A cross-cultural examination of proximity and hierarchy as dimensions of family structure

Meaningful cross-cultural application of family therapy theories requires that basic assumptions about normal family functioning be made explicit, and contextual factors be incorporated into the theories. Guided by this understanding, this article examines the family structure dimensions of proximity and generational hierarchy theoretically and empirically. These dimensions and their superordinate construct, boundary permeability, are analyzed in terms of their underlying assumptions. The cross-cultural validity of the dimensions is assessed using videotaped interactions, projective drawings, and interviews with a sample of 24 Turkish families. Results indicate that proximity is a valid dimension, moderated by the demographic variables of socioeconomic status (SES), mother's working status, family size, and clinical status. Hierarchy is not a valid dimension because the cultural norm of strong hierarchy suppresses variation. The implications for the cross-cultural transfer of family therapy theories are discussed.     

Connectedness versus separateness: applicability of family therapy to Japanese families.

This article, a product of the two authors' multicultural experiences, contrasts British and Japanese families in order to examine the applicability of the Western model of family therapy to Japanese families and therapists. Areas where the Western model is incompatible are identified, and modifications to fit the Japanese indigenous model are suggested. The most significant difference in value systems between the two cultures is the Japanese preference for connectedness. The Japanese person is seen as a part of the embedded interconnectedness of relationships, whereas British norms prioritize separateness and clear boundaries in relationships, individuality, and autonomy. This value orientation is manifested in the Japanese language, hierarchical nature of the family structure, the family life cycle, and the implicit communication style. Systemic thinking, which deals with the pattern of relationships, is valid for all families regardless of cultural differences. But therapists should note that the preferred direction of change for Japanese families in therapy, is toward a process of integration--how a person can be effectively integrated into the given system--rather than a process of differentiation. An authoritative therapist style, the use of individual sessions, silence, and other nonverbal techniques are relevant to bringing about the desired change toward better integration of the individual with his or her networks.     

The Adaptation of Patients During the Hospitalization Period of Bone Marrow Transplantation

A longitudinally study was conducted among 42 bone marrow transplantation (BMT) patients to investigate the association between pretransplant psychosocial variables and psychophysiological outcomes during the immediate convalescence period. Family relationships (cohesion, expressiveness, and conflict) and coping resources (cognitive, social, emotional, spiritual/philosophical, and physical resources) were assessed on the admission day (Day –7 Time 1). Data on psychological distress and pain intensity were obtained on Day +7 (Time 2) and Day +14 (Time 3). The average scores at Times 2 and 3 were computed to indicate the overall adjustments of the patients during the hospitalization period after the day of actual transplant (Day 0). It was shown that higher expressiveness family relationships and higher resources to cope effectively with stressful situations were associated with less psychological distress during the above period. Both pretransplant psychosocial variables were not associated with pain intensity during hospitalization. Allogeneic transplant patients reported higher pain intensity than did autologous transplant patients. Psychological distress and pain intensity were positively correlated with each other. Our findings show that pretransplant family relationships and coping resources associate moderately with psychological distress during the immediate convalescent period of BMT. The present findings support the family-centered approach to BMT care and provide a scientific basis for pretransplant psychosocial interventions.     

Sexual tensions in a remarried family

The remarried family is vulnerable to sexual tensions between adults and children because of the weakness of generational boundaries and because the emotional tasks confronting the new couple can result in the detouring of conflict through a child. The case presented here demonstrates the use of structural family therapy which included several therapeutic tools not usually associated with a structural approach. These included family and marital history, individual and subsystem work, education, and modeling. Unspoken sexual tensions between stepfather and stepdaughter were interwoven with the structural problems that the family was experiencing. Following three months of therapy, significant shifts were made in the family structure that resulted in clearer and more appropriate boundaries between parents and the identified patient.Appreciation is expressed by the author to David Abelson, MA, Karlotta Bartholomew, PhD, and Joellyn Ross, PhD, for their support.     

Exploring the Complexities of Familism and Acculturation: Central Constructs for People of Mexican Origin

We examined the relationships between three dimensions of familism: importance of family, family support, and family conflict with acculturation, assessed orthogonally (Mexican and American cultural contributions assessed independently), and the relative contribution these factors make to psychological adjustment among 248 (124 women, 124 men) adults of Mexican origin. After controlling for sociodemographic characteristics, positive associations were found between importance of family and the biculturalism of Mexican and American cultural identity; family support and Mexican cultural identity; but no associations between family conflict and level of acculturation. Psychological well-being was positively associated with Mexican cultural identity and family support, whereas psychological distress was associated with greater family conflict and lower family support. The greater relative contribution of Mexican cultural identity to familism and well-being, and the importance of assessing acculturation orthogonally are discussed. This research was supported in part by a Minority Supplement to National Institute of Mental Health Grant MH47193 to the Research Center on the Psychobiology of Ethnicity, Harbor-UCLA Medical Center and by a research award from Pitzer College to Norma Rodriguez.     

