Jeu de rôle en ligne : un espace de narrativité inscrit dans la mise en scène de soi et de la famille

AimThe purpose of this research is to study how the way in which players use their avatar in Massive Multiplayer Role-Playing Games (MMORPG) contributes to self-construction. This particular space leads the players to the creation of a specific narrative identity, nurtured by interactions and experiences shared with peers, onto which they project fragments of themselves and their personal history that will be staged through image, action, and language.MethodFour participants were recruited through a notice published on communication servers belonging to different communities of the same online game. The hypotheses were assessed through a series of two semi-structured remote interviews based on a grid of ten themes.ResultsThe results show that role-playing is used as a tool for rewriting personal history, enabling participants to heal, on the level of the fantasy, their individual and family wounds and trauma. In this study, we also noticed that digital transparency supports the spontaneity of communications thanks to its disinhibiting function. Thus, online role-playing games turn out to be a potential space of real creativity where participants can interact by trial and error without fear of failure, where they can be destroyed and can express their own emotions and desires without destroying the other, because it's just pretend. In this way, they develop their subjectivity and try to develop a better affective attunement in order to integrate into the virtual and material human community. Digital transparency also facilitates participants’ investment in online role-playing as a place of projection and staging of their psychic contents in a symbolic repetition where the family history, even the family romance, are reinterpreted and become factors of transformation, reconciliation, or emancipation.DiscussionNarrative identities are true reflections of the participants’ concerns and are invested during and outside game sessions. Through the position of narrator, the participants talk and develop meaningful friendships with other players. They try to give meaning to a shared subjective experience that they record as their own heritage as well as the group's collective memory. In this study, role-playing provides a form of containment for possible depressive affects and diverts attention from anxieties, like Pascal's entertainment. At first, this space could serve as a kind of technological substitute, a “prosthesis” for some players with defective psychic functions, who struggle to express their emotions and to bond with others. But over the years, they seem rather to seize upon the support provided by this “psychic orthosis” that links and connects to rewrite their own history, to seek out and to come to terms with others and themselves.ConclusionIn these overlapping potential spaces of creation, players try to orient their own lives by relying on the experiences they have been able to co-construct through a common narrative, presented as both foreign and unique to themselves. They may feel better equipped to face an intersubjectivity that could sometimes be experienced as disappointing or threatening.     

Understanding perceptions underlying the self-reported stress among parents of adolescents with autism spectrum disorder: Considerations for supporting families

BackgroundParents raising adolescents with autism spectrum disorder (ASD) often report higher stress than other parents. The influence of parents’ internal, or cognitive, experiences (i.e., their own perceptions) on this elevated stress has yet to be explored. Addressing this gap may reveal opportunities for enhancing support for families by elucidating malleable targets for reducing parents’ self-reported stress and/or informing family-focused intervention. The Double ABCX Model of Family Adaptation is a framework for understanding how perceptions, social support, and personal resources (i.e., coping) may affect stress.MethodsWe examined parents’ perceptions about ASD, perceived support, and coping among 214 parents of adolescents with ASD. Regression analyses were used to explore whether these factors were associated with parenting stress among those raising adolescents with ASD. Moderation effects of positive coping on the relationship between parent perceptions and parenting stress were also explored.ResultsParent perceptions about within family support, the extent of ASD symptom predictability, and treatment being able to ‘control’ ASD were related to parenting stress. However, positive coping did not moderate the relationship between these perceptions and parenting stress.ConclusionsStudy findings emphasize significant associations between specific parental perceptions and the self-reported stress among families of adolescents with ASD. Particularly important to parenting stress were how much parents’ perceived adequate support within the family, that treatment was useful for controlling their adolescent’s ASD, and that their adolescent’s symptoms were predictable. These findings suggest that the way parents think about their adolescents’ ASD and the adequacy of the support within their own families are associated with parenting stress, and therefore may serve as treatment targets for positively affecting whole family outcomes, as well as foundations for additional research.     

