Narrative exposure therapy for political imprisonment-related chronic posttraumatic stress disorder and depression

The psychological consequences of traumatic stress may last even into old age. In persons in their 60s and 70s who had been victims of political detention and torture four decades ago, we compared the outcome of narrative exposure therapy (NET) to that of psychoeducation (PED) only. From a group of 59 former political detainees, 18 who fulfilled the full PTSD criteria according to the Composite International Diagnostic Interview (CIDI) were offered and accepted participation in the treatment study. The participants were randomly assigned to either one session of PED (n=9) or five sessions of NET (n=9). Symptoms of PTSD (CIDI) and depression (Beck Depression Inventory, BDI) were assessed prior to treatment and after a 6-month follow-up. NET but not PED produced a significant reduction in post-traumatic symptoms and depression scores. Four out of 9 of those who completed NET, compared to 8/9 of those within the PED group, still had PTSD 6 months after the treatment had ended. These results indicate that NET may lead to the alleviation of post-traumatic and depression symptoms even when the conditions persist for excessive time periods.     

Money: a therapeutic tool for couples therapy

This article addresses the therapeutic importance of discussing money at every stage of a couple's relationship, both as a concrete reality and as a metaphor for security, adequacy, competence, commitment, acceptance, and acknowledgment in a relationship. I will present a developmental schema looking at financial issues that couples confront at various stages in the adult life cycle and how these affect and reflect relationship problems. The article also presents a money questionnaire as a useful tool for exploring family-of-origin financial history, affect, and behavior.     

Explication of interspousal criticality bias

Although bias towards perceiving spousal criticism is related to dysphoria and marital discord (Smith & Peterson, 2008), the bias construct has received insufficient elaboration. We explicated the criticality bias construct by exploring its correlates and incremental validity relative to perceived criticism, marital attributions, and negative affect. 118 couples completed self-report measures and undertook a videotaped discussion task. Signal detection analyses of both spouses' and outside observers' ratings of discussions produced bias indices. Criticality bias evidenced a pattern of convergent and discriminant validity mirroring perceived criticism's (Renshaw, 2008). Bias also provided incremental validity beyond perceived criticism, marital attributions, and negative affect to the prediction of behavior. Bias may be a dysfunctional way to view marital events and a stress generation process.     

Narrative Ideas for Consulting with Communities and Organizations: Ripples from the Gatherings

This paper reviews Michael White's early work with communities and extends ideas and practices from that work into the realm of consulting with organizations. We draw on Michael's writing and the records of two specific projects, as well as the recollections of team members in those projects, to describe how ideas and practices that were originally developed in working with individuals and families came to be applied in community settings. Specifically, we show how the central intention of the work is to use narrative ideas and practices in ways that allow communities to articulate, appreciate, document, utilize, and share their own knowledges of life and skills of living. We discuss the basic narrative ideas of stories, double listening, telling and retelling, making documents, and linking lives through shared purposes. For these projects, the teams developed structures that made it possible to use the basic idea with whole communities. We show how this work with communities has offered inspiration and ideas for our work in consulting to organizations. Finally, we describe and illustrate a particular way of working with organizations that carries the spirit of Michael's community work into situations requiring shorter blocks of time and more limited commitments than the original community contexts.     

Cultural differences in family, marital, and gender-role values among immigrants and majority members in the Netherlands

This study examined the size of differences in self-reported family, marital, and gender-role values in five cultural groups in the Netherlands (6338 Dutch mainstreamers and 422 Turkish, 369 Moroccan, 429 Surinamese, and 394 Antillean first- and second-generation immigrants). It was found that the three value scales were neither completely independent, nor could they be merged into a single value scale. The factor structures of all scales were identical for the five cultural groups, implying that the concepts can be compared. Age, sex, and notably education accounted for a substantial part of the cultural differences in all values. Cultural differences were larger for marital and family values than for gender-role values. Family and marital values yielded the same rank order of mean scores in the five cultural groups: Turks and Moroccans scored the lowest (having the most traditional values), followed by Surinamers, Antilleans, and Dutch mainstreamers. This rank order corresponds with the ethnic hierarchy of cultural groups that is based on the evaluation of ethnic groups by mainstreamers according to their liking of and likeness to ethnic groups. Generational differences were not found for family and gender-role values but first-generation immigrants in all groups had more traditional marital values than had second-generation immigrants. It was concluded that the theoretical framework based on a combination of three Hofstede dimensions (individualism-collectivism, power-distance, and femininity-masculinity), a model of the hierarchy of the ethnic groups in the Dutch society, and acculturation theory provided an adequate way to address family, marital, and gender-role value differences in the five cultural groups.     

