Marital Conflict Among Parents: Implications for Family Therapy with Adolescent Conduct Disorder

Conduct disorder is associated with several causative and maintaining factors, with family functioning being an important one. This is especially true in the Indian context, where a lot of the problem behaviors manifested by adolescents with conduct disorders are in the family context. Marital relationship of the parents is a key aspect of family functioning, affecting a number of other dimensions of family functioning, including adolescent adjustment. The paper highlights the role of parents’ marital conflict in the emergence and maintenance of adolescent conduct problems. The importance of family therapy in managing adolescent conduct disorder is discussed through case examples from India. Shalini Anant, MPhil, PhD Scholar, Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore 560029, India. Ahalya Raguram, PhD, Additional Professor, Department of Clinical Psychology, NIMHANS, Bangalore 560029, India. Address correspondence to Shalini Anant (shalinianant@gmail.com).     

An Exploratory Study of Predictors of Relationship Commitment for Cisgender Female Partners of Transgender Individuals

The current exploratory study investigates which variables predict commitment among cisgender women currently in a relationship with a transgender-identified partner. This study includes variables specific to gender diverse couples such as years in the relationship, amount of prior knowledge about transgender identity, and gender role beliefs. Also included are the general relationship factors of satisfaction, quality of alternatives, investment size, and the outcome variable of commitment, as described in the Investment Model of Commitment. Using convenience sampling from online support groups, the sample was n = 138 cisgender female partners. The findings of the regression analyses indicate one's personal resilience and the number of years in the relationship prior to transition are significantly related to partner commitment, with satisfaction mediating both associations. The longer a participant was in the relationship at the time of a gender transition of a partner, the less satisfaction they report, thus reducing commitment to the relationship. Additionally the more personal resilience a partner endorses, the higher the relationship satisfaction, and in turn, more commitment is reported. The results offer information about the important factors related to staying in relationships during and after a gender transition.     

Family of Origin Predictors of Marital Outcomes Among Coptic Orthodox Christian Egyptian-American Couples

Despite the importance of family within the Coptic community, the extant literature on Coptic family relationships is remarkably limited. The purpose of this study was to explore parental marital quality and family of origin (FOO) quality as predictors of marital satisfaction and marital stability among Coptic Orthodox Christian Egyptian-American couples. Self-report survey data from 255 married Coptic couples living in the United States were analyzed using an actor-partner interdependence model. Results indicated husband FOO quality predicted both marital satisfaction (β =.51, SE?=?.18, p?=?.005) and marital stability (β?=?.51, SE?=?.22, p?=?.022) among Coptic husbands but not among Coptic wives. Results further indicated wife parental marital quality, wife FOO quality, and husband parental marital quality were not predictive of marital satisfaction or marital stability among Coptic husbands or wives. Clinical implications, limitations, and recommendations for future research are discussed.     

Chaplaincy and Mental Health Care in Aotearoa New Zealand: An Exploratory Study

This paper summarizes an initial exploratory study undertaken to consider the ministry of New Zealand chaplaincy personnel working within the mental health care context. This qualitative research (a first among New Zealand mental health care chaplains) was not concerned with specific health care institutions per se, but solely about the perspectives of chaplains concerning their professional contribution and issues they experienced when trying to provide pastoral care to patients, families, and clinical staff involved in mental health care. Data from a single focus group indicated that chaplains were fulfilling various WHO-ICD-10AM pastoral interventions as a part of a multidisciplinary and holistic approach to mental health care; however, given a number of frustrations identified by participants, which either impeded or thwarted their professional role as chaplains, a number of improvements were subsequently identified in order to develop the efficiency and effectiveness of chaplaincy and thus maximize the benefits of pastoral care to patients, families, and clinical staff. Some implications of this exploratory study relating to mental health care chaplaincy, ecclesiastical organizations, health care institutions, and government responsibilities and the need for further research are noted.     

