Cognitive-Behavioral-Expressive Interventions with Aggressive and Resistant Youth

Abstract

Increasingly, youth placed in residential treatment facilities demonstrate violent. aaaressive behavior. Research on national, regional and local levels consistently demonstrate that youth referred for residential placement evidence violent and aggressive ideation and behavior. Tpically, such youth have experienced abuse and come from families of origin characterized by violence as well as probable sexual and substance abuse. Trends in the provision of services to youth reflect current emphasis upon maintaining youth at home and minimizing out of home care placement. Accordingly, youth placed in residential settings will be those who present behaviors, most likely violence and assaultiveness, who cannot be successfully treated in the community setting. Residential treatment centers, therefore, must develop treatment strategies to address the needs of these youth. Research into the nature of aggressive behavior has demonstrated that such youth, often the victims themselves of abuse, tend to exhibit aggressive behavior in early childhood and such behavior remains stable through adolescence and into young adulthood. Violent behavior is generally now thought to be multicausal in origin with genetic, family, environmental and leaning factors seen as etiologic agents. Current research further demonstrates that aggressive youth have characteristic cognitive processes of attribution and expectations which appear to predispose them to aggressive actions. Research into the emotional states of aggressive individuals further demonstrates a narrow band of affective expressions and a deviant state of arousal as typically being associated with aggressive behavior. Aggressive behavior has also been associated with deficiencies in problem solving behavior and social skills in youth. This intervention approach, initially developed with violent psychiatric inpatients, utilizes a multimodal approach to the treatment of aggressive behavior. The therapy model is a modification of the paradigm of John Monahan's model of the prediction of violent behavior and the Anger Management approaches of Raymond Novaco. In addition, the therapy approach utilized the methodologies found in the Creative Therapies, most notably those of Art and Music Therapy. As such, the program is a combination of cognitive-behavioral and expressive therapies which is targeted to reduce aggressive behavior by modification of dysfunctional cognitive, affective, behavioral and problem solving skills seen in aggressive individuals.