Shared Traumatic Reality and Boundary Theory: How Mental Health Professionals Cope With the Home/Work Conflict During Continuous Security Threats

ABSTRACT

In a shared traumatic reality, mental health professionals and their clients are exposed to the same communal disaster. Both living and working in the same high-stress community can create a conflict between the professional's work and his or her private life. The author analyzed three focus groups consisting of 30 mental health professionals who worked with traumatized populations in a missile-stricken area in southern Israel. The professionals’ experience was explored through the lens of boundary theory by examining the ways in which they created and maintained boundaries between the different domains of their lives. Findings demonstrated that these professionals presented a continuum of segmentation and integration of the domains as suggested by boundary theory, when both living and working in a highly stressed environment. The discussion deals with possible costs and benefits of the boundary theory continuum.     

Bowen Theory: A Study of Differentiation of Self, Social Anxiety, and Physiological Symptoms

The study tested several propositions about an important construct in Bowen's theory of differentiation of self, using an Israeli sample of university students to examine relationships between differentiation of self, social anxiety, and physiological symptoms. The main finding was that family differentiation was negatively correlated with social anxiety (particularly fear of negative evaluation) and physiological symptoms. Results suggest that differentiation is a meaningful construct for Israeli students, and that less differentiated students may be at risk for high levels of social anxiety and symptomatology. They also suggest that therapists should consider various aspects of differentiation when treating a client's social anxiety.     

An Intergroup Contact-Theory Framework for Evaluating Racial Climate on Predominantly White College Campuses

This study examined the association of racial climate to social integration outcomes among 215 African American students and 144 White students from a predominantly White university. Presented is preliminary evidence regarding the utility of an ecological approach based on Allport's (1954) intergroup contact theory in examining students' climate perceptions and their impact. Responses to a racial climate scale previously used in secondary settings were collected from participants, and, through factor analysis, a revised scale was developed. The revised scale showed evidence for five subscales assessing perceived intergroup interactions on campus at individual and institutional levels, as well as individuals' personal intergroup interactions. Group differences were found for the subscales and in relationships between subscales and college integration outcomes. Findings suggest the importance of understanding college climate at interpersonal and institutional levels and of assessing impact for both majority and minority students.     

Exploring the Edges: Boundaries and Breaks

In this article, we examine conceptual and practical issues pertaining to relationship boundaries within the helping profession. Although our focus is primarily on relationships between mental health professionals and clients, there are considerable implications for a new approach to ethically structuring and understanding the construct of "required distance" in many human-interactive professions, such as teaching, religious leadership, public administration, and others. We define the concept of boundary as applied to human relationships, provide examples of boundary breaks, and raise questions regarding how to evaluate the significance and morality issues raised by specific boundary breaks. Questions and dilemmas are presented regarding boundary setting and accidental or deliberate boundary breaking. Representative dangers present in boundary breaks are identified, and examples are provided. Possible beneficial outcomes are also discussed. Finally, a suggested protocol for assessing a proposed boundary break is provided, much of which is drawn from the work and thinking of Laura Brown, applied more generally in this article, with additions from our perspectives.     

Exploring the edges: boundaries and breaks

In this article, we examine conceptual and practical issues pertaining to relationship boundaries within the helping profession. Although our focus is primarily on relationships between mental health professionals and clients, there are considerable implications for a new approach to ethically structuring and understanding the construct of "required distance" in many human-interactive professions, such as teaching, religious leadership, public administration, and others. We define the concept of boundary as applied to human relationships, provide examples of boundary breaks, and raise questions regarding how to evaluate the significance and morality issues raised by specific boundary breaks. Questions and dilemmas are presented regarding boundary setting and accidental or deliberate boundary breaking. Representative dangers present in boundary breaks are identified, and examples are provided. Possible beneficial outcomes are also discussed. Finally, a suggested protocol for assessing a proposed boundary break is provided, much of which is drawn from the work and thinking of Laura Brown, applied more generally in this article, with additions from our perspectives.     

Can We Improve Our Physical Health by Altering Our Social Networks?

ABSTRACT— Persons with more types of social relationships live longer and have less cognitive decline with aging, greater resistance to infectious disease, and better prognoses when facing chronic life-threatening illnesses. We have known about the importance of social integration (engaging in diverse types of relationships) for health and longevity for 30 years. Yet, we still do not know why having a more diverse social network would have a positive influence on our health, and we have yet to design effective interventions that influence key components of the network and in turn physical health. Better understanding of the role of social integration in health will require research on how integrated social networks influence health relevant behaviors, regulate emotions and biological responses, and contribute to our expectations and worldviews.     

Early identification of mental health problems in schools: The status of instrumentation

When embedded within a continuum of mental health services including both prevention and treatment, school-based mental health identification programs can promote improved academic and mental health functioning among students. This article describes the scientific status of assessment instrumentation that may be used for early mental health identification in schools. Currently available instruments are described in terms of their ability to accurately detect youth with mental health problems. Implications for selecting mental health screening and assessment instruments and integrating them into schools are discussed. Finally, a range of approaches to early identification in schools as well as some of the broader ethical and practical issues related to the integration of these strategies into a school-wide continuum of services are presented.     

