Network intervention,existential depression,and the relocated Appalachian family

The authors use the concept of existential depression as the basis for a set of treatment interventions that are often useful to the relocated Appalachian family and describe the use of a number of different network intervention strategies for use with such families and the existential reasons for their use.Both are of Appalachian heritage and have extensive experience in family practice with the Appalachian family.     

Sexual dysfunction in women sexually abused as children

Women who were sexually victimized as children report problems in relating to both men and women. Studies have found that victims are less satisfied with their current sexual relationships and with the quality of their relationships with men in general. Fear of sex, arousal dysfunction and desire dysfunction were the most common sexual disturbances found in incest victims.The purpose of this paper was to examine the differences in sexual functioning in abused women who perceived themselves to be adjusted to the trauma of their sexual abuse and those who did not.A sample of 57 nonclinical adult women who had been sexually abused as children was studied. Data were analyzed by means of cross-tabulation, chi square statistics, analysis of variance, and multiple regression.Orgasm was experienced by 63% of the women. There was a significant interaction among ability to be an orgasmic, sexual esteem and adjustment to abuse. Over 56% of the women experienced physical discomfort during intercourse and 36% indicated that they needed sex therapy. The implications of these and other findings are discussed.     

Negotiating transitions: a supervision model for home-based family therapists

Home-based family-centered treatment programs provide mental health and case management services to families in their own home. Treatment objectives include the prevention of residential or psychiatric placement, strengthening the family unit, and promoting family self-sufficiency. Little has been written, however, regarding the supervision of home-based, family-centered therapists. The purpose of this article is to describe a supervision model to teach novice-level family therapists to think systemically and to do family therapy with multiproblem at-risk families.     

The logic of delusion

Piagetian concepts explaining normal mental development are applied to delusion, a major psychiatric disorder of thought which can result in bizarre conduct. Piaget constructed problems in which the errors of six to eight year old children fit the standard textbook definition of delusion surprisingly well. When we examined cases of delusional individuals, we concluded that their apparent irrational and bizarre conduct could be explained as problem-solving errors like those of Piaget's young children. In contradistinction to existing theories, we define delusion as a regression under stress to the logic of children of a particular age range, and that what appears bizarre and irrational is the result of an adult attempting to filter experience through a child's logic.Under a different title this paper was presented at the Biennial Congress of the World Federation for Mental Health in Mexico City in August, 1991.     

Treating emotionally disturbed youth: A comparison of home-based and outpatient interventions

The purpose of this study was to compare home-based and outpatient treatment for families with an emotionally disturbed child. Following treatment, both groups reported improvement in child and family functioning. Guidelines are offered to therapists working with families-at-risk of having a child removed from the home.John J. Zarski, PhD, is coordinator of the Marriage and Family Therapy Training Program and Leslie Barnes Fluharty, MS, is a doctoral student in counseling psychology at the University of Akron, Akron, OH.     

Familial dyadic patterns in defenses and object relations

The Defense Mechanisms Inventory was administered to 308 sets of marital couples, and adult sons or daughters. The inventory yields five defensive clusters as well as a composite object relations measure. Correlational analyses were aimed at determining the extent to which defensive and object relations styles generalize within the family. Results showed consistent similarities across the family in object relations styles and in acting out defenses. Dyadic analyses showed striking similarities between Husband-Wife, Father-Son, and Mother-Daughter, but not for Father-Daughter and Mother-Son dyads. Results are discussed in context of modeling, sex role, and systems theory.Data from this study were presented at the American Psychological Association annual convention, August, 1991, in San Francisco, CA.     

The role of professional societies: Codes of conduct and their enforcement

In discussions of professional standards and ethical values it is reasonable to consider who will develop the codes of conduct and guidelines for behavior that will reflect the standards and values of the community. Also worthy of consideration is whether the standards or guidelines are enforceable, and how and to what extent they will be enforced. The development of guidelines or professional codes of conduct is a responsibility that has been adopted by many professional societies. Useful to this discussion is an examination of the rationale behind the development of ethical codes by professional societies. The Ethics in Science Committee of the Council of Scientific Society Presidents (CSSP) has examined the codes of some of its member societies and some observations regarding them are pertinent. The nature and uses of ethical statements, codes and guidelines developed by professional societies are multiple and diverse. Their enforcement raises both practical and ethical concerns. An earlier version of this paper was presented at the Engineering Foundation Conference on “Ethics for Science and Engineering Based International Industries”, Durham, NC, USA, 14–17 September 1997.     

Psychoeducation: A promising intervention strategy for families of children and adolescents with mood disorders

Mood disorders and suicide in youth represent major health concerns requiring effective intervention strategies. This paper briefly summarizes the literature on childhood mood disorders and discusses expressed emotion (EE) and the link between lowering EE and improved outcome for mood disordered individuals. Family psychoeducation is discussed as a means of reducing EE and similarities and differences between psychoeducation and other therapeutic interventions explored. The authors' adaptations that made psychoeducation developmentally appropriate for families of children and adolescents are reviewed. Psychoeducation for families of mood disordered youth is suggested as worthy of further clinical and empirical effort.     

A structured approach to disengagement in family therapy with child-focused problems

The aim of this paper is to describe a structured approach to managing the disengagement process. Six distinct disengagement scenarios are first outlined. Thereafter, phasing out therapy, dealing with family belief systems concerning the permanence of improvements and relapse management are discussed. Ways in which disengagement from specific episodes of therapy may be construed as part of an ongoing therapeutic relationship and the practicalities of recontracting for further episodes of therapy, handing over cases, and referring cases on to other professionals are considered. An approach to therapeutic failure analysis is presented. Finally, ways in which disengagement may lead to significant loss experiences are discussed.