Working with Abusing Families

Abstract

Growing up in a context of violence has pervasive effects on children and young people's development, causing significant deleterious effects to the capacities to attach, to manage and regulate emotional lives, and to develop a sense of self and capacity to relate. The intergenerational effects of abuse have been shown to be extensive. The question is how best to intervene with abusive families. A model is presented which distinguishes between “family work,” an integrated systems approach which links protective and therapeutic work for individuals, groups, and families, where the courts and community are the client, and “family therapy” where the family itself is the client. The assessment of prognosis for work is outlined as well as the stages of therapeutic work including the stage of disclosure, work in a context of protection, rehabilitation, and a new family placement when rehabilitation cannot be achieved.     

Brief family therapy with alcohol-dependent men in Trinidad and Tobago

This study—the first of its kind in the English-speaking Caribbean—investigated the efficacy of modified brief family therapy in the treatment of alcoholism. Thirty men were treated with family therapy and milieu therapy and compared with 30 sex- and age-matched patients treated with milieu therapy alone. Follow-up over a period of 1 year showed significant levels of improvement in those treated with family therapy. The treatment group did not revert to their original drinking pattern. This can be attributed to family therapy. Family therapy was brief and involved seeing all significant members for 3 sessions, each session lasting 90 min. The role of family therapy and importance of culture in management of these patients are discussed. Our study confirms that a time-limited problem-solving family therapy approach is of use in these ethnic groups.     

低年级大学生中与愤怒特质相关联的躯体化:家庭亲密度和适应性的调节作用

背景:22%至58%的患者在初级保健机构主诉躯体症状.既往研究发现躯体化与愤怒特质和家庭功能相关.然而,有关研究却非常缺乏,特别是评估家庭功能在愤怒特质如何成为躯体主诉中的调节作用.目的:本研究的目的是验证家庭亲密度和适应性的变化是否调节愤怒特质和躯体化之间的关系强度.方法:采用横断面研究设计并从上海一所综合性大学招募2008名大学生.所有参加者完成问卷,包括采用症状自评量表(SCL-90)、状态-特质愤怒表达量表2(STAXI-2中文版)、家庭亲密度和适应性量表第二版(FACES II中文版)来评估其当前的躯体化程度、愤怒特质与家庭功能.采用分层线性回归分析(进入)分别对男性和女性验证家庭亲密度和适应性对愤怒和躯体化之间的关联性的调节作用.结果:躯体症状在男性女性中均与抑郁和愤怒特质以预期的方向显著相关.家庭亲密度和家庭适应性与躯体症状呈负相关.女大学生家庭亲密度对愤怒特质和躯体化之间的联系起到调节作用,而男大学生家庭亲密度的调节作用是轻微的.变量目前抑郁症状矫正后,家庭适应能力的调节作用在男性和女性中均没有显著性.结论:容易愤怒是躯体化的一个独立预测因素.对于女性来说,较高的家庭凝聚力是一种保护因素,可以减少愤怒特质对躯体症状的影响.没有当前抑郁的共病的话,家庭适应性在一定程度上可以避免有愤怒倾向的个体发展为躯体化.家庭凝聚力培养、家庭灵活性培养和抑郁治疗相结合的干预措施可能对有愤怒特质的躯体化患者更有效.     

Support for families with a family member suffering a cognitive disorder

The management of the care giving of a family member with dementia is an important issues these days. In the present article, I discuss the stages families go through on their way to finding out that a family member has a cognitive disorder. Stage I is a stage of bewilderment in which negative care is given. In Stage II, the relatives find out or realize that the person has a cognitive disorder and they try to extricate themselves from the negative care. In Stage III, the family members express hope that the person will recover, whereas in Stage IV they resign themselves to the fact that their loved one has a cognitive disorder and will never recover. The last stage, Stage V, is when the family members try new types of care. The family vacillates between the different stages and, after a long period of time, they accept the fact that the person has a cognitive disorder and finally create an environment in which the patient can live peacefully. It is a long process, and perhaps a very hard one for the family. Each member of the family has his or her own history and role withing the family; this cannot be forgotten and it is very common for family members to be unable to accept the situation. Even still, the family persists. Because they persist, they sometimes become angry; they also lament and ignore the situation. It is important to thoroughly observe the stage at which the family comes to accept the situation and to be mindful of caring for the family.     

