Physical and Mental Health and Functioning Among Traumatic Brain Injury Close Relatives: The Role of Posttraumatic Stress Symptoms

Severe Traumatic brain injury (sTBI) often instigates widespread long-lasting disability and is accompanied by extensive rehabilitation. Unsurprisingly, sTBI also holds malignant consequences for patients’ close relatives. The burden caused by the injury and its severity explains some of the ramifications for the relatives. Additionally, some findings demonstrate that patients with sTBI and their relatives develop posttraumatic stress (PTS) symptoms. However, although the link between PTS symptoms and physical and mental health is well-documented in literature, the effect of PTS symptoms on relatives of patients with sTBI has barely been examined. This study examines the influence of PTS symptoms of patients with sTBI and their relatives on the physical and mental health and functioning of the relatives. Patients who sustained a severe sTBI (Abbreviated Injury Scale of the head region > 3) and close relatives were included in a multi-center, prospective cohort study (TRAST-MI). One-hundred patients and their relatives were assessed at 2, 6, and 12 months post injury. Outcome variables included health-related quality of life (SF-12) as well as emotional, cognitive, interpersonal, and total functioning (PCRS). Relatives’ physical health was predicted by relatives’ PTS symptoms (Slope=−1.76; p = .043), and mental health was predicted by both patients’ (Slope=−2.77; p = .034) and relatives’ (Slope=−6.59; p < .001) PTS symptoms. Functioning level was only predicted by patients’ PTS symptoms (Slope=−.25; p_<.001). The findings emphasize that TBI should be considered a comprehensive traumatic experience reaching further than mere physical damage to the brain and its direct consequences, affecting the injured individual and close relatives.     

Promoting Recovery Identities Among Mothers with Histories of Addiction: Strategies of Family Engagement

Changes in identity are critical to managing transitions to recovery from substance and alcohol addictions. Identity change is particularly important for mothers, whose recovery processes are often in the context of critical but complex family relationships and societal expectations. But research and practice often underestimate the relational dimensions that promote or inhibit changes in one's identity during recovery. Here we analyze data from a study that involved interviews with 30 formerly incarcerated women participating in a community-based substance use treatment program in the Midwest. Drawing from Constructivist Grounded Theory Methods, our analysis identified three factors shaping levels of engagement with family members: (1) the relational consequences of a shared past; (2) ascribing permanence to the old identity of “addict” versus the ability to see women's capacity to change; and (3) the current provision of caregiving support to participants’ children. Our analysis supports and extends existing research by highlighting how family can both promote and inhibit a recovery identity process. We discuss potential implications for theorizing “recovery” and “identity” as relational and identify key elements to support practices more attuned to the hidden complexity of family support.     

COVID-19 Interconnectedness: Health Inequity,the Climate Crisis,and Collective Trauma

The COVID-19 pandemic brings to the forefront the complex interconnected dilemmas of globalization, health equity, economic security, environmental justice, and collective trauma, severely impacting the marginalized and people of color in the United States. This lack of access to and the quality of healthcare, affordable housing, and lack of financial resources also continue to have a more significant impact on documented and undocumented immigrants. This paper aims at examining these critical issues and developing a framework for family therapists to address these challenges by focusing on four interrelated dimensions: cultural values, social determinants of health, collective trauma, and the ethical and moral responsibility of family therapists. Given the fact that family therapists may unwittingly function as the best ally of an economic and political system that perpetuates institutionalized racism and class discrimination, we need to utilize a set of principles, values, and practices that are not just palliative or after the fact but bring forth into the psychotherapeutic and policy work a politics of care. Therefore, a strong call to promote and advocate for the broader continuum of health and critical thinking preparing professionals to meet the challenges of health equity, as well as economic and environmental justice, is needed. The issues discussed in this paper are specific to the United States despite their relevance to family therapy as a field. We are mindful not to generalize the United States' reality to the rest of the world, recognizing that issues discussed in this paper could potentially contribute to international discourse.     

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.     

Uncovering Multidimensional Poverty Experiences in Shaping Children’s Socioemotional Trajectories during the First 6 Years of Schooling

The extant literature has attested to the importance of poverty on child well-being generally using a unidimensional approach. Researchers have yet to establish solid evidence on how multiple dimensions of poverty (e.g., depth, volatility, and spells of exposure) might be associated with children’s socioemotional well-being during their early school years. Building upon Bronfenbrenner’s bioecological systems theory, this study used latent class analysis to identify poverty patterns by incorporating multiple dimensions of poverty and investigated the relationship between multidimensional poverty patterns and children’s socioemotional trajectories from kindergarten through fifth grade. Using the Early Childhood Longitudinal Study, Kindergarten Class of 1998–1999 (ECLS-K), a longitudinal dataset featuring a nationally representative cohort of children in the United States (N ≈ 20,090), the analysis identified seven poverty groups. Each group exhibited a unique poverty or economic pattern that incorporates the three poverty dimensions. Growth-curve results indicate that multidimensional poverty patterns were significantly associated with externalizing and internalizing behaviors both at kindergarten and over time by fifth grade. Children with the acutest form of economic deprivation—extreme poverty, volatile income, and multiple spells of poverty exposure—were reported to have the worst outcomes. The significant variations in children’s socioemotional trajectories due to different poverty patterns highlight the importance of poverty reduction and prevention strategies corresponding to those patterns for optimal effect. This study suggests a focus not just on helping families exit poverty temporarily, but on improving their economic security as a way to nurture children’s socioemotional well-being.     

