Clinical Guidelines for Working With Stepfamilies: What Family,Couple, Individual,and Child Therapists Need to Know

This article draws on four decades of research and clinical practice to delineate guidelines for evidence‐informed, clinically sound work with stepfamilies for couple, family, individual adult, and child therapists. Few clinicians receive adequate training in working with the intense and often complex dynamics created by stepfamily structure and history. This is despite the fact that stepfamilies are a fundamentally different family form that occurs world‐wide. As a result many clinicians rely on their training in first‐time family models. This is not only often unhelpful, but all too often inadvertently destructive. The article integrates a large body of increasingly sophisticated research about stepfamilies with the author's four decades of clinical practice with stepfamily relationships. It describes the ways in which stepfamilies are different from first‐time families. It delineates the dynamics of five major challenges stepfamily structure creates: (1) Insider/outsider positions are intense and they are fixed. (2) Children struggle with losses, loyalty binds, and change. (3) Issues of parenting, stepparenting, and discipline often divide the couple. (4) Stepcouples must build a new family culture while navigating previously established family cultures. (5) Ex‐spouses (other parents outside the household) are part of the family. Some available data are shared on the impact of cultural and legal differences on these challenges. A three‐level model of clinical intervention is presented: Psychoeducational, Interpersonal, and Intrapsychic/Intergenerational Family‐of‐Origin. The article describes some “easy wrong turns” for well‐meaning therapists and lists some general clinical guidelines for working with stepfamily relationships.     

Examining the relationship between family context and children’s physical activity beliefs: The role of parenting style

Objectives

Previous research studies examining parental influences on children’s physical activity (PA) have focused primarily on parents’ own PA behavior, as well as their PA-related beliefs and socially supportive behaviors. The present study, although aligned with this mainstream parental influence research, was grounded in a broader child development perspective to examine the influence of parenting style on children’s PA beliefs and quality of parent-child communication.

Method

Self-report questionnaires were administered to 173 children ranging in age from 9 to 12 years to assess their perceptions of parenting style, parent-child communication patterns, as well as their own perceptions of fitness competence, value, and goal orientation.

Results

Children’s constellation of beliefs and attitudes regarding PA as well as their perceptions of the parent-child communication process did vary as a function of the type of parenting style they perceived their parents to use. High challenge parenting style was linked to higher perceived fitness competence and value on the part of the children. High support parenting style was linked to more positive perceived parent-child communication patterns.

Conclusion

Parenting style may be a critical underlying family process variable that impacts children’s development of a positive constellation of beliefs about PA. Future work is needed to link parenting style and children’s PA beliefs to their PA behavior.     

The Development of Family Alliance From Pregnancy to Toddlerhood and Child Outcomes at 5 Years

This article presents a longitudinal study of the development of “family alliance” from pregnancy to toddlerhood in a community sample, as well as its links with the emotional and cognitive development of the child at age 5 years. Family alliance is defined as the quality of the interactive coordination between family members. We consider that the alliance constitutes a context for the child to learn emotion regulation and to develop an understanding of inner states. Family interactions (N = 38) were observed at the 5th month of pregnancy and at 3, 9, and 18 months after birth in a standardized situation of observation (Lausanne Trilogue Play). Marital satisfaction and child temperament were assessed through self‐reported questionnaires. Several outcomes of the child at age 5 years were measured: theory of mind performances, predominant emotional themes in pretend play, internalized and externalized symptoms. Results show that (a) three patterns of evolution of family alliance occur: “high stable” (n = 19), “high to low” (n = 10), and “low stable” (n = 9); (b) a high stable alliance is predictive of better outcomes in children at age 5 years, especially regarding theory of mind; (c) the temperament of the child is predictive of child outcomes; and (d) an interaction effect occurs between family alliance and temperament. These results highlight the importance of both family‐level and individual‐level variables for understanding individual differences in the social and cognitive development of children.     

Understanding children's emotional processes and behavioral strategies in the context of marital conflict

Marital conflict is a distressing context in which children must regulate their emotion and behavior; however, the associations between the multidimensionality of conflict and children’s regulatory processes need to be examined. The current study examined differences in children’s (N = 207, mean age = 8.02 years) emotions (mad, sad, scared, and happy) and behavioral strategies to regulate conflict exposure during resolved, unresolved, escalating, and child-rearing marital conflict vignettes. Children’s cortisol levels were assessed in relation to child-rearing and resolved conflict vignettes. Anger and sadness were associated with escalating and child-rearing conflicts, fearfulness was related to escalating and unresolved conflicts, and happiness was associated with resolution. Anger was associated with children’s strategies to stop conflict, whereas sadness was associated with monitoring and avoidant strategies. Cortisol recovery moderated the link between fearfulness and behavioral regulation. These results highlight the importance of children’s emotions and regulatory processes in understanding the impact of marital conflict.     

