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PubMed1994

[Sibling relations: an introduction to the horizontal relation dynamics in a psychoanalytic "family" concept].

This position encompasses the idea that the family concept is represented by a vertical, complementary relationship between child and parents. For decades this position was hardly disputed. The sibling relationship was set apart, or more exactly fixed on a negative, psychopathological potential, in great contrast to daily life-experience and to the cultural value-system. This view point (and its persistant dominance) is illuminated against the background of multiple motivated, collective counterprocesses and deficient, intersubjective development theories. A new and clear change that has been taken place in the concept of the sibling relationship during the last decade is expounded and discussed here. Important conclusions for the development theory are submitted. The sibling relationship is, like the parent-child relationship, an elementary experience and a transferable behaviour-model. Significant psychodynamic processes in sibling relationships are hereby described and possible variant family-dynamics resulting from the interplay between the horizontal and vertical levels are outlined. The creation of sibling relationships during children's games, of imaginary siblings and fantasies of wishing for a sibling are shown. The relevance of the sibling-dynamics for development processes and for family-dynamic processes thus becomes apparent. Important implications for the clinical-psychotherapeutic domain reinforce the demand for including the consideration of siblings in the psychodynamic discussion of the family and in the clinical setting.

Child↗
PubMed2001

Risk factors of child maltreatment within the family: towards a knowledgeable base of family nursing.

The purpose of this study was to compare family dynamics in child maltreating families (n=42) with that in ordinary families with children (n=77), and to ascertain risk factors of child maltreatment within the family. Child maltreatment was defined as physical, psychological or sexual abuse or neglect of a child by a parent. Data were collected using questionnaires (Family Dynamics Measure 2, FMD 2) (N=119) basing on Barnhill's conceptual framework of healthy family systems and analysed by forming sum variables and logistic regression. The study results indicate that family functioning in child maltreating families is lower on all dimensions of family dynamics (individuation, mutuality, flexibility, stability, communication and roles) than that in ordinary families with children. Furthermore, it seems that specific risk factors, detected with logistic regression analysis, are related to whether child maltreatment occurs in the family or not. These include the parent's low educational background, many children in the family, unemployment of a parent, low individuation of the family members, and poor stability and security within the family. The results of this study provide guidelines for detecting and preventing child maltreatment as well as for recognising its existence, although no generalizations can be made due to the small sample size and complexity of the phenomenon under study.

Adult↗
PubMed1999

The Swedish family: transition to parenthood.

Family interaction during pregnancy and the transition to parenthood creates the social environment in which the fetus becomes part of the family, family relationships and roles are reorganized, and the infant's temperament appears. The purpose of this study was to examine the relationships among family dynamics, parental-fetal attachment, and infant temperament across the transition to parenthood. A sample of 91 families in Helsingborg, Sweden completed the Family Dynamics Measure and the Maternal/Paternal Fetal Attachment Scale during the third trimester of pregnancy. When the infant was 8-9 months old, mothers (n = 62) and fathers (n = 54) again completed the Family Dynamics Measure. The mother completed the Revised Infant Temperament Questionnaire as well. Overall, we found small changes in family dynamics, with an increase in perceived role conflict and mutuality reported by mothers. Fathers reported greater fetal attachment than their partners. Greater paternal- and maternal fetal attachment was related to more positive family dynamics, and maternal-fetal attachment was positively related to infant mood at 8 months. The stability of family dynamics across the transition to parenthood is a sign that most families negotiate this transition without difficulty.

Demography↗
PubMed1975

Some dynamic and transactional aspects of family theraphy with psychotic patients.

The application of family therapy to families with psychotic patients involves both technical and theoretic observations and underpinnings. The implications of these for the understanding of certain family dynamics and the use of family therapy in general are investigated. The rhythm of real participation and observation on the therapist's part and the utilization of co-therapists is contrasted with a more authoritarian, 'director' model of intervention. Tendencies in these families towards frozenness and immobility, as well as splitting and chaos, must be counteracted, and are reflected in interactions and transactions between co-therapists. The importance of unravelling these patterns and aiding therapists in the framework of a specially designed, ongoing supervisory seminary is stressed.

