Divorce, Placement, and the Child

Those who subscribe to the family systems theory view family as a system made up of the marital, parent-child, parenting, and sibling subsystems, where each of the systems intermittently is influenced by the other (VanderValk, 2007). The family unit is a complex, integrated whole (Cox & Paley, 1997), that when disruption is experienced, such as divorce, becomes severed and the affects onto its members are unavoidable. “Distress in the marital dyad is likely to extend to other parts of the family system,” (Inge, 170). The family stressors caused by the divorce may include one or more affects, such as deteriorated parent-child relations and impaired parenting and parental depression. Additionally indirect stressors, known as spillover effects can include: “problems in the marital realm spill over into the parenting system, thus transferring to the parent-child system,” (Inge, 170). A recent study of middle and high school children found that divorce was identified as one of the main reasons for adolescents to seek counseling services from school counselors (Kesici, 2007). Additionally, children of divorced parents are more likely to commit suicide, become addicted to drugs, report greater levels of stress, and also report that the problems related to their parents’ divorce has affected their personal, social, career, and academic development (Kesici, 2007).

Frisco (2007) finds that “since the 1990's, more then 1 million children each year experience parental divorce, and 50% = 60% of U.S. children born in the 1990's will live in a single-parent household at some point in time,” (p. 722). In the 1960’s the divorce rate began to rise, as result, parents, professional, and family courts were made to make important and difficult decisions regarding the proper placement and custody of the children displaced by divorce (Kelly, 2007). At that time, it was customary for the mother to be a stay-at-home parent, thus being the primary caretaker, and therefore placement was usually granted to her, while allowing for occasional visits with the father (Kelly, 2007). However, around the 1980’s and 1990’s, as gender roles began to change and more women entered the work force, family courts began to see a greater need and benefit in mandating shared placement and custody of the minor children (Kelly, 2007). Today, the family courts and families are making many different placement arrangements. These arrangements vary substantially from; no contact, to every other weekend, to a weekly rotation between households.

While the results of such placements arrangements are difficult to obtain due to the large variation of external and internal factors, the author feels it imperative to focus of the extreme of the placements options, i.e. the rotating weekly placement. This type of placement arrangement has been proposed as a means of keeping fathers involved in the child’s social, educational, and work life, thereby increasing their overall time together. While this sounds beneficial at first glace, there is no conclusive data that suggests such a placement arrangement is better for the child’s development. Kelly (2007) reports that many mothers and mental health professionals express dissatisfaction in this rotation and believe “that children cannot go to school from more than one residence,” (p. 38). Conversely, children themselves, often report a desire to spend more time with their nonresident parent; request longer visits, and would gladly embrace a rotating week placement (Kelly, 2007). While this author believes that the weekly rotation would be emotionally and mentally taxing for the both the child and the parent, limited data has shown otherwise. “Early studies of joint physical custody reported better adjustment of children compared with those in sole custody, and more satisfaction expressed by shared-custody youngsters, but samples were small, nonrepresentative, and self-selected, (Kelly, 46). Such limited research has however “indicated that children in joint physical custody arrangements were better adjusted across multiple measures of general, behavioral, and emotional adjustment, self-esteem, family relations, and divorce-specific adjustment,” (Kelly, 46). Given this compilation of data, it is difficult to determine the specific placement arrangements appropriate to foster the emotional and mental needs of the child. Therefore, it is necessary to consider a wide variety of factors, i.e. parental involvement, mental health, financial resources, child’s wishes, et., before making a placement decision.

Regardless of the placement arrangements, parents’ attitudes and behavior may have the greatest impact on the child’s development, security, and over-all functioning. Cowdery and Knudson-Martin (2005) suggest that mother’s attitudes regarding the father’s involvement are significant to the father’s involvement in the child’s life, both during and after the marriage. Studies have also shown that when a mother believes that she is the better caretaker and remains hostile toward the father, that he is less likely to maintain relationships with his children (Kelly, 2007). “Maternal hurt and anger about the divorce also predicted more perceptions of visiting problems, compared with mothers who were not as angry and hurt, and mothers reported interfering with or sabotaging visits between 25% and 35% of the time,” (Kelly, 41). Unfortunately, when divorced couples are unable to resolve their conflicts and interpartental discord continues, the nonresident parent disconnects becoming less involved, more difficulties arise between the parent-child relationships and subsequently continue deteriorating into adulthood (Ahrons & Tanner, 2003). Carter and McGoldrick (2005) suggest that the way in which a family chooses to reorganize and relate to one another after a divorce is directly related to the health of all the members involved. Further, Carter and McGoldrick suggest that in order to ensure healthy adjustment of children during and after the divorce that; (1) Economic and psychological needs must be met; relationships that were important prior to the divorce must be maintained in a supportive way; the relationship between the parents must be supportive and cooperative; and healthy boundaries are essential.

Over the past 50 years, divorce rates have risen, gender roles have changed, and the family court system has been placed in the position of creating appropriate and fail placement arrangements. While there has been little conclusive data regarding the benefit or harm that such unique placements may cause, it has been found that children thrive emotionally, mentally, socially when involved with both parents. And while parents may not always be in agreement with the findings of the court, or the actions of the other parent, it is essential that they remain unbiased and supportive, always encouraging of the involvement of the one another, in order to provide the greatest benefit to their child.

Stephanie Lowrance-Henckel

References

Ahrons, C.R., & Tanner, J.L. (2003). Adult children and their fathers: Relationship changes 20 years after parental divorce. Family Relations, 52, 340-351.

Carter, B. & McGoldrick, M. (1999). The expanded family life cycle: Individual, family, and social perspectives. Allyn and Bacon. Needham Heights, MA

Cowdery, R.S., & Knudson-Marin, C. (2005). The construction of motherhood: Tasks, relational connection, and gender equality. Family Relations, 54, 335-345.

Cox, M.J. & Pailey, B. (1997). Families as systems. Annual Review of Psychology, 48, 243-267.

Frisco, M.L., Muller, C., & Frank, K. (2007). Parents’ union dissolution and adolescents’ school performance: Comparing methodological approaches. Journal of Marriage and Family, 69(3), 721-741.

Kelly, J.B. (2007). Children’s living arrangements following separation and divorce: Insights from empirical and clinical research. Family Process, 46(1), 35-52.

Kesici, S. (2007). Middle school students’ guidance and counseling needs. Kuram ve Uygulamade Egitim Bilimleri, 7(3), 1325-1349.

VanderValk, I., de Goede, M., Spruijt, E., & Meeus, W. (2007). A Longitudinal study on transactional relations between parental marital distress and adolescent emotional adjustment. Family Therapy, 34(3), 169-190.

Managing the Child with Behavioral Disorders in Group Therapy

As a leader of a support group for children, one can contest that may children with emotional trauma, can be described as disruptive, or with having a behavioral disorder. This child’s bad behavior is not unique, in fact, for those children who have a multitude of external stressors; he or she is the norm. Authors, Kann and Hanna (2000) reviewed current studies related to the prevalence of two behavioral disorders, Conduct Disorder and Oppositional Defiant Disorder, in children. Kann and Hanna (2000) found that risk factors play a significant role in the development of behavioral disorder, these “risk factors can be societal, familial, or individual in nature,” (p. 270). Researchers Moss et. al. (1995) found that most often, low economic status seems to be the most reliable correlate associated with behavioral disorders, while Kann and Hanna (2000) find that parental behavior and disorder seem to be a strong predictor of behavioral disorder in children.

Given the known impact that external stressors can have on a child’s likelihood to manifest behavioral disorders, it would be in both the client and the therapist’s best interest to meet privately in order to discuss the possibility that these issues exist. It is quite probable that the child’s behavior is rooted in the their experience of external stressors. Therefore, to ignore this possibility, and attempt merely to correct the behavior disorder, will surely result in failure to effectively treat the child. Meeting individually will also allow the therapist to discuss the impact and consequence of the child’s behavior onto the other group members without public embarrassment. Yalom and Leszcz (2006) suggest that in order for treatment to be effective “the individual’s behavior and the impact of that behavior on others need to be revealed and processed if the members are to arrive at an empathetic understanding of one another,” (p. 43). Additionally, during this individual meeting, the therapist should reiterate the group rules and behavior expectations that were explained to him or her at the initial meeting; be respectful others; keep hands, feet and other objects to yourself; wait to be called on before talking. It is possible that he or she has forgotten these rules and a simple reminder may prove effective for the next session or two.

While the therapist may be inclined to remove the child from group, it is not necessarily appropriate to exclude the child solely based on their display of behavioral issues. If these behaviors are a result of a trauma they have experienced, it is likely that these will improve as their treatment progresses and their issues are resolved (Kaduson, 2006). Furthermore, clients who present with interpersonal or impulsivity issues typically work better in groups, than they do in individual therapies (Yalom & Leszcz, 2005; Jacobs, Masson & Harvill, 2009). Group therapy, by its nature, is a social setting, which facilitates the development interpersonal skills and learning through modeling. Children, therefore, tend to behave favorably in group settings because of their desire to maintain social cohesion, (Gerrity & Delucia-Waack, 2007).

For the child who unable to verbalize their feelings or the source of their anger, treatment that utilizes play therapy may be effective in a group setting. Through play, children learn to communicate their feelings instead of acting them out, as is the case of with the disruptive child, (Pearce, 2006). Jacobs, Masson and Harvill (2009) also suggest that structured group activities be intermingled with lecture, a method that has shown to be tremendously effective at keeping the child client focused on the topic, thus reducing disruptive behaviors. Consistency is also key, as the child then knows what behaviors and consequences are expected and therefore will be better able to maintain status quo.

