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What is Multiple Impact Therapy?

Published on by Andrew Marshall1 Comment

Introduction

Multiple impact therapy (MIT) is a group psychotherapy technique most often used with families in extreme crisis.

It was one of the first group therapy programmes developed in the United States. In multiple impact therapy (MIT), families are seen concurrently by a number of multi-disciplinary medical professionals. The duration of the therapy is short, typically ranging from one to two full treatment days.

The focus of treatment is to find and evaluate structural patterns within the family, evaluate those patterns to see if they are the source of the problem, then modify the structure to alleviate the problem.

Background

MIT as a therapy technique was developed at the University of Texas Medical Branch in the 1950s. At the time, Texas had very few psychoanalysts and those that were available were unaffordable to most families. Because treatment was scarce, there were few specialised programmes for adolescents, many were admitted as patients to psychiatric hospitals. Beginning in 1957, parents began bringing their troubled kids to the University of Texas Medical Branch for treatment.

Dr. Robert MacGregor, the lead researcher of group psychotherapy at the University of Texas Medical Branch, began developing MIT by interviewing entire families together in a single session. MacGregor and his team established their main goal as highlighting and emphasizing the parent’s concern to the disturbed child. Between 1957 and 1958, the team saw 12 families as the procedures were being developed. The initial sessions showed that therapy with individual members, together with group sessions, produced the most effective results. The individual sessions gave members the opportunity to voice their personal resentments while the group sessions gave therapists the opportunity to repair poor communication between family members. The therapy’s short, intensive time frame was originally due to life constraints involving time and travel; however, researchers kept the structure because the momentum created in the two day meetings reduced the overall number of sessions needed for the family to improve.

Procedure

MIT may be prescribed to families as a treatment option for a number of reasons: when conventional therapy fails to show results, as an alternative to hospitalisation, as a final course of action before hospitalisation, or for families who were already in group therapy but were seeing few results.

Treatment occurs in approximately seven steps over a two-day period.

Planning

Because many families participating in MIT are unfamiliar with the treatment and with psychotherapy, the planning phase informs the family about what is to be expected over the two days of treatment. Therapists use this time to review current information about the child and interview the community representative (or inpatient staff member) to gather personal details.

Briefing

After the family arrives, the therapy team and family meet for an initial conference to establish why they are gathered there. Intergroup conflict may be high in this phase. Blaming, criticism and aggressive accusations are commonplace. Therapists typically look for signs of defective communication among the family members and make note for later meetings. At the end of this group meeting, each member meets with an individual therapist.

Pressurised Ventilation

In individual meetings with the parents, parents are under a high degree of stress from the full group meeting. Therapists specifically look for the hardships the parents have faced in dealing with their child’s delinquency.

Initial Interview with the Child

The brief initial interview with the child takes place to match family patterns with the child’s behaviour.

Multiple Therapist Situation

After the initial group meet and individual meetings, therapists meet with any member or any number of members together as they see fit. Notes and other data collected (some studies video recorded the group meetings) are used in this procedure to address behavioural patterns and breakdowns in communication. This phase takes up the majority of the first day.

Team-Family Conference

A final group meeting convenes at the end of day one. Family members face each other again for the first time since the initial meeting. The sharing of the revised attitudes the group have towards one another takes place. The shift from conflict in the initial interview to the improved attitudes in the final team conference leads to the creation of a climate of change among the group.

Second Day Procedures

The second day attempts to begin in the same climate that created in the first. Day one often illuminates many of the breakdowns the family has experienced while day two focuses on retention of improved attitudes and application to the family’s unique situation. On day two, logistical considerations are often discussed such as: should the child remain hospitalised, continue schooling, or consider a different method of treatment. A two-month and six month follow up appointment is typically scheduled.

Potential Positive and Negative Outcomes

The use of an interdisciplinary team allows the parents, the child and the group as a whole to be seen from multiple viewpoints and through the lens of professionals with different experience and expertise. A typical interdisciplinary team as used in Macgregor’s studies at the University of Texas consisted of a psychologist, an associate therapist, a social worker, a nurse, and a member of the family’s community or inpatient clinic, however, other researchers have used up to 9 therapists in a single session. By including the community or inpatient staff member in MIT, trust and respect with the child’s parents increases.

Fifty-five additional families were seen between 1958 and 1962 when MacGregor first published his findings on MIT. Within the fifty-five families, only seven were considered unsuccessful cases. Despite the apparent success of MIT, two major drawbacks, the relative efficiency of the programme and conflict between the interdisciplinary team, were noted.

What is Helper Theory?

Published on by Andrew Marshall1 Comment

Introduction

Helper theory or the helper therapy principle was first described by Frank Riessman (1965) in an article published in the journal Social Work. The principle suggests that when an individual (the “helper”) provides assistance to another person, the helper may benefit.

Riessman’s model has inspired subsequent research and practice by scholars, clinicians, and indigenous populations to address a variety of social and health-related issues plaguing individuals and communities around the world.

Refer to Peer Support and Skills and Abilities Required for Peer Support.

Riessman’s Formulation

Riessman’s seminal article explored how non-professionals supported one another in self-help/mutual-aid support groups based on Riessman’s observations of a sample of these groups, as well as his summary of the findings of research in the areas of social work, education, and leadership. This article suggested that although the “use of people with a problem to help other people who have the same problem in [a] more severe form” is “an age-old therapeutic approach,” the traditional focus on outcomes for those receiving help to the exclusion of considering outcomes for those providing help is too narrow; instead, Riessman (1965, p.27) advocated for increased consideration of the experience of “the individual that needs the help less, that is, the person who is providing the assistance” because “frequently it is he who improves!”

Although Riessman expressed doubt that individuals receiving help always benefit from the assistance provided to them, he felt more sure that individuals providing help are likely experiencing important gains; thus, according to Riessman, the helping interaction at least has the potential to be mutually beneficial for both parties involved (i.e. for both the individual giving and for the individual receiving aid), but it is not absolutely necessary for the “helpee” to benefit in order for the “helper” to enjoy the benefits of helping. In instances where true mutual benefit occurs, the helper and helpee benefit in different ways, such that the person receiving help benefits by way of receiving whatever specific form of assistance is offered to them (e.g. emotional support, information, etc.) while the person providing help benefits by the very act of providing help, regardless of the type of aid they provide.

