失独父母创伤后应激障碍的症状结构、特征及预测因素

为考察我国失独父母创伤后应激障碍(PTSD)的症状特征及预测因素, 采用失独父母自身和孩子有关的基本信息问卷, 创伤后应激检查量表平民版(PCL-C), 对中国的463名失独父母进行调查。结果表明: (1)采用验证性因素分析验证了包括闯入、回避性、麻木性、精神痛苦性唤起和焦虑性唤起等5个因子的PTSD精神痛苦性唤起模型在中国失独父母中的适用性。(2)根据DSM-IV的诊断标准进行筛查, 71.92%的失独父母为PTSD阳性, 其中PTSD的回避、闯入、精神痛苦性唤起、情感麻木、焦虑性唤起因子阳性率依次增高。(3)失独父母的年龄、孩子的离世时长与PTSD症状具有显著的相关性; 失独父母的PTSD症状得分在自身性别、家庭所在地及家庭收入状况上存在显著差异; 将所有因素纳入回归方程后发现: 最能预测失独父母PTSD症状的因素包括: 性别、家庭所在地、年龄。     

Sisterhood-Brotherhood is Powerful: Sibling Sub-Systems and Family Therapy

Sibling interaction is an often overlooked aspect of family functioning. Individual development and many family behavior patterns may be attributed to autonomous activities within the sibling sub-system.
A number of phenomena in which siblings have profound influence upon one another are explored. Siblings collude and align with each other, at times help each other resist the powerful vertical influences of parents. Other sibling systems serve to enmesh the youngsters even more with parents. Important sib-behavior patterns include: the death or departure of siblings; the interplay between the sibling sub-system and the parenting system; and the roles that "well" siblings play vis-à-vis their "sick" siblings during family crises. The sibling relationship is seen as a life-long process, highly influential throughout the life cycle.
Understanding of sibling sub-system structure and dynamics can lead to more flexible therapeutic interventions. Direct work with siblings provides the therapist with more options and greater leverage in producing change for all siblings, as well as for other family members.     

Marital Conflict by Proxy After Father Kills Mother: The Family Therapist As an Expert Witness in Court

The father killing the mother leaves the children effectively without parents. The extended family from both sides will often intervene to offer a home for the children, or at least to have a say in what arrangements are made for the children and how they are to be brought up. Intensely competitive and hostile feelings between the opposing sets of relatives are commonly aroused, and the children may be caught up in a battle reminiscent of the conflict between their parents, which culminated in the death of their mother. I and my colleagues have, as a team, seen more than 300 children who have lost one parent at the hands of the other, and we have been involved in subsequent custody battles as expert witnesses. Based on this experience and using this context as an example, the issues for the family therapist as expert witness in adversarial Court proceedings are presented. A case is described that illustrates the theoretical exposition — including the effectiveness of family therapy from the witness box.     

Gay and Catholic: Accepting My Sexuality,Finding Community,Living My Faith

Abstract

This article considers how the insights of gay and lesbian Christians can be situated in relation to a sex-negative religious tradition. Are they to be seen as anomalous appendages or as integral to the tradition itself? Thinking of the Bible as a ‘faith family photo album’ offers a useful analogy for exploring this methodological issue. The image of a photo album provokes questions as to which characters and primal scenes achieve archival status within religious communities and which are removed from public view. In this frame we can discern that what is received from the past is produced out of messy familial disputes often provoked by radical and subversive practice. The work of disputing which images can be displayed in the family album must continue as it is in the interplay between traditional teachings and transgressive performance that transformative adaptations occur without which Christianity cannot thrive as a living tradition.     

Depression Following Stroke: Brief, Problem-Focused Family Treatment

The brief, problem-focused treatment of a case of depression is described. Members of a family were seen in the treatment of a 58-year-old man suffering from depression secondary to two strokes. The identified patient did not attend any of the five sessions. Therapeutic interventions emphasized interdicting the self-defeating efforts of family members to be supportive and encouraging. It is proposed that successful therapeutic interventions often involve changing the behavior of persons other than the identified patient but that traditional therapists have avoided the full implication of this. Ethical concerns about this mode of treatment are considered.     

Death feigning by grass snakes (Natrix natrix) in response to handling by human "predators."

Death feigning, a variant of tonic immobility, is usually interpreted as a last-resort antipredator measure. The authors describe death feigning in grass snakes (Natrix natrix) and test some of its potential correlates. Death feigning was seen in 66% of wild-caught snakes but was not seen in hatchlings from laboratory-incubated eggs. Minimal indication of death feigning was mouth gaping, often with the tongue hanging free, but more dramatic cases involved voluntary supination and/or lack of muscle tone. Aside from hatchlings, which did not feign death, there was little variation in frequency or intensity of death feigning with body size. There was no effect of body temperature on death feigning nor were snakes that were moving when caught less likely to feign death than those that were not moving. Interpretation of the adaptive value of death feigning in grass snakes or in other animals is hampered by lack of evidence of this behavior in the field in response to natural predators.     

