The travails of Martin Orne: On privacy,public disclosure,and confidentiality in psychotherapy

The experiences of one psychotherapist have brought to the fore the entire issue of privacy and confidentiality and the responsibilities of mental health professionals. In a computer driven culture, where data about patients become subject to public scrutiny, how does the mental health professional practice, guided by the concept of confidentiality? Where does confidentiality begin and end? What about the patient's right to self-disclose? What about patient autonomy? In this paper, illustrated by one particular case where the rule of absolute confidentiality, an intrinsic part of the practice of psychotherapy, was questioned, our current confusion comes to the surface. The reader is urged to re-think the concept of confidentiality and patient self-disclosure.     

Reconstructing the professional at the end of modernity

Faced with incidents of sexual misconduct within the professional ministry, some would have us return to a construct of the professional from the past and some would reject the construct altogether. Both those approaches may perpetuate systemic factors that contribute to injustice. This article explores the history of the professional construct and its challenges, and offers a reconstruction that could support a more just relationship between ministers and members of congregations.     

The ecological context of family ministry: the cambridge model revisited

Family ministry in the local church occurs in an ecological context characterized by a diversity of family types. A viable ministry to families must be able to address this diversity at different levels within the social system: the types of nuclear and extended families within the congregation; the type of congregation itself considered as a family; and the minister's own family type. A comprehensive family typology is needed to conceptualize this notion. The Cambridge model of closed, open, and random families, created by David Kantor and William Lehr, is summarized and then applied to an understanding of the ecology of family ministry.     

Family Bereavement and Cultural Diversity: A Social Developmental Perspective

This article offers an integrative, interdisciplinary model of bereavement as a family developmental process that unfolds in cultural context. A critique of cultural assumptions highlights the culture-bound nature of prevailing North American practices, which view grief as an isolated individual experience and emphasize detachment from the dead as a way to promote recovery. Death and grief precipitate two kinds of family change, both guided by culture yet uniquely experienced and interpreted by individual families: 1) recreating the family without a key family member; but capable of coping with both existing and new tasks; and 2) incorporating the death into an ongoing but irrevocably altered family life-cycle developmental process. In supporting family change after a death, family therapists need to collaborate with grieving families in examining the goodness of fit between their unique circumstances and the bereavement expectations of their community and culture. Four case examples are presented, two of which will apply this social developmental model to emphasize transformations of attachment to the deceased — rather than detachment — that will support the ongoing family development of grieving families.     

Why Ask,Why Tell? Teaching and Learning about Lesbians and Gays in Family Therapy

The article by J.K. Long (1996) in this issue of Family Process helps puncture the conventional secrecy around homosexuality, challenging the silence of many supervisors. In this commentary, I will expand on the themes raised by Long and offer some tangible steps we can take to teach and learn about lesbians/gays in couples and families.     

Dual diagnosis: Clinical issues in the treatment of substance abuse,and affective,personality, and psychotic disorders

Co-morbidity of alcohol and substance with the spectrum of other psychiatric diagnoses is examined with specific emphasis on diagnostic indicators for anxiety and mood disorders. Diagnostic issues for the chemically dependent person are examined with the context of borderline personality disorder, schizophrenia and other psychiatric disorders. Clinical research related to the dually-diagnosed patient is explored     

Dream-sharing groups,spirituality, and community

This article examines the phenomenon of dream-sharing groups and argues that these groups offer a valuable source of spiritual revitalization and community healing in contemporary Western society. The article traces the historical development of dream-sharing groups, analyzes the various forms they take, and discusses their relation to the secularization of the modern West. Two concrete examples are offered—one from a public high school, the other from a prison—to illustrate the power of dream-sharing groups to stimulate a deep and powerful sense of relatedness to others, enabling people to recognize a shared humanity in the midst of social and cultural differences.