Riessman posited several different mechanisms which may facilitate the benefits experienced by an individual engaged in a helping role:

  • Gaining an improved self-image;
  • Becoming more committed to a position through the process of advocating it (i.e. “self-persuasion through persuading others”);
  • Experiencing meaningful development of abilities after having been given a stake in a system and learning through teaching others;
  • Gaining access to a socially-valued role and the resultant sense of social status and importance;
  • Enjoying opportunities to affirm one’s own wellness following placement in a system as a role model; and
  • Shifting one’s focus from self-concerns and problems to assisting others (and thus distracting oneself from ongoing difficulties).

Health Care

Lepore, Buzaglo, Liberman, Golant, Greener, and Davey (2014) investigated the helper-therapy principle in a randomised control trial of a “prosocial”, other-focused Internet Support Group (P-ISG) designed to elicit peer-instigated, supportive interactions online among female breast cancer survivors. When compared to female breast cancer survivors who participated in a standard, self-focused Internet Support Group (S-ISG), which was not designed to explicitly provide opportunities for helping interactions to take place, analyses found that individuals in the P-ISG condition did provide more support to others yet P-ISG participants experienced a higher level of depression and anxiety following the intervention than those in S-ISG. These results fail to provide support for the helper-therapy principle which posits that “helping others is effective at promoting mental health” (Lepore et al., 2014, p.4085). In accounting for these results, Lepore et al. (2014) suggest that it is possible that women in the P-ISG condition felt hesitant to express their negative feelings out of fear that doing so might impact others adversely, whereas women in the S-ISG felt more able to unburden themselves of emotional pain and thus enjoyed better mental health outcomes.

Arnold, Calhoun, Tedeschi, and Cann (2005) explored both the positive and negative sequelae of providing psychotherapy to clients who had experienced trauma and subsequent posttraumatic growth by conducting naturalistic interviews with a small sample of clinicians (N = 21). Although all interviewees indicated experiencing some degree of negative experience as a result of engaging in trauma-focused psychotherapy (such as intrusive thoughts, negative emotional responses, negative physical responses, and doubts about clinical competence), all participants also indicated some sort of positive personal outcome occurred as a result of assisting psychotherapy clients with these types of experiences. The positive reactions experienced by clinicians engaged in trauma work included: enjoying the gratification that comes through watching others grow and triumph following difficult times; increasing recognition of one’s own personal growth and development; expanding ability to connect emotionally with others; impacting one’s own sense of spirituality; increased awareness of one’s own good fortune in life; and increasing appreciation for the strength and resiliency of human beings. This finding suggests that the helper-therapy principle may operate in a clinical context whereby therapists (i.e. the helpers) benefit from engaging in the process of providing treatment to psychotherapy clients who have survived traumatic experiences.

Pagano, Post, and Johnson (2011) reviewed recent evidence examining “helper health benefits” among populations experiencing problematic involvement with alcohol, other mental health conditions, and/or general medical problems. In brief, their review suggests that when individuals with chronic health conditions (e.g. alcohol use disorder, body dysmorphic disorder with comorbid alcohol dependence, multiple sclerosis, chronic pain) help others living with the same chronic condition, the individual helper benefits (e.g. longer time-to-relapse, remission, reduced depression and other problematic symptoms, and increased self-confidence, self-esteem, and role functioning).

Additionally, Post’s (2005, p.73) review of the literature on altruism, happiness, and health indicates that “a strong correlation exists between the well-being, happiness, health, and longevity of people who are emotionally kind and compassionate in their charitable helping activities”. However, Post also notes that individual helpers may become overwhelmed by over-involvement in the lives of others, and that giving assistance beyond a certain variable threshold may lead to deleterious rather than beneficial outcomes for helpers.

Social Work

Melkman, Mor-Salwo, Mangold, Zeller, & Benbenishty (2015) used a grounded theory approach to understand:

  1. The motivations and experiences which led young adult “careleavers” (N = 28, aged 18-26) in Israel and Germany to assume a helper role; and
  2. The benefits they report enjoying as a result of helping others through volunteerism and/or human-service focused careers.

Participants reported that observing role models involved in helping roles, being exposed to prosocial values, and having opportunities to volunteer within the system in which they were simultaneously receiving care all contributed to later assumption of more stable and regular helping roles. These participants felt obliged to provide assistance to others, desired to provide this assistance to others, and felt sufficiently competent to carry out the tasks required of them in their helping role. These participants reported that helping others provided them with a sense of purpose in their lives, and also increased self-efficacy, social connectedness, and ability to cope with personal issues. Additionally, participants reported that assuming a helping role provided a sense of normalcy to their lives, as well as providing a sense of perspective on their own journey and outcomes. As one participant (a volunteer with a police department who was assigned to work with at-risk youth) shared with the researchers:

“The fact that I could bring a runaway girl back to her home and I made her trust me, the fact that I located a missing girl, the fact that I escorted a rape victim to hospital and I managed to give her strength and support her, these are the things that give me meaning, tell me that I’m in a much better situation than others” (Melkman et al., 2015, p.45).

Self-Help/Mutual-Help

Roberts, Salem, Rappaport, Toro, Luke, and Seidman (1999, p.859) found support for the helper-therapy principle among participants of GROW, a mutual-help group for individuals with serious mental illness, whereby “participants who offered help to others evidenced improvement over time in psychosocial adjustment”.

Maton (1988) reports that occupying both “helper” and “helpee” roles in a self-help/mutual-aid group (i.e. bidirectional support) was positively correlated with psychological well-being and positive perceptions regarding the benefits of group membership, and that these members with dual-roles had a greater sense of well-being and a more favourable opinion of the group than members who were helpees (i.e. recipients of assistance) only.

