The Support Network: Crisis intervention for extrafamilial child sexual abuse.

Describes the establishment of the Support Network, a community-based treatment program for children and families facing crises due to extrafamilial child sexual abuse. The components necessary to establish a Support Network are discussed. A crisis intervention model of treatment is proposed that provides these children and families with immediate contact with a therapist, emotional support, education, and problem-solving strategies, thus enabling some resolution of the crisis and a return to precrisis routines and adaptation. Termination and follow-up issues are also addressed, and a case example of 4-yr-old sexually abused girl is presented to illustrate the usefulness of the Support Network. It is contended that, by providing services to these children and their families, Support Network therapists also help to sensitize and educate other community professionals to the needs of the sexually abused child and his/her family. A list of selected references for use with children and families is appended. (48 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Longitudinal associations between parents' hostility and siblings' externalizing behavior in the context of marital discord.

This study examined longitudinal associations between parents' hostility and siblings' externalizing behavior in the context of interparental discord. The sample included 116 families (mothers, fathers, 2 siblings) assessed in middle childhood, when siblings were, on average, 8 and 10 years old, and in adolescence, at average ages of 14 and 16 years. Parents reported on their hostility toward each child and on each child's externalizing problems. Raters observed interparental hostility, and parents rated their marital quality. Results indicated both within-family and between-families effects. Specifically, the child who received more parental hostility than his or her sibling showed greater increases in externalizing problems than his or her sibling; this association was moderated by marital discord. In addition, the child who exhibited more behavioral problems than his or her sibling received greater increases in hostile mothering than did his or her sibling. Between-families effects were evident, in that children's externalizing problems were associated with increases in mothers' hostility toward both children in the family. Results support transactional models of development and family systems theory. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Saying goodbye: A casebook of termination in child and adolescent analysis and therapy.

Reviews the book, Saying goodbye: A casebook of termination in child and adolescent analysis and therapy edited by Anita G. Schmukler (see record 1991-98015-000). Anita Schmukler's new book is comprised of 10 clinical and 6 theoretical papers. Schmukler and her colleagues set themselves the task of exploring and illustrating the theoretical and technical issues involved in ending child analyses. The primary theoretical question under review is, of course, the selection of criteria for terminability. The theoretical articles in this book try to tease out with some specificity the changes in the child and in the sessions themselves that indicate termination is on the horizon. Several articles outline criteria for termination, as indicated both in symptomatic improvement in the outside world and in the evolution of the transference neurosis in the analyst's office. The life and times of children and analysts at work around termination are richly illustrated. All practicing child analysts will recognize the pains and pleasures inherent in their line of work. And all will feel helped by the clarity of conceptualization offered as they think through with their own child patients and their parents the question of when it is time to say goodbye. However, the most important criterion for terminability, the child's expanded capacity to integrate disparate parts of himself or herself and metabolize his or her own experience, is inadequately explored. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sibling status effects: Adult expectations.

Investigated expectations or beliefs held by 278 adults (average age 25.3 yrs) about a child based on his or her sibling status alone. Ss were asked to describe what they would expect a child without brothers or sisters, a child who was the oldest in his or her family, and a child who was the youngest in his or her family to be like. Ss seemed to have higher expectations for and give more positive ratings to oldest children than to only or youngest children. The ordinal position and parental status of the S also had an effect on the ratings given. Ss who were youngest children and Ss who were only children tended to show some bias toward their own sibling group; Ss who were oldest children actually gave their own sibling status lower group ratings than did other Ss. Ss with children tended to give higher ratings to all 3 sibling groups than did Ss without children. Results are discussed in terms of how these expectations may develop and their effects on the child's development. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Families of children with attention deficit hyperactivity disorder: a review

