title: Applying social constructionism in the treatment of patients who are intractably aggressive.
abstract: Interventions based on the philosophy of social constructionism can be used for the treatment of patients who are intractably aggressive. The interventions are aimed at disrupting common interactive patterns between the patient and treaters in the treatment milieu and replacing them with patterns that do not allow the intractable symptoms to disrupt treatment efforts. Two case examples illustrate the use of this approach with extremely violent inpatients with long histories of unsuccessful interventions. In both cases the treatment included discontinuing certain therapeutic or prosocial interventions; one case involved determining the patient's daily privilege level randomly. The author discusses the advantages and difficulties of such approaches, including the need for staff to reframe their own logical structure and to overcome resistance from different levels of the treatment system.
authors.affiliation: Mendota Mental Health Institute, Madison, WI 53704.
authors.forename: M F
authors.initials: MF
authors.lastname: Caldwell
mesh_terms: D000184:Acting Out; D000328:Adult; D000374:Aggression / Q000523:psychology*; D000987:Antisocial Personality Disorder / Q000523:psychology / Q000534:rehabilitation*; D001521:Behavior Therapy; D003131:Combined Modality Therapy; D006760:Hospitalization; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team; D010356:Patient Isolation / Q000523:psychology; D011369:Professional-Patient Relations; D012960:Socioenvironmental Therapy; D014754:Violence