Olson, Jason, Ferrari, and Hutcheson (2005) reviewed the existent literature on four mutual-help organisations (Alcoholics Anonymous, Oxford House, GROW, and Schizophrenics Anonymous). They suggest that the processes of change framework found within the transtheoretical model of intentional behaviour change (Prochaska, Diclemente, and Norcross, 1992) is a useful model to conceptualise the activities of mutual-help organization members throughout their journey of mental health recovery. They explicitly link social liberation, the last of the ten processes of change articulated by the model (the others being: consciousness raising, self-re-evaluation, helping relationships, self-liberation, environmental re-evaluation, dramatic relief/emotional arousal, stimulus control, reinforcement management, and counterconditioning) to the helper-therapy principle, along with a related concept known as bidirectional support (Maton, 1988). Per Olson et al. (2005), social liberation “involves the person in recovery focusing attention away from oneself and developing a broader recognition of social issues that contributed to the targeted problem” which encourages “recovering individuals to take more helping-related attitudes toward others who face similar problems” (Olson et al., 2005, p.174). In reviewing the research conducted among members of these four self-help/mutual-help organisations, they identify three different mechanisms which might underlie the therapeutic effect of mutual-help:

  1. When an individual helps another, the helper’s social functioning improves because the act of providing help to another allows the helper to work through their own difficulties;
  2. When an individual helps another, the helper’s social functioning improves because the act of providing help to another allows the helper to reinforce their own personal learning about recovery; and/or
  3. When an individual helps another, the helper experiences an increase in their own sense of competence and usefulness to others and enables the helper to adopt a “strength-based roles that have not been fully exercised in other areas of life” (Olson et al., 2005, p.175).

In reviewing the research on GROW, specifically, 67% of members of this organisation sampled by Young and Williams (1987) who were asked how they most benefited from participation reported that involvement in GROW “taught [them they] could help others” (the most endorsed answer among all listed categories). As suggested by a study by Maton and Salem (1995), this idea is most succinctly expressed by way of an axiom of GROW which is often recited at meetings: “If you need help, help others.”

A review of empirical studies investigating the effect of mutual help group participation for individuals with mental health problems by Pistrang, Barker, and Humphreys (2008, p.110) provides “limited but promising evidence that mutual help groups benefit people with three types of problems: chronic mental illness, depression/anxiety, and bereavement”.

References

Arnold, D., Calhoun, L. G., Tedeschi, R. & Cann, A. (2005). Vicarious posttraumatic growth in psychotherapy. Journal of Humanistic Psychology. 45(2), pp.239-263.

Lepore, S.J., Buzaglo, J.S., Liberman, M.A., Golant, M., Greener, J.R. & Davey A. (2014) Comparing standard versus prosocial internet support groups for patients with breast cancer: A randomized controlled trial of the helper therapy principle. Journal of Clinical Oncology. 32(36), pp.4081-4086.

Maton, K.I. (1988). Social support, organization characteristics, psychological wellbeing and group appraisal in three self-help populations. American Journal of Community Psychology. 16(1), pp.53-77.

Maton, K.I. & Salem, D.A. (1995). Organizational characteristics of empowering community settings: A multiple case study approach. American Journal of Community Psychology. 23(5), pp631-656.

Melkman, E., Mor-Salwo, Y., Mangold, K., Zeller, M. & Benbenishty, R. (July 2015). Care leavers as helpers: Motivations for and benefits of helping others. Children and Youth Services Review. 54, pp.41-48.

Olson, B.D., Jason, L.A., Ferrari, J.R. & Hutcheson, T.D. (2005). Bridging professional and mutual-help: An application of the transtheoretical model to the mutual-help organization. Applied and Preventive Psychology. 11(3), pp.167-178.

Pagano, M.E., Post, S.G. & Johnson, S.M. (2011). Alcoholics Anonymous-Related Helping and the Helper Therapy Principle. Alcoholism Treatment Quarterly. 29(1), pp.23-34.

Pistrang, N., Barker, C. & Humphreys, K. (2008). Mutual Help Groups for Mental Health Problems: A Review of Effectiveness Studies. American Journal of Community Psychology. 42(1-2), pp.110-121.

Post, S.G. (2005). Altruism, happiness, and health: it’s good to be good. International Journal of Behavioral Medicine. 12(2), pp.66-77.

Prochaska, J.O., DiClemente, C.C. & Norcross, J.C. (1992). In search of how people change: Applications to the addictive behaviors. American Psychologist. 47(9), pp.1102-1114.

Riessman, F. (1965) The ‘Helper’ Therapy Principle. Social Work. 10(2), pp.27-32.

Roberts, L., Salem, D., Rappaport, J., Toro, P.A., Luke, D.A. & Seidman, E. (1999). Giving and receiving help: Interpersonal transactions in mutual-help meetings and psychosocial adjustment of members. American Journal of Community Psychology. 27(6), pp.841-868.

Young, J. & Williams, C.L. (1987). An Evaluation of Grow, a Mutual-Help Community Mental Health Organisation. Community Health Studies. 11(1), pp.38-42.

What is the Impact of Shame in Body-Focused Repetitive Behaviours & Binge Eating?

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Research Paper Title

“Shame on you”: The impact of shame in body-focused repetitive behaviours and binge eating.

Background

Body-focused repetitive behaviours (BFRBs), such as hair-pulling, skin-picking, and nail-biting, have been associated with difficulties in emotion regulation.

Studies have suggested that aversive emotions are important triggers for impulsive behaviours such as BFRBs and binge eating.

In particular, shame has been hypothesized to be a key emotion before and after these behaviours, but no experimental studies yet have investigated its impact on BFRBs.

The researchers aimed to evaluate the role of shame in BFRB and binge eating episodes and the presence of shame following these behaviours.

Methods

Eighteen women with BFRBs, 18 with binge eating, and 18 community controls participated in the study.

Results

Results showed that an experimental shame condition triggered more shame in the binge eating and BFRB groups than in the control group.

In addition, the shame induced condition increased the urge to engage in BFRBs, but not in binge eating.

Conclusions

Results showed that participants from the BFRB and the binge eating groups reported more shame after engaging in their pathological behaviours compared to following the neutral condition.

