The Family Throughout the Therapeutic Wilderness Process: Our Stories

This article explores the experiences of families that have sent struggling adolescents to therapeutic wilderness programs. We employ a modified case study approach, in which we, the participants, are also observers of the experiences of our entire families. The article begins by explaining what wilderness therapy is and offering an overview of research that has examined the effectiveness of therapeutic wilderness programs. We delineate the process of seeking, selecting and participating in wilderness therapy as well as the role of an educational consultant in facilitating this. We describe our experiences from (1) the time we realized and accepted that our children were struggling and suffering to (2) considering sending our children to wilderness therapy to (3) the stresses of the decision making process to (4) what the experience was like for us including participating in a parent workshop to (5) planning the next steps and discharge, and finally to (6) seeing and living the results over the next few years. Areas of growth and struggle are noted. Our children’s perspectives on our families’ development over time and the interactions among us are also discussed.     

Community Data Collection with Children of Mothers Living with HIV: Boundaries of the Researcher Role

The TRACK‐II program is a multi‐site, community‐based randomized controlled trial evaluating an intervention to assist mothers living with HIV (MLH) in disclosing their HIV status to their young children. Many participants—both mothers and children—reported significant depression and/or suicidal ideation, a phenomenon that presented ethical challenges. This article focuses on participants at one site (Atlanta). Through the vignette of “Jordan,” we describe ethical challenges that may arise when faced with the responsibility of maximizing participants’ safety while maintaining the boundaries of the researcher role. Guided by community psychology values, our team has taken measures within our role as researchers to empower and protect children and mothers endorsing suicidal ideation. For example, we have relied on relationships with community‐based organizations and AIDS service organizations to connect HIV‐affected families to mental health services. Furthermore, we have expanded our system of documentation to follow‐up adequately with families at risk, and we track family resources to promote a strengths‐based framework. We have solicited families’ feedback about their supports and needs to understand how we may best serve them by connecting them to the resources they report needing most and empowering them to care for themselves.     

Creating a Participant Text: Writing,Multiple Voices,Narrative Multiplicity

This article uses the ideas of social constructionism to explore how families change by investigating the way our perceptions of ourselves in relation to others are formed through language. The idea that language has the inherent potential to generate a reply has strongly influenced our thinking. We propose that the reply to others is shaped by our initial reply to ourselves in inner conversation. Interaction moves back and forth from inner conversation to conversation with others, from monologue to dialogue, becoming the “stuff” of new narratives. The particular focus on language in this article is on how adding writing to the session conversation produces a “participant text,” a therapeutic narrative that is composed of the voices of the family and the therapists. These voices, often newly discovered or invented, allow our narrative discourse to expand and multiply. Using this approach with individuals, couples, and families from different socioeconomic levels, we have worked with mourning, divorcing couples, recovery from abuse, marital conflict, parenting dilemmas, and physical illness.     

Family Systems and Ecological Perspectives on the Impact of Deployment on Military Families

The scope of sustained military operations in Iraq and Afghanistan has placed great demands on the Armed Forces of the United States, and accordingly, military families have been faced with deployments in more rapid succession than ever before. When military parents fulfill occupational duties during wartime, military children and families face multiple challenges, including extended separations, disruptions in family routines, and potentially compromised parenting related to traumatic exposure and subsequent mental health problems. Such challenges can begin to exert a significant toll on the well-being of both individuals and relationships (e.g., marital, parent–child) within military families. In order to respond more effectively to the needs of military families, it is essential that mental health clinicians and researchers have a better understanding of the challenges faced by military families throughout the entire deployment experience and the ways in which these challenges may have a cumulative impact over multiple deployments. Moreover, the mental health field must become better prepared to support service members and families across a rapidly evolving landscape of military operations around the world, including those who are making the transition from active duty to Veteran status and navigating a return to civilian life and those families in which parents will continue to actively serve and deploy in combat zones. In this article, we utilize family systems and ecological perspectives to advance our understanding of how military families negotiate repeated deployment experiences and how such experiences impact the well-being and adjustment of families at the individual, dyadic, and whole family level.     

The Significance of Military Contexts and Culture for Understanding Family Well-Being: Parent Life Satisfaction and Adolescent Outcomes

Formal systems and informal networks are presumed to be significant contexts that affect military families. Their effects on both parents and adolescents in active duty military families are examined (N = 236 families). Social organization and contextual model of family stress theories are employed as frameworks for the analyses of how dimensions of military culture influence parents’ life satisfaction, as well as key developmental outcomes of their adolescents (for example, mental health). Key findings from our analyses included a positive relationship between parents support from military leaders and fellow soldiers and parental well-being findings revealed the importance of civilian parents’ satisfaction with military life on adolescent outcomes for families that have experienced stressful military contexts. These findings provide support for the significance of multiple contexts for understanding resilience among military members and their families.     