Attitudes and Perceived Barriers to Working with Families of Persons with Severe Mental Illness: Mental Health Professionals’ Perspectives

A state-wide survey of 453 clinicians serving people with severe mental illness in community mental health centers evaluated the degree to which they provide services to families and their perceptions of barriers to developing such services. Most clinicians did not provide many services to families and reported barriers related to the family or client (e.g., family’s lack of interest) and their own work environment (e.g., heavy workload). Clinicians who had received prior training on working with families provided more services, had more positive attitudes toward family, and felt more competent about their knowledge, confirming the importance of staff training.     

If I am not for myself,who is for me? The experiences of older migrant home care recipients during their hospitalization

Objective: Hospitalization is a major risk for older adults; therefore, it is crucial to provide the appropriate treatment during hospitalization. This study examined hospitalized older adults’ perceptions regarding three groups of treatment providers: nursing staff, family members, migrant home care workers.

Method: Qualitative interviews were conducted with 17 hospitalized older adults. Data were gathered by in-depth interviews. Content analysis included open coding, axial coding and integration of the main findings using constant comparisons.

Results: Three themes emerged: (1) ‘What is my worth?’ This theme was focused on the participants’ perceptions of themselves as helpless and dependent on others. (2) ‘What would I do without them?’ This theme referred to the perception of the migrant home care workers and nursing staff as essential. It meant immense gratitude, but also a sense of dependency on paid caregivers. (3) ‘They have their own busy life.’ This theme concerned participants’ low treatment expectations from their family members due to their perception of their family members as having multiple obligations.

Conclusion: Hospitalized older adults prefer to turn to paid caregivers rather than to their families. Findings are discussed in light of the tension between formal and informal care in countries that are transitioning from traditional family values to modern values, placing the care of older adults by paid caregivers.     

Family Communication in Long-Term Care During a Pandemic: Lessons for Enhancing Emotional Experiences

ObjectiveFamily visits with residents at long-term care (LTC) facilities have been restricted during the COVID-19 pandemic. The objective was to examine what communication methods, other than in-person visits, during the pandemic were associated with greater positive and lower negative emotional experiences for LTC residents and their family members and friends.DesignCross-sectional.SettingNationally targeted online survey.ParticipantsOne hundred sixty-one community-dwelling adults who had a family member or friend in a LTC facility.MeasurementsThe Positive and Negative Affect Scale was used to assess participant's own emotions and perceived resident emotions during the pandemic. Questions were asked about nine communication methods other than physical visits (e.g., phone, video-conference, e-mail, and letters) in terms of frequency of use during the pandemic. Sociodemographics, resident health, and facility factors were assessed and used as covariates where indicated.ResultsDuring the pandemic, greater phone frequency was associated with less participant negative emotions (β = −0.17). Greater e-mail frequency was associated with more perceived resident positive emotions (β = 0.28). Greater frequency of letters delivered by staff was associated with more participant negative emotions (β = 0.23). Greater frequency of letters delivered by staff and the postal service were associated with more perceived resident negative emotions (β = 0.28; β = 0.34, respectively).ConclusionThese findings highlight the importance of synchronous, familiar methods of communication like the phone and email between families and LTC residents to maintain their emotional well-being when in-person visits are restricted.     

Obsessive-compulsive tendencies and undermined confidence are related to reliance on proxies for internal states in a false feedback paradigm

Background and objectivesWe have previously hypothesized that obsessive-compulsive (OC) tendencies are associated with a general lack of subjective conviction regarding internal states, which leads to compensatory seeking of and reliance on more discernible substitutes (proxies) for these states (Lazarov, A., Dar, R., Oded, Y., &; Liberman, N. (2010). Behaviour Research and Therapy, 48, 516–523). This article presents two studies designed to provide further support to this hypothesis by using false biofeedback as a proxy for internal states.MethodsIn Study 1 we presented high and low OC participants with pre-programmed false feedback showing either increasing or decreasing levels of muscle tension. In Study 2 we presented similar false feedback on level of relaxation to non-selected participants, half of which received instructions that undermined their confidence in their ability to assess their own level of relaxation.ResultsIn Study 1, high OC participants were more affected by false biofeedback when judging their own level of muscle tension than were low OC participants. In Study 2, undermined confidence participants were more affected by false biofeedback when judging their own level of relaxation as compared to control participants.LimitationsOur findings are based on a non-clinical, highly functioning, largely female student sample and their generalization to OCD requires replication with a sample of OCD patients.ConclusionsThese results provide converging evidence for our hypothesis by replicating and extending our previous findings. We discuss the implication of our hypothesis for the understanding and treatment of OCD and outline directions for future research.     