Future studies should replicate these findings with larger samples and different shame-inducing conditions.

Reference

Houazene, S., Leclerc, J.B., O’Connor, K. & Aardema, F. (2021) “Shame on you”: The impact of shame in body-focused repetitive behaviors and binge eating. Behaviour Research and Therapy. doi: 10.1016/j.brat.2021.103804. Online ahead of print.

Sibyl (2019)

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Introduction

Sibyl is a 2019 French comedy-drama film directed by Justine Triet and starring Virginie Efira, Adèle Exarchopoulos and Gaspard Ulliel.

A jaded psychotherapist returns to her first passion of becoming a writer.

Outline

Sibyl is a psychotherapist who returns to her first passion: writing. Her newest patient, Margot, is a troubled up-and-coming actress, who proves to be too tempting a source of inspiration. Fascinated almost to the point of obsession, Sibyl becomes more and more involved in Margot’s tumultuous life.

Cast

  • Virginie Efira as Sybil.
  • Adèle Exarchopoulos as Margot Vasilis.
  • Gaspard Ulliel as Igor Maleski.
  • Sandra Hüller as Mikaela “Mika” Sanders.
  • Laure Calamy as Édith.
  • Niels Schneider as Gabriel.
  • Paul Hamy as Étienne.

Production

Filming took place in Paris, in studios located in Lyon and on the Italian island of Stromboli.

Release

Sibyl received mixed reviews from critics.

Trivia

  • It was selected to compete for the Palme d’Or at the 2019 Cannes Film Festival.

Production & Filming Details

  • Director(s): Justine Triet.
  • Producer(s): David Thion and Philippe Martin.
  • Writer(s): Justine Triet and Arthur Harari.
  • Music:
  • Cinematography: Simon Beaufils.
  • Editor(s): Laurent Senechal.
  • Production: Les Films Pelleas and Scope Films.
  • Distributor(s): Le Pacte.
  • Release Date: 24 May 2019 (Cannes International Film Festival).
  • Running Time: 100 minutes.
  • Rating: Unknown.
  • Country: France and Belgium.
  • Language: French and English (subtitles).

Video Link

Sybil (2007)

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Introduction

Sybil is a 2007 American made-for-television drama film directed by Joseph Sargent, and written by John Pielmeier, based on the 1973 book Sybil by Flora Rheta Schreiber, which fictionalised the story of Shirley Ardell Mason, who was diagnosed with multiple personality disorder (more commonly known then as “split personality”, now called dissociative identity disorder).

This is the second adaptation of the book, following the Emmy Award-winning 1976 mini-series Sybil that was broadcast by NBC.

Outline

Troubled Columbia University art student and later student teacher Sybil Dorsett is referred to psychiatrist Cornelia Wilbur by Dr. Atcheson, a colleague who believes that the young woman is suffering from female hysteria. As her treatment progresses, Sybil confesses that she frequently experiences blackouts and cannot account for large blocks of time. Wilbur helps her recall a childhood in which she suffered physical, emotional, and sexual abuse at the hands of her disturbed mother Hattie.

Eventually, 16 identities varying in age and personal traits begin to emerge. Chief among them is Victoria, a French woman who explains to Dr. Wilbur how she shepherds the many parts of Sybil’s whole. Frustrating the therapist are objections raised by her associates, who suspect she has influenced her patient into creating her other selves, and Sybil’s father, who refuses to admit his late wife was anything other than a loving mother.

Although she had promised never to hypnotize Sybil, later into the treatment, Dr. Wilbur takes her patient to her home by a lake and hypnotizes her into having all 16 personalities be the same age as she and become just aspects of Sybil. By nightfall, Sybil claims she feels different, and emotionally declares her hatred toward her mother.

The last part of the movie tells of the history of Shirley Mason, the real woman who was known by the pseudonym of Sybil Dorsett.

Cast

  • Jessica Lange ….. Dr. Cornelia Wilbur.
  • Tammy Blanchard ….. Sybil Dorsett.
  • Eddie Ruiz ….. Dr. Ladysman.
  • JoBeth Williams … Hattie Dorsett.

Trivia

  • The university scenes were filmed at Dalhousie University in Nova Scotia.
  • In January 2006, The Hollywood Reporter announced CBS had greenlit the project, but it was shelved after completion.
  • The film was released in Italy, New Zealand, the Dominican Republic, Brazil, Norway, and Hungary before finally being broadcast in the US by CBS on 07 June 2008.

Production & Filming Details

  • Director(s): Joseph Sargent.
  • Producer(s):
    • Andrea Lapins … associate producer.
    • Michael Mahoney … producer.
    • Norman Stephens … executive producer.
    • Mark Wolper … executive producer.
  • Writer(s): John Pielmeier.
  • Music: Charles Bernstein.
  • Cinematography: Donald M. Morgan.
  • Editor(s): Michael Brown (as Mike Brown).
  • Production:
    • Norman Stephens Productions.
    • Warner Bros. Television.
    • Wolper Organisation.
  • Distributor(s): CBS (original airing, US).
  • Release Date: 28 May 2007 (Italy).
  • Running Time: 89 minutes.
  • Rating: Unknown.
  • Country: US.
  • Language: English.

Video Link

Sybil (1976)

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Introduction

Sybil is a 1976 two-part, ​3 1⁄4-hour American television film starring Sally Field and Joanne Woodward.

It is based on the book of the same name, and was broadcast on NBC on 14-15 November 1976.

Refer to On This Day … 25 January for information Shirley Ardell Mason, whom Sybil is based on (2007 film version).

Outline

After suffering a small breakdown in front of her students (and then being forced to hear a neighbour play Chopin’s Étude in A Minor, “Winter Wind”, incessantly), Sybil Dorsett is given a neurological examination by Dr. Cornelia Wilbur, a psychiatrist. She admits to having blackouts and fears that are getting worse. Dr. Wilbur theorises that the incidents are a kind of hysteria, all related to a deeper problem. She asks Sybil to return at a later date for more counselling. Sybil says she will have to ask her father.

