Communication of Information about Genetic Risks: Putting Families at the Center

Genetic information is a family affair. With the expansion of genomic technologies, many new causal genes and variants have been established and the potential for molecular diagnoses increased, with implications not only for patients but also their relatives. The need for genetic counseling and intrafamilial circulation of information on genetic risks grew accordingly. Also, the amount and, particularly, the complexity of the information to convey multiplied. Sharing information about genetic risks with family members, however, has never been an easy matter and often becomes a source of personal and familial conflicts and distress. Ethical requisites generally prevent healthcare professionals from directly contacting their consultands' relatives (affected or still at risk), who often feel unsupported throughout that process. We discuss here the communication of genetic risks to family members. We first consider genomic testing as a basis for family‐centered health care, as opposed to a predominant focus on the individual. We reviewed the literature on sharing genetic risk information with family members, and the associated ethical issues for professionals. Some clinical cases are presented and discussed, and key issues for meeting the needs of individuals and families are addressed. We argue that genetic information is inextricably linked to the family and that communicating about genetic risks is a process grounded within the broader milieu of family relationships and functioning. We conclude for the need for a more family‐centered approach and interventions that can promote sensitive attitudes to the provision of genetic information to and within the family, as well as its inclusion in educational and training programmes for genetic healthcare professionals.     

Effectiveness of the ‘Hold me Tight’ Relationship Enhancement Program in a Self‐referred and a Clinician‐referred Sample: An Emotionally Focused Couples Therapy‐Based Approach

While evidence‐based couple therapies are available, only a minority of troubled couples seek help and they often do this too late. To reach more couples earlier, the couple relationship education (CRE) group program “Hold me Tight” (HmT) based on Emotionally Focused Couples Therapy (EFCT) was developed. This study is the first to examine the effectiveness of HmT. Using a three‐wave (waiting period, treatment, and follow‐up) within‐subject design, HmT was delivered to 79 self‐referred couples and 50 clinician‐referred couples. We applied a comprehensive outcome measure battery. Our main findings were that (1) self‐referred couples significantly improved during HmT on all measures, that is relationship satisfaction, security of partner‐bond, forgiveness, daily coordination, maintenance behavior, and psychological complaints, with a moderate‐to‐large mean effect size (d = .63), which was maintained (d = .57) during the 3.5 month follow‐up; (2) in clinician‐referred couples, who were vulnerable in terms of insecure attachment status and psychopathology, the improvement during HmT was moderate (d = .42), but this was reduced during the 3.5‐month follow‐up to a small effect (d = .22); (3) emotional functioning (typical HmT target) as well as behavioral functioning (typical Behavioral Couples Therapy‐based CRE target) improved during HmT; and (4) individual psychological complaints, although not specifically targeted, were reduced during HmT. These findings suggest that HmT is a promising intervention for enhancement of relationship functioning. Clinical implications are discussed.     

Multiple Levels of Family Factors and Oppositional Defiant Disorder Symptoms Among Chinese Children

Family factors are closely associated with child developmental outcomes. This study examined the relationship of oppositional defiant disorder (ODD) symptoms and factors at whole family, dyadic, and individual levels in Chinese children. Participants, who were recruited from 14 primary schools in north, east, and south‐west China, included 80 father‐child dyads and 169 mother‐child dyads. Children in the participating dyads were previously diagnosed with ODD. Results revealed that family cohesion/adaptability was indirectly associated with ODD symptoms via parent–child relationship and child emotion regulation. Parent–child relationship affected ODD symptoms directly and indirectly through child emotion regulation. In addition, the effects of family cohesion/adaptability on parent emotion regulation and child emotion regulation were mediated by the parent–child relationship. The tested model provides a comprehensive framework of how family factors at multiple levels are related to child ODD symptoms and highlights the importance of understanding child emotional and behavioral problems within the family context, more specifically within the multiple levels of family relationships.     

Explorer l’expérience subjective du confinement lié à l’épidémie de la Covid-19 par les familles : une analyse interprétative et phénoménologique (IPA) du discours de parents

IntroductionThe COVID-19 containment measures had many effects on parents and children (stress, concerns), and the functioning of the whole family has been disrupted (lifestyle, habits, relationships).ObjectiveThe objective of this work is to highlight the idiosyncratic nature of the experience of confinement, its psychological consequences, and the changes it has induced within families.MethodInterested in the experiences of parents who had been confined within their families, we conducted interviews with parents and analyzed their discourse using the IPA method. We interviewed five parents (38–44 years old) with at least two children each (3–13 years old). Three of the interviewees were women.ResultsWe have identified seven major axes that illustrate the confinement experience of these families: accompanied by extracts from participants’ interviews (verbatims). The subjects lived this experience in confinement as a unique opportunity to spend time with their family and recalibrate what matters to them fundamentally in life.ConclusionThe experience of confinement has brought changes in the daily lives of these parents as well as in their way of understanding their existence. A form of positive revaluation emanates from their discourse.     

