Clinical Ethicists Awakened: Addressing Two Generations of Clinical Ethics Issues Involving Undocumented Patients

Because the United States has failed to provide a pathway to citizenship for its long-term undocumented population, clinical ethicists have more than 20 years of addressing issues that arise in caring for this population. I illustrate that these challenges fall into two sets of issues. First-generation issues involve finding ethical ways to treat and discharge patients who are uninsured and ineligible for safety-net resources. More recently, ethicists have been invited to help address second-generation issues that involve facilitating the presentation for care of undocumented patients. In the current environment of widespread fear of deportation in the immigrant community, ethicists are working with health care providers to address patient concerns that prevent them from seeking care. I illustrate that in both generations of issues, values implicit within health care, namely, caring, efficiency, and promotion of public health, guide the strategies that are acceptable and recommended.     

Immigration as a Dynamic Experience: Personal Narratives and Clinical Implications for Family Therapists

This is a reflective account of the experiences of the authors who immigrated to the United States from India at different developmental, historical, political, and social stages. Although their culture-of-origin was the same, the meaning and experience of immigration was different for each author. The narratives show a natural continuum of experiences based on their developmental stage during immigration, reasons for immigration, and the historical context of both India and the US at the time of immigration. A common theme is the ambivalence experienced by them in their process of creating a physical and psychological home in a different culture.     

Third‐Order Thinking in Family Therapy: Addressing Social Justice Across Family Therapy Practice

We contend that the field of family therapy is undergoing a notable shift from second‐ to third‐order thinking. We offer theoretical support and examples to demonstrate how third‐order thinking provides a framework for integrating heightened sociocultural attunement into family therapy practice. We discuss the importance of third‐order thinking relative to being prepared to invite families into third‐order change. Finally, we offer a case example to show specific guidelines for third‐order practice.     

Social Support and Its Relation to Health: A Critical Evaluation

issues and problems related to the view that social support can moderate or reduce the adverse effects of stress on mental and physical health are discussed. Conceptual, methodological, and theoretical shortcomings of this body of research are presented. Research attention is directed toward the interactive process between provider and recipient of social support. Identification of factors involved in the receipt and offering of social support is essential for theory development. Recognition of individual differences in the giving, as well as taking, of social support is needed. The possibility is raised that the persistent belief in the power of social support to reduce stress, despite lack of convincing data, reflects a form of bias due to strong expectancies.     

Neurocognitive Impairment: Addressing Couple and Family Challenges

Conditions involving neurocognitive impairment pose enormous challenges to couples and families. However, research and practice tend to focus narrowly on immediate issues for individual caregivers and their dyadic relationship with the affected member. A broad family systems approach with attention to family processes over time is needed in training, practice, and research. In this paper, Rolland's Family Systems Illness model provides a guiding framework to consider the interaction of different psychosocial types of neurocognitive conditions and their evolution over time with individual, couple, and family life‐course development. Discussion addresses key family and couple issues with mild‐to‐severe cognitive impairment and progressive dementias, including: communication, multigenerational legacies, threatened future neurocognitive disability, ambiguous loss, decisional capacity, reaching limits, placement decisions, issues for adult children and spousal caregivers, and the transformation of intimate bonds. Principles and guidelines are offered to help couples and families master complex challenges, deepen bonds, and forge positive pathways ahead.     

Social Status as a Predictor of At-Risk Children

The purpose of this paper is to review the importance of children's social status as a predictor of social and academic success in school. Behavioral and cognitive correlates of social status are described, and the research on intervention strategies is discussed. Procedures for assessing children's social status are reviewed with a discussion of advantages and disadvantages of each procedure. Suggestions are made for the use of assessment and intervention procedures by classroom teachers. The author calls for a priority in the schools for promoting conditions that facilitate social acceptance of children.     

Navigating Critical Theory and Postmodernism: Social Justice and Therapist Power in Family Therapy

The family therapy field encourages commitment to diversity and social justice, but offers varying ideas about how to attentively consider these issues. Critical informed models advocate activism, whereas postmodern informed models encourage multiple perspectives. It is often not clear how activism and an emphasis on multiple perspectives connect, engendering the sense that critical and postmodern practices may be disparate. To understand how therapists negotiate these perspectives in practice, this qualitative grounded theory analysis drew on interviews with 11 therapists, each known for their work from both critical and postmodern perspectives. We found that these therapists generally engage in a set of shared constructionist practices while also demonstrating two distinct forms of activism: activism through countering and activism through collaborating. Ultimately, decisions made about how to navigate critical and postmodern influences were connected to how therapists viewed ethics and the ways they were comfortable using their therapeutic power. The findings illustrate practice strategies through which therapists apply each approach.     

Risk as a Determinant of Trust

I propose that the degree of trust an individual forms toward an interaction partner is a function of the degree of risk that is involved in the situation. Two experiments were conducted in order to test this hypothesis. Subjects had to decide whether they would lend either an inexpensive scientific book (low-risk condition) or an expensive scientific book (high-risk condition) to a fictitious male fellow student. After subjects had made their decision, they had to indicate the degree of trust they had formed toward the interaction partner by means of a scale that referred to similar trust-related interactions. The hypothesis was clearly confirmed: The degree of trust was higher in the high-risk condition than in the low-risk condition. Results are explained in terms of self-perception theory. Implications are discussed.     