OBJECTIVES: 1) To review the evidence of attention deficit hyperactivity disorder (ADHD) and other conditions in family members (siblings and parents) of children with ADHD and determine the importance of genetic and environmental factors in this condition. 2) To describe the prospective 10-year follow-up of 65 families with ADHD children and 43 families of matched normal controls. 3) To review various studies that have looked at parent-child interactions with ADHD children on and off stimulant medication, and such interactions over time. The paper thus provides an overview of family pathology and functioning of families of ADHD children over time. METHOD: The paper outlines twin, sibling, family and adoption studies with regard to possible genetic and environmental factors in ADHD. It also presents data of a prospective 10-year follow-up of 65 families with ADHD children and 43 families of normal controls. This family study evaluated sociocultural factors, child rearing practices, health of family members and relationships, as well as the parental view of the child's functioning over time. RESULTS: A review of the literature suggests that ADHD has a strong genetic component, but that environmental factors also play an important role. Families of children with ADHD have more problems than families of normal controls, but these problems improve as the child with ADHD grows up and leaves home. Families of ADHD subjects can appreciate positive as well as negative changes in their children over time. Generally, family interactions with children with ADHD are problematic but improve when the child is on medication and when the child becomes an adult. CONCLUSIONS: This condition has strong genetic underpinnings; therefore, diagnosing and treating family members (parents and siblings) as well as the child with ADHD is important in improving parent-child interactions and better long-term outcome for the child and his or her family.     

A new perspective on the Oedipal complex: A voice therapy session.

Presents clinical material using voice therapy, to elicit, identify, and counteract negative thought patterns. The case of a 38-yr-old man, who experienced suicidal impulses in competitive situations, illustrates the concept of "identification with the aggressor" in relation to a father's angry, rivalrous feelings toward his son. The author discusses the dynamics operating in families where immature or insecure parents compete with and show resentment toward the child of the same sex and direct overt or covert aggression toward him/her. Later, the internalized aggression emerges as a negative thought process when the individual strives to achieve personal or vocational goals. An exploration of the theoretical implications of the case contributes to an understanding of unresolved Oedipal issues that can affect young people at risk for suicide, particularly high-achieving adolescents who seemingly have everything to live for. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Genetic predisposition testing for cancer: effects on families' lives

Genetic testing to identify a predisposition to the development of cancer affects not only the person undergoing DNA analysis but also his or her entire family. Multiple complex issues arise in conjunction with the clinical application of this new tool for assessing cancer risk. Counseling families regarding genetic risk is multifaceted and requires genetic knowledge that may go beyond the expertise of the health care provider. The article describes the psychosocial effects of cancer predisposition testing on families, ethical and social concerns of cancer risk testing, and implications for nurses in counseling individuals and families considering predisposition testing.     

Caring for children affected by disaster

The child and adolescent psychiatrist must play an essential role in the wake of disaster. The focus of the community and the world understandably turns to the physical devastation wrought, and emergency and medical efforts take center stage. Physical evidence of the past may be lost, but the child psychiatrist is able to maintain focus on what cannot be seen. He or she may be the only one to advocate the child's emotional needs. It may be too difficult for others who lack the specialized expertise of mental health training to attend to both the child's physical and emotional needs, and it may be impossible for those without medical training to impress on medical personnel the importance of emotional issues. The child and adolescent psychiatrist, with his or her understanding of medical, mental health, and developmental concerns, is well positioned to support the child, the child's community, and the helpers whose own responses may complicate recovery.     

Providing psychological services to American Indian children and families.

Argues that psychologists must understand their clients' cultural values and backgrounds before they can offer appropriate mental health services. The present authors address issues that arise when non-Native American psychologists become involved in the delivery of psychological services to Native American children and families. The authors also review cultural differences, such as family structure, childrearing practices, and religion, in attitudes of and expectations for services, communication styles, and cultural values that may be relevant to service delivery. The focus is on helping the non-Native American psychologist understand and relate to his or her Native American clientele. (43 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family matters: A social systems perspective on physician-assisted suicide and the older adult.

Physician-assisted suicide is one of the most controversial issues facing health care providers today, provoking contentious debate that spans medical, psychological, legal, religious, and moral realms. Despite the wealth of theories and opinions proffered, most of this work focuses on concepts of individual competence and autonomy, with little or no attention paid to the dynamics of family or other psychosocial systems likely to affect an individual's decision to ask for assistance in ending his or her life. Moreover, concepts such as "autonomy" typically are examined from a legal perspective without consideration of the late-life developmental themes confronting older adults and their families, that is, the stage of life cycle transition and the predictable family stresses that typically accompany serious illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors associated with sexual behavior problems in young sexually abused children

