The family experience of "sudden health": the case of intractable epilepsy

This article reports the experience of "sudden health" among six families who participated in an exploratory qualitative study of families with a member who elects to have corrective surgery for intractable epilepsy. Families were interviewed pre- and post-surgery (6-8 months) and the interviews were analyzed using a constant comparative methodology. Findings indicated that (1) families were organized in two primary ways (nesting and crisis) to deal with epilepsy and the aftermath of surgery and (2) "sudden health" had differing effects on these families depending on their organizational style, emotional communication process, and developmental dynamics.     

Family response to traumatic brain injury

The stress experienced by families with a member who has experienced a traumatic brain injury (TBI) has recently been addressed in the counselling and rehabilitation literature. Given that rehabilitation centres have physical restoration of the patient as a primary mandate, the emotional and social adjustment needs of family members are often overlooked. Information on TBI and its effect on families will help counsellors and psychologists contribute to the family adjustment process.     

A theoretical framework for evaluation and treatment of the victims of child sexual assault by a nonfamily member

Thirty-seven families whose children were victims of sexual abuse by a nonfamily member were evaluated and treated during a nine-month period. The average age of the children was 5.36 years. The youngest children were boys, and all the adolescents were girls. A theoretical framework adapted from Ferreira's and Byng-Hall's work was developed to assess and treat child victims of sexual molestation and their families. The format consists of three concepts. First, the trauma from sexual abuse, being outside the realm of usual human experience, creates a breach in the family's adaptive and protective shield, including its shared values and beliefs. Second, the trauma has a "derailing" effect on the child's and family's predicted passage through their world. And third, issues that arise as a consequence of disclosure are intimately tied to preexisting family myths and beliefs. Evaluation, treatment, and short-term outcomes are discussed.     

An Effect Of Change In Patient Status On Marital Interaction

In the treatment of couples and families, even more so than of individuals, therapists invariably are forced to face the problem of assessment of change in the marital or family "system." The purpose of the present study was to investigate changes in marital interaction for a special population, that is, in which one member of each married pair had been, but was no longer, a hospitalized psychiatric patient. The primary question we addressed was whether changes in marital interaction could be amply detected and whether these changes could be attributed to the particular role shift that had occurred in one spouse--from "patient" to "nonpatient." Utilizing a technique called Interaction Testing, which the senior authors devised in 1960, we found that such alterations in marital interaction do indeed arise when one member of the couple moves out of a patient role and that our instrument is useful in elucidating the nature of such effects. In addition, it can be expected that a study of this kind will be of theoretical and methodological value in dealing with the general issues of problem-solving interaction in couples and families. The clinical aspect of the study may also be expected to stimulate useful thinking regarding family theapy in hospital settings, patient management, and aftercare.     

Searching for a normal life: personal accounts of adults with schizophrenia, their parents and well-siblings

Using a life course perspective, the research examines personal accounts of adults with schizophrenia, and their parents and well-siblings from six families. Accounts of multiple members of the same family, including the family member with schizophrenia, are used to describe how families understand and accommodate life changes that result from the illness. Families describe the loss of a normal life as one of the most devastating aspects of schizophrenia. We present the personal and social losses described by adults with schizophrenia and their well family members, and document families' search for ways that their ill family member can achieve or maintain valued social roles. The concerns of well family members for the future of the ill family member and ways families contemplate transfer of care issues are described. Implications of the study for community research and action are discussed.     

Severe traumatic brain injury: some effects on family caregivers

This study assesses the effects of severe traumatic brain injuries on family members and functioning-a topic of interest for those working with survivors and their families. This issue is receiving increased attention as recent findings suggest that family adjustment influences outcome for brain-injured persons. The Family Environment Scale and the Profile of Mood States were completed by 25 individuals who had a family member with a severe traumatic brain injury. These scales were also completed by a comparison group of 32 individuals who had no brain-injured family member. In terms of family functioning, the findings suggest that, when a family member suffers a severe traumatic brain injury, depression may be elevated, along with a decreased ability to express feelings, decreased time and energy for social and recreational activities, and increased control in comparison to families without a brain-injured member. While this might contribute to family isolation which could last for many years, the overall finding of the present study was that caregiver families were coping adequately.     

The impact of psychiatric diagnosis and family system relationship on problems identified by families coping with a mentally ill member.

The purpose of this study was to explore how psychiatric diagnosis and family relationships relate to problems identified by participants in three one-day public family psychoeducation workshops for families with a member with a serious mental illness. Workshop participants generated lists of problems they had faced, which were coded into eleven categories. Logistic regression models predicting listing of categories were developed based on ill member (diagnosis, sex, treatment compliance) and family member (sex, age, relationship to the ill member) characteristics. For models predicting content category from ill member characteristics, only denial/noncompliance and interpersonal/social categories were significantly predictive as dependent variables. For models predicting content categories from family member characteristics, only the resources/benefits model was predictive. The significant findings, in conjunction with the important negative results, suggest implications for further development of family intervention models. Building on previous research, groups composed of families coping with more than a single diagnosis and including a variety of family member relationships have the potential to reach consensus on curriculum topics.     