Sybil’s father, Willard Dorsett, and her stepmother, Freida, are in New York on a visit. Sybil meets them at a cafeteria for lunch. She explains to her father that the problems she used to have as a young girl have returned and that she wants to see a psychiatrist, Dr. Wilbur. Sybil’s parents make it clear to Sybil that they disapprove of psychiatrists and psychiatry, saying how evil and controlling psychiatrists are. Sybil becomes upset and dissociates into Peggy, who becomes enraged and breaks a glass. Peggy angrily storms out of the cafeteria. Later that evening, Dr. Wilbur receives a late night call from someone who identifies herself as Vickie and says Sybil is about to jump out a hotel window. Dr. Wilbur rescues Sybil, who denies knowing Vickie. Suddenly, Sybil becomes hysterical and begins speaking like a young girl. This girl introduces herself as Peggy, and Wilbur realises that Sybil is suffering from dissociative identity disorder, previously known as multiple personality disorder.

Vickie introduces herself to Wilbur at the next session. Vickie, who knows everything about the other personalities, tells Wilbur about some of them, including Marcia, who is suicidal, and Vanessa, who plays the piano although Sybil has not played in years and swears she forgot how to play piano.

Over the weeks, each of the personalities introduce themselves to Wilbur. At the same time, the personality Vanessa falls in love with a charming neighbour named Richard.

Wilbur finally explains to Sybil about the other personalities. As proof, Wilbur plays the session’s tape to allow Sybil to hear their voices, but when a voice that sounds like Sybil’s mother Hattie speaks, an infant personality named Ruthie emerges. Wilbur is unable to communicate with the pre-verbal child and must wait until Sybil returns.

Life becomes more chaotic for Sybil as the other personalities grow stronger. The personalities make Dr. Wilbur a Christmas card, but Sybil made everything purple, a colour that frightens Peggy. Dr. Wilbur hypnotises Vickie and asks about the purple. Vickie relates a memory of a time Sybil’s mother locked young Sybil in the wheat bin in the barn. Thinking she was smothering, Sybil used her purple crayon to scratch on the inside of the bin so someone would know she had been there.

Vanessa invites Richard and his son Matthew to have Christmas dinner, after which Richard spends the night in Sybil’s apartment. Sybil has a nightmare and awakens as Marcia, who tries to throw herself off the roof. Richard rescues her and calls Wilbur. Soon afterwards, Richard moves away, crushing both Sybil and Vanessa. Once again confronted with her diagnosis, Sybil attempts to convince Wilbur that she has in fact been faking all of the other personalities the entire time and denies that multiple personalities exist within her.

Wilbur goes in search of Sybil’s father, who mentions that Sybil’s mother Hattie was diagnosed with paranoid schizophrenia, but denies that she ever abused Sybil. Wilbur also seeks out Sybil’s paediatrician. The doctor gives Wilbur a frightening account of extensive internal scarring he found while treating Sybil for a bladder problem. Finally, Wilbur visits the old Dorsett house, where she discovers the green kitchen Sybil’s selves have described many times. She also finds the purple crayon scratches inside the wheat bin. She takes them back to New York City to prove all the memories really happened.

Dr. Wilbur takes Sybil for a drive, during which Peggy reveals the horrific physical abuse she suffered at her mother’s hands. After Peggy exhausts herself, Sybil emerges, remembering everything that Peggy has just said. Finally, she is able to express her rage against her mother.

Dr. Wilbur hypnotises Sybil to introduce her to the other personalities. Sybil, who has always been frightened of Peggy, meets her at last and is surprised that she is only a young girl. Sybil embraces a weeping Peggy. A voiceover from Dr. Wilbur explains that after this incident, Sybil recovered her memories and went on to live a full and happy life as an academic.

The “big chair” featured in the film in which the Sybil character felt comfortable provided the name for Tears for Fears hit album Songs From The Big Chair.

Cast

  • Joanne Woodward as Dr. Cornelia Wilbur.
  • Sally Field as Sybil Dorsett.
  • Brad Davis as Richard, Sybil’s neighbour boyfriend.
  • Martine Bartlett as Hattie Dorsett, Sybil’s mother.
  • Penelope Allen as Miss Penny.
  • Jane Hoffman as Frieda Dorsett.
  • Charles Lane as Dr. Quinoness.
  • Jessamine Milner as Grandma Dorsett.
  • William Prince as Willard Dorsett.
  • Camila Ashland as Cam.
  • Tommy Crebbs as Matthew.
  • Gina Petrushka as Dr. Lazarus.
  • Harold Pruett as Danny.
  • Natasha Ryan as Child Sybil.
  • Paul Tulley as Dr. Castle.
  • Anne Beesley as The Selves.
  • Virginia Campbell as The Selves.
  • Missy Karn as The Selves.
  • Tasha Lee as The Selves.
  • Cathy Lynn Lesko as The Selves.
  • Rachel Longaker as The Selves.
  • Jennifer McAllister as The Selves.
  • Kerry Muir as The Selves.
  • Karen Obediear as The Selves.
  • Tony Sherman as The Selves.
  • Danny Stevenson as The Selves.
  • Gordon Jump as Tractor farmer.
  • Lionel Pina as Tommy.

