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Article   |    
Applying Social Constructionism in the Treatment of Patients Who Are Intractably Aggressive
Michael F. Caldwell
Psychiatric Services 1994; doi:
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The author acknowledges the contributions of Trudy Ciszik, R.N., in the development of this paper.

Mendota Mental Health Institute, 301 Troy Drive, Madison, Wisconsin 53704

1994 by the American Psychiatric Association

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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 ofthe treatment system.

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