Using video life reviews with older adults

Reminiscence by elderly people, known as life review (Butler, 1963), has been widely used as a therapeutic technique. This paper discusses a study with fifteen ageing families in which a therapist assisted the ageing member in producing a videotaped vignette from the life review. The resulting video life reviews were found to be an effective tool in helping the ageing family in 're-storying' the past events with new narrative and meaning. Three predominant themes were identified: (1) historical and evaluative reviews, (2) transition reviews, and (3) reviews dealing with emotional pain. Also discussed are the reactions of the ageing families to the video life reviews, the therapeutic uses of the technique, and format suggestions for therapists.     

Relabeling and Reframing Reconsidered: The Beneficial Effects of a Pathological Label

Traditional labeling theory usually contends that pathological labels contribute to pathology and benign labels help alleviate it. However, it is likely that the role of pathological labels as the cause of pathology has been overstated and over-generalized. Family therapists have probably overused the practice of substituting a benign label for a pathological label—relabeling. In fact, there are many families in which a pathological label applied to one family member may have beneficial impact on the family system, including that member. Five such cases are presented, and labeling theory is reviewed. Definitions of the terms reframing and relabeling are suggested, and the differing implications of diagnosis and labeling theory are discussed.     

ABSTRACTS OF LITERATURE

This is a clinical controlled study comparing the effects of "behaviorally" orientated family therapy, "client-centered" family therapy, and no therapy at all for families with a delinquent member. Sample included 99 families randomly assigned to treatments. Results indicated the efficacy of the behavioral family therapy in reducing recidivism.     

The effect of relations in paired-associate learning

Previous studies have shown that the cued recall of paired associates is greater when one member of a pair has been apprehended as lying on the other member, as compared with the two having been apprehended as independent objects. The effect occurs when the objects have been perceived, imagined, or described in the relevant relationship. The additional thoughts hypothesis postulates that participants have more spontaneous "additional thoughts" when apprehending a pair in the relational condition. These may provide additional retrieval routes, thereby explaining the effect. In four experiments, the hypothesis was tested under conditions in which a clear unambiguous definition could be specified for an additional thought. The results showed that the greater recall in an "on" condition, as compared with an independent condition, occurs at least in part because more additional thoughts occur in the "on" condition. There was no evidence for any other contribution to the effect. It is argued that the findings question whether relations between objects play a fundamental role in the structure of memory.     

Coping in Families with a Retarded Child

The impact of a retarded child on a family has previously been described by individual family members' reports. This study of 40 families, 10 in each of four critical periods during the life of the retarded child, utilized videotaped interviews with whole families, with subsequent clinical observation and analysis based on the Beavers family assessment model. Healthy and problematic adaptations are delineated, with specific attention to systems concepts such as family structure and power, member individuation, feeling expression, and values. The report includes data analysis and a summary of pattern differences in family functioning.     

Interest in and barriers to participation in multiple family groups among head and neck cancer survivors and their primary family caregivers

This study examined interest in and barriers to participation in a multiple family group intervention (MFG) for adult cancer survivors and their family caregivers. The intervention was developed to assist families in coping with the persistent challenges of cancer diagnosis, treatment, and rehabilitation. Eighty eligible families having a member diagnosed and treated for cancers of the head and neck region completed a baseline quality of life survey consisting of standardized psychosocial measures, and then all patients and their families were invited to participate in a day-long multiple family group program. However, despite extensive recruitment efforts and accommodations to address anticipated barriers for nonparticipation, only 15 of the 80 (19%) eligible families agreed to attend the MFG workshop. Post-MFG, participating families reported high levels of program satisfaction and usefulness. These findings are discussed in the context of increasing the use of family-focused interventions in cancer care settings.     

The role of the clergy in serving the mentally retarded

Conclusion The clergyman, by at times being reflective, supportive, sometimes confrontational, and educative, is uniquely equipped to bring solace and hope to the retarded and their families (to quote Mostrom), recognizing that by providing a ray of hope, a way out, a meaningful answer, he can realistically show both the darkness and light—the truth that this child is also a child of God. In an age in which there is a crisis in moral, ethical, and spiritual values, are not the retarded a magnificent example of ways in which compassion, understanding, and helpfulness can enrich all of our lives? In a letter to me, Mr. Mostrom writes that others can give technical answers, but the clergy can give support essential to the family by walking along side of the retarded and their families, listening, understanding, showing that they care, and so giving strength and encouragement.Charlos C. Borgman, who had been a member of the Board of Trustees, Executive Vice-President, and Treasurer of the Academy of Religion and Mental Health before 1972, became a member of the Board of Directors and Executive Vice-President of the Institutes of Religion and Health after the merging of the Academy into the newly-formed Institutes. His many administrative and advisory services to national and international organizations serving people now include the folowing: American Field Service Scholarships, Inc., Chairman of its International Council; Public Corporation for Mental Health, Special Advisor; Silver Hill Foundation, member of the Board of Managers; the President's Committee on Mental Retardation, Special Advisor.This article is an expansion of an address Mr. Bergman delivered at the Second Pan-American Congress on Mental Retardation held in Panama City, Aust 2 24–29, 1975.     