The Alters

  • Peggy: A nine-year-old girl who believes she is still in the small town in which Sybil grew up. Peggy holds the rage Sybil felt at her mother’s abuse and frequently expresses her anger through temper tantrums and breaking glass. Like many of the selves, she enjoys drawing and painting. She fears hands, dishtowels, music, and the colours green and purple, all triggers to specific instances of abuse.
  • Vicky: A very sophisticated and mature eighteen-year-old girl who is aware of all the other personalities and knows everything the others do, though Sybil does not. Vicky speaks French and claims to have grown up in Paris with many brothers and sisters and loving parents. The dominant personality and the only personality to undergo hypnosis.
  • Vanessa: A young, vibrant, red-haired girl about twelve years old, she is outgoing and full of “joie de vivre”. Falls in love with Richard and helps Sybil build a relationship with him, until he moves away.
  • Marcia: A young girl obsessed with thoughts of death and suicide, who tries to kill herself (and thus Sybil) on several occasions. Dresses in black.
  • Ruthie: A preverbal infant. When Sybil is extremely frightened, she regresses into Ruthie and cannot move or speak.
  • Mary: Named for and strongly resembles Sybil’s grandmother. When Sybil’s grandmother (the only person Sybil felt loved her) died, Sybil was so bereft that she created Mary as an internalised version of Grandma. Mary speaks in the voice of an old woman and frequently behaves as one.
  • Nancy: A product of Sybil’s father’s religious fanaticism, Nancy fears the end of the world and God’s punishment.
  • Clara: Around 8-9 years old. Very religious; critical and resentful of Sybil.
  • Helen: Around 13-14 years old. Timid and afraid, but determined “to be somebody”.
  • Marjorie: Around 10-11 years old. Serene and quick to laugh, enjoys parties and travel.
  • Sybil Ann: Around 5-6 years old. Pale, timid, and extremely lethargic; the defeated Sybil.
  • Mike: A brash young boy who likes to build and do carpentry. He builds bookshelves and a partition wall for Sybil’s apartment, frightening her badly when she doesn’t know how they got there. He and Sid both believe that they will grow penes and be able “to give a girl a baby” when they are older.
  • Sid: Younger and a little more taciturn than Mike, he also enjoys building things, as well as sports. Identifies strongly with Sybil’s father and wants to be like him when he grows up.

Production

Sally Field stars in the title role, with Joanne Woodward playing the part of Sybil’s psychiatrist, Cornelia B. Wilbur. Woodward herself had starred in The Three Faces of Eve, in which she portrayed a woman with three personalities, winning the Academy Award for Best Actress for the role. Based on the book Sybil by Flora Rheta Schreiber, the movie dramatises the life of a shy young graduate student, Sybil Dorsett (in real life, Shirley Ardell Mason), suffering from dissociative identity disorder as a result of the psychological trauma she suffered as a child. With the help of her psychiatrist, Sybil gradually recalls the severe child abuse that led to the development of 16 different personalities. Field’s portrayal of Sybil won much critical acclaim, as well as an Emmy Award.

Edited and Unedited Versions

The film, originally 198 minutes long, was initially shown over the course of two nights on NBC in 1976. Due to high public interest, the VHS version of Sybil was released in the 1980s, with one version running 122 minutes and another, extended version running 132 minutes. Several key scenes, including Sybil’s final climactic “introduction” to her other personalities, are missing in both versions. The film is shown frequently on television, often with scenes restored or deleted to adjust for time constraints and the varying sensitivity of viewers. The DVD includes the full 198-minute version originally displayed on the NBC broadcast.

A 128-minute edit of the film was shown in cinemas in Australia, opening in January 1978.

Production & Filming Details

  • Director(s): Daniel Petrie.
  • Producer(s): Philip Capice, Peter Dunne, and Jacqueline Babbin.
  • Writer(s): Stewart Stern.
  • Music: Leonard Rosenman.
  • Cinematography: Mario Tosi.
  • Editor(s): Michael S. McLean and Rita Roland.
  • Production: Lorimar Productions.
  • Distributor(s):
  • Release Date: 14-15 November 1976.
  • Running Time: 198 minutes (original version), 133 minutes (theatrical), and 187 minutes (DVD).
  • Rating: Unknown.
  • Country: US.
  • Language: English.

Video Link

The Truth About … Improving Your Mental Health (2021)

Published on by Andrew Marshall1 Comment

Introduction

Professor Tanya Byron and Alex Scott uncover the latest science on how to improve your mental health and wellbeing – and reveal some surprising new techniques.

Part of the BBC’s The Truth About series (you can currently view all episodes on the BBC iPlayer).

Outline

Clinical psychologist Professor Tanya Byron teams up with former England footballer Alex Scott, who has suffered from depression, to discover how the latest science can help us gain greater control over our state of mind and improve our mental health and wellbeing.

Even in normal times, one in four of us will experience mental health difficulties, but living through a global pandemic has put our mental health under unprecedented strain. Over the past year, a team from Imperial College London, in collaboration with the BBC, have surveyed the mental health of over 350,000 people across the UK. This unique study provides a snapshot before and during the pandemic, revealing its shocking impact.

Production & Filming Details

  • Presenter(s): Tanya Byron and Alex Scott.
  • Director(s): Ruhi Hamid.
  • Producer(s):
    • Matthew Barrett … series producer (as Matt Barrett).
    • Tom Coveney … commissioning editor.
    • Fay Finlay … assistant producer.
    • Ruhi Hamid … producer (produced by).
    • Christine Johnston … producer: Cohort.
    • Mairead Maclean … assistant producer.
    • Jane McLaughlin … talent executive.
    • Paul Overton … executive producer.
    • Jacqueline Smith … executive producer.
  • Writer(s): Claudia Lewis (developed by).
  • Music:
  • Cinematography:
  • Editor(s): Clyde Wallbanks and Lauri White.
  • Production:
  • Distributor(s): BBC One.
  • Release Date: 20 January 2021 (UK).
  • Running Time: 57 minutes.
  • Rating: Unknown.
  • Country: US.
  • Language: English.

Video Link

Does the OCI-4 Show Promise as an Ultra-Brief Screening Tool for Identifying likely OCD?

Published on by Andrew MarshallLeave a comment

Research Paper Title

The OCI-4: An ultra-brief screening scale for obsessive-compulsive disorder.

Background

Obsessive-compulsive disorder (OCD) is a prevalent and burdensome condition that is typically assessed using in-depth interviews or lengthy self-report measures. Accordingly, routine screening in busy non-mental health settings is impractical, and OCD is often under- (or mis-) recognised.

Methods

The researchers evaluated an ultra-brief version of a widely used self-report measure, the Obsessive-Compulsive Inventory-Revised (OCI-R), which may be employed as a routine screener for OCD.

A total of 1,087 adults diagnosed with OCD, 1,306 unselected adults from the community, and 423 adults with anxiety related disorders completed the OCI-R along with measures of anxiety and mood.

