Intensive family intervention in a community consultation framework

This article describes a form of mental health consultation to community workers who have reached a state of crisis in their work with unmotivated, multi-problem families. The central part of the consultation is a therapeutic intervention that draws on principles of time extension and network intervention. The consultant sees the family together with its community workers in a one-time, intensive meeting of up to six hours duration. This meeting is divided into three phases, aimed at achieving respectively (1) structural, (2) emotional, and (3) cognitive imbalancing of the family system. This creates a new situation, which hopefully will enable the community workers and the family to move out of the crisis in which they had become stuck.     

Family-Focused Relational Psychotherapy: An Integrative Approach and Its Application to Adult Children of Divorce

This paper presents an integrative model of treatment—family focused relational psychotherapy—and applies it to work with adult children of divorce (ACDs). Three areas of assessment are identified—(a) assessment of individual ego development, (b) assessment of family of origin functioning, and (c) assessment of the nature of the parents' divorce (e.g., level of conflict). Based on this assessment, the treatment model is presented, which integrates strategies from relational/psychodynamic therapy, family of origin work, and experiential techniques. Case examples are presented to demonstrate the appropriate integration of these techniques with clients at different levels in the assessment schema. In addition, a review of the literature on the long-term effects of divorce on children suggests several specific issues that may arise in treatment. These include low self-esteem, emotional distress, externalizing problems, and interpersonal problems such as fear of commitment, difficulty trusting, a high rate of divorce, and strained relationships with parents.     

Strategies for counseling protestant evangelical families

A significant segment of the population—evangelical Christians—has historically been underrepresented in psychotherapy and in the treatment literature. Consequently, few guidelines for therapeutic decision making and intervention have been articulated. Because the clergy are showing an increasing willingness to refer these people to human service professionals, it is important that clinicians be informed about this group of potential clients. Therapeutic strategies whick take into account the unique characteristics of this population are discussed in light of four stages in the development of the helping relationship.Portions of this paper were presented at the meeting of the American Association of Marriage and Family Counselors, Philadelphia, October 1976.     

Illegality 1988

The author presents how the Holocaust appears symbolically in an obsessive-compulsive neurosis in 1988 in Budapest, through the therapy of a 16-year-old boy and his family. The behavior therapy that was first applied made the symptoms even more serious, supposedly because the index patient interpreted it as pursuit. The hypothesis supposed the appearance of the Holocaust in the third generation—as a family myth—and intervention based on this hypothesis brought an end to the neurotic symptoms. The knowledge of historical processes is very important in psychotherapeutic treatment.I would like to acknowledge my debt and my appreciation to Valeria Kiss, occupational therapist, Central National Institute, Budapest, who has had a major role in creating therapy, as co-therapist. I would like to thank Beata Susansky and Gareth Dewar for helping in translation and Andras Posman for helping with the figures of the genogram.     

Network Intervention with a Family in Crisis

This paper presents the process of network intervention with the Kellys who initially sought help for marital problems, continued in therapy by including their 16-year-old son, and ended up with a network assembly of 35 family members, relatives, friends and neighbors meeting at home to help solve the family's on-going conflicts.     

Men’s Decision-Making About Predictive <Emphasis Type="Italic">BRCA1/2</Emphasis> Testing: The Role of Family

Men who have a family history of breast and/or ovarian cancer may be offered a predictive genetic test to determine whether or not they carry the family specific BRCA1/2 mutation. Male carriers may be at increased risk of breast and prostate cancers. Relatively little is known about at-risk men’s decision-making about BRCA1/2 testing. This qualitative study explores the influences on male patients’ genetic test decisions. Twenty-nine in-depth interviews were undertaken with both carrier and noncarrier men and immediate family members (17 male patients, 8 female partners, and 4 adult children). These explored family members’ experiences of cancer and genetic testing, decision-making about testing, family support, communication of test results within the family, risk perception and risk management. Implicit influences on men’s testing decisions such as familial obligations are examined. The extent to which other family members—partners and adult children—were involved in testing decisions is also described. It is demonstrated that mothers of potential mutation carriers not only perceive themselves as having a right to be involved in making this decision, but also were perceived by their male partners as having a legitimate role to play in decision-making. There was evidence that (adult) children were excluded from the decision-making, and some expressed resentment about this. The implications of these findings for the practice of genetic counseling are discussed.     

