Therapists’ perspectives on suicide: A conceptual model of connectedness

Background: A sense of disconnection for people who are suicidal seems to be a key construct of previous literature. Therapists’ ways of encountering and understanding people who are suicidal have not been previously researched in depth using qualitative methodologies. Aims: The current study aims to develop a theoretical framework for the role played by connectedness in relation to suicide based on the perspectives of psychotherapists working in the field of suicide intervention. Method: Psychotherapists (N?=?12) from a suicide intervention service in Ireland were interviewed in relation to connectedness and suicide. The interviews were analysed using Constructivist Grounded Theory. A tentative theoretical model for connectedness in relation to suicide was developed. Results: Therapists view self-disconnect as at the core of suicidality and note that toxic relationships also play a critical role. Therapeutic connection can present as a life-saving paradox for people who are suicidal. Risk of death and therapeutic endeavour may present as challenging dynamics for working with people who are suicidal. Some discussion points include the worth of self-compassion development for people who are suicidal, the rephrasing of “psychotherapy” when trying to save someone’s life and the emphasis on relationship skills for all healthcare professionals who encounter people who are suicidal.

Clinical or methodological significance of this article: This article is one of the first in which therapists are interviewed about their understandings of suicide and the processes of suicide in the therapeutic space. It offers novel insights about how people who are suicidal present in therapy and what may be contributing to this presentation. The research also gives insights on the struggles for therapists working with people who are suicidal and who may be ambiguous about the prospect of therapy and connecting. The study also offers important direction for future studies in relation to what requires further discussion and exploration regarding engaging in therapy with people who are suicidal. In addition, the current study can offer previously unexplored insights regarding suicide and therapy that may have the potential to assist in future intervention for people who are risk of killing themselves.     

The Brief Assessment of Family Functioning Scale (BAFFS): a three-item version of the General Functioning Scale of the Family Assessment Device

The purpose of the present study is to compare results from the 12-item General Functioning Scale (GF-FAD) of the Family Assessment Device (FAD) to a three-item version, the Brief Assessment of Family Functioning Scale (BAFFS), designed to be used when brevity is especially important. We used principal components analysis of the GF-FAD, followed by multiple sample confirmatory factor analyses to test the robustness of the BAFFS in different samples. The BAFFS correlated highly with the GF-FAD, and demonstrated good concurrent validity with another measure of global marital functioning, the Dyadic Adjustment Scale-4 in a help-seeking sample. Like the 12-item version, the BAFFS moderately correlated with an objective, interview-based rating of family functioning, the McMaster Clinical Rating Scale. The BAFFS appears to serve as a good proxy for the GF-FAD when an ultra-brief family assessment measure is needed.     

Motor disorder and anxious and depressive symptomatology: a monozygotic co-twin control approach

The aim of this study was to investigate the relationship between poor motor ability and anxious and depressive symptomatology in child and adolescent monozygotic twins. The co-twin control design was used to explore these mental health issues in MZ twins concordant and discordant for a motor disorder, and controls. This methodology offers the unique opportunity to control for genetic effects and shared environmental influences, and permits the investigation of non-shared environmental influences. The Developmental Coordination Disorder Questionnaire was used to identify 23 sets of twins discordant for a motor disorder, 23 sets concordant for a motor disorder, and 773 sets of twins with no motor disorder from a total sample of 2122 Australian sets of twins. The Strengths and Weaknesses of ADHD Symptoms and Normal Behaviour questionnaire was used to exclude participants with high Attention Deficit Hyperactivity Disorder symptomatology. Anxious and depressive symptomatology were assessed using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) based questionnaires on Generalised Anxiety Disorder and Sad Affect. Results indicated significantly higher levels of anxious and depressive symptomatology in twins with a motor disorder in discordant pairs compared to their co-twins without a motor disorder, and controls. There were significantly higher levels of anxious symptomatology in twins with a motor disorder in discordant sets than in sets of twins concordant for a motor disorder. There were significantly higher levels of anxious symptomatology in concordant twins than in controls. Implications of these findings are discussed with emphasis on understanding and recognising the relationship between a motor disorder and anxious and depressive symptomatology in clinical practice for children and adolescents with these disorders.     

Plastin 3 expression in discordant spinal muscular atrophy (SMA) siblings

Spinal muscular atrophy (SMA) is caused by loss or mutations of the survival motor neuron 1 gene (SMN1). Its highly homologous copy, SMN2, is present in all SMA cases and is a phenotypic modifier. There are cases where asymptomatic siblings of typical SMA patients possess a homozygous deletion of SMN1 just like their symptomatic brothers or sisters. Plastin 3 (PLS3) when over expressed in lymphoblasts from females has been suggested to act as a genetic modifier of SMA.We studied PLS3 expression in four Spanish SMA families with discordant siblings haploidentical for the SMA locus. We excluded PLS3 as a possible modifier in two of our families with female discordant siblings. In the remaining two, we observed small differences in PLS3 expression between male and female discordant siblings. Indeed, we found that values of PLS3 expression in lymphoblasts and peripheral blood ranged from 12 to 200-fold less than those in fibroblasts. These findings warrant further investigation in motor neurons derived from induced pluripotential stem cells of these patients.     

