Psychological Differences Between HIV-Positive Mothers Who Disclose to All, Some, or None of Their Biological Children

This study explored the psychological differences between HIV-positive women who disclosed their serostatus to all, some, or none of their biological children. Data from this project come from a larger, longitudinal investigation of the disclosure process of HIV-infected women. Data were obtained regarding the disclosure processes and the psychological adjustment of women with children ( n  = 90) based on measures of depression, anxiety, and stress. Results suggest that women who disclose to all, some, or none of their children are not significantly different with regard to emotional well-being. Implications for marriage and family therapists are provided.     

Responding to children's disclosure of familial abuse: what survivors tell us.

This study is based on the reports of 384 adults who were abused physically, sexually, and/or emotionally in childhood by family members. It describes the survivors' attempts, as children, to get help by disclosing the abuse to someone who might intervene; those who did not disclose explain their reasons. The results indicate that disclosure usually did not bring an end to the abuse, and that little action was taken to control the perpetrator, even after disclosure took place. The responses received by the children to their disclosure are linked to their levels of self-esteem and family functioning as adults.     

Changing methods of disclosure. Literature review of disclosure to children with terminal illnesses,including HIV

More than 30 years after the first discovery of the deadly HIV virus, and in the wake of increased knowledge of transmission, treatment and behavioral intervention development, parents are still faced with the difficult task of whether, when and how to inform their child about her or his HIV status. Except for some general ethical considerations, there are no national or international guidelines available for handling HIV status disclosure to a child by parents and health professionals. Most studies on disclosure address the problem of stigma and the barriers to disclosure of HIV-positive status by adults to their sexual partners, caretakers, families and communities, but very few studies focus on disclosure to HIV-positive children. The majority of the studies that address disclosure to children limit themselves to stipulating reasons for barriers to such disclosure instead of the skills and knowledge necessary for effective disclosure to a child. Increasing availability of therapy for HIV across the world presses the issue of disclosure to the child. Even so, disclosure for children who are HIV-positive due to vertical transmission continues to be very difficult. There is a lack of interventions that consider guidelines for healthcare professionals, parents or persons involved with taking care of HIV-positive children. These interventions should be designed in an understanding manner towards the culture where they might be implemented and be as appropriate in the view of integrating different family structures and the child's development.     

Differences in substance use,sexual behavior,and demographic factors by levels of ‘outness’ to friends and family about being a male-for-male escort

Objectives: Male sex work (i.e., escorting) is a stigmatized profession, and men in the sex industry may hide their involvement to avoid negative social consequences. There is limited research comparing men who are out about being an escort to their friends and/or family to those who are out to neither friends nor family. Methods: Data were taken from a 2013 online study of male escorts who were categorized into 3 groups based on outness patterns — friends only (48.9%, n = 193), friends and family (26.6%, n = 105), or neither friends nor family (23.5%, n = 93) — and they were compared on demographic and behavioral variables. Results: We hypothesized that men out to neither friends nor family would perform poorer across indicators of health and well-being due to the lack of social support that can come from friends and family. However, with the exception of reporting lower satisfaction and pay from their last male client, this hypothesis was unsupported. Outness patterns were largely unassociated with social and sexual behaviors with the last male client, and the majority eschewed condomless anal sex with their last male client, suggesting escorts — regardless of how out they are to friends and family — could navigate safer-sex behaviors with their clients. Outness was associated with substance use (<12 months) and substance use with their last male client — men out to friends and family were, for the most part, the most likely to have used substances. Men out to friends and family were significantly more likely than others to have been escorting for more than 5 years and to be escorting full-time. Conclusions: Interventions for escorts that address substance use and sexual risk behaviors and incorporate supportive friend and family social networks may be an important area for future research.     

DIFFERENT AND SAME: FAMILY THERAPY WITH ASIAN-AMERICAN FAILIES

This paper is written for non-Asian family therapists who must deal with an increasing number of Asian-American client families. Unlike some writers in fthe field who advocate that client and therapist have the same ethnic background, the authors belive that cultural sensitivity can be learned. Several culturally important values are described, and suggestions on how to orient treatment to fit this client population are offered. A Detailed case example illustrates the treatment issues involued.     

