Counselling in general practice: Clients' perceptions of significant events and outcome

An investigation of clients' perceptions of the change process and outcome of counselling in primary care is presented. Significant events were identified by 51 clients post-session for a mean of 4.7 counselling sessions. Outcome was assessed by clients, through their perceptions of goal attainment and change in quality of life from pre-to post-counselling. Four-hundred-and-nine events were categorized by use of the Therapeutic Impact Content Analysis System (TICAS) and a content analysis system was created to categorize clients' goals. Results showed that ‘reassurance’, ‘problem solution ’, ‘insight’ and ‘involvement’ impacts were reported most frequently by clients. No category of significant events was related to change in quality of life. For 11 clients who set goals in the ‘expression’ category, more ‘reassurance’ and fewer ‘problem solution’ impacts were related to attainment of ‘expression’. Some suggestions are made for the lack of significant relationships with overall measures of outcome and it was suggested that more qualitative analysis of the process of outcome is needed.     

Parenting behaviors of women who were sexually abused as children in their families of origin.

This research explored links between a childhood history of family sexual abuse and current parenting behaviors of mothers of school-age children, using observations of family interaction and interviews with the mothers. Videotaped family interaction tasks, analyzed with Benjamin's Structural Analysis of Social Behavior, showed that women who had been sexually abused in their childhood families were more self-focused, rather than child-focused, compared to nonabused women. In interviews, the women who had been abused gave strong evidence of greater reliance on their children for emotional support. These findings lend support to theoretical and clinical impressions of highly permeable intergenerational boundaries, including parent-child role reversal, in family systems marked by child sexual abuse, even when the abuse occurred in the previous generation.     

Counselling and the Relevance of Counsellors' and Clients' Views and Attitudes

Directing attention towards the counsellor's experience of the client and neglecting to include the client's experience of the counsellor can lead to serious errors and to a considerable distortion in attitudes and theoretical presuppositions. The behaviouristic revolution has generally tended to leave unanswered questions related to the role of the counsellor as a variable in the client-counsellor relationship. Theoretical views are discussed in relation to practical problems encountered in clinical practice.     

Mothers who were severely abused during childhood and their children talk about emotions: Co‐construction of narratives in light of maternal trauma

The article focuses on detailed examination of the co‐construction of emotion dialogues between mothers and their 6‐year‐old children in light of mothers' experiences of being sexually, physically, and emotionally abused during childhood. We present examples from dialogues between 3 mothers and their children about emotional events experienced by the children and illustrate emotionally mismatched co‐construction processes. To better understand these difficulties, the article also provides vignettes from interviews with mothers about children's inner worlds and show how examining the interviews may help explain the unfolding of the dialogues and particularly points of difficulty. The dialogues between the mothers and their children were assessed using the Autobiographical Emotional Events Dialogue procedure (Koren‐Karie, Oppenheim, Chaimovich, & Etzion‐Carasso, 2000). The maternal interviews were obtained using the Insightfulness Assessment procedure (Oppenheim & Koren‐Karie, 2002). The discussion focuses on the significance of mother–child dialogues in shaping children's inner world, and points to the importance of providing intervention for adults who experienced childhood traumas that address not only their own personal issues but also their functioning as parents.     

Adults sexually abused as children: Legal actions and Issues

This article first briefly discusses the problem of delayed memories and long-term effects of child sexual abuse and the current trend to bring civil lawsuits or criminal prosecutions for childhood sexual abuse. The article addresses the primary obstacle to such actions—the statute of limitations—which in most states places a time limit on when legal actions can be commenced. It describes the purpose of the statute of limitations and the need for changing or extending it in child sexual abuse cases; it then summarizes and analyzes the methods used by state legislation and judicial decisions to change or extend the statute of limitations in both criminal and civil actions. The article examines the pros and cons of bringing legal actions for child sexual abuse many years later, and concludes with a discussion regarding the current debate about the accuracy and authenticity of long-term memory and the advisability of legal reforms to extend or eliminate the statute of limitations in this area.     

