Family therapy in primary health care: Skills training and outcome evaluation

Some of the theoretical tenets of family therapy such as emphasis on the activation and utilization of existing family resources and the importance it accords to context appear to have a good fit with primary health care's commitment to empowering individuals in their struggle against ill health and the circumstances in which it occurs. This paper explores the possibility of teaching a problem-solving approach to family therapy to nurses in a South African primary health care system. Training consisted of conceptual, pragmatic, and self-growth exercises, and trainees' conceptual and performance skills were compared to the skills of a group of untrained nurses.We thank Bukelwa Selema, co-trainer on the program, for her contributions to joining effectively with the nurses and enriching the experiential process. We also thank Dr. P.J. Beukes, Dr. J.H. Olivier, Dr. G.M. Louw, Matron L.C. Langley and other staff in the Soweto primary health care system for their support. In particular, we are grateful to nursing sisters Martha Nkoane and Millicent Matomela, who roleplayed clients on the videotaped training modules. We are also grateful to Edcent Williams, who was one of the videotape raters, and Mike Spruce, Ricky Snyders, Nico Cloete, Ricky Mauer, and Brenda Radebe for their inputs at various stages of designing and implementing the programme.     

The evolution of family therapy approaches to substance abuse: Personal reflections and thoughts on integration

This article reviews the emergence of the original family therapy model for treating substance abuse developed by Duncan Stanton and Thomas C. Todd, its original successes, and the subsequent awareness of some shortcomings as it was used in a variety of settings in the United States and other countries. Also outlined are newer approaches that have been important influences on the model and thoughts on how these new ideas can be integrated in a pragmatic fashion into a workable overall model of practice.     

Experienced closeness and distance among family members

This study looks at experienced emotional closeness among family members using a projective measure, the Family Paper Sculpture. Results support the hypothesis that, in a non-clinical population, experiences of extreme closeness and extreme distance may be different manifestations of the same underlying process. Some support is found for the hypothesis that families in which relationships are experienced as very close or very distant at one point in time may experience those same relationships as extreme in the opposite direction at another point in time. Global coding of taped family interactions supports the hypothesis that extremes of experienced closeness are associated with more conflict, less ability to resolve differences, and less warmth and support among family members. It is suggested that the experience of being very close, varying through time with the experience of being very distant, may be associated with disappointed attempts to achieve closeness with autonomy.worked on this research while a graduate student in psychology at the University of Houston-Clear Lake.David C. Bell, PhD, completed work on this report while at Texas A & M University. He is presently working on a book about connection and dependency.The studies reported here were supported by grants from the National Institute for Mental Health and the Hogg Foundation for Mental Health. The authors would like to thank David Gutterman, Sheila Jones, Judy Nunn, and Theresa Rourke for coding the global scales.     

Disclosure of father-child sexual abuse: Dilemmas for families and therapists

Following disclosure of father-child sexual abuse, family members are faced with significant dilemmas related to the abuse disclosure and to the future of familial relationships. The resolution of these dilemmas has an impact on the resulting family structure as well as the therapist's stance, the therapeutic process, and therapeutic goals. This paper presents clinical issues that arise in relation to father/perpetrator and mother responses to the dilemmas they face following their child's disclosure of abuse. Clinical case examples are used to illustrate several resolutions that families reach following disclosure of abuse. The cases illustrate the systemic functioning of families and the impact that family members' decisions have on the therapeutic process.This paper was sponsored in part by a grant from the U. S. Department of the Navy. Names of clients were changed by the author to protect their identities.     

A scale to measure Bowen's concept of emotional cutoff

This paper describes the Emotional Cut-off Scale (ECS), an instrument designed to measure Bowen's concept of emotional cutoff. The development of the scale and psychometric data from its use in three later studies are presented. The concept of emotional cut-off is critical to Bowen's broader theory. It is hoped that the ECS will allow researchers to begin to empirically examine propositions derived from Bowen's theory.     