Young men's perspectives on family support and disclosure of same-sex attraction

Young men who have sex with men (YMSM) face myriad challenges when deciding to disclose their sexual orientation to family members. Key to this decision is consideration of how disclosure may influence the support they receive from family. This paper explores a diverse sample of YMSM's (N = 43) perspectives on disclosure of their same-sex attractions to key family members and its impact on family support. Several stages/categories of disclosure are described and some YMSM seemed to continue to move between categories. Additionally, relationships after disclosure included negotiations between the expression of their sexual orientation and the maintenance of family support.     

Adolescent Children of Alcoholics on Disclosure,Support, and Assessment of Trustworthy Adults

The aim of this study is to describe adolescent children of alcoholics’ (COA) perspectives on disclosure and support. COA reported assessing the trustworthiness of adults before disclosing their home situation. Before disclosure they may have raised their own level of consciousness, told a peer, told an adult stranger, or in-directly communicated with an adult. These findings are the result of interviews with 27 adolescents attending support groups for COA in Sweden. Adults, who ask questions, listen carefully and cooperate with the child/adolescent, and who are knowledgeable about families with alcohol problems, are considered as supportive and trustworthy. The adolescents reported psychological, communicative, environmental, and generational aspects of the disclosure process.     

To Refer or Not to Refer: Exploring Family Therapists' Beliefs and Practices Related to the Referral of Lesbian,Gay, and Bisexual Clients

This study explored how negative beliefs toward lesbian, gay, and bisexual (LGB) individuals and LGB clinical competence influenced family therapists' beliefs and practices regarding referring based on the sexual orientation of the client. The sample consisted of 741 experienced clinicians. The results of this study indicated that the majority of the participants believe it is ethical to refer LGB clients; however, most had never made such a referral. Furthermore, participants who had referred based solely on the client's sexual orientation reported higher levels of negative beliefs toward LGB individuals and lower levels of LGB clinical competence. Finally, negative beliefs toward LGB persons not only predicted the practice of referring, but also the belief that it is ethical to refer an LGB client.     

Reflections on Closeted Helping Professionals

Abstract

Reflections noted in the provocative paper by Roui-lard elsewhere in this volume are reconsidered from a variety of professional and client perspectives. Among these viewpoints is a discussion regarding the boundaries of disclosure of sexual orientation. Public or professional responsibilities concerning disclosure are considered in light of the right to privacy of lesbian and gay helping professionals. The impact of disclosure upon lesbian or gay clients as it relates to the age of the client and of the service being provided is considered. Some political implications of “coming out” versus remaining “closeted” are also discussed.     

Disclosure Stress,Social Support,and Depressive Symptoms Among Cisgender Bisexual Youth

Bisexual youth are at elevated risk for depression when compared with lesbians and gay men. Research on bisexual stigma suggests that these youth are uniquely vulnerable to stress related to sexual identity disclosure. Depression associated with this stress may be buffered by social support from parents and friends. We examined the differential influence of social support from parents and friends (Child and Adolescent Social Support Scale) on the relation between disclosure stress (LGBTQ Coming Out Stress Scale) and depressive symptoms (Beck Depression Inventory) and differences by gender in a sample of cisgender bisexual youth (N = 383) using structural equation modeling. Parental support buffered the association between stressful disclosure to family and depressive symptoms, especially for bisexual men; bisexual women seemed not to benefit from such support when disclosure stress was high. This nuanced examination elucidates the ways family members and clinicians can best support bisexual youth sexual identity disclosure.     

"In search of a tale they can live with": about loss, family secrets, and selective disclosure

Several authors have written about family secrets in the family therapy literature in interesting ways. According to these authors, the questions “who knows the secret?” and “who does not know the secret?” are central. In the present study, we have qualitatively analyzed the documentary film Familiegeheim (Family Secret) by the Dutch director Jaap van Hoewijk. The film shows van Hoewijk’s investigation into the death of his father in 1974 and tells the story of a family in which the suicide of the father is kept secret from the three children. Our analysis of the film highlights the complex ways in which families deal with sensitive issues like loss, grief, and suicide. The concept of family secrets seems to poorly capture this complexity, focusing one‐sidedly on the destructive effects of withholding delicate information. The concept of selective disclosure is proposed as an alternative. Selective disclosure refers to the complex processes involved in dealing with the dialectic tension between sharing information and keeping it secret. The concept is not only focused on the destructiveness of secrecy but, in addition, also makes room for an appreciation of the caution with which family members deal with sensitive family issues.     