Problem Definition in Marital and Family Therapy: A Qualitative Study

This paper describes findings from a grounded theory study on the process of constructing problem definitions by marital and family therapists. Coding of the observations and interviews resulted in two meta-problem definition processes. In the first meta-process clinicians kept their definitions internal to themselves during the therapy session. In contrast, the second meta-definition process involved clinicians bringing forth their internal problem definitions and incorporating them into the therapeutic conversation. Implications for existing conceptualizations and marital and family therapy practice and supervision are discussed, as well as suggestions for further consideration.     

Support for Resistance Among Iraqi Students: An Exploratory Study

This study examines predictors of expressed support for resistance to U.S.-led forces in Iraq among a sample of 130 university students in Baghdad. Based on a review of the literature and common discourse, personality, clash of civilization and social-psychological variables are tested as likely predictors of support for resistance. Data were collected in March 2004 during a period of relative political stability and optimism. Only social-psychological variables significantly predicted support. In particular, national identity, perceived procedural injustice, and higher life satisfaction prior to the U.S.-led invasion were significant predictors. Findings are discussed in relation to media and academic accounts explaining political violence in the current conflict.     

The Field of Marital and Family Therapy

This article defines the emergence of marital and family therapy as a distinct clinical discipline and an area of clinical practice. Significant historical developments that shaped the field and the integrative aspects of family systems theory are described. The role of the American Association for Marriage and Family Therapy in professional credentialing and state and federal advocacy is reviewed, along with the contributions of the Commission on Accreditation for Marital and Family Therapy Education. These areas of development set the stage for recommendations for further interdisciplinary collaboration among the mental health disciplines.     

Understanding Forgiveness as Discovery: Implications for Marital and Family Therapy

This article explores the concept of forgiveness in relationship systems and examines various conceptualizations and definitions found in the literature. Forgiveness is described as a complex psychological and relational process that is more a discovery than an act of will. A rationale for viewing forgiveness in a contextual, historical, and relational attachment paradigm is presented, and the association of forgiveness with empathy and emotional intelligence is discussed. Marital and family therapists are encouraged to attend to contextual family of origin issues and to facilitate an empathic relational environment where ambivalence is expected and tolerated for enhancing the process of forgiveness. Relevant clinical cases are shared to illustrate the process of forgiveness as discovery.     

Suicide Among Health Care Practitioners and Technicians in Colorado: An Epidemiological Study

Suicide is a public health concern with risks that vary between occupation groups. Many suicide victims with a health care occupation die by poisoning, but few studies have epidemiologically studied this association. The objective of this study was to quantify the increased risk of suicide death by poisoning among health care professionals in Colorado. Eleven years (2004–2014, N = 8,753) of suicide deaths in Colorado were compiled from the Colorado Violent Death Reporting System. A retrospective cohort study using multivariate logistic regression was conducted to examine the risk associated with having a health care occupation and eventual suicide death by poisoning, compared independently to firearm and hanging methods. Suicide victims with a health care occupation were more likely to die by poisoning rather than by hanging (RR 1.54, 95% CI: 1.41–1.68) or firearm (RR 1.79, 95% CI: 1.60–2.01), when compared to suicide victims without a health care occupation. The association between health care occupation and suicide method was significantly (p = .032) modified by gender. The results show that health care workers who die by suicide have an increased risk of eventual suicide death by poisoning rather than by firearm or hanging. These results can be used to inform tailored suicide prevention efforts in health care professionals.     

Prevalence of Alcohol Use and Reasons for Drinking Among Occupational Therapists: An Exploratory Investigation

Alcohol use by occupational therapists (OTs) and reasons for consuming alcohol were examined. Five hundred participants, randomly selected from American Occupational Therapy Association membership, were mailed surveys, resulting in 165 completed returns. The majority reported drinking alcohol generally for social-interactive motives, consuming one or two drinks one to four times per month. Two-fifths were found to drink intermittently in a potentially unhealthy manner. The percentage of OTs likely consuming alcohol at harmful levels, though comparatively small, is sufficient to warrant consideration by the profession to address the implications of potential alcohol misuse among a segment of its practitioners.     

