”Attachment to Home” and Other Factors Related to Widows' Relocation Decisions

Widowhood has been identified as a stage of life when older persons are more apt to voluntarily relocate. Theoretically there is an "environmental press" to move brought about by circumstances and the inappropriateness fo single-family dwellings after the death of spouse. A number of indentified factors were hypothesized to influence recent widows' relocation. Following initial interviews with 221 older respondents, those who actually moved during a 2-year period were re-interviewed. Results indicated that "attachment-to-home" factors and family proximity were the best indicators of widows' staying in or moving from their homes. Movers and stayers are contrasted, and movers' situations before and after relocation are analyzed.     

“Family Matters”: A Systematic Review of the Evidence For Family Psychoeducation For Major Depressive Disorder

The first aim of this systematic review was to evaluate the evidence for family psychoeducation (FPE) interventions for major depressive disorder (MDD). A second aim was to compare the efficacy of different modes of delivering face‐to‐face FPE interventions. Ten studies (based on nine distinct samples) were identified comprising four single‐family studies, four multifamily studies, one single versus multifamily comparative study, and one peer‐led, mixed‐diagnosis study. Seven studies measured patient functioning and six reported positive outcomes. Six studies measured carer's well‐being and four reported positive outcomes. Results provide preliminary evidence that FPE leads to improved outcomes for patient functioning and family–carer's well‐being for persons with depression. The implications for future development and delivery of FPE interventions for MDD are discussed.     

Family Therapy with the Elderly

This article outlines health and lifestyle challenges to elderly persons and associated changes in their family systems. Flexibility, related to attachment patterns, is considered central to healthy adaptation. Family therapy approaches and relevant systemic and cultural factors influencing psychotherapy with the elderly are discussed. Key family therapy concepts and strategies (genograms, transmission of family histories and circular patterns of interaction), are reviewed and exemplified. Four types of family therapy presentations are elucidated by composite case examples. Firstly, the elderly person can be the identified patient. Secondly, another family member can seek help for him/herself in relation to the elderly person. Thirdly, another family member can be the identified patient without direct reference to the elderly person. Finally, the wider health care system involved with the elderly person and family can be the focus of therapy. Family therapy offers important conceptual and strategic advantages in working with the elderly and their systems.     

THE PROBLEM OF THE SIBLING AS THE REFERRING PERSON*

This paper is the first concerning observations gathered at our Center during studies of the treatment of families with a chronically psychotic member.' It draws the attention of family therapists to a danger not uncommon in such cases, one that arises when the person referring his family of origin is a sibling of the index patient and, in many ways, the most “competent” and prestigious family member. The theoretical part of the paper and the clinical example that follows are intended to demonstrate how this pitfall can be turned into a springboard for therapeutic success.     

A wedding in the family: home making in a global kin network

Rituals such as weddings and funerals are significant for transnational family networks as events where scattered relatives meet and validate shared kinship and common origins. They are particularly important when taking place at a family ‘home’ that has been a centre of social and economic relations and locus of emotional attachment. This article analyses a wedding on a Caribbean island involving a large global family network, which occurred at a critical point in the family’s history. It became an occasion when members asserted their notions of belonging rooted in the ‘home’, not just as members of a common kin group, but as persons whose life trajectories had involved them in different social, economic and geographical contexts. Individually they had dissimilar interpretations and expectations of their place in the home, and these were played out at the wedding. The gathering allowed a display of family solidarity, but was also a site where differing views of individuals’ contribution to the global household were expressed, and rights to belong in the family home and, by implication, the island were contested.     

Remarriage Between Divorced People with Children from Previous Marriages: A Proposal for Preparation for Remarriage*

This paper discusses the special attributes of the legally reconstituted families formed when divorced persons who have children from their previous marriages remarry. The remarriage family is identified as a high risk group for which society has not as yet established norms. Interviews with 70 couples suggest that the stress for couples and families involved in divorce and remarriage would be prevented or reduced through remarriage preparation courses.     

Counseling severely dysfunctional families of mentally and physically disabled persons

Some families of mentally and physically disabled persons behave in an extremely self-destructive or resistant manner. These severely dysfunctional families pose a formidable obstacle to their disabled relatives' habilitation. Because such families are particularly frustrating to work with, little professional assistance has been provided to them. This article examines probable causes of severely dysfunctional family behavior, details several maladaptive family patterns and suggests practical treatment strategies for helping these families.     

