Testing the Biobehavioral Family Model in pediatric asthma: pathways of effect

This study uses a laboratory-based multiinformant, multimethod approach to test the hypothesis that a negative family emotional climate (NFEC) contributes to asthma disease severity by way of child depressive symptoms, and that parent-child relational insecurity mediates the effect. Children with asthma (n = 199; aged 7-17; 55% male) reported parental conflict, parent-child relational security, and depressive symptoms. Parent(s) reported demographics, asthma history, and symptoms. Asthma diagnosis was confirmed by clinical evaluation and pulmonary function tests, with disease severity rated by an asthma clinician according to NHLBI guidelines. Family interactions were evoked using the Family Process Assessment Protocol, and rated using the Iowa Family Interaction Rating Scales. Path analysis indicated a good fit of data to the hypothesized model (chi2[1] = .11, p =.74, NFI = .99, RMSEA = .00). Observed NFEC predicted child depression (beta = .19, p < .01), which predicted asthma disease severity beta = .23, p < .01). Relational security inversely predicted depressive symptoms (p = -.40, p < .001), and was not a mediator as predicted, but rather an independent contributor. The findings are consistent with the Biobehavioral Family Model, which suggests a psychobiologic influence of specific family relational processes on asthma disease severity by way of child depressive symptoms.     

Contextual Adult Life Span Theory for Adapting Psychotherapy with Older Adults

Our aging population is growing in size and diversity. To integrate different views on aging and make explicit the role of culture as a contextual factor, we modified Knight’s (Psychotherapy with older adults, 2004) Contextual, Cohort-based, Maturity, Specific Challenge (CCMSC) model of psychotherapy with older adults into the Contextual Adult Lifespan Theory for Adapting Psychotherapy (CALTAP). This article describes various components of the CALTAP, which serves as a meta-theoretical framework in guiding an integrated psychotherapy approach for the aging population. The interaction between environmental factors like cohort differences and socio-cultural contexts and individual factors such as maturation and age-related specific challenges not only shapes the experience and presentation of older adults in clinical settings, but also highlights special considerations in adapting psychotherapy for older adults.     

Spirituality as a Resiliency Quality in Xhosa-speaking Families in South Africa

The purpose of this qualitative study was to explore spirituality as a characteristic of family resilience in Xhosa-speaking families in South Africa. A parent, and in some cases an adolescent, represented each of the 51 families that participated. Participants were expected to respond to three open-ended questions regarding their family and identify factors or strengths that had recently helped their family. The results indicate that spirituality is an important coping resource. The core theme of spirituality consists of six related categories that facilitated the successful adaptation of the participating families after a crisis. These categories are Gifts from God; Guidance; God's Works; God's Plan; Prayer; and Faith.     

Family expressed emotion prior to onset of psychosis

This study compared components of expressed emotion (EE; rejection, warmth, protectiveness, and fusion) across three samples: two in which the subjects had an established schizophrenic or mood disorder, and a third in which the subjects were at high risk for an initial psychosis. METHODS: Family members rated themselves on the Social Adjustment Scale-III and, in the prodromal sample, estimated the duration of the prodrome. RESULTS: Scores were all but identical in the two established-disorder samples but were markedly higher than scores in the prodromal sample on all four factors. In mothers, warmth (decreasing), rejection, protectiveness, and fusion (increasing) were significantly correlated with duration of prodrome, whereas for fathers, warmth and protectiveness were similarly correlated. CONCLUSION: These data suggest that expressed emotion is largely reactive to deterioration manifested by the young person developing a psychotic disorder, rather than a trait of family members.     

The flexible application of a manualized treatment for PTSD symptoms and functional impairment related to the 9/11 World Trade Center attack

The purpose of this treatment effectiveness study was to evaluate the flexible application of a manualized cognitive behavioral treatment (CBT) for PTSD and related symptoms in survivors of the 9/11 terrorist attack on the World Trade Center. Treatment delivery ranged from 12 to 25 sessions; therapist experience ranged from no prior training to extensive training in CBT; and training and supervision of clinicians in the treatment manual was considerably less than that required in a randomized clinical trial (RCT). Paired t-tests demonstrated significant pre-post reductions in symptoms of PTSD and depression for the flexible application of the treatment. A benchmarking analysis revealed that the moderate-to-large effect sizes found for these variables were similar to those obtained in an RCT of the same treatment. Furthermore, effect sizes on measures of outcomes particularly relevant to this population of mass violence survivors such as functional impairment, use of alcohol and drugs to cope, and use of social support to cope, were also medium to large.     