Violence Exposure and Early Adolescent Alcohol Use: An Exploratory Study of Family Risk and Protective Factors

In this short-term longitudinal exploratory interview study, the relations between exposure to community violence and subsequent alcohol use were examined, with a focus on caregiver and family variables as moderators. Maternal caregivers and their children (N =101 families; 98% African American; M child age = 11.2 yrs) were interviewed separately and completed measures of violence exposure, caregiver and child adjustment, including substance use, and family functioning. Family interaction was also videotaped and coded. Child alcohol use at Time 2 was positively associated with all forms of violence exposure, and was negatively related to felt acceptance from caregiver, but was not associated with caregiver-rated family competence, observer-rated family interaction, maternal problems with alcohol, or maternal psychopathology. Logistic regression analyses predicting child alcohol use at Time 2 indicated that exposure to community violence increased risk of alcohol use, and felt acceptance from the caregiver decreased the likelihood of alcohol use, but did not buffer the effects of violence exposure on alcohol use. Implications and future directions are discussed.     

Family Support and Mental Health Service Use Among Suicidal Adolescents

Despite the fact that multiple evidence-based treatments exist for suicidal adolescents, these youth are unlikely to engage in mental health treatment. While family members can be influential in connecting adolescents to mental health care, suicidal youth are more likely to be exposed to family environments characterized by abuse, neglect, and to have poorer parent–child attachment quality than non-suicidal youth. This study analyzed data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) to examine the relationships between perceived levels of parental support, symptom severity, and mental health service use in a nationally representative sample of suicidal adolescents in the U.S. (n = 1804). Higher levels of parental support were associated with a lower likelihood of mental health service use, lower levels of depression, and lower likelihood of an actual suicide attempt. Additionally, the presence of a suicide attempt and higher levels of depression were associated with a higher likelihood of mental health service use. When mediation effects were tested, the presence of a suicide attempt partially mediated the relationship between parental support and mental health service use. Implications discussed include the protective nature of parental support the need for more family-based interventions for this population.     

Stress and Coping Among Displaced Bosnian Refugees: An Exploratory Study

Traumatic experiences associated with the recent war in Bosnia (1992–1995) have impacted the lives of many Bosnian refugees and displaced people. Approximately 25% of Bosnians were forced to leave their homes and resettle in other areas of Bosnia or abroad. In this study, 82 displaced Bosnians living in the area of Tuzla, Bosnia, and 53 refugees living in the San Francisco Bay area completed the same questionnaire in the Bosnian language. The study describes war-related stress and the association of marital status, anxiety, depression, and sensitivity levels. Furthermore, being single, having lower anxiety ratings, finding and adapting to a new environment easily, and moving on with their lives indicated better self-reported health. Findings also revealed that being divorced or separated, better self-reported health, and lower anxiety, depression, and sensitivity ratings were predictors of more effective coping.     

Systemic Family Therapy Competences in Child and Adolescent Mental Health Care

This article is based on a doctoral research project aiming to identify a comprehensive and detailed outline of the systemic therapist competences in child and adolescent mental health care in Norway. Because of the growing demands to offer specialized services within child and adolescent mental health care, I intended the identified competences to target the psychosocial difficulties that are categorized as associated abnormal psychosocial situations (axis 5) in the multiaxial diagnostic system (WHO, Multiaxial classification of child and adolescent psychiatric disorders. The ICD-10 classification of mental and behavioural disorders in children and adolescents. Cambridge University Press, Cambridge, 1996). The project is based on twelve qualitative in-depth interviews with six experienced systemic family therapists, and fieldwork observations of the therapists (participants) in practice. The qualitative methodology is based on Grounded Theory and five overarching categories were identified through the analysis: (1): the importance of ethical and contextual awareness in systemic therapy; (2) the systemic therapist’s stance; (3) therapeutic processes; (4) therapeutic practices; and (5) session-specific features. Challenges, such as limiting the systemic approach to five overarching competences, are discussed alongside this strengths and limitations of the study. The detailed outline of systemic therapist competences is intended to offer a framework for delivering flexible, yet specialized systemic therapy in the context of child and adolescent mental health care. This research may therefore facilitate a “bridge-building process” between mental health’s biomedical focus and postmodern systemic ideas.     

