Using a cognitive analytic approach to formulate a complex sexual and violent offender to inform multi-agency working: developing a shared understanding

Abstract

Cognitive Analytic Therapy (CAT) is a collaborative time-limited psychotherapy developed by Ryle. The approach aims to formulate how early experiences influence the development of unhelpful patterns that maintain a person's current difficult experiences. Within the UK, forensic services personnel are increasing their uses of CAT approaches within contextual, i.e. treatment teams, settings. Offending behaviour is relational (perpetrator to victim), and CAT is a relational model. Within the context of National Health Service consultation service (Serious Offender Liaison Service) working with the Police and Criminal Justice Social Work to assess, formulate and give advice regarding working with serious sexual and violent offenders, often with personality disorders, a case example is presented. The paper suggests that utilising a relational model, such as CAT, and applying one of the main the tools of this approach, through diagrammatic representations (maps) of the formulation, can enable agencies working with an individual to share a common formulation and language.     

Personal construct psychotherapy: Fixed-role therapy with forensic clients

Abstract

Fixed-role therapy, a dramaturgical approach to psychotherapy developed by Kelly in 1955, has been used in a variety of situations over the years with various client groups, including criminal offenders. Some of the benefits and limitations of fixed-role therapy with sexual abusers will be discussed. It is suggested that the strengths of some offenders, such as the social skills necessary to succeed at confidence games, be recognized and directed in fixed-role sessions. Illustrations of a number of issues will be drawn from two clinical case examples.     

Intervention with sexually abusive young people in Australia and New Zealand

Abstract

Research into the treatment of sexual offenders with an intellectual disability has increased over the past decade. This research can be used to investigate the efficacy of treatment; however, empirical limitations of the research make generalizations difficult. Marques has provided a framework for examining treatment efficacy that emphasizes the contribution of researchers and clinicians to report treatment outcomes rather than a strict reliance on rigorous empirical investigations, such as controlled outcome research. This review uses Marques’ framework to present an overview about group treatment for sexual offenders with an intellectual disability using nine identified studies. This paper attempts to consolidate our knowledge about specific treatment issues, while demonstrating the varied outcomes that are reported in the literature. In employing this framework, the literature suggests that our knowledge can be substantially improved by research addressing specific areas of treatment.     

Using wilderness therapy in treating adolescent sexual offenders

Abstract

This article describes a follow-up study of 14 adolescent sexual offenders who had attended a community treatment programme. A core component of their treatment included outdoor wilderness group therapy. Interviews were conducted with adolescents and parents and tapped several areas including social skills and peer relationships, victim empathy, cognitive distortions, safety plans and coping with high risk situations, sexual offending cycle, perceived level of risk, intimacy and sexuality. The study also examined the child protection service records of the It adolescents. Data from child protection service computer records showed that none of the adolescents had reoffended. Interviews with adolescents and families focusing particularly on the wilderness component of the programme showed positive changes.     

基于提升公安民警幸福感的阅读疗法研究

近年来,国民幸福感相关研究得到世界各国的重视,公安民警是压力密集型的应急职业,需要健康的心理保证才能适应它,但公安民警的幸福感现状令人担忧,开设心理讲座,开办心理咨询热线,通过专家门诊来缓解警察内心的压力,这是问题的一个方面,但心理的自我调适还是最重要的。表现为个人行为,自我完成的阅读疗法是进行心理自我调适的方法之一,利用阅读疗法提升公安民警幸福感的方法进行研究,以进一步增强警队的战斗力。     

重症胃肠功能障碍中西医结合集束化防治管理优化方案研究

目的 观察3个不同的集束化防治管理方案对重症胃肠功能障碍（急性胃肠损伤）患者关键预后指标的影响,筛选优化的集束化防治管理方案。方法 将180例ICU患者随机分为3组,实施3种不同的治疗方案（方案1是尽早限制性给予肠内营养,以及早期给予肠外营养和中药;方案2是尽早给予合理性肠内营养和中药,3 d后肠内营养不足目标热量60%时加肠外营养;方案3是方案2减去中药）,疗程为7 d,比较3种方案对患者腹腔内压（intra abdominal pressure,IAP）、腹腔灌注压（abdominal perfusion pressure, APP）、胃肠功能、病情严重程度、ICU住院时间、28 d存活率、ICU病死率等的影响。结果 治疗后方案2组患者IAP显著降低,APP显著升高,病情严重程度减轻,28 d存活率显著增高（P<0.05）。结论 方案2能改善重症胃肠功能障碍患者的IAP、APP和病情,提高患者28 d存活率,显著优于方案1和方案3。     