Adults who are more anxious and were anxiously attached as children report later first memories

Here, we examined retrospective reports of adults’ earliest autobiographical memory, the age of this report and whether the reported age was associated with exposure to early life adversity, current anxiety and childhood attachment. Across four studies, we found that reporting a later ‘earliest’ memory was associated with higher self-reported anxiety in both American (Studies 1, 2 and 4) and Australian (Study 3) samples. Furthermore, in Studies 2–4, we found that reporting a later earliest memory uniquely predicted anxiety when controlling for number of adverse childhood events (a risk factor for the development of anxiety). In Study 4, we established that this relation is partially mediated by childhood anxious attachment. Although we consistently demonstrated that later earliest memories were associated with current anxiety, we found little evidence for a relation between reported age at the time of earliest memory and childhood adversity. We also found no evidence of gender differences in the associations of interest. These results suggest that poorer memory of early childhood is associated with greater childhood anxious attachment and anxiety in adulthood. The implications of this work are discussed in terms of the adaptive nature of autobiographical memory and the development of a coherent life narrative.     

Counselling children and adults about AIDS/HIV: The ripple effect on haemophilia care settings

Haemophilia and HIV/AIDS are life-long, life-threatening conditions for which there is treatment but no cure. Both affect not only the patient but all members of the family. This paper focusses on how the counselling of those with AIDS/HIV has been affected by dilemmas such as treatment, infectious aspects, blood donation, sex, the media and having children. The impact of haemophilia and AIDS on the family and the ripple effect on health care staff is addressed.     

Pathways to violence in the children of mothers who were depressed postpartum

The impact of postnatal depression on a child's risk for violent behavior was evaluated in an urban British community sample (N=122 families). Mothers were interviewed during pregnancy, at 3 months postpartum, and when the child was 1, 4, and 11 years of age. Mothers, teachers, and children reported on violent symptoms at age 11. Structural equation modeling revealed that the child's violence was predicted by the mother's postnatal depression even when her depression during pregnancy, her later history of depression, and family characteristics were taken into account. Violence was associated with symptoms of attention-deficit/hyperactivity disorder and problems with anger management. Children were most violent if mothers had been depressed at 3 months and at least once thereafter.     

An exploration of body dissatisfaction and perceptions of Black and White girls enrolled in an intervention for overweight children

Silhouette measures are one approach to assessing body dissatisfaction in children, although little is known about their use among racially diverse, overweight girls seeking weight-loss treatment. This study assessed racial differences in body dissatisfaction and body size perceptions of 58 girls (ages 6–11, 66% Black, 34% White) participating in a randomized trial for pediatric overweight. Body dissatisfaction did not differ between races; 99% of girls reported an ideal figure smaller than their current one. Black girls selected a larger silhouette to represent their ideal body size, and most girls in both racial groups underestimated their actual size. Outcomes strengthen the argument that, despite an overall preference for a larger body size, obesity might mitigate cultural factors that protect Black girls from body dissatisfaction. Additional research is needed to enhance understanding of children's body size perceptions and dissatisfaction to inform assessment and treatment of pediatric obesity and associated disordered eating symptoms.     

Psychological characteristics and perceptions of stuttering of adults who stutter with and without support group experience

Purpose

To compare adults who stutter with and without support group experience on measures of self-esteem, self-efficacy, life satisfaction, self-stigma, perceived stuttering severity, perceived origin and future course of stuttering, and importance of fluency.

Method

Participants were 279 adults who stutter recruited from the National Stuttering Association and Board Recognized Specialists in Fluency Disorders. Participants completed a Web-based survey comprised of various measures of well-being including the Rosenberg Self-Esteem Scale, Generalized Self-Efficacy Scale, Satisfaction with Life Scale, a measure of perceived stuttering severity, the Self-Stigma of Stuttering Scale, and other stuttering-related questions.