Analyses were conducted to reduce the number of items and examine evidence for sensitivity and specificity to OCD clinical status, test-retest reliability, sensitivity to treatment, and convergent and discriminant validity.

Results

Four items that optimally assess different dimensions of OCD (washing, checking, ordering, obsessing) were identified. Psychometric evaluation revealed good to excellent test-retest reliability, validity, prediction of clinical OCD status, and sensitivity to treatment.

Conclusions

A 4-item version of the OCI-R, called the OCI-4, shows promise as an ultra-brief screening tool for identifying likely OCD in settings where in-depth assessment is impractical. Patients with a positive screen may be referred for further evaluation and appropriate treatment.

Reference

Abramovitch, A., Abramovitchm J.S. & McKay, D. (2021) The OCI-4: An ultra-brief screening scale for obsessive-compulsive disorder. Journal of Anxiety Disorder. doi: 10.1016/j.janxdis.2021.102354. Online ahead of print.

On This Day … 25 January

Published on by Andrew Marshall2 Comments

People (Births)

  • 1923 – Shirley Ardell Mason, American psychiatric patient (d. 1998).

Shirley Ardell Mason

Shirley Ardell Mason (25 January 1923 to 26 February 1998) was an American art teacher who was reputed to have dissociative identity disorder (previously known as multiple personality disorder).

Her life was purportedly described, with adaptations to protect her anonymity, in 1973 in the book Sybil, subtitled The True Story of a Woman Possessed by 16 Separate Personalities. Two films of the same name were made, one released in 1976 and the other in 2007. Both the book and the films used the name Sybil Isabel Dorsett to protect Mason’s identity, though the 2007 remake stated Mason’s name at its conclusion.

Mason’s diagnosis and treatment under Cornelia B. Wilbur have been criticised, with allegations that Wilbur manipulated or possibly misdiagnosed Mason.

Biography

Mason was born and raised in Dodge Centre, Minnesota, the only surviving child of Walter Wingfield Mason (a carpenter and architect) and Martha Alice “Mattie” Atkinson. In regard to Mason’s mother: “…many people in Dodge Centre say Mattie” – “Hattie” in the book – “was bizarre,” according to Bettie Borst Christensen, who grew up across the street. “She had a witch-like laugh….She didn’t laugh much, but when she did, it was like a screech.” Christensen remembers Mason’s mother walking around after dark, looking in the neighbours’ windows. At one point, Martha Mason was reportedly diagnosed with schizophrenia.

Mason graduated from Dodge Centre High School in 1941 and became an art student at Mankato State College, now Minnesota State University, Mankato. In the early 1950s, Mason was a substitute teacher and a student at Columbia University. She had long suffered from blackouts and emotional breakdowns, and finally entered psychotherapy with Cornelia B. Wilbur, a Freudian psychiatrist. Their sessions together are the basis of the book. From 1970-1971, she taught art at Rio Grande College in Rio Grande, Ohio (now the University of Rio Grande).

Some people in Mason’s home town, reading the book, recognised Mason as Sybil. By that time, Mason had severed nearly all ties with her past and was living in West Virginia. She later moved to Lexington, Kentucky, where she lived near Wilbur. She taught art classes at a community college and ran an art gallery out of her home for many years.

Wilbur diagnosed Mason with breast cancer in 1990, and she declined treatment; it later went into remission. The following year, Wilbur developed Parkinson’s disease, and Mason moved into Wilbur’s house to take care of her until Wilbur’s death in 1992. Mason was a devout Seventh-day Adventist. When her breast cancer returned Mason gave away her books and paintings to friends. She left the rest of her estate to a Seventh-day Adventist TV minister. Mason died on 26 February 1998.

Over one hundred paintings were found locked in a closet in Mason’s Lexington home when it was being emptied after her estate sale. These paintings, often referred to as the “Hidden Paintings”, span the years 1943, eleven years before starting psychotherapy with Dr. Wilbur, to 1965, the year of her successful integration. Several of the paintings were signed by Shirley. However, many remained unsigned, and include examples of some of the artwork presumably created by, and signed by the alternate personalities.

Sybil

Flora Rheta Schreiber’s non-fiction book Sybil: The True Story of a Woman Possessed by 16 Separate Personalities told a version of Mason’s story with names and details changed to protect her anonymity. The book, whose veracity was challenged (e.g. Sybil Exposed by Debbie Nathan), stated that Mason had multiple personalities as a result of severe child sexual abuse at the hands of her mother, who, Wilbur believed, had schizophrenia.

The book was made into a highly acclaimed TV movie starring Sally Field and Joanne Woodward, in 1976. The TV movie was remade in 2007 with Tammy Blanchard and Jessica Lange.

Controversy

Mason’s diagnosis had been challenged. Psychiatrist Herbert Spiegel saw Mason for several sessions while Wilbur was on vacation and felt that Wilbur was manipulating Mason into behaving as though she had multiple personalities when she did not. Spiegel suspected Wilbur of having publicised Mason’s case for financial gain. According to Spiegel, Wilbur’s client was a hysteric but did not show signs of multiple personalities; in fact, he later stated that Mason denied to him that she was “multiple” but claimed that Wilbur wanted her to exhibit other personalities. Spiegel confronted Wilbur, who responded that the publisher would not publish the book unless it was what she said it was.

Spiegel revealed that he possessed audio tapes in which Wilbur tells Mason about some of the other personalities she has already seen in prior sessions. Spiegel believes these tapes are the “smoking gun” proving that Wilbur induced her client to believe she was multiple. Spiegel made these claims 24 years later, after Schreiber, Wilbur and Mason had all died and he was finally asked about the topic.

In August 1998, psychologist Robert Rieber of John Jay College of Criminal Justice stated that the tapes belonged to him and that Wilbur had given them to him decades earlier. He cited the tapes to challenge Mason’s diagnosis. Rieber had never interviewed or treated Mason but asserted that she was an “extremely suggestible hysteric.” He claimed Wilbur had manipulated Mason in order to secure a book deal.

In a review of Rieber’s book, psychiatrist Mark Lawrence asserts that Rieber repeatedly distorted the evidence and left out a number of important facts about Mason’s case to advance his case against the validity of the diagnosis.

