THE THERAPEUTIC ALLIANCE IN HOME‐BASED FAMILY THERAPY: IS IT PREDICTIVE OF OUTCOME?

This study examined the association between the therapeutic alliance in family therapy and changes in symptom distress, interpersonal relationships, and family coping. The participants (N = 81) were members of low socioeconomic status families referred to a university clinic for in-home family therapy. Participants completed the Outcome Questionnaire, Family Crisis Oriented Personal Evaluation, and the Family Therapy Alliance questionnaires. Regression analyses revealed that the therapeutic alliance explained 19% of the variance in symptom distress changes for mother, 55% for fathers, and 39% for adolescents. The implications of these findings for practicing and researching family therapy are presented.     

An Empirical Test of the Relative Validity of Expert and Lay Judgments of Risk

This article investigates how accurately experts (underwriters) and lay persons (university students) judge the risks posed by life-threatening events Only one prior study (Slovic, Fischhoff, & Lichtenstein, 1985) has previously investigated the veracity of expert versus lay judgments of the magnitude of risk. In that study, a heterogeneous grouping of 15 experts was found to judge, using marginal estimations, a variety of risks as closer to the true annual frequencies of death than convenience samples of the lay population. In this study, we use a larger, homogenous sample of experts performing an ecologically valid task. We also ask our respondents to assess frequencies and relative frequencies directly, rather than ask for a "risk" estimate--a response mode subject to possible qualitative attributions-as was done in the Slovic et al. study. Although we find that the experts outperformed lay persons on a number of measures, the differences are small, and both groups showed similar global biases in terms of: (1) overestimating the likelihood of dying from a condition (marginal probability) and of dying from a condition given that it happens to you (conditional probability), and (2) underestimating the ratios of marginal and conditional likelihoods between pairs of potentially lethal events. In spite of these scaling problems, both groups showed quite good performance in ordering the lethal events in terms of marginal and conditional likelihoods. We discuss the nature of expertise using a framework developed by Bolger and Wright (1994), and consider whether the commonsense assumption of the superiority of expert risk assessors in making magnitude judgments of risk is, in fact, sensible.     

Meeting summary--cell biology of Parkinson's disease and related neurodegenerative disorders

Parkinsonian disorders (idiopathic Parkinson's disease and clinically similar disorders) are characterized by impaired movements caused by the degeneration of brain centers involved in regulating normal and smooth movements of the body and its extremities. The mechanisms that cause such degeneration are unknown. This Perspective summarizes research described at a meeting held in June 2003, which was organized by the National Institute of Neurological Disorders and Stroke and the National Institute on Aging to provide an update on recent advances in the cell biology of parkinsonian disorders.     

Preaching to the converted: conversion language and the constitution of the TV evangelical community

A paradox is noted in the presentation of conversion in TV evangelism; this is that although the necessity of being converted is a common theme it is clear that the evangelists are aware that their audience is already converted. An attempt is made to resolve the paradox by showing how TV evangelists use conversion language as rhetoric to legitimate their role and the rationality of the organisation which they represent. It is further shown how this legitimation is itself made possible through another use of conversion language which creates a sense of moral community embracing evangelists, organisation and audience as copartners in the shared project of conversion. Finally, it is shown how the presentation of TV evangelism as the central ritual of a moral community generates a further conversion rhetoric which depicts the community as both exclusive of and yet open to non-members; a contradiction which is resolved through the establishment of distinctive roles within the community related to the activity of winning converts.     

Treatment of the mother in the incest family: The beginning phase

This paper discusses significant counter-transference issues and presents a conceptual framework for ordering the strategies in treating the mother in the incest family. The development of empathy is suggested as the primary engagement tool, and obstacles to its development are analyzed.The major theoretical construct that is employed in formulating the treatment approach is that of the traumagenic dynamics model presented by Finkelhor and Browne (1985). The manner in which this framework can be employed in assessment and prioritizing treatment goals is outlined. Specific approaches for the beginning phase of work with the mother are then described.     

Disability and identity: the challenge of epilepsy

Through examining the case of people with epilepsy (which, as we demonstrate, has an ambiguous status in relation to both popular and academic conceptions of disability) we explore the fluid, negotiable and contingent nature of identity and, in particular, the identification as ‘disabled’. Disability, we argue, cannot be reduced to either biology or social oppression, or even primarily to biological or social factors: it is the outcome of a complex interaction between a multiplicity of factors – biological, environmental, social, psychological, cultural and political – which will interact and be experienced differently by different people, at different times and in different situations. Rather than conceiving of disability in ‘all or nothing’ terms and of differing explanations as competing and mutually exclusive, it would be more productive to see them as partial and potentially complementary contributions to the better understanding of a complex and multifarious reality.     

Personalization of Mail Surveys for General Public and Populations with a Group Identity: Results from Nine Studies*

Abstract The effect of personalization on mail survey response rates was examined in nine studies that included 17 comparisons under several research conditions. A study of this variable across multiple experiments in five agricultural experiment stations was undertaken because of conflicting results from previous research and from concern that the effectiveness of personalization might have decreased over time. Results show that, while response to general public surveys appeared to increase modestly across all treatment groups, there was no positive effect for populations in which a group identity (e.g., Dear Oregon Gardner or Dear ATV Owner) is employed to address respondents in cover letters. Personalization appears to remain useful for improving response in surveys of the general public.     

A qualitative study of innovations implemented to improve transition of care from maternity to child and family health (CFH) services in Australia

BackgroundThe transition of care (ToC) from maternity services, particularly from midwifery care to child and family health (CFH) nursing services, is a critical time in the support of women as they transition into early parenting. However significant issues in service provision exist, particularly meeting the needs of women with social and emotional health risk factors. These include insufficient resources, poor communication and information transfer, limited interface between private and public health systems and tension around role boundaries. In response some services are implementing strategies to improve the transition of care from maternity to CFH services.AimThis paper describes a range of innovations developed to improve transition of care between maternity and child and family health services and identifies the characteristics common to all innovations.MethodsData reported were collected in phase three of a mixed methods study investigating the feasibility of implementing a national approach to child and family health services in Australia (CHoRUS study). Data were collected from 33 professionals including midwives, child and family health nurses, allied health staff and managers, at seven sites across four Australian states. Data were analysed thematically, guided by Braun and Clarke's six-step process of thematic analysis.FindingsThe range of innovations implemented included those which addressed; information sharing, the efficient use of funding and resources, development of new roles to improve co-ordination of care, the co-location of services and working together. Four of the seven sites implemented innovations that specifically targeted families with additional needs. Successful implementation was dependent on the preliminary work undertaken which required professionals and/or organisations to work collaboratively.ConclusionImproving the transition of care requires co-ordination and collaboration to ensure families are adequately supported. Collaboration between professionals and services facilitated innovative practice and was core to successful change.