In general, child clients, more so than their adult counterparts, have a tendency to evoke feelings within their therapists of irritation, disgust, anger, resentment, sympathy, anguish, and defeat (Church, 1994). Therapists also report that clients with behavioral disorders are often the most challenging and difficult to manage (Kann & Hanna, 2000; Church, 1994). Kann and Hanna (2000) suggest, “the consequences of these behaviors affect not only the children and adolescents who suffer from them, but their families, their peers, and society as a whole,” (p. 267) and left untreated, this disorder can further manifest itself in adulthood. Therefore, while the child may prove difficult to control, it is imperative that they receive treatment.

When working with children with behavior disorders, it is important that the therapist remain empathetic, understanding, and consistent. As previously noted, a strong correlation exists between the presence of external stressors and the child’s likilhood to present with behavioral disorders. Kann and Hanna (2000) report that in most adolscents report that they only feel comfortable with disclosing personal information when they believe that their therapist is genuinely concerned with their thoughts, experiences and feelings. It has been shown that children flourish when in a predictable environment, as these rituals tend to serve as the foundation for structure and stability, thereby setting the tone for healthy interactions (Dickstein, 2002). If provisions are made to incorporate these aspects, group therapy can prove to be incredibly therapeutic and effective in correcting behavioral disorders in children.

Stephanie Lowrance-Henckel

References

Church, E. (1994). The role of autonomy in adolescent psychotherapy. Psychotherapy, 31, 101-108.

Dickstein, S. (2002). Family routines and rituals-The importance of family functioning: Comment on a special section. Journal of Family Psychology, 16, 441-444.

Gerrity, D. & DeLucia-Waack, J. (2007). Effectiveness of groups in schools. Journal for Specialists in Group Work, 32(1), 97.

Jacobs, E., Masson, R. & Harvill, R. (2009). Group counseling; Strategies and skills (6th ed.). ThomsonBrooks/Cole. Belmont, CA.

Kann, T. R. & Hanna, F.J. (2000). Disruptive behavior disorders in children and adolescents: How do girls differ from boys? Journal of Counseling and Development, 78(3), 267-274.

Kaduson, H.G. (Editor). (2006). Short-term play therapy for children (2nd ed.). New York, NY. Guilford Publications, Inc.

Moss, H.B., Mezzich, A., Yao, J.K., Gavaler, J. & Martin, C.s. (1995). Aggressivity among sons of substance-abusing fathers: Association with psychiatric disorder in the father and son, paternal personality, pubertal development, and socioeconomic status. American Journal of Drug and Alcohol Abuse, 21, 195-208.

Pearce, J.W. (2006). Psychotherapy of abused and neglected children (2nd ed.) New York, NY. Guilford Publications, Inc.

Yalom, I. & Leszcz, M. (1995). The theory and practice of group psychotherapy (4th ed.). BasicBooks. New York, NY.

Effects of Child Abuse on Client and Family System

Each year, in the United States, over 3.6 million investigations and assessments are made by social service agencies regarding an incidence of child abuse (the Administration for Children and Families, 2008), and it is estimated that five children die each day as a result of abuse or neglect (U.S. Department of Health and Human Services, 1995). Research has shown that children who live in abusive environments, often manifest a plethora of short and long-term pathological effects including; emotional and mental functioning, decreased social skills, delayed development, failure to thrive (Herrenkohl & Herrenkohl, 2007; Gallo-Lopez, 2006; Briere & Runtz, 1993), and often report feelings of loneliness, shame, guilt, and fear (Osgood & Chambers, 2000), all which left untreated can manifest into depression, PTSD, and suicide attempts (Herrenkohl & Herrenkohl, 2007) . Additionally, there is a concern that these childhood victims of abuse can grow to become adult abusers, perpetuating the cycle of abuse (Cicchetti & Toth, 2000). However, studies have shown that group therapy and membership within a support group, have been effective in treating these pathologies and lessening the persistence of long-term effects of this abuse, thereby often ending the cycle of abuse (Powell & Faherty, 1990). Given these frightening statistics that denote the continued prevalence of child abuse, coupled with research that has shown that support groups can be an effective treatment, it is imperative that these groups be made available to all children exposed to or direct victims of violence and abuse.

Literature Review

Child abuse or maltreatment commonly occurs throughout the United States and across other countries of the world. In fact, data has shown that a referral of suspected abuse is filed every 10 seconds in the Unites States alone. Child abuse or maltreatment can be defined as any act which in which the child is subjected to physical, sexual, emotional, and mental abuse, cruelty, neglect, and/or exposure to domestic violence, (Herrenkohl & Herrenkohl, 2007; DeMause, 1998). Data collected by the Administration for Children and Families (2008) found that “during Federal fiscal year 2006, an estimated 3.3 million referrals, involving the alleged maltreatment of approximately 6.0 million children, were made to CPS agencies. An estimated 3.6 million children received an investigation or assessment,” (para. 10). While this number seems staggering, many speculate that the incidence of child abuse is actually higher, because the majority of abused children never gain the attention of government agencies. This under-reporting is especially true for children who are mentally, emotionally, or sexually abused, and therefore shown no outwardly physical signs of abuse. While the immediate consequences and effects of this abuse onto children is documented, i.e. the presence of short and long term psychological, emotional, physical and social disorders (Noll, 2008), research has found that these victims often develop pathologies which continue on into their adult lives, (Cicchetti & Toth, 2000). Even more frightening is the prevalence of these childhood victims to later become the abuser themselves, (Cicchetti & Toth, 2000). A National Institute of Justice study, in an attempt to confirm the existence of the cycle of abuse, found "that childhood abuse increased the odds of future delinquency and adult criminality overall by 40 percent" (Widom, 1992), but could not confirm the percentage of abusees who later become abusers.

The issue of child abuse is not a new one; in fact children have long been the victims of their abusers’ torment, rage, and dysfunction. DeMause (1998) purports that historically, throughout the world, children have been used as “receptacles, into which adults project disowned parts of their psyches,” (para. 5). Children, by their subordinate nature, have traditionally been viewed as expendable and therefore, have historically been subjected to routine rapes, beatings, mutilation, sacrifice, and abandonment. Only within the last decade, and primarily in developed countries, have children been considered as valuable persons, thereby freeing them from such ritualistic abuse. While the occurrence of child abuse has lessened, it has not been eradicated, often even perpetuated from generation to generation. Researchers have speculated that victims may even come to view the abuse as a natural tradition of child rearing, and thus passing it onto their own children, although Herrenkohl and Herrenkohl (2007) argue that it m ay be difficult to confirm this as reality, citing a lack of comprehensive, longitudinal research and data regarding the effects of abuse in exclusivity.

It has been a contention that exposure to abuse in childhood results in effects that impinge on all aspects of the victims life, including their; emotional and mental functioning, decreased social skills, delayed development, failure to thrive, and the presence of psychological pathologies which were not present prior to the abuse, (Herrenkohl & Herrenkohl, 2007; Gallo-Lopez, 2006; Briere & Runtz, 1993). Even once the child is no longer in the abusive situation, he or she is likely to experience continued long-term effects, reporting feelings of loneliness, shame, guilt, and fear (Osgood & Chambers, 2000). As result, most children who have been previously victimized are presented for treatment and “are likely to have symptoms consistent with either posttraumatic stress disorder (PTSD), acute stress disorder (ASD), or one of several adjustment disorders,” (Gallo-Lopez, 245). Untreated, these issues persist throughout the victim’s lifetime, manifesting themselves and thus producing a direct correlation with one’s prevalence to; continually suffer from depression (Gallo-Lopez, 2006; Herrenkohl & Herrenkohl, 2007), drop out high-school (Herrenkohl & Herrenkohl, 2007), experience teenage pregnancy (Herrenkohl & Herrenkohl, 2007), attempt suicide (Herrenkohl & Herrenkohl, 2007; Bridgeland, Duane & Stewart, 2001), “and engage in delinquency, violence, and abuse substances,” (Herrenkohl & Herrenkohl, 554), furthermore males are at a higher risk of early onset of these manifestations, as opposed to their female counterparts, and this pre-disposition is “related to alienation, trait anger, interaction anxiousness and pro-use beliefs about alcohol,” (Thomas, 36).

While many researchers have reported that childhood abuse and maltreatment directly results in the development of pathologies (Gallo-Lopez, 2006; Briere & Runtz, 1993; Osgood & Chambers, 2000; Bridgeland, Duane & Stewart, 2001), others contend that the prevalence of abuse in exclusivity may not be the only contributing factor (Herrenkohl & Herrenkohl, 2007). Often, when working with a client who has experienced childhood abuse, one will find the existence of over-lapping risk factors and external stressors within the family unit as well as within the child’s direct community, e.g. poverty, single-parent home, criminality, illness, addiction, et. Because these two areas are so integrated, it is difficult to isolate the effects of the child’s experience and exposure to risk with that specifically of the abuse. Research conducted by Herrenkohl and Herrenkohl (2007), attempted to separately analyze the two influences on the development of the child, i.e. experience and external stress vs. abuse, and found that “the lasting, adverse effects on youths’ internalizing and externalizing behaviors appear to extend from the victimization itself, not the hardship of the family or problems experienced by parents when their children were young,” (p. 560).

While it is unclear the extent that domestic abuse has upon the developing child, nor is there clarity regarding how and to what degree environmental stressors exacerbate the individual response of the child, one can say, without question, that certain pathologies do present after an incident of abuse, which had not been observed prior. Treatment of the abused child is often made difficult because many children are unable or afraid to discuss their experiences or the maltreatment they have endured, (Pearce, 2006). This inability to talk about the abuse may be due to the conditioning that they have received, i.e. the repetitive messages to maintain the secret of abuse, fear of isolation, threats of further harm to the family. Eventually these children become so engendered in their families that they are unable to talk openly and their experiences (McGarvey & Haen, 2005). Furthermore, longitudinal studies have shown a wide range of gender differences in the response to abuse, whereas externalizing behavior problems present in boys and internalizing behavioral problems for girls (Yates, Dodds, Sroufe & Egelnad, 2003). However, the incidence of abuse places both genders at great risk for “developing delinquency, substance abuse/dependence, and problems in social relations with others, inclusive of dating violence as adolescents and IPV [Intimate Partner Violence] as adults,” (Graham-Berman, Lynch, Banyard, DeVoe & Halabu, 2007). Therefore, interventions and treatment programs should focus on a wide range of behavioral and mental health issues, (Graham-Berman, et. al., 2007). Powell and Faherty (1990) report group therapy is the modal of choice for adolescent victims, stating that this is often more effective an individual therapy with this group. In groups, children are presented with others who have experienced similar events, and through the discussion and continued exposure of others who have experienced maltreatment, the child’s anxiety levels decrease, they find a sense of camaraderie, and their ability to discuss their own abuse increases, thus allowing them to talk more freely, (Pearce, 2006). Also, when treating children in groups, a wide variety of topics can be discussed, which will aide to treat children for pathologies that they currently experience and even aide them in dealing with others before they fully manifest, but without treatment are likely to appear.

