Group psychotherapy as a technique for assisting ego-impaired children and adolescents

This paper describes an approach to working with egoimpaired children and adolescents. The structure and process of psychotherapy groups within a residential program are discussed. We describe how insight-oriented groups act as a collective superego, thereby encouraging maturation. Functions of the group relating to socialization, milieu issues, peer issues, family relationships, personal issues, selfesteem, empowerment, and special issues are discussed. The focus of the discussion is on the structure and process of the groups. Brief clinical vignettes are utilized to illustrate components of the approach.     

Job strain and rumination about work issues during leisure time: A diary study

Previous research has suggested that high job strain (high demand, low control at work) is associated with an inability to “unwind” physiologically after work. It was speculated that one mechanism related to the “unwinding process” is an individual's ability to “cognitively switch-off” about work related issues after work. This hypothesis was tested in a diary study of primary and secondary school teachers who were asked to keep an hourly record of their work-related thoughts over a workday evening between 17.00 hrs and 21.00 hrs. As expected both groups demonstrated a degree of unwinding and disengagement from work issues over the evening. High strain (n = 34) teachers however took longer to unwind and ruminated more about work-related issues, relative to low job strain (n = 35) teachers. High job strain teachers also reported they had less personal control over what they were doing in the evening. Across the evening all individuals reported higher ruminative thoughts about work issues when alone than when with family and friends, but high strain teachers reported more ruminative cognitions when watching television and with family and friends than low strain teachers. The results could not be explained by work patterns as there was no difference in the number of hours worked in the evening between the two groups. It is argued that one reason why high job strain teachers failed to successfully unwind after work is that they ruminated more about work issues, than did low job strain teachers.     

Generational differences in acculturation among Asian families in Canada: A comparison of Vietnamese,Korean, and East‐Indian groups

By examining generational differences between adolescents and their parents, the present study attempts to establish which specific aspects of strong kinship are maintained among Asian groups undergoing acculturation. Vietnamese (adolescent N = 104; parent N = 70), Korean (N = 111; N = 83), and East‐Indian (N = 97; N = 84) families were compared for family relations and acculturation attitudes. As compared to the Anglo‐Celtic group (adolescent N = 151; parent N = 116), Asian adolescents maintained stronger responsibilities within the family while disagreeing more with parents about their independence and roles in decision making, and expressing different preferences about intercultural contacts. However, since both parents and adolescents from the three groups clearly differ from each other for both family relations and acculturation attitudes, it is argued that generational differences should be particularized by each group's selective emphasis upon different cultural issues.     

A Patient's Perspective on Genetic Counseling and Predictive Testing for Alzheimer's Disease

The availability of genetic testing for Alzheimer's disease is anticipated to be widespread in the future. As an individual at risk with a family history of Alzheimer's disease, I discuss why I sought predictive tests and how I would use the information from such tests. I relay what I learned in my genetic counseling session, my response to the counseling process, and steps I have since taken. I discuss life planning, psychological and fear of discrimination issues from a patient's perspective.     

Factors Affecting the Psychodiagnostic Significance of Color Perception

50 males, 17 and 18 years of age, and their natural parents were given the Blacky Defense Preference Inventory to determine if there are commonalities of defense preferences within families and within sex groups.

The results tended to support the hypothesis that male adolescents manifest defense preferences more similar to those of their father than to nonrelated adult males but failed to support a comparable hypothesis concerning the adolescent's similarity of defense preferences to his mother versus nonrelated adult females. The adolescent males did not reveal defense preferences more similar to those of their father than of their mother nor were sex differences in defense preferences observed. An additional finding suggested that the adult males are more heterogeneous in their defense preferences than are adult females.     

