Integrative Family Therapy With Childhood Chronic Illness: An Ethics of Practice

A challenge for contemporary family therapists is negotiating differences between modern and postmodern frameworks in the practice context. Modernists espouse a systemic metaphor; use evidence‐based and interventive approaches, including strategic, structural‐ or solution‐focused techniques, and believe in the therapist's knowledge, expertise and power to influence individuals or families to change. On the other hand, postmodernists follow a social constructionist, dialogical or narrative paradigm, which identifies the main ingredient of therapy as language, conversation, understanding and the therapist's ‘not knowing’ stance in eliciting a person's expertise and story Yet many practitioners adopt a middle way between these paradigm polarities, one that is less theory‐driven and more pragmatic, flexible, integrative and practice‐based. This is consistent with evidence‐based practice and research demonstrating common factors across all therapies. The value of preserving systemic thinking in family therapy is recognised while reaching forward to a postmodern social constructionist and dialogical approach. The article describes this integrative stance in family therapy as paramodern based on an ethics of practice. This is illustrated by a detailed case study of integrative family therapy, which addresses anxiety, anger and sleeping issues associated with a chronic childhood illness called Perthe's disease.     

危重病性多发性周围神经病与肌病的临床及肌电图探讨

目的探讨危重病性多发性神经病与肌病的临床、电生理特点。方法对6例危重病性多发性神经病与肌病患者的临床资料、肌电图结果进行分析。结果患者均因严重感染等基础疾病转入ICU,均进行气管插管呼吸机辅助呼吸,6例患者均出现四肢基本对称的肌力下降、感觉异常及腱反射减弱。肌电图结果示四肢周围神经的运动及感觉复合电位波幅明显下降或引不出,4例患者同时合并肌病样改变。结论危重病性多发性神经病与肌病是重症患者气管插管呼吸机辅助呼吸后常见的并发症,电生理检查有助于本病的诊断,早期认识及治疗本病与预后关系很大。     

Voices of Resilience

Abstract

Terminally ill older adults have the capacity to live well in the context of dying. Having negotiated a lifetime of challenges, they have resources to demonstrate resilience and achieve wholeness in life's final phase, but research has not adequately investigated this process. This qualitative research study considered the paths to resilience used by 30 older adult hospice clients in Kansas and Illinois. Responses were coded using the grounded theory method of Strauss and Corbin (1990) where data drives interpretation and text is coded into categories. Results centered on four themes that included: (1) a redefinition of self; (2) use of religion/spirituality or openness to uncertainty; (3) maintenance of social investments; and (4) guarding independence even as the scope of life contracted. Results imply that attention should be paid to building environments of wellness. This may be accomplished paradoxically through facilitating continuity of client interests and yet opportunities for creativity and growth as well. Listening with a healing stance and cultivating a habit of being fully present in interactions with clients assist in this process.     

Preventing Alcohol Use Among Urban American Indian Youth: The Seventh Generation Program

SUMMARY

In comparing alcohol use between American Indian and non-Indian youth, the age at first involvement with alcohol is younger, the frequency and amount of drinking are greater, and negative consequences are more common for Indians. This article presents the results from the first phase of an innovative alcohol prevention program targeting urban Indian youth. Urban Indian youth were chosen as the participants since the majority of the roughly two million American Indians now live in urban areas. The Seventh Generation Program described in this article is unique in that it blends mainstream prevention approaches with American Indian culture to produce a program that is culturally sensitive to and appropriate for the urban Indian community in which it was developed. A quasi-experimental research design was used to evaluate the Generation Program.     

Book Reviews

Critical appraisal of research studies forms a central role within the application and uptake of evidence‐based approaches within health and social care. While there are established checklists for evaluating quantitative research, this is not the case for qualitative research. This article outlines the process of developing an evaluative tool for qualitative studies, reflecting the uniqueness of the associated paradigm, and illustrates its use by reference to three qualitative research papers appraised within a systematic review of community‐based rehabilitation services. At its centre are concerns with the context of the study and the way the data are collected and analysed. Use of such an evaluative template opens the way for the quality of qualitative research to be judged in a systematic manner and for qualitative research to take its rightful place within debates over what works, where, when and how within health and social care policy and practice.     

Precise Simulated Percentiles in a Pinch

A percentile point simulation algorithm is presented. The algorithm is useful when computer storage and time considerations are at a premium. The algorithm employs various time- and storage-saving ideas, including a “pinching” mechanism that reduces the proportion of simulated values stored as the number of iterations is increased. Algorithm output includes a measure of precision as well as the simulated percentile point. The simulation can be stopped when the desired degree of precision has been attained.     

Predictors of Burden of Family Caregivers of Women with Substance Use Disorders or Co-Occurring Substance and Mental Disorders

ABSTRACT

This study examined the impact of having a female family member with a substance use or co-occurring disorders on family caregivers. Predictors of subjective burden (worry, stigma, and displeasure) and objective burden (family disruption) on caregivers and on types of burden were explored. Subjects were 82 women receiving substance abuse treatment and their family member providing most social support. Behavioral problems of the recipient and lack of social support for caregivers predicted higher levels of family member burden, with different types of social support predicting different types of burden. Having a dual disorder did not predict family member burden. Implications of findings for treatment are discussed.     

Creative Solutions and Development for Social Workers Treating People with Serious Mental Illness - Contributions from Supervision

Social workers who are engaged in a therapeutic work with clients who have serious mental illness often face specific challenges and find themselves in crisis states in therapy, which stem from the return of the clients’ symptoms and their cognitive impairments as well as social stigma. These crisis states cause dramatic changes in the way social workers mentalize their clients and they are propelled to draw from covert, unformulated, and dissociated knowledge that they have about the client’s experience, which contributes to achieving new, surprising, and creative ways to mentalize the client. Such crisis resolutions enhance therapists’ personal and professional development and serve as an identification model for their clients.     

论精神疾病患者的“预先指示权”

对患者"预先指示"权的尊重意味着当患者丧失决定能力时对其自我决定权和知情同意权的尊重.患者的预先指示是患者就医疗干预和代理人问题上所事先表达的一种意愿,是患者对医疗行为行使控制权的表现.精神疾病患者在行使预先指示权时会遇到许多法律问题.应本着患者利益最佳化的原则去善待预先指示,包括其消极指示和积极指示,以保护患者本人真实的主观意志.我国对患者(包括精神疾病患者)的预先指示权尚缺乏认识和规定,应引入这一法律设计,以彰显对精神病患者权利的切实保障.