Results

Participants with support group experience as a whole demonstrated lower internalized stigma, were more likely to believe that they would stutter for the rest of their lives, and less likely to perceive production of fluent speech as being highly or moderately important when talking to other people, compared to participants with no support group experience. Individuals who joined support groups to help others feel better about themselves reported higher self-esteem, self-efficacy, and life satisfaction, and lower internalized stigma and perceived stuttering severity, compared to participants with no support group experience. Participants who stutter as an overall group demonstrated similar levels of self-esteem, higher self-efficacy, and lower life satisfaction compared to averages from normative data for adults who do not stutter.

Conclusions

Findings support the notion that self-help support groups limit internalization of negative attitudes about the self, and that focusing on helping others feel better in a support group context is linked to higher levels of psychological well-being.Educational objectives: At the end of this activity the reader will be able to: (a) describe the potential psychological benefits of stuttering self-help support groups for people who stutter, (b) contrast between important aspects of well-being including self-esteem self-efficacy, and life satisfaction, (c) summarize differences in self-esteem, self-efficacy, life satisfaction, self-stigma, perceived stuttering severity, and perceptions of stuttering between adults who stutter with and without support group experience, (d) summarize differences in self-esteem, self-efficacy, and life satisfaction between adults who stutter and normative data for adults who do not stutter.     

Preliminary study of self-perceived communication competence amongst adults who do and do not stutter

PurposeAdults who stutter report a significant impact of stuttering on their quality of life, including negative thoughts and attitudes toward communication. In addition to this impact, adolescents who stutter also report lower levels of self-perceived communication competence (SPCC) compared to fluent peers. The purpose of this study was to extend the investigation of SPCC to adults who do and do not stutter. Additional aims investigated included if 1) SPCC predicted overall impact of stuttering, and, 2) stuttering frequency predicted SPCC among adults who stutter.MethodsTwenty-four adults who stutter and twenty-seven adults who do not stutter matched for age, gender, and education completed the Self-Perceived Communication Competence Scale (Richmond & McCroskey, 1997). All participants who stutter completed the Overall Assessment of the Speaker’s Experience of Stuttering (OASES [ages 18+]; Yaruss & Quesal, 2006) and speaking samples to measure stuttering frequency.ResultsAdults who stutter reported significantly lower SPCC scale total scores than adults who do not stutter. For adults who stutter, lower SPCC scale scores significantly predicted more severe overall impact of stuttering as measured by the OASES. Stuttering frequency did not predict SPCC scale scores.DiscussionThis is the first study to report differences in self-perceived communication competence between adults who do and do not stutter. Results suggest adults who stutter report lower self-perceived communication competence compared to adults who do not stutter. Adults who perceive themselves to have greater communication competence reported less severe overall impact of stuttering, and stuttering frequency did not influence SPCC. Clinical implications for intervention are discussed.     

Mental health and education: Counselling as prophylaxis

Though school counselling is concerned primarily with prevention rather than cure, in practice the urgent needs of the wayward and the sick leave little time for genuinely preventive work. Furthermore, effective prophylaxis in the strong sense of laying foundations of robust mental health, competence and well-being in all children must involve the whole school to some degree, and particularly a team of willing and able teachers working along with the school counsellor on curriculum development in personal and social education. Though the needs of the few can be met by one-to-one counselling, the needs of the many will be answered only through group work. Trained counsellors must take the initiative in such work. They will retard the mental health movement if they permit their colleagues to feel complacently that the appointment of a school counsellor is an ample school contribution to the objectives of preventive psychiatry. Mental health is every teacher's business.     

Clients' perceptions of how reorientation therapy and self-help can promote changes in sexual orientation

Presented is a summary of 882 homosexual people's responses to 5 open-ended questions about sexual reorientation therapy. Of the 882 participants, 726 reported that they had received reorientation therapy from a professional therapist or a pastoral counselor. As a group, 779 (89.7%) of the participants viewed themselves as "more homosexual than heterosexual," "almost exclusively homosexual," or "exclusively homosexual" in their orientation before receiving reorientation therapy or making self-help efforts to change. The majority reported they believed sexual reorientation therapy and various forms of self-help were helpful to them, psychologically, spiritually, and sexually.     