A Family Therapeutic Approach to Transgenerational Traumatization

The phenomenon of transgenerational traumatization has currently become widely recognized and described, although the task of disentangling the underlying interactional mechanisms remains a difficult one. These transgenerational mechanisms were first detected in families of the survivors of the Holocaust, but they may be equally prominent in families of parents who have been traumatized in other ways, for example, as victims of child neglect and abuse, as orphaned children, or during military service. In cases in which parents have themselves been subjected to early parental deprivation, one or more children may become projectively identified with a parent's (posttraumatic) "bad child"-self, whereas the parent him/herself has identified with — enacts the role of — the idealized internal "martyr" parent. A case study is presented describing the individual and family therapeutic treatment of a woman who, as a child, had been traumatically separated from her parents.     

Preparing for Deployment: Examining Family- and Individual-Level Factors

Deployment can be a significant source of stress for military families. Understanding how families prepare in the face of such stress, and which families are more versus less likely to prepare, is a priority of the Department of Defense. However, there has been scant research on how families prepare for deployments and the factors associated with engagement in preparation activities. The current study is a cross-sectional examination of the proportion of households engaging in deployment preparation activities and family-level and individual-level factors that are associated with these activities in a large and representative sample of married, deployable service members and their families from all military services and components (n = 1,621). Overall, results showed that families reported high rates of engaging in preparation activities, with particularly strong engagement in financial and legal preparation tasks. Talking about deployment to prepare a spouse or child was also relatively highly endorsed but not as frequently cited compared to other logistical preparation activities. Older spouses, officers, active component families, and those with higher marital satisfaction reported greater participation in preparation activities. Families with greater socioemotional difficulties, as indexed by child emotional problems or greater depressive symptoms in the service member or spouse, as well as those with lower spouse-reported marital satisfaction, were more likely to seek professional help. Evaluating the effectiveness of programs in reaching the families that may be least likely to prepare, as well as examining the longitudinal association between deployment preparation and postdeployment family adjustment, is an important area for further inquiry.     

Pathological Conflict Avoidance in Anorexia Nervosa: Family Perspectives

Conflict avoidance is a common pattern in families of patients with anorexia nervosa (AN), but little systematic controlled research has been conducted to elucidate the formal mechanics of such interaction. Forty family triads with daughters suffering from AN were compared to 40 matched control (CON) triads, on five measures of conflictual family situations. Results revealed that the AN group had significantly more difficulty in choosing the topic of discussion, adhering to the topic, developing and exploring the chosen topic, and reaching a solution—all within a family setting. Findings empirically support previous clinical and research evidence on the pathological avoidance of conflict in families with a member who has AN. Therapeutic implications are discussed.     

Characteristics of Schizogenic Families During a Joint Story-Telling Task

For a joint family story-telling task, families with a schizophrenic offspring were compared to normal families on the completeness and clarity of the final composite stories and on their interactional behavior. The composite stories from schizogenic families were more “vague and confused”, fragmented, and less complete as to the five components required to satisfy the task instructions. Schizogenic families displayed more conflict, failure, and confusion during the interactional task than control families, and, fathers and mothers of schizophrenic offspring displayed more “anxiety and tension”, “depressive mood”, “evasiveness” and “lack of interest” than fathers and mothers of normal families. Mothers of schizophrenic offspring were also described as more “hostile” than control mothers. Comparing schizogenic families from which the patient was absent during the task with schizogenic families with the patient present, and with control families, indicated that the central findings were not attributable to the immediate presence and participation of the schizophrenic member.     

Improving partnerships with families and carers in in‐patient mental health services for older people: a staff training programme and family liaison service

In spite of policies advocating the involvement of families in the care of mental health service users in the UK, there are few examples of initiatives to develop staff confidence and skills in partnership working. This article describes a whole team training initiative and family liaison service to promote family inclusive working on in‐patient wards for older people in Somerset, UK. A three‐day staff‐training programme is described and training outcomes are reported. Staff report a substantial increase in confidence and family meetings held. A pre‐and post‐ training case note audit shows increased consideration of the needs of families. To further increase face to face meetings with families a family liaison service has been established, whereby a staff member with systemic family therapy training joins ward staff to hold family meetings as part of the assessment/admission process. Evaluation of this service has shown it to be effective with positive feedback from families and staff.