Enhancing Family Communication: Examining the Impact of a Therapeutic Wilderness Program for Struggling Teens and Parents

Every year approximately 130 families participate in Intercept, a program for struggling teens and their families at the Voyageur Outward Bound School, because they are concerned about the loss of trust, poor communication, and/or other high-risk behaviors they are experiencing with their children. Though families hope for improvements in family functioning, little research has been done on the impact of this type of program on the parent/child relationship or how families function once they leave the program. This phenomenological study collected qualitative data from nine families to determine what positive relationship outcomes emerged between parent(s) and their adolescent child post-program, as well as what aspects of the program curriculum were helpful in improving the parent/child relationship. Results showed that communication among family members improved as a result of participation in the Outward Bound program, and families reported utilizing new skills they had learned, including the use of time-outs, improved listening, and other assertive communication tools. Families reported that the parent/child conference at the end of the program was the most helpful aspect of the Intercept curriculum for improving the parent/child relationship. Implications for family therapy include support for therapeutic wilderness programs as a viable intervention for families of high-risk teens struggling with communication.     

Family Communication Following BRCA1/2 Genetic Testing: A Close Look at the Process

This study examines the process of communicating BRCA1/2 genetic test results to family members, and the factors influencing disclosure. Twenty-nine semi-structured telephone interviews with BRCA1/2 tested individuals, 4 to 9 years post-notification, were conducted. Our results suggest that individual, familial, relational and socio-medical factors influence the decision to disclose/not disclose genetic test results to family members. These factors are at play in all three communication phases: the Decision-making phase, in which the individual ponders various factors before deciding to disclose test results to family members; the Disclosure phase, in which communication per se takes place; and the Reaction phase, which shapes the participant’s subsequent disclosure/non-disclosure decisions. We propose a guiding framework to assist in identifying and evaluating significant factors that might shape the course and outcome of the transmission of genetic information to family members.     

Family Communication and Genetic Counseling: The Case of Hereditary Breast and Ovarian Cancer

In familial breast/ovarian cancer, the information that the proband is able to supply about other family members is of critical importance for genetic counseling. This frequently requires family communication. Forty-six women attending a cancer genetics clinic were interviewed as part of a longitudinal study. Nearly all reported affected maternal, rather than paternal relatives, which may indicate lack of awareness by women with paternal histories. There was also much more communication among female relatives. Mothers, where they were still alive, were key figures in supplying family information. Although the majority of the sample contacted at least one relative regarding counseling, most named a relative with whom they did not feel able to communicate on this subject. Probands balanced the perceived obligation of passing on information with that of not causing alarm. Communication, both obtaining and giving information, was impeded by adoption, divorce and remarriage, family rifts, and large age gaps between siblings.     

Complexities of Genetic Counseling for ALS: A Case of Two Siblings with Discordant Genetic Test Results

Rapid advances in the genetics of amyotrophic lateral sclerosis (ALS) have dramatically changed the approach of clinicians and researchers to the motor neuron diseases. We report two siblings in whom the genetic study provided conflicting results, hence raising a number of issues which deserve to be considered by clinicians involved in genetic testing for ALS. The first patient died within 2 years of ALS onset, while her brother still manages to walk unaided, 7 years into onset. Genetic analyses, performed on the first patient as part of a research protocol, and as clinical genetic testing on the brother, provided different results. Results for Patient 1 were negative for all investigated genes, thus suggesting that her disease may be a phenocopy, while her brother carried an autosomal dominant TARDBP mutation (p.A382T). A multidisciplinary approach may help patients and clinicians face the emerging dilemmas in such a complex field. Sharing and updating of advances, not to mention uncertainties inherent to current knowledge, with patients and families may prove to be an effective way to support them and to make them aware of the present limits of our knowledge and of the blurred border between research and clinical practice.     