Characteristics of adults with autism spectrum disorder who use residential services and supports through adult developmental disability services in the United States

BackgroundMany children and adults with Autism Spectrum Disorder (ASD) need services and support across their lifespans. Currently many residential and community living supports are delivered through state intellectual and developmental disabilities (IDD) service systems.MethodA random sample of 11,947 individual users of adult IDD services from 25 states that included 1,459 individuals with an autism diagnosis was analyzed for this study looking at demographic characteristics and living arrangements. Comparisons were made between adults with and without ASD who receive services through the IDD service system.ResultsOverall, individuals with an ASD diagnosis were younger on average, had a higher percentage of males, and had higher percentages of the No Intellectual Disabilities (ID) and Severe ID categories compared to individuals without an ASD diagnosis. There was a significant association between the type of living arrangement and ASD status with a higher percentage of participants with ASD living in a family member’s home, but a lower percentage of people with ASD living in agency apartments, in their own home or an “other” living arrangement. However, with age, gender, and level of ID and challenging behavior taken into account, people with ASD had 29% higher odds of living in a family member’s home but 42% lower odds of living in their own home when compared to people with other developmental disabilities who received residential services through state IDD service systems.ConclusionsThere are key differences in access and utilization of residential services between people with ASD and people without ASD. While state developmental disabilities systems are serving individuals with ASD there are potential influences of state policies regarding ASD eligibility for various residential services. Implications for future research are discussed.     

Sleep,but not other daily routines,mediates the association between maternal employment and BMI for preschool children

BackgroundIt has been established that the more time mothers spend working outside of the home, the more likely their preschool-aged children are to be overweight. However, the mechanisms explaining this relationship are not well understood. Our objective was to explore child sleep, dietary habits, TV time, and family mealtime routines as mediators of the relationship between maternal employment status (full-time, part-time, and no or minimal employment) and child body mass index (BMI) percentile.MethodsData were drawn from waves 1 and 2 of STRONG Kids, a prospective panel study examining childhood obesity among parent–preschooler dyads (n = 247). Mothers reported their own work hours, their child's hours of nighttime sleep, dietary habits, TV time, and mealtime routines. Trained staff measured child height and weight.ResultsCompared to working 0–19 h/week, both full-time (>35 h/week) and part-time (20–34 h/week) employment predicted higher child BMI percentile 1 year later. Hours of child nighttime sleep partially mediated the association between maternal full-time employment and child BMI percentile. Adjusting for individual and family characteristics, children whose mothers were employed full time were less likely to sleep longer hours than children whose mothers were employed 0–19 h/week (b = −0.49, p < 0.04). Shorter child nighttime sleep was associated with higher BMI percentile (b = −7.31, p < 0.001). None of the other mediation pathways tested were significant.ConclusionsThese findings add to the growing literature on the importance of adequate sleep for young children's health.     

School,Neighborhood, and Family Factors Are Associated With Children's Bullying Involvement: A Nationally Representative Longitudinal Study

ObjectivesTo test whether school, neighborhood, and family factors are independently associated with children's involvement in bullying, over and above their own behaviors that may increase their risk for becoming involved in bullying.MethodWe examined bullying in the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally representative 1994–1995 birth cohort of 2,232 children. We used mother and teacher reports to identify children who experienced bullying between the ages of 5 and 7 years either as victims, bullies, or bully-victims. We collected information about school characteristics from the Department for Children, Schools and Families. We collected reports from mothers about children's neighborhood and home environments and reports from mothers and teachers about children's internalizing and externalizing problems when they were 5 years old.ResultsMultinomial logistic regressions showed that over and above other socioenvironmental factors and children's behavior problems, school size was associated with an increased risk for being a victim of bullying, problems with neighbors was associated with an increased risk for being a bully-victim, and family factors (e.g., child maltreatment, domestic violence) were associated with all groups of children involved in bullying.ConclusionsSocioenvironmental factors are associated with children's risk for becoming involved in bullying over and above their own behaviors. Intervention programs amend at reducing bullying should extend their focus beyond schools to include local communities and families.     

