Conceived Through Rape/Incest? Adoptive Parents’ Experiences Managing Uncertainty and Disclosure Surrounding their Children's Origins

Adoptive parents may be placed with children conceived under difficult circumstances, such as via rape or incest. At the same time, adoptive parents are generally encouraged to communicate openly with their children about their adoption stories and birth families. No research has examined the experiences of parents who adopt children who were conceived through rape or incest. This exploratory study examines how parents discuss their decision-making when adopting children conceived via rape or incest, how they manage varying levels of uncertainty about their children's origins, and whether and how they plan to disclose this information to children. The researchers used thematic analysis to examine the experiences of 11 couples (22 parents) interviewed at four time points after adopting children who were reportedly conceived via rape or incest. Findings revealed that even soon after adopting, parents discussed the need to eventually talk to their children about their conception circumstances. Parents generally struggled to determine how and when to disclose this information, particularly when they felt uncertain about the veracity of the conception stories they had been told. Some hoped to rely on professionals or birth mothers to guide them in these communications. Findings have implications for supporting adoptive families as they navigate the complexity of managing sensitive information and uncertainty when adopting children conceived through rape or incest. Practitioners should provide ongoing guidance to adoptive parents about how and when to disclose developmentally appropriate information to children about difficult conception circumstances.     

Attachment-based family therapy for depressed adolescents: programmatic treatment development

Few effective psychosocial treatment models for depressed adolescents have been developed, let alone ones that use the developmentally potent context of the family as the focus of intervention. Attachment-based family therapy (ABFT) is a brief, manualized treatment model tailored to the specific needs of depressed adolescents and their families. Attachment theory serves as the main theoretical framework to guide the process of repairing relational ruptures and rebuilding trustworthy relationships. Empirically supported risk factors for depression are the primary problem states that therapists target with specific treatment strategies or tasks. Parent problem states include criticism/hostility, personal distress, parenting skills, and disengagement. Adolescent problem states include motivation, negative self-concept, poor affect regulation, and disengagement. Intervention tasks include relational reframing, building alliances with the adolescent and with the parent, addressing attachment failures, and building competency. A small, randomized clinical trial provides initial support for the model. Several process research studies, using both qualitative and quantitative methods, have helped refine the clinical guidelines for each treatment task. ABFT is a promising new treatment for depressed adolescents and more research on it is warranted.     

Suicide ideation as a predictor of treatment outcomes in cognitive-behavioral therapy for unipolar mood disorders

Background/Objective: Suicide ideation is common in depressed patients. However, no studies to date have examined whether pretreatment suicide ideation is associated with poorer outcomes after cognitive-behavioral therapy for adult depression. Method: 475 depressed outpatients (age: M = 39.9 years, SD = 11.71; 60.2% female) took part in a pre-treatment and a post-treatment assessment. Pre-treatment suicide ideation measured with the BDI suicide item was considered as a predictor of treatment outcomes – controlling for age, gender, number of attended therapy sessions, as well as pre-treatment depression severity. Results: Hierarchical regression revealed that age, gender, number of completed therapy sessions and depression severity at baseline could explain 25% of the variance in post-treatment BDI-scores. Adding suicide ideation significantly improved the amount of variance explained to 27%. Treatment outcomes were worse for patients with more severe depression, suicidal patients, patients receiving more therapy-sessions and older patients. Conclusions: Suicide ideation added only little incremental variance to the prospective prediction of post-treatment depression severity. Depressed patients with suicide ideation can attain almost as good treatment outcomes as patients without suicide ideation, which is a clinically encouraging result.     

Intervenciones familiares en el tratamiento de los pacientes con esquizofrenia: aproximaciones recientes

Resumen

Después de mencionar los postulados básicos que subyacen a los modelos tradicionales de terapia familiar a los que se han planteado serias críticas, se revisan nuevos modelos que superan estas limitaciones. Estos nuevos modelos de intervención familiar comparten dos características principales: considerar a los familiares aliados naturales del proceso de rehabilitación del paciente y basarse en el empleo de estrategias terapéuticas claramente operacionalizadas. Se describen brevemente cuatro de estas estrategias y se revisa la evidencia que apoya su eficacia: la terapia familiar orientada a la crisis de Goldstein, el paquete de intervenciones psicosociales desarrollado por Leff y cols., la terapia familiar conductual de Falloom y el programa de psicoeducación familiar de Anderson y cols. Su eficacia es analizada en términos de la disminución observada en las tasas de recaídas y en la consecución de otros beneficios para el paciente y la familia. Se señalan un conjunto de principios generales que deben presidir las intervenciones con estas familias. Por último, se hace una reflexión acerca de algunas deficiencias que estudios futuros han de subsanar para poder alcanzar unas conclusiones más sólidas sobre la eficacia de estos nuevos procedimientos terapéuticos.