抑郁症患者自尊与家庭环境的相关研究

目的：探讨抑郁症患者自尊与家庭环境的关系。方法：采用家庭环境量表（FES-CV）和自尊量表（SES）对90例抑郁症患者进行问卷调查。结果：抑郁症患者的家庭环境量表得分与中国常模比较差异有显著性（P〈0.01）,其中抑郁症患者在家庭亲密度、成功性、文化性、娱乐性和组织性方面显著低于国内常模,且矛盾性明显为高。抑郁症患者的家庭亲密度、情感表达、独立性、成功性与自尊之间呈正相关（P〈0.01或〈0.05）。结论：抑郁症患者的自尊水平与家庭环境有关。     

Altar-Making with Latino Families

Summary

This paper explores the uses of making altars in family therapy. Offering artistic expression in the form of altar-making can serve as a creative resource for clients, especially for many Latinos/Hispanics familiar with Catholicism, altars, and/or folk healing beliefs. Altar- making can have many uses. Specifically, altar-making can help people explore spiritual themes in their lives, cope with bereavement and grief, help clients remember their loved ones (White, 1997), memorialize the living, unify families, help families and couples learn to work collaboratively, and strengthen blended families. Suggestions for creating an altar are discussed from a narrative therapy perspective. A case illustration and an artist's perspective are also provided.     

Bipolar Illness and the Family

The purpose of this article is to introduce family systems therapy and family focused treatment to clinicians working with patients who are diagnosed with bipolar illness. The characteristic traits of healthy family functioning are identified as a template for the clinician to work with the family toward management of bipolar illness. Nathan Ackerman's model of how families handle crises and Carter's and McGoldrick's work with family life cycles provide a guide to understanding family systems work. The focus is on the family system and not just the patient. The issues of bipolar illness are addressed in the family context. Based on the research of Goldstein and Miklowitz and others, treatment of bipolar illness is differentiated from other chronic mental illnesses. Family focused treatment is offered as a model to manage dynamics off bipolar illness. An essential component of therapy with the patient and the family is addressing grief. Interventions and treatment suggestions are offered.     

1680例精神分裂症患者家庭环境调查

目的:探讨精神分裂症患者家庭环境的特点。方法:采用家庭环境量表中文版(FES-CV)对l 680例精神分裂症患者家属(研究组)和1 720名正常人(对照组)进行测试。结果:与正常人群相比,精神分裂症患者的家庭环境量表各因子中亲密度、情感表达、成功性、组织性得分较低(P0.05),矛盾性和控制性得分较高(P0.05)。结论:家庭成员之间缺乏亲情、情感表达低下、缺乏组织性、矛盾较多可能是精神分裂症患者家庭环境的普遍特点。     

A young woman with visual hallucinations,delusions of persecution and a history of performing arson with possible three‐generation Fahr disease

Objective: Fahr disease (FD) is a rare neurological and psychiatric disorder. The disease is classified by intracranial calcification of the basal ganglia with the globus pallidus region being particularly affected. We examined a young woman with visual hallucinations, delusions of persecution and a history of performing arson with possible third‐generation FD. Method: Case report of third‐generation FD. Results: A 23‐year‐old woman was arrested for two arsons: i) The patient exhibited progressive psychotic symptoms, including visual hallucinations, delusion of injury, irritability, lability of mood, mental retardation and visual disorders and ii) Computed tomography (CT) imaging demonstrated bilateral calcifications of the basal ganglia (globus pallidus) in the patient, her mother and her grandmother. Conclusion: We found a family with a three‐generation history of FD who exhibited calcification in the brain and mental retardation. Compared to her mother, the patient described here displayed anticipation of disease onset.     

Factors predicting mortality in midlife adults with and without Down syndrome living with family

Background Little is known about the mortality of individuals with Down syndrome who have lived at home with their families throughout their lives. The current study evaluates the predictors, causes and patterns of mortality among co‐residing individuals in midlife with Down syndrome as compared with co‐residing individuals with ID owing to other causes. Method This paper examines mortality in 169 individuals with and 292 individuals without Down syndrome from 1988 to 2007. Dates and causes of death were obtained from maternal report, the Social Security Death Index and the National Death Index. Risk factors predicting mortality, including demographic variables, transition variables, and initial and change measures of health, functional abilities and behaviour problems, were obtained from maternal report. Results Having Down syndrome is a risk factor of mortality, net of other risk factors including older age, poorer functional abilities, worsening behaviour problems, residential relocation and parental death. The causes of death among individuals with and without Down syndrome who are in midlife and co‐residing with their families are similar, and are most commonly due to cardiovascular or respiratory problems. Conclusions The findings indicate that midlife adults with Down syndrome who co‐reside with their families generally exhibit similar causes of mortality as do midlife adults with intellectual disability owing to other causes, but show an elevated risk of mortality in midlife net of other variables, such as age and changes in functional abilities and behaviour problems.