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Experiences of Japanese nurse scholars: insights for U.S. faculty.

The purpose of this paper is to describe the international educational experiences of Japanese nurse scholars to develop more understanding within academic settings in the United States (U.S.). Based on Heideggerian phenomenology, interpretive methods were used to analyze 42 interviews. Participants of this study were 22 Japanese nurse scholars who had received or were in the process of receiving master or doctoral degrees from schools of nursing in the U.S., and three Japanese nurse consultants. To build trust and aid with self-disclosure, participants were interviewed up to three times. The analytic process used overlapping strategies, including early identification of principal themes, interpretive writing based on exemplars, and paradigm cases illustrative of major themes. Themes discussed in this paper include: changes in the sense of self; cultural differences in self-disclosure; the importance of the advisor; mental health issues; strategies for support; differences between practices in the U.S. and Japan; and experiences of returning to Japan.

Attitude of Health Personnel↗

The different patterns of group climate critical incidents in high and low cohesion sessions of group psychotherapy.

The total data set for this study consisted of 958 critical incidents from high and low cohesion sessions in person-centered group psychotherapy. These incidents were typically noted on a group climate questionnaire at the end of each session. Altogether 211 clients and students participated in twenty-six groups. The high cohesion sessions were dominated by the following cohesion dimensions in rank order: self-disclosure and feedback (24.0%); attraction and bonding (20.2%); listening and empathy (20.0%); process performance and goal attainment (15.0%); and support and caring (10.6%). The corresponding rank order for the low cohesion sessions was strikingly different: avoidance and defensiveness (43.5%); conflict and rebellion (22.2%); and self-disclosure and feedback (8.9%). Apparently then, there are very different patterns of critical incidents in high and low cohesion sessions of group psychotherapy.

Adult↗

A study of friendship characteristics and problem behaviors among middle adolescents.

Exploratory and confirmatory factor analyses were used with a 15-item adolescent self-report measure to identify 4 salient friendship characteristics--Reciprocity of Relations, Overt Hostility, Covert Hostility, and Self-Disclosure--with a sample of about 1,100 middle adolescents. Higher levels of Overt and Covert Hostility and lower levels of Reciprocity of Relations with one's closest friend were associated with higher levels of alcohol consumption, percentage of friends who drink, delinquent activity, depressive symptoms, and suicidal behaviors. Self-Disclosure was positively correlated with some adolescent problem behaviors, possibly reflecting developmental changes toward greater interpersonal involvement with friends in concert with age normative tasks such as increased alcohol use. Longitudinal, prospective analyses indicated that delinquent activity and depressive symptoms were significant lagged predictors of Overt and Covert Hostility, but that friendship characteristics were not significant lagged predictors of adolescent problem behaviors.

Adolescent↗

Dysthymia: a randomized study of cognitive marital therapy and antidepressants.

Preliminary data from a randomized study of the effectiveness of combined marital therapy and antidepressant medication in the treatment of dysthymic married women is presented. The study compares doxepin with placebo, and a marital therapy designed to enhance intimacy through facilitating self-disclosure between spouses with a more supportive and educational therapeutic approach. After ten weeks of combined treatment, the dysthymic women show statistically significant improvement on all the depression measures as well as on the intimacy scale. A trend is developing for greater reduction of depressive symptomatology in the group treated with self-disclosure. The evidence appears to suggest the possibility that the presence of a patient's husband as a supportive figure may of itself be a potent therapeutic manoeuvre in the treatment of dysthymic women.

Clinical Trials as Topic↗

Depression and self-report disclosure after live related donor and cadaver renal transplants.

Important psychological reactions are associated with renal transplantation in general. Differences in psychological adjustment between recipients of kidneys from cadavers (CRs) and recipients of kidneys from live related donors (LRRs), however, have been poorly researched. In this study 10 LRRs (mean age 35,7 years; mean number of years after transplant 4,5) were compared with 30 CRs (mean age 38,6 years; mean number of years after transplant 5,3). The prevalence of depression and self-disclosed stress-inducing factors which might have affected long-term psychological adjustment after the transplant were investigated. The psychological status of each patient was assessed by means of a clinical interview, a mental status examination, the Beck Depression Inventory and a self-report questionnaire. There were found to be no long-term statistically significant differences between the LRR and CR groups in terms of the prevalence of depression, although 20% of the patients overall were depressed to varying degrees. The CR group was more concerned about the psychological and personal characteristics of the donors and their families than the LRR group, who expressed concern about the future well-being of the donors. Many members of both groups expressed having experienced both fear of graft rejection, before and immediately after the transplant, and anxiety, which decreased with time. The therapeutic value of a positive psychological climate in the renal unit and of supportive family relationships was confirmed for both groups. In comparison with their existence while on dialysis, most of the patients, irrespective of donor type, ultimately enjoyed an enhanced quality of life.

