The Prevention of Rehospitalization of Adolescents and Young Adults

Abstract

This paper presents a family-oriented therapy approach for the prevention of rehospitalization of adolescents and young adults with diverse diagnoses. The dilemma of the family is presented in terms of the incongruities evident in the organizational hierarchy of these families. The main premise is that if the hierarchy is corrected so that the parents are jointly in charge of the youth and the extended kin cooperate, rehospitalization can be prevented. A therapeutic strategy is presented with the emphasis on overcoming the family's attempt to avoid a hierarchy in which the parents are in charge of the family.

Family therapy with adolescent offenders: A collaborative treatment strategy

“…They must be convinced that they are presently gambling with the child's life, and that the child would be much safer in detention than continuing in his or her present lifestyle. Haley (1980) and Madanes (1980Madanes ( , 1981 have identified some basic resistance "themes" that therapists will often encounter when trying to get parents to take an active role in structuring consequences for a youth, which need not be repeated here. In our program, we have developed a synthesis of some of these strategies, added some of our own ideas, and have come up with an approach that has been particularly successful in helping the parents become willing to involve the juvenile system.…”

“…If this doesn't deter the adolescent,, parents may attempt to enforce disciplinary measures such as grounding. Madanes (1980) has noted that sometimes it is necessary to establish a hierarchy of consequences, so that if the youth acts in an unacceptable manner and then refuses to comply with the consequences for breaking it, there is then another consequence of a more serious nature. But some adolescents continue to ignore the more serious consequences as well.…”

“…Among the more viable of these explanations is that there may be more involved in the maintenance of the adolescent's law-breaking behavior than inappropriate family structure or interactions. Madanes (1980Madanes ( , 1981 has noted that while the disruptive behavior of an adolescent may have originally developed as a function of problems in family interaction, when the problem becomes chronic the adolescent's inappropriate behavior may persist regardless of what set it off. For example, there may be payoffs to the adolescent for continuing law-breaking behaviors that are outside of the family's control (i.e., peer approval or financial gain).…”

“…For the clinician working with law-breaking adolescents, some useful literature has recently emerged from the structural/strategic and functional models of family therapy (Alexander, 1973(Alexander, , 1974Alexander & Barton, 1980;Alexander & Parsons, 1973;Barton & Alexander, 1977;Fishman et al, 1982;Haley, 1980;Madanes, 1980Madanes, , 1981. Common to these treatment models is an emphasis on the therapist's involvement in restructuring interactional patterns and helping the parents and adolescent negotiate a set of rules, privileges, and consequences for the adolescent.…”

'Can I (let you let me) leave?’ Therapy with the adolescent and his family

“…The therapeutic framework is based on an understanding of communication (Watzlawick et al, 1967 ;Watzlawick, 1978) ; on the therapeutic use of resistance (Haley, 1963 ;Erickson and Rossi, 1975) ; on the importance of understanding the context within which the problem is maintained (Watzlawick et al, 1974); and on a cybernetic understanding of behaviour patterns (Bateson, 1973;Palazzoli et al, 1978). The main operational base is to identify family structure (Minuchin, 1974;Minuchin et al, 1978;Kaufman and Kaufmann, 1979), and to pay particular attention to violations in hierarchy as a manifestation of system distress (Haley, 1967(Haley, , 1976(Haley, , 1980Madanes, 1980). Such a framework provides the therapist with a framework within which to'work, and outside which to step at times, as he struggles with the complexities of treatment.…”