Children's understanding of death according to parents and pediatricians

Thirty pediatricians and 30 parents were interviewed on (a) how and when children develop concepts about death, (b) children's emotional responses to the thought of death, (c) the possibility of dialogue between adults and children about death, and (d) differences in healthy and seriously ill children's conceptualization of death. Pediatricians were no different than parents in their opinions. Moreover, in some cases, less educated parents and older doctors tended to hold opinions that were even farther from reality. Overall, the results suggest that children, healthy or sick, are left alone with the problem of death and are not helped either by their parents or by their doctors.     

The impact of the therapeutic environment

This paper emphasizes the impact of the setting, space, and general physical properties of the clinic upon the difficult patient's profound neediness and absence of inner regulatory structure. Moreover, the clinic's administrative style and requirements often related to fiscal restraints, demands for accountability for both how funds are spent and treatment outcome, all impinge upon the patient. Humanizing clinics so they have the capacity for psychotherapeutic holding and provision of safety for difficult patients are discussed in detail in this contribution.     

Preventing Substance Abuse Among American-Indian Adolescents: A Bicultural Competence Skills Approach

Tobacco, alcohol, and drug use are problems for American-Indian people. We reviewed these problems and the explanations for them and described a bicultural competence skills approach for preventing substance abuse with American-Indian adolescents. Data from a study of that approach suggest its efficacy with American-Indian youth. At posttest and a 6-month follow-up, American-Indian subjects who received preventive intervention based on bicultural competence skills concepts improved more than did American-Indian subjects in a no-intervention control condition on measures of substance-use knowledge, attitudes, and interactive skills, and on self-reported rates of tobacco, alcohol, and drug use. Our findings have implications for future substance-abuse prevention research with American-Indian people.     

A record-keeping format for training systemic therapists

Training in systemic therapy necessitates a structured approach to teaching systemic thinking. The Systemic Therapy Sessions Summary Form, a record-keeping method, is presented as a tool for enhancing training in systemic therapy. The purpose of this form is to provide the structure for the trainee to develop circular hypotheses, to connect reflexively the assessment and intervention components of therapy, and to maintain a sense of the evolving nature of therapy across sessions. A case example illustrates the use of this record-keeping format.     

The Anorectic Process in the Family: A Six-Stage Model as a Guide for Individual Therapy

This article presents a conceptual framework for individual treatment with chronic anorectic patients. In the first part of the article, the six-stage model for the anorectic process developed over the past years by M. Selvini-Palazzoli and her team is briefly explained. After presenting the model, we then discuss some related concepts, namely, "family game," "rule," and "strategy." Finally, the therapeutic technique in individual treatment is discussed. Two basic assumptions underlie this technique: first, the therapeutic relationship is instrumental, its main purpose being to improve the patient's personal relations outside therapy; second, the focus of the treatment is on the strategic incapacity of the patient who is caught up in and unable to cope with the "concealed family game."     

Systemic crisis intervention as a response to adolescent crises: an outcome study

The present study demonstrates the safety and effectiveness of an outpatient program designed to respond to adolescent-precipitated crises by mobilizing and restructuring the family's kinship system. Families of 75 adolescents at risk for hospitalization were followed up to 24 months after treatment with Systemic Crisis Intervention. Measures of offspring and family functioning, suicidal behavior, institutional use, and treatment costs are presented. Results clearly demonstrate the safety, effectiveness, and economic viability of Systemic Crisis Intervention.     

Systemic Optimism — Systemic Pessimism: Two Perspectives on Change

Therapists have a mandate to bring about change, and family therapists appear to have unusual leverage to fullfill such a mandate, that is, to facilitate changes rapidly and effectively. Because and in spite of this mandate, the very notion of change deserves critical reflection. The history of ideas and our clinical experience teach us that changes may be problematic. They may come too fast or too slowly, may endure or fade away, may turn out to be desirable or undesirable, equitable or inequitable, and may, when further consequences and larger systems levels are taken into account, be beneficial or disastrous. This essay examines some of the problematical and contradictory aspects of change and delineates two perspectives on change--systemic optimism and systemic pessimism.     

CHILD-REARING BELIEFS WITHIN DIVERSE SOCIAL STRUCTURES: MOTHERS AND DAY-CARE PROVIDERS IN MEXICO*

The child-rearing beliefs of 32 mothers and 36 day-care providers in Mexico were compared. Day-care providers expected children to master developmental skills at an earlier age than did mothers. Day-care providers more strongly valued the development of independent and cooperative behavior, and placed less importance on obedience. They also reported employing more flexible and nonauthoritarian discipline strategies than did mothers. Mothers and caregivers did not differ in the extent to which they attributed the success of their discipline strategies to their own actions rather than to external factors. Also examined was how mothers' beliefs differed in families characterized by interdependent versus individualistic social structures. In interdependent families, mothers were more likely to believe in later mastery of developmental skills and to make external attributions. These findings suggest that Mexican children experience incongruous social norms as they move between home and day care settings, and that these norms, at least within the home, are associated with the social structural features of the setting.     

RELATIONSHIP BETWEEN HOLLAND'S TYPOLOGY AND COGNITIVE STYLES

This paper combines the results of two studies across different cultures which included an investigation into the relationship between field-dependence-independence and vocational orientations within the framework of Holland's theory of career choice and Witkin's theory of psychological differentiation. The samples included 179 Canadian senior high school students and 376 Pakistani college and university students. Both samples were administered Self-Directed Search and Group Embedded Figures Test. The results indicated a significant relationship between cognitive styles and vocational orientations. It was evident from the findings of these two studies that the theories of Holland and Witkin dove-tail nicely with each other.