Ethical issues and the family doctor

Issues recognized as having ethical or moral components are becoming increasingly common, for society in general, the health care system and for general practitioner/family physicians in particular. Some of the peculiar problems for GP's relate to the provision of continuing, comprehensive, primary medical care to large numbers of individuals who provide extensive potential for conflict between all the involved elements: patients, physicians, families, consultants and societal attitudes. There is a need for more formal education programs.     

Divorced women's sexual and contraceptive issues

This work attempts to answer the question: could divorce create a feeling of alienation in women which causes one to feel vulnerable and detached and thus making sexual decision-making and planning difficult? When a women is married her sexuality is taken for granted because she is expected to have children; however, after a divorce, she must face many of the conflicts she felt as a young single woman. Guilt, planning contraceptive use, and coming to terms with her sexual behavior all present themselves again. 1 factor that must be considered is that contraceptive use is always assumed to be the function of the married women. Very little research has gone into the contraceptive use habits of unmarried women. This is primarily due to the societal assumption that unmarried woman don't have sex. This work contains the clinical observation of the author in which 28% of 459 prenatal patients were interviewed specifically because they were divorced. The conclusion is that divorced women are being neglected by the health care profession and are in great need of contraceptive counseling. This work primarily discusses a study done to expand and examine the conclusions of the clinical research. The study consisted of 101 sexually active, legally divorced, single women between the ages of 18-44 and physiologically capable of becoming pregnant. 53 of these women had experienced post-divorce pregnancies. Each woman was interviewed and given 3 standard tests: the Rosenberg Self-Acceptance Scale, the Snyder's Self-Monitoring Scale and Beckham's Coping Strategies Scale. The conclusion of the author is that divorce and its associated psychological problems may temporarily or permanently affect one's thoughts, feelings, and life course. Sexual and contraceptive use decision-making are both directly both directly affected by these changes. Some divorced women may be experiencing inadequate self-esteem, identity, and self-awareness.     

Facing up to the issues: Reply to Hellige (1983)

In a recent article in this journal, Hellige (Brain and Cognition, 2, 199-203, 1983) presented a critique of the chimeric-face technique that was used by us to validate a hand preference questionnaire. Data were presented by Hellige to show that the left visual field (LVF) bias that occurs on this task is due primarily to differences in detail in the features of the two faces and not because of right hemisphere dominance for face perception. In our rebuttal, we acknowledge that the two faces are not mirror-image duplicates of each other, but contend that this fact does not explain why differences between left-handers and right-handers have been observed on this task. Further data on the role of handedness as well as other variables impacting on this task are presented. A possible explanation is also offered for the rather small extent of LVF bias that Hellige obtained when he used corrected (i.e., true mirror-image) versions of Jaynes' chimeric faces.     

Compulsive and addictive sexual disorders and the family

In the treatment of sexual addiction and compulsivity, the family unit is often neglected. Yet this disorder has a major impact not only on the identified patient, but also on the spouse or partner (the coaddict) and on the family as a whole. Moreover, the family unit is the context in which the sexual addict continues to live, and the mental health of the partner has a significant impact on the sexual addict's recovery. Increasing evidence points to a family history of addiction or dysfunction as a primary contributor to both sexual addiction and coaddiction in adulthood. When compulsive sexual behaviors are present within a family, treatment of both members of the couple improves the couple's relationship as well as the mental health of each partner. In addition, treatment of children in such a family can help break the cycle of sexual addiction and prevent its perpetuation into the next generation.     

Family law issues in family therapy practice

Abstract

The American Journal of Family Therapy is pleased to innaugurate this new section with the intent of being at the cutting edge of the interface of the interrelationship of family law and family therapy. We introduce this endeavor with several articles on child custody-an arena of crucial concern in both disciplines. One article is a summary of child custody laws extant throu hout the United States. to commend it psychologically and legally. The third item, in keeping with the theme, is a speculative fable about joint custody written by a matrimonial attorney who practices family mediation and who has training as a family therapist. It captures the tenor of the times. The second article discusses a model for child custody ev a f uations, which has much     

Family law issues in family therapy practice

Abstract

The FAST represents a vast improvement over other figure placement techniques (FPTs). It offers an assessment procedure that measures both cohesion and power, assesses several family levels, allows for interpretation and comparison of individual and collective perceptions, and yields a more complex view of family dynamics by providing information regarding family organization across situations. Further, the FAST allows clinicians to hypothesize about treatment prognosis, plan systemic interventions, and monitor structural transformations that occur during therapy. As structural and developmental theories seem to be two of the more commonly recognized perspectives across disciplines (as evidenced by the types of relational additions in the soon-to-be-published DSM-IV), the FAST has the potential to become an interdisciplinary diagnostic and empirical link. Recommendations are noted here to maximize the potential of the FAST as a theoretically grounded and psychometrically sound family instrument.     

