A Family’s Coming Out Process: Systemic Change and Multiple Realities

The paucity of investigative studies exploring the coming out process of families was the impetus for this case study with a six member family-of-choice. In-depth interviews highlight the complexities of negotiating family rules, journey with the family as they struggled with their new identity, and reveal how the reflexive process contributed to the family’s co-creation of new stories. The four themes that emerged (embracing gay identity, integrating as a family, building social networks, and social awakening), offer details of how the family reconfigured from the rubble of confusion to become more cohesive, awakened and empowered. Implications for clinical practice with families with gay members are addressed.     

Qualitative Research in Marriage and Family Therapy: Who is in the Interview?

Qualitative interviews are a rich means of gathering information from families. The qualitative interviewer has a choice of interviewing individual family members, multiple family members at the same time, or a combination. The configuration of interviewees is a choice guided by the epistemology of the researcher, research aims, and questions. This article reviews the literature on interviewing different configurations of family members. A content analysis was conducted on articles in the marriage and family therapy literature from 1990 to 2005. Over half of the articles were conducted with individual family members separate from their families. This finding is discussed in the context of the decision regarding whom to interview.     

Health-Related Quality of Life in a National Sample of Caregivers: Findings from the Behavioral Risk Factor Surveillance System

Purpose Recent national public health agendas, such as Healthy People 2010, call for improved public health surveillance and health promotion programs for people with disabilities and their caregivers. The goal of this study was to understand the public health impact of caregiving on health-related quality of life (HRQoL) using population-level data. Design & Methods A cross-sectional study design was used. 184,450 adults surveyed during the 2000 national Behavioral Risk Factor Surveillance System survey formed the sample. Binary logistic regression models ascertained differences between caregivers and non-caregivers in reporting reduced (“fair” or “poor”) health. Ordinary least squares regression (OLS) and multinomial logistic regression models examined the influence of caregiving status on HRQoL, measured as categories of healthy days reported in the last 30 days and the number of days reported as physical and mental health not good in the last 30 days. Results Sixteen percent (16%) of the survey respondents were caregivers. There was an interaction effect between caregiving status and age of the caregiver. In the fully adjusted models, caregivers <55 years old had a 35% increased risk of having fair or poor health (odds ratio [OR] = 1.35, 95% confidence interval [CI] 1.28, 1.43) as compared to non-caregivers in that age group, while caregivers 55 years and older had a 3% decreased risk in having fair or poor health (OR = 0.97, 95% confidence interval [CI] 0.92, 1.03) compared to non-caregivers of the same age. In the adjusted models that examined the association of caregiving and healthy days, younger caregivers similarly showed larger deficits in both mental and physical HRQoL compared to older caregivers. For example combining mental and physical days, caregivers <55 had 1.44 fewer healthy days (β = −1.44, standard error (SE) = 0.07), while caregivers 55+ had 0.55 fewer days *β = −0.55, standard error (SE) = 0.13 (compared to non-caregivers in their respective age groups). Implications With increasing population age and the projected increase in caregivers, it is important that we understand the social and public health burden of caregiving and begin to identify interventions to sustain the HRQoL of caregivers. We found that caregivers have a slight to modest decline in HRQoL compared to non-caregivers, and that caregiving affects the HRQoL of younger adults more than older adults. Further research at the population level as to the type and level of burden of caregiving is needed.     

Interactive Genetic Counseling Role-Play: A Novel Educational Strategy for Family Physicians

Background Family physicians (FPs) are increasingly involved in delivering genetic services. Familiarization with aspects of genetic counseling may enable FPs to help patients make informed choices. Purpose Exploration of interactive role-play as a means to raise FPs’ awareness of the process and content of genetic counseling. Methods FPs attending two large Canadian family medicine conferences in 2005 were eligible—93 participated. FPs discussed a case during a one-on-one session with a genetic counselor. Evaluation involved pre and post intervention questionnaires Results FPs’ baseline genetic knowledge was self-rated as uniformly poor. Baseline confidence was highest in eliciting family history and providing psychosocial support and lowest in discussing risks/benefits of genetic testing and counseling process. Post-intervention, 80% of FPs had better appreciation of family history and 97% indicated this was an effective learning experience. Conclusions Role-play with FPs is effective in raising awareness of the process and content of genetic counseling and may be applied to other health disciplines. This research was funded by: The Canadian Institutes of Health Research (CIHR) Institute of Genetics, The Genetics Education Project (funded by the Ontario Women’s Health Council), and GeneSens (funded by a CIHR Interdisciplinary Capacity Enhancement Team Grant).     

