Case 6 therapy for aggression
1. Aronson: prevention high school tragedy
- The author reviews motivations of students who commit violent acts in schools. He
recommends the use of "jigsaw groups," an intervention originally developed to ease
the tensions of desegregation in Texas schools. This model involves grouping students
multiculturally and encouraging collaboration and interdependence instead of
competition. The intervention has had a positive effect on standardized test scores and
self-esteem.
- the rampage killings are just the pathological tip of an enormous iceberg: The
poisonous social atmosphere prevalent at most high schools in this country an
atmosphere characterized by exclusion, rejection, taunting and humiliation. In high
school, there is an iron-clad hierarchy of cliques with athletes, class officers,
cheerleaders, and "preppies" at the top. At the bottom are kids who those at the top
refer to as nerds, goths, geeks, loners, homos kids who are too fat, too thin, too short,
too tall, who wear the wrong clothes or simply don't fit in. The teenagers near the top
of the hierarchy are constantly rejecting, taunting, and ridiculing those near the
bottom. Those in the middle join in the taunting as a way of differentiating themselves
from those at the bottom and showing those at the top that they are different from the
geeks and the loners.
- Rejection and the accompanying humiliation was the dominant issue underlying every
one of the rampage killings in the United States. The behaviour of the shooters was
pathological in the extreme, but it is certainly not unfathomable. Our data indicate that
the problem is widespread and is far broader than the shootings themselves. Moreover,
it has been going on for a very long time.
- We called our technique the jigsaw classroom because it resembled the assembling of
a jigsaw puzzle, with each student having a vital piece of the puzzle. Students are
placed in diverse six-person learning groups. The day's lesson is divided into six
paragraphs so that each student is assigned one segment of the written material. Each
piece, like the pieces of a jigsaw puzzle, must be put together before anyone can view
the whole picture. Each student must learn his or her own section and teach it to the
other members of the group who do not have any other access to that material. the
students quickly learn that their grade is dependent on their ability to learn from one
another. Unlike the traditional classroom, where students are competing against each
other, the jigsaw classroom has students depending on each other.
- Through the jigsaw process, the children find it essential to pay more attention to each
other; in the process of paying attention they begin to gain more respect for each other.
Compared to students in traditional classrooms, students in jigsaw groups showed a
decrease in prejudice and stereotyping and an increase in their liking for their
groupmates, both within and across ethnic boundaries. In addition, children in the
jigsaw classrooms performed better on standardized exams and showed a significantly
greater increase in self-esteem than children in traditional classrooms. Children in the
jigsaw classrooms also showed far greater liking for school than those in traditional
classrooms. Moreover, children in schools where the jigsaw technique was practiced
showed substantial evidence of true integration.
- One reason for the success of this technique is that the process of participating in a
cooperative group breaks down in-group versus out-group perceptions and allows the
individual to develop the cognitive category of "oneness" where no one is excluded
from group membership. In addition, the process of working cooperatively encourages
the development of empathy.
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, - Bridgeman showed the children a series of cartoons aimed at testing a child's ability to
empathize to put themselves in the shoes of the cartoon characters. Through their
experience with jigsaw, they had developed the ability to take the perspective of the
letter carrier to put themselves in his shoes. They realized that he would be confused at
seeing the boy cry over receiving a nice present because. the letter carrier hadn't
witnessed the farewell scene.
- The extent to which children can develop the ability to see the world from the
perspective of another human being has profound implications for interpersonal
relations in general. When we develop the ability to understand what another person is
going through it increases the probability that our heart will open to that person. Once
our heart opens to another person, it becomes virtually impossible to feel prejudice
against that person, to bully that person, to taunt that person, or to humiliate that
person
2. Bernstein: Schematherapy
- Resocialization: the gradual reintroduction of the patient into the community. Patients
are assessed at regular intervals, usually on an annual basis, with standardized risk
assessment instruments. When their risk levels diminish, they are given permission to
go on leave, first for short periods of time under high supervision, and then later, for
longer, unsupervised leave.
- Although a substantial recidivism rate, it is considerably lower than the recidivism
numbers from ex-prisoners (prisoners who did not receive the specialized TBS
treatment).
- some empirical data exist that support the notion that TBS treatment can benefit some
forensic psychiatric patients, and may be superior in reducing recidivism risks over
imprisonment without specialized treatment. However, no randomized clinical trials
have been conducted to confirm this. although TBS does appear to be more effective
than incarceration, there is little evidence about which elements of TBS treatment
might account for this
- In this article, we describe a multicentre randomized clinical trial that is being
conducted in the Netherlands to address these questions for the largest group of
offenders in TBS clinics: those with personality disorders. The study is a three-year
randomized clinical trial and three-year follow-up comparing the effectiveness of
Schema Therapy (ST) to treatment as usual for male forensic patients with Antisocial,
Borderline, Narcissistic, or Paranoid Personality Disorders (PDs) at seven TBS clinics.
Given the high rates of recidivism in forensic patients with personality disorders,
compared to other mentally ill offenders, we felt that an intensive, longer-term form of
treatment was needed to achieve reductions in personality disorder symptoms and
recidivism risk in these patients.
Schematherapy (ST)
- an integrative therapy for personality disorders (PDs) combining cognitive,
behavioural, psychodynamic object relations, and humanistic/experiential approaches.
ST is an intensive form of individual psychotherapy that is usually delivered twice a
week in forensic inpatients with severe PDs. Treatment usually lasts from two to three
years, with frequency often reduced in the third year of treatment. Group forms of ST
have also been developed, including for use in the forensic field, but these are usually
intended as ancillary treatments in forensic patients who are also undergoing
individual ST.
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