Group Dynamics

Unfortunately, support groups, like other social service and therapeutic programs are reactive in nature (Turnell, 2006) and therefore all participants will have experienced some level of abuse or mistreatment within their home. While many support groups are open to the public, running this sort of group can be difficult because abuse can be experienced at many levels, and it would be quite difficult to create a “one size fits all” type of treatment. For those children who have experienced higher levels of abuse, it is important that they be placed accordingly, with others who have been subjected to similar levels. For this reason is, groups which aim to treat more severely abused children, may only accept participants who have been recommended by social service agencies, transitional living homes, or emergency placement shelters for abused women and children. Tjaden and Thoennes (1998) have estimated that more that 2 million women are victims of domestic violence each year in the United States, a staggering figure. However, these statistics fails to account for the children of these women. Pyles and Mee Kim (2006) find that these women come from diverse backgrounds, “including women of color, women with disabilities, and women from both urban and rural settings,” (p.222). And most often, victims trying to escape the abusive situation are further victimized by the multitude of barriers they face when trying to attain a safety from their abusers (Tolman & Rosen, 2001). Furthermore, it is estimated that women, on average, attempt to leave their abuser four to six times before finally leaving for good, (Oths & Robertson, 2007) and are at their greatest risk for lethal violence immediately after leaving the relationship (Websdale, 1999). Therefore, children who participate in these programs will have likely encountered numerous of these barriers, and while there current status will indicate their momentary safety, a great likelihood remains that they will find themselves being cared for by their abuser again at some point in the future. Even given the great potential for diversity, the children of this program will share the commonality of abuse itself and the materials presented will be applicable regardless of cultural differences.

Researchers have suggested that some of the most effective domestic violence support groups include teachings and considerations from the family systems theory (Dickstein, 2002). This is because “domestic violence is a pattern of behavior involving abuse of family members and includes physical, sexual, emotional, and psychological abuse,” (Shepard-White, 499). When utilizing the family systems theory, facilitators understand the importance of family interaction and the influence of such encounters, especially when the family unit fails to adhere to the norms of the family ritual. Systems theorists identify that regulated activities, such as rituals and daily routines, serve as the foundation for structure and stability, setting the tone for healthy families (Dickstein, 2002). Bente Storm Mowatt Haugland (2005) suggests “families have a tendency to maintain established patterns of behavior in the face of change or adversity,” (p. 226). Therefore, the level and frequency at which one experiences a disruption of the rituals and routines related to parental abuse can be an important indicator of how the abuse affects the family functioning, (Bente Storm Mowatt Haugland, 2005). In almost all cases, children who attend support groups for domestic violence, will have suffered from frequent disruptions of rituals and routines normally found in their family cycle due to the fluctuation between different phases of the abuse continuum, i.e. honeymoon period, to the tension-building, then the triggering event, and finally the abuse or acute battering stage, only then to repeat itself again. Because of the many stressors and traumas the children will have endured during their life cycle, coupled with the indirect affects of such disruptions to the normal family cycle, it will be imperative that issues related to healthy functioning and development be discussed.

Regardless of the level of abuse the child client has suffered, there are a great number of topics that should be focused on throughout the duration of the group, the first and most important aspect being that of safety (Carter & McGoldrick, 1999). McGarvey and Haen (2005) suggest that establishing a feeling of safety forms the foundation of treatment for abused children, safety which can first be formed by the therapist-client relationship and then extended to include the other members within the group, thus the purpose of pre-screening clients for suitability for inclusion of the group. While safety is foremost, facilitators should aim to include teachings that will provide; education on the effects and severity of abuse, safety planning, power dynamics (Carter & McGoldrick, 1999), feelings recognition, and treatment that should aid in the child in the transition of leaving the abuser, offer a sense of camaraderie, and provide a starting point for further psychotherapeutic treatment of the child. Even given the greatest potential for diversity, the children within the group will share the commonality of abuse itself and the materials presented should and will be applicable regardless of cultural differences. While gender effects differ, externalizing versus internalizing pathologies, age of onset, and severity, research has found that treatment need not be radically different or adapted for these groups, (Opland, Winters and Stinchfield, 1995).

Conclusions

In the United States, it is estimated that five children die each day as result of abuse or neglect (U.S. Department of Health and Human Services, 1995). Those children who survive the abuse develop short and long-term effects to include: emotional and mental functioning, decreased social skills, delayed development, failure to thrive (Herrenkohl & Herrenkohl, 2007; Gallo-Lopez, 2006; Briere & Runtz, 1993), additionally reporting feelings of loneliness, shame, guilt, and fear (Osgood & Chambers, 2000), all which left untreated can manifest into depression, PTSD, and suicide attempts. Additionally, there is a concern that these childhood victims of abuse can grow to become adult abusers, perpetuating the cycle of abuse; this due to the way abuse has been normalized within their family structure. Group therapy and attendance of support groups has been found to be independently effective and therapeutic for the adolescent client (Powell & Faherty, 1990). Therefore, given the risks associated with abuse and the therapeutic benefits of group therapy and support, it is imperative that these types of programs be made available, further expanded, and facilitated by knowledgeable leaders….. America’s children depend upon it!

Stephanie Lowrance-Henckel

References

Administration for Children and Families: Summary: Child Maltreatment 2006. (2008). Washington, D.C. Retrieved on October 25, 2008 from http://www.acf.hhs.gov/programs/cb/pubs/cm06/summary.htm

Bente Storm Mowatt Haugland (2005). Recurrent disruptions of rituals and routines in families with paternal alcohol abuse. Family Relations, 54(2), 225-241.

Briere, J., & Runtz, M. (1993). Childhood sexual abuse: Long-term sequelae and implications for psychological assessment. Journal of Interpersonal Violence, 8, 312-330.

Bridgeland, W. M., Duane, E.A. & Stewart, C.S. (2001). Voctimization and attempted suicide among college students. College Student Journal, 35(1), 63-76.

Cicchetti, D. & Toth, S.L. (2000). Developmental processes in maltreated children. In: D. Hansen, Editor, Nebraska symposium on motivation, Vol. 46: Child maltreatment, University of Nebraska Press, Lincoln, NE. 85–165.

DeMause, L. (1998). The History of child abuse. The Journal of Psychohistory, 25(3). Retrieved on November 1, 2008 from http://www.psychohistory.com/htm/05_history.html

Dickstein, S. (2002). Family routines and rituals-The importance of family functioning: Comment on a special section. Journal of Family Psychology, 16, 441-444.

Gallo-Lopez, L. (2006). A Creative play therapt approach to the group treatment of young sexually abused children. In H.G. Kaduson (Eds.), Short-term play therapy for children (2nd ed.). 245-270. New York, NY. Guilford Publications, Inc.

Graham-Berman, S.A., Lynch, S., Banyard, V., DeVoe, E.R. & Halabu, H. (2007). Community-based intervention foe children exposed to intimate partner violence: An efficacy trial. Journal of Consulting and Clinical Psychology, 75(2), 199-209.

Herrenkohl, T., & Herrenkohl, R. (2007, October). Examining the overlap and prediction of multiple forms of child maltreatment, stressors, and socioeconomic status: A longitudinal analysis of youth outcomes. Journal of Family Violence, 22(7), 553-562.

McGarvey, T.P. & Haen, C. (2005). Intervention strategies for treating traumatized siblings on a pediatric inpatient unit. American Journal of Orthopsychiatry, 75(3), 395-408.

Noll, J.G. (2008). Sexual abuse of children — Unique in its effects on development? Child Abuse & Neglect, 32(6), 603-605.

Opland, E.A., Winters, K.C., & Stinchfield, R.D. (1995). Examining gender differences in drug-abusing adolescents. Psychology of Addictive Behaviors, 9, 167-175.

Osgood, D. W., & Chambers, J. M. (2000). Social disorganization outside the metropolis: An analysis of rural violence. Criminology, 38, 81–115.

Oths, K. S. & Robertson, T. (2007). Give me shelter. Temporal patterns of women fleeing domestic abuse. Human Organization, 66(3), 249-260.

Pearce, J.W. (2006). Psychotherapy of abused and neglected children (2nd. Ed). New York, NY. Guilford Publications, Inc.Powell, L. & Faherty, S.L. (1990). Treating sexually abused latency aged girls. Arts in Psychotherapy, 17, 35-47.

Powell, L. & Faherty, S.L. (1990). Treating sexually abused latency aged girls. Arts in Psychotherapy, 17, 35-47.

Pyles, L. & Mee Kim, K. (2006). A Multilevel approach to cultural competence: A Study of the community response to underserved domestic violence victims. Families in Society, 87(2), 221-229.

Shepard-White, F. (2002). A Place for starr. .Journal of Child and Family Studies, 11(4), 499-501.

Thomas, B.S. (1996). A path analysis of gender differences in adolescent onset of alcohol, tobacco and other drug use (ATOD), reported ATOD use and adverse consequences of ATOD use. Journal of Addictive Diseases, 15, 33-52.