Countertransference↗
PubMed1996

The diagnostic value of the Bene-Anthony Family Relations Test.

The aim of this study was to assess whether interning psychologists, who used the Bene-Anthony as an evaluation technique in the psychotherapeutic treatment of their clients, were of the opinion that the test results deepened their insight into the nature of their clients' family dynamics. Subjects were 32 children, ages 4 to 16 years, who were referred for evaluation for the presence of emotional or specific developmental disorders. The interns were of the opinion the Bene-Anthony significantly contributed to their understanding of the family dynamics. Family relationships appeared to be more complex after the application of the test than they seemed before, and the test also clarified the negative nature of the family relationships. The Bene-Anthony may be effectively used for evaluation of family systems in which dysfunctionality occurs.

Adolescent↗
PubMed1994

Adoptive family system dynamics: variations by level of openness in the adoption.

This study examines the consequences of variations in levels of openness in adoption, especially focusing on the dynamics of the adoptive family system from the perspective of the adoptive parents. Participants included the father, mother, and at least one adopted child in 190 adoptive families, and 169 birthmothers, drawn from adoption agencies across the United States. Families included 62 confidential, 17 time-limited mediated, 52 ongoing mediated, and 59 fully disclosed adoptions. When compared to parents in confidential adoptions, those in open adoptions generally demonstrated higher levels of acknowledgment of the adoption, empathy toward the birthparents and their child, a stronger sense of permanence in the relationship with their child as projected into the future, and less fear that the birthmother might try to reclaim her child. Despite these mean differences, variations within all levels of openness were present, and results are discussed in terms of the ongoing process involved in building a family through adoption.

Adaptation, Psychological↗
PubMed1995

Adolescent suicide, depression and family dysfunction.

This study investigated associations between adolescents' perceptions of their family dynamics (McMaster Family Assessment Device, FAD) and depression, suicide thoughts and attempts. High school students (mean age 15.2 years) completed self-report questionnaires including the Beck Depression Inventory (BDI), the FAD, questions about suicidal thoughts, plans and attempts, deliberate self harm, and selected life experiences. Univariate analysis showed that family dysfunction measured on the FAD is associated with thinking and planning suicide, deliberate self harm, suicide attempts, as well as severe depression (BDI > or = 22). Despite this, stepwise regression indicated that family dysfunction influences suicide behaviors indirectly through other variables such as depression. The FAD is recommended as a useful addition to questionnaires seeking to identify vulnerability to both depression and adolescent attempted suicide in early detection studies.

Adolescent↗
PubMed1992

The family in different sub-cultures.

The family has been considered, according to the different angles from which research has been conducted, as an anthropological reality; as an institutional segment; as an etiopathogenetic nucleus; as a communicative environment. The family, taken as a highly complex (open-closed) system, is by now a common conception not only among family therapists, but also for those concerned--from a transcultural point of view--with individual and family dynamics in connection with extra-familial dynamics in a society in constant and rapid transformation. The therapists must be able to contribute to a reconstruction of the interactive dynamics of the family network, stimulating the contribution that each member may make to reparative, and at the same time creative, development. In the various family typologies the model of a therapeutic network flexibly based on cultural identification may be introduced.

Culture↗
PubMed2005

Cultural diversity at the end of life: issues and guidelines for family physicians.

Ethnic minorities currently compose approximately one third of the population of the United States. The U.S. model of health care, which values autonomy in medical decision making, is not easily applied to members of some racial or ethnic groups. Cultural factors strongly influence patients' reactions to serious illness and decisions about end-of-life care. Research has identified three basic dimensions in end-of-life treatment that vary culturally: communication of "bad news"; locus of decision making; and attitudes toward advance directives and end-of-life care. In contrast to the emphasis on "truth telling" in the United States, it is not uncommon for health care professionals outside the United States to conceal serious diagnoses from patients, because disclosure of serious illness may be viewed as disrespectful, impolite, or even harmful to the patient. Similarly, with regard to decision making, the U.S. emphasis on patient autonomy may contrast with preferences for more family-based, physician-based, or shared physician- and family-based decision making among some cultures. Finally, survey data suggest lower rates of advance directive completion among patients of specific ethnic backgrounds, which may reflect distrust of the U.S. health care system, current health care disparities, cultural perspectives on death and suffering, and family dynamics. By paying attention to the patient's values, spirituality, and relationship dynamics, the family physician can elicit and follow cultural preferences.

