Differentiation of Self and Dyadic Adjustment in Couple Relationships: A Dyadic Analysis Using the Actor‐Partner Interdependence Model

Bowen's multigenerational theory provides an account of how the internalization of experiences within the family of origin promotes development of the ability to maintain a distinct self whilst also making intimate connections with others. Differentiated people can maintain their I‐position in intimate relationships. They can remain calm in conflictual relationships, resolve relational problems effectively, and reach compromises. Fusion with others, emotional cut‐off, and emotional reactivity instead are common reactions to relational stress in undifferentiated people. Emotional reactivity is the tendency to react to stressors with irrational and intense emotional arousal. Fusion with others is an excessive emotional involvement in significant relationships, whilst emotional cut‐off is the tendency to manage relationship anxiety through physical and emotional distance. This study is based on Bowen's theory, starting from the assumption that dyadic adjustment can be affected both by a member's differentiation of self (actor effect) and by his or her partner's differentiation of self (partner effect). We used the Actor‐Partner Interdependence Model to study the relationship between differentiation of self and dyadic adjustment in a convenience sample of 137 heterosexual Italian couples (nonindependent, dyadic data). The couples completed the Differentiation of Self Inventory and the Dyadic Adjustment Scale. Men's dyadic adjustment depended only on their personal I‐position, whereas women's dyadic adjustment was affected by their personal I‐position and emotional cut‐off as well as by their partner's I‐position and emotional cut‐off. The empirical and clinical implications of the results are discussed.     

Fuzzy Logic and Arithmetical Hierarchy III

Fuzzy logic is understood as a logic with a comparative and truth-functional notion of truth. Arithmetical complexity of sets of tautologies (identically true sentences) and satisfiable sentences (sentences true in at least one interpretation) as well of sets of provable formulas of the most important systems of fuzzy predicate logic is determined or at least estimated.     

Therapist Factors Matter: A Systematic Review of Parent Interventions Directed at Children’s Behavior Problems

The present review systematically explored research examining the relationship between therapist‐related factors and the outcomes of parent interventions directed at children’s behavior problems. A systematic search of the literature was conducted with online scientific databases, parenting programs, web sites, and bibliographic references of the selected articles, according to PRISMA guidelines. A total of 24 quantitative studies met the inclusion criteria. Although some methodological limitations were identified with respect to the measurement of therapist factors, the reviewed research strongly suggests that the therapist plays a critical role in parent interventions directed at behavior problems. In particular, many parent outcomes are found to be related to the parent–therapist alliance, the therapist’s fidelity to the intervention, specific therapist’s in‐session actions, and the therapist’s personal variables. The parent–therapist alliance and therapist fidelity to the intervention consistently relate to changes in parenting practices, and alliance additionally relates to fewer perceived barriers to participation in treatment, more treatment acceptability, and greater parenting satisfaction and self‐efficacy. In addition, specific in‐session therapist interpersonal actions relate to parents’ engagement and satisfaction, while both the therapist’s interpersonal actions and more active skills relate to parent change. Therapist’s personal variables have been scarcely or poorly studied to date, but the results found justify the need to develop further research in this area. In conclusion, more attention should be given to the role of the therapist when implementing parenting programs directed at behavior problems, and more and better research is needed that can overcome the methodological limitations identified.     

A fundamental change in vision: where black lives matter

Using the lens of clinical work, the author, a white supervisor, plots her concerns about unconscious racism in the training of a black supervisee. Years later this supervisee brings a distressed black trainee nurse to supervision who is struggling with relational difficulties while suffering from unconscious racism in her hospital. Supervisor and supervisee grapple to offer the patient treatment on both fronts. The author explores the underlying presence of ‘white privilege’ and ‘unconscious racism’ which finds a global audience as a result of the killing of George Floyd – an event which also had implications for the long-term supervisory partnership. Links to Jessica Benjamin’s concept of ‘doer and done to’ are made, as well as discussion of a gradual change of vision in the supervisor herself. The author also makes use of insights gained from consultancy work in a multi-racial company and two Channel 4 UK television programmes that feature workshops on unconscious racism in a mixed secondary school in the London Borough of Sutton.     

OBSERVATION AND COMPARISON OF MEALTIME BEHAVIORS IN A SAMPLE OF CHILDREN WITH AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDERS AND A CONTROL SAMPLE OF CHILDREN WITH TYPICAL DEVELOPMENT

Despite widespread use of behavioral observations to evaluate child feeding behaviors in research and clinical practice, few studies have comprehensively characterized mealtimes or identified features that differentiate children with and without disordered feeding; these were the aims of the current study. Mealtime observations were conducted for 18 children with avoidant restrictive food intake disorder (ARFID) and 21 typically developing children. Observations were coded inductively, and associations between disorder and observed mealtime actions were examined. Most behaviors were observed across both clinical and nonclinical mealtimes, and many did not differ in frequency between children with and without ARFID. However, significant group differences were observed in the frequencies of behaviors relating to food intake, visual and physical engagement with feeding, and movement during mealtimes. The comparability of behaviors across clinical and nonclinical groups suggests that eating behaviors exist on a continuum from “normal” to “abnormal,” with group differences relating to frequency rather than type of behavior. The behavioral differences observed in this study suggest that identification of children with ARFID should focus on child engagement with food and restlessness during mealtimes. Reliance on emotional and escape‐maintained behaviors will lead to underrecognition of families in need of clinical support.     