Disclosure of Child Sexual Abuse: The Case of Pacific Islanders

A number of factors influence the disclosure of child sexual abuse by survivors. While the influence of race and ethnicity on disclosure patterns is getting more attention, little has been written on abused children of Pacific Islanders, due in part to both lack of relevant data and a relatively small Pacific Islander population in the United States. Drawing on interviews with Pacific Islander women who were sexually abused in childhood and who delayed revealing their victimization, we explore the reasons for delayed disclosure. Findings suggest that cultural norms and family dynamics affect disclosure decisions. Concerns for the family and self-blame were the most common reasons for delay and lack of disclosure. We discuss implications of the findings and make policy recommendations.     

The impact on the family therapist of a focus on death, dying, and bereavement

Recognizing the growing numbers of family therapists who are choosing a focus on death, dying, and bereavement, this article addresses the nature of the commitment required--as well as the gifts and challenges presented by work in this area. Particular attention is given to therapists' vulnerability to compassion fatigue and/or vicarious traumatization, both of which are described and discussed. A variety of strategies for individuals and institutions, aimed at supporting professionals and preventing problems, are considered. It is concluded that as family therapists focus on self-care as well as client care, they have the potential to increase not only their effectiveness but also to enhance their own well-being. Implications for training and for research on this topic also are considered.     

When therapists do not want their clients to be homosexual: a response to Rosik's article

This commentary is a response to Rosik's "Motivational, Ethical, and Epistemological Foundations in the Treatment of Unwanted Homoerotic Attraction" (this issue). Such treatment raises complex questions that cannot be resolved by focusing on the therapist's conservative versus liberal values. Most such clients are deeply ambivalent about their homosexual attractions. The degree to which their homosexuality is "unwanted" is highly variable among them and sometimes within them over time. Clients who are exclusively homosexual are very unlikely to be able to change their sexual attractions, whereas some clients who are bisexual may be more able to "manage" their homoerotic attractions (acting only on their heterosexual feelings). Marriage and family therapists should be able to support a client along whatever sexual orientation path the client ultimately takes, and the client's sense of integrity and interpersonal relatedness are the most important goals of all.     

Irish child sexual abuse victims attending a specialist centre

We profiled a cohort of CSA cases referred for assessment to a specialist child sexual abuse (CSA) centre in a national paediatric hospital in Ireland. Historical and clinical data were drawn from records of 171 cases. The majority of cases were referred by social workers following purposeful disclosure of CSA. Three quarters of the cases were female with a mean age of 9 years. They were from a wide spectrum of socioeconomic groups and many had suffered a range of family adversities. In most cases, the abuse involved masturbation of the child by the abuser. Almost all of the perpetrators were male with a mean age of 28 years and in 60% of cases extrafamilial abuse had occurred. In 23% of cases, the perpetrator had a history of previous sexual offending. Anxiety was the most common emotional problem before disclosure and after disclosure the most common emotional problem was guilt. Before disclosure school refusal was the most common behavioural problem and after disclosure fighting was the most prevalent behavioural difficulty. The most common factors supporting the credibility of CSA allegations were labile mood, the child's ability to differentiate fact from fantasy and a detailed disclosure of contextual details. More adolescents showed deterioration in schoolwork after disclosure and for more pre school children clinginess following disclosure was a significant emotional problem. More primary school aged children were abused by perpetrators who had abused a number of children. For children abused by such perpetrators, vaginal intercourse was less common. Vaginal intercourse was more common in 6–11‐year‐old victims and those who were abused on a daily basis. The threat that disclosure posed to the integrity of the family structure was more often a factor hindering disclosure in victims abused by father figures and abused very frequently. Copyright © 2003 John Wiley & Sons, Ltd.     

Using Psychodynamic, Cognitive-Behavioral, and Solution-Focused Questioning to Co-Construct a New Narrative

The narrative and social construction metaphors are used as the conceptual frame for the clinical work with a client who felt trapped in an emotionally abusive relationship. To help the client deconstruct a problem-saturated narrative, questions were asked which drew from psychodynamic, cognitive-behavioral, and solution-focused models. The rationale for the use and timing of deconstructive questions from the various models is discussed. The problem-saturated story during the time of intake is presented, as is the change process that led to a more solution-focused narrative. An effective short-term treatment was created through the use of interventions drawn from multiple clinical models. Effectiveness was judged by client's improved emotional state, and the ability of the client to imagine and pursue identified solutions.     