Harnessing the Power of Play in Emotionally Focused Family Therapy With Preschool Children

Emotionally focused family therapy (EFFT) is an attachment‐based therapy model that has been used with older children and adolescents. More recently, it has been suggested for use with young children. EFFT holds promise as a clinical treatment for young children coping with attachment problems, but more detailed guidelines are needed for implementing the model with this age‐group. Whereas preschool and kindergarten age children are less able to participate in talk therapy than older children, accommodations need to be made to this approach when the identified patient is a young child. This article offers a variety of play therapy activities that may be incorporated within an EFFT framework to strengthen the emotional bonds in families with children ages four to six.     

Integrative module-based family therapy: application and training

The field of marriage and family therapy is currently at a crossroads. The challenge for contemporary therapists is how to incorporate the wisdom of previous models with the accountability that comes from evidence-based practice. The Integrative Module-Based Family Therapy treatment model provides a formalized series of steps that clinicians can use in their case planning and implementation. It is based on nine clinically relevant modules for assessment and intervention that are consistent with current best practices and empirically supported treatments. It thus meets the need for a structured family therapy practice and training approach that is respectful of the "art" of family therapy while still adhering to the principles of the "science" of evidence-based treatment.     

Affective disorders

Unipolar depressive disorders are especially common among persons presenting with marital and family problems, rendering their impact on the treatment of marital and family problems of interest to every marriage and family therapist. The current paper describes empirically based decision making rules for determining who may benefit most from marital and family therapy interventions. Using well-controlled outcome research, it is concluded that both marital therapy and parenting interventions can play an important role in the treatment of many but not all depressed persons. Predictors of treatment response are discussed and recent epidemiological research is used to examine the size of the population that may respond especially well to marital therapy. Future directions for research are suggested and public policy implications are discussed.     

The Subjective Value of "Home" to Older Homeowners

Older individuals generally report a high level of housing satisfaction with their current homes and seldom wish to move, yet most objective measures of the physical quality of their housing suggest that their residential situation is often far from desirable or adequate. The purpose of the present study was to investigate whether a group of subjective values could be identified which might provide a better understanding of the meaning of "home" to older persons. Using factor analytical procedures, four factors were found: (1) traditional family orientation; (2) cost vs. comfort trade-off; (3) status value of homeownership; and (4) competence in familiar environment. Results are discussed in regard to the implications of these subjective-value factors for both public housing and relocation counseling.     

The experiences of university students with a mood disorder

Mood disorders typically materialise in young adulthood, a life-stage when many enter university. However, Padron notes that few studies have examined the experiences of students with a mood disorder. The current study offers a thematic analysis of semi-structured interviews with five university students who had personal experience of such a disorder. Participants described how symptoms affected their academic and social experiences of university based around the themes of: Social and family support, Powerful symptoms, Stigma and labelling, and Inter-professional dynamic. It was concluded that stigma and lack of information prevented students from obtaining sufficient support, whilst the addition of key staff such as a university-wide mental health trainer is identified as a potential way forward to help such students negotiate the higher education environment.     

Benefits to Children Who Participate in Family Therapy with their Substance‐Using Mother

It is rare that family members other than the identified patient are followed over time in studies of therapy effectiveness. Family therapy is believed to be effective because it targets processes within the system that maintain symptoms. If these processes are changed, then all family members can benefit. Using a sample of 183 mother–child dyads from a study comparing family therapy for adult substance use versus an attention control, change in child's substance use (tobacco, alcohol, and marijuana) was estimated. Children who participated in family therapy with their mothers showed greater decreases in alcohol and tobacco use and were less likely to begin using compared to children whose mothers participated in the attention control condition.     

SYSTEMIC AND NONSYSTEMIC DIAGNOSTIC PROCESSES: AN EMPIRICAL COMPARISON

This study concerned the extent to which systemic and nonsystemic clinicians differ in their diagnostic processes. Experienced therapists, identified either with a family systems or a psychodynamic orientation, viewed a stimulus film of a family session and individual interviews with each parent and identified patient. Subjects listed "clinically relevant factors" and formulated hypotheses. Content analyses showed that the systemic clinicians, in contrast to the nonsystemic ones, identified as relevant a greater number of different subsystems, more triads, and fewer monads. Whereas they formulated more functional and fewer temporal hypotheses, almost no explicitly circular hypotheses were developed by either group of therapists.     