Spouses, adult children, and children-in-law as caregivers of older adults: a meta-analytic comparison

The present meta-analysis integrates the results from 168 empirical studies on differences between caregiving spouses, adult children, and children-in-law. Spouses differ from children and children-in-law significantly with regard to sociodemographic variables; also, they provide more support but report fewer care recipient behavior problems. Spouse caregivers report more depression symptoms, greater financial and physical burden, and lower levels of psychological well-being. Higher levels of psychological distress among spouses are explained mostly--but not completely--by higher levels of care provision. Few differences emerge between children and children-in-law, but children-in-law perceive the relationship with the care recipient as less positive and they report fewer uplifts of caregiving.     

Let's talk openly about sex: Sexual communication,self-esteem and efficacy as correlates of sexual well-being

Drawing from theories of sexual development, the aim of this study was investigate whether sexual well-being was more positive when youth reported more frequent and better quality sex-related communication, and greater sexual subjectivity (sexual body esteem and pleasure self-efficacy). Sexual well-being was measured with reference to partnered behaviour, including safe-sex behavioural competence, sexual assertiveness, and emotional reactions. Young adults (N = 209; 61% female) aged 17–21 completed questionnaires. While also considering age, gender, romantic status and coital experience in regression analyses, participants higher in competence reported more frequent communication with mothers in high school, and current higher quality communication with mothers and friends. Participants reported more positive emotions related to sex when they had better quality communication with their friends. Associations of sexual subjectivity with greater sexual well-being were found, and small indirect effects were found between retrospectively reported communication frequency and sexual well-being via pleasure self-efficacy.     

The relationships between family functioning and attachment orientations to post-traumatic stress symptoms among young adults who were evacuated from Gaza Strip settlements as adolescents

Background and Objectives: This study examined post-traumatic stress disorder (PTSD) symptoms among young adults that were evicted from their residences in Gaza settlements (“Gush Katif”) as adolescents and actively participated in the resistance events. Furthermore, we examined the moderating role of exposure to forced relocation on the association between attachment orientations and family functioning and PTSD symptoms. Design: We conducted a correlative, cross-sectional study in 2013. Methods: Participants were Israeli evicted residents (ER group; N = 102), comparison groups of evicted nonresidents (ENR group; N = 27), and nonevicted nonresidents (NENR group; N = 53). All participants completed a battery of self-reported questionnaires. Results: The ER group reported a higher number of PTSD symptoms as compared to the comparison groups. However, ER participants did not differ from ENR and NENR participants in their perception of family functioning. Importantly, the group (ER vs. NENR) moderated the association between attachment-anxiety and PTSD symptoms and between family adaptability and PTSD symptoms. Conclusions: Nine years after the forced relocation from Gaza settlements, young adults that were evicted from their residences as adolescents suffer from PTSD symptoms that are more related to the relocation itself than the stress entailed in the resistance events.     

Comparison of behaviors of suspected sexually abused and nonsexually abused preschool children using anatomical dolls

Using anatomical dolls, the play behaviors of nine sexually abused preschool children (five males, four females), ranging in age from 3 to 5 years, were compared with nine preschool children for whom there was no suspicion of sexual abuse and who were matched on the basis of age, gender, race, family status, and socioeconomic status. There was no significant difference between the two groups on explicit sexual behavior (vaginal, oral, and anal intercourse with thrusting motions between the dolls or between the child and the dolls and masturbation by the child). The groups were significantly [t(8)=2.19, p <.05; Wilcoxon W=6, p <.05) different when behaviors with suspicious sexual implication were combined with explicit sexual behaviors. There were no differences between the groups on measures of nonsexual behavior. The occurrence of the suspicious sexual behaviors is discussed and reviews of previous doll research and physical evidence of child sexual abuse are provided.This project was supported in part by a grant from The Graduate College of Western Michigan University, Kalamazoo, Michigan.