Process and Content in a Therapy Group for Bipolar Outpatients

Although the literature suggests that homogeneous therapy groups are useful for bipolar outpatients, little is known about the process in such groups. Using the GCQ-S and a content analysis of discussion topics, we evaluated group process during the first 31 sessions of an outpatient bipolar group. Compared with normative samples, our group scored significantly higher in the Engaged dimension and significantly lower in the Avoiding and Conflict dimensions and in the anxiety/tension scale. Furthermore, 81% of the discussion topics were related to the three group goals, and an additional 18% dealt with general group issues such as orienting new members and attendance. The results from this pilot study suggest that bipolar patients can discuss relevant issues in a homogeneous group environment that is cohesive, open, and safe.     

Mothers and Children Together

Summary

Treatment groups for both mothers and children together who have experienced mother assault is a unique therapeutic milieu which has been underutilized in the treatment field. This article presents a 10-week feminist-informed family systems group model as part of a treatment approach for children exposed to family violence and can be used with families of children from pre-school to adolescence. This model provides a context in which the experience of family violence can be debriefed, and issues related to trauma, safety, secrecy, and post-abuse family restructuring can be addressed by family members together. In addition, play and art therapy based interventions are presented and are tailored for the beginning, middle, and end of the group process.     

The nature of stress experienced by lesbians and gay men

Abstract

This study examined both the meanings and sources/causes of stress from the perspectives of lesbians and gay men (n=30), using a series of focus groups. The findings suggest that stress is considered a part of life itself, and is perceived to contain both negative (e.g. detrimental effects on health and overall functioning, unfairness, out-of-control), and positive (e.g. a motivator, growth-facilitator) elements. The sources/causes of stress (i.e. stressors) identified include stress experienced from the “coming out” process, stress in family relations and intimate relationships, conflict over one's sexuality given society's homophobic and heterosexist attitudes toward lesbians and gay men, as well as stress from financial and work-related issues. More importantly, this study suggests that culture/ethnicity, gender, and aging, which are interconnected with one's sexual identity, play an important role in shaping the experiences of stress among lesbians and gay men.     

Premature termination: A clinical study

Ten patients who terminated prematurely from 10 different therapy groups were interviewed using a semistructured interview protocol. Half the subjects were patients in private therapy groups; the other half were patients in clinic therapy groups. Among the issues inquired about were subjects' initial attitudes about group treatment; the nature of the preparation process; subjects' experience of the group therapist, other group members, and the group process; their reasons for leaving their groups; and the nature of the termination process. The findings reported focus on patients' perceptions of therapists' motives; the importance of establishing appropriate treatment goals; the handling of negative feelings about the group and/or the group therapist; the issue of narcissistic injury; the experience of the balance between giving and receiving; the difficulties caused by unresolved conflicts within groups; and the problems posed by inadequate preparation for the group experience. Guidelines for practices aimed at minimizing premature terminations are offered.     

Contemporary family therapy in the United States

Major issues in contemporary family therapy in the United States are described. Issues from outside the field impacting family therapy include health care reform, family 'values', multiple forms of 'family', and the growing aging population. Issues within the field include the challenge of social construction theory, the decline of the expert, the feminist critique, sensitivity to culture, rediscovering individuals within families, focus on strengths and resources, a both–and attitude toward collaboration with other professionals, emphasis upon the person of the therapist, and convergence of 'schools' of family therapy. Therapists in the United States are also opening up the private process of therapy through reflecting teams, including clients in therapist thinking, multi-family groups, and through psychoeducational groups. Finally, attempts to bridge the gap between research and practice are analyzed.     

The psychotherapy of genetics

The evolution of genomic science and its effect on medicine and health care offer opportunities for family therapists to participate in the comprehensive care of patients and families with genetic disorders. This article provides an overview of what we now know about the psychological and interpersonal experience of patients and families facing some of these illnesses. Case examples illustrate the process of decision-making about testing and treatment, and the importance of understanding developmental issues and transgenerational family dynamics in any related psychotherapy. Challenging emotional issues include managing anger, ambivalence, and guilt; challenging interpersonal issues include dealing with differing coping and communication styles, decisions about disclosure and secrets, and conflict resolution. Family-oriented interventions include individual, couple, and family therapy, and psychoeducational groups. Recommendations are made for family therapists to participate as part of the genetic healthcare team.     