Compulsive gambling: Structured family intervention

Family intervention has been an effective procedure for getting alcoholics into treatment for more than twenty years. Now this technique is being used with compulsive gamblers. Because the gambling disorder is so easy to hide, the patient seems to be further into the illness by the time the family seeks help. Furthermore, because the gambling offers intermittent rewards, the denial in both the patient and family appears to be stronger than found with most alcoholics.During the intervention it is important to tell the compulsive gambler why the help of a professional was sought; what changes have been observed by family members and friends as a result of his/her gambling; how family relationships have been affected; what is feared will happen if he/she doesn't get help; and what each family member hopes will happen once the gambler is in recovery.Most concerned persons enter family interventions with the sole purpose of getting the gambler into treatment. However, since this is a family disease, ethically the primary goal of family intervention needs to be to getsomeone into treatment, if not the individual suffering with the disease then one or more of those concerned persons suffering from it.     

Family Therapy and Lithium Deficiency*

Lithium carbonate's usefulness in relieving the more dramatic symptoms of bipolar-affective disorder can obscure the family systems components of this illness. A compromised form of family therapy results which may stabilize the marriage but cause troubles for the larger family system. This paper offers a partial modus operandi for keeping family therapy systems oriented and avoiding the infantilization of the identified patient which occurs when the importance of purely medical treatment is overplayed.     

THE FAMILY FIRO MODEL: A MODEST PROPOSAL FOR ORGANIZING FAMILY TREATMENT

This paper presents a model for organizing family issues and family treatment. Schutz's FIRO model is offered as a framework for organizing family issues into inclusion, control and affection categories. Following Schutz's theory of group development, we propose that inclusion, control and affection constitute a logical hierarchy of core issues to be dealt with in treating multiproblem families-inclusion first, then control, and then affection (intimacy). Furthermore, we propose that the FIRO model can be used to organize theories of family therapy. We attempt to demonstrate that different family therapies are best suited for one of the three core issues of family interaction. We advocate an "intelligent eclecticism" based on the premise that when an issue is appropriately matched with a therapy, therapeutic effectiveness should be enhanced. We also discuss implications of our Family FIRO model for clinical practice.     

Informal caregiving for elders in Sweden: an analysis of current policy developments

In Sweden, care of elderly people is a public responsibility. There are comprehensive public policies and programs providing health care, social services, pensions, and other forms of social insurance. Even so, families are still the major providers of care for older people. In the 1990s, the family was "rediscovered" regarding eldercare in Sweden. New policies and legislative changes were promoted to support family caregivers. The development of services and support for caregivers at the municipal level has been stimulated through the use of national grants. As a result, family caregivers have received more recognition and are now more visible. However, the "Swedish model" of publicly financed services and universal care has difficulty addressing caregivers. Reductions in institutional care and cutbacks in public services have had negative repercussions for caregivers and may explain why research shows that family caregiving is expanding. At the same time, a growing "caregivers movement" is lobbying local and national governments to provide more easily accessible, flexible, and tailored support. In 2009, the Swedish Parliament passed a new law that states: "Municipalities are obliged to offer support to persons caring for people with chronic illnesses, elderly people, or people with functional disabilities." The question is whether the new legislation represents a paradigm shift from a welfare system focused on the individual to a more family-oriented system. If so, what are the driving forces, motives, and consequences of this development for the different stakeholders? This will be the starting point for a policy analysis of current developments in family caregiving of elderly people in Sweden.     

The Interaction of Divorce,Suicide, and Homicide

A study of the data from the continental states of the USA showed that both suicide and homicide rates were related to the divorce rates and that suicide rates were related to migration rates. These associations remained even when controls were introduced for other sociodemographic variables, such as the proportion of blacks and old persons in each state and the median family income in each state.     

Psychiatric emergencies: the check effect revisited.

Federal income support to persons with alcohol and drug related disabilities was ended in 1997. The argument for ending the programs was that recipients were using their benefits to purchase drugs and alcohol. This supposedly led to the "check effect," an increase in psychiatric emergencies in American communities in the days following the receipt of disability benefits. We test two hypotheses implied by this argument. The first is that psychiatric emergencies are elevated in the fourth through eighth day of the month. The second is that the excess of emergencies in these days was significantly reduced when benefits were ended. The tests are based on 35,500 psychiatric emergencies in San Francisco, California occurring over 1,551 days. Results support the first hypothesis but not the second. The implications are that there is a general check effect and that it was not reduced by ending benefits to persons with drug and alcohol related disabilities.