Diagnosis of Fabry Disease via Analysis of Family History

Fabry disease is an X-linked lysosomal storage condition caused by a deficiency of α-galactosidase A. In order to determine the average number of family members who are diagnosed with Fabry disease following the diagnosis of a proband, four lysosomal storage disease centers across the United States reviewed the completed pedigrees of their Fabry disease patients. In addition, data from three Fabry disease families from other centers were submitted by patients directly. The pedigree review found 74 probands (54 males and 20 females) who had 357 diagnosed family members, of which 223 were female (60.5%) and 146 were male (39.5%). Analysis found that, on average, there were five family members diagnosed with Fabry disease for every proband. Now that enzyme replacement therapy (ERT) is available for the treatment of Fabry disease, this finding emphasizes the need for all health care professionals to ensure a detailed pedigree has been constructed for each patient affected by Fabry disease and to encourage testing and evaluation of all at-risk family members.     

Predictors of Growth and Distress Following Childhood Parentification: A Retrospective Exploratory Study

While most of the existing literature has focused on the risks associated with parentification, we examined the potential benefits (i.e., posttraumatic growth) associated with parentification. Predictors of posttraumatic growth explored in our study included: attachment, differentiation of self, parentification, and resiliency. Partial support was found for the predictor variables leading to posttraumatic growth, with resilience emerging as the strongest predictor; resilience explained 14% of the variance in posttraumatic growth. These findings suggest that future research might explore additional resiliency factors that explain positive psychological outcomes related to childhood parentification.     

Economic Disadvantage in Complex Family Systems: Expansion of Family Stress Models

Economic disadvantage is associated with multiple risks to early socioemotional development. This article reviews research regarding family stress frameworks to model the pathways from economic disadvantage to negative child outcomes via family processes. Future research in this area should expand definitions of family and household to incorporate diversity and instability. This expansion would be particularly relevant for research among low-income ethnic minority families and families with young children. This line of research would highlight specific pathways to target to prevent the onset of early parental and child dysfunction.     

Job’s Story and Family Health

This paper examines the book of Job for encoded psychological meaning. Its main conclusion is that the story imagery expresses a need to rectify fatherly and parental oblivion for a child who is the object of the destructive envy of a sibling. A family dynamic is constructed from the story’s repeated emphasis of Job’s blamelessness and the story’s position that Satan both proposes and causes Job’s sufferings. The emergent family model sees Job as representing a son, Satan an envious rival, and God a father or parent(s). This paper proposes that Job’s story may be reactive to a period where male authority was at risk of becoming excessive, threatening family and community health.

What Children Feel About Their First Encounter with Child and Adolescent Psychiatry

The first meeting in psychotherapeutic and psychosocial work, has a big impact on the continuation. It is a less explored research field. Children’s “voices” tend to come in the back-ground in family therapy and other settings. In a project at CAP (Child and Adolescent Psychiatry) the children’s views were collected in interviews with parents and therapists present. The grounded theory analysis process was used. The children addressed the importance of the therapist’s actions and positions in helping them to be able to communicate and to be in a dialogue. To be accepted and allowed to express feelings was important, and so was how the therapist managed to adjust to each person in the room and give space for various perspectives.     

Coping with Family Conflict: What’s Helpful and What’s Not for Low-income Adolescents

Family conflict is exacerbated by poverty-related stress and is detrimental to adolescent mental health. Adolescent coping with family conflict has the potential to buffer or exacerbate the negative effects of family conflict on internalizing symptoms. We examined coping with family conflict among 82 low-income adolescents (53.7% female, mean age = 13.5 years at Time 1, SD = 1.98; range 11–18), and their primary caregivers (95% female, mean age = 34.9 years, SD = 7.45). Adolescents were 25.9% Caucasian, 28.4% African American, 38.3% Hispanic, and 7.4% Other (Multi-racial, Native American, or Asian). Results show that family conflict is more strongly associated with internalizing symptoms for adolescents under high levels of poverty-related stress. Regression analyses indicate that secondary control coping moderates the effects of family conflict on internalizing symptoms. In addition, analyses reveal that disengagement coping exacerbates symptoms across time for both adolescent girls and boys. Regression analyses also suggest that primary control coping is helpful for coping with family conflict, but only for girls. Results highlight the importance of examining coping concurrently and across time as well as including moderating effects of gender. Intervention efforts targeting low-income adolescents should incorporate the instruction of secondary control strategies for coping with family conflict.