A Study of Husbands and Wives from Dual-Career and Traditional-Career Families

Husbands and wives of dual-career families were compared with husbands and wives of traditional-career families on the variables of inner-directedness, self-actualizing values, existentiality, self-regard, and self-acceptance. Also, comparisons between the two sets of couples were made on shared and unshared interests. Our findings indicate that the husbands and wives in our sample of dual-career families do not differ in major ways from our sample of husbands and wives of traditional-career families; however, in every instance of difference, the direction of difference supports the view that husbands and wives of dual-career families are more inner-directed and flexible in applying personal values than husbands and wives of traditional-career families.     

Professional Politics and the Concepts of Family Therapy, Family Consultation, and Systems Consultation

At a time when an increasing number of professionals are calling themselves "family therapists," many teachers and theorists in this field are troubled that the term "family therapy" no longer adequately characterizes the concepts or activities of the field. Recently, clinical, political, and economic circumstances have emerged that suggest the need for alternatives to the role of "family therapist." By adding the roles of family consultant and systems consultant, we can open up new options for ourselves and our clients. During initial contacts with families, agencies, and other professionals, we can heighten our therapeutic potential by proceeding with consultative stocktaking, not starting with therapy. Family consultation also can assist in redirecting therapy when a new problem or an impasse develops, in focusing on competency rather than on pathology, and in engaging constructively with families that have a physically or mentally ill member.     

Mental health services for children. The state of the art

Throughout this century, people in the United States have been concerned about the serious deficiencies in the mental health care of our children. Despite eloquent needs assessment and recommendations for remediation, most of the unserved needs and deficiencies of our mental-health-care-delivery system remain the same. This article reviews the current status of mental health services to children, youth, and families to highlight the necessity of an integrated system of mental health care. The development of a continuum of care that is coordinated across the mental health and non-mental-health systems that naturally occur in all children's lives has the potential to vastly improve mental health services to children, youth, and families.     

The Role of Families in Adolescent HIV Prevention: A Review

Recent research has highlighted the significant contribution families make in the prevention of HIV risk behaviors among adolescents. As the most proximal and fundamental social system influencing child development, families provide many of the factors that protect adolescents from engaging in sexual risk behaviors. Among these are positive family relations, effective communication about sexuality and safer sexual behaviors, enhancement and support of academic functioning, and monitoring of peer activities. HIV risk behaviors occur in a social context, and it is becoming clear that the earliest and most effective way to intervene is in the context where one initially learns about relationships and behavior—the family. Both the Centers for Disease Control and Prevention and the National Institute for Mental Health have taken steps to support and emphasize research that will further elucidate our understanding of the role of families in HIV prevention. This article uses Ecodevelopmental Theory to guide and organize the findings of this promising research area. Within this context, and with special attention to the comorbidity of adolescent problem behaviors, this article reviews empirical research on the role of families in HIV prevention, discusses current intervention efforts that involve families and ecosystems, and addresses prospects and implications for future research and interventions.     

Pathways of Risk and Resilience: Impact of a Family Resilience Program on Active‐Duty Military Parents

Over the past decade, studies into the impact of wartime deployment and related adversities on service members and their families have offered empirical support for systemic models of family functioning and a more nuanced understanding of the mechanisms by which stress and trauma reverberate across family and partner relationships. They have also advanced our understanding of the ways in which families may contribute to the resilience of children and parents contending with the stressors of serial deployments and parental physical and psychological injuries. This study is the latest in a series designed to further clarify the systemic functioning of military families and to explicate the role of resilient family processes in reducing symptoms of distress and poor adaptation among family members. Drawing upon the implementation of the Families Overcoming Under Stress (FOCUS) Family Resilience Program at 14 active‐duty military installations across the United States, structural equation modeling was conducted with data from 434 marine and navy active‐duty families who participated in the FOCUS program. The goal was to better understand the ways in which parental distress reverberates across military family systems and, through longitudinal path analytic modeling, determine the pathways of program impact on parental distress. The findings indicated significant cross‐influence of distress between the military and civilian parents within families, families with more distressed military parents were more likely to sustain participation in the program, and reductions in distress among both military and civilian parents were significantly mediated by improvements in resilient family processes. These results are consistent with family systemic and resilient models that support preventive interventions designed to enhance family resilient processes as an important part of comprehensive services for distressed military families.     

