Prevalence of Genetic Testing in CHARGE Syndrome

Parents of 145 individuals with a clinical diagnosis of CHARGE syndrome, ages 2 to 39 years, indicated in a survey whether their child had been tested for the CHD7 mutation, which is the only gene presently known to be associated with CHARGE. More than two thirds (68%) of the affected individuals had never been gene tested. Of the 46 who had been tested, 74% tested positive for the mutation. Half (50%) of those who underwent testing did so as a part of a conference blood draw by Baylor College of Medicine in 1999. Children who were tested were significantly younger than those who had not been tested. A second group of 43 parents were informally surveyed at a conference in 2009. More than half of their children had been tested, and nearly 70% were positive for the mutation. Reasons given by these parents for testing included confirming the diagnosis and assisting research. Reasons given for not testing included lack of opportunity, no known benefit, and lack of insurance coverage.     

Developing an indicator of family function and a practicable outcome measure for systemic family and couple therapy: the SCORE

There is a need for a measure of outcome in systemic family and couples therapy (SFCT) that reflects current theory and practice. To meet the needs of SFCT practice the measure needs to use self‐report by family members, take a short time to complete and be easy to understand. The development of such a measure, called the SCORE, is reported in this article. Substantial piloting, consultation and review in terms of clinical judgement led to the construction of the SCORE 40 which has forty items about how the family functions, rated by family members over 11 years of age on a Likert scale, in addition to independent ratings of the family and its difficulties. The SCORE 40 is shown to be a viable instrument but is too substantial for everyday clinical use. In a research project to reduce and refine the measure and determine its psychometric properties the SCORE 40 was administered to 510 members of 228 families at the start of their first appointment for family therapy at clinics throughout the UK. The scale has good psychometric properties and could operate with either three or four dimensions. The analyses of these data, combined with data from a convenience sample of 126 non‐clinical families, allowed a reduction to fifteen items while retaining most of the information provided by the SCORE 40. This version is offered with three dimensions of: (1) Strengths and adaptability; (2) Overwhelmed by difficulties; and (3) Disrupted communication. It is hoped that the ready availability of the SCORE 15 will encourage routine evaluation of outcomes in clinics as well as the SCORE being used flexibly for both therapy and research.     

Causal attributions during therapy I: Responsibility and blame

The way that responsibility is attributed and blame is expressed and apportioned in families is a crucial but rather neglected issue for family therapy. A case is made for analysing causal attributions as a way to gain a better understanding of these processes. The Leeds Attributional Coding System (Stratton et al. , 1988) was used to analyse all the attributions made early in therapy by eight families which included biological, step- and adoptive parents. Some 1799 attributions made by family members during ten therapy sessions were identified and their attributional dimensions recorded. Both parents and children used attributional patterns consistent with blaming the child and there was evidence of the occurrence of an 'attributional discrepancy', found previously in families of abuse, with more personal and controllable causes being applied to the child. Considering attributional dimensions in combination proved an effective way of identifying incidences of characterological blaming. Limited changes in the form of these attributions, by focusing on change in just one of the dimensions, could convert them into more benign and productive contributions to family conversations.     

Learning and career specialty preferences of medical school applicants

The present research examined relationships among medical school applicants’ preferred approaches to learning, methods of instruction, and specialty areas (n = 912). Based on confidential responses to a progressive series of paired comparisons, applicants’ preferences for lecture (L), self-study (SS), group discussion (GD), and computers (C) were assessed across three dimensions: (1) comfort; (2) effectiveness; and (3) interest. Using cluster analysis to generate four instructional “profiles,” participants’ comparative preferences for self-study/lecture versus group discussion/computers (+SS, L/−GD, C) were positively associated with interests in surgery and neurology, whereas opposing preferences (+GD, C/−L, SS) corresponded with the practice of family medicine. Using a matriculant subset (N = 160), analyses indicated that these relationships remained after controlling for sex and psychological type.     

Resilience to Interpersonal Trauma and Decreased Risk for Psychopathology in an Epidemiologic Sample

Quantitative measures of psychological resilience related to discrete stressors, such as interpersonal (IP) trauma, are lacking. The current study examined whether a novel, quantitative measure of resilience was related to decreased risk for a broad range of lifetime DSM-IV axis I disorders in an epidemiologic sample. Resilience was defined as the residual resulting from the difference between the individual’s predicted and observed PTSD symptom count, based on their cumulative exposure to IP traumatic events. Participants were 6288 adults (59.5% women; M _age  = 46.9, SD = 14.5) from the National Epidemiologic Study on Alcohol and Related Conditions endorsing at least one lifetime IP traumatic event. Logistic regressions were conducted to examine the relationship between resilience and axis I diagnoses, covarying for age, sex, education level, social support, and recent stressful life events. Greater resilience scores were associated with decreased likelihood of major depression (OR = .64, p < .001), generalized anxiety disorder (OR = .65, p < .001), social anxiety disorder (OR = .74, p < .001), panic disorder (OR = .65, p <. 001), and alcohol dependence (OR = .85, p < .001). Discrepancy between expected and observed PTSD symptom severity based on IP trauma load may represent a useful, quantitative measure of resilience.     

Dialogical construction of the selves of trainees as competent researchers

There is a widespread perception among family therapy trainees and practitioners of research as an alien activity. This perception is both damaging and unnecessary. Exercises to enhance the relationship of trainees to research were conducted in stages. Concepts of dialogically constructed selves were introduced, and exercises explored the trainees' construction of ‘self as a systemic therapist’. The idea of an extensive repertoire of selves was proposed. During subsequent research training the fact that all trainees had successfully completed a collaborative research project was exploited. Pairs successfully conducted a dialogue in which they actively and imaginatively constructed their selves as researchers.     

“Coming Out” to Parents in a Christian Context: A Consensual Qualitative Analysis of LGB Student Experiences

Disclosures of same-sex attraction are some of the most difficult experiences for lesbian, gay, and bisexual (LGB) individuals. For LGB individuals of faith, disclosure to parents is often complicated by the intersection of religion/spirituality and sexuality. This study presents a grounded theory about a particular subgroup to address gaps in the literature concerning how LGB students on Christian college campuses describe and experience their parental disclosures. Consensual qualitative research analysis (Hill, Knox, Thompson, Williams, & Hess, 2005; Hill, Thompson, & Williams, 1997) revealed themes related to predisclosure influencing factors, the disclosure event experience, and longer term impacts of the disclosure. Implications for parents, counselors, and college faculty/staff are provided.     

Causal attributions during therapy II: Reconstituted families and parental blaming

A powerful route to understanding communication within the family is provided by identifying and coding the causal attributions they make during family therapy sessions. The analysis of attributions of responsibility reported in the first of these linked papers (Stratton, 2003) is here extended to explore the accounts given by biological, step- and adoptive parents about their children. Some 1799 causal attributions offered spontaneously by the family members during therapy were analysed according to the Leeds Attributional Coding System (Stratton et al ., 1988). Attributional styles that previously have been found to relate to abuse were more common when stepfathers talked about their children, although none of the parents were believed to be abusing their children. The adoptive parents' attributions were more explicit about problems with the children but were more likely to be functional. Stepfathers made substantially more attributions in the form of blaming a child, with the dimensions identifying characterological blaming being especially significant. Alternative styles of attributing which would offer a way of avoiding characterological blaming are presented. Possible causes and consequences of the consistencies in problematic attributing, and the implications for therapy, are discussed.