OBJECTIVE: To identify variables associated with the presence of sexual behavior problems in young sexually abused children. METHOD: Data were gathered from the clinical records of 100 sexually abused boys and girls ages 3-7 years enrolled in two treatment programs. Information was coded systematically on approximately 350 areas related to the child and family's history and functioning, the sexual abuse experience, and treatment outcome. The children were grouped and compared according to their presenting sexual behavior into three categories: (1) developmentally "expected"; (2) "sexualized/self-focused"; and (3) problematic "interpersonal" sexual behavior. RESULTS: Bivariate and multivariate analyses highlighted five variables which were predictive of sexual behavior problems among sexually abused children. Sexual arousal of the child during his/her sexual abuse, the perpetrator's use of sadism, and a history of physical and emotional abuse differentiated between those children with and without "interpersonal" sexual behavior problems. Who the child blamed for his/her sexual abuse further contributed to the distinction between children whose sexual behavior was exclusively "self-focused" (sexualized) versus "interpersonal." CONCLUSIONS: The five major predictor variables, as well as other variables identified in this study, have potential utility in assessing child risk for negative outcomes and determining referral priorities for sexual abuse treatment. Given that sexual arousal and who the child blames for the abuse are prominent variables associated with sexual problems and self-blame, clinicians will need to ensure that sexually abused children and their caregivers are given specific opportunities to deal with these areas in the supportive context of treatment. Children with sexual behavior problems differ not only in the type and level of sexual behavior they exhibit but in most other areas as well, suggesting a need for differential assessment and individualized treatment approaches.     

Children’s attention to interactions directed to others: Guatemalan mayan and european american patterns.

This study investigated differences in attention and learning among Guatemalan Mayan and European American children, ages 5–11 years, who were present but not addressed while their sibling was shown how to construct a novel toy. Each child waited with a distracter toy for her or his turn to make a different toy. Nonaddressed children from Mayan traditional families (with little maternal involvement in Western schooling; n = 40) showed more sustained attention and learning than their counterparts from Mayan families with extensive involvement in Western schooling (n = 40) or European American children (with extensive family involvement in schooling; n = 40). The nonaddressed Mayan children from highly schooled families in turn attended more than the European American children. These findings are consistent with research showing that traditional indigenous ways of organizing learning emphasize observation of ongoing interactions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A time to die: withdrawal of paediatric intensive care

Each individual has the right to a dignified death, which may necessitate a decision to cease active treatment. The key to making such a decision is communication between professionals, child and family. Ethical principles may help to provide a basis and structure for decision making. It may be useful for units to formulate a decision-making framework based on an agreed ethical approach. As a minor, the child is non-autonomous and his/her interests are represented by the parents; however, it is essential that the child is included, if possible, in the decision-making process. The nurse is responsible for updating him/herself on ethical issues, and acquiring the knowledge necessary to represent both the child and his/her colleagues in discussion. Withdrawal of aggressive care does not mean abandoning the child and family. On the contrary, all the skills and resources available will be required to ensure a peaceful and dignified death, and to support the child and family.     

Review of Black families in therapy: A multisystems approach.

Reviews the book, Black families in therapy: A multisystems approach by Nancy Boyd-Franklin (see record 1989-97374-000). In this book, the author develops the thesis that the sine qua non for successful engagement and treatment of Black families is an informed understanding both of the cultural heritage and of the current socio—politico—economic issues faced by Black Americans. The author supports her thesis by blending relevant literature from a wide range of disciplines with her own extensive clinical experience and that of her colleagues. The book is intended for trainers and practitioners from the different mental health disciplines. Although not a basic text on family therapy, it would make an excellent primary reference in courses on marital and family therapy. Clearly, the book is useful as a general reference for therapists whose work brings them into contact with culturally diverse families, and should be required reading for therapists who work or plan to work with Black families. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Differences in the attitudes of couples whose children were conceived through artificial insemination by donor in 1980 and in 1996

OBJECTIVE: To compare the attitudes of couples whose children were conceived through artificial insemination by donor (AID) in 1980 and in 1996. DESIGN: Replication study. SETTING: Infertility clinic of the Utrecht university hospital. PATIENT(S): Couples who conceived a child through AID in 1980 (n = 134) or in 1996 (n = 110). INTERVENTION(S): Anonymous questionnaires. MAIN OUTCOME MEASURE(S): Answers to questionnaires. RESULT(S): Couples who conceive a child through AID still strongly prefer (84%) absolute anonymity of the donor. In both 1980 and 1996, most couples (approximately 80%) decided not to inform their child about the nature of his or her conception. In 1996, couples who considered informing their child hesitated significantly less and showed significantly more openness toward others. In addition, more couples wanted unidentifiable data about the donor and considered it more important to use the same donor for a subsequent child. CONCLUSION(S): Between 1980 and 1996, the number of couples who conceived a child through AID and adhered to absolute anonymity of the donor and secrecy toward the child remained the same, whereas their openness toward others and desire for unidentifiable data about the donor increased.     

