中国丧亲个体社会支持体验的质性研究

本研究通过对28位丧亲者进行深度访谈,使用解释现象学分析法对质性数据进行分析,探索中国丧亲个体的社会支持体验。结果显示,丧亲社会支持的内容包括后事处理、情感支持、生活恢复帮助,经济与物资支持等。支持来源除家人和朋友之外,还包括同事、相同经历者,以及相关机构等。社会支持通过调节情绪、改变认知等方式促进个体对丧亲的适应。本研究结果为最新丧亲社会支持模型提供了支持,同时也反映出中国社会对丧亲人群的社会支持特色。     

The use of self-disclosure among Swedish psychotherapists

Although self-disclosure, when handled with discretion, is often seen as an important intervention in many psychotherapy orientations, including psychodynamic as well as humanistic and cognitive-behavioral approaches, many psychotherapists seem reluctant to use it. The frequency and type of those interventions from psychotherapists of different orientations is less well known. In this study, a random sample of Swedish psychotherapists was asked about their use of different types of self-disclosing information. The results showed that therapists with CBT orientation told their clients more about their training and about their personal ways of handling affective-relational issues. It was apparent that the trend toward more use of self-disclosure in relational psychodynamic treatment has not been accepted among a large number of psychodynamic and psychoanalytic psychotherapists in Sweden. It is recommended that psychotherapists inform their clients more about their training and in appropriate ways share more with their clients about their own relational experiences. Doing so may help enhance clients’ hope and their ability to address their ongoing difficulties.     

Mapping grief: A study in practice using a quantitative and qualitative approach to exploring and addressing the range of responses to loss

The Adult Attitude to Grief (AAG) scale was devised for an earlier study (Machin, 2001) to test the validity of a concept of loss, which proposed that grief reactions fall broadly into three categories — ‘overwhelmed’, ‘balanced’ and ‘controlled’. There was statistical support for the proposed differences but the AAG scale, more importantly, provided insight into the diverse reactions taking place in individual bereaved respondents. This paper describes a second study undertaken to examine the clinical usefulness of the AAG scale with clients receiving help within the Psychological Services Operating Unit of the North Staffordshire Combined Healthcare (NHS) Trust. The scale has been used both in its original form with bereaved clients and in a modified form with clients having distress symptoms associated with other losses, such as relationship breakdown or the onset of chronic illness. The use of the AAG scale in this clinical setting suggests that, both as an assessment tool and as a cue for therapeutic dialogue, it provides a promising way of mapping the general and particular characteristics of response to loss in individual clients. Consideration is also given to varying therapeutic approaches needed to help clients regain the equilibrium disturbed by their grief.     

Death of a Clinician: The Personal, Practical and Clinical Implications of Therapist Mortality

Death is inevitable and yet in US culture the discussion of death is somewhat taboo. Marriage and Family therapists are trained in the implications of grief and loss for clients who lose loved ones and yet examination of the impact of therapist mortality on clients is lacking in the clinical literature. This article examines ways that private practice therapists can both protect their client’s confidentiality and mitigate the impact of therapist sudden death on their clients with planning and forethought. In addition, the factors influencing the lack of empirical research on this topic is discussed in the context of social mores on death and how therapists’ own denial of mortality may impact their ability to connect with clients through the pain of grief and loss. Recommendations are made for therapists to evaluate their own attitudes towards mortality and develop a plan for client care in the event of their death.     

Community responses following suicide, homicide, and other deaths: the perspective of potential comforters

To determine whether actual responses of potential comforters in the community differ according to cause of death, 83 college students participated in a structured, individual interview. They were asked demographic questions about themselves, the bereaved, and the deceased, and then about various aspects of how they, and others in the community, responded to the death. Students were grouped by their reports of the cause of death (suicide, homicide, accident, natural anticipated death, or natural unanticipated death). When the death was by suicide or homicide, others were perceived as relatively less supportive of the bereaved person. When the death was by suicide, respondents themselves tended more to blame the bereaved person. When the death was by homicide, the bereaved person was perceived as reacting relatively worse. Potential comforters were relatively more shocked when the death was by homicide or accident.     

Therapeutic Relationship

This article addresses the important role of the therapeutic relationship in cognitive-behavioral therapy (CBT). As has been noted from the inception of CBT, there are critical features of both the therapist and the relationship that optimize the likelihood of therapeutic success, and this article briefly describes these features. It is further argued that a successful therapeutic relationship in CBT is not static but is flexible and adaptive both across and within clients, as their needs and concerns vary. A positive therapeutic relationship is viewed within CBT as a necessary but insufficient condition for change, as the relationship serves as a foundation upon which interventions are scaffolded, but that the client’s response to various interventions itself shapes the interactions between therapist and client. Finally, it is argued that the key therapeutic ingredients of CBT are largely teachable, and the article provides several suggestions to promote an effective therapeutic relationship in CBT.     