Therapy with greek families living in Australia

Language and cultural differences can pose barriers to effective intervention in migrant families in conflict. Family therapy approaches can provide some useful strategies for overcoming these obstacles. A family therapy approach can (1) emphasize the value of utilizing natural network support systems; (2) provide a model which helps clarify communication problems arising in the relay of information through a third person acting as an interpreter; (3) underline the importance of non-verbal and process aspects of family communication; (4) suggest techniques for negotiating, joining, and finding commonalities of family experience between a therapist and family of different ethnic background. The therapist needs to develop sensitivity to both the universal and specific ethno-cultural structures, norms and problems of families; when this sensitivity is achieved powerful and culturally syntonic healing forces can be released. Examples of successful family therapy interventions in some Greek families in conflict will be given.Originally published inThe Australian Journal of Family Therapy, Vol. 1, No. 2 (January 1980) pp. 62–68. Reprinted here with permission. Title slightly changed from original.     

Clients' Experiences of Obstructive Silence: Integrating Conscious Reports and Analytic Theories

The psychodynamic literature has associated clients' silences in psychotherapy sessions with a variety of processes. These processes include wishes to merge with the therapist, to gain control in session, to communicate the unsayable, to express helplessness and, most frequently, the intertwined processes of resistance and regression. Experiences of obstructive silence—that is, moments in which clients detached from the process of therapeutic inquiry—were examined in this study. A grounded theory analysis was used to explore clients' experiences of silences in psychotherapy across psychotherapeutic modalities. Two types of obstructive pausing processes, Disengaged pauses and Interactional pauses, were identified. The implications of delineating conscious aspects of these complex experiences are stressed and techniques are suggested for therapeutic intervention in moments of experienced threat.     

Why Parents Matter!: The Conceptual Basis for a Community-Based HIV Prevention Program for the Parents of African American Youth

The Parents Matter! Program (PMP) is a community-based family intervention designed to promote positive parenting and effective parent-child communication about sexuality and sexual risk reduction. Its ultimate goal is to reduce sexual risk behavior among adolescents. PMP offers parents instruction and guidance in general parenting skills related to decreased sexual risk behavior among youth (e.g., relationship building, monitoring) and sexual communication skills necessary for parents to effectively convey their values and expectations about sexual behavior—as well as critical HIV, STD, and pregnancy prevention messages—to their children. We briefly review the literature concerning parental influences on adolescent sexual risk behavior and present the conceptual model and theoretical foundation upon which PMP is based.     

Resolution of an impasse at a network meeting: Dialogical sequence analysis of the use of a shared formulation

The study describes the resolution of an impasse at a network meeting during clinical child neurological assessment procedure, analysed by dialogical sequence analysis (DSA) a micro-analytic method for analysing utterances. The two earlier studies of the project describe how a DSA-based case conceptualisation can be used to assess change in the dyadic interaction between neuropsychologist and parent. This study applies the same formulation to analyse group level interaction at the network meeting. The case of a four-year-old girl was selected from a database of videotaped and transcribed child neurological team assessment processes. A repetitive problematic pattern was clearly manifested between parents and the child. At an early stage of the assessment, the neuropsychologist formulated and shared with the parents a clinical formulation of the pattern, summarised as the controlling/coercive parents to the rebellious child. In the earlier studies, microanalysis using DSA confirmed the accuracy of the neuropsychologist’s initial formulation, which she had used in the encounters with the parents. This study traces how she made use of it to address a re-enactment of the problematic pattern, now between the parents and professionals at the network meeting. The analysis of the phases of the conflict resolution by using DSA suggests that the impasse represented a re-enactment of the role positions of coercion and rebelliousness. The use of the original formulation at the meeting helped the conflicting parties to reach an observing stance to the pattern and a more empathic attitude to each other. The micro-analytic methodology by DSA used in this study allows to show the therapeutic potential of the network meeting and also how the development of an empathic stance is manifested in the discourse content.     

