James Spensley

Biofeedback, Brief Psychotherapy and Tension Headache

SYNOPSIS

Doxepin: A Useful Adjunct in the Treatment of Heroin Addicts in a Methadone Program

An uncontrolled trial of doxepin as an adjunct to treatment of heroin addicts in a methadone program was performed over a 14-month period. Approximately 10% (27) of the programs population utilized a mean of 73 mg of doxepin, usually briefly, and beneficial results were noted in 93% (25). One adverse reaction occurred. No instance of habituation or addiction was noted. A controlled study is warranted to confirm the impression that doxepin represents a useful adjunct in the treatment of heroin addicts in a methadone program.

DISCIPLINE STEREOTYPING AND EVALUATIVE ATTITUDES AMONG COMMUNITY MENTAL HEALTH CENTER STAFF

The Adjective Check List was administered to psychiatrists, psychiatric social workers, and clinical psychologists on the staff of a university-operated community mental health center, to measure attitudes toward five mental health disciplines. Adjective stereotypes and evaluative attitudes were highly positive, although social workers tended to be more negative toward psychiatrists than toward the other disciplines. Cognitive and dynamic factors are examined in an attempt to understand discipline differences in stereotyping and evaluative attitudes.

The adolescent transvestite on a psychiatric service: Family patterns

The symptom of transvestism is explored in a study of 18 adolescent boys who dressed in womens clothing and of their families. Twelve of this group who exhibit similar manifest behavior and family interaction are designated as transvestites. Their stated or apparent purpose in cross-dressing is to appear as a girl, with masturbation apparently of secondary importance. A sister is present in these families and is always the mothers preferred child. The mother—daughter relationship is characterized by relative absence of overt hostility. There is an intense interdependent interaction between the mother and the transvestite son; hostility is directed by the mother toward masculinity and specifically toward the sons masculine strivings. Dressing as a girl is openly or subtly encouraged by the mother. The father is present but relates to the son in a distant and passive manner. These observations are tentative, and further study is needed of the dynamics of transvestism. Direct observation of entire families may provide important information about the dynamics of many sexual deviations.

The Support Group in Psychiatric Residency: How Can We Best Help Our Residents?

A support group for psychiatric residents is described and contrasted with another group described. Issues that need to be addressed in the planning of such groups are whom to include and at what stage of residency, the structure and setting of the group, the choice of moderator, and the role of faculty. Specific suggestions addressing these issues are made using the experiences of the two groups and other reports in the literature.

Patients' Stated Preferences for Psychiatric Technicians or Psychiatrists as Primary Therapists—a Comparative Study

a psychotherapist, challenging the traditional position that extensive formal and preferably medical training are essential. In the fall of 1968, two community mental health programmes, one in Sacramento, the other in San Mateo, were invited by the Department of Mental Hygiene of the State of California to submit a proposal that would embody some type of demonstration project around new uses of health services manpower. The Sacramento Project sought to approach new uses of mental health manpower at a point when its community mental health programme was rapidly expanding, and the number of Sacramento County patients treated in state hospital settings was rapidly diminishing. This situation created an increased need for trained professionals in Sacramento. Four licensed psychiatric technicians who had experience in state hospital settings were selected to work in Sacramento to evaluate an expanded role for the psychiatric technician in community mental health. The psychiatric technicians selected were all previously employed in the state hospital system. Their experience varied between three and twelve years. They had an average of 32 college units in related subjects that they accumulate during their employment within the state hospital system. Training had included a comprehensive one year in-service learning process geared toward the complete care and treatment of hospitalised psychiatric patients. Following an initial orientation period of approximately one month, the four technicians were assigned to a newly organised catchment area team. This team of

Interdisciplinary Training of Mental Health Professionals

Interdisciplinary mental health teams are expected to staff the mental health centers of today and tomorrow. Existing training programs do not prepare staff to work in such settings. Instead of being trained separately and then learning to work as a team, mental health professionals should be trained by interdisciplinary programs. Task analysis suggests that such training should develop knowledge and skill in diagnosis-assessment, treatment, consultation, research, teaching, administration, prevention, and professional identity. A one-year training program for first-year psychiatric residents, psychology interns, and Master’s level students in social work and mental health nursing is described. Didactic teaching and clinical experience would be carried on by university faculty who are also members of a mental health team serving a catchment area in Sacramento County.