Expanding Possibilities: Flexibility and Solidarity with Under-resourced Immigrant Families During the COVID-19 Pandemic

The novel coronavirus has added new anxieties and forms of grieving to the myriad practical and emotional burdens already present in the lives of underserved and uninsured immigrant families and communities. In this article, we relate our experiences since the COVID-19 crisis to the lessons we have learned over time as mental health professionals working with families in no-cost, student-managed community comprehensive health clinics in academic-community partnerships. We compare and contrast the learnings of flexibility of time, space, procedures, or attendance we acquired in this clinical community setting during regular times, with the new challenges families and therapists face, and the adaptations needed to continue to work with our clients in culturally responsive and empowering ways during the COVID-19 pandemic. We describe families, students, professionals, promotoras (community links), and IT support staff joining together in solidarity as the creative problem solvers of new possibilities when families do not have access to Wi-Fi, smartphones, or computers, or suffer overcrowding and lack of privacy. We describe many anxieties related to economic insecurity or fear of facing death alone, but also how to visualize expanding possibilities in styles of parenting or types of emotional support among family members as elements of hope that may endure beyond these unprecedented tragic times of loss and uncertainty.     

Social relationships and vulnerability to becoming homeless among poor families.

This study compares social relationships of 677 mothers in families requesting shelter with those of 495 mothers in housed families, randomly selected from the public assistance caseload in New York City. As hypothesized, women seeking shelter had experienced higher levels of a variety of childhood and adult events indicative of disruptions in social relationships. Contrary to our hypothesis, they were more likely than were housed mothers to have had recent contact with parents, other relatives, and friends, although they felt less able to draw on these resources for help with their current housing needs. More than three fourths of families seeking shelter had already stayed with members of their social network in the past year. The data suggest that they had used up potential sources of support before turning to public shelter.     

Have Phobias,Will Travel: Addressing One Barrier to the Delivery of an Evidence-Based Treatment

Although a host of evidence-based treatments exist for youth with anxiety disorders, less than 30% of youth and their families receive these treatments. One of the main barriers to receiving these treatments is the lack of access to care, due largely to the absence of mental health professionals who have expertise in the delivery of these treatments in certain geographic locales. The current study examined whether a brief intensive treatment for specific phobias (SPs), Augmented One-Session Treatment (OST-A), would result in comparable treatment gains for families who traveled a considerable distance to receive this treatment when compared to families who resided in our local community. Participants included 76 youth with a clinically confirmed diagnosis of SP (38 local families and an age- and sex-matched sample of 38 nonlocal families). Although SP severity at pretreatment was significantly greater for the nonlocal youth than the local youth, both nonlocal and local youth showed commensurate improvement and maintenance of treatment gains over a 6-month period across several clinical outcome measures. Findings from this study show that OST-A is effective when families choose to travel for treatment, addressing at least one of the barriers to use of this evidence-based treatment.     

"If I Don''t Get Simple, I Cry"

Poor families have taught us special lessons that are applicable to all families. They have instructed us about the problems, within families, of developing relationships adequate to the tasks of family life. One consequence is that therapists are attending more to the evolution of the structure of family relationships, particularly, the phenomenon of underorganization. Poor families have also provided insight into the dynamic relationship between families and their social context. As a result, a therapeutic perspective is emerging that focuses on the influence of the community on the individual and the family, a perspective that may be called an eco-structural approach to therapy.     

Parent and Adolescent Gender Role Attitudes in 1990s Great Britain

Using data from the British Household Panel Survey, this short-term longitudinal study examined relationships between early- and mid-adolescents' gender role attitudes and the attitudes of their parents. Between 1994 and 1997, 602 families answered questions about the roles of husbands and wives, and whether or not having a working mother is harmful to families. Results confirmed that the gender differences that have been found consistently in the literature regarding adults extend back into early adolescence. Adolescent girls' attitudes were markedly more nontraditional than all other family members. However, results only partially supported our hypotheses regarding family influence on attitudes. In particular, we found little evidence that adolescent attitudes would more closely resemble those of the same-gender parent. Analysis of individual questions supports arguments that gender roles are complex and socially determined, and that British men of both adult and adolescent generations have begun in principle to accept nontraditional roles for wives but are less willing to support any erosion of male power in the family.     

