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.     

A Mixed-method Study of Individual,Couple, and Parental Functioning During the State-regulated COVID-19 Lockdown in Spain

During the recent COVID-19 outbreak in Spain, we explored the individual and relational well-being of people confined together with their partners and/or children during the first 3 weeks of state-regulated lockdown. Adults 18 years or older (N = 407) completed an online survey that included demographic, household, and employment information along with standardized measures of psychological distress (State-Trait Anxiety and Beck Depression) and relationship functioning—either the Dyadic Adjustment Scale if there were no children in the household or a Basic Family Relations Evaluation Questionnaire (CERFB) measuring conjugal, parental, and coparental functions. Qualitative analyses of responses to an open-ended question about perceived changes in couple or family dynamics during lockdown revealed nine specific themes comprising two overarching categories: relational improvement and deterioration. The overall prevalence of improvement themes (61.7%) exceeded deterioration themes (41.0%), with increased (re)connection and conflict atmosphere cited most often. Quantitative analyses found elevated levels of state anxiety but not trait anxiety or depression during lockdown. Consistent with the qualitative results, couples having no children at home reported high levels of dyadic adjustment, but with children present CERFB parental functioning exceeded conjugal functioning, a pattern sometimes associated with child triangulation into adult conflicts. Although correlates of psychological distress (e.g., unemployment, perceived economic risk) were relatively stable across subgroups, predictors of relationship functioning varied substantially with household/parental status (e.g., telecommuting and employment facilitated conjugal functioning only for couples with children).     

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.