Examining Differential Effects of Internal and External Resources on Counselor Burnout Symptoms in South Korea

This study aims to bring to light the relationship between internal/external resources and counselors’ burnout depending on the type of clients (traumatized/bereaved vs. personal growth issues). Moderated mediation analysis was conducted with 165 counselors in South Korea. The results indicated that counselors of traumatized or bereaved clients were more likely to be affected by internal resources (countertransference management ability), whereas counselors of clients with personal growth issues were more likely to be affected by external resources (environmental resources). Implications and limitations of this study are discussed.     

Exploring Characteristics of Children Presenting to Counseling for Grief and Loss

To date, researchers exploring childhood bereavement have largely relied on unstandardized assessment instruments and/or have independently evaluated specific constructs rather than factoring in the dimensionality of loss. The purpose of this study was to utilize psychometrically established instruments to examine the multivariate shared relationship between characteristics of bereaved children referred for counseling--their ages, genders, ethnicities, types of loss, and life stressors—and their behavioral manifestations as well as the relationship between these characteristics and levels of parent-child relational stress. Utilizing archival clinical files, we examined these characteristics from bereaved children (N?=?98) whose parents sought counseling services from two university-based counseling clinics. Two canonical correlational analyses (CCA) were conducted to examine the following: (1) relationship between characteristics of bereaved children and their subsequent behavioral manifestations, (2) relationship between characteristics of bereaved children and levels of parent-child relational stress. Correlational findings from this study provided insight into bereaved children’s manifestations of loss and levels of parent-child relational stress as contingent upon these specific characteristics. Specifically, results indicated a strong relationship between age and bereaved children’s behavioral manifestations. This finding reinforced the importance for clinicians to understand developmental implications when working with bereaved children. Furthermore, caregivers who reported minimal overall external stressors also reported less parent-child relational interference. This finding further emphasizes the importance for caregivers to maintain utmost stability for bereaved children.     

The management needs of the bereaved following loss of a partner

A case of death results in the formation of a social group, the group consisting of the bereaved, which remains in existence for a brief spell only, but which calls for careful attention. 124 widowed persons were questioned about their reaction to their loss, and changes in their habits after bereavement. Factors of influence are indicated, important among them dependence on the deceased, the age of the bereaved person, and physical and mental health.     

Disentangling the Impact of Resistance and Ambivalence on Therapy Outcomes in Cognitive Behavioural Therapy for Generalized Anxiety Disorder

Resistance and ambivalence about change are increasingly recognized as important determinants of treatment outcomes. Moreover, resistance and ambivalence are thought to be theoretically related in that clients who are more ambivalent about change are more likely to demonstrate resistance to the process and tasks of treatment. In the context of cognitive behavioural therapy (CBT) for generalized anxiety disorder, the present study simultaneously examined early resistance and ambivalence using two observer-based coding systems in order to determine their inter-relationship and, importantly, to investigate their relative contributions to outcome. Resistance was also coded during mid-treatment in order to investigate possible mediation pathways. Early ambivalence (clients’ arguments against change or counter-change talk) was found to be no longer related to outcomes when early resistance was taken into account, suggesting that disharmony in the therapeutic relationship is more important to outcomes than ambivalence per se. Moreover, mid-treatment resistance partially mediated the relationship between early resistance and post-treatment worry severity. That is, higher early opposition to therapist direction is related to poorer outcomes, in part because it is associated with greater resistance during the working phase of CBT. The findings underscore the critical need for therapists to be sensitive to identifying resistance early and throughout treatment.     

Baseline Client Interpersonal Agency Moderates the Indirect Effect of Treatment on Long-term Worry in Variants of CBT for Generalized Anxiety Disorder

In a recent trial for generalized anxiety disorder (GAD), cognitive-behavioral therapy (CBT) integrated with motivational interviewing (MI) promoted more long-term worry reduction than CBT alone (Westra, Constantino, & Antony, 2016). A follow-up analysis found that CBT vs. MI-CBT clients evidenced greater increases in friendly submissiveness (FS) across treatment, which in turn promoted lower long-term worry (Constantino, Romano, Coyne, Westra, & Antony, 2018). It was unsurprising that traditional directive CBT promoted more FS than when person-centered MI was integrated; however, given that problematic low agency characterizes GAD, that greater FS promoted better outcome was unexpected. To further unpack this unexpected result, we tested the following moderated mediation hypothesis: for clients with more vs. less problematic low agency at baseline, CBT would still promote more in-session FS than MI-CBT, but this increase would in turn predict increased worry over follow-up. Clients receiving CBT (n = 43) or MI-CBT (n = 42) rated their interpersonal problems at baseline and their worry after treatment and across 12-month follow-up. Therapists rated clients’ in-session FS multiple times. As predicted, multilevel modeling revealed that for clients with more problematic low agency, CBT vs. MI-CBT facilitated greater FS, which in turn related to increased worry across follow-up. For clients with more problematic high agency, CBT’s facilitation of greater FS related to reduced worry across follow-up. A baseline interpersonal problem characteristic of GAD may have implications for treatment matching and for appreciating different pathways to long-term improvement, or deterioration, for different GAD subgroups.     

