Resolving the trauma organized system of sexual abuse by confronting the abuser: A focal family therapy approach with a woman who was a childhood victim of sexual abuse

The longer-term emotional and interpersonal effects of sexual abuse in childhood are reviewed and approaches to treatment discussed. The notion of a 'trauma organized system' to account for the long-standing effects of abuse is described. A major potential issue in creating therapeutic change is confronting the abuser, and a case is described where a woman brought her family for therapy when it was feared that the father, who had abused her in childhood, might abuse his grandchildren. A focal family therapy approach was used: this takes into account the traumatic nature of abusive events and their long-term organizing effects on individual and family functioning. The process of therapeutic work is described, including the resolution of traumatic effects by confronting the abusive act.     

Surviving cancer competently intervention program (SCCIP): a cognitive-behavioral and family therapy intervention for adolescent survivors of childhood cancer and their families.

Psychological reactions to having had childhood cancer often continue after treatment ends, for survivors and their parents. Based on our previous research, we developed an intervention program for adolescent survivors of childhood cancer, their parents, and siblings. Surviving Cancer Competently: An Intervention Program--SCCIP--is a one-day family group intervention that combines cognitive-behavioral and family therapy approaches. The goals of SCCIP are to reduce symptoms of distress and to improve family functioning and development. SCCIP is described and data from a pilot study of 19 families are presented. Program evaluation data indicated that all family members found SCCIP helpful. Standardized measures administered before the intervention and again at 6 months after SCCIP showed that symptoms of posttraumatic stress and anxiety decreased. Changes in family functioning were more difficult to discern. Overall, the results were promising with regard to the feasibility of the program and its potential for reducing symptoms of distress for all family members.     

Phobia and counterphobia: family aspects of agoraphobia

Twelve cases with agoraphobic and other phobic symptoms are presented. Their family backgrounds and marital relationships are delineated. A consistent pattern, the phobic-counterphobic system, emerges. This contains five elements. (1) Anxious ambivalent attachment, which characterizes the previous childhood relationships of both partners in the marriage. The future patient has responded to this with a tendency to clinging behaviour, her spouse with a propensity to detachment. (2) A marriage in which, initially, each, through the other, escapes from their childhood difficulties. (3) A precipitating change with challenges the couple's illusionary unity. (4) A period of escalation and failure of reassurance by the husband. (5) The illness, which stabilizes the system and leads to a 'compulsory marriage'. Therapeutic approaches for each of these elements are described.     

Redressing the balance—involving children in family therapy

This paper argues that family therapists have tended to ignore the problem of how to engage children in family therapy, and it presents a number of techniques specifically aimed at involving children in therapy. The socio-historical context of childhood is discussed and its implications for therapists examined. A number of visual techniques are then described, illustrated by case examples. These serve the function of addressing the whole family system on a number of levels and involving children fully in the process of therapy.     

Perceived Social Support and Mental Health among First-Year College Students with Histories of Bullying Victimization

Although childhood bullying victimization is associated with adult depression and anxiety, the majority of previously bullied youth do not develop psychopathology. Identifying protective factors has implications for designing interventions that can support a successful adjustment to emerging adulthood. In this study, we investigate whether perceived social support protects against depression and anxiety among first-year college students who had previously experienced bullying. We collected data from 1474 first-year college students attending four large universities across the United States. Students completed a web-based survey in fall 2012 (Wave 1) and 436 (29.5 %) participated in a follow-up survey in spring 2013 (Wave 2). Participants reported on childhood bullying victimization, current depression and anxiety, and current social support (overall and from family, friends, and significant others). Results indicated that a history of childhood bullying victimization was positively associated with depression and anxiety in both fall and spring. Further, overall social support reported in fall moderated the association between childhood bullying victimization and fall and spring anxiety. Also, higher levels of perceived family support, in particular, buffered previously bullied students’ risk for spring anxiety. Results suggest that perceptions of familial social support during the initial adjustment to college may protect previously bullied first-year students from anxiety during their adjustment to college. Research and clinical implications, study limitations, and future directions are discussed.     