Therapy with religious couples

Although 95% of married couples identify with a particular religion, there is great variation in how couples rely on their religion to define or structure their relationship. Various denominations will imply particular “rules” or will shape how the couple deals with interpersonal and family challenges, such as sexuality, parenting, and power. In this article, we review couple relationships within a religious context and advance several treatment principles for treating religious couples. We present a clinical case to illustrate marital therapy with a religious couple, with an Adlerian context. ©2009 Wiley Periodicals, Inc. J Clin Psychol: In Session 65:1–13, 2009.     

Posttraumatic growth in cancer patients and partners—effects of role,gender and the dyad on couples' posttraumatic growth experience

Background/Aim: Little is known about factors influencing positive effects in couples facing a cancer diagnosis. Methods: A heterogeneous sample of 224 couples from a multi‐site study (four oncology units) completed questionnaire surveys including the Posttraumatic Growth Inventory (PTGI) as a measure of positive psychological effects. Results: The data demonstrated that all three investigated factors—gender, role (patient vs partner) and the dyad (belonging to any of the 224 couples)—significantly contributed to variation in PTGI total scores and subscales. Variability between couples (factor dyad) appeared stronger than variability between patient and partner participants (factor role) and between male and female participants (factor gender). Role and gender analysis showed that patients demonstrated higher levels of posttraumatic growth than partners; and female participants scored higher on PTGI than males. Male patient–female partner pairs show greater association in their experience of posttraumatic growth than female patient–male partner pairs. Correlations also suggested that, regardless of the gender and role composition, patients and partners may experience parallel growth. Conclusions: Our findings indicate that positive psychological experiences may be shared by partners affected by cancer in similar ways as have been shown for negative psychological effects. Intra‐couple similarities or processes may have a more important function in experiencing benefits than factors like gender or being the patient or the partner. These results underline the importance of a family approach to understanding negative and positive psychological effects of cancer. Copyright © 2009 John Wiley & Sons, Ltd.     

Selective termination in dichorionic twins discordant for congenital defect

Objective

To evaluate the perinatal outcome of selective termination in dichorionic twins discordant for congenital defect, performed at the Hospital General Universitario Gregorio Marañon.

Study design

Twenty-eight dichorionic twins with an anomalous fetus were included from May 2008 to February 2011. Intracardiac KCl (1–2 ml; 15 mEq/ml) under ultrasonographic guidance was used in all procedures. Congenital defect, gestational age at the procedure, incidence and perinatal outcome were retrieved.

Results

Selective termination was performed in 14 (50%) cases of structural defects with normal karyotype and in 14 (50%) cases of chromosomal abnormality, 13 of them (92.8%) trisomy 21. Median gestational age at the procedure was 17.8 weeks (range 14.5–24; SD 2.3), and 12 (42.8%) were performed before 18 weeks. The presenting fetus was terminated in 11 cases (39.3%). Selective termination was followed by the subsequent delivery of a viable infant in 27 out of 28 cases (96.4%). Fetal loss before 24 weeks occurred in 1 case (3.6%). Median gestational age at delivery was 38 weeks (range 24.1–40.1; SD 3.8). Twenty-four (88.9%) were delivered >34 weeks and 1 (3.7%) before 28 weeks.

Conclusion

Selective termination in dichorionic twins discordant for congenital defect is a safe procedure with low risk of unintended fetal loss. This option is a reasonable alternative to expectant management or termination of the whole pregnancy.     

Examining the context of microbicide acceptability among married women and men in India

Married women in India are increasingly at risk of HIV, often due to their husbands' extramarital sexual behaviour. Topical microbicides may provide protection to women who are unable to negotiate condom use. During the formative phase of a study to develop measures related to microbicide acceptability, we conducted in‐depth interviews with 14 ‘high‐risk’ and 16 ‘low‐risk’ married women and 15 husbands. Some participants had recently completed a 2‐week microbicide safety trial. A sequence of in‐depth interviews with each participant explored the context of microbicide acceptability, including perceptions of couple harmony, vulnerability to HIV, sexual power, and ability to control life events. Women's perceptions of control and sexual power influenced attitudes towards microbicide use. HIV risk was most commonly associated with partner infidelity and easily detected, according to both men and women, by a lack of marital harmony. Despite this, high‐risk women denied perceiving HIV risk until confronted with specific evidence of a husband's positive HIV or STI diagnosis. This study provides an in‐depth examination of HIV risk for Indian married women, identifying potential determinants of microbicide use, and providing guidance for the development of psychometric scales to measure couple harmony, HIV risk perception, and sexual power and control.