Participation in Breast Cancer Genetic Counseling: The Influence of Educational Level, Ethnic Background, and Risk Perception

Genetic counseling has been suggested as a means of providing information and support to women with a family history of breast cancer. Yet women who undergo cancer genetic counseling in the United States generally consist of only a subset of those at risk, namely well-educated, upper-middle class, European American and Jewish women. We report outcomes from a study that provided a unique opportunity to determine whether women of African American, European American, Native American, or Ashkenazi Jewish ancestry have varying interest in having cancer genetic counseling. The study offered a genetic counseling session to 97 women with a family history of breast cancer who were participating in a larger interview study designed to assess attitudes toward genetic testing for breast cancer. The study offered genetic counseling free of charge to all study participants with a family history of breast cancer, removing the potential barriers of cost, the need for a physician referral, and lack of awareness of genetic counseling. Fifty women out of the 97 women offered genetic counseling (52%) accepted the offer by completing a session. Those who accepted genetic counseling had a higher educational level, a higher perceived risk of breast cancer, and were more likely to expect a positive BRCA1 or BRCA2 genetic test if they were to undergo genetic testing. When controlling for education level, there was no correlation between the participants' ethnic background and acceptance of a genetic counseling session. Outreach efforts to minority populations may increase awareness of the availability of genetic counseling and may facilitate participation by such populations.     

Use of Services Prior to and Following Intensive Family Preservation Services

A goal of short-term intensive family preservation services (IFPS) is to facilitate access to other services. However, service use following IFPS has rarely been studied. I describe the types of aftercare services that IFPS therapists recommended and use of these services in the two months following IFPS termination. Since families were using services that were not on the recommended aftercare plans, use of these services is also described. Primary caregivers of families who received family preservation through either child welfare or mental health were interviewed at two months after family preservation for the purpose of ascertaining service use. Different types of services were recommended and used based on whether families received IFPS through child welfare or mental health. However, there were also differences in the presenting problems and demographics between families in child welfare and mental health. Future research should include an independent assessment of need in order to determine the relationship between need and the types of services recommended and used. Even though families used services prior to IFPS, the findings indicated that IFPS facilitated use of new services. More research is needed on the process of how therapists decide what services to recommend and what they do to help families access services. It is also important to examine whether use of less restrictive services helps prevent out-of-home placements and the relationship between informal support and use of formal services.     

Experiential Exercises in MFT Training: Gender, Power, and Diversity

An experiential exercise that is used to empower Marriage and Family Therapy students and systematically introduce students to feminist themes is described. Faculty in the university's theatre department recruit their students to serve as client families. Role-play exercises with theatre students based on vignettes developed by clinical faculty increases realism and includes other training benefits. This approach is consistent with a feminist model of training and supervision.     

Understanding Forgiveness as Discovery: Implications for Marital and Family Therapy

This article explores the concept of forgiveness in relationship systems and examines various conceptualizations and definitions found in the literature. Forgiveness is described as a complex psychological and relational process that is more a discovery than an act of will. A rationale for viewing forgiveness in a contextual, historical, and relational attachment paradigm is presented, and the association of forgiveness with empathy and emotional intelligence is discussed. Marital and family therapists are encouraged to attend to contextual family of origin issues and to facilitate an empathic relational environment where ambivalence is expected and tolerated for enhancing the process of forgiveness. Relevant clinical cases are shared to illustrate the process of forgiveness as discovery.     

Alliance Ratings as a Part of Trainee Evaluations Within Family Therapy Training

Client-reported therapeutic alliance scores were examined as a measure of improvement in therapeutic skills across master's-level marriage and family therapy (MFT) training. The results indicate significant correlations between alliance ratings and training variables, with the number of cumulative clinical hours identified as a significant predictor of alliance ratings according to a regression analysis. Trainees lacking the expected number of clinical contact hours in each level of training were found to be more likely to receive consistently marginal alliance ratings. Additionally, alliance ratings were especially useful in identifying trainees who were functioning at minimal levels of competency.     

Critical Incidents in the Professional Lives of First Year MFT Students

First year MFT students engaged in a journaling project, selecting one event daily which captured something about being a student, including the process of therapy, consultation, and supervision, that struck them as important in terms of their professional development. On reflection, the students saw therapeutic success and professional confidence as systemic products of a variety of contextual factors: transient and enduring aspects of the self and the client, faculty, peer, and family influences, and treatment setting and program factors. Students and faculty experienced this formative self study as valuable and believe that it should be done at the beginning, middle, and end of an educational program and the results shared with both faculty and students.     

Preparing Students for Family Practice

This paper highlights the content of a course designed to prepare students for family practice, with emphasis on mothers as primary caregivers. A model is presented of relatively healthy family interactions characterized by co-parenting and equitable division of labor in the home. The strengths perspective is applied to family practice with mother-headed families where noncustodial fathers share responsibilities for childrearing. Challenges inherent in carrying out dual roles of wage labor and family caregiving are linked to social support and differences among women based on class, race, and ethnicity.     

Medication Administration By Family Members of Dependent Elders In Shared Care Arrangements

Twenty-three long-term care family caregivers whose care-recipients were enrolled in adult day care programs participated in face-to-face, semistructured interviews designed to learn more about their medication administration experiences. Two distinct styles of decision making were identified: self-directed and physician-directed. To help them with their medication administration responsibility, both groups used primary (physicians, pharmacists, or both) and secondary sources of information (the internet, information hotlines, nurses, more experienced caregivers, and family members with health backgrounds). Self-directed caregivers, who were significantly younger than the physician-directed caregivers, were twice as likely to report use of secondary sources of information to manage their medication administration tasks. Secondary sources of information appear to be important for the development of a caregiver's maturation and critical thinking skills over the long term and need more attention from formal providers in shared care relationships with family caregivers.     

Familicide: The killing of spouse and children

A familicide is a multiple-victim homicide incident in which the killer's spouse and one or more children are slain. National archives of Canadian and British homicides, containing 109 familicide incidents, permit some elucidation of the characteristic and epidemiology of this crime. Familicides were almost exclusively perpetrated by men, unlike other spouse-killings and other filicides. Half the familicidal men killed themselves as well, a much higher rate of suicide than among other uxoricidal or filicidal men. De facto unions were overrepresented, compared to their prevalence in the populations-at-large, but to a much lesser extent in familicides than in other uxoricides. Stepchildren were overrepresented as familicide victims, compared to their numbers in the populations-at-large, but to a much lesser extent than in other filicides; unlike killers of their genetic offspring, men who killed their stepchildren were rarely suicidal. An initial binary categorization of familicides as accusatory versus despondent is tentatively proposed. © 1995 Wiley-Liss, Inc.     

Values in Family Therapy Practice and Research: An Invitation for Reflection

Values have been shown to be a pervasive part of both marriage and family therapy (MFT) clinical practice and research. Yet, many therapists and researchers remain unclear about how values affect their work. This article examines the influence of Western philosophical assumptions and therapy traditions in light of current understandings of values in therapy. The influence of values in MFT research processes is similarly examined. Implications for how family therapy professionals can be more reflective and sophisticated in their understanding of values in clinical practice and scientific inquiry are discussed. Suggestions for addressing values in MFT training also are given.