Structure of the Modern Japanese Family: Evidence From the Results of a Doll Location Test by Adolescents

To test Herzberg's (1966, 1987; Herzberg, Mausner, &; Snyderman, 1959) motivator-hygiene theory, I examined the relationship between work values and job satisfaction. Educators (N # 386) from 18 Canadian secondary schools were asked to report the degree to which they experienced 16 work values and five dimensions of job satisfaction. Factor analysis suggested five sets of work values: intrinsic work-related, intrinsic work-outcome, extrinsic job-related, extrinsic job-outcome, and extrinsic people-related. Regression analyses identified the best predictors for each of the five dimensions of job satisfaction. The results support and extend Herzberg's theory. In addition to those identified by Herzberg, other factors contributed portions of variance to the five dimensions of job satisfaction.     

Communication Between Breast Cancer Patients Who Received Inconclusive Genetic Test Results and Their Daughters and Sisters Years After Testing

Inconclusive genetic test results including screening recommendations for the breast cancer patients and their first-degree relatives are the most common outcomes of BRCA 1/2 testing. Patients themselves should communicate these results to their relatives. Our aim was to explore communication of breast cancer genetic counseling results with daughters and sisters over a long period of time. Breast cancer patients, who had received an inconclusive DNA test result 7–14 years earlier, completed a self-report questionnaire. Additionally, in-depth interviews were conducted and analysed thematically. Of the 93 respondents, 85 (91 %) considered themselves responsible for communicating genetic test results to relatives. In-depth interviews (n?=?14) showed, that counselees wanted ‘to hand over’ their responsibilities to communicate the test results and screening recommendations to their sisters. Although most patients had informed their daughters and sisters about the genetic test results, usually little is spoken about genetic test results and screening recommendations once the duty of informing is completed. We recommend that, similar to the procedure for BRCA1/2-mutation carriers, a separate letter for first-degree relatives of patients with an inconclusive test result should be provided. In this way information about risks and screening recommendations can be verified by family members years after genetic testing has been completed.     

Examining Religious Disaffiliation Through a Family Systems Lens: Implications for Treatment

Religious disaffiliation can be emotionally and relationally challenging. Research indicates that people who disaffiliate can experience grief, emotional distress, and even posttraumatic stress disorder (PTSD) symptoms. Research also indicates that disaffiliation can put strain on family relationships, yet exactly how this impacts the family system as a whole is much less understood. This qualitative study, using grounded theory analytic procedures, fills a gap in the literature by utilizing a systemic approach to explore the impact of religious disaffiliation on family units. Twelve participants from five different families representing five different religions were interviewed. At least one disaffiliated member and one affiliated member were interviewed from each family system. Results offered a deeper understanding of (a) the relational impact of religious disaffiliation and (b) the relational challenges of navigating interactions after disaffiliation. Six clinical implications are offered with the goal of helping family members understand their unique experience of this transitional time, process their emotions, enhance distress tolerance skills, and effectively communicate with one another in a spirit of kindness and respect to prevent relational wounds, expedite the healing process, and protect family bonds.     

Notes on the Tenacity of Therapeutic Presuppositions in Process Research: Examining the Artfulness of Blamings in Family Therapy

In their recent contribution to the Journal of Family Therapy , Frosh et al . apply discourse analytic methods to the study of 'process' in family therapy. While we welcome this contribution, we suggest that the authors' reading of the data has been affected by a number of fundamental presuppositions, which have led them to neglect the skilful rhetorical work taking place in the session. In this paper, we have undertaken an alternative analysis of the data, examining its rhetorical features and suspending judgement on the efficacy of the therapeutic project and on the truth status of statements made by participants in the session. While acknowledging that our microanalytic method has some shortcomings, we contend that attention to the situated and strategic nature of 'therapy talk' has exposed the primacy of notions of responsibility and blame in family work, and has shown how these issues are artfully negotiated by therapist and family in the cut and thrust of the therapeutic interview.     

A Family Affair: Examining the Impact of Parental Infidelity on Children Using a Structural Family Therapy Framework

Infidelity has a permeating impact on social systems, but no system is more impacted by infidelity than the nuclear family. This paper examines the impact of parental infidelity on the family using a structural family therapy (SFT) framework. Conceptualizing and treating infidelity from an SFT approach provides a systemic understanding of how interactions between the parental units about infidelity impact parent–child dynamics. Clinical recommendations are outlined for couple and family therapists to help families find healthy and adaptable ways to create and maintain structures that minimize the harmful impact of infidelity on the family system.     