Family therapy in israel: A review of therapy done under unusual circumstances

Major issues affecting family therapy practice in Israel are discussed. Issues making family therapy in Israel unique include historical topics such as the legacy of the Holocaust, the emergence of the family therapy movement from the cradle of the kibbutz; and more recent events such as constant wars, the specter of terrorist threat, and coping with the everyday pressures of life in Israel—stress, loss, and bereavement. Future trends in family therapy in the Israeli context include the peace process and the adjustment it requires from families living in the West Bank and the Golan Heights. The advent of peace and normalization will force family therapists to grapple with issues until now not given the attention they require by a country always on the brink of war, including family violence, feminist issues and patriarchal family orientations, single-parent families, and cultural diversity.The authors would like to acknowledge the help of Israel Charny, Yael Geron, Tzipi Glick, Ruth Malkinson, Judith Wertheimer, and Susan Zeidel.     

Family counseling: Basic concepts for ministers

Much of the time that ministers spend counseling is taken with family related issues. Yet many ministers find themselves in the difficult position of having little or no formal education or training in family counseling. This article deals with some basic issues related to problematic families and pastoral counseling that are meant to bridge the gap between having no formal training in family counseling and having advanced training and education.     

Subjective Well-Being of Brazilian Children from Different Family Settings

Subjective well-being concerns an evaluation of one’s life, considering cognitive and affective aspects. Contextual factors, such as family, may influence this process. One of the main development contexts of children is family and aspects of these relationships, such as different settings, might contribute to children’s subjective well-being. The aim of this study was to compare the well-being of children from different family settings (intact, single-parent, stepfamilies, multigenerational). Participants were 2,135 boys and girls, from 9 to 13 years old (M = 10.97, SD = 0.99), students of public and private schools from a Brazilian southern State. Children answered a questionnaire with sociodemographic variables and three well-being scales (PWI-SC, BMSLSS, GDSI). Children were divided in four groups according to whom they live with (intact, single-parent, stepfamilies, multigenerational families). To evaluate differences between groups a Multivariate Analysis of Variance (MANOVA) were performed, considering well-being scales as dependent variables and family setting as independent variable. Results indicated significant differences in the well-being of children in relation to their family setting and age. Children from intact families showed significant positive differences on the well-being from children of other settings (the lowest means were from the children of stepfamilies). It is argued that transitions and instability that children are being subjected to may affect their well-being.

     

The WebQuest: An Illustration of Instructional Technology Implementation in MFT Training

This teaching case illustrates the innovative application of an instructional technology modality, the WebQuest, in family therapy training. It describes what a WebQuest involves, and how it can be used as a tool for developing critical thinking and application of contemporary marriage and family therapy (MFT) theory to social and global issues. The authors discuss the results of the survey and focus groups conducted to assess the value of this assignment from the students’ perspectives. Results indicate that its application in a family therapy theories course fostered students’ awareness of global issues impacting family life, integration of family therapy theories to serve children and families, creativity in developing their own intervention models, and ability to discuss and integrate knowledge from different knowledge bases and perspectives.     

The Adolescent Behavior Checklist: Validation Using Structured Diagnostic Interviews

The purpose of this study was to evaluate the discriminant validity of scores from the Adolescent Behavior Checklist (ABC), a self-report measure of ADHD symptomatology for adolescents ages 11–17 years. Validity was assessed through correlational, univariate, and discriminant function analyses using three groups: (1) adolescents diagnosed with ADHD, (2) adolescents currently experiencing a mood and/or anxiety disorder, and (3) adolescents with no major psychological disorder. Convergent and divergent validity of the ABC factor scores was demonstrated through correlational results with (1) parent and adolescent report of ADHD symptoms during structured psychiatric interviews and (2) scores on questionnaires measuring related and nonrelated constructs. Univariate analyses indicated that the ADHD group obtained significantly higher scores than did the nonclinical adolescents across all ABC factors. Additionally, the ADHD group scored significantly higher than did the psychiatric controls on the following ABC factors: Conduct Problems, Impulsivity/Hyperactivity, and Social Problems. Results from discriminant analyses supported the reliability of ABC scores in correctly classifying participants into groups. Compared to the Youth Self-Report, the ABC was found to be somewhat better at classifying when used in a multiinformant discriminant analysis. Therefore, overall results from the current study suggest that the ABC is a valid and useful self-report screening measure for ADHD symptoms and related difficulties.     