A scale to measure Bowen's concept of emotional cutoff

This paper describes the Emotional Cut-off Scale (ECS), an instrument designed to measure Bowen's concept of emotional cutoff. The development of the scale and psychometric data from its use in three later studies are presented. The concept of emotional cut-off is critical to Bowen's broader theory. It is hoped that the ECS will allow researchers to begin to empirically examine propositions derived from Bowen's theory.     

Idealization and mourning in love relationships: normal and pathological spectra

Prior to the last two decades, psychoanalytic literature focused on the psychopathology of sexual life, rather than on an integrated overview of love relationships. Only in the last twenty-five years has its scope been expanded to include the psychodynamics and phenomenology of love relationships per se. Nevertheless, a selective, critical review of the literature indicates that little attention has been paid to a) the interrelation of narcissism, self-esteem, and love relationships; b) the role of the ego-ideal and idealizations in the capacity for falling in love and sustaining love relationships; and c) the faculty for, and/or impediments to, transcending intrapsychic self-boundaries in mature love relationships. In this paper, a brief exposition of the ego-ideal developmental sequences and their integration into the superego as a differentiated structure serves as an introduction to the proposal of a developmental continuum of mechanisms of idealization and their respective nodal transmutations throughout the life cycle. This developmental continuum may contribute to the ongoing elucidation of the aforementioned problems. This referential frame is ultimately applied to the exploration of categorical and dimensional pathological variations of idealization and mourning in love relationships and in different levels of personality organization: neurotic, borderline, and narcissistic structures. A clinical vignette illustrates some of the correspondence criteria between this frame of reference and its clinical applications.     

Assessment of affect integration: validation of the affect consciousness construct

Affect integration, or the capacity to utilize the motivational and signal properties of affect for personal adjustment, is assumed to be an important aspect of psychological health and functioning. Affect integration has been operationalized through the affect consciousness (AC) construct as degrees of awareness, tolerance, nonverbal expression, and conceptual expression of nine discrete affects. A semistructured Affect Consciousness Interview (ACI) and separate Affect Consciousness Scales (ACSs) have been developed to specifically assess these aspects of affect integration. This study explored the construct validity of AC in a Norwegian clinical sample including estimates of reliability and assessment of structure by factor analyses. External validity issues were addressed by examining the relationships between scores on the ACSs and self-rated symptom- and interpersonal problem measures as well as independent, observer-based ratings of personality disorder criteria and the Global Assessment of Functioning (GAF) scale from the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994).     

Assessment of Affect Integration: Validation of the Affect Consciousness Construct

Affect integration, or the capacity to utilize the motivational and signal properties of affect for personal adjustment, is assumed to be an important aspect of psychological health and functioning. Affect integration has been operationalized through the affect consciousness (AC) construct as degrees of awareness, tolerance, nonverbal expression, and conceptual expression of nine discrete affects. A semistructured Affect Consciousness Interview (ACI) and separate Affect Consciousness Scales (ACSs) have been developed to specifically assess these aspects of affect integration. This study explored the construct validity of AC in a Norwegian clinical sample including estimates of reliability and assessment of structure by factor analyses. External validity issues were addressed by examining the relationships between scores on the ACSs and self-rated symptom- and interpersonal problem measures as well as independent, observer-based ratings of personality disorder criteria and the Global Assessment of Functioning (GAF) scale from the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM–IV]; American Psychiatric Association, 1994).     

Testing compensatory health beliefs in a UK population

Compensatory health beliefs, beliefs that healthy behaviours can compensate or neutralise unhealthy behaviours, have been proposed as one way of understanding why people engage in health-risk behaviours (Knäuper, B., Rabiau, M., Cohen, O., & Patriciu, N. (2004). Compensatory health beliefs scale development and psychometric properties. Psychology and Health, 19, 607–624). However, measuring compensatory health beliefs has proved a challenge, with several recent studies being unable to replicate the psychometric properties of Knäuper et al.'s (2004) scales. The aims of this study were to: (1) test the factor structure of the compensatory health beliefs scale in the UK, (2) examine the predictive validity of the scale by testing the relationships between compensatory health beliefs and health behaviours over a six-month time interval and (3) assess the 6-month test–retest reliability of the scale. A total of 393 participants completed measures of compensatory health beliefs and health behaviours at two time points separated by six months. The findings were potentially problematic for research into compensatory health beliefs: the factor structure was not confirmed, there was little evidence of predictive validity, and test–retest reliability was poor. Further research is required to understand the operation of compensatory health beliefs and to develop the measurement of compensatory health beliefs.     

