Family reconciliation as a response to adolescent crises

Concern for adolescents who act in dangerous, life-threatening ways has heightened dramatically in recent years. Many of these adolescents appear to come from nuclear families isolated from their kinship systems. Without the mediating effects of kin, the adolescent transition can become a major crisis. Kinship systems remain cohesive when members can reconcile their beliefs about essential aspects of family functioning with the demands for adaptation during major life transitions. Reconciliation is lost when members believe that kin can no longer be trusted to insure their well-being. Kinship fragmentation ensues as family members leave the field or are excluded. Isolated nuclear families then rapidly lose the resilience to respond to life transitions without resorting to extreme, maladaptive solutions. The Systemic Crisis Intervention Program (SCIP) uses the opportunity of the crisis precipitated by the adolescent's life-threatening behavior to alter family myths that have led to network fragmentation. Crisis teams mobilize and meet with kin in four-hour gatherings to foster reconciliation and kinship system reintegration.     

Chronic Illness and the Life Cycle:A Conceptual Framework

This article provides a conceptual framework for thinking about the system created at the interface of chronic illness with the family life cycle. First, a psychosocial typology and time phases of illness schema is described as a necessary, preliminary step to create a common language that bridges the worlds of illness, individual, and family development. This schema organizes similarities and differences between diseases in a manner useful to psychosocial-developmental rather than biomedical inquiry. Then, drawing on several major life-cycle theories in the literature, key concepts (periods of transition, life-structure building and maintaining, centripetality, and centrifugality) are used in a complementary fashion to link these three lines of development. Equipped with these psychosocial languages, consideration is given to transgenerational aspects of illness, loss, and crisis, and the interwoven threads of illness, family, and individual development. Clinical vignettes are provided to highlight this conceptual framework.     

Families of Adolescent Drug Abusers Are “Rigid”: Are These Families Either “Disengaged” or “Enmeshed,” or Both?

The FACES instrument, based on Olson's Circumplex Model of family functioning, was administered to 96 adolescent drug-abuse clients and their parents. The majority of these families categorized themselves as "disengaged" (rather than "enmeshed") on the cohesion dimension, and as "rigid" (rather than "chaotic") on the adaptability dimension. These findings were unexpected as they were substantially different from published findings on families with other types of problems. Family therapists, utilizing Olson's Clinical Rating Scale for the Circumplex Model, characterized significantly more of these same families as "enmeshed," rather than "disengaged." Possible explanations for the difference between the therapists' perceptions and the families' self-perceptions are discussed.     

Stability and Change in Type A Components and Cardiovascular Reactivity in Medical Students During Periods of Academic Stress1

This study examined the effects of academic stress upon components of Type A behavior and cardiovascular reactivity. In a longitudinal design, heart rate and blood pressure responses to the Type A Structured Interview (SI) and additional laboratory challenges were measured in medical students at three points during an academic semester. Sessions 1 and 3 were scheduled during vacation periods; Session 2 took place during an intensive examination week. Results indicated that three “stylistic” components of Pattern A derived from the SI—loud and explosive speech, short response latency, and potential for hostility—increased significantly during the exam period. Similar increases achieved marginal significance for another stylistic component, rapid and accelerated speech. By contrast, global Type A assessments did not increase with academic demands. Cardiovascular reactivity was significantly but only moderately stable across the three sessions, showing less consistency than has been reported in previous research. In addition, there was little evidence in this study that cardiovascular reactivity was potentiated by academic stress or by Type A behavior. These results demonstrate the influence of naturalistic environmental factors on overt behavioral components that have recently been suggested as coronary risk factors. Therefore, it is advisable for future experimental and epidemiological research to examine the social and environmental context in which these behaviors occur.     

The evolution of a therapy group for vietnam veterans on a general psychiatry unit

The evolution of a therapy group for hospitalized Vietnam veterans with post-traumatic stress disorder (PTSD) and related symptomatology is described. The literature on group treatment for this population is briefly reviewed and discussed in relation to an inpatient psychiatry setting. The prevailing conditions at the time of group inception are recalled along with the initial goals of the therapeutic intervention. Problems encountered are also discussed, along with the changes made in response to these identified difficulties. The results of three and one-half years of experience with this group are described in detail.The authors would like to thank Cynthia Sturm, Ph.D. for her helpful editorial assistance.     

PROMOTING AUTOMOBILE SAFETY BELT USE BY YOUNG CHILDREN

A program using behavioral practice, assertiveness training, and social and contrived reinforcers was developed to establish and maintain automobile safety belt use by young children. Sixteen children (ages 4.8 to 7 years) who never used their safety belts during a 5-day preexperimental observation period were randomly assigned to two groups of eight each. A multiple baseline design across groups was used to evaluate the effectiveness of the training program. During the 8-day baseline period for Group 1, no children used their safety belts when unobtrusively observed while being driven from school. During the 26-day intervention period, the children were buckled up on 96% of the observations. Follow-up probes conducted 2–3 months after program discontinuance found safety belt use to range from 86% to 100%. For Group 2, the 14-day baseline safety belt use averaged 6% and increased to a mean of 81% during the 20-day training and maintenance program. Follow-up probes 2–3 months later found safety belt use to occur during 75% to 96% of the observations. Parent questionnaires indicated the generalizability and social validity of the program.     

MAINTAINING PERFORMANCE OF AUTISTIC CLIENTS IN COMMUNITY SETTINGS WITH DELAYED CONTINGENCIES

To facilitate the classroom and workshop integration of three autistic clients, we examined the feasibility of teaching them to respond appropriately without the continual presence of specially trained treatment providers. Within a multiple baseline design, a 4-step treatment process was implemented to promote durable responsive performance. Results indicated that the therapist could be removed from the treatment environment and that appropriate behavior could be successfully maintained in community settings with only infrequent and delayed contingencies.     

Saying and doing: A contingency-space analysis

Correspondences between verbal responding (saying) and nonverbal responding (doing) may be organized in terms of the classes of verbal/nonverbal relations into which particular instances of verbal/nonverbal response sequences can enter. Contingency spaces, which display relations among events in terms of the probability of one event given or not given another, have been useful in analyses of nonverbal behavior. We derive a taxonomy of verbal/nonverbal behavior relations from a contingency space that takes into account two conditional probabilities: the probability of a nonverbal response given a verbal response and that probability given the absence of the verbal response. For example, positive correspondence may be said to exist as a response class when the probability of doing is high given saying but is otherwise low. Criteria for other generalized classes, including negative correspondence, follow from this analysis.