Group psychotherapy with grandparents rearing their emotionally disturbed grandchildren

This paper discusses the increasing incidence of grandchildren being raised by grandparents, and describes a clinical service developed to assist grandparents in rearing their emotionally disturbed grand-children. The development of a cohesive working group and the active involvement of grandparents for support as well as self-understanding is demonstrated.     

Optimism and pessimism as predictors of physical and psychological health among grandmothers raising their grandchildren

This study examines the role of personality in predicting psychological and physical health among grandmothers who are coping with a non-normative non-traumatic stressor, i.e. serving as primary caregivers for their grandchildren. Using the Life Orientation Test-Revised (LOT-R), a measure of personality disposition, we examine the contributions of both optimism and pessimism to health outcomes. ANOVAs and regression analyses of the LOT-R and self reports of health in 67 African American and Latino grandmothers revealed psychological (obsessive compulsive symptoms, depression, hostility) and physical (sleep disorder, hypertension) health outcomes are differentially predicted by optimism and pessimism among older and younger age-groups of grandmothers. Implications for grandmothers’ response to caregiving stress and for future studies of personality’s relation to health are discussed.     

When grandparents drive their grandchildren

Driving their grandchildren has become one of the common tasks grandparents perform as part of the support they provide for working parents. The current research made use of qualitative and quantitative methodologies in two complementary studies conducted on grandparents who drive their grandchildren, the first using personal interviews and the second self-report questionnaires. The goal of the qualitative study was to capture grandparents’ subjective experience (n = 27), whereas the quantitative study sought to provide more specific data on the factors affecting grandparents’ experience behind the wheel and attitudes to child restraints by examining the contribution of driving styles and parental influence (n = 330). The findings of the qualitative study indicate that having grandchildren in the car is a unique situation which affects grandparents’ emotions and driving behavior. Less careful drivers were found to adapt a more careful driving style when driving their grandchildren than when driving without them. In the quantitative study, risky and anxious drivers felt more tension when driving their grandchildren. Furthermore, parental intervention was found to heighten tension among grandparents. Finally, heightened tension and less angry and more careful grandparents’ driving styles were associated with more positive attitudes to child restraints. Possible explanations of the findings are discussed.     

Infants' behavior with their mothers and grandmothers

Grandparents are a relatively neglected part of children's social network. In order to look at attachment behavior of young children toward their grandmothers, the present study examined infants' behavior in a play-separation situation with their mothers and maternal grandmothers. In a series of 13 3-min segments, mothers, grandmothers, and strangers were signaled in turn to leave the room and to return. The infants' (N=30) playroom behavior was examined by measuring duration of play, cry, proximity to each adult, hold by each adult, and proximity to the door. In this situation, mothers and grandmothers were treated almost interchangeably, while strangers were treated as strangers. These findings did not vary by amount of contact (from daily to twice a month), age of infant (12 to 24 months), or “birth order” of the grandchild. The findings may be specific to middle-class, stable families in which the grandmother lives nearby and has frequent contact with the grandchild. From these data, grandmother is seen as one who can serve some of the same functions as an attachment figure and who is able to play an important role in the young child's social development.     

The marital and family functioning of adults with ADHD and their spouses

Little is known about the family relationships of adults with Attention-Deficit/Hyperactivity Disorder (ADHD). Thus, the marital adjustment and family functioning of 33 married adults with ADHD and their spouses was compared to 26 non-ADHD control participants and their spouses. Results revealed that married adults with ADHD reported poorer overall marital adjustment on the Dyadic Adjustment Scale (DAS; Spanier, 1989) and more family dysfunction on the Family Assessment Device (FAD; Eptein, Baldwin, & Bishop, 1983) than control adults. The spouses of adults with ADHD did not differ from control spouses in reports of overall marital adjustment and family dysfunction. A greater proportion of their marital adjustment scores, however, fell within the maladjusted range. The ADHD adults' perceptions of the health of their marriages and families were more negative than their spouses' perceptions. The way in which spouses of ADHD adults compensated for their partners' difficulties were explored through clinical interviews. The findings in this study underscore the need for assessments and treatments to address marital and family functioning of adults with ADHD.     

Intrainformant agreement and family functioning in depressed and nondepressed parents and their children

Abstract

This investigation examined perceptions of family functioning, marital satisfaction, and parent-child bonding in 65 families (child, mother, father) with one or more depressed parents and 26 families with no depressed parent. Intrainformant agreement between offspring and their parents across family functioning measures was examined for the two proband groups. Results revealed more dysfunction in family adaptability, cohesiveness, and parent-child bonding and lower levels of marital satisfaction in the depressed as compared to the nondepressed proband group. Analyses of intrainformant data revealed no significant differences in levels of agreement between informants from the two proband groups for any of the raters. There was, however, significant agreement between informants in both proband groups. Thus, differential reports of family functioning are attributable to variations in perception of functioning, rather than to different levels of internal consistency in reporting across raters in depressed and nondepressed proband groups.     