The death crisis and pastoral counseling

Death is an event that presents a crisis to the family system. Conceptualizing death as a stressor event and recognizing the variety of coping resources present in and available to bereaved families and individuals, along with the meaning attached to death, can help interventionists to perceive stategies for providing assistance in time of grief. Pastoral counselors are often needed to interpret death from a faith perspective, yet they may need to interpret the family's reaction to the death crisis in order to facilitate their readjustment. Analysis of the death event using Reuben Hill's crisis equation provides a workable conceptual framework.     

Bullying: A Family and School System Treatment Model

Because bullying is often conceptualized as a school problem, most interventions are school-based and exclude the family. However, joint family and school involvement must occur for long-term problem resolution. This article incorporates structural and narrative interventions within a family and school system treatment model comprised of the following stages: structuring change, changing the story, and solidifying change. The therapist helps to shift family structure, while also changing the dominant bullying story. This article also examines the appropriate implementation of the birth certificate for new identity formation, and death certificate for bullying cessation.     

An Object-Relations Approach to Psychotherapy with Marital Couples,Families, and Children

AN APPROACH to object relations is presented here that conceptualizes the dynamics of interpersonal relationships. Although it is beyond the scope of this paper to provide a thorough review of the object-relations school of thought, the concepts introduced here have direct clinical implications for understanding and influencing the dynamics of the patient-therapist dyad, of the marital pair, and of the family unit. Included are the following concepts: (a) Couples in conflict are viewed as more similar than dissimilar despite apparent differences; (b) The therapist's countertransference reactions are seen as not irrational but a valid reflection of the patient's struggle; (c) The adult or child who is the identified patient is often a carrier or container of the split-off, unacceptable impulses of the other(s); (d) The individual is perceived as part of a unit in which even the more obvious pathological traits have an inherent healthy reparative function.     

Claudia Card's Concept of Social Death: A New Way of Looking at Genocide

Scholarship in the multidisciplinary field of genocide studies often emphasizes body counts and the number of biological deaths as a way of measuring and comparing the severity and scope of individual genocides. The prevalence of this way of framing genocide is problematic insofar it risks marginalizing the voices and experiences of victims who may not succumb to biological death but nevertheless suffer the loss of family members and other loved ones, and suffer the destruction of relationships, as well as the foundational institutions that give rise to and sustain those relationships. The concept of social death, which Claudia Card offers as the central evil of genocide, marks a radical shift in conceptualizing genocide and provides space for recovering the marginalized voices of many who suffer the evils of genocide but do not suffer biological death. Here her concept of social death is explored, defended, and criticized.     

Sorrow,shame, and self-esteem: Perception of self and others in groups for women survivors of child sexual abuse

Despite evidence that exists about the severity of impact of child sexual abuse (CSA), less has been published about treatment options. Much CSA is enshrouded in secrecy in the context of dysfunctional family dynamics, therefore group work is often recommended as a method of treatment. Although long- and short-term groups are seen as being equally effective, there are few published studies of long-term analytic groups for survivors of CSA. This study was designed to analyse the process of one long-term group. A case is made for using Core Conflictual Relationship Theme (CCRT), a method designed to analyse individual therapy, with reference to group theory. Shifts in self-perception and in relation to others are analysed from the beginning to the end of therapy.     

Pet Loss and Human Emotion: Romanian Students' Reflections on Pet Loss

Thirty-five graduate and undergraduate students, owners of dogs and cats, were asked to respond in writing to a several questions regarding their relationship with their pet. In this retrospective analysis, we discuss aspects that describe the pet-owner relationship, including attachment and the role played by the pet in the owner's life (e.g., emotional support, the pet being seen as a family member). Most of the participants felt that their pet's loss caused great pain; some considered that even if they had suffered greatly, the death of their pet was not felt more intensely and severely than the death of any other family member or a friend.     

Life cycle and loss--the spiritual vacuum of heroin addiction

This research studied the function of heroin addiction as a family-learned method of coping with death, separation, and loss across the life cycle. Heroin addicts, psychiatric outpatients, and normal students were given an extensive interview and test battery to determine the incidence of loss of family members and significant others. Because the impact of death is often overcome through religious rituals, this study also investigated the subjects' perception of their families' religious values and orientation to life's meaning and purpose. Results indicate that the incidence of death differs significantly across groups and that addicts have a distinct orientation to death, are more suicidal, and have more premature and bizarre death experiences. During childhood they have more family separations, and they tend to develop a distinct pattern of continuously separating from and returning to their families. They are also less likely to have a clearly defined purpose in life. A subset of parents from each group were also interviewed and tested, and these results support the theory of the intergenerational transmission of behavior.     

