Psychotherapy with an adolescent boy who refused medical treatment

In this paper we describe psychotherapeutic work carried out in a paediatric hospital to illustrate the important contribution of a psychoanalytically-oriented approach in a hospital context. The work concerns an adolescent boy who had undergone several surgical operations with the result that some of his natural orifices were obstructed and artificial ones had to be created. He was referred to us because he refused pharmacological and rehabilitative treatment necessary prior to further surgery and his eventual recovery. The boy's experience of loss of control of his life and the more primitive anxieties of not feeling safely contained in his physical and psychic skin emerged and were worked through in the psychotherapeutic relationship. The parallel work with medical staff reduced the risk of splitting and acting out by the patient and professionals. The approach adopted enabled this boy to resume his medical treatment and his developmental process.     

The Parent Alienation Syndrome: A Family Therapy and Collaborative Systems Approach to Amelioration,by L. Gottlieb

No abstract available for this article.     

Associations of Identity Dimensions with Big Five Personality Domains and Facets

Personality is among the most important factors contributing to individual differences in identity formation. However, previous studies mainly focused on broad personality domains and neglected more specific facets. In addition, it has only recently been recognized that identity formation is guided by multiple types of commitment and exploration. The present study aimed to remedy these limitations by relating the 30 personality facets of the NEO‐PI‐3 to five identity dimensions. In general, identity formation was especially facilitated by high levels of Conscientiousness and, to a lesser extent, also by high levels of Extraversion and low levels of Neuroticism. Openness and Agreeableness predicted greater involvement in both the positive side (i.e. exploration in breadth and depth) and negative side (i.e. ruminative exploration) of the exploration process. Personality facets and their overarching domains, as well as facets underlying the same domain, were often differentially associated with identity dimensions. Additionally, we found that some personality facets both have bright and dark sides, as they predicted both proactive identity work and a weakened sense of identity. Overall, the present study underscores the utility of multidimensional models of identity formation and points to the benefits of considering personality facets in addition to broad domains. Copyright © 2012 John Wiley & Sons, Ltd.     

Investigating a socially anxious‐impulsive subgroup of adolescents: A prospective community study

Previous research has identified a subgroup of socially anxious adults who are both anxious and impulsive. To date, however, this subgroup has not been identified in adolescence. Therefore, in this study we aimed to identify this subgroup in a sample of adolescents. In addition, we hypothesized that this subgroup would be higher on problem behaviors, and that these processes would be moderated by gender. We used longitudinal data from 714 adolescents who were in the 7th and 8th grades at Time 1. They were followed annually for three years. Cluster analyses identified an anxious‐inhibited subgroup as well as an anxious‐impulsive subgroup in early adolescence (Time 1). The socially anxious‐impulsive adolescent boys were generally higher on both intoxication frequency and delinquency compared with all other adolescents in all clusters at each time point. Findings suggest that social anxiety subgroups may differ on problem behavior, and that early detection of an anxious‐impulsive subgroup may be important to prevent maladjustment, especially for adolescent boys.     

‘I don't want to be the mother of a paedophile’: the perspectives of mothers whose adolescent sons with learning disabilities sexually offend

The subject of sexual abuse is a major focus of professional and public concern. Sexual abuse of (and by) people with learning disabilities evokes even greater disquieting emotions, and makes severe demands on the social services, and the criminal justice system. The aims of the project were: 1) to determine whether group psychotherapy produced effective outcomes for adolescent boys with learning disabilities who exhibit sexually abusive behaviour, 2) to explore the perspectives of parents and other care-givers, and 3) to document the nature and extent of service support to families. This paper focuses solely on the mothers' perspectives. This was a three-year project with six boys (under 16) receiving group psychotherapy, using both quantitative and qualitative methods. Clinical measures were used to track changes throughout the course of psychotherapy. Semi-structured interviews (taped and transcribed) were held (separately) with the boys, their parents, paid care-givers and the therapists. The mothers tried hard to make sense of, and come to terms with, what was happening to their sons and to themselves, they struggled to reconcile their own confused and often conflicting emotions, and to maintain their own sense of identity. They felt almost totally unsupported by the services, both in the past and present, and could see little hope for the future. There is an urgent need for development of effective and sympathetic services for the parents of boys with learning disabilities who have been abused, and who are now showing abusive behaviour.     