Models of family functioning and their contribution to patient outcomes in chronic pain

This paper analyzes the relationship between family functioning and chronic pain, and evaluates a model which integrates the role of family variables with the pain-coping process in patients with rheumatoid arthritis (RA) and fibromyalgia (FM). Family variables, assessed by subscales of the Family Environment Scale (FES), and different components of the pain-coping process varied significantly in their contribution to pain, psychological functioning, and disability in these two chronic pain disorders. High system maintenance control and low independence contributed significantly to pain in RA and FM, respectively, while low family cohesiveness contributed to psychological disturbances in FM subjects. Lack of promotion of activity and recreation in the family was associated with greater disability in both groups. In addition to family variables, helplessness proved to be a potent predictor of pain and psychological functioning in both groups, and disability in FM subjects. Pain-coping had its predominant influence on pain. As an exploratory test of the model, the data confirm the importance of examining this integrated framework in longitudinal, prospective studies, and its potential utility in clinical assessment and intervention.This research was supported by a Multipurpose Arthritis and Musculoskeletal Diseases Center grant AR40770 from the National Institute of Arthritis and Musculoskeletal Diseases at the University of California, San Diego. Portions of this paper were presented at the convention of the American Psychological Association, August 1992, in Washington, DC, and at the meeting of the Society of Behavioral Medicine, March 1993, in San Francisco.The authors gratefully acknowledge Teresa A. Krall, M.A., and Karen Schoenfeld-Smith, M.A. for their valuable assistance in statistical analysis for this article.     

Multigenerational stress and nuclear family functioning

This longitudinal study tested Bowen theorys assumption that stressors in the interdependent multigenerational family influence variation in nuclear family functioning. Forty-nine newly developing nuclear families and their multigenerational families were studied over five years. Quantitative analysis demonstrated an association between the perceived impact of multigenerational stressors and variation in nuclear family functioning. Multigenerational stressors, as compared to individual or nuclear family stressors, had a stronger association with nuclear family functioning. The stress response was manifested in symptomatic outcomes of the nuclear family emotional process. Generally, the number of stressors and the total impact of stressors increased over time, stressors in some years associated with functioning in subsequent years, nuclear family-of-origin stressors demonstrated a decreasing association over time, and developing nuclear family stressors demonstrated a somewhat increasing association over time.     

Grandparents' psychological well-being after loss of contact with their grandchildren.

This study examined how loss of contact with grandchildren due to parental separation or divorce, family feud, or a sudden event, such as relocation, affected the emotional well-being of grandparents (N = 442). Using data from the Longitudinal Study of Generations, the depressive symptoms of grandparents were tracked over 15 years. Growth curve analysis was used to compare grandparents who had lost contact with their grandchildren with those who had not and to examine preloss to postloss change in depressive symptoms. Grandparents who lost contact with their grandchildren experienced a steeper increase in depressive symptoms as they aged compared with other grandparents. Depressive symptoms of grandparents who lost contact because of a sudden event increased up to 3 years following the loss but returned to equilibrium thereafter. The authors conclude that grandparents who lost contact with their grandchildren experienced a negative impact on their emotional health.     

Therapists' perceptions of healthy family functioning

Abstract

For several decades family theorists, researchers, and clinicians have attempted to describe healthy and dysfunctional family functioning. The numerous articles and studies with this focus have been reviewed elsewhere (Riskin & Faunce, 1972; Jacob, 1975). Until recently a disproportionate amount of attention has been given to pathology. Several volumes in the past few years have tried to redress this bias by focusing primarily on healthy family functioning (Kantor & Lehr, 1976; Lewis, Beavers, Gossett & Phillips, 1976).     

The personal well-being of single-parent family heads rearing their children by themselves: A comparative study

This article summarizes a study comparing the sense of well-being of divorced maternal and paternal single parents rearing their children by themselves with that of two-parent family heads. There were differences between the family's sense of well-being only in terms of the two extremes of their economic situation. In a good economic situation, single-parent families have a higher sense of well-being than the two-parent families; in a poor economic situation, the reverse is true. When the economic situation is average, their sense of well-being is similar. The concept of an androgynous sex role and a croblem-focused coping style (in that order) were important. Recommendations for other studies and directions for future thought about therapy procedures are included.This article is based on a doctoral dissertation submitted under the supervision of Professor M. Loewenberg at Bar-Ilan University, Israel, 1992.     

