"Lesbians, gay men, and their parents": a critique of LaSala and the prevailing clinical "wisdom"

This article challenges the popular assumption that coming out to family of origin is important for lesbians and gay men's mental health and couple relationships. First, I present theory emphasizing the unique position of lesbians/gays in families of origin and the significance of "families of choice." Second, I review the quantitative research on social support received by lesbians/gays from family of origin, friends, and other social network sources. Third, I demonstrate how the dominant clinical opinion about coming out to family is based on an unwarranted use of theory developed for heterosexuals and on overgeneralization of findings from studies of white, upper-middle-class, North American lesbians/gays. Fourth, I propose five determinants of lesbian/gay persons' decisions to come out to family-of-origin members. Fifth, I argue that such decisions are constrained by "realistic" costs/benefits in various sociocultural niches rather than being a simple function of individuals' levels of differentiation. Lastly, I offer an expanded contextual stance for the family therapist working with lesbian/gay clients.     

Family Unification with Reactive Attachment Disorder Children: A Brief Treatment

This is a case study of a family with a child (age eight) with reactive attachment disorder and the subsequent individual and family therapy. Treatment of choice for the child was Eye Movement Desensitization and Reprocessing (EMDR) and supportive educational counseling for the parents and family. Qualitative evaluation of the process demonstrated that the parents observed an instant change in the child's attitude. The child reported that she felt better about family, school, and truthfulness, and stated about the therapy: It opened a window for me. A 12-month evaluation demonstrated continued positive effects.     

Sculpting Present and Future: A Systemic Intervention Model Applied to Psychosomatic Families

We present a therapeutic intervention model for use with psychosomatic families. This method, the result of our extensive research on various psychosomatic disorders, uses family sculptures of the "present" and "future": each family member is requested to represent the family as it now "is," and how it "will be" in the future. We discuss the theoretical reasons for our choice of this method: (a) the opportunity to use a therapeutic language that is similar to the nonverbal language of the psychosomatic symptom, and (b) the usefulness of reinserting temporal dimensions into family systems that seem to have lost their evolutionary potential and to be in a sort of "time lock." Two clinical cases are discussed (a child with chronic asthma and an anorexic adolescent); the use of sculptures in both cases revealed the underlying problems and made positive therapeutic interventions possible. Finally, we point out how the use of sculpture as a therapeutic technique enables therapists to deal with multiple systemic levels.     

Experiential Family Therapy: An Innovative Approach to the Resolution of Family Conflict in Genetic Counseling

Experiential family therapy is an intuitive approach that utilizes active, multisensory techniques. These techniques, such as role plays and drawings, increase the family's expression of affect and uncover new information. Increased affect and uncovered information stimulate change and growth in the family system. Experiential techniques are especially useful when more traditional, verbal-based communication is not effective. In this article, I will present a pediatric case in which the patient, a 7-year-old boy diagnosed with autism, was referred to the genetics clinic to rule out the presence of an associated genetic disorder. I will then describe a hypothetical second counseling session with the same family and suggest how three experiential family therapy techniques: family drawing, empty chair technique, and continuums might be used in the session to help resolve a marital conflict between the patient's parents.     

"Enmeshment" and the Too Richly Cross-Joined System

This paper traces out a connection between Minuchin's concept of an "enmeshed" family and Ashby's discussion of the problems inherent in a system in which all the parts are tightly interlocked. Adaptiveness to change in such a system will depend on the possibility for the joins between parts to become temporarily inactive. This observation supports maneuvers in family therapy that emphasize the creation of boundaries between subsystems, differentiating individuals from one another, and blocking customary sequences of interaction.     

Areas of resistance in the beginning phase of family therapy

When family therapy is undertaken with a family that seeks treatment for a child as an identified patient, gaining access to the family is often a venture fraught with anxiety and considerable resistance. At the beginning of family therapy, the risk of losing families is probably the greatest, yet little research directed at the problems involved has been reported. To encourage more interest, this phase is explored from the perspective of therapist behavior. Three areas are examined, and consideration is given to the strategies and techniques used to reduce resistance and facilitate engagement in treatment. Research needs are pointed out.This paper was presented at the Seventeenth Annual Meeting of the Public Health Service Professional Association, Orlando, Florida, October 17–21, 1982.     

An approach to families of acting-out adolescents--a case study.