I haven't thought about this for years! Dating recent recalls of vivid memories

In three studies, we examined memories for previous recall. In Studies 1 and 2, undergraduates were asked whether they had vivid memories about various childhood events. After a one‐hour (Study 1) or 2‐week (Study 2) interval, they completed a second questionnaire containing new, but also previously presented childhood items. Participants estimated how recently they had thought about old and new items. A non‐trivial proportion of recent recalls of vivid childhood memories was dated incorrectly. In Study 3, women with recovered and continuous memories of childhood sexual abuse (CSA) completed the childhood events questionnaires used in studies 1 and 2. After a one‐hour interval, they indicated how recently they had thought about new, but also previously presented childhood items. Compared to women with continuous CSA memories, women with recovered memories underestimated their prior remembering. Copyright © 2005 John Wiley & Sons, Ltd.     

A developmental perspective on antisocial behavior

A developmental model of antisocial behavior is outlined. Recent findings are reviewed that concern the etiology and course of antisocial behavior from early childhood through adolescence. Evidence is presented in support of the hypothesis that the route to chronic delinquency is marked by a reliable developmental sequence of experiences. As a first step, ineffective parenting practices are viewed as determinants for childhood conduct disorders. The general model also takes into account the contextual variables that influence the family interaction process. As a second step, the conduct-disordered behaviors lead to academic failure and peer rejection. These dual failures lead, in turn, to increased risk for depressed mood and involvement in a deviant peer group. This third step usually occurs during later childhood and early adolescence. It is assumed that children following this developmental sequence are at high risk for engaging in chronic delinquent behavior. Finally, implications for prevention and intervention are discussed.     

Addressing Barriers to Change in the Treatment of Childhood Obsessive Compulsive Disorder

Although considerable evidence supports the use of cognitive behavior therapy (CBT) for the treatment of childhood obsessive compulsive disorder, large numbers of youth fail to respond and clinical remission is often elusive. Poor family functioning frequently is implicated as an obstacle for youth undergoing CBT, with features such as symptom accommodation, family conflict, and blame known to attenuate outcomes. These features are common in child and adolescent obsessive compulsive disorder (OCD) and they may pose particular challenges for exposure-based treatments. Nonetheless, interventions that focus specifically on family functioning have, to date, been limited. This paper reviews the literature on family features associated with childhood OCD and discusses their links to treatment outcome. It then describes the development of a brief family intervention tailored to address the needs of highly distressed families of youth with OCD in the service of improving individual child CBT outcomes. Preliminary pilot data are presented and clinical implications are discussed.     

Casework towards the family re-integration of a sexually abusive father—a single case study

A family is presented where sexual abuse of one child had occurred but the family wished to stay together. Work with the family over 3 years, during which time the father served a prison sentence, is described.
The problems, for professionals as well as the family, in deciding when a family is safe are discussed.     

Beyond the “Psychosomatic Family”: A Biobehavioral Family Model of Pediatric Illness

This article proposes a multilevel systems model of the interactive biological, psychological, and social processes in childhood illness. This heuristic model can organize the investigation of pathways and mechanisms by which these levels influence one another. A pivotal feature of this biobehavioral family model is the construct of responsivity, which is conceptualized at both family (interpersonal responsivity) and individual (biobehavioral reactivity) levels. Individual biobehavioral reactivity is proposed as a bidirectional pathway by which family patterns and disease processes influence one another. Illustrative clinical material and relevant research are presented with recommendations for future study. This model integrates individual and family-level theory and thus has the capacity to bridge the fields of psychosomatics, pediatrics, behavioral medicine, and family systems medicine.     

Delimiting Family in Syntheses of Research on Childhood Chronic Conditions and Family Life

Synthesis of family research presents unique challenges to investigators who must delimit what will be included as a family study in the proposed review. In this paper, the authors discuss the conceptual and pragmatic challenges of conducting systematic reviews of the literature on the intersection between family life and childhood chronic conditions. A proposed framework for delimiting the family domain of interest is presented. The framework addresses both topical salience and level of relevance and provides direction to future researchers, with the goal of supporting the overall quality of family research synthesis efforts. For users of synthesis studies, knowledge of how investigators conceptualize the boundaries of family research is important contextual information for understanding the limits and applicability of the results.     

The centrality of values in families and family therapy

Values are discussed in terms of development, nature, and implications for family therapy. Clinical examples are used to demonstrate concepts and a model is presented which depicts how the various leverages utilized in family therapy relate to family values. Individual development, cultural heritage (legacy), the nuclear family system, and the contemporary context are described as factors which interact to form values. A case is made for conceptualizing values as central to family therapy relative to engaging families, intervening in families, and evaluating therapeutic impact.     

A Developmental Model for Family Systems

This paper reviews the historical context of concepts of development and some of the problems of applying them to family systems. A model of family systems development is presented that emphasizes changes in family shape through the individual life cycle. Some clinical uses of the model are described.     