Girls’ cortisol concentrations,mothers’ anxiety,and self- versus parent-ratings of autistic girls’ anxiety

BackgroundAutistic girls’ change in salivary cortisol concentrations from morning to afternoon were compared with their parents’ own anxiety states as potential correlates of the autistic girls’ self-ratings of their anxiety and those given by their parents about their daughters’ anxiety.MethodsThirty-three autistic girls (6 yr to 10 yr, M = 8.21 yr, SD = 1.29 yr) and 19 autistic adolescent females (11 yr to 15 yr, M = 12.74 yr, SD = 1.52 yr) completed anxiety inventories about themselves and provided saliva samples in the morning and afternoon. Their mothers also rated their daughters’ anxiety and their own anxiety.ResultsThere were no significant differences between mothers’ and daughters’ ratings of the latter’s GAD. The autistic girls’ self-ratings of their anxiety were more strongly influenced by their mothers’ anxiety in the younger girls, but more responsive to their own chronic stress state (i.e., cortisol) in the adolescent girls.ConclusionsMothers’ evaluations of their autistic daughters’ anxiety appear to be strongly influenced by their own anxiety. There was also some indication that autistic girls may disguise their anxiety.     

Characteristics associated with healthcare independence among autistic adults

BackgroundHealthcare independence refers to someone’s ability to assume responsibility for their own health and complete tasks like taking medication as prescribed or scheduling healthcare appointments. Prior studies have shown that autistic people tend to need more support with healthcare tasks than people with other chronic conditions. We sought to identify modifiable and non-modifiable factors linked with healthcare independence among autistic adults.MethodWe conducted a cross-sectional survey to examine how executive functioning skills, restrictive and repetitive behaviors, gender, education, and age were linked with healthcare independence among this population. Participants included: (a) autistic adults (n = 19) who are their own legal guardian, who participated via self-report; and (b) family members of autistic adults with a legal guardian (n = 11), who provided proxy-reports.ResultsFindings differed between self- and proxy-reports. Among autistic adults who self-reported, difficulties in executive functioning were strongly linked with less healthcare independence. Among proxy-reports, greater restrictive and repetitive behaviors were strongly linked with less healthcare independence. According to the proxy-reports, having not completed high school, being older during the healthcare transition, and being male were all independently linked with less healthcare independence.ConclusionsInterventions aimed at supporting executive functioning, providing opportunities to increase independence with healthcare tasks, and reducing the extent to which restrictive and repetitive behaviors interfere with daily activities may be viable options for supporting healthcare independence among autistic adults. Our findings are an important first step for future initiatives to better identify individuals who need additional care coordination, supports, or services to maximize healthcare independence.     

Association between incongruence about survivor function and outcomes among stroke survivors and family caregivers

Background: Stroke survivors and family caregivers often have incongruent appraisals of survivor cognitive, physical, and psychosocial function. Partner incongruence contributes to poor outcomes for survivors and caregivers.

Objectives: This study explored whether partner incongruence: (1) differs by function domain; (2) increases or decreases over time, and; (3) is associated with self-rated health, distress, stress, and depressive symptoms.

Methods: Structured surveys were administered to 32 survivors and caregivers at approximately 3 (enrollment) and 7 months (follow-up) post-stroke. Paired t-tests were used to examine partners’ ratings of survivor function at enrollment and follow-up, and changes in incongruence over time. Partial correlations were used to examine the association between incongruence at enrollment and outcomes at follow-up.

Results: Survivors consistently rated their own memory and thinking as significantly better than caregivers rated their memory and thinking. At follow-up, survivors rated their own communication as significantly better than caregivers rated their communication. Incongruence about survivor memory and thinking was associated with survivor distress, as well as caregiver distress, stress, and depressive symptoms. Incongruence about survivor ADLs was associated with caregiver stress and depressive symptoms. Incongruence about survivor social participation was associated with caregiver distress.