Cybernetics of cybernetics in assessment of marital quality

Quality of marriage is a term or a phrase that still lacks a clear and precise referent. Marital adjustment, success, satisfaction, compatibility, and stability are terms that have been variously employed. Following the lead of Fincham and Bradbury, a case is made for the fact that the best measure for marital quality is the global evaluation of marriage, i.e. the evaluation placed on the relationship as a whole by the marital partners. This is cybernetics of cybernetics wherein the observer becomes part of the observed.     

Neurocardiology shows that the central,not peripheral,action of propranolol reduces mortality following acute coronary artery occlusion in the conscious pig

Neurocardiology emphasizes the role of the higher cerebral mechanisms in cardiovascular disorders. Several large clinical trials (BHAT, MIAMI, and ISIS) have consistently shown that treatment with a beta-receptor blocker (propranolol, metoprolol, or atenolol) will produce a 26% to 29% reduction in mortality in high-risk survivors of acute myocardial infarction. Becauseall beta-blockers cross the blood-brain barrier, it is not clear whether the salutary action is on the central or peripheral receptors. Therefore the effects of intracerebral versus intravenous propranolol were observed in 30 conscious pigs following complete occlusion of the left anterior descending coronary artery. Controls showed the propranolol to remain confined throughout the experiment to the central or peripheral compartment into which it was injected. To assure the occurrence of ventricular fibrillation (VF), each pig was psychologically stressed by being unconditioned to the laboratory.Intracerebral propranolol (0.05 mg/kg) prevented VF within a 20 min period of reversible ischemia in 6 of 9 pigs, whereas VF was prevented in 0 of 11 controls injected intravenously with either dextro-propranolol (2 pigs) or vehicle (9 pigs) (P<.0006, binomial probability ratio). In some pigs in which VF was not manifested by 20 min, the ischemia was reversed and additional control observations were achieved; a total of 10 counter-balanced within-subjects experiments confirmed the between-subjects result (P<.01, paired-t test). In contrast intravenous propranolol (0.2 to 2.0 mg/kg) in 7 pigs had no effect on VF latency compared to 7 vehicle controls. It is concluded that beta-receptor antagonists prevent VF in the ischemic myocardium by their effect on thebrain andnot the heart.     

On teaching articulatory phonetics via an orthography

In six experiments, the ability of university students to obtain generalizable knowledge about subphonemic distinctive features through learning to read an orthography based on these features was explored. In the reference experiment, it was found that learning four grapheme-phoneme pairs did not generate “feature awareness,” as tested by generalization to new instances of the orthography. In a second experiment, it was demonstrated that this failure was not due to inherent limitations in the testing technique, and a third experiment indicated that a considerable increase in exposure to the orthography and its principles did not help. In the last three experiments, instruction in articulatory phonetics was given prior to subjects’ learning the orthography, but reliable generalization to new instances emerged only when the instruction was based directly on the phonemes used in acquisition. Also, successful generalization was found to go hand in hand with verbalizable awareness of phonetic structure. A high level of performance was achieved only when the orthography/speech isomorphism was pointed out clearly. The results indicate that usable knowledge about an implicitly known property of speech is relatively resistant to instruction via an orthography, and that direct instruction in the property is necessary. An analogy is drawn with the acquisition of reading by nonreaders, with the results of the study lending weight to the use of curricula that emphasize phonemic awareness.     

A systematic review of relationship maintenance: Reflecting back and looking to the future

Relationship maintenance processes include a wide range of activities and cognitions that romantic partners engage in to sustain or enhance their relationships. In this article, we review literature from the past two decades (2002–2021). We focus on key definitional and conceptual issues in the study of relational maintenance. Guided by a lens of intersectionality, we then perform a theoretically-driven review of the empirical articles published over the last 20 years paying careful attention to the nature of the samples, methods, and privileged research questions. We conclude by offering a reflection on the current state of this literature and provide suggestions for future research.