Spiritual Distress and Depression in Bereavement: A Meaning-Oriented Contribution

One key focus of a meaning reconstruction model of bereavement concerns spiritual meanings attributed to the death, whether consoling or troubling. Specifically, previous studies in our research program suggest that religiously inclined violent death survivors are at risk for elevated levels of both bereavement distress and complicated spiritual grief, a crisis of faith following loss that refers to the erosion of the mourner’s relationship to God and/or the religious community. However, more research is needed to understand the convergence of depression and spiritual struggle in the context of violent and natural loss. In this study of a diverse sample of 59 American Christians bereaved less than 5 years, we sought to: (1) determine if individuals bereaved by homicide, suicide or fatal accident differed from those bereaved by natural causes in their levels of depression and spiritual coping; (2) investigate the relation between the latter constructs; and (3) ascertain if cause of death mediates the effect of religious coping on depression. We found that: (a) violently bereaved individuals endorsed more negative religious coping, and (b) depression was associated with greater spiritual struggle, particularly a sense of disrupted relationship with God. Contrary to expectations, positive religious coping was unrelated to post-loss depression, and cause of death did not mediate the relationship between spiritual coping and depressive symptomatology. A clinical case study concludes the article, illustrating the interweaving of spiritual and psychological distress in tragic bereavement, and their implications for a meaning-oriented grief therapy.     

The Relationship of Purpose in Life to Coping Strategies and Time Since the Death of a Significant Other

The authors investigated the relationship of experienced purpose in life to strategies used to cope with a loss resulting from death and the amount of time since the loss. Forty undergraduates who had suffered the death of a significant other completed an information sheet, the Purpose in Life Test, and the revised Ways of Coping Checklist. People who experienced low purpose in life reported using more emotion-focused coping strategies than did individuals with high purpose. These results are linked to the literature on emotion-focused coping and depression and are discussed in terms of the assessment and preventive treatment of bereaved clients.     

Therapist empathy,homework compliance,and outcome in cognitive behavioral therapy for generalized anxiety disorder: partitioning within- and between-therapist effects

Although client-perceived therapist empathy relates to positive therapy outcomes, including in cognitive behavioral therapy (CBT), little is known about how empathy exerts its ameliorative effect. One possible way is by promoting clients’ subsequent homework compliance, a variable that also predicts positive outcomes in CBT. The present study sought to investigate simultaneously, in the context of 43 therapist–client dyads receiving 15 sessions of CBT for generalized anxiety disorder, (1) the association of early client-perceived therapist empathy (averaged over sessions 1, 3, 5) with mid-treatment client homework compliance (averaged over sessions 6, 8, 10); (2) the association of mid-treatment homework compliance on client posttreatment worry severity; and (3) the indirect effect of early perceived therapist empathy on posttreatment worry through mid-treatment homework compliance. Given that clients were nested within therapists, we examined both within- and between-therapist differences in clients’ ratings of therapist empathy and homework compliance, and tested both of these indices as predictors of the relevant dependent variables in a multilevel model. At the within-therapist level (i.e., differences between clients within a given therapist’s caseload), greater early empathy was associated with greater mid-treatment homework compliance. At the between-therapist level (i.e., differences between therapists across all of their cases), greater between-therapist homework compliance was related to lower posttreatment worry. Finally, homework compliance was not found to mediate the relationship between empathy and posttreatment outcome. The results underscore the importance of parsing client and therapist effects, and are discussed with regard to their training and research implications.     