Social Support and Subjective Health in Fibromyalgia: Self-Compassion as a Mediator

Individuals with fibromyalgia report lower levels of health-related quality of life (HRQL) compared to other chronically ill populations and interpersonal factors (i.e., social support) may influence risk. What is less understood is how intrapersonal factors (i.e., self-compassion) may impact the social support-HRQL linkage. We examined the association between social support and HRQL in a sample of persons with fibromyalgia and tested the potential mediating role of self-compassion. Self-identified adults in the United States with fibromyalgia (N?=?508) were recruited from state, regional, and national organizations and support groups and completed an online battery of self-report questionnaires including: Multidimensional Health Profile—Psychosocial Functioning Index, Short-Form 36 Health Survey, and Self-Compassion Scale-Short Form. Individuals with greater subjective social support reported higher levels of self-compassion and, in turn, higher mental HRQL. These findings provide greater information about psychosocial constructs and HRQL and extend our understanding of self-compassion among individuals living with fibromyalgia.

     

Addressing Sexual Assault within Social Systems: System Justification as a Barrier to College Prevention Efforts

Sexual assault perpetrated by men against women is a distressingly common occurrence, particularly on college campuses. One of the barriers to assault prevention efforts is the general perception of violence against women as an unwanted yet implicitly tolerated aspect of the status quo. Drawing on system justification theory, a concept used to explain why individuals accept aspects of their social systems that are objectively unjust, the mechanisms that perpetuate sexual assault are examined. Furthermore, this theory is used to examine current prevention efforts on college campuses and suggestions for modifications to these programs will be made.     

Resisting Gendered Smoking Pressures: Critical Consciousness as a Correlate of Women's Smoking Status

Gender is one of the social structures, along with social class and ethnicity, that shapes women's smoking behaviors. We examined how different responses to gender pressures (internalization and resistance) relate to smoking. We analyzed data from a national random digit dial survey of 945 women and found that never smokers scored high on resistance to gender pressure (indicated by high scores on feminist consciousness) and on education and Body Mass Index; current smokers had the reverse pattern. Ex-smokers scored high on one measure of resistance (advertising skepticism) and on two measures of internalization (embodied femininity and weight concern); they were also likely to have high household income and to be European American. Results are discussed in terms of their implications for smoking cessation programs and antismoking campaigns.     

Conservatism as a Determinant of Sexual Experiences

An examination of the relationship of conservatism to reports of sexual experiences and reasons for nonparticipation was conducted using 64 male and 50 female introductory psychology students. Conservatism was found to be inversely related to the frequency and variety of sexual behaviors. High conservative subjects gave the reason that it was morally wrong more often than any other reason for not engaging in coital activities and more intimate forms of petting. Results were in accord with previous research and were interpreted as supporting the notion that the fear of loss of control of one's impulses and hence the basis for conservative attitudes are determinants of sexual experiences.     

The Cybernetic Metaphor: A Critical Examination of Ecosystemic Epistemology as a Foundation of Family Therapy

This article proposes that recent disputes between two groups of family therapists, represented by Watzlawick and Keeney, have a substantive base as yet unexplicated in current literature. However, guiding principles of the approach known as ecosystemic epistemology have received considerable attention by Wittgenstein, a colleague of Russell's, and Rorty, a contemporary philosopher. Both contend that the prospect of systematizing language and culture may be ill advised. The article suggests that discussion regarding the nature and practice of family therapy ought not be confined to epistemological thinking.     

Unemployment, Underemployment, and Mental Health: Conceptualizing Employment Status as a Continuum

The economy is one of the most important social environments that affect well-being, and community psychologists have long studied the social costs of one key economic stressor—job loss. But economically inadequate employment has received much less research attention than unemployment in regard to mental health effects. This paper contrasts these two literatures and considers factors that might account for their differential growth including actual rates of unemployment and underemployment. Recent panel studies offer no support for another possible basis for this differential growth—the assumption that inadequate employment is more like adequate employment than unemployment. Implications of a paradigm shift from a dichotomous perspective (employment vs. unemployment) to a continuum perspective with variations of both unemployment and employment are discussed for research and prevention. Another implication is the need to expand standard labor force statistics to reflect better the degree of underemployment.     

家庭收入与青少年社会适应：家庭社会资本的中介作用

为了探讨家庭社会资本在家庭收入对青少年社会适应影响中的中介作用,选取了418名农村小学3-6年小学生作为被试,采用家庭经济压力问卷、同伴提名法、学习成绩、孤独感问卷和家庭社会资本问卷进行研究。结果表明：（1）家庭经济压力与学业成就、同伴接纳存在显著的负相关,与孤独感存在显著正相关;（2）家庭经济压力通过家庭社会资本的完全中介作用影响学业成就（中介效应值为–0.14）;（3）家庭经济压力通过家庭社会资本的完全中介作用影响孤独感（中介效应值为0.03）;（4）家庭经济压力通过家庭社会资本的完全中介作用影响同伴接纳（中介效应值为–0.07）。研究得出,家庭收入完全通过家庭社会资本来影响青少年的社会适应。