Certain types of acting-out in the adolescent express the feelings of deprivation of the parental pair in a maladaptive aggressive way. Family therapists have attempted to convert the acting-out behavioral disorders into an effective state, i.e., make the family aware of their feelings of deprivation by focusing on the aggressive component. In many instances, the family becomes depressed and then interrupts or terminates treatment. The authors feel that this is due to the therapist's interpretations which bring about the depressive state via guilt provocation. The family understands the interpretations as meaning "You are bad to have your adolescent offspring behave in such a way". The therapist is thus seen as the family's collective super-ego. In order to prevent premature termination, the therapist should instead help the members of the family to become more conscious of their loving, "welfare" feelings for one another. In this way the self-esteem of the family is increased, which then permits more verbal action of aggressive feelings--thus a decrease in the acting-out, and ultimately an increase in the capacity to mourn. It should be pointed out, however, that in certain families, the technique described is not applicable. In these cases, although there is acting-out, the families are unable to draw on sufficient good experiences together which are necessary to elicit positive feeling for one another. The absence of readily available "welfare" feelings is of diagnostic and prognostic significance and differentiates the disorganized, sociopathic or schizophrenic family from the acting-out of parental deprivation as illustrated in this paper.     

Transitioning into and out of large-effect drinking in young adulthood

As individuals age beyond the college years into young adulthood, many exhibit a tendency to moderate or "mature out of" alcohol involvement. The current study classified effect-drinking statuses in young adults and examined transitions among statuses using latent transition analysis, a latent variable state-sequential model for longitudinal data. At 3 occasions over 7 years (Years 1, 4, and 7), 443 men (47%) and women (mean age of both at baseline = 18.5 years; 51% with family history of alcoholism) responded to 3 past-30-day items assessing drinking and subjective effects of drinking: whether the respondent drank alcohol, felt high, and felt drunk. Latent statuses included abstainers (14% at Year 1), limited-effect drinkers (8%), moderate-effect drinkers (23%), and large-effect drinkers (54%). Respondents with family history of alcoholism were less likely to transition out of large-effect drinking than those without family history. Men exhibited more severe initial effect-drinking statuses and lower transition probabilities into less severe effect-drinking statuses than women.     

Native and alien. On ethnic identity]

Freud's theory of the antagonism between family and culture provides the point of departure for this study, which sets out to rehabilitate the concepts "ethnic" and "ethnic identity". The family represents the locus of established tradition and familiar ritual and seeks to make each new generation identify with "us and ours". Culture, by contrast, is dependent on contact and confrontation with things alien and foreign. Between these extremes and the potential dangers specific to each of them, ethnicity--which is neither biological nor cultural--represents a mediating factor. In adolescence, a phase of dis- and re-orientation, the individual needs to draw upon his ethnic identity to reconcile the disturbing contradiction between familial and cultural claims, between the native and the alien.     

The problem of gender in family therapy theory

The field of family therapy is now a continuous process like a car cruising on automatic control with the driver comfortably in the lotus position. Family therapy theory rests on normative concepts of the traditional family and idealized conceptions of family relationships. Inequalities in the family associated with gender have been regarded as of little importance to the development of macro theory in the field. The two most influential therapeutic models, psychodynamic and systemic approaches, are each marked by gender bias. The alpha prejudice of psychodynamic theories exaggerates gender differences; the beta prejudice of systemic approaches ignores them. The construction of gender role concepts has led to a false dichotomy, whether supported by traditionalists or feminists. On close examination, gender role ideals turn out to be simplifications and caricatures. The uncritical use of gender role concepts supports power differences between men and women and ignores the complexities and commonalities of human experience. The failure of family therapy theory to deal with gender issues needs to be addressed if a theory that is not just "more of the same" is to be developed.     

Familienfunktionalität und Therapieerfolg

Background

Even though it is a treatment standard of child psychotherapy to involve the parents, hardly any research has been carried out about the impact of family functioning on treatment outcome. Aims of the present study were to investigate the change in and the prognostic power of family functioning on treatment outcome of short-term psychodynamic psychotherapy in children and adolescents.

Patients and methods

The sample consisted of 54 children and adolescents undergoing outpatient short-term psychodynamic psychotherapy. To assess family functioning, their parents were asked to complete the Family Assessment Measure (FAM).

Results

Patients from families with high levels of functioning in task accomplishment, communication and affective expression were more often treated successfully. Improvement in levels of functioning in role performance, emotionality and control were only found in the group of successfully treated patients.

Conclusion

Family functioning is a decisive factor in the differential indication of psychotherapeutic treatment in children and adolescents.     

Infinite "Backward" Induction Arguments

A large family of paradoxical arguments have been subsumed under the label "backward induction arguments". These include the iterated prisonerÕs dilemma, the centipede game, and the surprise test paradox. They are described as backward because they begin by considering a future hypothetical alternative, rule it out, and then rule out each predecessor. Thus they go backward in time ruling out finitely many alternatives. I present examples that go forward in time and eliminate infinitely many alternatives. These pose problems for solutions that focus on common knowledge assumptions.     