Conclusions: Findings from this study suggest that survivors and caregivers often have incongruent appraisals of survivor function, that incongruence does not improve naturally over time, and that incongruence may be detrimental for survivor and caregiver outcomes. Further research should be directed at the mitigation of incongruence and strategies to improve outcomes for both survivors and family caregivers.     

The association of mothers' and fathers' insomnia symptoms with school-aged children's sleep assessed by parent report and in-home sleep-electroencephalography

ObjectiveSleep plays an essential role for children's well-being. Because children's sleep is associated with parental sleep patterns, it must be considered in the family context. As a first aim of the present study, we test whether parental insomnia symptoms are related to children's in-home sleep-electroencephalography (EEG). Second, we examine the association between parental insomnia symptoms and maternal and paternal perception of children's sleep using actor–partner interdependence models.MethodsA total of 191 healthy children enrolled in public school and aged 7–12 years took part in the study. Ninety-six were formerly very preterm born children. Children underwent in-home sleep-EEG, and parents reported children's sleep-related behavior by using the German version of the Children's Sleep Habits Questionnaire. Further, parents completed the Insomnia Severity Index to report their own insomnia symptoms.ResultsMaternal but not paternal insomnia symptoms were related to less children's EEG-derived total sleep time, more stage 2 sleep, less slow wave sleep, later sleep onset time, and later awakening time. Mothers' and fathers' own insomnia symptoms were related to their reports of children's bedtime resistance, sleep duration, sleep anxiety, night wakings, and/or daytime sleepiness. Moreover, maternal insomnia symptoms were associated with paternal reports of children's bedtime resistance, sleep anxiety, and sleep-disordered breathing. The associations between parental insomnia symptoms and parents' perception of children's sleep could not be explained by children's objectively measured sleep.ConclusionsMothers' insomnia symptoms and children's objective sleep patterns are associated. Moreover, the parents' own insomnia symptoms might bias their perception of children's sleep-related behavior problems.     

Grandparenting and psychosocial health among older Chileans: A longitudinal analysis

Objectives: To investigate factors associated with Chilean grandparents’ provision of help to grandchildren and associations between provision of such help and grandparents’ mental well-being two years later. Methods: Data are drawn from a representative sample of 2000 people aged 66–68 resident in low- or middle-income areas of Santiago who were surveyed in 2005 and re-interviewed two years later. Multivariable analyses were used to investigate factors associated with provision of help to grandchildren at baseline and associations between providing such help and life satisfaction, SF36-Mental Component Summary scores, and depression two years later. Results: 41% of grandparents lived with one or more grandchildren and over half provided four or more hours per week of help to grandchildren. Models controlling for baseline mental health, grandchild characteristics, marital and household characteristics, socio-economic status and functional health showed that grandfathers who provided four or more hours per week of help to grandchildren had better life satisfaction two years later and that those providing material help had higher SF36 MCS scores at follow-up. Grandmothers providing four or more hours of help a week had lower risks of depression. Conclusion: Older Chileans make important contributions to their families through the provision of help to grandchildren and these appear to have some benefits for their own psychosocial health. Gender differences in the pattern of associations may reflect differences in overall family responsibilities and merit further investigation.     

A model of adaptation for families of elderly patients with dementia: focusing on family resilience

ABSTRACT

Objectives: We constructed a model explaining families’ positive adaptation in chronic crisis situations such as the problematic behavior of elderly patients with dementia and attendant caregiving stress, based on the family resilience model. Our aim was to devise an adaptation model for families of elderly patients with dementia.

Method: A survey of problematic behavior in elderly patients with dementia, family stress, family resilience, and family adaptation was conducted with 292 consenting individuals. The collected data were analyzed using structural equation modeling.

Results: The communication process, family stress, and problematic behavior of elderly patients with dementia had direct and indirect effects on family adaptation, while belief system, organization pattern, and social support had indirect effects. Specifically, family stress and more severe problematic behavior by elderly patients with dementia negatively influenced family adaptation, while greater family resilience improved such adaptation.

Conclusion: Interventions aiming to enhance family resilience, based on the results of this study, are required to help families with positive adaptation. Such family programs might involve practical support such as education on the characteristics of elderly persons with dementia and coping methods for their problematic behavior; forming self-help groups for families; revitalizing communication within families; and activating communication channels with experts.     

