Family caregiver's self-perceived health status and its relation to burden

The study aims to analyze how health is self-perceived by a sample of caregivers of dependant relatives and how it compares with general Spanish population scores. The study also focuses on the relations between self-perceived health and burden. The sample comprised 1,257 caregivers living in Biscay who completed the protocol including sociodemographic data, measures of health-related quality of life (SF-36) and burden (Zarit Burden Inventory). Results show that the health perception of the caregivers taking part into the study reached lower scores in comparison to general Spanish population and that this perception was lower in mental than in physical health. Correlational data supports previous findings indicating that high levels of burden are associated with a worse perception of mental and physical health and provide information on how to guide interventions to improve family caregivers' quality of life.     

Rhetorical theory and family therapy practice

The study found that a connection exists between rhetoric and therapy because both fields are interested in using language as a tool for generating change. Persuasion is viewed as inherent in human communication, even though people do not necessarily intentionally attempt to persuade others. Following a brief (but detailed) explanation of the theoretical stance which informs the implementation of rhetorical techniques in therapy, three pragmatic exemplars are offered to demonstrate the employment of two classical rhetorical concepts, the parastasis catalogue and syncrisis.The authors are grateful to Sandra Kodner, MS for her participation in the development of this project.     

Attributions related to wife abuse: A comparison of the perceptions of volunteer advocate-counselors and marriage and family therapists

Attributions related to wife abuse held by advocate-counselors working in women's shelter home settings and marriage and family therapists were compared. The major finding was that the two groups were surprisingly similar in their attributions even though their theoretical backgrounds and training were considerably different. Implications for practice and training are presented.     

The need for developing standardized family pedigree nomenclature

To assess the variation in usage of symbols used in recording a genetic family history, full members of the National Society of Genetic Counselors were surveyed by questionnaire. The questionnaire return rate was 55.3% and genetic counselors from a broad range of clinical experience, genetic counseling training programs and geographic regions responded. There was striking variation in symbols used for recording routine medical information in a genetic family history (i.e., pregnancy, spontaneous abortion, termination of pregnancy). There was even less consensus in recording situations representing new reproductive technologies (i.e., artificial insemination by donor semen, donor ovum, surrogate motherhood). The results of this survey document the need for developing standardized nomenclature in recording genetic family histories as a quality assurance measure in the delivery of genetic services. Such standardization will reduce the chance of incorrect interpretation of patient and family medical and genetic information.     

Attending to the shame: Working with addicted populations

Shame is a potent emotion that plays a major role in the life of addicted individuals. Shame's ability to penetrate and skew major motivational systems may play a part in the formation of addicted lifestyles. The shame-based or shame-prone individual, such as the addicted client, poses unique problems for the therapist. This paper explicates the processes and consequences of shame and offers guidelines to help clinicians work with addicted clients.Mitchell B. Young, MS, is a third-year doctoral student in the department of counseling and development at Purdue University.The author wishes to express appreciation to Kate Kerr, PhD, for her fine editorial work.     

Assertiveness predicts threat and challenge reactions to potential stress among women.

In this study assertiveness as a moderator of stress reactions among women was examined. Specifically, the experimenters examined how high and low assertive women cognitively appraised, affectively and physiologically responded to, and behaviorally coped with the stress of giving an impromptu speech. High assertive women appraised the speech stressor as challenging, whereas low assertive women appraised the stressor as threatening. High assertive women also had a challenge pattern of autonomic response during the task, compared with the threat response of low assertive women. Afterward, the high assertive women reported experiencing less stress and negative emotion and greater positive emotion than did the low assertive women. Overall, the high assertive women's stress-related reactions indicated challenge, whereas the low assertive women's reactions indicated threat (see J. Tomaka, J. Blascovich, R. M. Kelsey, & C. L. Leitten, 1993).     

Coparenting and Toddler's Interactive Styles in Family Coalitions

The current study examined the coparenting and toddler's interactive styles in family coalitions. According to structural family theory, boundaries between generations are clear in alliances, but disturbed in coalitions: the parents look to the child to regulate their conflictual relationship and the child attempts to meet this need. In a normative sample studied longitudinally during the Lausanne Trilogue Play situation (LTP, N=38), 15 coalition cases were detected. Styles of coparenting and of child's interactions were determined and compared in coalition and alliance cases at 18 months. Findings confirm the structural family model by showing the specific ways in which the coparenting and the toddler's interactive styles are associated in 3 different patterns of coalitions: binding, detouring, and triangulation. They illustrate how the child's triangular capacity, or her ability to simultaneously communicate with both parents, is used to regulate the parents' relationship. They suggest that the LTP observational paradigm is a promising assessment method of early family interactions. They point to the importance of assessing early the child's contribution to family coalitions.     

Comparison of outcomes across low-intensity psychological interventions for depression and anxiety within a stepped-care setting: A naturalistic cohort study using propensity score modelling

Low-intensity interventions for common mental disorders (CMD) address issues such as clinician shortages and barriers to accessing care. However, there is a lack of research into their comparative effectiveness in routine care. We aimed to compare treatment effects of three such interventions, utilizing four years' worth of routine clinical data. Users completing a course of guided self-help bibliotherapy (GSH), internet-delivered cognitive behavioural therapy (iCBT) or psychoeducational group therapy (PGT) from a stepped-care service within the NHS in England were included. Propensity score models (stratification and weighting) were used to control for allocation bias and determine average treatment effect (ATE) between the interventions. 21,215 users comprised the study sample (GSH = 12,896, iCBT = 6862, PGT = 1457). Adherence-to-treatment rates were higher in iCBT. All interventions showed significant improvements in depression (PHQ-9), anxiety (GAD-7) and functioning (WSAS) scores, with largest effect sizes for iCBT. Both propensity score models showed a significant ATE in favour of iCBT versus GSH and PGT, and in favour of GSH versus PGT. Discernible differences in effectiveness were seen for iCBT in comparison with GSH and PGT. Given variance in delivery mode and human resources between different low-intensity interventions, building on these findings would be valuable for future service provision and policy decision making.     

The Development of Symbolic Uses of Objects in Infants in a Triadic Context: A Pragmatic and Semiotic Perspective

In this study, we address the construction of the first symbolic uses of objects in contexts of triadic interaction (adult–child–object). We assume that symbolic productions are based on public rules of the use of objects previously agreed by the community. The first symbols are not rooted in any literal, evident reality, but in shared rules of uses about the material world. We observed six dyads communicating and interacting together with 10 objects in a semi‐structured situation longitudinally from 9 to 15 months of age. We found that the infants gradually constructed symbolic meanings, and we identified five symbolic levels and sublevels. At 9 months, the infants attended and engaged in the symbolic uses produced by an adult even though they themselves were not yet able to produce them. At 12 months, infants began to use objects symbolically to communicate with adults. The highest percentage of these first symbolic uses was of level 1, that is, with a close relation to the conventional use of the object used to perform the symbol. At 15 months, children increased their symbolic uses and performed symbolic uses at all levels, whereas adults reduced such practices. Adult semiotic mediation and the social meanings of objects can be considered important factors in children's symbolic productions. Copyright © 2014 John Wiley & Sons, Ltd.