The epidemiology of physical attack and rape among crack-using women

This prospective study examines the epidemiology of physical attack and rape among a sample of 171 not-in-treatment, crack-cocaine using women. Since initiating crack use, 62% of the women reported suffering a physical attack. The annual rate of victimization by physical attack was 45%. Overall, more than half of the victims sought medical care subsequent to an attack. The prevalence of rape since crack use was initiated was 32%, and the annual rate was 11%. Among those women having been raped since they initiated crack use, 83% reported they were high on crack when the crime occurred as were an estimated 57% of the perpetrators. Logistic regression analyses showed that duration of crack use, arrest for prostitution, and some college education were predictors of having experienced a physical attack. Duration of crack use and a history of prostitution were predictors of suffering a rape. Drug abuse treatment programs must be sensitive to high levels of violence victimization experienced by crack-cocaine using women. Screening women for victimization, and treating the problems that emanate from it, may help make drug abuse treatment more effective.     

The Power Equity Guide: attending to gender in family therapy

In the past two decades, feminist scholars have challenged the field of family therapy to incorporate the organizing principle of gender in its theory, practice, and training. In this paper, we introduce a training, research, and therapeutic tool that provides guidance for addressing or observing gender and power differentials in the practice of family therapy. As a training tool, the Power Equity Guide helps trainees to translate their theoretical understanding of feminist principles into specific behaviors in therapy. Researchers and supervisors can use the Power Equity Guide to evaluate the practice of gender-informed family therapy. We also provide specific suggestions for its use by trainers, supervisors, therapists, and researchers.     

Biracial youth and families in therapy: issues and interventions

Empirical research and clinical resources focusing specifically on minority youth and families have increased tremendously in the last 2 decades. Despite this trend, certain groups continue to be relatively neglected. In particular, very few resources exist for understanding the unique challenges that often face biracial youth and their families. In this article, we use a nationally representative database to compare functioning in biracial youth to white adolescents and other minority adolescents. Results suggest that biracial/biethnic youth are a particularly vulnerable group in terms of self-reported delinquency, school problems, internalizing symptoms, and self-regard. As a group, they are also more likely to receive some form of psychological intervention. Given these findings and the shortcoming of clinical resources for work with this population, we provide an in-depth discussion of why biracial youth may be particularly vulnerable from a social-constructionist framework and offer several strategies based on narrative family therapy for working with biracial youngsters and their families.     

Individual and crossover effects of stress on adjustment in medical student marriages

High-stress individuals may benefit from social support, although their support providers may be adversely affected via stress crossover effects. Individual and crossover effects of perceived stress within medical student marriages (n = 30) were investigated. Perceived spousal support was positively associated with individuals' own marital and emotional adjustment, attenuating stress effects. With regard to crossover effects, medical students' perceived stress was significantly associated with their spouses' emotional adjustment. Further, medical students' own emotional adjustment fully mediated this crossover effect. Results suggest that the contagion of negative affect may serve as a key mechanism through which stress crossover effects operate in marriage.     

Internship training in marriage and family therapy: a survey of doctoral program objectives and implementation

This article presents the results of a survey that examined the implementation of the Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE) internship requirement by accredited doctoral Marriage and Family Therapy (MFT) programs. Representatives from each of 10 doctoral MFT programs provided responses to questions regarding program objectives for internship training. Respondents also provided subjective impressions regarding the effectiveness with which established internship goals are accomplished, associated benefits and difficulties, and adequacy of the standards. Results suggest that although most programs perceive the internship requirement as beneficial, many express concern regarding the effects of the internship requirement on other aspects of training and in relationship to the overall goals for doctoral MFT education. Conclusions and recommendations are offered based on the mixed findings.     

Controversies and challenges of ritual abuse

Children who have survived ritual abuse have endured physical, psychological, and sexual trauma; brain-washing; and mind-altering drugs. Their trust in adults has been eroded. Their coping strategies include anxiety, denial, self-hypnosis, dissociation, and self-mutilation. Although reports of ritual abuse initially seem hard to believe, nurses have a responsibility to detect clues to abuse, diagnose the child's responses, and recognize controversial issues regarding ritual abuse. To evaluate ritual abuse, nurses should avoid interview strategies that influence the child's recall (e.g., coaching, suggestions) and recognize that some reports are discounted as false memories because they emerge from fantasy, distortions, innocent deceptions, false beliefs, lies, or adult coaching. Nurses play an important role in case finding and treatment. They can evaluate clues to ritual abuse to reduce sources of error in assessment, build a child's trust, monitor their own attitudes toward ritual abuse, and intervene to increase self-esteem, empathy, boundary establishment, and coping. Nurses have an important opportunity to detect and begin healing the wounds caused by a child's abuse.     

Family therapy trainees' evaluations of their best and worst supervision experiences

Supervisees in Commission on Accreditation for Marriage and Family Therapy Education-(COAMFTE) accredited and candidacy training programs were asked to describe their best and worst supervision experiences in terms of the context of training and supervision, the perceived personal attributes of the supervisor, and specific behaviors perceived to be enacted by the supervisor during supervision. Contextual factors such as supervision modality, frequency and duration of supervisory contacts, and sources of supervisory data appeared to distinguish between supervisees' perceptions of their best and worst experiences. These experiences were further distinguished by the supervisees' perceptions regarding the supervisor's level of interpersonal attractiveness, trustworthiness, and expertise. Key behaviors perceived to be enacted by supervisors during best and worst experiences clustered into several dimensions that included creating an open supervisory environment, communication and encouragement, attending to personal growth, and providing conceptual and technical guidance and direction.     

School dropout and injecting drug use in a national sample of white non-Hispanic American adults

In this study we sought to extend our previous finding of an association between school dropout and injecting drug use (IDU) among African Americans by testing the association in a sample of White non-Hispanic Americans. A nationally representative sample of White non-Hispanic Americans age eighteen years and older was drawn from public use data files of the 1995-1996 National Household Surveys on Drug Abuse (NHSDA). Adults with a self-report history of IDU were identified, and were matched to non-IDU adults in the same neighborhoods of residence. Conditional logistic regression was used to estimate the association between dropping out of high school and the occurrence of IDU. White non-Hispanic American high school dropouts were more likely than high school graduates to have injected a drug at least once. The findings of this research on non-Hispanic Whites are generally consistent with our earlier evidence on the association between educational status and a history of IDU among African-American adults. School dropout prevention programs may merit attention in an overall strategy of preventing injecting drug use and HIV/AIDS.     

Evaluation of a family-based substance abuse prevention program targeted for the middle school years

A family-based substance abuse prevention program was evaluated which emphasizes family cohesion, school and peer attachment, self-esteem, and attitudes about adolescent use of alcohol and tobacco. The program was implemented in rural communities and targeted families with students entering middle or junior high school. Baseline surveys were conducted with students and parents in four schools and were readministered one year later. Because the program was voluntary, a quasi-experimental design was used to compare participants (29 students and 28 parents) and nonparticipants (268 students and 134 parents). Analyses of covariance indicated that student participants, as compared to nonparticipants, had higher family cohesion, less family fighting, greater school attachment, higher self-esteem, and believed that alcohol should be consumed at an older age at the one year follow-up. There were fewer significant results for parent participants. Strategies for involving parents in prevention programs are discussed.