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2 APTO 1 (1958)

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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


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