Family,gender, and attitudes toward retirement

The relationships between marital status, proximity of children, and attitudes toward retirement of 432 men and 373 women on the verge of retirement were studied. Three dimensions of attitudes were examined: attitudes toward losses associated with retirement, toward gains in entering retirement, and toward gains in leaving work. Women hold significantly more positive attitudes toward both types of gains; there are no gender differences concerning attitudes toward losses. The married of both sexes perceive more gains in entering retirement. Proximity of children is curvilinearly related to gain in entering retirement, especially among women. Attitudes toward losses and gains in leaving work are not associated with familial state. The meaning of work and the myth of the primacy of family for women are discussed.This paper draws on research supported by Grant Number 1 R01 AG 05206-01 from the National Institute on Aging.     

Legal recognition of same-sex relationships in the United States: a social science perspective

Whether and how civil society should recognize committed relationships between same-sex partners has become a prominent, often divisive, policy issue. The present article reviews relevant behavioral and social science research to assess the validity of key factual claims in this debate. The data indicate that same-sex and heterosexual relationships do not differ in their essential psychosocial dimensions; that a parent's sexual orientation is unrelated to her or his ability to provide a healthy and nurturing family environment; and that marriage bestows substantial psychological, social, and health benefits. It is concluded that same-sex couples and their children are likely to benefit in numerous ways from legal recognition of their families, and providing such recognition through marriage will bestow greater benefit than civil unions or domestic partnerships. Trends in public opinion toward greater support for legal recognition of same-sex couples are discussed.     

Peer functioning, family dysfunction, and psychological symptoms in a risk factor model for adolescent inpatients' suicidal ideation severity

Examined models of suicidal ideation severity that include two psychosocial risk factors (i.e., peer and family functioning) and four domains of psychological symptoms (i.e., generalized anxiety, depression, conduct problems, and substance abuse/dependence). Participants were 96 psychiatric inpatients (32 boys, 64 girls), ages 12 to 17, who were hospitalized because of concerns of suicidality. Adolescents completed a structured diagnostic interview, measures of suicidal ideation, and several dimensions of family and peer functioning. Results supported a model in which greater levels of perceived peer rejection and lower levels of close friendship support were associated directly with more severe suicidal ideation. In addition, indirect pathways included deviant peer affiliation and global family dysfunction related to suicidal ideation via substance use and depression symptoms. The results are among the first to demonstrate relations between suicidal ideation and several areas of adolescent peer functioning, as well as divergent processes for peer and family predictors of suicidal ideation.     

Family size and psychological functioning in the Orthodox Jewish community

Caring for children is a known psychosocial stressor; however, its effects on psychological functioning may have substantial cross-cultural variance. We explored relationships between family size and a variety of psychological outcomes among Orthodox Jews in four separate studies: (1) an international treatment-seeking sample (n?=?82), (2) a community sample from Canada (n?=?226), (3) an out-patient clinical sample from greater New York (n?=?82), and (4) a large dyadic sample of Israeli couples (n?=?789). Surprisingly, results suggested that family size was not associated with greater stress, anxiety, depression, global functioning, family functioning, family communication, family satisfaction, or even parenting stress. It is possible that the high religious value placed on family life as well as structural adaptions in families buffer against potential stressors associated with child rearing, and further research on these potential effects is warranted.     

A Structural Approach to the Single-Parent Family

Although the single-parent family is becoming a predominant family structure, there is a surprising scarcity of articles discussing its typical problems or detailing specific therapeutic approaches. This paper attempts, first, to list some core problems encountered by all single parents and, second, to present a sequence of therapeutic approaches geared toward dealing with these problems.
Structural theory, with its emphasis on subsystems, generational boundaries, and organizational patterns, provides a framework for viewing the built-in vulnerabilities of the single-parent family unit. Minuchin's ( 3 ) emphasis on generational boundaries and the problem of enmeshment underlies the theoretical and therapeutic approach presented here. I have drawn heavily on Haley's ( 2 ) idea that the therapist must be an authority, a problem-solver, and a teacher. Finally, the emphasis on creating new organizational patterns is most thoroughly explored in Aponte's ( 1 ) discussions of "underorganized families" (many of whom are single-parent families).     

