Stuttering and the valsalva mechanism: A hypothesis in need of investigation

This note presents the hypothesis than the excessively forceful closure of the mouth of larynx associated with certain types of stuttering may involve a neurological confusion between speech and the human body's Valsalva mechanism, which is designed to increase pulmonary pressure by forceful closure of the upper airway to assist in many types of physical effort. It is suggested that such behavior may result from excessive neuromotor tuning of the Valsalva mechanism prior to speech, especially in situations where the stutterer anticipates the need to “try hard” to speak properly. Such tuning may both interfere with phonation and render the Valsalva mechanism overexcitable to triggering stimuli, such as the increase in subglottal pressure that accompanies the start of articulation.     

Ethical Issues in Family-Centered Primary Care

In 1969 a new primary care medical specialty, family practice, was formally created. One element in the development of this specialty from the roots of general practice was an understanding of the importance of family process in health and health care. Family physicians are now trained to work with families in the provision of primary medical care, and many provide some formal family counseling and therapy. The family physician who works with families faces many of the same ethical conflicts with which family therapists are confronted. The primary relationship of the family physician to his or her patients, however, as the provider of continuing health care, modifies these conflicts and creates new and vexing problems.     

Early adolescent egocentrism: a review of six articles

This paper reviews six articles which appear to be representative of the past fifteen years during which researchers have focused on early adolescent egocentrism. Each article is described in chronological order and compared to research findings suggested by the other articles. Although the researchers have suggested some interesting associations, there is a lack of consistency among their findings. The author indicates methodological problems and questions for further research which arise from the reviewed articles.     

Adolescent pregnancy: effects of family support, education, and religion on the decision to carry or terminate among Puerto Rican teenagers

Why do some pregnant teenagers decide to carry to term while others terminate their pregnancy? This study examined the influence of family relationships and support, religion, and education on the decision to carry or to abort. A nonrandom sample of 43 pregnant Puerto Rican teenagers (21 who carried and 22 who aborted) were interviewed in 1982 using a 34-item interview schedule. It was found that girls in the carry group were more significantly influenced and supported by family and friends than were those in the abort group. Fathers were the least influential persons in both carry and abort groups, while mothers were the most influential in the carry group, and sisters in the abort group. Brothers, boyfriends, and best friends were more influential for carry girls than for abort girls. Contrary to expectations, girls in the abort group reported a greater degree of religiosity than did those in the carry group. Further, girls who received strong support from family and friends reported a higher degree of satisfaction with their decision than did those who received less support. Finally, girls in the abort group were more likely to continue their education than were those in the carry group. Overall, the findings of this study have immediate implications for research and counseling services. Practitioners should focus on the girls in conjunction with their families in order to achieve better results in both treatment and preventive services.     

Redundancy: a similar principle in independent adaptation techniques

The present study examined the similarities between four auditory adaptation techniques to determine whether the effects were correlated. The four adaptation techniques compared were: Simultaneous Dichotic Loudness Balance technique (SDLB; Hood, 1950), Magnitude Estimated Binaural technique (MEB; Botté, Canévet, & Scharf, 1982), Magnitude Estimated Monaural technique, (MEM; Weiler, Sandman, & Pederson, 1981), and the Monaural Reaction Time technique (RT; Davis & Weiler, 1976). Results did not show significant correlations between the four techniques, except (r = 0.39) between MEB and MEM procedures. This correlation was much less than the reliability of the measures would allow (r = 0.98 and r = 0.99, respectively). Thus, it appears that the different methods either produced different adaptation effects or measured different aspects of auditory adaptation. The normal ear apparently shows several forms of adaptation, which reduces the perceptual strength of a continuing stimulus, in favor of an intermittent, less redundant one.     

Perceptual learning of a non-focal color discrimination between ages three and six

A match-to-sample task and a preference-ranking procedure were used to provide predifferentiation experiences on a color discrimination of 3-, 4-, 5-, and 6-year-old children. Chronological age was the best predictor of task success. Six-year-olds averaged twice as many correct matches as 3-year-olds. Gender and predifferentiation experience were not significant as main effects or in interactions affecting test performance. There was no difference between scores of untrained and trained children. The predifferentiation experiences had no effect. The data suggest that the years between 3 and 6 may be an important period in the development of the perceptual abilities needed to discriminate among subtle differences in one hue. Boys' and girls' abilities seem to develop at the same rate during this age span.     

Family Characteristics and Posttraumatic Stress Disorder: A Follow-Up of Israeli Combat Stress Reaction Casualties

This study assessed the role of family status and family relationships in the course of combat-related posttraumatic stress disorder (PTSD). The sample consisted of 382 Israeli soldiers who suffered a combat stress reaction episode during the 1982 Lebanon War. Results showed that one year after the war married soldiers had higher rates of PTSD than did unmarried soldiers. Furthermore, higher rates of PTSD were associated with low expressiveness, low cohesiveness, and high conflict in the casualties' families. Theoretical, methodological, and clinical implications are discussed.     

Chronic Illness and the Life Cycle:A Conceptual Framework

This article provides a conceptual framework for thinking about the system created at the interface of chronic illness with the family life cycle. First, a psychosocial typology and time phases of illness schema is described as a necessary, preliminary step to create a common language that bridges the worlds of illness, individual, and family development. This schema organizes similarities and differences between diseases in a manner useful to psychosocial-developmental rather than biomedical inquiry. Then, drawing on several major life-cycle theories in the literature, key concepts (periods of transition, life-structure building and maintaining, centripetality, and centrifugality) are used in a complementary fashion to link these three lines of development. Equipped with these psychosocial languages, consideration is given to transgenerational aspects of illness, loss, and crisis, and the interwoven threads of illness, family, and individual development. Clinical vignettes are provided to highlight this conceptual framework.     

Toward a generative theory of the therapeutic field

In the various models of family therapy, family systems are described as being patterned and programmed in their operations and development. The regularities and patterns found in family life are believed to be the expression of a program that determines the behavior of the family system and each of its members. Therapists holding this view will use "programming methods" in order to map family phenomena, and therapeutic work will consist of disrupting the problematic sequences in a deterministic way. However, if we take into consideration the impossibility of always linking inputs and outputs and the inability to evaluate consistently the behaviors in a system, problems associated with indeterminancy appear. Under such conditions, it may be impossible for therapists to formulate programs of family functioning. Therefore, we have operationalized a set of methodological principles that can be applied in such conditions. In this article we present the theoretical and practical implications for the field of therapy of "nonprogramming methods." A videotaped session is analyzed in order to show the application of the nonprogramming methods in clinical practice.     

Interventive Interviewing: Part I. Strategizing as a Fourth Guideline for the Therapist

A clinical interview affords far more opportunities to act therapeutically than most therapists realize. Because so many of these opportunities remain outside the therapist's conscious awareness, it is useful to elaborate guidelines that orient his or her general activity in directions that are liable to be therapeutic. The Milan associates defined three such basic guidelines: hypothesizing, circularity, and neutrality. Hypothesizing is clear and easy to accept. The notions of circularity and neutrality have aroused considerable interest but are not as readily understood. These guidelines may be clarified and operationalized when reformulated as conceptual postures. This process is enhanced by differentiating a fourth guideline, strategizing, which entails the therapist's decision making, including decisions about how to employ these postures. This paper, the first in a series of three, explores these four interviewing guidelines. The other papers will appear in a subsequent issue. Part II will focus on reflexive questioning, a mode of inquiry oriented toward mobilizing the family's own healing capacity. Part III will provide a scheme for analyzing and choosing among four major types of questions: linear questions, circular questions, reflexive questions, and strategic questions.