Behavior Therapy in Psychiatric Hospitals

Behavior Therapy in Psychiatric Hospitals

PW Corrigan and RP Liberman, editors

New York NY: Springer Publishing Company; 1994.244 p

Corrigan and Liberman have pulled together an assorted collection of clinical reports on the application of behavior therapy techniques to patients in psychiatric hospitals and a few other settings. These settings include Liberman’s research unit at Camarillo, a forensic unit at Fulton State Hospital in Missouri, a unit at the Albuquerque VA Medical Center, a psychiatric hospital in Munich, Germany, an adolescent ward at a private California hospital, a behavioral medicine unit at the University Health Sciences Center in St Louis, the Therapeutic Contracting Program from McLean Hospital Harvard Medical School, a ward in a state hospital in New York City, and a unit at Tinley Park Mental Health Center in suburban Chicago.

There are also chapters, more general in focus, on implementing and maintaining programs and on selling them in the “Health Care Marketplace”. Most of the programs are token economics or variants thereof.

This book is well on the way toward anachronism. Focusing as it does on the impersonal and manipulative aspects of rewarding people for desired behaviors, it is very much out of step with the current increasing value being placed on patients’ rights and on patients’ active participation in their own treatment programs.

The accounts of programs tend to be anecdotal or didactic rather than research-oriented or scientific and, in that respect, there is really nothing here that supersedes Paul and Lentz’s (1977) definitive study of almost 20 years ago. However, the book can provide at least some food for thought for those working with long-hospitalized, chronic patients. These patients are now a highly selected group, since bed closures and fiscal restraints, and mental health reform have led us to discharge, and try to maintain outside the hospital, all but the very sickest patients. This group of patients provides an interesting challenge to those few remaining professionals

who work with them. Thus, besides making us aware that there is still a group of die-hards doing behavior therapy and even running token economies, albeit with increasing difficulty, Corrigan and Liberman’s book can make us aware of a few methods that can supplement the meagre, available therapy armamentarium for such patients. We must remember to use them in a more collaborative and less high-handed way, however.