Family Therapy in Trouble: Psychoeducation as Solution and as Problem

The authors cite clinical literature attesting to the importance of recognizing the family, rather than the individual, as the proper locus of conceptualizing, diagnosing, and treating mental illnesses. Specifically with regard to severe psychiatric illnesses, in particular schizophrenia, family dysfunction contributes to the emergence of the illness, significantly affects its course, and strongly influences the achievement and maintenance of treatment gains. Currently, a movement is afoot to limit sharply the amount and kind of treatment offered to schizophrenic patients and their families. Rooted in a “medical model” or “biogenic” view of the etiology of schizophrenia, this school of thought prescribes psychoeducation as the family treatment of choice. The present article looks at some misconceptions regarding treatment that prompted a widespread turning away from psychoanalytically oriented family psychotherapy for schizophrenic patients and their families, examines the reductionism (biological and behavioral) inhering in the exclusive use of psychoeducation, and looks at the clinical dangers of such reductionism. Finally, it proposes that family psycho-therapists should not abandon a concern with the inner lives of severely ill patients and their families in the face of spuriously generalized claims made by reductionist researchers.     

Solutions to neurosis: A theology of self

For Karen Horney neurosis is a serious impediment to health and wholeness and has the power to place a person in bondage. Yet the situation is far from hopeless, for strivings and anxieties contain intrinsic value and can be directed positively to the purpose of human maturity. The theory lends itself to a strong theology of the self, and thus encourages the pastoral counselor who cooperates with the inherent strengths of the person in his or her drive toward health.     

The assessment of child abuse potential and the prevention of child abuse and neglect: A policy analysis

A frequently advocated strategy for increasing the efficiency of child abuse prevention programs is to deliver prevention services to "high-risk" populations. This article critically reviews procedures for the reliable and valid assessment of child abuse potential within an ecological perspective. Factors that limit the usefulness of child abuse risk assessment are discussed. These factors include the uncertain criteria of child abuse and neglect, the low base rate of the phenomenon, and the financial and social costs of such procedures. Finally, the prevention implications of the current and future state of the art in child abuse risk assessment are considered and preventive interventions that do not depend on individual case risk screening are advocated.     

The social supports of suicide attempters: The different roles of family and friends

The social support patterns of a sample of 101 suicide attempters were compared with the patterns of a control sample on the basis of structured interview data. Network characteristics and the extent of support in different functional categories were examined as to their absolute and relative power to discriminate between the suicide attempters and the controls. A clear separation of the functions of kin and of friends/acquaintances emerged. The crucial difference between the attempters and the controls lay in the number of friends with whom the subjects had agreeable everyday interactions and in the number of kin that provided crisis support, both psychological and instrumental. Other support differences between the two groups were of secondary importance. While there was no overall difference in the frequency of social interactions between the two groups, the size of the social network differed greatly. Consequences for the conceptualization and measurement of social support as well as for the prevention of suicidal behavior are discussed.