological disorders. Because they are allied with others, the efforts
of psychologists can now influence the psychological well-being of a
much larger proportion of the population than is possible through traditional treatment.
These collaborative efforts between psychologists and the community
take place on three fronts: prevention, containment, and alternative modes
of treatment and rehabilitation. We take these areas up in turn.
PREVENTION
An ounce of prevention is worth a pound of cure, we are told. And a review
of the chapters that deal with anxiety, depression, crime and delinquency,
and children's disorders, makes clear that many of the multiple causes of
these distresses could well have been prevented. Unfortunately, our society
budgets much less for preventive efforts than for treatment, largely because
of the squeaky-wheel principle. But it has chosen to invest resources in three
areas that are significant for prevention: child-care facilities, preschool preparation,
and job training.
Child-Care
Imagine a mother raising three children, all of them under five. Worse yet,
imagine her as a single parent, responsible for the economics, as well as the
psychological welfare of her brood.
I had to work at night, while the children slept. If one of them was sick and
needed me, and the neighbor's kid wasn't free to baby-sit, I missed work and pay.
There was one year when I was fired from four jobs because Julie and Richard
were sick a lot and needed me. Finally, l just couldn't take it. Such mothers are
hardly rare in our society. In 1982, it was estimated that
more than five million women maintained families while being employed
(Monthly Labor Review, 1983). And they were not the only ones who
needed child-care facilities. Often, in two-parent families, both adults have
to work in order to make ends meet. Either their own needs, or those of their
children, and commonly both, are neglected.
Child-care facilities provide a safe and healthy environment for young
children, one that parents and children can count on. Not only do they reduce
familial pressures, but often they provide children with experiences
that simply could not be gotten at home, such as learning to socialize with
other children and to respond to adults other than parents. These experiences
are likely beneficial for children when they begin school.
Preschool Interventions
The early school years are fertile ground for psychological problems. Once a
child falls behind in work, fails to make friends, or becomes disruptive in the
classroom or playground, the likelihood is high that these problems will endure
and grow. Often, such problems develop because children are ill prepared
for the school experience, either intellectually or socially. Preschool
programs, such as Operation Head start are intended to encourage the development
of cognitive and intellectual skills necessary for kindergarten and
the early school grades.
Job Training and Retraining
Poverty and unemployment take enormous tolls of psychological distress,
and probably spawn more social problems than any other cause. Simple
economic need often drives people to crime and violence. Training the unemployed
in the host of skills necessary to both finding a job and keeping it
goes a long way toward preventing psychological problems.
It is important to note that psychologists do not usually establish or control
child-care, preschool, or job-training facilities. Rather, their contribution
is made through consultation and collaboration with members of the
community who want to establish these centers in the first place. They often
and successfully consult in schools to increase communication between
teachers, students, and their families (Sarason, 1974). They may even consult
with urban renewal organizations regarding creating new cities that are
psychologically stimulating and that encourage neighborliness and conviviality
(Lemkau, 1969). And often they consult with legislators, policymakers,
and the courts on such issues as school desegregation and detention
of juveniles, issues whose resolution can eventually prevent the development
of psychological difficulties. By collaboration with other members of
the community, the resources of psychologists can be utilized more broadly
and effectively than would be possible in traditional professional roles.
How effective are these efforts at prevention? The evidence with regard to
preschool programs such as Operation Head start suggests that they are not
as good as had earlier been hoped, but that they are surely better than no
preschool training at all. Child-care facilities and job training, on the other
hand, have not yet been evaluated for their impact on psychological distress.
Undoubtedly, they are effective, but how effective is not yet clear. The entire area
of prevention, however, is still in its infancy, still more of a hope than a
reality (Cowen, 1977); it may yet be too early to expect full and careful evaluation of these efforts.
CONTAINMENT
Psychological crises often have immediate consequences. A heated argument
may result in violence; a painful rejection, in suicide; an overwhelming
impulse, in rape, murder, or drunkenness. Containment services are
designed to limit the consequences of such crises, as they affect the individual,
the potential or actual victim, and their families. In the main, these services
are characterized by three features. First, treatment is delivered
quickly. The potential Friday night suicide, for example, need not wait until
Monday morning when the clinics open; by then, it may be too late. He or
she can immediately go to a crisis intervention center, or phone a "hot-line"
for counseling. Second, services are delivered to a broad range of people, including
many who would never seek traditional psychological help. And
third, they are located in the community and offered by the community,
rather than through hospitals, clinics, or professionally trained therapists.
Their very visibility and availability ensures their use.