Boys will be girls, girls will be boys: Children affect parents as parents affect children in gender nonconformity.

There are transformational possibilities in the family when presented with a child who is transgender or gender nonconforming. Challenging orthodox psychoanalytic thinking that these children's gender presentations are a consequence of poor parental rearing, trauma, or attachment disruptions, it is proposed that gender nonconformity is healthy rather than pathological and that typically these children initially just show up in their families, rather than being shaped by them. Looking at the metabolism of transphobia and the transformational possibilities within the family when boys will be girls and girls will be boys, 3 family types that either support or impede their children's creative gender development are presented: the transformers, the transphobic, and the transporting, with case material to illustrate each of the family types. A psychological construct is developed to explain the feedback loop between family and child: The transgender or gender nonconforming child who transgresses binary gender norms may face culturally imbued transphobia and psychological trauma within the family while simultaneously facilitating the family's transcendence of transphobia through transformative experiences with the child as he or she transitions from the gender assigned at birth to his or her authentic and affirmed gender identity or expression. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Whatever happened to Kleinian child analysis?

This article comments on the status of contemporary Kleinian child analysis in Britain. Although many of Melanie Klein's theoretical constructs remain unchanged, the clinical work of the contemporary Kleinians has been powerfully influenced by the work of Wilfred Bion and his followers. I discuss some of the major Kleinian concepts as well as some of the changes that have taken place in Kleinian child analysis, including those that result from the application of Bion's constructs. I interviewed Edna O'Shaughnessy, a foremost Kleinian child analyst, regarding her perspective on theoretical and pragmatic issues, and her comments are included. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Identity of two: The phenomenology of shame in borderline development and treatment.

Describes the identity of borderline individuals as being shame-based. Shame underlies anger as the major affective state, and shame creates an "identity of 2": bad self and good mother. Shame brings into focal awareness both the self and the other, with the imagery that the other rejects the self. The factors in the mother–child relationship that favor shame as the interactive matrix are discussed. Shame represents a complete mother–child system. It disallows firm boundaries between mother and child because the image of the self cannot be detached from the image of the other. There is no stable sense of self, defined by secure boundaries, and no ability to trust perceptions of self and the world. The therapist must provide the route out of shame by providing a new paradigm of nurturance that includes insistence on separation and forgiveness, as well as the identification of the system of shame. The therapist must be vigilant about his or her own shame and must be able to forgive the client's parents for the damage they have caused. The therapist's avoidance of shame, particularly as evidenced in the routine substitution of guilt as the problematic phenomenon, serves to protect him or her from powerful, painful feelings but acts as a disservice to the client who profoundly suffers shame. The goal for borderline clients is not to become shame-free, but to live lives undetermined by shame. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Analyst subjectivity, analyst disclosure, and the aims of psychoanalysis

It is preferable to think of what we directly disclose to our patients as "analyst disclosure" rather than as the commonly used "self-disclosure." The author suggests this change because, to some extent, we have equated the analyst's subjectivity with the self-concept in ways that fail to distinguish how disclosure both overlaps and is distinct from other forms of interpretation. What distinguishes the analysts's subjectivity in disclosure is her or his deliberate attempt to reveal a construction of the self to the patient so that something new can be explored. This paper elaborates these issues by examining some of the therapeutic aims of analyst disclosure.     

Parent-child conversations about science: The socialization of gender inequities?

This study investigated the family as a context for the gender typing of science achievement. Adolescents (N=52) from 2 age levels (mean ages=11 and 13 years) participated with their mothers and fathers on separate occasions; families were from predominantly middle-income European American backgrounds. Questionnaires measured the parents' and the child's attitudes. Each parent also engaged his or her child in 4 structured teaching activities (including science and nonscience tasks). There were no child gender or grade-level differences in children's science-related grades, self-efficacy, or interest. However, parents were more likely to believe that science was less interesting and more difficult for daughters than sons. In addition, parents' beliefs significantly predicted children's interest and self-efficacy in science. When parents' teaching language was examined, fathers tended to use more cognitively demanding speech with sons than with daughters during one of the science tasks. (PsycINFO Database Record (c) 2010 APA, all rights reserved)