降黄散熏蒸治疗湿热内蕴型新生儿黄疸55例

目的 观察降黄散熏蒸治疗湿热内蕴型新生儿黄疸的临床疗效及安全性。方法 将110例黄疸新生儿按区组随机法分为治疗组和对照组,每组55例。两组患儿均接受蓝光照射,治疗组加用降黄散熏蒸治疗,对照组加用茵栀黄颗粒口服,均治疗5 d,观察两组临床疗效及安全性。结果 两组临床疗效比较,差异无统计学意义（P＞0.05）。治疗后两组患儿血清总胆红素水平均较治疗前明显降低（P＜0.05）,两组治疗前后血清总胆红素差值比较,差异无统计学意义（P＞0.05）。治疗组患儿黄疸消退时间较对照组明显缩短（P＜0.05）,不良反应发生率明显低于对照组（P＜0.05）。结论 降黄散熏蒸治疗湿热内蕴型新生儿黄疸具有黄疸消退时间短、不良反应少、疗效显著的优势。     

大黄联合芒硝辅助治疗急性胰腺炎临床观察

目的 观察大黄联合芒硝辅助治疗急性胰腺炎的临床疗效。方法 将68例轻度及中重度急性胰腺炎患者随机分为对照组和观察组,每组34例。对照组患者给予禁食、胃肠减压、抗感染、抑制胰腺分泌、补充液体、营养支持等常规治疗;观察组在常规治疗基础上给予大黄煎液灌胃及芒硝敷脐。治疗后观察临床疗效、胃肠功能恢复情况及主要生化指标（血常规,血、尿淀粉酶,血钙）复常率。结果 两组临床疗效分布比较,差异有统计学意义（P＜0.05）,观察组临床疗效明显优于对照组;与对照组比较,观察组肠鸣音恢复时间、开始排气排便时间、胃管拔除时间、进食恢复时间明显缩短（P＜0.05）;观察组血常规、血淀粉酶、血钙水平复常率均明显高于对照组（P＜0.05）。结论 大黄联合芒硝辅助治疗急性胰腺炎可提高临床疗效。     

活血洗剂熏洗治疗Ⅰ、Ⅱ期肛裂临床观察

目的 观察活血洗剂熏洗对Ⅰ、Ⅱ期肛裂患者的临床疗效。方法 将86例肛裂患者按照随机数字表法随机分为两组,每组43例,对照组应用高锰酸钾洗剂治疗,治疗组应用活血洗剂熏洗治疗,观察两组患者在治疗第1天、第3天、第7天时创面分泌物、创面疼痛、创面肉芽生长情况,以及血清肿瘤坏死因子 α（tumor necrosis factor alpha, TNF α）、白细胞介素 6（interleukin 6, IL 6）水平,随访时观察两组患者肛管静息压（anal resting pressure,ARP）、肛管最大收缩压（anal maximum contraction pressure,AMCP）及大便失禁严重度评分（Wexner评分）。结果 活血洗剂可降低患者的创面分泌物积分、创面疼痛积分、创面肉芽生长积分、ARP、Wexner积分（P<0.05）,降低血清TNF α、IL 6水平（P<0.05）,且以上指标降低程度明显大于对照组（P<0.05）;活血洗剂对AMCP无明显影响（P>0.05）。结论 活血洗剂可减少肛裂患者的创面分泌物,减轻创面疼痛,促进创面肉芽生长,降低炎症反应,改善肛门功能。     

调脾化痰法联合西药治疗非酒精性脂肪性肝病脾虚痰阻证临床观察

目的 观察非酒精性脂肪性肝病脾虚痰阻证患者采用调脾化痰法治疗的临床效果。方法 将80例患者随机分为西药组和联合组,每组40例（最终每组脱落2例）。西药组患者口服西药阿托伐他汀钙片,联合组患者口服调脾化痰汤联合西药阿托伐他汀,两组均治疗2个月（即2个疗程）。观察两组患者中医证候疗效,治疗前后分别检测血脂［总胆固醇（total cholesterol,TC）、低密度脂蛋白胆固醇（low density lipoprotein-cholesterol,LDL-C）、三酰甘油（triglycerin,TG）］和肝功能［丙氨酸氨基转移酶（alanine transferase,ALT）、天冬氨酸氨基转移酶（aspartate transferase,AST）］水平。结果 两组患者中医证候疗效分布比较,差异有统计学意义（P<0.05）。与治疗前比较,治疗后两组患者TC、LDL-C、TG、ALT、AST水平均显著下降（P＜0.05）;两组患者治疗前后TC、LDL-C、TG、ALT、AST差值比较,差异均有统计学意义（P＜0.05）。治疗过程中联合组未见明显不良反应。结论 对非酒精性脂肪性肝病脾虚痰阻证的治疗,中药联合西药的疗效优于单纯西药。