Tjaden, P., & Thoennes, N. (1998). Prevalence, incidence and consequences of violence against women: Findings from the national violence against women survey. Washington, DC: National Institute of Justice.

Tolman, R. M., & Rosen, D. (2001). Domestic violence in the lives of women receiving welfare: Mental health, substance dependence, and economic well-being. Violence Against Women, 7, 141-158.

Turnell, A. (2006). Constructive child protection practice: An oxymoron or news of difference? Journal of Systematic Therapies, 25(2), 3-12.

U.S. Department of Health and Human Services. (1995). A nation’s shame: Fatal child abuse and neglect in the United States (Report of the U.S. Advidory Board on Child Abuse and Neglect). Washington, DC: U.S. Government Printing Office.

Websdale, N. (1999). Understanding domestic homicide. Boston, MA. Northeastern University Press.

Widom, C.S. (1992). The Cycle of violence. Washington, D.C.: National Institute of Justice, U.S.: Department of Justice.

Yates, T.M., Dodds, M.F., Sroufe, L.A. & Egeland, B. (2003). Exposure to partner violence and child behavior problems: A prospective study controlling for child physical abuse and neglect, child cognitive ability, socioeconomic status, and life stress. Development and Psychopathology, 15, 199-218.

Confidentiality Issues Regarding the Treatment of Minors in Wisconsin

At the onset of any professional counseling relationship, it is imperative that the counselor obtain informed consent, by meeting with both the minor and her parents in order to inform them of the intentions of and possible outcomes of the service, explaining the importance that he or she places on confidentiality and also to specify the times in which a counselor must breach this, i.e. harm to self or others, sexual relations, abuse, and suicide. Counselors, who practice within the state of Wisconsin, are considered “mandated reporters” and are therefore governed by laws that pertain to the abuse or neglect of a minor. Wisconsin Statute §48.981(2), states that a professional “having reasonable cause to suspect that a child seen in the course of professional duties has been abused or neglected or having reason to believe that a child seen in the course of professional duties has been threatened with abuse or neglect and that abuse or neglect of the child will occur.”

Additionally, the state of Wisconsin finds that children under the age of 16 years of age, are unable to consent to activities of the sexual nature, and those who engage in a child in such activities will receive a felony conviction, (Wis. Stat. §948.02(1), (2)), therefore, any reports of such activities, regardless of implied consent must be reported to the health and human services department in their county. This requirement directly conflicts with the counselor’s ethical requirements, whereas ACA (2005) code B.1.c. finds that “Counselors do not share confidential information without client consent or without sound legal or ethical justification,” and also in code B.2.a. which states “the general requirement that counselors keep information confidential does not apply when disclosure is required to protect clients of identified others from serious and foreseeable harm or when legal requirement demand that confidential information must be revealed.” This would then imply that a counselor is required to follow the laws in her state or county first, being that of a mandated reporter trumps the client’s right to confidentiality.

In situations where the information discloses does not include the sexual activity of, abuse and/or neglect to, or an intention of harm, issues of confidentiality related to minors, can mirror that of adults. Wisconsin Statute §118.126(1) states that a counselor “who engages in alcohol or other drug abuse program activities shall keep confidential information” that had been disclosed by a minor client during therapy sessions. And finally, in cases where a minor discloses their intent to commit suicide, Wisconsin law protects a counselor’s decision to breech confidentiality in finding §118.295 one “who, in good faith attempts to prevent suicide by a pupil is immune from civil liability for his or her acts or omissions in respect to the suicide or attempted suicide.” While, the law does not state that one must disclose these intentions, it does give permission for this disclosure.

Of additional concern, when working with minor children is the issue of parental disclosure. According to Remley and Herlihy (2001, p.103), “counselors have an ethical obligation of privacy to minor clients, and a legal obligation to the parents or legal guardians of those same minor clients to keep their children safe.” Unfortunately however, Wisconsin laws find that minor clients do not possess the ability to consent to services, or have the mentally capacity to make educated decisions regarding counseling services or to understand the rights and/or limitations of confidentiality, (Davis & Mickelson, 1994). As result, Remley and Herlihy (2001) suggest that the minors are afforded no privacy or disclosure rights from their parents and/or guardians who are legally responsible for them. Conversely they find that “a child, regardless of age, has an ethical right to privacy and confidentiality in the counseling relationship” (p. 176).

As a counselor in private practice, based on ACA (2005) code B.2.a., one does not necessarily have a legal obligation to inform a minor client’s parents and/or guardians of any situation in which the client is not in immediate danger. Many counselors will however struggle with the term “danger” finding the term in-and-of itself is subjective. What is the definition of foreseeable harm? Would statutory rape be considered harm? And while the law implies that a minor does not have the capacity to make informed decisions about their care, Remley and Herlihy (2001) find that parents or guardians “probably have a legal right to know the content of counseling sessions with their children,” (p. 177). Given this information, one could conclude that in cases that did not involve abuse, neglect, or sexual activity in a minor child under the age of 16, that the counselor may use their professional judgment in deciding which information, if any, should be disclosed. In the best case scenario, the counselor would work with the minor client in devising a plan to jointly inform or discuss the relevant and necessary information to the parent, past this it would seems that disclosure is a subjective.
Stephanie Lowrance-Henckel

References

American Counseling Association (2005). Code of Ethics. Alexandria, VA

Remley, T. P., & Herlihy, B. (2001). Ethical, legal, and professional issues in
counseling. Upper Saddle River, NJ: Merrill Prentice Hall.

Wisconsin Statutes §48.981(1) and §48.981(2). (1999-2001). Wisconsin Legislature. Retrieved on October 25, 2008 from http://nxt.legis.state.wi.us/nxt/gateway.dll?f=templates&fn=default.htm&d=stats&jd=Wisconsin%20Statute%20§48.981(2)

Wisconsin Statute §118.295. (1999-2001). Wisconsin Legislature. Retrieved on October 25, 2008 from http://nxt.legis.state.wi.us/nxt/gateway.dll?f=templates&fn=default.htm&d=stats&jd=Wisconsin%20Statute%20§48.981(2)

Wisconsin Statute §118.126. (1999-2001). Wisconsin Legislature. Retrieved on October 25, 2008 from http://nxt.legis.state.wi.us/nxt/gateway.dll?f=templates&fn=default.htm&d=stats&jd=Wisconsin%20Statute%20§48.981(2)

One Flew Over the Cuckoo's Nest - An analysis

Just recently this writer had the opportunity to experience the 1975 movie, One Flew Over the Cockoo's Nest. How in all her years of interest in the field of psychology has she missed this film, is quite a mystery. This writer was absolutely shocked and horrified as she watched this movie, “One flew over the cuckoo’s nest” unfold. Although she had heard rumors of these mental institutions and the stereotypes that had carried over all these years, she failed to realize the scope of injustice that was done onto the patients. While analyzing this movie, the writer found herself feverishly writing notes regarding the ethical, therapeutic, and humanistic violations that were depicted, and now as she sits to write, finds it difficult to limit herself to discussing only a few.

The main perpetrator of the movie was nurse Ratched. Although we are unclear of her qualifications, one would presume that she were a psychiatric nurse practioner. And while this title would suppose that she had received education and training pertinent to this field, her title should be used loosely.. as she did not deserve to hold the authority that she did. If one were to critique her leadership abilities and place a style to it, it would be leader-directed or leader-oriented. And while she would be then called to lead a group, she failed to understand each client’s needs and structure group focus to meet those needs, (Lantz, 2001). In the leader-directed approach, she would have been responsible for providing information and educating the clients on the chosen topic. Because these clients appear to be mentally functioning at a child-like level, structured group activities should also be intermingled with lecture, as attentions can easily wane, and hands-on activities has been shown to be tremendously effective at keeping the client focused on the topic, (Jacobs, Masson & Harvill, 2009) and broadening their depth of understanding. While the goal in working with groups is to maintain a singular focus, it is sometimes necessary to shift if as a leader, one recognizes a disconnect or the client’s inability to attend to the topic. Continued attempts to persevere will surely end in the client becoming disruptive, resentful, and tuning out to the topic, however one must impress that the change in topic remain therapeutic and healthy for the clients as a whole, nothing like that depicted in the movie.

If one further attempted to analyze the group dynamic and the supposed therapeutic nature of this group, isolated from the facilitator, they would also find it quite unhealthy. In an effort to analyze this the characteristics of effective group therapy, Yalom (1995) finds a number of factors, which can substantially contribute to the group process and success. These factors can include; instillation of hope, universality, imparting information, altruism, the corrective recapitulation of the primary family group, development of socializing techniques, imitative behavior, interpersonal learning, group cohesiveness, catharsis, and existential factors. In the three scenes that the viewer was privy too, not one time did there appear to be a single focus or topic, instead the discussion was based around the facilitator’s choice for belittlement of the day and the group also served as a arena for the clients to air their grievances about treatment, and each other without being heard or redirected. It appeared that no group format existed, besides the time allotment, and no rules were presented or adhered to. At one point, nurse Ratched referred to the group as being therapeutic, but even to the most unskilled eye, this was a ridiculous assumption. No therapy was being conducted in these groups, no understanding of disorder, treatment, healthy living, self-esteem building, no realizations, and even worse, the clients appeared become increasingly distraught throughout group, then were left hanging without the opportunity to process. These clients were brought together based on their ability to attend to the group, but never really pre-screened for compatibility, i.e. level of disorder, commonality between issues and ailments, in short, this created chaos. Due to the dynamics of the group, coupled with the dictator-like, uncompassionate, judgmental leader, these clients failed to progress. And while all of these clients arrived to the facility wounded, fearful, lonely, and ashamed, they may have ended up worse than when they initially presented for treatment. This writer believes that therapeutic groups can only begin to have individual progress when the participant him or herself feels as though they are safe, accepted, understood, and can see the “light” or hope for the future, but none of these feelings were facilitated for the clients in this ward.