Need-adapted treatment of schizophrenic processes: The essential role of family-centered therapy meetings

Need-adapted treatment is a psychotherapeutically oriented approach to psychoses that has been planned and is implemented individually in each case, combining different activities so that they meet the needs of each patient as well as the people making up her or his personal interactional network (usually the family). A systemic initial intervention, carried out as a conjoint session of the patient, the family members, and a team of 3–4 staff members is an essential part of this approach. The name therapy meeting was given to these sessions because of their notable therapeutic significance. Therapy meetings are often continued during the later phases of treatment to follow up the course of treatment and to reassess the therapeutic plans.     

Being at risk for cardiovascular disease: perceptions and preventive behavior in people with and without a known genetic predisposition

This study compares and explains differences in perceptions of cardiovascular disease (CVD) risk and preventive behaviors in people with and without a known genetic predisposition to CVD. A cross-sectional study using two samples was performed. The first sample (genetic predisposition; n?=?51) consisted of individuals recently diagnosed with familial hypercholesterolemia (FH) through DNA testing. The second sample (no genetic predisposition; n?=?49) was recruited among patients with CVD-risk profiles based on family history of CVD, cholesterol levels, and blood pressure, registered at general practices. Participants filled out a postal questionnaire asking about their perceived risk, causal attributions (i.e. genetic and lifestyle), and about perceived efficacy and adoption of preventive behavior (i.e. medication adherence and adoption of a healthy diet and being sufficiently active). Perceived comparative risk, genetic attributions of CVD, and perceived efficacy of medication were higher in the "genetic predisposition" sample than in the "no genetic predisposition" sample. The samples did not differ on lifestyle attributions, efficacy of a healthy lifestyle, or preventive behavior. Individual differences in perceived risk, genetic attributions, perceived efficacy of medication, and adoption of a healthy lifestyle were best explained by family history of CVD. Our findings suggest that in people diagnosed with a single gene disorder characterized by a family disease history such as FH, family disease history may be more important than DNA information in explaining perceptions of and responses to risk.     

部队士兵家庭教养方式与个性特征的关系

目的本研究旨在探讨部队士兵家庭教养方式与个性特征可能存在的相关关系。方法采用家庭教养方式评价量表（EMBU）和艾森克个性问卷对南京军区某几个基层部队随机选取的310名士兵进行测验。结果（1）部队士兵体验到的来自父母的情感温暖和理解的情况与其内外向程度呈正相关,与其精神质程度呈负相关,且都极其显著。（2）部队士兵体验到的来自父母的拒绝和否认与其神经质程度呈正相关,与其掩饰性程度呈负相关,且都极其显著。结论积极的家庭教养方式对士兵个性的形成有积极影响。     

The Use of Teaching Stories in Conjoint Family Therapy

Two general factors have been singled out as being held in common by all types of psychotherapy: an educational, rational factor (often called "content") and a factor operative in the relationship between the therapist and his patient (often called "process"). In the field of family therapy, the non-educational aspects of intervention are sometimes presented in the form of "therapeutic, paradoxical communications" (Haley, Bateson, Jackson, Weakland) or the 'therapy of the absurd" (Whitaker, Malone). In the present paper, I wish to present a form of therapeutic communication, the teaching story, that embodies a unique mixture of both the educational and the paradox, or absurd.     

From General Laws To Singularities

This article comprises several sections. The first is devoted to an explanation of a number of notions stemming from work by Ilya Prigogine and others on open systems far from equilibrium. As a result of this work, I have been able to stand back from the traditional approach employed in family therapy, that of open systems at equilibrium (the theory of Ludwig von Bertalanffy). The second section describes a clinical example based on elements close to Prigogine's theories. In the third part I develop an approach that--although continuing to draw on Prigogine's work--is much more closely linked to the research I have carried out with Félix Guattari over recent years. In this part I attempt to study a level that, in my view, has too often been left outside the field of inquiry: that of couplings between "singularities" of members of the family system and the therapist. A clinical case is presented in which this "semiotic" level, as Guattari terms it, is used together with that of the "intrinsic rules" of the system. Finally, I propose a few avenues of inquiry and research on the basis of the concepts presented.     

Under what conditions would people be willing to make a living organ donation?

The aim was to examine the factors involved in people's willingness to make a living organ donation. A convenience sample of 200 people in southern France rated willingness to be a living donor in 48 scenarios consisting of all combinations of five factors: recipient's identity (close family member and city resident); donor's surgical risk (little and some); donor's possible long-term health consequences (none, some lessening over time, and durable); transplant success ("generally durably successful" and "durably successful one time out of two"); and likelihood of other donors (subject is one of the rare compatible donors or one among others). Cluster analyses showed the existence of three distinct organ donation philosophies. For the largest cluster (49% of participants), willingness to donate was very high to a family member, but low to a city resident. For the second cluster (37%), willingness was high to family, but also moderately high to a city resident. For the third cluster (14%), willingness was always low. Thus, most participants judged themselves ready to make a living organ donation to a family member and many even to a stranger.