Scene-Based Psychodramatic Family Therapy With Troubled Adolescents and Parents: A Pilot Study

Scene-Based Psychodramatic Family Therapy (SB-PFT) is an innovative treatment used with troubled adolescents and their parents to improve family relationships and reduce adolescents’ problematic behavior. It integrates the principles of family therapy, psychodrama, and multiple-family group methodology. This research is a pilot study to obtain empirical evidence on the SB-PFT therapeutic process by gauging the perception of change of troubled adolescents and their parents, and assess the perceived helpfulness of its methodology and techniques. Ten multiple-family intervention groups were drawn up, with 110 participants (63 adolescents and 47 parents), and we adopted a qualitative methodology with focus groups, using an inductive analysis of 290 active constructions of participant narratives. Concerning perception of change, the adolescents reported mainly gaining in social support, prosocial attitudes, keys to problem solving, and expression of emotions due to the treatment. The parents perceived improvement in social support, keys for educational practices, emotional well-being, and expression of emotions due to the treatment. Regarding the perceived helpfulness of methodology and techniques, both adolescents and parents highlighted the usefulness of the group methodology for gaining social support, relativizing the problem, and expressing emotions. Additionally, participants referred to role-playing and mirror techniques as the most useful techniques. In conclusion, this first study on SB-PFT presents and describes its treatment for troubled adolescents and their parents. The participants’ positive perception of their personal and relational change after treatment should serve to promote further studies with quantitative methodology in order to verify the effectiveness of SB-PFT treatment.     

Building an Expanded Therapeutic Alliance: A Task Analysis with Families Trapped in Parental-Adolescent Conflict

Parental-adolescent conflict is part of the normal developmental cycle of families, but when it occurs in a dysfunctional way, it is associated with the appearance of various harmful conditions for the family system and for the adolescent in particular. Family therapy is one of the main options for psychotherapeutic intervention in these cases and has ample evidence of its effectiveness. The success of this intervention is conditioned to the construction of an adequate therapeutic alliance with the family, but the process of this task has not been clarified yet. The present study is a task analysis, the purpose of which was to create a heuristic model of how an expanded alliance may be built in these kinds of cases. The model was revised and improved from the intensive analysis of six cases. The resulting model can be a useful guide for family therapists in that it describes the specific client and therapist behaviors involved in balancing the alliance, as well as the potential obstacles and suggested ways to resolve them.     

The Findings of a Cochrane Meta-Analysis of Couple Therapy in Adult Depression: Implications for Research and Clinical Practice

The association between depressive symptoms and distressed intimate relationships supported the assumption that couple therapy, by focusing on the interpersonal context of depression, might be more effective as a treatment for depression than individual psychotherapy or drug therapy. This issue was addressed by a Cochrane meta-analysis assessing the evidence from clinical trials of couple therapy for depression in comparison with individual psychotherapy, drug therapy, and no/minimal intervention, including fourteen studies with 651 participants. No study was found free of bias and the quality of the evidence was low, with major problems of small sample sizes, missing outcome data, selective reporting, lack of information on random sequence generation and allocation concealment, recruitment of people not representative of clinical practice, and allegiance bias. The meta-analysis showed that both couple therapy and individual psychotherapy improved depressive symptoms at end of treatment and after 6 months or longer, with moderate effect sizes, without any difference between the two treatments. Couple therapy was more effective in reducing couple distress. This effect was larger in studies with distressed couples only and should be considered as relevant in its own right. Couple therapy is a viable option for the treatment of a depressed partner, especially in discordant couples. Future research should address several issues left open to provide a sound empirical foundation for clinical practice.     

A Task Analysis of Client Re-engagement: Therapeutic De-escalation of High-Conflict Coparents

Parents who are engaged in protracted conflict following a divorce are often referred to coparenting therapy. Episodes of intense conflict are common during these therapy sessions and often result in coparents disengaging from the therapist while they engage in escalating conflict with each other, potentially disrupting their progress in therapy. The purpose of this study was to identify how therapists successfully re-engage clients in the session. To understand this process, 24 disengagement events (12 successful and 12 unsuccessful) from 13 cases were analyzed using a task analytic approach. The sample included coparent dyads referred by the judicial system to a high-conflict coparenting therapy program. Task analysis was used to create a model of how re-engagement unfolds in treatment. The empirical model that resulted has five phases: (1) disengagement from the therapeutic process, (2) disruption of the conflict, (3) de-escalating the most escalated coparent, (4) de-escalating the other coparent, and (5) therapist buffered re-engagement. Successful episodes of re-engagement tended to have therapists who remained active throughout the conflict episode, used structuring interventions aimed at disrupting and then regulating the most escalated partner, blocked attempts to re-engage in conflict, and then repeated this process with the less escalated partner. Additional interventions that promote therapeutic re-engagement are described for each phase, and implications for clinicians and researchers are discussed.