Lethal sex: conditions of disclosure in counseling sexually active clients with HIV

Confidentiality in psychological counseling is necessary if clients are to feel comfortable in revealing their darkest secrets. But this bond of trust has its moral limits. These limits are crossed in some cases in which HIV positive clients are sexually active with unsuspecting third parties. Distinguishing between Type 1 and Type 2 cases, the author shows how he has used applied ethics in drafting and defending a model rule for the American Counseling Association's Code of Ethics that permits, and sometimes morally requires disclosure in the former cases, but not in the latter.     

Coping with childhood cancer: The case for long-term counselling help for patients and their families

A case is made for a skilled, independent counselling service to be made available to children with cancer, and their families. Evidence is presented from a selected review of recent literature, and the stated needs and views of a small group of parents obtained by counsellors' in-depth interviews. This evidence shows the stresses imposed, and the inability of the medical team fully to address these needs concurrently with treating the illness. Skilled, long-term counselling for patient and family is seen to be an important aspect of a comprehensive childhood cancer service.     

Expressive disclosure to improve well-being in patients with amyotrophic lateral sclerosis: A randomised,controlled trial

Amyotrophic lateral sclerosis (ALS) is a terminal neurological disease associated with progressive paralysis, loss of communicative ability and functional decline. Expressive disclosure may help people with ALS, particularly those who are emotionally or socially inhibited, meet psychological challenges associated with the disease. People with ALS (N?=?48) were randomised to expressive disclosure about their disease or no disclosure. Psychological well-being (affect, depression and quality of life) was assessed pre-intervention and also three and six months later. Results of multi-level models indicated that the group that disclosed thoughts and feelings about ALS had higher well-being than the control group at three months post-intervention, but not six months. Ambivalence over emotional expression (AEE) moderated three-month post-intervention well-being. Those low in AEE had higher well-being than those high in AEE regardless of condition. Those high in AEE, who disclosed, had increased well-being from pre-intervention, whereas controls had decreased well-being from pre-intervention. Expressive disclosure may be helpful for people with ALS, but only those who have difficulty expressing emotions. In addition, the intervention had only temporary effects; the dynamic challenges of ALS progression may mean that the effect of processing thoughts and feelings about the disease in one stage may not generalise to later stages.     

Depressed patients with dysfunctional families: description and course of illness.

Sixty-eight depressed patients were subdivided according to their family's level of family functioning into functional and dysfunctional groups. Patients from dysfunctional families did not differ from those from functional families on measures of severity of depression, chronicity of depression, depression subtypes, other nonaffective psychiatric diagnoses, history of depression, or neuroendocrine functioning. Patients from dysfunctional families did have significantly higher levels of neuroticism. A 12-month follow-up of these patients indicated that depressed patients with dysfunctional families had a significantly poorer course of illness, as manifested by higher levels of depression, lower levels of overall adjustment, and a lower proportion of recovered patients. Thus, impaired family functioning appears to be an important prognostic factor in major depression.     

Intraindividual relations between the intensity and disclosure of daily emotional events: The moderating role of depressive symptoms

Individuals with high levels of depressive symptoms tend to engage in lower levels of emotional disclosure than individuals who are lower in depressive symptoms. However, little is known about how depressive symptoms relate to the intraindividual relation between daily disclosure and the intensity of the daily events. The authors addressed these relations using a daily diary methodology. College students (N = 239) completed a measure of depression symptoms. They then completed measures of the intensity of the day's most unpleasant event and their disclosure of that event each day for 7 days. Results indicated that depression moderated the intensity-disclosure relation such that depression symptoms were associated with diminished emotional disclosure for high-intensity events but not for low-intensity events. Individuals with relatively higher levels of depressive symptoms also experienced unpleasant daily events at a higher intensity level than did individuals with relatively fewer symptoms. Sex differences emerged such that men were less likely than women to disclose high-intensity negative events. These findings extend the use of the diary methodology to the study of emotional disclosure and also suggest possible interventions for counseling psychology practitioners.     

Expressed emotion, communication deviance, and culture in families of patients with schizophrenia: a review of the literature

The aim of this article is to critically review the literature on expressed emotion (EE), communication deviance (CD), and culture in families of patients with schizophrenia. There is growing evidence that EE and CD are highly linked. Yet the two constructs together predict the development of schizophrenia and the associated symptoms better than either construct alone. In this article, the authors review data indicating that both the expression and the levels of high EE and CD vary by ethnicity. It may be especially difficult for family members to communicate coherently and in a less critical manner when focusing on patients' inability to sustain particular cultural norms and values that are endorsed by their family and ethnic background. The authors propose that more attention to the role of culture in EE and CD and greater focus on the proper assessment of these variables would further enhance our understanding of these constructs.     