A cross-cultural study of family functioning

The Family Assessment Device (FAD) was used to compare patterns of family functioning in two cultural settings, North America and Hungary. The sample size consisted of 95 nonclinical North American families and 58 nonclinical Hungarian families. No cross-cultural differences were found in the families' general functioning nor in their affective involvement or affective responsiveness as measured by the FAD. Hungarian families, however, perceived their functioning as significantly better than the North American families in problem-solving and in communication. North American families rated themselves significantly better than the Hungarians in setting family rules and boundaries and in meeting their family responsibilities. Results from this study suggest that cultural values can affect a family's functioning and that differences in areas of family functioning can be captured using the FAD. A discussion of broad societal values of the two cultures was used to interpret the contrasting patterns of family functioning.Cross-cultural studies serve many purposes. In general they provide knowledge about the different cultures under investigation. As such, they broaden and enrich our perspectives of ourselves and the world around us. More specifically they highlight similarities and differences across cultures, information that can be helpful in further refining our understanding of the impact of diverse and varying socio-political forces.A topic of particular interest to family therapists and researchers is family functioning in different cultural settings. In spite of continuing research in this area, few studies examine cross-cultural patterns of family interactions and even fewer do so with instruments specifically designed to assess family functioning.From a family perspective, particularly looking at pathology in family functioning, cross-cultural comparisons can be used to highlight areas of dysfunction common to families irrespective of the cultural context. From a cross-cultural perspective, family comparisons can be used to point out the cultural effects and emphases given to different dimensions of functioning within a common system (i.e., the family unit).Both conceptual and methodological problems have contributed to shortcomings in previous cross-cultural studies (Fabrega, 1974; Kleinman, 1987; Flaherty et al., 1988; Rogler, 1989). A basic criticism of such studies has been the assumption that meanings and values in one culture are equivalent to those in another.Another issue, which is particularly pertinent to our study, is the use of an instrument which is developed in one culture and administered in another cultural setting. A potential problem this raises is inferring cultural differences between groups when the translated and the original instruments are not actually comparable in meaning. In fact, one objective of the study was to see whether our own self-report measure of family functioning, the Family Assessment Device (FAD, Epstein et al., 1978, 1983), could be successfully used in another cultural setting.The following report is part of a larger research project, conducted in 1986–87, that compared depressed and nonclinical families across two cultures. The findings presented here are comparisons between nonclinical Hungarian and nonclinical North American families. In our earlier study differences in family interactions between clinically depressed and nonclinical families were evident in both cultural settings (Keitner et al., in press). It was not clear, however, if significant cross-cultural differences in family functioning would be found for the normal group of families and, if so, how these would differ from their ill counterparts. Inclusion of the normal families thus served two purposes, as controls in the larger study to test within cultural differences and as comparison groups in a separate analysis to test between cultural differences.A specific objective of this study was to contrast patterns of perceived family functioning in nonclinical Hungarian families and North American families. Another objective was to determine if the Family Assessment Device (FAD), a self-report measure of family functioning, could be successfully used in different cultural contexts. Hungary was chosen as an appropriate country of study for several reasons. It is at the crossroads of East and West, sharing enough similarities with western culture to validate comparisons, yet different enough in both its cultural and sociopolitical system that some differences could be expected to emerge. Because it is likely that the Hungarian social system is less familiar to readers than that of North American, the results are discussed with particular reference to Hungary.We would like to thank Drs. J. Furedi and T. Kurimay for help in translating the Family Assessment Device and Professors J. Szilard and Muszong-Kovacs for their support of this study. This work was supported in part by the Firan Foundation.     

The impact of family functioning on family racial socialization processes

This longitudinal study evaluated the relationship between family functioning and family racial socialization processes in a clinical sample of African American youth referred for drug abuse treatment. Participants were 77 African American adolescents and their parents. Results showed that participants assigned to structural ecosystems therapy experienced a greater increase in family racial socialization processes during treatment than participants assigned to the treatment as usual in community settings condition. Participants in structural ecosystems therapy also demonstrated a greater increase in family functioning than participants in community settings condition, and this improvement in family functioning mediated the relationship between treatment condition and family racial socialization processes. Research and clinical implications are discussed.     