Adult↗

[Validity of patient self report data in rehabilitation research: identifying circumstances of the patients' completion of questionnaires].

BACKGROUND: Self-report questionnaires have become wide-spread and are an integral part in different fields of rehabilitation. However, it is still unclear to what extent the validity of the patients' reports is affected by motivational factors. How difficult is it for the patient to fill out questionnaires? What are the situational characteristics in which the patients fill them out? The present study aims to identify the situational, motivational and cognitive requisites of the respondents and to analyse possible impacts on the validity of self-reports. METHOD: A total of n = 105 patients scheduled for inpatient rehabilitation were interviewed by means of a guided open-ended interview in the admission phase. It is a consecutive sample of all admissions in two rehabilitation clinics in Schleswig-Holstein, which provide each patient with a questionnaire to fill out prior to their stay. The analysis involved a description of statements (categories) that have been derived by content analysis based on the patient interviews. In addition, physicians rated various patients' characteristics at the end of their hospital stay. RESULTS: The participation rate of the patients was 95.5 %. Of all patients, 95 % filled out the questionnaires at home, 69 % without a break. 57 % of the patients interviewed had filled out the questionnaires by themselves without any help, another 22 % worked it through together with their partner or spouse. The extent of influence on the responses appeared to be dependent on the amount of help necessary. In a substantial number of patients the questionnaires were regarded as an "official" document that had to be worked through meticulously. Physicians attested 96 % of the patients to have provided honest reports with regard to personal characteristics, and 95 % to have shown a sufficient degree of willingness of self-disclosure. By and large the patients' perceptions of themselves fit with the perceptions the physician in 76 % of the patients from the physicians' point of view. All patients except one were attested a positive motivation to take part in rehabilitation activities in the clinic by the physician. In individual cases there were substantial deficits of cognitive capacities necessary to work through a questionnaire, as well as limitations in literacy. Four patients had insufficient mastery of the German language. DISCUSSION AND CONCLUSION: The vast majority of the patients possessed sufficient motivational and cognitive prerequisites to provide valid self-reports. Patients with problems in responding asked partners or others for help, its impact on the self-reports being as yet not clear-cut. In individual cases it can not be ruled out that patients who think about early retirement provide distorted statements.

Adult↗

Long and Short Routes to Success in Electronically Mediated Negotiations: Group Affiliations and Good Vibrations.

To understand why e-mail negotiations break down, we investigated two distinct elements of negotiators' relationships with each other: shared membership in a social group and mutual self-disclosure. In an experiment, some participants negotiated with a member of an outgroup (a student at a competitor university), whereas others negotiated with a member of an ingroup (a student at the same university). In addition, some negotiators exchanged personal information with their counterparts, whereas others did not. When neither common ingroup status nor a personalized relationship existed between negotiators, negotiations were more likely to end in impasse. These results are attributable to the positive influence of mutual self-disclosure and common group membership on negotiation processes and rapport between negotiators. Copyright 1999 Academic Press.

Journal Article↗

A longitudinal study of maternal messages about dating and sexuality and their influence on Latino adolescents.