Aging and Ethnicity: Issues for Clinical Practice

Due to dramatic improvements in life expectancy among Americans from diverse ethnic groups, the graying of America is resulting in a particularly marked increase in ethnic diversity in late life. Clinicians must be prepared to address the problems of older ethnic minority patients, who present with distinct problems during late life and may present these problems in culturally prescribed ways. Cultural variations in views about the nature of mental disorders, issues in assessing and treating depression and dementia, and attention to issues of family caregivers are deserving of special attention.     

Psychosocial issues among children and adolescents in an integrated paediatric HIV psychology service in Botswana

This study explored the psychosocial issues faced by children and adolescents with HIV in Botswana. Data on psychosocial issues were collected from 27 young children aged 5–9 years and 128 adolescents aged 10–19 years (n = 155). Data were analysed using Microsoft Excel 2007 and MiniTab16. The most frequently identified psychosocial issues were behaviour problems (70%), family issues (58%), and HIV medication adherence (57%). Compared to young children, adolescents were more likely to have HIV medication adherence issues. Missed appointments were most commonly attributed to patient forgetfulness (21%) and conflicting appointments (18%).     

Differential diagnosis of steroid-dependent nephrotic syndrome with psychosis: Practical and ethical issues

The present case illustrates practical and ethical issues that can be encountered by clinical psychologists providing consultation services in medical settings. The neuropsychological consultation service was asked to evaluate a 22-year-old male with psychosis, steroid-dependent nephrotic syndrome, and a family history of schizophrenia. MRI revealedmarked cortical atrophy. Clinical findings were consistent with (1) steroid inducedapparent atrophy, which has been shown to be reversible with withdrawal of steroids; (2) uremia secondary to steroid withdrawal; (3) cortical atrophy, found in some schizophrenics; or (4) an atypical, diffuse degenerative disorder. Clinical interview and psychological testing revealed significant thought disorder, prominent delusions, somatic hallucinations, and mood disturbance. Deterioration in social and academic functioning was also present. Except for impaired attention and concentration, neuropsychological evaluation showed no clear evidence of brain-based dysfunction. Further, neuropsychological results effectively ruled out a degenerative process and were not consistent with a steroid effects profile. A conclusive differential diagnosis of steroid induced psychosis versus severe psychopathology would require withdrawal from steroids and antipsychotics. In addition to the practical and ethical issues of withholding antipsychotics, steroid withdrawal would require either dialysis or renal transplant surgery. Decision making regarding dialysis dependency and the possibility of postsurgical psychosis secondary to true psychopathology were salient issues to both the patient and the treatment team.     

Introduction to Group-Analytic Psychotherapy by S. H. Foulkes

This article will explore special leader issues that emerge in psychodynamically oriented therapy groups with adult children of alcoholics. Particular focus will be on countertransference feelings that get stirred up in group leaders and techniques for dealing with some of these special dilemmas. Specific issues include (a) assumption of sameness between the therapist and the patient (the therapist assuming that he or she “understands” because of having also grown up in an alcoholic family); (b) the “will to restore,” which may be destructive when the therapist, whose own self-esteem is dependent on the patient's progress in therapy, forces a “rush to recovery” on the patient; (c) other personal issues in the life of the therapist that may also resonate with experiences of the patient; (d) “countertransference goodness and availability” as it affects therapists' abilities to set reasonable limits on their patients, as well as reasonable expectations for themselves; and (e) special issues regarding therapist transparency and self-disclosure.