Above all other problems, is that of ethics. The American Counseling Association, realizing that there were great disparities in treatment of mentally ill clients, created their first code of ethics in 1952, (Code of Ethics, 2005). While we then know that there was such a guideline for therapists, we must then assume that the practioners depicted in the movie were not taught such principles during their training, nor could there have been any consequences for failing to adhere to these rules. If in fact, these guidelines had been taught, reviewed, and therapists been penalized for not implementing them, almost all of the issues could have been avoided.

If this writer were called to evaluate and consult for this facility, she would have found herself outraged on the first day, maybe even the first hour. Her recommendations would have been simple and drastic. All employees would have been placed on “leave” until they could receive their own psychiatric evaluations, and if found competent, received proper training. All Electro-Convulsive therapies would have been halted, as these were preformed for the wrong purpose, by unqualified staff, and the practice of lobotomizing clients would have been terminated. A competent and skill staff would be temporarily placed within the facility and all clients would have been re-evaluated and placed in wards according to their disorder, competency level, and need. The practice of medicating, or should we say, sedating all patients into compliance would have gradually waned (for fear of withdrawal symptoms), during which time the clients would be re-assessed for proper medications. The new group leaders would be well trained in group dynamics, and new groups would be formed. These groups would follow a model outlined by Yalom (1995) and others, which would allow for a group purpose, rules, and phases, to allow for proper processing. And the ACA code of ethics (2005) would be the law of the facility, the credo, “Do no harm” would be repeatedly drilled into the employees heads, so that no one lost sight of this again! Only after these changes were made would the clients actually be treated, instead of becoming worse, and even some may one day be able to leave the facility as functioning members of society.
Stephanie Lowrance-Henckel

References

Code of Ethics. (2005). American Counseling Association. Washington, DC.
Jacobs, E., Masson, R. & Harvill, R. (2009). Group counseling: Strategies and skills (6th ed.). ThomsonBrooks/Cole. Belmont, CA.
Lantz, J. (2001). Play time: An examination of play intervention strategies for children with autism spectrum disorders. The Reporter, 6(3), 1-7, 24.
One flew over the cuckoo’s nest. (1975). Milos Forman (Director). Fantasy Films, Oregon. Video recording.
Yalom, I. (1995). The theory and practice of group psychotherapy (4th ed.). BasicBooks. New York, NY.

Model of Group Therapy: Essential when the client is a child

Leading a group can be a very daunting and intense experience. To make matters worse, many leaders are either unprepared, under skilled, or under-educated about group dynamics and it’s processes. While there are numerous resources outlining these conditions for work with adults, very little materials cover work with children or adolescents, especially when working with child victims of abuse. The purpose of this article is to provide a brief and basic summary of an appropriate group model for use when working with abused children within an open enrollment, agency setting.

It is imperative that one understands that as a group leader of children participants, he or she must use the leader-directed or oriented approach. Jacobs, Masson and Harvill (2009) suggest that children’s group leaders be prepared “to take on more responsibility for the group than in a group composed of adults,” (p. 399) as children will not usually come to group ready to discuss a particular topic nor will they be inclined to stay on topic if not directed. Additionally, a substantial portion of any children’s group will include an education component, whether that be regarding the importance of self-esteem, anger management, or general safety planning to reduce the likelihood that a child be further victimized, it will be the leader’s responsibility to present this information. It is therefore necessary that this leader understand each child’s needs and structure group focus to meet those needs, (Lantz, 2001).

As with any other type of group, it is important that each session be structured with a beginning, middle, and closing phase. When working with child clients, particularly in an open enrollment type group, it is necessary to formally engage the children in the beginning stage. Introducing new students, reiterating the group purpose, and acknowledging the commonality that all the participants share will aide in the effectiveness of the group in two ways; (1) this will allow the “new” child to begin feeling comfortable, safe, and sense of belonging, and (2) reinforce the effectiveness, commonality, and focus to the “seasoned” participants. This phase should be no longer than 10 minutes, otherwise the leader risks the chance that the children will become bored and thus engaging in alternative activities that will deter from the order of the group.

The middle phase will contain the depth of the discussion and topic for the day. In the leader-directed approach, he or she will be responsible for providing information and educating the children on the chosen topic. Structured group activities should also be intermingled with lecture, as attentions can easily wane. Hands-on activities, will enhance the the group as they have been shown to be tremendously effective at keeping the child client focused on the topic, (Jacobs, Masson & Harvill, 2009) and broadening their depth of understanding. While the goal in working with children groups is to maintain a singular focus, it is sometimes necessary to shift if, as a leader, one recognizes a disconnect or a child’s inability to attend to the topic. Continued attempts to persevere will surely end in the children becoming disruptive, resentful, and tuning out to the topic. Again, as a children’s group leader, it is necessary to be observant and gain an understanding of each participants needs in order to remain beneficial to the clients.

The final phase is just as important as it’s counterparts. This phase allows for the child client to process those feelings that surfaced as result of group, gain a sense of closure, and participate in the ending rituals of the group. The final phase can include several techniques such as: relaxation breathing, songs, or a movement activity. Often times, leaders will impart food into their final phase. Kaduson (2006) maintains that food is beneficial in two ways, “it provides an effective form of tangible nurturance,” (p.251) thus reinforcing that group is a safe and caring place, and “second, snack time parallels a family meal in ways that often facilitate treatment….. just as shared meals help strengthen bonds within functional families, snack times provide the group members with opportunities to process issues, talk through problems, share feelings, and resolve conflicts together,” (p. 251).Which ever method is used, is important to remember that the “ritual” of this phase is important to facilitate the continued growth of the group, (Kaduson, 2006) and that it should be employed at every session, (Jacobs, Masson & Harvill, 2009).

It is crucial that one does not undervalue their work as a group leader or the value that group therapy can provide for the child participants. Authors such as Shechtman (2004), in addition to many other professionals, agree that group therapy and interventions instilled therein are quite effective when working with children. And “for some children, groups can be much better than individual counseling because groups allow children a place to learn and practice new skills,” (Jacobs, Masson & Harvill, 397). While this article serves to provide the reader with only a brief summary of a group model used with children, the phases and formation of rituals should be considered quite heavily when planning such groups. Kaduson (2006) finds that an emphasis needs to be placed on predictability when working with children, as this experience leads to a naturally occurring sense of safety and order within the group. Likewise, “beginning and ending rituals contribute to the establishment of trust and security, as anxiety is reduced when children can anticipate what will happen,” (p. 250).
Stephanie Henckel

References

Jacobs, E., Masson, R. & Harvill, R. (2009). Group counseling; Strategies and skills (6th ed.). ThomsonBrooks/Cole. Belmont, CA.
Kaduson, H. (2006). Short-term play therapy for children (2nd ed.). Guilford Publications, Inc. New York, NY.
Lantz, J. (2001). Play time: An examination of play intervention strategies for children with autism spectrum disorders. The Reporter, 6(3), 1-7, 24.
Shechtman, Z. (2004). Group counseling/psychotherapy with children. The Group Worker, 32(3), 7-9.

Reality therapy and the Asian American Client

A study conducted by Tsai-Chae and Nagata (2008) found that “immigrant families from traditional Asian backgrounds can experience greater family dysfunction than other ethnic minority groups,” (p.205). Additionally, the majority of these conflicts arise during adulthood and in comparison to European American adolescents the “levels of family conflict were significantly higher among Asian American college students,” (p.305). These intergenerational conflicts, which arise during adulthood, have been positively correlated with psychological problems such as anxiety and depression “and Asian American students who enter counseling frequently attribute their psychological distress to relationships with their parents,” (p.305). While the counselor may be initially concerned about an Asian client’s reluctance to “open-up” and discuss the root of his or her issues, it is important to note that, in general, Asians Americans tend to under utilize mental health services and “recent reports indicate that less than 6% of Asian Americans with a psychological problem sought assistance,” (Hsu & Alden, 315). Of those Asian Americans who do seek the assistance of a mental health professional tend to do so only after there is a persistent and excessive somatic or behavior symptom of their emotional distress (Hsu & Alden, 2008). Asian clients often express a desire to honor their parents and a fear of causing them shame, this value is founded in the Asian belief that family members share a single sense of identity and responsibility to each other, therefore the client’s behaviors are not just representative of themselves but of their family as a whole. In acknowledging this value, one could assume that a client’s hesitance to talk with the therapist, would be founded in the belief that “the burden of the stigma of mental illness not only falls on the afflicted individual but also on all family members,” (p.318). Therefore, a concern of bringing shame upon his or her family may be the basis for the client’s reluctance to admit to mental health problems.

Reality therapy, an approach founded by William Glasser, similar to that of Rational Emotive Behavioral Therapies (REBT) and has been shown effective when working with diverse clients. “Reality therapy explores the client’s values and behavioral choices, exposing inconsistencies and enforcing responsibility for those choices,” (Okun & Kantrowitz, 138). Those who subscribe to the Reality approach believe that, as humans, we alone, are responsible for our actions. Reality therapist’s propose that “human beings are motivated to change (1) when they determine that their current behavior is not getting them what they want and (2) when they believe they can choose other behaviors that will get them closer to what they want,” (Corey & Corey, 140). The goal of treatment utilizing this approach is to assist the client in satisfying their basic needs, i.e. “survival, love and belonging, power, freedom, and fun,” (p.140) thereby directing change to those behaviors which inhibit that fulfillment of these needs. Regardless of which method one may chose, the overall goal is to treat the client’s emotional and physical disturbances. Reality therapy would focus on negative effects of the client’s current choice of actions and assist him or her in finding more appropriative constructive behaviors which would encourage a balance between their own needs and values and that of their family.