Workplace discrimination: A meta‐analytic extension,critique, and future research agenda

Despite a large and growing literature on workplace discrimination, there has been a myopic focus on the direct relationships between discrimination and a common set of outcomes. The aim of this meta‐analytic review was both to challenge and advance current understanding of workplace discrimination and its associations with outcomes by identifying the pathways through which discrimination affects outcomes, examining boundary conditions to explain when discrimination is most harmful for employees, and exploring a potential third variable explanation for discrimination–outcome relationships. Mediation tests indicated that workplace discrimination is associated with employee outcomes through both job stress and justice. Moderator analyses showed that discrimination appears to be most detrimental when it is observed rather than personally experienced, interpersonal rather than formal, and measured broadly rather than specifically. We also found that discrimination–outcome relationships differ across work and nonwork contexts and as a function of the social identity targeted by discrimination. Discrimination generally explained meaningful incremental variance in outcomes after controlling for the effects of negative affectivity, but the relationships between discrimination and health were substantially decreased. We conclude by offering a constructive critique of the empirical discrimination literature and by detailing an agenda for future research.     

Bowen家庭治疗模式评析

和其它经典的家庭治疗一样,Bowen家庭治疗模式也建立在系统理论的基础之上.他认为,个人症状的出现,在于个人与家庭情感的融合而使自己丧失了自我判断和选择的能力.因此,主张用代际互动疗法来解构病态的三角关系,增加与扩大家庭中的互动,从而增强个体的自我分化程度,以减轻焦虑.     

Using Minuchin's structural family therapy techniques with Italian-American families

Italian-American families have general characteristics about which family therapists should be informed in order to select appropriate and effective family therapy for this cultural group. The author identifies Minuchin's structural family therapy techniques as relevant for working with Italian-American families, adding a note of personal validation of the need and efficacy of the Minuchin approach.     

Epistemology, family patterns, and psychosomatics: the case of obesity

A family systems model of obesity is developed that attempts to integrate systems epistemology, Minuchin's work on psychosomatic disorders, and a review of the literature on obesity. The model presents obesity as being inextricably embedded in relationship patterns that fundamentally influence its etiology and maintenance. It is argued that the emergent properties of these relationships need to be the focus of analysis, rather than the elementary components residing within the individual, which are emphasized in traditional theories of obesity. The radical shift involved in moving from the traditional mechanistic models to a systems perspective is also discussed because these approaches are based on different epistemologies. The fundamental differences between these epistemologies are important and often underemphasized, which has led to much confusion in past research. Based on the model developed here and supportive data from the obesity literature, the conclusion is reached that obesity research and treatment are likely to be advanced by adopting a systemic approach.     

Styles in Intimate Relationships: The A-R-C Model

From a continuum of differentiation in intimate or close and prolonged relationships the author derives a model based on three styles: Abuse-Atrophy (A); Reactive-Repetitive (R), and Conductive-Constructive (C).     

Competencies of Process: Toward a Relational Framework for Integrated Care

As integrated care (IC) has gained more traction within both the psychosocial and medical fields, the need to train medical family therapy students and established professionals in this care typology has increased in tandem. To address this stated need, there is a large body of literature pertaining to models of care, typologies of intervention, clinical and financial effectiveness, and now a burgeoning discussion related to the academic and practice-based competencies necessary for IC practice. While the ability of the medical family therapist as behavioral health provider (MedFT/BHP) to practice in integrated settings may rely on an understanding of population-based medicine, disease etiology, medication and psychopharmacology, as well as augmentations to patient conceptualization and practice, all of the specifics related to that care are ultimately leveraged on the relationships formed by the MedFT/BHP with their healthcare colleagues. What this means is while we have attempted to distill the gestalt of integrated care into its major practice-based parts (e.g., model development and implementation, competencies, financial viability, efficacy/effectiveness, mechanisms of activation, and marketing), we have not adequately described the competencies necessary to set the stage for these types of close working relationships: relationships that make integration, of any kind, a possibility. The following paper was written to discuss three competencies related to the relational process of integration: (a) conceptual flexibility, (b) understanding and acceptance, and (c) acknowledgment and appreciation, as well as how these competencies provide the backdrop against which integrated care, as a practice, can emerge.     

"Enmeshment" and the Too Richly Cross-Joined System

This paper traces out a connection between Minuchin's concept of an "enmeshed" family and Ashby's discussion of the problems inherent in a system in which all the parts are tightly interlocked. Adaptiveness to change in such a system will depend on the possibility for the joins between parts to become temporarily inactive. This observation supports maneuvers in family therapy that emphasize the creation of boundaries between subsystems, differentiating individuals from one another, and blocking customary sequences of interaction.     

Stress, Coping, and Differentiation of Self: A Test of Bowen Theory

Differentiation of self from the family of origin is thought to be a significant factor in psychological functioning. Bowen contended that the effects of stress are moderated by differentiation of self, such that high levels of stress would have more impact on individuals lower in differentiation as compared to individuals higher in differentiation in predicting dysfunction. We tested this hypothesis and also assessed the relations among stress, coping, differentiation of self, and dysfunction. Results provided support for Bowen's prediction; differentiation indeed moderated the effects of perceived stress in predicting psychological functioning in expected ways. The interaction of differentiation of self and stress predicted variance in functioning beyond what was accounted for by coping styles, suggesting that although coping and differentiation of self are related, they are not synonymous.