Narrative process modes as a bridging concept for the theory, research and clinical practice of systemic therapy

This article is concerned with the relationships which hold between the clinical practice and the theory of family therapy; and between these and academic research. These relationships are seen as tenuous and thin because, in the first place, there is a lack of rigorous theoretical underpinning; and second, the research methods employed do not fit in with current family therapy practice, and with the theory that underlies this practice. The role of the concept of narrative process modes is proposed as a bridging and mediating one. The external, internal and reflective narrative process modes are seen as relevant from the point of view of family therapy process research, and the clinical practice of marital and family therapy.     

Attachment as an Integrating Concept in Couple and Family Therapy: Some Considerations with Special Reference to South Africa

Couples, marital, and family therapy in South Africa and throughout the world have undergone radical changes in theory and practice in the last three to four decades. These developments are seen in the emergence of different approaches which may be regarded as modern or post-modern, intrapsychic or systemic. While these different approaches are often seen as theoretically and clinically incompatible, it is the aim in this paper to suggest that the time has come to seek points of integration of these different approaches, and the construct of attachment is proposed as an ideal integrating concept. Two case illustrations are used to demonstrate attachment as an integrating concept. It is suggested that the concept of attachment may also be applied to family therapists and associations, including and especially in South Africa.     

Soft Meaning and Sincerity in the Family System

The concept of “sincerity” is often dismissed as being irrelevant to the understanding of families as systems, since sincerity is seen as a linear, intrapsychic construct. This paper makes the opposite argument. Much family communication involves a particular kind of “soft” meanings. Such meanings are flexible and open to varied interpretation, but their use is nevertheless framed by social rules. Sincerity rules function as social agreements to refrain from manipulating “soft” meaning in particular ways. The expectation that family members are (or are not) likely to communicate sincerely is a crucial systems property, altering both the interpersonal strategies and relationship structures that are likely to emerge within families. The analysis of soft meaning developed in this paper suggests new ways of understanding the rich, tangled, sometimes paradoxical communication typical of families. However, a number of premises frequently associated with family systems theory must be abandoned before a clear analysis of family communication can proceed.     

The Clergy,the Clinician,and the Narrative of Violent Death

When death of a loved one occurs, humans use stories as a way of processing their grief and releasing their emotional attachment. In the case of traumatic and violent death, the story telling process is distorted, and focuses intensely and sometimes obsessively, on a often fantasized reenactment of the dying. Violent dying grief is often complicated further by the public and legal processes that surround violent death. The bereaved who get stuck in this dynamic may constitute a new psychiatric diagnosis called “prolonged grief disorder” and the author describes the criteria for this disorder. Clergy can play a key role in stabilizing and meditating the effects of trauma by inviting the bereaved to refocus their story telling, to a story of the loved one’s life. In a case the author illustrates many of the techniques used in this process of working with a prolonged grief disorder.     

International Family Therapy: A View from Kyoto, Japan

"International family therapy" is an emergent field within (or overarching) the field of family therapy. At this stage, it can be described as the collecting and sharing of experiences by family therapists from different countries. Recent publications (7) gather information principally from Western cultures in which systemic family therapy has grown over the past thirty years. Japan is of particular interest to Western practitioners because it is a highly successful, post-industrial culture that differs markedly from the West. Familiar family therapy interventions often work for unfamiliar reasons, and different goals are often needed in order to respond to apparently similar family problems. An expanded sense of choice around strategies for family life and family therapy that such diversity implies is the primary contribution that this maturing, international family therapy movement can make to family therapy.     

The Invisible Griever

Many people are equipped, through crisis intervention strategies and plans, to handle the immediate ramifications of a death within a particular school or community system. However, after the crisis has passed the question generally surfaces as to how one can help the children who have been greatly impacted by the death and are in the midst of the grieving process. The grieving child has often been invisible to adult caregivers like counselors, teachers, and school psychologist. The means of helping a child who has experienced a death in his family can be greatly enhanced by the developmcnt of grief support groups. Through the use of support groups children can learn to share their feelings, discover that they are not alone, and move through the grieve process.     

Identity continuity and loss after death,divorce, and job loss

This paper examined the relationship of constructs identified by identity continuity and attachment theories of grief to adjustment to loss from the framework of identity theory. Connections between loss salience, identity construal, and balance of identity construal on grief intensity via their association with post-loss identity disruption were examined across three types of self-relevant losses; death of a family member, job loss, or divorce. We hypothesized that lower salience, higher endorsement of identity attributes represented by relational and individualistic self-construals, and an overall balance across identity attributes would be related to decreased grief severity across all types of loss. Results supported hypotheses with the exception that the hypothesized ameliorative effect of increases in relational self-construal was only seen in the bereaved group.