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2 APTO 1 (1958)

handle is hein.journals/ijotcc2 and id is 1 raw text is: RETURN POSTAOI GUARANTELD The Journal of the Association for Psychiatric Treatment of Offenders September, 1958, Vol. 2 No.1 and 2 Realistic Goal-Setting In Treating Delinquents JACOB CHWAST, Ph.D. It has been becoming increasingly clear that treatment goals for the typical delinquent are quite different from those for the usual neurotic. For the latter, it has been held that treatment should help him achieve sufficient insight into himself to manage his life and his relationships with other people more efectively. While therapy is accomplishing this larger purpose, it has been assumed that his disabling symptoms, if present, would disappear. It is necessary, from the stand- point of therapeutic realism, that this rather ambi- tious, yet laudable, objective not be carried over unchanged from traditional psychoanalytic treat- ment if the therapist is to work successfully with offenders. We have witnessed too many failures by such an approach. Recently, the stress has been correctly placed upon first trying to curb the offender's antisocial acts, and then to socialite him. Later, if it should be possible and necessary, more complete person- ality integration is attempted. This writer has been impressed with the fact cbt in working with non-institutionalized delinquents the ther- apist must proceed from one small victory to another, without biting off too much at one time. It is well and good to try first an curb the anti- social activity of the offender, but to realize only this first goal is quite a feat in itself. If it can be done, so much the better; but one may be unable to achieve this goal completely at the beginning of therapy. Therefore, in the initial contact, the immediate aim may well be merely to keep things from getting worse. By doing this, the possibility of dangerous acting-out can be minimized. The following cases illustrate these principles of real- istic, if modest, initial goals: Laura, sixeen, pretty and rather sophisticated, came an s agency accompanied by a friend because she'd run away from home two days before. Already hanging out with a fast crowd, the girl seemed headed for serious sexual delinquencies, drug-use and other difficulties, in addition, of course, to the immediate risks to herself in living away from home. She spoke with some hatred of her nagging mother, who favored a younger sister, and some contempt of her bragging, nar- cissistic father. When the latter arrived shortly after being called, he brought a friend of the family along. The father was so intent upon proving that he was good to his family, and how impor- tant he was, that it took heroic efforts to impress him with the urgency of the situation. Finally, with the cooperation of his friend, it was possible to get him to restrain his temper for the present. Laura was then released to her father after she had agreed to return the next day with her mother. The family friend also agreed to go home with Laura and her father to smooth things over when they arrived there and to look in on them in the evening. As of now, while arrangements for sustained treatment are being made, Laura has obtained a job and seems to be getting along better with her parents. Roger, a small-sized, twelve year old, had been habitually running away, skipping school and stealing. By allowing the boy to come to the office practically daily, gaining the cooperation of a friend of his father who came with Roger on one occasion, and visiting his home to talk with his resistant parents, sufficient support has been given to keep him out of trouble for the time keing. The point illustrated by these cases is that help to offenders must often be immediate and treatment must proceed by small steps. Merely holding-the-line may prevent further antisocial flare-ups and thus keep the patient from being lost to treatment from the start. Indeed, holding- the-line until normal maturatiooal processes supervene would seem to be a valid and realistic goal in working with many adolescent delin- quents. By this means, recurring stressful situa- tions eoald be handled, even though not too much change in personality might be expected at the time. This consideration would suggest a e- evaluation of the types of agency programs intended for delinquents. While there is the need for intensive treatment facilities, with their usually elaborate set-ups and procedures, it is also essential to provide psychotherapeutic first- aid, with a minimum of formality and a maxi- mum of concrete, on-the-spot service. Narcissism and the Superego In Treatment of Psychopathy WM. HANNIBAL RUBIN, M.D. Narcissism is adominant problem in the treat- ment of psychopathic patients. The histories of such patients indicate that the insecurities in their earliest relationships have caused narcissistic hurts from which they do not recover. Difficulties in his early years, such an tensions between the parents, ambivalence of the maternal figure, and substitution of the parental figures, have been experienced by the psychopath an rejections and set in motion defenses against further injury. In Thomas Mann's novel The Confessions of Felix Krull, we find a rather thorough demon- stration of the factors producing psychopathy. The accounts of the insecurities of his early life Continued on page 3 Psychiatric Treatment Of Juvenile Delinquents FLORA BOENHEIM, M.D. New York, N. Y. Juvenile delinquents are usually set to the psychiatrist by schools or courts. In creating them we must realize that there is not a single cause of juvenile delinquency, but rather a large, often overlapping, variety of social and psychological causes, such as poor economic conditions, bad housing, broken marriages of parents, sibling rivalries, and frustration. One must realis that each juvenile represents an individual problem and that each requires an individual approach, further that with different causes of delisquency and different personalities the methods of uast- meat have to be different, too. What can the psychiatrist do with juvenile delinquents? Of course, he cannot change the social conditions that have aused the trouble, although in cases where the environmental con- ditions are particularly unfavorable he may sug- gest placement of a child either with other relatives or in a foster home or institution. How- ever, successful therapy is possible. The child who is brought to the psychiatrist is generally afraid. He considers his being brought there as a punishment. Therefore he is shy, re- luctane to speak, suspicious and often defiant. The flot task is an break this emotional barrier and to gain confidence. The easiest way to gain contact with a child is often by asking him some friendly questions, such as, if he has friends, what are their names, what games he plays with them, etc. At first he will answer the questions only curtly, but then one question may just hit the point where some interest is provoked in him; he will become more talkative, will gradually lose his fea and suspicion, and gain confidence. To smaller children, up to about eleven years of age, on gives some toys. Watching their play one often sees that they represent their problems Continued on page 3 ptQ

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