Wells Goodrich

Adoption Predicts Psychiatric Treatment Resistances in Hospitalized Adolescents

This study predicted treatment resistance in 104 adolescents undergoing long-term residential treatment from adoptive status. Resistance was defined by rejection of adults and runaway behavior. Results indicated that these hospitalized adoptees: (1) formed significantly closer bonds with peers while rejecting close ties with adults; and (2) had significantly more runaway episodes and hospitalization terminations by runaway than nonadoptees. Termination runaways occurred after 1 year of hospitalization for adoptees. Significantly more adoptees ran away in groups of two or more patients. Psychodynamic and theoretical considerations for psychiatric treatment of adoptees are discussed and illustrated by case material, emphasizing the value of differentiating treatment approaches for patient subgroups.

Introduction of Family Therapy into Child Psychiatry Training: Two Styles of Change

Prior to 1967, I was based at the National Institute of Mental Health for 15 years, and was involved in psychoanalytically-oriented adult psychiatry, child development studies, and family therapy. During the decade following 1967, I spent five years each at two teaching hospitals in New York City* and at Rochester, New York.** At each of these hospitals, a new family training program was introduced where there had been none previously. Finally, in 1978, I returned to Washington and, for the third time, was asked to introduce family therapy into an ongoing child psychiatry fellowship program at Georgetown University Medical Center. In this paper, I will take the opportunity to reflect upon these three experiences. They illustrate two contrasting styles of introducing family therapy training into training programs in psychiatry, programs which had previously concentrated primarily upon individual diagnosis and therapy.

Transitional object attachment in normal and in chronically disturbed adolescents.

Our study investigated transitional object (TO) attachment, in adolescence, and in earlier childhood. We expected attachment to be skewed by psychopathological development. Our findings demonstrated that neither occurrence nor duration of attachment to a childhood TO had a statistically significant bearing on psychopathology in adolescence. Attachment to a TO in adolescence, particularly if it was the first time a TO had been used, did have a significant correspondence with psychopathology and/or with the treatment situation.

Gaps in Family Therapy Practice: Discussion of Dr. Langsley’s Paper

Dr. Langsley has raised several major training and clinical issues with which I resonate strongly. The training of residents, psychologists, and social workers is very complicated in the diagnostic treatment planning phase with the disturbed child. How do you make the choice of whether to go one of three ways: traditional one-to-one child therapy, family therapy alone, or concurrent individual and family therapy? This depends partly on what population you have in the clinic. You may end up, at least in Rochester where I used to be Head of Child Psychiatry, with something like 40% or more of the cases initially assigned to classical one-to-one therapy. Or, do you go the road of an exploratory initial period with both individual therapy and concurrent family therapy, while you are getting more deeply involved in both the understanding of what is going on here and beginning to make certain initial therapeutic moves? Or, do you see that individual therapy is really not relevant and you should start right out with family therapy alone? Until we conduct more research and follow-up studies, we will not be clear about the appropriateness and effectiveness of various treatment strategies.