Delivered as Described: A Successful Case of Cognitive Processing Therapy With an Older Woman Veteran With PTSD

Cognitive processing therapy (CPT) is a first-line, evidence-based treatment for posttraumatic stress disorder (PTSD). Little is known, however, about the use of CPT for older adults. As the United States population continues to grow and age, an understanding of the utility of CPT for older adults is vital. We present a case study describing the assessment and cognitive treatment of a 74-year-old woman veteran with PTSD secondary to military sexual trauma. CPT was associated with decreased PTSD symptoms as measured before and after treatment. Factors contributing to the veteran’s response, as well as contextual and environmental factors, are discussed. The case demonstrates that CPT may be effective for older adults without major modification.     

When family considerations influence work decisions: Decision-making processes

The work–family literature has provided an abundance of evidence that various family factors are linked to various work decisions, suggesting that the “family-relatedness” of work decisions is a prevalent phenomenon (Greenhaus & Powell, 2012). However, the cognitive processes by which such linkages occur have received little attention. We offer a framework by which to examine individuals' decision-making processes when they take family considerations into account in their work decisions. The framework suggests stages through which individuals proceed when making a work decision that takes family considerations into account and cognitive processes that influence how they proceed through each stage.     

Coparenting Interventions for Fragile Families: What Do We Know and Where Do We Need To Go Next?

With a large and growing share of American families now forming outside of marriage, triangular infant–mother–father relationship systems in “fragile families” have begun to attract the interest of family scholars and clinicians. A relatively novel conceptualization has concerned the feasibility of intervening to support the development of a sustained and positive coparenting alliance between mothers and fathers who have not made an enduring relationship commitment to one another. At this point in time, there are very few published outcome studies of programs explicitly conceived to help build coparenting alliances in such families. This article reviews what we currently know from this evolving field of study, and from those related responsible fatherhood and marriage and relationship enhancement (MRE) initiatives that included any explicit targeting, strengthening, and assessment of fragile family coparenting in their designs. We summarize lessons learned thus far from Access and Visitation (AV) programs for non‐residential fathers, from MRE programs for low‐income, unmarried couples, and from newer programs for fragile families directly designed to target and support coparenting per se. We close with recommendations for charting this important new family process terrain.     

The Effects of Parental Education and Family Income on Mother–Child Relationships,Father–Child Relationships,and Family Environments in the People's Republic of China

Using a cross‐sectional design with 407 Chinese children aged 3–5 years and their parents, this study examined the effects of socioeconomic status, specifically parents' education and family income, on the children's mother–child relationships, father–child relationships, and the social environment in their families. The results indicated that income negatively predicted conflict in father–child relationships and positively predicted family active‐recreational environments. Income also positively predicted family cohesion among girls but not boys. Maternal education negatively predicted conflict in mother–child relationships and positively predicted closeness in mother–child and father–child relationships, family cohesion, and the intellectual‐cultural and active‐recreational environments in the family. Paternal education positively predicted family cohesion and intellectual‐cultural and active‐recreational environments. Income was found to partially mediate the effects of both maternal and paternal education on family active‐recreational environments. Findings are discussed in the frameworks of the family stress model and the family investment model.     

Scaffolding a community of competent practitioners: positioning and agency in a training program for narrative counseling

This article explores the scaffolding of learning experiences in a postgraduate program in New Zealand that offers training in narrative counseling. The authors draw on positioning theory to identify student shifts in learning, and in agency, that help build an increasingly skilled and peer-generated context for learning. We describe a selection of exercises and one key assignment, introduced in the course in a particular order, that we believe enable students to step into positions of agency which ultimately allow a competent community of learner-practitioners to emerge. We also describe a dance of positioning for ourselves as teachers in this program. We suggest that, at any given time, our own positioning is tied up with possibilities for student positioning. Acknowledging relationships of power in classrooms, we explore ways to align poststructuralist counseling practices and the teaching of these practices.     

Coping,psychological adjustment,and complementary and alternative medicine use in persons living with hiv and aids

Abstract

Many HIV-positive individuals dissatisfied with allopathic approaches to disease management have turned to complementary and alternative medicines (CAM). Although people use CAM for a variety of reasons (e.g., symptom management, holistic approach towards healthcare, improved immunity), the psychological benefits that these treatments may have are still not fully understood. The present study was designed to further previous research that demonstrated relationships between CAM use, stress appraisals, and coping behaviors. HIV-positive individuals (N= 127) completed measures assessing stress appraisals, coping, psychological adjustment, satisfaction with life, and immune functioning. After controlling for ethnicity and sexual orientation, stress appraisals and coping behaviors were found to be related to CAM use. Further, curvilinear relationships between CAM use and adjustment emerged, suggesting that some CAM use may be adaptive. Self-reported immune measures were unrelated to CAM use. In all, it appears that CAM use may be a complex form of coping that assists individuals in adjusting to a life-threatening illness. The implications of these findings with respect to adherence to highly active antiretroviral therapies (HAART) are also discussed.