A Method of Co-Therapy for Schizophrenic Families

This paper describes a model of treatment for families in which one child has been given the diagnosis of schizophrenia. Male and female therapists adopt structured roles that are used as a paradigm for exploring family patterns. The paradigm employs a three-generational hypothesis that defines schizophrenia as a lifelong, restricting mode of relating, involving the primary family triad, that makes the child vulnerable to repeated psychotic episodes. Therapy is directed at the difficulties of autonomous development within the family by focusing on differentiating the relationship between nuclear and extended family members, expecially defining and strengthening generational and sexual boundaries. The second focus of therapy is on the resolution of issues of separation and loss, with attention to unresolved mourning in the family of origin and the concomitant stress in giving up the infantile relationship with the index child in the nuclear family. Stages of therapy will be described including: (a) initiation of therapy, (b) breaking of fusion, (c) repair of alienation, and (d) solidifying the marital alliance and generational boundaries. Case illustrations will be included.     

Acculturation, enculturation, and Asian American college students' mental health and attitudes toward seeking professional psychological help

In the present study, we tested a theoretically and empirically derived partially indirect effects acculturation and enculturation model of Asian American college students' mental health and attitudes toward seeking professional psychological help. Latent variable path analysis with 296 self-identified Asian American college students supported the partially indirect effects model and demonstrated the ways in which behavioral acculturation, behavioral enculturation, values acculturation, values enculturation, and acculturation gap family conflict related to mental health and attitudes toward seeking professional psychological help directly and indirectly through acculturative stress. We also tested a generational status moderator hypothesis to determine whether differences in model-implied relationships emerged across U.S.- (n = 185) and foreign-born (n = 107) participants. Consistent with this hypothesis, statistically significant differences in structural coefficients emerged across generational status. Limitations, future directions for research, and counseling implications are discussed.     

Growing Up with an Anxious Sibling: Psychosocial Correlates and Predictors of Sibling Relationship Quality

Relationships between young people with anxiety and their non-affected siblings are important for both individuals in the dyad, and for family dynamics throughout the lifespan; however, these relationships are not well understood. This study examined the experience of growing up with an anxious sibling from the sibling without anxiety’s point of view. We measured psychosocial factors associated with sibling relationship quality in 64 young adults with an anxious sibling. Overall, participants with anxious siblings were resilient, reporting comparable sibling relationship quality, anxiety symptoms, and psychological functioning relative to peers without anxious siblings. The contributions of caregiver burden and attributions about the causes of the sibling’s anxiety-related behavior accounted for significant variance in both sibling relationship warmth/closeness and conflict, with responsibility attributions emerging as an individual predictor of conflict. Clinical and research implications for understanding sibling relationships in the context of anxiety, and for the role of attributions in family relationships are considered.     

An Analogue Study of the Psychological and Psychosocial Processes Associated With Post‐concussion Symptoms

This study used an analogue design to investigate post‐concussion syndrome and the psychological and psychosocial processes associated with post‐concussion symptom (PCSx) reporting. The study examined the role of expectation in reporting of PCSx, the nature of associated psychological and psychosocial difficulties, and the “good‐old‐days” phenomenon. Forty‐five healthy participants were randomly assigned to one of two groups: (1) a control group or (2) an expectation group who were asked to perform as if they had experienced a mild traumatic brain injury. Fourteen psychiatric patients comprised the clinical group. Self‐report questionnaires assessing PCSx and psychological and psychosocial variables were administered. It was hypothesised that PCSx would be non‐specific, that the expectation group would report greater dysfunction than controls, and that the “good‐old‐days” phenomenon would cause the expectation and clinical groups to underestimate pre‐morbid PCSx. All participants reported some degree of dysfunction, and the expectation and clinical groups underestimated past PCSx. The expectation group reported more PCSx and psychological and psychosocial dysfunction than controls, resembling the clinical group. The results demonstrate that expectation can cause otherwise healthy individuals to resemble a clinical group in terms of their level of endorsement of psychological and psychosocial dysfunction.     

Stories of family caregivers of people with dementia in Greece: Implications for counselling

A substantial body of literature has identified high rates of burden, psychological morbidity, social isolation, health and financial difficulties among dementia caregivers. The present qualitative study adopted an Interpretive Phenomenological Analysis approach in order to explore the lived experiences of dementia family caregivers within the Greek sociocultural context. The sample was purposive and consisted of 10 women dementia family caregivers from Athens and Thessaloniki. Individual in-depth interviews were conducted and analysed according to IPA. The participants’ personal accounts included themes related to ethical/existential and cultural aspects of family caregiving; changes in family relationships; impact of the caregiving experiences; sources of support and help seeking; positive and meaningful aspects of the care experience. The research findings are discussed in the context of Gilligan’s moral psychological theory, and cultural dimensions of family caregivers. Implications for counselling interventions aiming at supporting caregivers are presented.     