Gendered Division of Childrearing: Ideals,Realities, and the Relationship to Parental Well-Being

Recent cultural expectations about fathers' involvement in childrearing may have changed more rapidly than fathers' behaviors, creating discrepancies between parenting ideals and realities that can generate tensions in family life. In this study, a 1999 national probability sample of 234 married parents, both mothers and fathers expressed strongly egalitarian ideals that fathers should be equally involved in child-rearing across five nurturant domains—discipline, emotional support, play, monitoring, and care-giving—as well as in financial support. In contrast, mothers perceived much less father involvement in actual parenting than fathers perceived—especially in disciplining and providing emotional support for their children. Ideal–actual discrepancies were related to well-being: if fathers were seen as less than ideally involved in nurturant parenting, parents reported more stress and fathers who perceived greater than ideal father involvement in financial support were more likely to say the division of household labor was unfair to the mother. Ideal–actual gaps differed for mothers and fathers and were sometimes differentially related to well-being. For example, less than ideal father involvement in disciplining children was associated with mothers' higher stress levels, and the discrepancy in expectations about father involvement in play and monitoring children was correlated with mothers' increased feelings of unfairness in the household division of labor. On the other hand, fathers who felt an ideal–actual gap in disciplining children almost always felt overly involved in discipline and were less likely to report that the division of labor in the household was unfair to their spouses.     

The 1979 division 27 award for distinguished contributions to community psychology and community mental health: Emory L. Cowen

Summary The metaphor of the paper's title offers a framework for a brief summary. Effective wooing of primary prevention requires that we take seriously, and adhere to, its clear, sensible defining guidelines; systematize, and further develop, its generative base; use that base to guide the formulation of new primary prevention programs; further develop frameworks to promote informed choices of programs derecions from among many attractive possibilities; and be more hard-nosed as program evaluators. That type of courtship should improve our love life with — and perhaps even, science of — primary prevention in mental health. Editor's Note: Emory L. Cowen was honored at the 1979 annual meeting of the American Psychological Association in New York, New York, on September 4, 1979, receiving the Division of Community Psychology Award for Distinguished Contributions to Community Psychology and Community Mental Health. The selection was made by an Awards Committee composed of all the past-Presidents of the Division. Dr. Cowen was introduced by Jack M. Chinsky of the University of Connecticut, and Julian Rappaport of the University of Illinois at Urbana—Champaign.This paper bears some (superficial) resemblance to a talk given at division 27's Distinguished Contribution Award ceremony, during the 87th Annual APA Meetings, New York, N.Y., 9/4/79. This draft is surely lengthier, more convoluted,no more informative, and muchless fun than the spoken version. Conceivably, the main accomplishment of my incessant revisions will prove to be the significant incapacitation of 10 gifted typing fingers attached to the hands of Sharon DeVita — the prime initial victim of my obsessionality. To Sharon, who suffered the indignity and boredom of eternal retypings, my boundless gratitude for her patience, forbearance, and good cheer, well beyond the call of duty.Preparation of this paper was done under support of a grant from the NIMH Experimental and Special Training Branch (MH 14547-02-03), which the author acknowledges with gratitude.     

Etiological hypotheses in a time-series case study of multiple behavior problems

A 15-year-old male was treated over a 20-month period for multiple behavior problems, including social isolation, family conflict, classroom behavior problems, scholastic underachievement, and impulsivity. Initial assessment data suggested that the problems were the result of a complex, interacting set of environmental, cognitive, and psychophysiological factors. Treatment was delivered and validated using a time-series design to test hypotheses generated by etiological theory. Discussion addresses the need for better use of psychopathological principles and etiological theory in clinical practice. The success of the case study suggests that this can be done by combining behavioral and psychometric clinical assessment, idiographic application of theory, an hypotheticodeductive approach to intervention, and time-series methodology.This study was supported in part by the University of Nebraska — Lincoln College of Arts and Sciences, by the UN-L Research Council, and by a George C. Holmes Fellowship granted to the senior author.The authors wish to acknowledge the assistance of Ms. Dorie Reed.     

Ethos,pathos and logos in Aristotle's Rhetoric: A re-examination

In Aristotle's Rhetoric, logos must be conceived as enthymematical argumentation relative to the issue of the case. Ethos and pathos also can take the form of an enthymeme, but this argumentation doesn't relate (directly) to the issue. In this kind of enthymeme, the conclusion is relative to the ethos of the speaker or (reasons for) the pathos of the audience. In an ideal situation — with a good procedure and rational judges — logos dominates and in the real situation of Aristotle's time — with an imperfect procedure and irrational judges — ethos and pathos prevail.I should like to thank R. Berkenbosch and J. Wisse for their comments.     