Currently this writer finds herself most aligned herself with Reality therapy. As she has explored this method, and has read descriptions depicting Reality therapy in practice, and finds great benefit in this approach's belief that; to get better or be "treated" one must recognize and change those behaviors that are self-defeating. Often times, she herself has heard the common-sense voice of Dr. Phil ringing through her head, “Is it working for you?” and finds great value in this approach. When working with guests who appear on his show experiencing emotional distress at the way events are playing out in their lives, Dr. Phil inquires about the action they have taken to alter these events. If he believes that their actions are self-defeating or fail to promote the positive response the guest desires, he simply suggests that their approach is not working and informs that they must change how they have been doing things, if they are to expect a different outcome. -“The definition of insanity – doing the same thing over and over, expecting a different result.”

Stephanie Henckel

References

Corey, M. S. & Corey, G. (2007). Becoming a helper (5th ed.). Thomson Brooks/Cole. Belmont, CA.

Hsu, L. & Alden, L. (2008). Cultural influences on willingness to seek treatment for social anxiety in Chinese- and European-heritage students. Cultural Diversity and Ethnic Minority Psychology, 14 (3), 215-223.

Okun, B. F. & Kantrowitz, R. E. (2008). Effective helping: Interviewing and counseling techniques (7th ed.) Thomson Brooks/Cole. Belmont, CA.

Tsai-Chae, A.H. & Nagat, D.K. (2008). Asian values and perceptions of intergenerational family conflict among Asian American students. Cultural Diversity and Ethnic Minority Psychology, 14(3), 205-214.

Eclectism Approach to Therapy

For those of us, just beginning our careers in psychotherapy, it would seem most appropriate to pick one style of treatment, understand it fully, and specialize in this mode for a short time. However, this learner feels that it this single approach will surely limit the population and the diversity of clients that she could see and effectively treat, therefore, she would have to gain additional insight and practice in other therapies.

“The basis for eclectic practice is the contention that different clients and different problems require different treatments,” (Patterson, 159). As has consistently been “drilled” into our heads, is that the clients we will encounter will be complex, unpredictable, ever changing, and diverse. Therefore, it would be foolish to suppose that one a single approach could be a “fit” for all of these clients, or for that matter, “fit” a single client throughout their entire lifetime.

This learner currently finds herself aligned with Reality or Choice therapy. Her affiliation with this approach was chosen carefully in regard to her target population, i.e. those struggling with addictions. She strongly believes that “we” are not victims of circumstance, but rather freethinking and able individuals, who make choices throughout their lives. When applying this approach to someone who is struggling with addiction, the learner would contend, “If they made the choice to use, thus becoming addicted, then if they want it badly enough, they can make the choice to stop their usage.”

However, this learner also finds the Gestalt approach to be quite interesting and aligned with her own views of life and human existence. Therapists who subscribe to this method present goals for their clients with include; being more self-aware by acknowledging and accepting the integration of their own thoughts, feelings, and actions. One could easily describe Gestalt therapy as an approach to “wholeness” or as being one with the environment in which the client lives. “The Gestalt Therapist views life (the way we play, work, live, make love, die, etc.) as a "creative process". Therapy becomes a modality to objectively examine the way individuals, couples, groups and systems creatively adapt to their environment. Change occurs by heightening awareness and modifying the behaviors that impede the process of effective adaptation,” (Gestalt Counseling & Training Institute, para.2). While she contends that Reality or Choice therapies could present as a better “fit” for the client struggling with addiction, she also finds the Gestalt approach as an interesting alternative or one that could be easily integrated into the over therapeutic approach.

While one would be inclined to believe that most therapists would only utilize one particular therapeutic approach, “many mental health counselors continue to describe themselves as theoretically eclectic. Perhaps this resistance to identifying a single theory is a consequence of the widespread belief that one theory cannot possibly apply to,” (Bauman & Waldo, 13) all diverse populations. Additionally, many approaches have overlapping goals and principles, therefore this integration occurs in a natural process, rather than by abrupt changes. This learner only cautions that before one attempts to incorporate several approaches into one therapeutic session, that he or she gains sufficient knowledge and understanding of the processes that each entails. But in the end, she finds that the eclectic approach would better serve a wide variety of clients, thereby ensuring that the counselor becomes more effective in their practice.

Stephanie Henckel

References

Bauman, S. & Waldo, M. (1998). Existential theory and mental health counseling: If it were a snake, it would have bitten!. Journal of Mental Health Counseling, 20(1), 13.

Gestalt Counseling & Training Institute. (2007). About gestalt therapy. Retrieved on September 3, 2008 from http://www.gestalt-annarbor.org/about_gestalt.htm

Patterson, C.H. (1989) Eclecticism in psychotherapy: Is integration possible? Psychotherapy, 26, 157-161.

War on Drugs: A Failed System?

The United States’ War on Drugs, a Failed System

Introduction
In 1968 the United States began an official “War on Drugs.” Since that year, ineffective policies have been created, incarceration rates have risen, and the costs associated with the drug war increase by the year. The United States currently spends over $40 billion a year to fight the “War on Drugs,” and yet it continues to be the world’s largest consumer of illegal drugs (Williams, 2001, p.1541), which implies that, the cost associated with the drug war far from justifies it’s results. In the past 20 years, the number of inmates incarcerated on drug charges has tripled with sixty to seventy percent test positive for drug usage at the time of their arrest. Federal surveys have shown an increase in drug use between 1991 and 1997, with the rate of first time use for 12th grade students nearly doubling. It appears drug use, incarceration rates, and the cost to fight the drug war continues to mount with no avail and because of this, the United States must change its’ tactics. The following will present data, statistics, and information regarding this failure. In addition, it will be shown that the gross expenditures to fight the drug war have failed to result in a decline in drug usage and rather, have caused an increase in black market profits and violence associated with the drug trade. Finally, recommendations for decriminalization, legalization, and government regulation will be presented. To fully understand the issues, the problems must be defined.

America’s fight to abolish drugs is not a new issue; it has always been a lengthy and costly battle. The origins of this fight can be traced back to 1874 when the Women’s Christian Temperance Union formed to prevent the use of drugs and alcohol. Then in 1914 the Harrison Act was passed. It was the first official drug law created to stop drug use by controlling opium trade. The results of this act were immediate. Just six weeks after this bill passed, on May 15, 1915, the New York Medical Journal writes:
As was expected ... the immediate effects of the Harrison antinarcotic law were seen in the flocking of drug habitués to hospitals and sanatoriums. Sporadic crimes of violence were reported too, due usually to desperate efforts by addicts to obtain drugs....The really serious results of this legislation, however, will only appear gradually and will not always be recognized as such. These will be the failures of promising careers, the disrupting of happy families, the commission of crimes that will never be traced to their real cause, (p. 799).

Six months later an editorial in American Medicine wrote:
Abuses in the sale of narcotic drugs are increasing. . . . A particular sinister sequence . . . is the character of the places to which [addicts] are forced to go to get their drugs and the type of people with whom they are obliged to mix….. The moral dangers, as well as the effect on the self-respect of the addict, call for no comment, (p.800).

Then two more federal laws were passed, the Boggs Act of 1952 and the Narcotics Control Act of 1956, which raised the penalties for all drug offenses by setting mandatory sentences. A first-offense marijuana possession carried a minimum sentence of two to ten years with a fine of up to $20,000 and a third-time offense offered life in prison. After these acts were passed, reports once again showed that drug usage increased, proving these Acts ineffective. In 1968, President Nixon initiated the “War on Drugs” after soldiers came home from Vietnam addicted to heroin. Then in 1970, the Comprehensive Drug Abuse Prevention and Control Act passed. This Act established a plan to regulate and control drugs according to classifications, which were determined by the Attorney General. The same year, congress repealed most of the mandatory penalties for drug-related offenses because the mandatory minimum sentences of the 1950s were often unduly harsh and had done nothing to eliminate the drug culture. Next President Ronald Reagan passed the Comprehensive Crime Control Act of 1984, raising the federal penalties for both marijuana possession and dealing. A later amendment to this Act allowed for life sentences for repeat drug offenders, and the death penalty for major suppliers, which reinstated the failed and once abandoned policies of the 1970 Act. Then in 1982, Nancy Reagan created the “Just Say No” campaign and Daryl Gates, Police Chief of the Los Angeles police department, developed the D.A.R.E. program. These programs were designed to teach youths how to avoid pressures to use drugs. In 1989, President George Bush declared that illegal drugs were public enemy number one, again increasing the federal budget for this war. The United States government attempted many times to eradicate illegal drugs, and prevent them from entering and being used within its borders, but has failed. After drastic steps, enacting many new laws, and the increasingly large amounts of money that have been spent for the “War on Drugs”, drug usage steadily increased while crime rates and poverty have risen.

Theory and Research From Prior Research
One reason this drug initiative has failed is the inaccurate system of defining and classifying drugs. In Erich Goode’s (1997) book, “Between Politics and Reason”, he explains that drugs are given many definitions, as; medical substances, either illegal or controlled substances, publicly defined substances, or substances taken for a certain effect, while other drugs are defined by subjective criterion, meaning, a drug is what the members of society say or think is. What becomes apparent is that there is no correct definition for all contexts of its use. Furthermore, many of these definitions actually prevent us from reaching a sound understanding of the drug itself and its possible uses. Hans Van Mastrigt also addressed this issue in his (1990) article, The Abolition of the Drug Policy: Toward Strategic Alternatives, where he evaluates these classifications and gives reasons why people should reject these standards. He focuses on the fact that drugs are currently classified by assessing the harm connected with their use. Under this classification standard “harm” is defined by physical or psychological harm, as well as addiction. Where this definition seems to fail is that it is not used consistently. Alcohol and tobacco should be considered “hard drugs” from a pharmaceutical viewpoint, but they are not regulated. Alternatively, “soft drugs” like cannabis and cocaine have been placed under strict administrations of control (Bean, 1974). Van Mastright further states that the pharmacology of a drug can only provide partial information in regards to the problems associated with drug use and abuse. Many other factors can contribute to the harm drug consumption causes, such as: the amount or quantity used, the route of administration, or the frequency of use. Van Mastright says to fully understand drug abuse it must be understood in a “real world” context because the situation in which the drug is used contributes to its’ physical damage and addiction. The current standards fail to recognize that the risks and dangers associated with drugs are not unique. Serious health risks are related to a wide variety of behavior. Many people die of socially acceptable behavior and the risks associated with them; driving a vehicle, participating in sports, and even work related injuries. It is also ridiculous to classify drugs based on their ability to cause addiction. “The subjective experience of addiction is, for example, not limited to the consumption of substances, but can arise with such "normal" human behaviors as working, eating, playing and loving,” (Peele, 1985, p.13). The ability to become addicted is not caused by the action or substance itself, but by a person’s own unique qualities, beliefs, and convictions. The current definitions of drugs and harm associated with their uses do not make sense, nor are they unique to the drug experience. It is not difficult to understand why the United States is losing this war when years of drug policies were created based on these faulty definitions of what a drug is.