Religion and Family Relational Health: An Overview and Conceptual Model

This paper presents a review of research addressing religion and family relational health. Strengths of the extant data include the correlation of three dimensions of religious experience (religious practices, religious beliefs, and religious community) with certain aspects of mother–child, father–child, and marital relationships and specific connections between the three dimensions of religious experience and family relationships are identified. Key weaknesses in the research at present include a paucity of research examining the hows, whys, and processes involved behind identified religion–family correlations and a lack of data on non-nuclear families, families of color, interfaith families, and non-Christian religions including Judaism and Islam. Implications for clinical practice and recommendations for future research are offered. Loren Marks is an Assistant Professor of Family, Child, and Consumer Sciences in the School of Human Ecology at Louisiana State University. He and his research collaborator, David Dollahite of BYU, have conducted extensive qualitative research with over 125 Christian, Jewish, Mormon, and Muslim families to examine the interfaces between religion, individual development, and family relationships.     

Successful rural black adolescents: a psychosocial profile

The purpose of this study was to investigate important psychosocial variables associated with the educational development of black adolescents in a southern rural environment. The study explored factors related to academic and social success among rural black adolescents. The focus of the investigation was on identifying psychological and social variables which may successfully influence the transaction between black youth and the rural educational system. Such success variables are important for research because of the traditional emphasis in the social sciences on concepts of deficit in the person-environment interactions of black youth. This article presents a profile of successful black adolescents in a rural school system in the Southeast. The profile was developed from personal interviews with 68 black students identified by teachers as successful, often despite social or economic hardship. The implications for future research and rural educational policy and program from the profile are discussed.     

Dimensions of DSM-IV personality disorders and life-success

This study examined associations between dimensional representations of DSM-IV personality disorders and life-success in a community sample of 304 men at age 48. Measures included a standardized social interview and the SCID-II for assessment of personality disorders. The identified indicators of life-success were factor-analyzed resulting in two moderately correlated components representing "status and wealth" and "successful intimate relationships." Avoidant, obsessivecompulsive, and narcissistic dimensional scores were positively associated with "status and wealth." Inverse relationships were found between dependent, schizotypal, schizoid, and adult antisocial personality disorder dimensions and this domain of life-success. Avoidant, schizoid, and borderline personality disorder dimensions were negatively associated with "successful intimate relationships." The findings suggest that although most personality disorders are associated with impaired psychosocial functioning and life-failure, some personality disorder traits (even if considered as pathological) can contribute positively to one important aspect of life-success: status and wealth.     

Pathways to children's externalizing behavior: a three-generation study

In this study, based on Family Interactional Theory (FIT), the authors tested a longitudinal model of the intergenerational effects of the grandmothers' parent-child relationships and the grandparents' smoking on the grandchildren's externalizing behavior via parents' psychological symptoms, tobacco use, and child rearing. Using Mplus, the authors obtained a structural equation model that demonstrated generational associations from grandmothers (G1) to parents (G2) to their oldest children (G3) and thus was in accord with FIT. They identified a pathway from the grandmothers' parenting to the grandchildren's externalizing behavior via the parents' psychological symptoms, their smoking, and their child rearing. Parents' psychological symptoms in adolescence were associated with their tobacco use in their late twenties, controlling for the continuity of their psychological symptoms and their tobacco use. This 3-generational model adds to the literature on parent-child relationships (G1), smoking from adolescence to early adulthood (G2), and externalizing behavior in the G3 child.     

Psychosocial risk and resistance factors among children with chronic illness,healthy siblings,and healthy controls

Psychosocial risk and resistance factors within the domains of parental functioning, family Stressors, and family resources were examined as predictors of psychological adjustment and physical problems in juvenile rheumatic disease patients (N=93), their healthy siblings (N=72), and demographically matched healthy controls (N=93). Family socioeconomic status and background variables showed few consistent relationships with child functioning. However, a constellation of risk and resistance factors tended to show comparable associations with functioning for patients, siblings, and controls. Higher parental depression and medical symptoms and more family Stressors, sibling problems, and burden of illness on the family predicted more problems among the patients. These relationships held when disease duration and severity were controlled. For the siblings, increased parental and patient dysfunction, more family Stressors, and less family cohesion and expressiveness were associated with more problems. Although the associations were not as strong, mothers' depression and lack of family cohesion and expressiveness also were related to more adjustment problems among the control children. These findings imply that there may be a general association between certain risk and resistance factors and childhood adaptation.This research was supported in part by NIH Multipurpose Arthritis Center Grant AM20610, NIMH Grant MH16744, and Veterans Administration Medical and Health Services Research and Development Service Research funds. Jan Gottlieb provided valuable help in all phases of the research. We appreciate the help of the staff of the Pediatric Rheumatology Clinic at Children's Hospital at Stanford and the families who participated in this study.