Debbie Nathan’s Sybil Exposed draws upon an archive of Schreiber’s papers stored at John Jay College of Criminal Justice and other first-hand sources. Nathan claims that Wilbur, Mason, and Schreiber knowingly perpetrated a fraud and describes the purported manipulation of Wilbur by Mason and vice versa and that the case created an “industry” of repressed memory. Nathan hypothesizes that Mason’s physical and sensory issues may have been due to untreated pernicious anaemia, the symptoms of which were mistaken at the time for psychogenic issues. She notes that after Mason was treated with calf’s-liver supplements for chronic blood disorders as a child and young woman, her psychological symptoms likewise went into remission for years at a time, and that Wilbur herself noted that “Sybil” suffered from pernicious anaemia later in life. Nathan’s writing and her research methods have been publicly criticised by Mason’s family and by Dr. Patrick Suraci, who was personally acquainted with Shirley Mason.

In addition, Suraci claims that Spiegel behaved unethically in withholding tapes which supposedly proved Wilbur had induced Mason to believe she had multiple personalities. Spiegel also claimed to have made films of himself hypnotising Mason, supposedly proving that Wilbur had “implanted false memories” in her mind, but when Suraci asked to see the films Spiegel said he had lost them. Although Wilbur’s papers were destroyed, copies and excerpts within Flora Rheta Schreiber’s papers at the Lloyd Sealy Library of John Jay College were unsealed in 1998.

In 2013, Nancy Preston published After Sybil, a personal memoir which includes facsimile reproductions of Mason’s personal letters to her, along with colour plates of her paintings. According to Preston, Mason taught art at Ohio’s Rio Grande College, where Preston was a student. The two became close friends and corresponded until a few days before Mason’s death. In the letters, Mason claimed that she had had multiple personalities.

On This Day … 24 January

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People (Births)

  • 1850 – Hermann Ebbinghaus, German psychologist (d. 1909).
  • 1853 – Sigbert Josef Maria Ganser, German psychiatrist (d. 1931).

Hermann Ebbinghaus

Hermann Ebbinghaus (24 January 1850 to 26 February 1909) was a German psychologist who pioneered the experimental study of memory, and is known for his discovery of the forgetting curve and the spacing effect. He was also the first person to describe the learning curve. He was the father of the neo-Kantian philosopher Julius Ebbinghaus.

Early Life

Ebbinghaus was born in Barmen, in the Rhine Province of the Kingdom of Prussia, as the son of a wealthy merchant, Carl Ebbinghaus. Little is known about his infancy except that he was brought up in the Lutheran faith and was a pupil at the town Gymnasium. At the age of 17 (1867), he began attending the University of Bonn, where he had planned to study history and philology. However, during his time there he developed an interest in philosophy. In 1870, his studies were interrupted when he served with the Prussian Army in the Franco-Prussian War. Following this short stint in the military, Ebbinghaus finished his dissertation on Eduard von Hartmann’s Philosophie des Unbewussten (philosophy of the unconscious) and received his doctorate on 16 August 1873, when he was 23 years old. During the next three years, he spent time at Halle and Berlin.

Professional Career

After acquiring his PhD, Ebbinghaus moved around England and France, tutoring students to support himself. In England, he may have taught in two small schools in the south of the country (Gorfein, 1885). In London, in a used bookstore, he came across Gustav Fechner’s book Elemente der Psychophysik (Elements of Psychophysics), which spurred him to conduct his famous memory experiments. After beginning his studies at the University of Berlin, he founded the third psychological testing lab in Germany (third to Wilhelm Wundt and Georg Elias Müller). He began his memory studies here in 1879. In 1885 – the same year that he published his monumental work, Über das Gedächtnis. Untersuchungen zur experimentellen Psychologie, later published in English under the title Memory: A Contribution to Experimental Psychology – he was made a professor at the University of Berlin, most likely in recognition of this publication. In 1890, along with Arthur König, he founded the psychological journal Zeitschrift für Physiologie und Psychologie der Sinnesorgane (“The Psychology and Physiology of the Sense Organs'”).

In 1894, he was passed over for promotion to head of the philosophy department at Berlin, most likely due to his lack of publications. Instead, Carl Stumpf received the promotion. As a result of this, Ebbinghaus left to join the University of Breslau (now Wrocław, Poland), in a chair left open by Theodor Lipps (who took over Stumpf’s position when he moved to Berlin). While in Breslau, he worked on a commission that studied how children’s mental ability declined during the school day. While the specifics on how these mental abilities were measured have been lost, the successes achieved by the commission laid the groundwork for future intelligence testing. At Breslau, he again founded a psychological testing laboratory.

In 1902, Ebbinghaus published his next piece of writing entitled Die Grundzüge der Psychologie (Fundamentals of Psychology). It was an instant success and continued to be long after his death. In 1904, he moved to Halle where he spent the last few years of his life. His last published work, Abriss der Psychologie (Outline of Psychology) was published six years later, in 1908. This, too, continued to be a success, being re-released in eight different editions. Shortly after this publication, on 26 February 1909, Ebbinghaus died from pneumonia at the age of 59.

Sigbert Ganser

Sigbert Josef Maria Ganser (24 January 1853 to 04 January 1931) was a German psychiatrist born in Rhaunen.

He earned his medical doctorate in 1876 from the University of Munich. Afterwards he worked briefly at a psychiatric clinic in Würzburg, and later as an assistant to neuroanatomist Bernhard von Gudden (1824-1886) in Munich. In 1886, he became head of the psychiatric department at Dresden General Hospital. Among his students was neurologist Hans Queckenstedt (1876-1918).

Sigbert Ganser is remembered for a hysterical disorder that he first described in 1898. He identified the disorder in three prisoners while working at a prison in Halle. The features included approximate or nonsensical answers to simple questions, perceptual abnormalities, and clouding of consciousness. Ganser believed that these symptoms were an associative reaction caused by an unconscious attempt by the patient to escape from an intolerable mental situation. The disorder was to become known as Ganser syndrome.