Additionally, the government has “created” facts and distorted the truths about the “War on Drugs”. In fact, these false statements have been so publicized and repeatedly quoted that most Americans and politicians accept them without questioning their merit. The most erroneous distortion is that drug use has actually declined over time. Citizens are often told that America is winning the drug war and regular drug use has been cut in half since 1979. However, federal surveys show the exact opposite. They show increases in use, especially by adolescents, (Monitoring The Future: National Survey Results on Drug Use, 1975-2000). Research conducted by Johnston, O’Malley, & Bachman (2001), found in 1980 marijuana use among American high school seniors dropped for the first time, but then in 1992 it began to rise again. Between 1992 and 1997 the rate of usages nearly doubled, from 22% to 39%, and thirty-day use also rose significantly, doubling from 12% to 24% in 1997. The United States Department of Health and Human Services states that overdose deaths and emergency room visits due to drug usage are at record highs with both consistently escalating since the 1980s. Their data showed that, "from 1990 to 2000, total drug-related episodes increased 62 percent, from 371,208 to 601, 776,” (2001, p. 2). The government often states that America is winning the drug war, but statistics show that drug use is higher than it was ten years ago and the drugs are now more dangerous than ever, causing more overdose deaths and hospitalizations.

The government has created ineffective laws, drugs are improperly classified, misunderstood, and the American people have been improperly informed about the success of the “War on Drugs”, yet they still spend over $40 billion a year fighting a losing, impractical, self-defeating war. The National Drug Control Budget Executive Summary shows that in 1969, The Nixon administration spent $65 million on the drug war; in 1982 the Reagan administration spent $1.65 billion, and in 2002, the Bush administration spent more than $18.822 billion, (these totals do not include state and local budgets). Between 1969 and 2002, the federal budget increased over 292 times, and yet the National Survey Results on Drug Use from 1975-2002, shows that there is little or no change in the frequency and usage of illegal drugs. The monetary costs to Americans for the drug war is enormous and it is apparent that it is doing little or nothing to stop, control, or prevent drug use in America.

Another major issue concerning the United States is number of inmates incarcerated in its’ prison system for drug related charges. Decriminalizing personal possession would also alleviate the overcrowding of American prisons. “In 1997, there were 216,254 drug offenders in state prisons (out of a total State prison population of 1,046,706 that year). Of these, 92,373 were in for possession,” (Mumola, 1999, p.2), and this figure does not include the additional 10,094 prisoners in federal prisons. In 1997 alone, a total of 102,467 people were incarcerated for possession, and the estimated cost to Americans for their incarceration was over $20 million (based on Jones (1999), who showed the average cost to house an inmate is $20,000 a year). Besides the cost to Americans, the impractical use of the judicial system and the loss of freedom to those prosecuted; there is another issue, the children.

Nearly two million young people in the United States have one or both parents incarcerated many for non-violent drug offenses. Many young people have lost their parents due to incarceration and have been put into the foster care system, both which have shown to increase the likelihood of delinquency (Greenfield, Lawrence, & Snell, 1999, p.8). Children are also incarcerated for drug related offenses for drug related offenses under the current system. In fact “the number of offenders under age 18 admitted to prison for drug offenses increased twelve fold between 1985 to 1997. This increase troubles many social scientists. Thorton (2007) concludes, “Policies that stigmatize and imprison drug users may hurt rather than help troubled young people. The abstractions of prohibition or legalization have little to do with troubled people’s behavior or needs” (423). This statement is not an endorsement of policies that fail to police illegal drug markets, but rather made to identify that the drug war has created black markets that are very dangerous yet attractive to troubled youths with limited opportunities and resources and who are at the highest risk of becoming drug users themselves. “The drug war does not cause the family and social problems that put young people at risk, but rather diverts resources and attention from education and treatment programs that might help them, (Cleveland, 433). As an additional detriment to young people, is that under federal law those convicted of a drug offense lose their right to federal college loans - 43,000 students were affected by this provision in 2001 -increasing the likelihood that they will be undereducated and unable to compete for good jobs,” (Storm, 2000, p.4). As consequence, many young Americans have had their lives ruined, not by the drugs themselves, but by drug laws and their enforcement.

Programs financed by the government to prevent the usage of drugs among youths, such as D.A.R.E, have shown to be ineffective and counterproductive, even encouraging drug use among certain populations. Still these programs continue to receive large amounts of federal funding (Lynam, Milich, et al., 1999). Furthermore, recent studies have shown that youth are more influenced by their peers and their perception of the prevalence of drug usage, and then are discouraged by such preventative programs. One such study conducted by Hammermeister, Roland & Page (2002), Are high school students accurate or clueless in estimating substance abuse among peers, demonstrated this influence. This study was conducted using qualitative research by obtaining investigative data collected through self-report surveys. The self-report surveys were administered to “223 high school students enrolled in health or physical education courses at three separate high schools in the Pacific Northwest (two in Idaho and one in Washington). Health and physical education classes were selected because these are required for graduation and would provide a representative sample of students in each school” (Hammermeister, Roland & Page, 568). The data collected from this survey found that there was a direct correlation between the students’ perceptions of drug usage and their own self reported usage. Although, student’s often over-estimated the prevalence of their peer’s usage, when compared, the data showed that the estimations and self-reported usage of each school were relative to the other two schools. Demonstrating that in those schools where the perception was greatest (see Table 1), the reported self-usage was also the highest (see Table 2). Studies such as the Hammermeister, Roland & Page (2002) research have shown that although educational and preventative programs have become regular installments in the school system, they are less influential on youth’s behavior than peer pressure.

Americans have been deceived into believing that violence and criminal activity are a direct result of illegal drug consumption. However several recent studies have offered contradictory data to this theory and in fact have found a direct correlation between increased penalties and arrests to an increase in criminal activity. One such finding was produced by Shepard & Blackley (2007) titled, The Impact of marijuana law enforcement in an economic model of crime. This study was conducted using quantitative research whereby investigative data was collected from existing government reports. Data was obtained from 1,200 U.S. counties, which were randomly selected from a national pool for the 1994-2001 time period from; police reports, U.S. Department of Justice Uniform crime reports, U.S. Department of Commerce, Bureau of Economic Analysis, Regional Economic Accounts, U.S. Department of Labor, Bureau of Labor Statistics, Local Area Unemployment Statistics, FBI Uniform crime reports from the University of Michigan, and National Archive of Criminal Justice Data. There was little control over the initial procedures of data collection, but the data can be considered reliable as it was initially gathered from reputable agencies. The results of this provided evidence that “marijuana arrests are positively associated with higher levels of property crime and homicides during the 1994-2001 period. Specifically, possession arrests are found to be related to the commission of property crimes, while sales arrests are found to be associated with burglary and homicide rates” (Shepard and Blackley, p.9), see Tables 3 and 4. Furthermore, it has been found that criminal activity is more associated with the drugs’ illegal classification and its’ governing laws than usage of such substances. The connection between drugs and illegal activity has a greater probability of being caused by: the “effects that involve the manufacture, distribution, and sale of illegal drugs, with no legal mechanisms for dispute resolution” (407), the violent crime directly associated with the attempt to enforce drug prohibition, and because the resources used for drug enforcement cannot be used against other types of crime which in turns reduces the enforcement effectiveness in those areas. Chris Paul (1994), a published economist claims, the
“competition for market control creates negative externalities which take several forms. First, violence increases as sellers attempt to monopolize markets, enforce contracts and protect property risking harm or harming non-participants. Second, as a consequence often-higher 'monopoly' price, the number and severity of crimes increase as buyers attempt to support their use. Third, some of the revenue is used to corrupt police, politicians and otherwise legitimate businesses. Fourth, as illustrated by the current 'war on drugs,' non-participants' civil liberties are eroded as law enforcement agencies attempt to identify voluntary market participants. Finally, steps taken by the public to insulate themselves from these crimes and civil disruptions constitute additional social costs" (114).

With all this information, it is clear that the current policies failing to eliminate the criminal activity associated with the illegal drug trade in the United States, because the main cause of this activity, the underground market, are left intact. Therefore, “the only way to truly eliminate those problems is to legalize the sale of drugs” (Thorton, 430).

Recommendations
Americans must accept the “War on Drugs” is not working and a society without drugs is impossible, if not intolerable. The question then is, “How does America implement policies that will regulate the production, distribution, and consumption of currently illegal drugs in order to create a safer atmosphere for its people?” The first thing United States governments must do is decriminalize personal possession of drugs as other countries already have. In 1976, the Netherlands decriminalized the possession of marijuana and almost immediately discovered a decline in usage from 13% to 6% (Heather, Wodak, Nadelmann, & O'Hare, 1993), proving that sometimes the forbidden fruit really is the sweetest.
The United States’ government has decriminalized personal possession; it must take responsibility for distribution of safer forms of currently illegal drugs. According to a United Nations report, "US authorities reported the mean purity level of heroin to be around 6% in 1987 but about 37% in 1997, in which year levels were even reaching 60% in New York," (1999, p.86). The United States’ government should regulate these drugs, just as they do with tobacco and alcohol. Regulation would ensure there are of safe levels of certain ingredients, while omitting the lethal chemicals often added to street drugs to increase quantity and weight for higher profits. The current policies of prohibition have caused deregulation. “Anarchy now rules the distribution and sale of drugs” (Trebach, 523). By taking control of the distribution of these drugs, the government would then be able regulate the sale of these drugs just as they do with tobacco and alcohol. Once decriminalized, the Controlled Substances Authority (CSA) would be able to issue licenses to competent sellers and be able to establish conditions for sale, such as age requirements. This governmental control of the production, sale, and distribution would eliminate the black market (as well as the violence, crime, and illegal profits) that prohibition of drugs has caused and that society has thus far been unable to control. It is obvious that the only real way to win the “War on Drugs,” is to decriminalize, regulate, and distribute these drugs to the American people, just as it has with tobacco and alcohol.