What do network members know? Network members as reporters of depression among Caucasian-American and African-American older women

Objective: To determine whether family members and friends can be accurate reporters of depression in older women and whether their reports predict diagnostic depression concurrently and across a one-year time interval.

Method: African-American and Caucasian older women (N?=?153; mean age?=?75) previously screened for depression nominated network members (NMs) who could be contacted as informants. NMs completed an informant version of the CES-D, described their closeness to the participant, the extent of the participant's support from family and friends, and their assessment of the participant's typical coping strategies. These reports were then used to predict participant CES-D, Hamilton depression scores, and Structured Clinical Interview (SCID) depression diagnoses concurrently and at six-month and one-year intervals.

Results: NMs’ estimates of participants CES-D status were highly correlated with participants own CES-D scores, and also predicted Hamilton depression scores and SCID diagnoses concurrently and at six months and one year later. NMs’ ratings of participants’ use of positive coping also predicted depression at six months and one year.

Conclusion: NMs knew when elderly women were depressed and their reports were accurate predictors of depression even one year later, which implies that elderly depression does not abate spontaneously. Future research should test the possibility that family and friends might be recruited as allies in encouraging earlier treatment and in providing support to older adults through difficult life transitions.     

The Spiritualities of Therapists' Lives

Summary

We situate how the personal spiritual quests of our own lives have influenced our work as family therapists, particularly influencing our chosen theories of change. We provide a definition of and approach to spirituality that centers its ethical, moral, and deeply relational nature, and propose that therapists' own spirituality can be a beneficial resource in the relationships they build and foster with those who consult them. Careful attention is given to how God calls us into relationships with others. Narrative therapy and spirituality are both defined as inherently relationalist practices and ways of being. Drawing on narrative therapy ideas, we describe a four step process we have used to explore therapists' spirituality in supervisory contexts specifically focusing on the relational nature of their work, and illustrate this process by giving supervision dialogues from some of our experiences.     

Australian parents’ work–family conflict: accumulated effects on children’s family environment and mental health

Purpose

Many parents struggle to balance their work and family responsibilities. Yet, little research in the field of social psychiatry has explored the emergence of work–family conflict (WFC) as an important social determinant of mental health, particularly for children. The current study used longitudinal Australian population-based data to investigate the impact of parents’ accumulated experiences of work–family conflict on children’s mental health. Levels of parent psychological distress, marital satisfaction and parenting irritability were examined as potential explanatory factors within the family environment.

Methods

The study used five waves of data from the Australian Longitudinal Study of Australian Children (LSAC), a representative community sample of Australian children and their parents. Analyses were restricted to coupled, employed mothers (1903) and fathers (1584) who reported their WFC levels in all five waves. Structural Equation Modelling (SEM) was used to examine the association between accumulated experiences of work–family conflict across all time-points (AWFC) and children’s mental health at wave 5. Family environment factors were assessed as possible explanatory mediators.

Results

There was a significant association between AWFC and children’s mental health at wave 5. Parent psychological distress, marital satisfaction and parenting irritability were all found to significantly explain this association (accounting for 66% of the total effect).

Conclusions

Children whose parents have ongoing or accumulated difficulties managing their work and family responsibilities are more likely to have poorer mental health. This has important implications for family-friendly work arrangements and demonstrates the need to further understand the intergenerational impacts of parents’ jobs on their children’s psychological wellbeing.

     

Integrating Music Therapy Into Marriage and Family Therapy: Theoretical and Clinical Perspectives

ABSTRACT

The integration of music therapy into marriage and family therapy is an under researched and largely unknown to many clinicians in this field. The understanding of musical integration should be expanded upon for others to utilize in their own therapeutic way. Musical integration in many areas of research shed light upon the improvements it can make to areas of post-operative rehabilitation, biological structures of the mind and body, stress reduction techniques, and therapeutic enhancement. Following a trial integration of music into couples therapy, clients participating in this trial integration found multiple positives effects upon themselves and their relational well-being. Musical integration holds the potential for significant change in the lives of many clients seeking therapeutic help from a marriage and family therapist and the ability to be refined through continued understanding and integration.