Open field investigation of enhancing children's social skills

This study evaluated two approaches directed towards enhancing social skills in groups of first and third grade children. In the behavioral intervention, following collection of baseline data, triads of first and third grade children were taught one of four social skills—either touching, asking questions, sharing or praising. The behavioral intervention consisted of instructions, modeling, behavioral rehearsal, feedback and reinforcement. While increases in social behaviors were noted, follow-up indicated substantial erosion in gains. In the ecological intervention, dramatic increases in sharing were noted for an isolate child after being placed in a group whose members displayed high levels of sharing. The differential effectiveness of behavioral versus ecological approaches in establishing and maintaining behaviors are discussed.     

The influence of parents and family context on children's involvement in household tasks

To determine the relative impact of a number of family variables on children's performance of gender-typed household tasks, this study took account of the gender of the child, the gender of a sibling within the same age range (8–14 years), whether a first or second child and three parental variables: the degree of encouragement given to perform masculineand femininetasks, parental involvement in the same tasks, and parents' general egalitarianism. The sample consisted of 191 white, mainly Anglo Australian two-parent families, with the two oldest children in a boy—boy, girl—girl, boy—girl, or girl—boy sequence. To check on the robustness of effects, measures were taken on two occasions, on average 16 months apart. Among the family context variables, the gender of the child was the strongest contributing variable, with girls doing more feminine tasks than boys and boys doing more masculine tasks than girls. There was limited support for the proposition that first children do more housework than second children of the same gender, while the results for gender of sibling were small and inconsistent. Among the parental variables, encouragement had strong positive effects for feminine tasks (i.e., more encouragement by parents corresponded to more involvement by children). In contrast, parental involvement in the same tasks (modeling) and parental egalitarianism predicted only the performance of masculine tasks, and the direction of the effects was mostly negative (e.g., the more a father was involved in masculine tasks, the less a child did of those tasks). The results point to involvement in gender-typed activities being influenced by multiple factors, with parental encouragement and gender of child being most prominent among these. They also point to the value of sampling on more than one occasion and of considering separately the performance of feminine and masculine tasks. This research was financially supported by the Australian Research Council. We are happy to acknowledge that support, together with the essential assistance of the Department of Education and the many parents and children who participated in the study.     

The effect of social network intervention for women with rheumatoid arthritis

A partially-controlled intervention study was performed. Female patients with rheumatoid arthritis (RA) were allocated to three groups: the network intervention group (n = 104), the attention control group (n = 85), and the no-treatment control group (n = 75). The network intervention consisted of an assessment session and a network meeting. Patients were assessed at baseline and approximately 10 and 18 months after the intervention. The network intervention group reported an increase in network size. Daily emotional support increased for the intervention patients compared with patients in the attention control group. The degree of social dysfunction was reduced for patients in the intervention group compared to patients in the no-treatment control group. Furthermore, for single patients, the intervention significantly increased the social network size and improved both social functioning, and perceived overall health, compared to both control groups. The results suggest that the social needs of single patients should be given special attention in clinical settings.     

Spouses' family work participation and its relation to wives' occupational level

Past statistical and conceptual limitations may mistakenly overstate women's and men's unequal participation in family work. The present study used log-linear models to examine spouses' participation in household work and parenting and their perceptions of equity regarding this participation. Wives' occupational level, an important but often overlooked source of variation, was used to classify couples according to three family types—single-wage traditional (TR)—and two types of dual-wage families—dual-earner (DE) in which wives held jobs while husbands held jobs or careers, and dual-career (DC). Data were taken from a study of 81 couples of comparable socioeconomic status and age who had an adolescent child living at home. As hypothesized, results indicated more sharing of household work in dual-wage families than typically reported, particularly for DC families. Husbands and wives in all family types were largely in agreement regarding the distribution of responsibility for household and parenting tasks, but perceptions of equity varied by family type. Spouses with comparable perceptions of fairness reported higher marital satisfaction.Appreciation is expressed to Sue Lucas and Darl Lewis for their assistance with this study. Portions of this paper were presented at the Third Annual Meeting of the American Psychological Society, Washington, DC June, 1991.     

Family-Based Intervention with High-Risk Infants and Their Families

A model of family-based intervention for high-risk infants hospitalized in the neonatal intensive care unit and their families is presented. The theoretical underpinnings, principles, and nature of the intervention are described. The adaptation of the model from a clinical–research demonstration project to a clinical consultation service is highlighted, with particular emphasis on the practical application of the model. Domains of the intervention include infant behavior, family organization and functioning, caregiving environment, and home discharge/community resources. Three case illustrations are provided to demonstrate the breadth of the intervention and how it can be individualized based upon the presentation of the infant and family.