Advance Directives↗
PubMed1995

[How to intervene effectively with a dying patient].

Nurses are in a strategic position to meet the needs of the dying patient. However, when confronted with death, nurses often utilize avoidance behaviors, such as: tending to the dying patient only if a technique is required; initiating conversations on casual topics or directing the conversation towards the patient's "health"; requesting consults to avoid talking about dying; and unnecessarily overmedicating the patient. This paper explains the rights and needs of the dying patient and describes associated nursing interventions. For example, the dying patient has the primordial right to choose whether or not to receive treatment. For nurses to intervene effectively, they must learn to manage their own emotions relating to death. A strong theoretical understanding of the dying process must be acquired. They must also develop internal strengths and receive help from various resources. By doing so, nurses reinvest their shared life experiences and apply them to other dying patients continuously refining their conceptual model of loss. Through verbal and non-verbal cues, nurses transmit profound messages to their patients. Some efficient nursing interventions consist of: providing basic care and medications to prevent terminal suffering; offering an attentive and reassuring presence; respecting the contemplative phases; listening for latent messages in conversations; understanding symbolic language; respecting family dynamics; allowing family members to choose physical and psychosocial interventions to improve the patient's comfort; frequently visiting the patient and intensifying their presence; permitting the dying patient to verbalize fears and anxieties; and consistently offering tenderness, empathy, acceptance, warmth and respect. As death nears, scientific and technological aspects of nursing become less important for the patient, and the art of sincere human empathy becomes paramount.

Attitude of Health Personnel↗
PubMedDate not supplied

The relationship of family dynamics/social support to patient functioning in IDDM patients on intensive insulin therapy.

A 6 month pilot study was conducted to examine the relationship between family dynamics/social support and patient functioning in diabetic patients on intensive insulin therapy. Intensified therapy was associated with improvements in the DUHP symptom score, MHI psychological well-being score, and in the DUHP social functioning score. In diabetic patients, regardless of therapy, extreme family dynamics were correlated with higher DUHP symptom scores and lower MHI psychological well-being scores at the initial measurement time. However, over the 6 month study period, extreme family dynamics were predictive of improvements in the DUHP symptoms score and in the quality of friendships in diabetic patients on intensive insuline therapy. In diabetic patients, regardless of therapy, higher levels of social support correlated with higher levels of psychological and social functioning at the initial measurement time, and with improvements in quality of family life over the 6 month measurement time. Higher social support was also associated with improvements in quantity of friends and the DUHP social functioning score in diabetic patients on intensive insulin therapy. The study also generated empiric support for co-evolutionary models of disease states/family dynamics/treatment systems by showing that 6 month changes in family dynamics were predicted by the initial FACES adaptability measure and the initial mean monthly glucose value. Intensified therapy predicted lower family cohesion and more family rigidity over the 6 month study period. These findings also suggest, when combined with the result that diabetic patients from more cohesive families experienced a rise in monthly mean glucose values, that some diabetic patients may become trapped in a vicious cycle which perpetuates poor glucose control and extreme family dynamics.

Adaptation, Psychological↗
PubMed2004

Designing biosensors for Rho family proteins--deciphering the dynamics of Rho family GTPase activation in living cells.

Rho family GTPases are molecular switches that couple changes in the extracellular environment to intracellular signal transduction pathways. Their ability to regulate behaviors such as cell motility suggests very tight kinetic and spatial control of their activity, which is missed in most biochemical assays. Fluorescent probes that non-invasively report the changing subcellular location of Rho GTPase activity in single living cells are now allowing us to examine spatio-temporal regulation of the activity of these proteins, and are providing new biological insights. Several strategies can be used to construct such probes, and there are advantages and disadvantages associated with the diverse probe designs.

