Family therapy and outcome: Relationships between therapist and family styles

This study examined therapeutic outcome for a group of 175 clinic families divided into levels of family competence and style, and, later, into seven clinical groupings. The division into these groups was based on the level of rated Competence and Style determined by using the Beavers Systems Model. Therapists also rated their level of Openness/Sharing Strategy, Power Differential, and Partnership with the family at the third session. Results indicate that more competent families who fared well in therapy had therapists who formed a partnership, disclosed strategy, and employed a minimal power differential with the family. The most disturbed families, and those with a Centrifugal style, did better with therapists employing a high power differential and lower levels of openness and partnership. The study also presented the distribution of individual diagnoses by family groups. Implications for family therapists, including the value of family assessment, are provided.     

The role of blood pressure, cortisol, and prolactine among soldiers injured in the 1991–1993 war in Croatia

Ninety soldiers with at least three months of combat exposure—60 injured soldiers (30 with permanent disabling and 30 with nondisabling injuries), 30 noninjured soldiers and 30 healthy controls—were interviewed and investigated with physiological (Prolactine, Cortisol, BP, Hb) and psychological tests (MMPI), IES-15 (Impact of Event Scale), PTSS (Post-Traumatic Symptom Scale). Their was related injuries had a different effect on the physiological stress response of the soldiers as reflected in the levels of prolactine, cortisol, hemoglobin and blood pressure. In a report of personality characteristics of the same soldiers, we demonstrated that the experience of posttraumatic stress was not dependent upon physical injury, but rather on the psychological appraisal of the situation. The results of the present article confirm earlier findings that the relationship between physiological and psychological consequences of trauma are complex, and that the perception of an event and the social context within which the traumatized soldier exists is as important as the event itself. The physiological response to the trauma varied greatly among the soldiers regarding the psychosocial impact of the consequence of the injury. So the anticipation of future possible trauma among less severely wounded soldiers (expected to go back to war) was followed by pathological stress responses. Trauma seems to operate somewhat independently from the overt conscious appraisal of the situation and relationship between psychological, psychosocial, and physiological aspects are interrelated in a multifactorial way. An integrative approach is therefore of great importance in assessment as well as in treatment of Posttraumatic Stress Disorder (PTSD). Editorial Note This historical article is being published for the first time. It is based on the Ph.D. thesis of Dr. Harry A. Teitelbaum for which he was awarded a doctorate by the University of Maryland in College Park in 1936. The dissertation was stored prior to publication and was not rediscovered until 1997. Teitelbaum’s work was performed during the early days of the development of knowledge regarding the mechanisms that regulate endocrine function. The understanding of the broad capability of interactions among endocrine glands was evolving. It was a field that Teitelbaum contributed to for several years, many of which were spent in collaboration with Horsley Gantt in his laboratory at Johns Hopkins. Although some of the experimental strategies and some of the wording of the report seem quaint today, the contribution of Teitelbaum’s research was solid and highly relevant to questions being asked at the time.     

The interaction between cohesive systems and dispersive systems: Creating the trigenerational therapeutic context

The author presents a model for research investigation and clinical use that deals with the interaction between cohesive and dispersive family of origin systems as reflected in marital and family interaction in nuclear families.From a paper presented at the tenth annual meeting of the American Family Therapy Association, June, 1988, Montreal, PQ, Canada.     

Commentary on reviews of “outcome” studies of family and marital psychotherapy

Reviews of the outcome literature in family and marital therapy are critically evaluated. The literature is equivocal in regard to the effectiveness of family therapy, particularly in comparison to alternative forms of treatment, so that statements to the effect that family therapy has demonstrated its general efficacy would not appear to be justified. Problems are identified which require solution before the efficacy of family therapy can be demonstrated.Paper presented at the 45th annual conference of the American Association for Marriage and Family Therapy, Chicago, Illinois, October 31, 1987.     

Difficulties in assessing depressive-like reactions to chronic severe external stress as exemplified by spouse caregivers of Alzheimer patients

Problems in making differential diagnoses and severity ratings of depressive-like reactions in chronically, heavily stressed persons are described. These assessment concerns are especially pertinent to older persons. The assessment concern discussed relates to difficulties in determining the extent to which stress reactions are inevitable consequences of stressor demands versus excessive pathological reactions versus natural manifestations of aging. The newly revised criteria of the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III-R) and its associated structured interviews do not lessen the difficulties described. However, they reflect progress in specifying the amount of cross-sectional and longitudinal consistency required before maladaptive behaviours meet diagnostic and/or severity criteria as pathological indicators. Stressor level is important among the criteria for the less severe DSM-III-R depression-related disorders, but the specific response demands of the stressors are ignored. By contrast, biomedical factors are consistently given significant weight. To clarify these matters, the five DSM-III-R diagnostic axes, depressive diagnostic criteria, and associated structured interviews for eliciting relevant data are reviewed.     

Intuition in family therapy: A short manual on post-modern witchcraft

Intuition is an important part of a mature clinician's work. Yet, it is a component of clinical work which is looked upon with suspicion, due in part to the Middle-Age's association between intuition and the work of witches. This paper describes a tenuous link between intuition, witches, and Carl Whitaker. Patterns for including intuition in family therapy are discussed.     

The Contribution of Neuroimaging to the Study of Language and Aphasia

New structural and functional imaging methods continue to be developed at a rapid pace. In the last 25 years, advanced imaging techniques have provided insights into how language is represented and processed in the brain and how it can be disrupted by damage to, or dysfunction of, various parts of the brain. Imaging studies have also yielded new information regarding how individuals recover language after stroke. We briefly review the strengths and weaknesses of the various radiological methods currently used to study language and aphasia.     

Adolescent and parent perceptions of media influence on adolescent sexuality

Empirical evidence suggests that television and other media influence adolescents' attitudes and behaviors. Much of the research in this area is based on surveys in which adolescents are asked to rank the relative importance of a fixed set of factors such as parents, peers, and media. We reviewed data from focus groups conducted with adolescents and their parents to examine the extent to which adolescents identify--without prompting--media as a source of influence on sexual behavior. Adolescents seemed indifferent to media influence (e.g., media influence was mentioned in only one adolescent focus group), but their parents expressed significant concern about media influence. Future research should investigate the extent to which influences exist outside of adolescents' consciousness. For now, parents and sexuality educators may need to convince adolescents that concerns about the media are valid before trying to change media-influenced behavior.