RESUMEN
Use of seclusion and restraint on three inpatient adolescent psychiatric units was examined during two five-month periods before and after implementation of a "therapeutic management" protocol. Under the protocol, staff classified disruptive behaviors into four stages and provided verbal and behavioral interventions to control behavior at each stage. Patients who required seclusion and restraint had significant latitude to determine the timing of their release from the interventions and met with staff one hour and 24 hours after their release to explore alternatives to aggression. The number of episodes of seclusion and restraint fell by 64 percent after the protocol was adopted, and the number of patients who required those interventions dropped by 39 percent. The mean duration of episodes of seclusion and restraint was reduced by 59 percent. Therapeutic management provides a corrective experience by addressing the developmental needs, deficient cognitive skills, and poor internalized controls of disruptive adolescents.
Asunto(s)
Adolescente Hospitalizado/psicología , Agresión , Restricción Física , Aislamiento Social , Adolescente , Comunicación , Hospitales Psiquiátricos , Humanos , Capacitación en Servicio , Trastornos Mentales/terapia , Medio Oeste de Estados Unidos , Auxiliares de Psiquiatría/educación , Psicotrópicos/uso terapéuticoRESUMEN
The important, often neglected factor of choice, learned in childhood, is examined in detail and illustrated by clinical examples. The primary etiological factors in psychopathology of choice are: (1) Too much choice allowed before integration is possible; (2) Too little choice allowed and (3) Distortions of choice due to racial, sexual, and religious prejudices or cognitive distortions.