Making Menarche Positive and Powerful for Both Mother and Daughter

Abstract

Psychotherapists who treat mothers with preadolescent daughters are in an excellent position to positively influence mother-daughter relationships at a time when Western societal influences are pushing them apart. Therapists are encouraged to help mothers process their own experiences with menarche, development of secondary sexual characteristics, and attitudes toward their bodies. By exploring these areas with their clients and then by encouraging the mothers to have early intimate discussions with their daughters, therapists can learn valuable information about their clients and can lay the groundwork for healthier mother-daughter relationships. Examples are given to help therapists encourage mothers to begin these difficult dialogues with their daughters. Suggestions are presented to help mothers overcome their daughters' reluctance to discuss sensitive topics of bodily maturation, menstruation, and emerging sexual development.     

Parent–adolescent conflict,treatment adherence and glycemic control in Type 1 diabetes: The importance of adolescent externalising symptoms

Parent–adolescent conflict has been demonstrated to relate to treatment adherence and glycemic control in adolescents with Type 1 diabetes. The present longitudinal study investigated how these variables were interrelated over time, and examined whether externalising and internalising symptoms function as mediating variables. A total of 109 adolescents with diabetes participated at four annual time points and completed measures on conflict with parents, internalising and externalising symptoms. Information on treatment non-adherence and glycemic control was obtained from treating physicians. Cross-lagged analyses from a structural equation modelling approach indicated that father–adolescent but not mother–adolescent conflict positively influenced treatment non-adherence over time, which, in turn, was associated with higher glycosylated haemoglobin-values. Further, externalising but not internalising symptoms were found to mediate the pathway from father–adolescent conflict to treatment adherence over time. Finally, mother–adolescent conflict was found to relate indirectly to treatment non-adherence through its relationship with externalising symptoms. Hence, the present longitudinal study provides evidence that externalising symptoms represent an important mechanism through which earlier experiences of parent–adolescent conflict may influence later treatment non-adherence and poorer glycemic control. Implications and suggestions for future research are outlined.     

Depressive mood and smoking onset: A comparison of adolescents with and without asthma

This prospective population-based study aimed to compare associations between depressive feelings and smoking behaviour of adolescents with and without asthma. Data were collected from a two-wave 22–24 months prospective study among 5938 adolescents who completed self-report questionnaires. Logistic regression analyses showed that depressive feelings and smoking were related both cross-sectionally and longitudinally. Smoking behaviour was similar for adolescents with and without asthma, as well as its correlation with depressive feelings. However, participants with asthma were more likely to report depressive feelings than those without asthma, implying an indirect relationship between asthma and smoking behaviour. Implications for prevention are addressed.     

Understanding adolescent type 1 diabetes self-management as an adaptive process: A grounded theory approach

Objective: To develop a conceptual understanding of the process of adapting to the self-management of type 1 diabetes during adolescence.

Design: Participants were recruited from a National Health Service paediatric diabetes service within the south-west of England which runs six countywide diabetes clinics. Thirteen interviews were conducted using a social constructivist grounded theory approach.

Results: The findings illustrate how self-management can be understood in terms of a continuum-based framework, ranging from difficulties with, to successful self-management. Adaptation within the continuum can further be understood by specific transitional phases and process mechanisms, providing further depth to individuals’ experiences of adaptation.

Conclusion: This investigation provides a conceptual understanding of the complex issues adolescents encounter while adapting to and integrating a diabetes self-management regime into their lives. It provides an invaluable framework for exploring psychological mechanisms and contextualising them within a self-management continuum. Implications for healthcare professionals are discussed and further research proposes whether the model could be applicable to other chronic illnesses.     

South African Adolescents' Career Development through the Lens of the Systems Theory Framework: An Exploratory Study

Adolescent career development has predominantly been studied in the context of middle class Eurocentric cultures and there have been calls for greater attention to the career development of non-dominant and disadvantaged groups. Further, there have been calls to explore career development in terms of its context and process. In this regard, the need for research measures and approaches sensitive to adolescents and particular cultures has been recognised. This is particularly the case in South African career psychology. The present study used a qualitative career assessment instrument, My System of Career Influences, to explore influences on the career development of disadvantaged South African adolescents living in a children's home. Consistent with previous international and national studies, parents were shown to be an important influence. Unlike previous studies, the influence of working overseas was also identified as an important influence. The MSCI was shown to be effective in providing insight into both the context and process of career development and as a research instrument that may be used with adolescents. Recommendations for future research are made.