Animals↗
PubMed2000

Discussions of "code status" on a family practice teaching ward: what barriers do family physicians face?

BACKGROUND: Patients want physicians to ascertain their wishes related to resuscitation, yet such discussions of "code status" are often delayed in the hospital setting, which compromises patient autonomy. Few studies have examined family physicians' views on this topic. Our objectives were to explore the experiences of family physicians and family practice residents in establishing code status with their patients who had been admitted to hospital and to identify barriers to these discussions. METHODS: Semistructured, in-depth interviews were conducted with 5 family physicians and 5 family practice residents admitting patients to a family practice teaching ward in a university-affiliated urban tertiary care hospital. Interview transcripts were analysed inductively, and grounded theory was used to identify conceptual categories and recurring themes. Key findings were validated by means of member checking with participants, consensus meetings of the research team and consultation with qualitative researchers. RESULTS: Barriers to code-status discussions included personal discomfort with confronting mortality, fear of damaging the doctor-patient relationship or harming the patient by raising the topic of death, limited time to establish trust, and difficulty in managing complex family dynamics. In spite of these challenges, family physicians and residents viewed discussions of resuscitation as a significant part of their role. INTERPRETATION: Family physicians and residents need to develop personal awareness about difficulties in confronting mortality, enhance their communication strategies for broaching the topic of code status in the context of a trusting doctor-patient relationship and sharpen their skills in understanding and managing family dynamics related to end-of-life decisions. Awareness of the barriers to code-status discussions can inform research, education and hospital policy. Consultation with patients is needed to develop effective communication strategies.

Attitude to Death↗
PubMed1991

[The significance of familial relationship dynamics for the success of inpatient treatment in child and adolescent psychiatry].

A sample of 131 consecutively hospitalized psychiatric inpatients (adolescents of 12 years and older) was investigated with regard to the question of whether family relationship variables influence therapy outcome. Before the beginning of treatment, the familial relationship structure, specifically bonding behavior and rejecting/detachment behavior in the interactions among father, mother and adolescent, was investigated. The clinical rating scales used yielded values representing directed relationship characteristics of the family triad. These relationship values were used as prognostic variables for prediction of therapy outcome, which was assessed independently of the family diagnostic ratings. The results show that the relationship dynamics in the family have a high prognostic value with regard to changes in symptoms during therapy. Several different prognostically relevant characteristics of the relationship structure could be identified.

Adolescent↗
PubMed2000

Allegations of sexual abuse in child custody disputes.

OBJECTIVE: Allegations of sexual abuse are increasingly made in the context of divorce proceedings. The aim of the study was to describe ideal typical patterns of family dynamics when sexual abuse is alleged in divorce proceedings. METHOD: Development of an assessment plan according to the methods of the qualitative descriptive social sciences and retrospective assessment of 24 legal cases of custody and visitation right proceedings in which allegations of sexual abuse (N = 30 children) were made. RESULTS: In our sample, we found a significant incidence of sexual deviations of a parent. With respect to the allegations of sexual abuse in divorce cases, we were able to identify four types of family dynamics. Our qualitative assessment of the data showed that distinguishing between actual abuse and false allegations cannot adequately help to clarify the family dynamics. Rather, it tends to conceal the fact that even a false allegation usually originates from a sexualized atmosphere in the family. The main family structures which were observed without exception in our sample generally already existed before the separation phase and had corresponding effects on the child which must be considered in the evaluation.

Adolescent↗
PubMed2004

Couple power dynamics, systemic family functioning, and child adjustment: a test of a mediational model in a multiethnic sample.

Power dynamics in the marital dyad and systemic elements of whole-family functioning (cohesion, subsystem boundary formations) were examined in relation to each other and also in relation to child adjustment in a multiethnic sample of families. Support was found for a mediational model, such that family functioning was found to mediate the relationship between marital power dynamics and children's internalizing and externalizing behavior. Some support also was found for ethnicity as a moderator of the association between systemic family processes and children's adjustment. Disturbances in family cohesion and subsystem boundaries were more strongly related to internalizing symptomatology for children in European American families compared to children in Hispanic American families.

Adult↗