PURPOSE: To learn more about the nature of mother-adolescent discussions about sexuality and their influence on adolescents' behaviors and attitudes in Latino families. METHODS: Fifty-five Latino mothers and their midadolescent children (35 girls, 20 boys, mean age 13 years) were observed talking about dating and sexuality. The videotaped conversations were coded for the prevalence of five maternal message types: beliefs and values, advice, cautionary messages, comments about the adolescents' everyday experiences, and maternal self-disclosure about her own dating and sexuality experiences. A structural equation model was used to examined how time spent on the various message types was related to three adolescent-related outcomes collected about 1 year later: sexual behavior, attitudes toward premarital sex, and reports of openness in the mother-child relationship. RESULTS: Latino mothers focused the conversation on their personal beliefs and values about dating and sexuality. Discussions about beliefs and values were accompanied by more parental advice and cautionary messages. More maternal self-disclosure about personal dating and sexuality experiences was related to the adolescents' reporting a better functioning relationship with their mothers and having more conservative attitudes toward premarital sex. Sexuality communication was both positively and negatively related to adolescent sexual behavior, but the messages were not the same. CONCLUSIONS: Maternal communication in Latino families influences adolescents' behaviors and attitudes toward sex and adolescents' perceptions of openness in the mother-child relationship. Observational methods are useful for studying the complexity of the communication process and for studying participants from ethnic minority populations who may be unfamiliar with or uncomfortable filling out questionnaires.

Adolescent↗

Concepts of intimacy in the general population.

A random sample of 50 adults in the general population received an open ended interview regarding their concepts of intimacy. A second random sample of 24 couples from the general population and 24 clinical couples received a standardized interview in which concepts of intimacy were systematically rated to develop an operational definition of the dimensions of intimacy. Self-disclosure was identified as a fundamental aspect of intimacy in interpersonal relationships and marriage. Expression of affection, compatibility, cohesion, identity, and the ability to resolve conflict were also considered important aspects of intimacy. Sexual satisfaction was considered less important than previous definitions of intimacy have suggested. The perception of his or her parents' level of intimacy was thought to influence the subject's own interpersonal relationships. Couples with marital maladjustment and/or psychiatric illness were less aware of aspects of their marriage which influence intimacy. They more frequently disagreed that sexuality influenced their level of intimacy. The study suggests that self-disclosure and parental interpersonal intimacy may be fundamental factors in marital adjustment which merit further research.

Adult↗

Pivotal moments in the therapeutic relationship.

It is perhaps conventional wisdom that the therapeutic relationship is a cornerstone of psychiatric nursing. It is almost a sine qua non. However, while its importance may be widely recognized, it is notoriously undefined and even those who profess to practise or utilize it, or those who advocate it most strongly, have difficulty in saying exactly what it is. This report details a study carried out with six experienced psychiatric nurses to explore and describe perceptions and understandings of pivotal moments within therapeutic relationships. The nurses were asked, in a series of one-to-one interviews, to consider relationships with clients that they would themselves describe as therapeutic and meditate on those moments at which everything seemed to change and the relationship became qualitatively different. Among the factors the nurses reported as being significant were empathy, uniqueness, meaning and purpose, and appropriate self-disclosure (although many of those terms may require clarification). This paper will consider the implications of these and others for nursing practice and the identity of psychiatric nursing practice.

Adult↗

Nurses' experiences of caring for South Asian minority ethnic patients in a general hospital in England.

Healthcare provision for minority ethnic groups in the UK has generally revealed inequalities in access and differential service provision. British healthcare policy has started to address such issues. However, very few studies have specifically examined the experiences of nurses caring for minority ethnic patients. This paper focuses on the focus group interviews of a broader ethnographic study, aimed at describing nurses' experiences of caring for South Asian minority ethnic patients, in a general hospital in the south of England. A sample of 43 nurses of all grades from six medical wards took part in the focus groups: three ward sisters, 22 staff nurses and 18 care assistants; 40 participants were white, one was African-Caribbean and two were South Asian. Data analysis revealed eight themes: changes in service provision; false consciousness of equity; limited cultural knowledge; victim blaming; valuing of the relatives; denial of racism; ethnocentrism, and self-disclosure. The study revealed a good local service response to government policies in addressing inequality. However, there was a tendency to treat all minority ethnic patients the same, with evidence of ethnocentric practices, victim-blaming approaches and poor cultural competence in nursing staff, which raise questions about the quality of service provision. The study indicates that ongoing training and development in the area of cultural competence is necessary.

Anthropology, Cultural↗

College student mental health: a person-environment interactional analysis.