Digging Deeper: An Object Relations Couple Therapy Update

Over the past two decades, neurobiology research has added clarity to the process of emotional and behavioral change. In turn, this has led to endorsement of interventions that appear to be most helpful in individual and couple therapy. In addition to research on emotional dysregulation, contemporary studies have focused on the construction of meaning and its relevance to interpersonal relationships. According to Lisa Barrett, Richard Lane, and others, the brain references concepts to rapidly arrive at the most probable conclusions. Encoded experience and memory fragments guide this process and are vital in understanding partners' emotional responses. These findings support an object relations perspective that emphasizes the importance of past relational experiences that inform the present. This is particularly relevant in work with couples, as each individual's beliefs, expectations, and capacity for intimacy are invariably tied to earlier relationships. Research findings on memory reconstruction provide a basis for interventions that can add to the existing treatment approach, as it is suggested that working in a specific way with emotionally based memories has the potential to modify and reduce their predictive power and ability to unleash beliefs and behaviors that work against intimacy. The therapist who is informed by emerging neuroscience research can better uncover and actively work with memories that may be compromising a couple's relationship.     

South African International Migration and its Impact on Older Family Members

In this article, we explore the impact of South African families’ emigration on parents/grandparents who must renegotiate their lives in their loved ones’ physical absence. We adopted a transnational perspective in a bigger qualitative project to consider both sides of the migratory spectrum. Here we focus on elderly family members who remain behind—a group largely neglected in prior research. Our findings illustrate the complex emotions and relational changes experienced by elderly people whose families emigrate. New technologies bridge distances, allowing new ways to connect and take care of each other, and of re-imagining transnational relationships and what constitutes family life, but these bridges cannot negate the loss experienced by those remaining. People have to make sense of the emigration and forge new relational bonds with remaining family members. Our findings stress grandparents’ meaningful role in a family system and highlight some gendered and racial differences in families’ experiences.     

They May Disapprove,but I Still Love You: Attachment Behaviors Moderate the Effect of Social Disapproval on Marital Relationship Quality

The degree of approval for a relationship from one’s social network has been shown to predict relationship outcomes. Additional research has shown that attachment can buffer the negative effects of various factors (e.g., depression) on relationships. Using an actor–partner interdependence model in an SEM framework, we research the effects of disapproval from parents and friends for one’s relationship on marital relationship quality for self and partner in a sample of 858 married couples. We also examine whether each spouse’s attachment behaviors can moderate these effects. Results indicated that one’s own attachment behaviors moderate the effects of their own parents’ and friends’ disapproval on their self-reported relationship quality for both men and women. Partner’s attachment behaviors moderate own friend’s disapproval on self-reported relationship quality for men and women; additionally, the main effect of partner’s friends’ and parents’ disapproval became nonsignificant with that test. The findings provide evidence that attachment behaviors of both partners play a role in buffering the negative effects of the social network disapproval on relationship outcomes. Clinical implications are discussed.     

The other between fear and desire – countertransference fantasy as a bridge between me and the other

This paper attempts to show how unrepresented rupture/injury of primary expectations of the early relationship is reactivated in the analytic process. This becomes perceptible especially as unconscious fear and a specific defence described as ‘living behind a glass-wall’. The author, however, postulates the existence of an inherent dialogical-dyadic principle in the psyche, which she calls archetypal hope, and shows how this principle may become active in the analytical space. These aspects of analytical treatments are sketched with two vignettes, in which unconscious processes of exchange cause the analyst to experience unrepresented states. The author describes how the analyst is gradually able to experience and understand this, and how this understanding finally – without first becoming explicit – becomes effective in the analytical space. Special attention is given to the analytic attitude. A readiness to accept and move into regression and a receptivity to attune to the early sensory experience of the analysand is regarded as essential. Through this the analyst gains access to the inner space of the analysand and, through bodily experience and pre-symbolic processes, the unrepresented may thus become figurable. The reverie and countertransference fantasies are understood as a bridge: they connect the analytic pair. However, the reverie also creates the transition between that which was not – the absent representation – and that which wants to emerge. It thus bridges the personal unconscious (implicit expectation) and the archetypal (the archetypal hope). Through this, the space of hope may become a space of possibility, and help bridge the chasm between the experienced and the hoped-for.     

Archetypes and the ‘Impoverished Genome’ argument: updates from evolutionary genetics

Throughout his career, Jung felt the psyche had ‘ancestral layers’ that contained elements of an individual’s species history, and clinical experience has shown that this idea can be an aid to psychological healing and emotional well-being. Thus, some later thinkers have attempted to link such theoretical constructs to the genome, as Jung had little knowledge of genetics in his day. But in the early 2000s, genome studies suggested that the genome might contain too little content to be capable of encoding symbolic information. This opinion gave rise to an oft-repeated ‘impoverished genome’ argument, i.e. that the genome could not provide a significant contribution to the collective unconscious, prompting theorists to propose other sources for it, or to argue that it doesn’t exist. Today, however, developments in evolutionary neurogenetics calls the impoverished genome argument into question for a number of independent reasons. These developments re-open the idea that the genome may be worth reconsidering as the biological substrate for the collective unconscious.