Management of religious issues in family therapy

Social scientists have long emphasized the reciprocal relationship between family and religion in society. Yet the family therapy literature is virtually devoid of consideration of religious variables in family life and function. Four major psychosocial aspects of religion in family life are discussed: sacralization, coalitions with the supernatural, religious conflict as a projection of family conflict, and family conflict as a projection of religious conflict. Clinical issues presented include: family therapy in religious and secular contexts, family religious expectations and transference, therapist religious countertransferences, religious identification in family therapy, and family therapy in different degrees of congruence or difference in religious orientation between the family and the therapist. The family therapist must learn how to correctly interpret and appropriately respond to religious issues as they appear in family life and family therapy.     

The management of sexual issues in adolescent treatment programs

Disturbed adolescents confined to inpatient treatment settings present special problems for the management of sexual behaviors. Ego impaired, delinquent, and autonomy-seeking adolescents provoke unique conflicts among their peers and staff. Staff's sexual anxiety caused by societal stereotypes of adolescents, inexperience with the techniques of unbiased observation and limit-setting, ignorance of normal adolescent development, and countertransference may lead to inadequate or inappropriate interventions. The authors describe the goals of a training program to reduce staff sexual anxiety: to develop a body of knowledge about the interaction between normal sexual development and psychopathology; to promote awareness about the staff's own feelings and the ways they influence observation and interaction; to lessen anxiety about self-exposure in the group setting; and to gain mutual support. Specific guidelines regarding effective staff interventions at an individual and group level are described. Alertness to the broad implications of sexuality in staff and patients and the necessity for careful monitoring of ward anxiety is emphasized.     

Ethical issues in therapy: therapist self-disclosure of sexual feelings

Although therapist sexual attraction to clients is common, and therapist self-disclosure is an often-used intervention, therapist self-disclosure of sexual feelings to clients is an understudied phenomenon. In this article, I critically review the small base of literature on therapist self-disclosure of sexual feelings, including information on prevalence rates, empirical research, and case studies. By incorporating these findings with information from relevant sections of the American Psychological Association (2002) Ethics Code, my intent is to evaluate different aspects of therapist self-disclosure of sexual feelings and arrive at conclusions regarding therapists' use of these disclosures. It appears that direct, explicit disclosure of sexual feelings can run the risk of harming clients and may therefore be unethical. Therefore, the use of this technique is discouraged. I discuss the issue of using less explicit interventions.     

Countertransference and the developing family therapist: Treatment and supervision issues

All therapists experience reactions toward clients, which have traditionally been called countertransference. Such reactions toward families pose special issues for beginning and developing family therapists. This clinically based and clinically oriented article describes some of the reactions, clues pointing to their existence, and indicates some of the ways beginning and developing family therapists and their supervisors and consultants can deal constructively with these reactions.     

Facing ambiguity with action

An insurrection, threats to our election system, and widespread distrust have spurred a national conversation about civic engagement. Many people of faith are responding with a desire to take action. However, the path to action is often deeply ambiguous. How we choose to take action that counts. This article is a personal reflection on how political engagement can animate faith and faith can guide political engagement. It suggests constant reflection on the subtle ways we can be led into complacency or inaction when interacting with political institutions. By reflecting on these mechanisms and connecting with our faith communities, this article posits that people of faith can thoughtfully and boldly make the daily decisions that make up our civic engagement.     

Childhood family and personological risk factors for sexual offending

Childhood family characteristics including poor parent–child bonding, parental neglect and deviance, discontinued parental care, physical and sexual abuse, and child personal characteristics including antisocial, hyperactive, and impulsive behavior, precocious sexual behavior, and social skill and empathy deficits are first reviewed as risk factors for sexual offending by men. The implications for sexual offender treatment with male sexual offenders are then discussed.     

Application of family therapy theory to complex social issues: using the WebQuest in family therapy training

This paper describes how the WebQuest is used to foster critical thinking and application of theory to complex social problems in a Master's level class on contemporary family therapy theories. The issue of child trafficking and prostitution is explored through the web‐based inquiry learning where scaffold learning is provided. Scaffolding includes resource links and guidance on cognitive and social skills, which are provided to facilitate the learner's development. The WebQuest design includes the task, the process and the evaluation rubrics. Student feedback on the WebQuest was positive and included increased motivation in learning, critical thinking and global awareness.     

The effects of family structure on the sexual behavior of adolescents.

The effects of two family structures, single- and two-parent homes, on adolescent sexual behavior were studied. The variables of race, age, and gender were controlled. The analysis compared the age at first intercourse, frequency of intercourse in the last four weeks, and virgin/nonvirgin status of adolescents from black single-parent families, white single-parent families, black two-parent families, and white two-parent families. For males, the two-parent family was related to less sexual activity and older age at first intercourse. For females, the two-parent family was not as important as race in influencing sexual behavior. The white females from two-parent families were more likely to be virgins, but once having had sexual intercourse, tended to have a higher level of sexual activity than did black females from two-parent homes.