Mothers continuing bonds and ambivalence to personal mortality after the death of their child--an interpretative phenomenological analysis

The main objective of this study was to identify how bereaved mothers describe their coping strategies in their own words. The literature on parental bereavement is sparse, and the present study aims to add to existing knowledge by eliciting the mothers' experiences covering a wide range of child ages including infants, younger children and adults. Semi-structured interviews were held with 13 bereaved mothers in the UK. Causes of death include accident, illness and suicide. The methodological approach was interpretative phenomenological analysis (IPA). This article reports two inter-related recurrent themes: (1) Continuing the bond with the deceased child and (2) Ambivalence to personal mortality. Participants reported that the relationship with their child was continued in a variety of ways, from tending to the grave and the child's remains, through linking objects or by establishing a symbolic representation of the child within their daily lives. All mothers talked openly about their own mortality, either demonstrating ambivalence about their own death, or expressing clear suicidal ideation. Death was seen as a release from living with the pain of loss. The presence of surviving siblings appeared to moderate suicidal ideation, but mothers expressed concerns about their ability to care adequately for other family members during times of intense grief.     

“We Hardly Ever Talk about It”: Emotional Responsive Attunement in Couples after a Child's Death

Within Western cultural traditions, the idea that parents should talk about the death of their child with each other is deeply rooted. However, across bereaved parent couples there are wide variations in communication about their grief with each other. In this study, we explored the experiences of bereaved couples related to the process of talking and not talking. We used a thematic coding approach to analyze 20 interviews with 26 bereaved parents (11 interviewed as couples, four as individuals). Four main meanings emerged out of our analysis: not talking because of the inadequacy and pointlessness of words in grief, not talking as a way to regulate emotions in daily life, not talking as an expression of a personal, intimate process, and not talking because the partner has the same loss but a different grief process. In addition, we found that the process of talking and not talking can partly be understood as an emotional responsive process on an intrapersonal and interpersonal level. In this process partners search for a bearable distance from their own grief and their partner's, and attune with their relational context. A better understanding of this process is sought in a dialectical approach, emphasizing the value of both talking and not talking in a tense relationship with each other. Implications for clinical work are described.     

The broken heart phenomenon: An examination of the mortality of bereavement

Bereaved people are at greater risk of losing their lives than the non-bereaved. This paper explores the evidence on this ‘bereavement—mortality relationship’, to establish who among the bereaved are most vulnerable to such dire consequences of loss. Information is drawn from several sources, including epidemiological research on sociodemographic variables, analyses of causes of death and recent empirical studies that have identified differences between bereaved decedents and survivors. The survey shows that risk factors interact in complex ways to determine level of vulnerability. A simple explanation in terms of ‘broken heart’ cannot account for the pattern of results. Some bereaved subgroups are more vulnerable to death than others, excess risk occurs across a variety of causes of death (suggesting different underlying processes), and personal characteristics in combination with circumstantial factors lead to high vulnerability. It is concluded that two types of process underlie the bereavement–mortality relationship. These are related: (a) to the direct effects of grief (broken heart); and (b) to secondary consequences associated with the stress of bereavement.     

Counselling strategies for bereaved people offered in primary care

The aim of this study was to identify strategies that general practice-based counsellors used when offering support to bereaved clients. Over the last decade, there has been a rapid growth in the provision of counselling services associated with British primary care services. A study was designed involving qualitative methods of data collection (semi-structured interviews) and analysis (a grounded theory approach). Counsellors were recruited from two cities in Southern Britain (Plymouth and Southampton). Twenty nine (76% response rate) counsellors agreed to participate (Southampton n = 15, Plymouth, n = 14). Semi-structured face-to-face audio-taped interviews elicited information about their perceptions of the appropriateness of general practitioner referrals, counselling strategies and models of bereavement. Analysis indicated that counsellors saw bereavement counselling within a broader agenda of work concerned with loss and relationship management. Many drew on eclectic approaches to bereavement counselling and specific strategies included: facilitating telling of the 'story' of the loss; engaging in active listening and valuing allowing people to talk; establishing a supportive relationship; and enabling the bereaved person to deal with unfinished business and to say 'goodbye'. Counsellors drew on implicit stage/phase models of grief that assumed levels of distress reduced over time. The value of these strategies requires more exploration.     

Exploring Maternal Grief: A Mixed-Methods Investigation of Mothers’ Responses to the Death of a Child From Cancer

This study investigated the meaning-making phenomena underlying the responses of 13 bereaved mothers to the death of a child from cancer. Using a mixed-methods research design incorporating constructivist data collection methods, we found specific characteristics, coping processes, and factors to distinguish adaptive as opposed to complicated grief responses to this type of loss. However, the findings did not distinguish the bereaved mothers themselves as “adaptive” or “complicated grievers,” as they all evidenced both types of responses to their loss within or across different datasets. Despite this finding, the mothers’ results varied in terms of the proportions of adaptive as compared to complicated grief responses to their loss, which in turn were related to features of their self-construing, change or reinforcement of their world assumptions, ongoing relationship to their child and others in their social world, and management of loss- and restoration-oriented coping. Results suggest the utility of constructivist and cognitive coping models and methods in illuminating the experience of parental bereavement.