The United Nations Office for Drug Control and Crime Prevention (1998) states “the international illicit drug business generates as much as $400 billion in trade annually… That amounts to 8% of all international trade and is comparable to the annual turnover in textiles,” (p. 3). The United States government has attempted to stop drugs from being produced abroad, by creating crop substitution programs, which grow legal crops, but these efforts have also failed. They have failed because profits from the cultivation and sale of drugs are enormous due to prohibition so as that profits from legal crops cannot compare monetarily. According to a report prepared for ONDCP by Abt Associates in 2000, "Between 1989 and 1998, American users spent $69 billion to $77 billion yearly on cocaine and $19 billion to $22 billion yearly on heroin," (2000, p.5). But if the United States’ government became the supplier of these currently illegal drugs, it would receive the profits from every sale by way of taxes. In addition, billions of dollars would be saved, no longer needed to fight the drug war in such an aggressive manner. This revenue could be used to reduce the actual consumption through better education and treatment facilities.

Treatment facilities and harm reduction programs are necessary and could be effective if governmentally funded. The funds required for these programs could be made available by reallocating a portion of the current drug war monies. Previously, monies had been dispersed for addictive treatment, but Reagan’s administration had discontinued this allocation, even though it encountered opposition from many members of congress. It is important that treatment be available, inexpensively and repeatedly on demand, as it is understood that relapse is often part of the process of recovery. It must be understood that treatment is an essential step in getting one off drugs, and that “it is very difficult to rehabilitate a dead addict” (Trebach, 522). The United Kingdom has already implemented such programs in which they dispense maintenance medications of oral and injectable drugs, free needle exchanges, provide instruction regarding the correct use of needles, free condoms and safe sex education all in an effort to stop the spread of AIDS, detoxication, abstinence, and mental health therapy, in addition to general health care. And although crime remains in this county, there has been a reduction in criminal activity, an example that could prove to be valuable to the United States.

“There is persuasive evidence from experience with other drugs that the most effective way to reduce consumption is through education,” (Chambliss, 1995, p.102). Chambliss has found that education programs for addicts have significantly impacted tobacco and alcohol use and that these individuals have found benefits from self-help groups. Americans would be more likely to seek the help they need to overcome their addiction, if drugs were legalized and the stigma of criminality was not attached to them. Contrary to popular beliefs, addiction is not a major problem. The fact is that most people who report using cocaine and marijuana are occasional users and most claim they have no trouble stopping if they decide to. Additionally only three percent of the people who tried cocaine say they had difficulty stopping, (Chambliss, 1995). These statistics contradict previous information given by the United States government, and shed an entirely different light on the subject of addiction. The most important factor in reducing the consumption of drugs will be education. Education has been proven time and time again as the most powerful tool available, and therefore stands to reason, that those fully educated on the risks associated with drug use are less likely to try it in the first place.

Conclusion
In conclusion, it is imperative that the United States change its current policies to gain control over drug use within its borders. “The United States has been conducting a drug war for seven decades, during which time there have been steady increases in the seizures of illegal drugs, the numbers of people using drugs, and the health and social costs of drug taking,” (Smith, 1995, p.1655). Economists have argued that the drug war has been destined to fail due to the financial gains one has to receive through illegal sales. “Any success in reducing the supply will raise the price of illegal drugs. Addicts must then commit more crime to feed their habit; and a rise in the profit margins of drug smugglers urges them on to greater efforts,” (Smith, 1995, p.1655). The United States government has created illogical, unfounded, counterproductive drug policies, based on inaccurate drug definition, moral beliefs and distortions of fact. Americans have been led to believe that the drug war is imperative to their safety, and drugs themselves are responsible for the increase in crime and poverty. The fact is that most drug related crime is not derived from the use of drugs, but by the black market, which has been created by the drug war. Many Americans and prominent legislative supporters such as; Superior Judge James Gray of Orange County as well as Judge Robert Sweet of the Manhattan Federal Court, believe that the only way to win this war is to decriminalize personal possession. Additionally, fifty senior federal judges have refused to hear drug cases, and recently, former United States Surgeon General, Dr. Joycelyn Elders, publicly supported decriminalization. The United States’ “” is doomed to fail, and while other countries that have decriminalized or legalized drugs have shown promising results, the drug problem in the United States seems increase. The United States government must create new policies that allow decriminalization and legalization, which would be more likely than prohibition, to succeed in achieving everybody’s aim of minimizing the harm from drug abuse.

References
Abt Associates, (2000). What America's Users Spend on Illegal Drugs 1988-1998. Washington, DC: ONDCP. Retrieved November 25, 2007 from http://www.whitehousedrugpolicy.gov/publications/pdf/spending_drugs_1988_1998.pdf

American Medicine, (November 1915), 21, 10, 799-800.

Bean, P. (1974) The Social Control of Drugs. London: Martin Robertson

Brecher, E. M. (1972). The consumers union report on licit and illicit drugs. Consumer Reports Magazine. Retrieved on November, 12, 2007, from http://www.druglibrary.org/schaffer/Library/studies/cu/cu8.html.

Chepesiuk, R. (1999). The war on drugs: An international encyclopedia. Santa Barbara, CA: ABC-CLIO, Inc.

Ferraiolo, K. (2007, April). From killer weed to popular medicine: The evolution of american drug control policy, 1937-2000. Journal of Policy History, 19(2), 147-179.

France, S. (1990). Should we fight or switch? The ABA Journal, 76. 42-46.

Goode, E. (1997). Between politics and reason: The drug legalization debate. New York, NY: St. Martin’s Press.

Greenfield, Lawrence, A., & Snell, T.L. (1999), US Department of Justice, Bureau of Justice Statistics, Women Offenders. Washington, DC: US Department of Justice. Retrieved on November 27, 2007, from http://www.ojp.usdoj.gov/bjs/crimoff.htm

Hammermeister, J., Roland, M., & Page, R. (2002). Are high school students accurate or clueless in estimating substance abuse among peers? Adolescence, 37(147), 567-573.

Heather N, Wodak A, Nadelmann E, & O'Hare P, (Eds.). (1993). Psychoactive drugs and harm reduction: From faith to science. London: Whurr. Retrieved on November 6, 2007, from http://www.drugtext.org/library/articles/rosenbaum01.htm

Johnston, L. D., O’Malley, P.M., & Bachman, J.G. (2001). Monitoring the future: National survey results on drug use, 1975-2000, Volume 1: Secondary school students. Washington, DC: National Institute on Drug Abuse.

Johnston, L. D., O’Malley, P.M., & Bachman, J.G. (2003). Monitoring the future: National survey results on drug use, 1975-2002, Volume 2: College students and adults ages 19-40. Bethesda, MD: National Institute on Drug Abuse.

Jones, S. (1999, June, 24). What does the drug war cost. New Times, CA. Retrieved on November 17, 2007, from http://www.mapinc.org/drugnews/v99/n667/a01.html

Lynam, D.R., Milich, R., et al. (1999). Project D.A.R.E.: No effects at 10-year follow-up, Journal of Consulting and Clinical Psychology, 67(4). 590-593.

Mental Sequelae of the Harrison Law (May 15, 1915). New York Medical Journal, 102, 1014.

Mumola, C. J. (1999). Substance abuse and treatment, state and federal prisoners, 1997. Washington, DC: US Dept. of Justice, 3.

Office of Applied Studies, Substance Abuse and Mental Health Services Administration, & US Dept. of Health and Human Services. (2001). Year-end 2000 emergency room data from the drug abuse warning network. Washington, DC: DHHS.

Peele, S. (1985). The Meaning of Addiction. Compulsive Experience and its Interpretation. Lexington, Massachusetts: Lexington Books.

Shepard, E., Blackley, P. (2007). The Impact of marijuana law enforcement in an economic model of crime. Journal of Drug Issues. 37 (2). 403-424.

Smith, R. (1995). The war on drugs: Prohibition isn’t working – some legalization will help. British Medical Journal, 311. 1655-1656.

Strom, K. J., (2000), US department of justice, bureau of justice statistics, & profile of state prisoners under age 18, 1985-1997. Washington, DC: US Department of Justice.

Terry-McElrath, Y.M. & McBride, D.C. (2004). Local implementation of drug policy and access to treatment services for juveniles. Crime & Delinquency, 50, 60-87.

Thornton, M. (2007, Winter). Prohibition versus legalization: Do economists reach a conclusion on drug policy?. Independent Review, 11(3), 417-433.

Trebach, A. (1990, Fall). A bundle of peaceful compromises. Journal of Drug Issues, 20(4), 515-531.

United nations office for drug control and crime prevention, economic and social consequences of drug abuse and illicit trafficking. (1998). New York, NY: UNODCCP

United nations office for drug control and crime prevention, global illicit drug trends 1999. (1999). New York, NY: UNODCCP

Van Mastright, H. (1990) The abolition of drug policy: Toward strategic alternatives. Journal of Drug Issues, 20(4). 647-657.

Visano, L.A. (2001) Wars on drugs: From the politics of punishments to the prospects of peacekeeping. Addictions 1996: An international research journal.

Stephanie Lowrance-Henckel