Treatment Engagement: Building Therapeutic Alliance in Home-Based Treatment with Adolescents and their Families

Client engagement is an essential yet challenging ingredient in effective therapy. Engaged clients are more likely to bond with therapists and counselors, endorse treatment goals, participate to a greater degree, remain in treatment longer, and report higher levels of satisfaction. This study explored the process of engaging high-risk youth and their parents in a unique home-based family therapy intervention. Qualitative interviews were conducted with 19 families who completed family therapy sessions that included a core component aimed at increasing treatment engagement. Parents’ and youths’ perceptions of engagement suggest the importance of developing therapeutic alliance with therapists, who facilitated building a shared alliance among family members. Implications for improving client engagement are discussed within the context of alliance building with the therapist and among family members.     

Cross-ethnic Applicability of the Gender-based Attitudes Toward Marriage and Child Rearing Scales

The reliability and validity of Hoffman and Kloska’s (1995) Gender-based Attitudes toward Marital Roles (GATMR) and Gender-based Attitudes toward Child Rearing (GATCR) were assessed for a sample of Mexican American mothers and fathers (n = 167) of fifth-grade children in a large metropolitan area in the southwestern United States. Factor analysis was conducted, and the results suggest that the 6-item GATMR is conceptually distinct and reliable for this ethnic group. Correlation of GATMR scores for mothers and fathers with divisions of family labor suggest good validity. A 5-item revised GATCR demonstrated modest reliability and good construct validity. The value of these scales for work with Mexican American families is noted. Theoretical implications for gender socialization are explored, and suggestions for further research are offered. This research was supported by Grant # MH 54154-01A2 from the National Institute of Mental Health.     

Suffering and Spirituality in the Poetry of Emily Dickinson

After a brief review of recent accounts of spirituality in its relation to medicine and psychotherapy, Emily Dickinson’s poetry is considered as a springboard to a more specific account of spirituality. While not conventionally religious, she is arguably among the most spiritual of poets inasmuch as her themes of God, love, beauty, and especially death and suffering all depend upon the jarring juxtaposition of embodied human experience and transcendent human significance. Her poems suggest a complex view of the ambiguous relation of suffering to human action and meaning. Psychotherapy is a spiritual process not because it necessarily involves supernatural beings or destinies, but because it represents the struggle between human will and aspiration on the one hand and acceptance of biological and other realities on the other.     

Integrating Psychotherapeutic Processes with Cognitive Behavioral Procedures

There has been a recent focus on the processes that underlie intervention delivery for children and adolescents throughout the Cognitive-Behavioral Therapy (CBT) literature. Certain process variables have been associated with treatment outcome among youth receiving CBT. Data for these process variables including: the therapeutic alliance or therapeutic relationship, child and parent involvement, other child and therapist variables, and issues of diversity, are reviewed. Based on this data, specific clinical recommendations are made. The treatment relationship as a very important process (VIP), and the facilitation of CBT so that it is real and relevant to youth are emphatically discussed. Process issues in modular CBT are identified. Ultimately, genuine collaborative empiricism and guided discovery preserve the therapeutic relationship as a VIP, and foster the customization of therapeutic tools and the treatment trajectory.     

Is there a Relationship between Family Structure and Substance Use among Public Middle School Students?

We investigated the relationship between family structure and substance use in a sample of 2,138 public middle school students in a southern state. The CDC Middle School Youth Risk Behavior Survey was utilized and adjusted logistic regression models were created separately for four race/gender categories (African American females/males, and Caucasian females/males) to examine associations among selected drug use variables (tobacco, alcohol, marijuana and inhalants). Analyses were adjusted for social economic status. Results suggested differences (p ≤ .05) among race/gender groups for the protective effect of living in an intact family (both mother and father, real or adoptive) regarding substance use among middle school students. In addition, family structure appeared to have a stronger relationship with substance use for Caucasians as opposed to African American adolescents. Caucasian adolescents living in cohabitated family households were more likely to report substance use, when compared to those living in intact two-parent households. Adolescents who are undergoing parental divorce may need special attention as they transition into new family structures.