Stability and Invariance of Psychopathic Traits from Late Adolescence to Young Adulthood

The current study examined the longitudinal stability and invariance of psychopathic traits in a large community sample of male twins from ages 17 to 23. Participants were assessed across 6 years to gauge the stability and measurement invariance of the Minnesota Temperament Inventory (MTI), a Cleckley-based measure of psychopathic personality traits, and how family functioning and externalizing behavior were linked to these traits. A latent variable approach was used to model the structure of the MTI and provide a statistical test of measurement invariance across time. The results revealed support for invariance and moderate to strong stability of the MTI factors, which showed significant associations with the external correlates in late adolescence but not early adulthood.     

Research trauma in incarcerated spaces: Listening to incarcerated women's narratives

This paper discusses researcher emotional experiences evoked while conducting narrative interviews in a research project that explored the rehabilitation experiences of 18 incarcerated women. I highlight the significance of listening as a methodology in spaces of incarceration. The importance of retrospective reflexivity in locating experiences of trauma encountered during the research process is discussed. The paper also brings to the fore the transformative power of stories for listeners as I share how my prejudices and attitudes regarding incarcerated women, as people who are framed as dangerous, were challenged. Experiences with interviewing and connecting with the incarcerated women further emphasised the importance of proactive self-care for researchers, with the significance of reflexivity as a self-care tool when doing qualitative research with vulnerable populations.     

Do Parent–Adolescent Discrepancies in Family Functioning Increase the Risk of Hispanic Adolescent HIV Risk Behaviors?

In the family‐based prevention science literature, family functioning, defined as positive parenting, parental involvement, family cohesion, family communication, parental monitoring of peers, and parent–adolescent communication, has been shown to ameliorate HIV risk behaviors in Hispanic youth. However, the majority of studies have relied solely on parent or adolescent reports and we know very little about parent–adolescent family functioning discrepancies. Therefore, the purpose of this study was to examine whether and to what extent parent–adolescent discrepancies in family functioning increased the risk of HIV risk behaviors, including substance use and sexual risk behaviors, and whether these associations vary as a function of acculturation and youth gender. A total of 746 Hispanic 8th grade youth and their primary caregivers were included in the study. Structural equation modeling findings indicate that parent–adolescent family functioning discrepancies are associated with an increased risk of Hispanic adolescent HIV risk behaviors, including lifetime and past 90‐day alcohol and illicit drug use, and early sex initiation. In addition, study findings indicate that results vary by acculturation and youth gender. Findings are discussed in the context of existing family‐based research and practice in preventing and reducing HIV risk behaviors among Hispanic youth and their families.     

Profession Differences in Family Focused Practice in the Adult Mental Health System

There is a large gulf between what psychiatric services should (or could) provide and what they do in practice. This article sought to determine practice differences between the differing professions working in adult mental health services in terms of their family focused work. Three hundred and seven adult mental health professionals completed a cross‐sectional survey of family focused practices in adult mental health services. Findings highlight that social workers engaged in more family focused practice compared to psychiatric nurses, who performed consistently the lowest on direct family care, compared to both social workers and psychologists. Clear skill, knowledge, and confidence differences are indicated between the professions. The article concludes by offering direction for future profession education and training in family focused practices.     

Learning from parents' stories about what works in early intervention

Using a multiple case study approach, this ethnography examined the experiences of parents of children deemed at risk for developmental delays or disabilities who had received early intervention (EI) services (birth to age 3 years) in a large urban location in Western Canada. Participants (11 adult parents and 7 children) were drawn from six families. Methods of data collection included focus groups (FG), face‐to‐face interviews and file reviews. Member check and expert reviews were conducted throughout data collection and data analyses as part of the validation process in this ethnography. Qualitative content analyses followed by thematic analyses highlighted the implementation of family‐centred practices (FCP) as a main theme. Parents identified how EI professionals using FCP embraced collaborative practices. FCP resulted in parents leading the EI process for their children. More specifically, EI professionals shared strategies and information to support parents in gaining a deeper understanding of their children's individual developmental characteristics. Parents expressed how empowering this level of understanding was for them as they learned to articulate what were their children's needs for developmental, health and educational services. Recommendations for future research include inquiring about parents' experiences for families of diverse constellations and/or residing in smaller urban or rural communities.     

Relationships among perceived psychological growth,resilience and burnout in physicians

The purpose of this study was to examine the relationships between perceived growth as a physician (i.e., positive psychological changes experienced as a result of the professional experience) and burnout after controlling for the effects of perceived family support, dispositional resilience, age, and marital status among physicians. Physicians (n = 289) rated perceived support from family and completed the short form of the Posttraumatic Growth Inventory, the Resilience Scale, and Maslach Burnout Inventory. Results of hierarchical regression analyses revealed that the addition of perceived growth significantly improved prediction of resilience and perceived family support for burnout, showing that higher growth, resilience, and family support all were associated with lower levels of burnout. Moreover, the effects of growth on depersonalization, a domain of burnout, were stronger for physicians who perceived a lower level of family support, whereas the effects of growth on personal accomplishment, another domain of burnout, were stronger for physicians who showed a lower level of dispositional resilience. Current results have clinical implications for understanding protective factors for burnout, that is, a sense of personal growth may be a key factor for physicians who may be less resilient or may not perceive strong family support.