Involving caregiving grandmothers in family interventions when mothers with substance use problems are incarcerated

The alarming rate of incarceration of women disproportionately affects women of color, frequently intersects with the women's substance use problems, and often results in grandmothers providing care for their grandchildren during their daughters' incarceration. Numerous factors complicate the grandmothers' caregiving experiences and contribute to strains that exceed those typically associated with grandparent caregiving. Such complicating factors include the stresses associated with their daughters' substance use problems and incarceration; the complex biopsychosocial needs of many of their grandchildren; the challenging relational issues they must address; and often, the long-term, multifaceted effects of poverty. Despite the critical roles they play, the multiple vulnerabilities they face, and the potential for multigenerational, culturally relevant family interventions to yield gains for all three generations, grandmothers have received little attention in intervention research with this group of families. This paper provides a theoretical and empirical rationale for the inclusion of caregiving grandmothers in interventions and research with families affected by maternal incarceration and substance use problems, in general, and for the promise of multifamily groups, in particular. Strategies for tailoring multifamily groups with this population of families are also included.     

Parent psychopathology and family functioning among childhood firesetters

The purpose of this study was to identify parent and family characteristics related to juvenile firesetting and antisocial behavior among severely disturbed children. Hospitalized children (ages 6–12) identified as firesetters (n=27) and nonfiresetters (n=27) were compared in terms of parental psychopathology, dyadic adjustment, and family environment. To separate the impact of conduct disorder in contributing to group differences, diagnosis and firesetting status were separated in the data analyses. The results indicated that parents of firesetters showed significantly greater dysfunction in terms of psychiatric symptoms, and higher levels of depression, and reported lower levels of affectional expresssion, consensus, and overall adjustment in their dyadic relationships. The findings suggest that among a clinical sample, specific parent and marital characteristics delineate firesetters. The contribution of parental and marital influences to antisocial behavior more generally and the need to focus specifically on firesetting in relation to these variables are discussed.Completion of this research was supported by grants (MH39976, MH35408) and by a Research Scientist Development Award (MH00353) from the National Institute of Mental Health. The authors appreciate the assistance of Debra Colbus and Antoinette Rodgers and the clinical research team of the Child Psychiatric Treatment Service.     

Relationships between adolescents' attachment styles and family functioning

This study examined the relationship between university students' perceptions of their familial attachment and the manner in which their families cope with life's difficulties. It was hypothesized that individuals with high levels of secure attachment would perceive their families as using more active coping strategies (e.g., mobilizing the family to deal with a problem and making efforts to acquire social support). The results supported this hypothesis. Further, individuals with high levels of anxious/ambivalent attachment perceived their families as using a passive appraisal coping strategy, possibly because of a desire to avoid confrontation for fear of disturbing family accord. The findings are discussed in terms of individuals' dispositional coping styles formed as a function of type of familial attachment, as well as situational factors that might serve to mitigate the use of their basic coping strategies.     

The Georgia family Q-sort: an observational measure of family functioning

The development of a new observational measure of family functioning using a Q-sort methodology is described. The Q-sort is one way of obtaining observer measures of family that complements both microcoding and global ratings of family processes. Evidence for construct validity is presented along with a discussion of the advantages and disadvantages of the Q-sort approach to family observation.     

Personality and family functioning in families of depressed patients

In this cross-sectional study, the authors attempted to identify correlates of family functioning in 86 couples with a depressed member during the acute phase of the patient's depression. Demographic variables, psychiatric status, and personality traits of both the patient and spouse were investigated as potential predictors of family functioning. Regression analyses indicated that lower levels of personality pathology in the patient, higher levels of patient conscientiousness, and less psychological distress in the spouse were associated with healthier family functioning. Future research implications and clinical importance of these findings are discussed.     

Quality of life and family functioning in schizophrenia patients

Quality of life and family functioning of patients with schizophrenia are described. A sample of 49 schizophrenic patients and their 70 relatives, treated at the Mental Health Services of Arica, Chile, were included in the study. The Quality of Life Questionnaire of Sevilla (CSCV), the General Health Questionnaire (GHQ-12) and the Family Function Questionnaire (APGAR) were used to assess the patients, the last one also administered to their caregivers. Contrary to the results found in researches done in developed countries, the patients of this sample indicated suitable levels of quality of life, to a great extent, related to the perception of their family functioning. This confirms the importance of the family as social network of emotional support. Nevertheless, perceived family functioning is different in patients and their caregivers. Higher scores were obtained in caregivers who participated in a family psychoeducational program. The conclusion reached was that there are differences in the levels of quality of life perceived by patients of developed countries and those of developing countries, being higher in the latter ones, despite limitations in economic, sanitary and community resources. Future research should study why the variables that explain these levels of quality of life differ.