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.     

Stability and Change in Type A Components and Cardiovascular Reactivity in Medical Students During Periods of Academic Stress1

This study examined the effects of academic stress upon components of Type A behavior and cardiovascular reactivity. In a longitudinal design, heart rate and blood pressure responses to the Type A Structured Interview (SI) and additional laboratory challenges were measured in medical students at three points during an academic semester. Sessions 1 and 3 were scheduled during vacation periods; Session 2 took place during an intensive examination week. Results indicated that three “stylistic” components of Pattern A derived from the SI—loud and explosive speech, short response latency, and potential for hostility—increased significantly during the exam period. Similar increases achieved marginal significance for another stylistic component, rapid and accelerated speech. By contrast, global Type A assessments did not increase with academic demands. Cardiovascular reactivity was significantly but only moderately stable across the three sessions, showing less consistency than has been reported in previous research. In addition, there was little evidence in this study that cardiovascular reactivity was potentiated by academic stress or by Type A behavior. These results demonstrate the influence of naturalistic environmental factors on overt behavioral components that have recently been suggested as coronary risk factors. Therefore, it is advisable for future experimental and epidemiological research to examine the social and environmental context in which these behaviors occur.     

The evolution of a therapy group for vietnam veterans on a general psychiatry unit

The evolution of a therapy group for hospitalized Vietnam veterans with post-traumatic stress disorder (PTSD) and related symptomatology is described. The literature on group treatment for this population is briefly reviewed and discussed in relation to an inpatient psychiatry setting. The prevailing conditions at the time of group inception are recalled along with the initial goals of the therapeutic intervention. Problems encountered are also discussed, along with the changes made in response to these identified difficulties. The results of three and one-half years of experience with this group are described in detail.The authors would like to thank Cynthia Sturm, Ph.D. for her helpful editorial assistance.     

PROMOTING AUTOMOBILE SAFETY BELT USE BY YOUNG CHILDREN

A program using behavioral practice, assertiveness training, and social and contrived reinforcers was developed to establish and maintain automobile safety belt use by young children. Sixteen children (ages 4.8 to 7 years) who never used their safety belts during a 5-day preexperimental observation period were randomly assigned to two groups of eight each. A multiple baseline design across groups was used to evaluate the effectiveness of the training program. During the 8-day baseline period for Group 1, no children used their safety belts when unobtrusively observed while being driven from school. During the 26-day intervention period, the children were buckled up on 96% of the observations. Follow-up probes conducted 2–3 months after program discontinuance found safety belt use to range from 86% to 100%. For Group 2, the 14-day baseline safety belt use averaged 6% and increased to a mean of 81% during the 20-day training and maintenance program. Follow-up probes 2–3 months later found safety belt use to occur during 75% to 96% of the observations. Parent questionnaires indicated the generalizability and social validity of the program.     

The Job Search Process: An Attitudinal and Behavioral Analysis

Job search attitudes and behaviors among college students were studied. Major job-seeking factors were identified and discussed in relation to job search experience.     

Task-dependent compensatory responses to perturbations applied during rhythmic movements in humans

Modulation of the responses to perturbation applied during different phases of three rhythmic movements in humans-running, cycling, and hopping-was studied. The perturbation was an electrical stimulus. The results showed gating and modulation of the responses in both ipsi- and contralateral limb muscles. The responses during running and cycling were only excitatory in nature, while during hopping an inhibitory response was observed. These responses were not correlated with the normal activity during the movement. The latency of the response in general was not altered for different stimulation phases. The alterations in the step cycle demonstrated overt behavioral changes due to the responses. There were differences between the responses observed during these movements and walking. In running, the major adaptation to perturbations appears to be in the contralateral side as seen in the changes in the step cycle. During cycling (except for one phase) and hopping, the same set of muscles was activated in response to perturbation. This represents a simplifying strategy in response organization. The dependency of the response on the task characteristics, postural stability requirement, and external constraints imposed on the subject is discussed. These studies provide insights into task-dependent strategies adopted by the nervous system to meet unexpected perturbation during rhythmic movements in humans.     

Interhemispheric integration of compound nouns: effects of stimulus arrangement and mode of presentation

Normal subjects had to name German compound nouns which were presented tachistoscopically. The compound nouns were displayed either unilaterally to the left or right visual field or bilaterally with one element to each visual field. In the bilateral condition a distinction was made as to whether familiar or unfamiliar arrangement of the elements was used. Representation in print was compared with pictorial representation of the compound nouns. A right visual-field superiority was observed with printed representation, but no laterality effects with pictorial representation. Bilateral processing was superior to unilateral processing. Within the bilateral conditions, the familiar arrangement of the elements yielded a significantly better performance than unfamiliar arrangement. This difference can be explained by reading habits and/or by different styles of interhemispheric integration.