Alexithymia, emotional disclosure, and health: a program of research

This article reviews a program of research on alexithymia, emotional disclosure, and health. The article first describes two lines of research and then outlines current work attempting to integrate these lines. The first research line involves basic correlational studies on alexithymia's link to health problems; these studies suggest that alexithymia is a potential risk factor for symptoms and illness behavior, although not necessarily organic disease. The second research line involves experimental studies of the health effects of emotional disclosure via expressive writing or talking; these studies suggest that disclosure improves health on average, but that the effects are not that robust and that various moderators likely are involved. The next section of the article describes recent attempts to integrate the two research lines by examining how baseline levels of alexithymia influence the effects of emotional disclosure; these analyses suggest that alexithymia interferes with or attenuates the health benefits of disclosure. Finally, the article describes initial forays into research on interventions with the alexithymic patients. This evolving program of research demonstrates the value of integrating emotion, personality, and health, and highlights the bidirectional relationship between clinical problems and basic research.     

Expressive disclosure and benefit finding among breast cancer patients: mechanisms for positive health effects.

A randomized trial (n = 60; A. L. Stanton, S. Danoff-Burg, L. A. Sworowski, et al., 2002) revealed that 4 sessions of written expressive disclosure or benefit finding produced lower physical symptom reports and medical appointments for cancer-related morbidities at 3-month follow-up among breast cancer patients relative to a fact-control condition. The goal of this article is to investigate mechanisms underlying these effects. Within-session heart rate habituation mediated effects of expressive disclosure on physical symptoms, and greater use of negative emotion words in essays predicted a decline in physical symptoms. Postwriting mood and use of positive emotion and cognitive mechanism words in essays were not significant mediators, although greater cognitive mechanism word use was related to greater heart rate habituation and negative emotion word use.     

A computerized scoring procedure for the Kvebaek Family Sculpture Technique applied to families of children with rheumatic diseases.

A new computer-based quantification procedure was applied to data obtained from administering the Kvebaek Family Sculpture Technique (KFST) to 92 mothers of children with recent onset of rheumatic symptoms (median = 7 months). Four family configuration types (close, hierarchical, unspecified, and skewed) were defined on the basis of distance and structural parameters of the configuration. The types differed with regard to the childhood environment of the mother, chronic family difficulties, and the psychosocial functioning of the primary patient. Comparisons of the families of the mothers that did (n = 23) and did not (n = 69) wish a change of family configuration showed that the families of the mothers who wished change differed with regard to configuration types, distance variables, and psychosocial characteristics. The results are discussed in the context of structural family-systems theory. The computerized scoring procedure opens new possibilities for research about various family members' perspectives and assessment of changes in family configurations during therapy or over time.     

Quanta, quarks, and families: implications of quantum physics for family research

This paper offers recommendations for family research in light of the scientific paradigm ushered in by quantum physics in the early twentieth century. After summarizing the basic discoveries of quantum physics, the author discusses philosophical implications of these discoveries, and then presents implications for conducting scientific research about families within a post-Newtonian paradigm that emphasizes relations, process, and dynamic causation. The author argues for using complementary research models, including linear and systemic, because no one theory or methodology can illuminate fully the inscrutable nature of family processes.     

Psychological support for families of ICU patients: longitudinal documentation of the service

This study is the first systematic effort to investigate psychological services provided to relatives of ICU patients at Nicosia General Hospital. Documentation of psychological sessions provided to relatives of ICU patients for the years 2011–2014 was analyzed. To investigate possible differences in the total number of sessions for the referenced years, the records were analyzed using patients’ demographics, the outcome of hospitalization and the total number of sessions with relatives. A questionnaire was sent to the ICU staff aiming to identify their perception towards the need for psychological support. A total number of 863 psychological sessions were conducted with 640 relatives of 345 patients hospitalized in the ICU. Results indicate that more sessions are recorded when the outcome of younger patients’ condition worsens, whereas the number of sessions decreases for older patients’ families. When comparing the personnel’s beliefs, regarding the importance of providing psychological services to different age groups, significant difference was found suggesting that the older the patient the less sessions they believe are required indicating a possible ageism bias.