Psychometric properties of the Shared Decision-Making Questionnaire (SDM-Q-9) in oncology practicePropiedades psicométricas del Questionnaire Shared Decision-Making (SDM-Q-9) en oncología

Background/Objective: This study sought to assess the psychometric properties of the 9-item Shared Decision-Making Questionnaire (SDM-Q-9) in patients with resected, non-metastatic cancer and eligible for adjuvant chemotherapy. Method: A total of 568 patients were recruited from a multi-institutional, prospective, transversal study. Patients answered the SDM-Q-9 after visiting their medical oncologist who, in turn, completed the SDM-Q–Physician version. Reliability, factorial structures [exploratory factor analysis (EFA), confirmatory factor analysis (CFA)], and convergent validity of the SDM-Q-9 scores were explored. Results: SDM-Q-9 showed a clear factorial structure, compatible with a strong and replicable general factor and a secondary group factor, in patients with resected, non-metastatic cancer. Total sum scores derived from the general factor showed good reliability in terms of omega coefficient: .90. The association between patient and physician perception of SDM was weak and failed to reach statistical significance. Males and patients over 60 years of age displayed the greatest satisfaction with SDM. Conclusions: SDM-Q-9 can aid in evaluating SDM from the cancer patients’ perspective. SDM-Q-9 is helpful in studies examining patient perspectives of SDM and as an indicator of the degree of quality and satisfaction with health care and patient-physician relationship.     

EARLY REGULATION IN CHILDREN WHO ARE LATER DIAGNOSED WITH AUTISM SPECTRUM DISORDER. A LONGITUDINAL STUDY WITHIN THE DANISH NATIONAL BIRTH COHORT

Studies have shown that children later diagnosed with autism spectrum disorders (ASD) in their first years of life might show symptoms in main developmental areas and that these signs might be sensed by the parents. The present study investigated in a large birth cohort if children later diagnosed with ASD had deviations at 6 and 18 months in areas such as the ability to self‐regulate emotions, feeding, and sleeping. The study was based on prospective information collected from 76,322 mothers who participated in the Danish National Birth Cohort. When the children reached an average age of 11 years, 973 children with ASD and a control group of 300 children with intellectual disability (IDnoASD) were identified via Danish health registries. Associations were found between short periods of breast‐feeding and the children later diagnosed with ASD and IDnoASD as well as associations at 18 months to deviations in regulation of emotions and activity. The similarities in these associations emphasize how difficult it is to distinguish between diagnoses early in life.     

Falling into language life: a montage of pre‐faces in search of a text‐ual body

Clinical work, as all of consciousness, is steeped in and emerges out of language. Language is the medium of our knowing, and knowing the medium of our relating. Language has us; words dream us. For the mythical Navajo as for John of the New Testament, in the Beginning was the Word. Before any kind of distinction of thought, feeling, sensation or intuition comes language – language, not as ‘just words’, but as image. Words are images, and images as encompassing worlds present themselves as and through language. As a determinant of identity, language undermines all cues as to individual subjectivity, Yahweh's ‘I am here’ rendering time and place relative, and subjectivity co‐constituted. This paper is a meditation on language for clinicians in the form that language presents itself, as a meandering flow of consciousness with associations and signposts leading onward.     

Evaluation of Service‐Learning‐Infused Courses With Refugee Families

This study evaluated the impact of service‐learning‐infused courses on multicultural competence and social justice advocacy skills among counseling students. The project, in which students acted as job coaches for refugee families, was integrated into 1st‐ and 2nd‐year counseling courses. Results indicated an increase in multicultural knowledge and advocacy skills, with greater changes reported among 1st‐year students. Implications for counselor training, including placement of service‐learning projects within the counseling curriculum, are discussed. Este estudio evaluó el impacto de cursos con elementos de aprendizaje por medio del servicio en la competencia multicultural y las habilidades de defensoría de justicia social entre estudiantes de consejería. El projecto, en el cual los estudiantes proporcionaron orientación laboral a familias de refugiados, estaba integrado en cursos de consejería de primer y segundo año. Los resultados indicaron un aumento del conocimiento multicultural y las habilidades de defensoría, con mayores cambios comunicados por los estudiantes de primer año. Se discuten las implicaciones para la formación de consejeros, incluyendo la inserción de projectos de aprendizaje por medio del servicio en el currículum de consejería.