Mental illness,partial hospitalization,and the family

Summary When illness is socially defined, the task of therapy is to enable the patient to move from a sick role to one of maximal social functioning. In a day hospital setting, methods are explored to involve a patient with his family both directly and indirectly. Thus the patient is supported both in the treatment milieu and when he is at home. Not only the patient, but the family, is vulnerable at this time and each must be helped to make parallel and complementary shifts in interpersonal behavior. To view the family solely as a resource for the support of the ill member and his treatment is to fail to accept the need of the family as a whole for reorganization and strengthening.     

The emerging self in conceptualizing and treating mental illness

1. The course of severe mental illnesses is more heterogeneous than previously thought and is influenced by many complex, interacting factors. 2. The experience of self and capacity to cope of people with mental illnesses contribute to the recovery process. 3. Changes in traditional treatment models and a focus on broader societal interventions are needed to facilitate recovery. 4. Psychiatric nurses play an important role in these new developments as evident, for example, in the 3R Program (relapse, recovery, and rehabilitation).     

Maintaining the therapeutic alliance with Ms. T. in the initial phase of treatment

This paper addresses the difficulties in developing and maintaining the therapeutic alliance with a patient who regularly sought consultations with other therapists during the initial phase of treatment. Separation individuation theory illuminated her approach-avoidance behavior as enacted inside and outside the treatment room; a behavior reminiscent of the ambitendent toddler of the rapprochment subphase of development. Separation-individuation theory aided the therapist in the management of her countertransference, thus avoiding the undermining of the tentative treatment alliance.     

Sexual functioning and practices in a multi-ethnic study of midlife women: baseline results from SWAN

This study examined the sexual practices and function of midlife women by ethnicity (African American, Caucasian, Chinese, Hispanic, Japanese) and menopausal status. Sexual behavior was compared in 3,262 women in the baseline cohort of SWAN. Participants were 42 to 52 years old, premenopausal or early perimenopausal, and not hysterectomized or using hormones. Analysis used multivariate proportional odds regression. In our sample, 79% had engaged in sex with a partner in the last 6 months, and a third considered sex to be very important. Common reasons for no sex (n = 676) were lack of partner (67%), lack of interest (33%), and fatigue (16%). Compared with Caucasians, Japanese and Chinese women were less likely, and African Americans more likely, to report sex as very important (p < 0.005). Significant ethnic differences were found for frequency of all practices. Perimenopause status was associated only with higher frequencies of masturbation and pain during intercourse.     

Where are the children in home–school relations? Notes towards a research agenda

In this article we unpack the assumptions behind the dominant British research, policy and practice home-school relations consensus that holds parents' involvement and participation in their children's education to be unquestionably necessary and beneficial. It presupposes a one-way relationship between parents and children in which children are implicitly placed as dependent and inert recipients of the decisions and activities of parents and teachers. It does not take account of the impacts of the gender of children and their parents, ethnicity, age or family form. We draw on evidence from a diverse range of sources to show that children do have individual and collective interests and priorities in the process of home-school relations, and that gender is particularly important in this. We argue for research on home-school relations that takes an essentially child-centred approach, treating children as competent informants on diverse aspects of parental involvement in their education.     

Child Welfare Policy in the United States

Recent developments in child welfare in the United States can be seen as enactments of state paternalism toward families. New programs and procedures in the areas of foster care and “in-home” family services aim to reinforce parents' and childrens' rights, but these rights are typically framed as protections against bureaucratic abuse rather than as rights to basic material resources. The prevailing cultural assumption toward child welfare in the United States is that the government should not intervene in family life unless there is legal evidence of functional failure. Families are still seen as autonomous units that essentially determine their own fates. This ideology serves to limit the public and political perception of more preventive and developmental options.     

Joint model-based clustering of nonlinear longitudinal trajectories and associated time-to-event data analysis,linked by latent class membership: with application to AIDS clinical studies

Longitudinal and time-to-event data are often observed together. Finite mixture models are currently used to analyze nonlinear heterogeneous longitudinal data, which, by releasing the homogeneity restriction of nonlinear mixed-effects (NLME) models, can cluster individuals into one of the pre-specified classes with class membership probabilities. This clustering may have clinical significance, and be associated with clinically important time-to-event data. This article develops a joint modeling approach to a finite mixture of NLME models for longitudinal data and proportional hazard Cox model for time-to-event data, linked by individual latent class indicators, under a Bayesian framework. The proposed joint models and method are applied to a real AIDS clinical trial data set, followed by simulation studies to assess the performance of the proposed joint model and a naive two-step model, in which finite mixture model and Cox model are fitted separately.