The Results of Family Therapy Revisited: The Nonbehavioral Methods

Studies from 1971 to 1976 reporting on the outcome of the nonbehavioral family therapies are analyzed and critically reviewed. Such research has increased in both quality and quantity since 1970 and, broadly speaking, has legitimized the status of family therapy as a viable mode of helping. Particularly potent effects were noted for family therapy as an alternative to psychiatric hospitalization, with psychosomatic problems in children and adolescents, and in certain applications with parent-child and parent-adolescent relationships. However, a number of studies comparing family therapy with no formal treatment or an alternative treatment found little difference in outcome. Problems in family therapy outcome research are discussed and some future directions suggested.     

The Anorectic Process in the Family: A Six-Stage Model as a Guide for Individual Therapy

This article presents a conceptual framework for individual treatment with chronic anorectic patients. In the first part of the article, the six-stage model for the anorectic process developed over the past years by M. Selvini-Palazzoli and her team is briefly explained. After presenting the model, we then discuss some related concepts, namely, "family game," "rule," and "strategy." Finally, the therapeutic technique in individual treatment is discussed. Two basic assumptions underlie this technique: first, the therapeutic relationship is instrumental, its main purpose being to improve the patient's personal relations outside therapy; second, the focus of the treatment is on the strategic incapacity of the patient who is caught up in and unable to cope with the "concealed family game."     

Death in the Family: Adapting a Family Systems Framework to the Grief Process

This paper presents a framework for adapting a family systems approach to the grief process. The framework places the bereaved and therapist in the larger context. The therapist builds a relationship around each family member's unique experience with death, and uses the grief timeline to facilitate timely systemic interventions. This perspective helps the therapist navigate pitfalls and remainstrategically positioned to address grief sensitively and effectively in psychotherapy.     

The Process of Family Reconstruction after DNA Testing for Huntington Disease

The needs of families to reconstruct their relationships in response to the DNA testing for Huntington disease of one or more of their asymptomatic members are presented. Data were collected from family interviews with 18 families, and from their responses on a post interview questionnaire. Findings are that families need to (a) address unfinished business associated with the decision for testing; (b) bring family members, peripheral in the decision for testing, into the loop; (c) reorganize patterns of communication and roles altered by the testing and heal ruptures in family membership; and (d) revise family stories about illness to provide a meaning for HD and explain the test results in a way that leaves them with a sense of mastery. Findings suggest that families should be more involved in the initial decision for testing of a member and that protocols should be established to provide help for their ongoing adjustment.     

Family Communication of BRCA1/2 Results and Family Uptake of BRCA1/2 Testing in a Diverse Population of BRCA1/2 Carriers

Previous studies examining communication of BRCA1/2 results with relatives and family uptake of BRCA1/2 testing have sampled from predominantly white, high SES cohorts ascertained solely from tertiary care centers. No studies have focused on family communication and testing among relatives of diverse BRCA1/2 carriers. We conducted structured interviews with 73 BRCA1/2 carriers identified at a public hospital and a tertiary cancer center. We asked participants if each first- and second-degree relative was aware of their BRCA1/2 results and whether or not each relative had tested. Generalized estimating equations identified rates and predictors of family communication and testing. Participants disclosed their test results to 73 % of 606 eligible relatives and 31 % of 514 eligible relatives tested. Communication and testing rates were similar for relatives of participants from the public hospital and the tertiary cancer center. Hospital site was not a significant predictor of either result disclosure or relative uptake of testing. African American and Asian/Pacific Islander participants were significantly less likely to disclose their results to their relatives; relatives of African American participants were significantly less likely to test. Addressing these disparities will require further research into the best ways to facilitate family communication and counsel at-risk relatives of racially and socioeconomically diverse BRCA1/2 mutation carriers.