The interactional effects of person characteristics (stimulus screening tendency, self-disclosure tendency, locus of control, and integration of self with other students and the college) and environmental factors (life events) on psychological distress were studied in the comparison of a group of college students who sought help (N = 70) from a student counseling service with a group that did not seek help (N = 70). The results confirmed the importance of social support on the psychological effects of stress. Stimulus screening and locus of control also were related to psychological strain. The pattern of the relationships depended upon whether mood disturbance or help seeking behavior was targeted.

Adult↗

Commentary on Becoming a Daughter: Trauma is a powerful teacher.

Personal life crises profoundly impact genetic counselor practice. In this commentary, themes from Matloff's (in press) article, Becoming a Daughter are highlighted and expanded upon. These themes include: personal impact of a life crisis, and professional impact vis a vis empathy countertransference, self-disclosure, nondirectiveness, and self-confidence. Strategies that help genetic counselors manage personal life crises within their clinical practice and also promote their professional development are emphasized, including normalization of life crises, self-reflection, boundary-setting, and use of peer supervision and consultation.

Breast Neoplasms↗

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.

Humans↗

Accuracy in perceptions of interpersonal interactions: effects of dysphoria, friendship, and similarity.

Conflicting views of depressives' interpersonal accuracy were addressed in an investigation of the accuracy of mild depressives (dysphorics) across differing social contexts. Women who were either friends or strangers and who were either similar or dissimilar in level of dysphoria conversed about 3 topics: a neutral topic, their own disclosure of a personal problem, and their partner's disclosure. Dysphorics were not more accurate in general than nondysphorics. After self-disclosure, all women more accurately detected sympathy from a similar stranger. After the partner's disclosure, women also better detected the mood of a similar partner. When interacting with nondysphoric strangers, however, dysphorics underestimated their partner's sympathy toward them. Implications for cognitive and interpersonal theories of depression and for depressives' relationships are discussed.

Depression↗

Principles of leadership in brief training groups for mental health care professionals.

Leadership in brief training groups requires a high level of skill, energy, and professionalism. The group needs to be led in a purposeful, constructive manner. A metaphor for beneficial leadership is suggested through the image of a mountain guide who sustains and helps members of the group in their exploration of the psychological terrain that is themselves. The leader has five main tasks: (1) to contain the anxieties of the group, (2) quickly establish a therapeutic atmosphere in the group, (3) guide the group toward issues that can be addressed in the time available, (4) guard against damaging self-disclosure and loss of self-esteem, and (5) help the group end well. Clinical vignettes illustrate the realization of these practice points.

Group Processes↗

Group processes in helping groups: toward a developmental perspective.

Ten interaction dimensions of group behavior and three emotional atmosphere categories were coded and analyzed on the basis of interactions among old and young participants in experimental "support-discussion" groups. The seven groups of elderly and five groups of young differed significantly with respect to frequencies of Boundary, Self-disclosure, and Support behaviors. In addition, the young were rated as showing signs of boredom more frequently. The implications of these results for development and age-linked assumptions about helping group interactions and interventions were explored. The results suggest that this approach is promising in generating knowledge that could facilitate age-appropriate group intervention strategies.

Adolescent↗

Telephone support groups: a nontraditional approach to reaching underserved cancer patients.

PURPOSE: This article explores the initiation and clinical issues of a long-term telephone support group serving a population of people with cancer who are homebound, isolated, or otherwise unable to travel to a central location. It explores social, interpersonal, and intrapsychic issues and themes, and compares telephone and face-to-face groups. DESCRIPTION OF PROGRAM: Five years ago, Cancer Care, Inc. created its first and only ongoing telephone support group to respond to the needs of homebound people with cancer. Approximately 30 clients have been members of the group since its inception. The group meets weekly for 1 hour through a conference call set up by an outside telephone company operator. Membership is stable at 12 clients ranging in age from 44 to 86 years. FINDINGS: Anonymity appears to have facilitated bonding and increased self-disclosure. A high level of continuity in group members' participation was reached. Group members learned to become advocates for themselves and were successful in reaching out to others outside of the group. CLINICAL IMPLICATIONS: Due to changes in the economic climate and increased comfort with technology, the formation of support groups that meet and are facilitated through the telephone is a viable, and sometimes the only, practical option. A telephone support group connects a group of people who cannot normally be together, allows patients to use a resource to which they would not have access otherwise, and helps them transcend physical limitations.

Adult↗