Barriers to disclosing child sexual abuse (CSA) in ethnic minority communities: A review of the literature and implications for practice in Australia

Research on child sexual abuse (CSA) among ethnic minority communities in Australia is essentially absent. To begin to address the gap, a systematic literature review was conducted; which necessarily borrowed from overseas to help inform the national context. A wide array of barriers to disclosure were identified, suggesting that this is a fundamental issue for ethnic minorities. The most significant of these barriers appears to be the need to protect family name. This also leads to non-supportive and protective responses from non-offending mothers, however this experience (although more intense) is shared with the Western mainstream. In comparison, fear of stigmatising their whole community is a unique barrier and highlights that racism is a significant and additional burden. The findings suggest that service worker training in Australia is critical for informing professionals of: the importance of family reputation for collectivist groups; the importance of responding supportively and protectively to child victims who have disclosed to them first; the cross-cultural complexities that surround construals of ‘child safety’; educating non-offending mothers about the importance of at least believing their child's disclosure (associated with mediating mental illness among victims, but also culturally appropriate because it acknowledges the protective role of family cohesion in collectivist cultures and the high motivation to avoid social exclusion – the most common reprisal for shaming the family name); exploring acculturation as a possible predictor of disclosure; and the risk of racism being overlooked or minimised. Overall, it is argued that practice informed by a well-developed national research agenda is critical.     

Disclosure of Child Sexual Abuse Among Adult Male Survivors

Men who were sexually abused during childhood are a stigmatized, under-studied, and marginalized population that is at risk for long-term mental health problems. However, many mental health practitioners feel under-prepared and ill-equipped to effectively treat male survivors of child sexual abuse. Furthermore, little is known about factors that may impact the mental health of male survivors such as disclosure of the sexual abuse. The purpose of this study was to (a) describe the disclosure process of male survivors using a lifespan approach, (b) identify disclosure differences based on age and type of abuser, and (c) explore relationships between disclosure attributes and current mental health. Using a large, purposive sample of male survivors (N = 487), the study found that, on average, men delayed telling (M = 21.38 years) and discussing the abuse (M = 28.23 years) for many years. Older age and being abused by a family member (i.e., incest) were both related to delays in disclosure. Most participants who told someone during childhood did not receive emotionally supportive or protective responses and the helpfulness of responses across the lifespan was mixed. Several variables (e.g., timing of disclosure, discussing with a spouse, response to disclosure) were related to current mental health problems. These findings are helpful for clinical social workers who practice with clients from this population. Specific suggestions for improving clinical practice (e.g., assessment, treatment, professional training) are discussed.     

Universal screening for intimate partner violence: a systematic review

Intimate partner violence (IPV) is known to be prevalent among therapy-seeking populations. Yet, despite a growing understanding of the dynamics of IPV and of the acceptability of screening, universal screening practices have not been systematically adopted in family therapy settings. A rapidly growing body of research data-almost entirely conducted in medical settings-has investigated attitudes and practices regarding universal screening for IPV. This article is a systematic review of the IPV universal screening research literature. The review summarizes literature related to IPV screening rates and practices, factors associated with provider screening practice, the role of training and institutional support on screening practice, impact of screening on disclosure rates, client beliefs and preferences for screening, and key safety considerations and screening competencies. Implications for family therapy and recommendations for further inquiry and screening model development are provided.     

Mahler applied

Conclusion It is crucial to recognize that individuation is not a smooth or painless process. Indeed, some of the pressures on the individuating client as a member of a family come from his spouse and the family system. Marriage itself is a partial symbiosis out of which one or both members individuate, with the ideal being an optimal distance between them. The developmental approach to the family notes that there is a crisis in the life cycle whenever there is a passage from one stage to the next, i.e., birth of the first child, the last child beginning school, the last child leaving home. The adolescent's attempt to separate from his family is another well-known crisis situation, at times being expressed through schizophrenic breakdown in the family. The extreme on the continuum of resistance to individuation comes from the schizophrenic family, where individuation creates excessive anxiety, as differences among members upset the homeostatic balance. It is the task of the therapist to avoid being drawn into the family's symbiotic system, and instead to aid the client in achieving a higher level of differentiation.What is apparent in studying Mahler's work is the complexity of the entire process of becoming an individual. Working with clients who are striving for mastery in this area, and with those who fear it, is further dramatic proof that separate functioning demands great psychic investment as well as a significant amount of time. Mahler has provided clinicians with a valuable framework for intervention and guidelines for assessment of individual growth.