Sensory Extenders Versus Meters and Predictors: Clarifying Strategies for the Use of Objective Tests in Family Therapy

Cromwell and Peterson's goal of introducing quantitative testing into family assessment and therapy is laudable; the system they propose--the Multisystem-Multimethod (MS-MM) approach is not. MS-MM is confusing, deceptive, and misleading for clinicians who want to use tests to sharpen their diagnostic assessments and predictions. What is needed is specific theory linking various family processes and individual behaviors, as well as equally specific information about the reliability and validity of the tests. Likewise, the MS-MM approach is completely inadequate for clinicians seeking to use tests to enlarge their clinical imaginations. What is needed is a more down-to-earth examination of the influence of testing on the family therapy system.     

Family Environments of Women Seeking BRCA1/BRCA2 Genetic Mutation Testing: An Exploratory Analysis

Although there is some understanding of the shared characteristics and predictors of psychological distress of women participating in hereditary breast and ovarian cancer registries, these same characteristics are only beginning to be identified in research on community women seeking genetic testing for BRCA1/BRCA2 gene mutations. This study provides an initial exploration of characteristics associated with family environments for 51 community women waiting to receive such genetic testing results. Thirty-four of the 36 women classified on family environment type of the Family Environment Scale (FES) were from Personal Growth-Oriented families. Comparisons of women with and without personal cancer histories resulted in a trend for women with personal cancer histories to be classified as from Independence-Oriented families. Reported distress appears to vary for different family emphases based on family and personal cancer history. A moral-religious family emphasis consistently appeared to be associated with decreased psychological distress. Preliminary analyses comparing these community women (who were not part of a hereditary registry but were self- or physician-referred) seeking genetic testing with normal and distressed family means found that increased cohesion and expressiveness may be related to decreased conflict, indicative of potentially supportive family environments for these women. When compared with normative data, a subset consisting of the Ashkenazi Jewish women showed a trend of less cohesion than normal families, but similar cohesion levels as distressed families.     

Dyadic Coping in Couple Therapy Process: An Exploratory Study

This study aimed at moving beyond previous research on couple therapy efficacy by examining moment‐by‐moment proximal couple and therapist interactions as well as final treatment outcomes and their reciprocal association. Seven hundred four episodes of dyadic coping within 56 early therapy sessions, taken from 28 married couples in treatment, were intensively analyzed and processed using a mixed‐methods software (T‐LAB). Results showed that negative dyadic coping was self‐perpetuating, and therapists tended to passively observe the negative couple interaction; on the contrary, positive dyadic coping appeared to require a therapist's intervention to be maintained, and successful interventions mainly included information gathering as well as interpreting. Couples who dropped out of treatment were not actively engaged from the outset of therapy, and they used more negative dyadic coping, whereas couples who successfully completed treatment showed more positive dyadic coping very early in therapy. Results highlight the role of therapist action and control as critical to establishing rapport and credibility in couple therapy and suggest that dyadic coping patterns early in therapy may contribute to variable treatment response.     

Predictors of Recent Mental Health Service Use in a Medical Population: Implications for Integrated Care

This study investigated the relationship between physical and mental health and psychosocial variables and recent (within the last 12 months) mental health service use among 240 medical patients recruited from general and specialty outpatient clinics at an academic medical center. Results indicated 43.3% of the participants had recently received mental health services in the form of psychotropic medication (75%), psychotherapy (2%), or a combination of these treatments (20.2%). Among patients with moderate to severe symptoms of anxiety or depression, approximately two-thirds were receiving mental health treatment. Moreover, four variables (healthcare provider referral for mental health services, perceived need for mental health services, prior use of mental health services, and frequency of medical appointments) were significant unique predictors of recent mental health service use. This suggests collaborative/integrated medical care may increase needed mental health service use.