Concurrent individual and family therapy in a case of elective mutism

In this paper, following a literature review a family containing a child who had been electively mute for four years is described. A concurrent programme of individual and family therapy and the systemic hypothesis which guided these interventions is then presented in detail. Behavioural and psychometric data are presented to illustrate the dramatic improvement which the identified patient showed over the course of treatment. Finally, the probable mechanisms underpinning the child's improvement, and how these differed from our initial expectations, are discussed.     

The Role of the Family in Childhood Obsessive–Compulsive Disorder

While obsessive–compulsive disorder is widely recognized to have a strong genetic component, psychosocial factors are also acknowledged to be important. The primary focus of this paper is on familial factors associated with OCD in children and adolescents. It explores the family context as a possible risk factor in the development and maintenance of the disorder, including parental modeling, expressed emotion, parenting style, and family accommodation of the child's symptoms. The involvement of the family in the treatment of the disorder is also reviewed. Finally, future directions for research investigating familial factors in childhood OCD are presented.     

Re-Collection in Existential Psychotherapy with Couples and Families Dealing with Death

Re-collection is a treatment dynamic in existential family therapy in which the client family is helped to remember and honor meanings that family members have previously actualized and deposited in the past. This shrinks the family meaning vacuum and those symptoms and problems that grow and flourish in a family meaning vacuum. In this article, an existential orientation to re-collection with families who are dealing with the death of a loved one is presented, described, and illustrated with case material.     

Family of origin: An experiential workshop

Abstract

A rationale is presented and a one day, content-free family of origin experiential workshop is described in detail. The workshop is designed for clients in ongoing family therapy. Its purposes are 1) motivating family members to engage in family of origin investigations; 2) supplying information in a supportive experiential learning paradigm for use in ongoing peer and multiple family therapy groups; 3) minimally teaching procedures for conducting a Bowen-like search; 4) contributing to an agency-wide atmosphere of intrigue and support for intergenerational therapeutic work. Sculpture, role-play and dramaturgical techniques are interwoven into a fabric deliberately left unfinished in order to provide maximal material for the ongoing family therapy.     

The Role of Childhood Neglect and Childhood Poverty in Predicting Mental Health, Academic Achievement and Crime in Adulthood

This study examines the roles of childhood neglect and childhood poverty (family and neighborhood) in predicting Posttraumatic Stress Disorder (PTSD), Major Depressive Disorder (MDD), academic achievement, and crime in young adulthood. Using existing data from a prospective cohort design study, 1,005 children with documented histories of neglect (N = 507) and matched controls (N = 497) were interviewed in young adulthood (mean age 29). Official criminal histories were also used to assess outcomes. Data were analyzed using logistic and ordinary least squares regressions and hierarchical linear modeling (HLM) to control for neighborhood clustering. Results from HLM revealed that childhood neglect and childhood family poverty uniquely predicted PTSD and adult arrest, MDD was predicted only by childhood family poverty, and a significant interaction between childhood family poverty and childhood neighborhood poverty predicted academic achievement for the control group only. Childhood neglect, childhood family poverty, and childhood neighborhood poverty each contribute to poor outcomes later in life. While interventions should be developed for neglected children to prevent negative outcomes, the current findings suggest that it is also important to consider the ecological context in which these children are growing up.     

Childhood Overweight and Obesity: Maternal and Family Factors

Treatment programs for childhood overweight and obesity have highlighted the importance of the family in treatment. Considering this, it is surprising that few studies have examined the role of family factors in the development of childhood overweight and obesity. The objective of this study was to examine which family and maternal factors predict increases in weight in boys and girls during middle to late childhood. This study used longitudinal data from the childhood growth and development (GAD) Study. The GAD Study involved 286 healthy weight, overweight and obese children, aged 6–13 years at baseline, who completed baseline, 1-year follow-up and 2-year follow-up assessments. Overweight/obese children were recruited from clinical and community settings. A broad range of maternal and family factors were assessed. Linear mixed models were used to identify which factors predicted child Body Mass Index (BMI) z-scores over time. For community-based children, maternal BMI and single-parent family structure were significant longitudinal predictors of child BMI z-scores. For the clinical participants, low family income was the only significant multivariate predictor of child BMI z-scores. The strong association between child BMI, maternal BMI and family structure confirms the need to target prevention and intervention efforts for childhood overweight and obesity towards families with overweight parents, particularly single-parent families.