"Hot-lines"
The telephone hat-line is a twenty-four-hour phone service for people who
are undergoing deep distress. The first of these hot-lines was established
inl958 by Norman Farberow and Edwin Schneidman as part of the Los
Angeles Suicide Prevention Center (Farberow, 1974). Presently, more than
200 communities have developed such centers.
In the main, hot-lines are staffed by carefully trained nonprofessional volunteers.
The primary functions of the volunteer are to establish a sympathetic
relationship with the caller, to help him clarify his problem, and to
formulate a constructive plan that immediately mobilizes the individual's
resources as well as those of family, friends, and community. Volunteers
will often attempt to assess the suicidal potential of their caller, as well as whether
the suicide has already been attempted. This kind of
work is exceedingly stressful for the volunteers, for they, too, are on the "hot
seat." The results of their efforts often determine whether someone will
continue to live, yet because callers often hang up without leaving their
name or phone number, the volunteers rarely learn to what extent they have
helped. As a result, volunteers often become discouraged on this job, and
frequently burn out quickly.
Beyond offering instant counseling, hot-lines serve to educate callers
about available treatment resources. Often, callers will be referred to a community
mental health center, where the causes of the crisis can be explored
and treated in greater depth. The emphasis, however, is not on long-term
treatment, but on crisis intervention and speedy referral.
Such emergency treatment appears effective in reducing suicide rates.
Among 8000 high-risk callers to the Suicide Prevention Center in Los Angeles,
Farberow (1970) reports that fewer than 2 percent committed suicide,
compared to the estimated 6 percent overall rate of suicide among such persons.
Hot-line services have been extended to people who are experiencing
many different kinds of crises. For example, there are child-abuse hot lines,
which seek to cool parental rage before harm is done to children. Other hotlines
exist to defuse impulses to drink, gamble, and engage in violent behavior.
Finally, there are yet others that have no particular focus or specialty,
but that attempt to provide a listening ear and immediate counsel to whoever calls.
Hot-line users are often ashamed of their behavior and their lack of control.
The fact that they are assured of anonymity encourages them to call in
the first place; that may be one of the hot-line's greatest strengths. For while
hot-line services neither cure nor provide long-term solutions, they diffuse
crises and head off serious and immediate losses. That is no small virtue.
Short-Term Treatment
In many cases, distraught individuals may be unable to undertake long-term
treatment, but they may be able to go for short-term crisis treatment. Such
treatment rarely requires more than six sessions. In it, the therapist is extremely
active, helping the client to focus on his or her problem, providing
support and reassurance, and devising constructive solutions (Golan, 1978).
Such crisis intervention often enables a person to resume her life without
hospitalization or disruption of employment.
Help for Victims and Their Families
Being the victim of brutality often has enormous psychological consequences
that, if left unattended, can be long-lasting. Immediately after being
raped, for example, women experience considerable psychological disorganization,
including feelings of insecurity and loneliness and rampant fear,
and they are subject to heightened influence by others. Depending on their
prior experiences and background, these fears and insecurities can develop
into stable patterns of avoidance (Burgess and Holmstrom, 1974). Their
spouses and families, moreover, often experience changes in these women's
attitude and affection that can be directly traced to these traumatic experiences
(Bard and Sangrey, 1979). Political hostages, too, have similar reactions to the
trauma and humiliation that result from being held against their will (Sank, 1979).
Short-term crisis interventions may range from support and counseling, to brief
behavioral treatments that are useful in alleviating and containing these symptoms.
Until recently, battered wives and children had no recourse except to
"take it," or perhaps to turn to the police and courts. As their numbers have
become known, however, concern for these victims has heightened and has
led to the establishment of shelters for battered women. Such shelters provide
temporary sanctuary for women and their children, enabling them to
take some time out to recover from abuse and plan their futures. Staffed almost
entirely by nonprofessionals, their central function is protection. Unfortunately,
shelters arc often dangerous and unhappy places-dangerous
because of possible retaliation from still-angry husbands, and unhappy because
these women are beset with doubts about themselves and their futures.
At present, there are no more than seventy such shelters in the United
States, each able to house from ten to fifty women. But wife-battering is a
much larger problem than these numbers would suggest. Many more
shelters are clearly required, but support from government and social agencies
has simply not been generous...
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More info below:
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For the spouse of a Borderline
For Borderline patients or BPD APD NPD
The Treatment method I recommend
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http://treating-borderline-personality.weebly.com
More info below:
Healing the Unconscious...Looking for therapy?
For the spouse of a Borderline
For Borderline patients or BPD APD NPD
The Treatment method I recommend
is The Liberator Method.
Click here:
http://www.theliberatormethod.com/Welcome.html