伦理,胚胎和干细胞研究

道德是关于规则、直觉、理解和观点的一个复杂系统。而后者影响着我们相互间处理事务的方式。它们交叉地渗入我们的道德思考。这种思维与胚胎、干细胞的伦理密切相关,因为胚胎和干细胞涉及我们对与治疗和移植组织有关的人的生命及其启始问题。就像在许多对待生命及其可以阐释的研究方法方面,要有一个道德的思辩历程一样,解决这些问题,部分地需要讨论,部分地需要回答。只有在我们认定这种讨论能够融入应用干细胞治疗的胚胎及其类源和人体组织的使用中时,我们才会清楚,大多数人体不同部位的干细胞应用是经过了对人的生命启始、我们儿童、家庭进行了思考。     

Long-Term Trajectories and Service Needs for Military Families

The deployment of US military personnel to recent conflicts has been a significant stressor for their families; yet, we know relatively little about the long-term family effects of these deployments. Using data from prior military service eras, we review our current understanding of the long-term functioning and needs of military families. These data suggest that overseas deployment, exposure to combat, experiencing or participating in violence during war deployment, service member injury or disability, and combat-related post-traumatic stress disorder (PTSD) all have profound impacts on the functioning of military families. We offer several recommendations to address these impacts such as the provision of family-centered, trauma-informed resources to families of veterans with PTSD and veterans who experienced high levels of combat and war violence. Recent efforts to address the needs of caregivers of veterans should be evaluated and expanded, as necessary. We should also help military families plan for predictable life events likely to challenge their resilience and coping capacities. Future research should focus on the following: factors that mediate the relationship between PTSD, war atrocities, caregiver burden, and family dysfunction; effective family-centered interventions that can be scaled-up to meet the needs of a dispersed population; and system-level innovations necessary to ensure adequate access to these interventions.     

Understanding and Supporting the Resilience of a New Generation of Combat-Exposed Military Families and Their Children

Taking our nation to war has exposed a generation of military families and children to combat and its consequences. Every dollar spent on bullets, trucks, fuel, and food carried a future ‘tax’ in the form of consequences for psychological and physical health and family relationships. In this commentary, I focus on several themes that emerge from the special collection or articles. For example, I consider how best to define the ecological niche(s) occupied by military-connected children and families. Not surprisingly given significant gaps in our knowledge, evidence regarding the well-being of military-connected children is mixed. I also consider the multi-layered environments within which individuals and families function, recognizing both the challenges and opportunities they provide. The need to respond rapidly to the evolving needs of military families has highlighted the value of both prevention science and implementation science. Public health models emphasizing a full continuum of care that emphasizes not only treatment but also universal, selective, and indicated prevention also are appealing given the uneven density, uncertain locations, and unknown identities of military families in civilian communities (Beardslee 2013; Murphy and Fairbank 2013). Finally, it is important to recognize that we are at the beginning, not the end, of the post-war lifetimes for the new generation of veterans and their families.     

Military children and families: strengths and challenges during peace and war

Throughout history, military children and families have shown great capacity for adaptation and resilience. However, in recent years, unprecedented lengthy and multiple combat deployments of service members have posed multiple challenges for U.S. military children and families. Despite needs to better understand the impact of deployment on military children and families and to provide proper support for them, rigorous research is lacking. Programs exist that are intended to help, but their effectiveness is largely unknown. They need to be better coordinated and delivered at the level of individuals, families, and communities. Research and programs need to take a comprehensive approach that is strengths based and problem focused. Programs for military children and families often focus on the prevention or reduction of problems. It is just as important to recognize their assets and to promote them. This article reviews existing research on military children and families, with attention to their strengths as well as their challenges. Issues in need of further research are identified, especially research into programs that assist military children and families. Military children and families deserve greater attention from psychology.     

SERIOUS DELINQUENT BEHAVIOR AS PART OF A SIGNIFICANTLY HANDICAPPING CONDITION: CURES AND SUPPORTIVE ENVIRONMENTS

The past 20 years have been productive ones for the field of applied behavior analysis. A brief review of our own efforts during this period reveals that we have accomplished several but not all of our goals for the Teaching-Family approach. In this context, we note that the setting of realistic and appropriate goals is important for the field and for society. Moreover, we suggest that the realistic goal for some persons with serious delinquent behavior may be extended supportive and socializing treatment rather than permanent cure from conventional short-term treatment programs. We base this suggestion on the accumulating evidence that serious delinquent behavior may often be part of a significantly disabling and durable condition that consists of multiple antisocial and dysfunctional behaviors, often runs in families, and robustly eludes effective short-term treatment. Like other significant disabilities such as retardation, autism, and blindness, the effects of this condition may be a function of an interaction of environmental and constitutional variables. We argue that our field has the wherewithal to construct effective and humane long-term supportive environments for seriously delinquent youths. In this regard, we explore the dimensions, rationales, logistics, and beginnings of a new treatment direction that involves long-term supportive family treatment. We contend that such supportive families may be able to provide long, perhaps even lifetime, socializing influences through models, values, and contingencies that seem essential for developing and maintaining prosocial behavior in these high-risk youths.