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PubMed2005

"To me, it's my life": medical communication, trust, and activism in cyberspace.

This paper studies the conversations and activities of an online support group for breast cancer sufferers and survivors and their supporters. Using communications medium theory and social capital theory, it examines the mundane and profound exchanges, the poignant self-disclosures, the creative expressions of solidarity, and the minor but not-insignificant political actions of people--initially strangers--who come together as a 'virtuous circle,' not only to assist with medical issues but also to meet emotional and even material needs. Sponsored by the Canadian nonprofit organization Breast Cancer Action Nova Scotia (BCANS), this virtual community has logged over a half million messages since 1996. Not every BCANS participant is an activist--many are just trying to grapple with their disease--but some find ways to shatter the professional "information monopoly," and to press for healthcare improvements. The study illustrates the scope, passion, and complexity of peer-to-peer medical communication in a virtual environment that promotes "thick trust". BCANS participants discuss with candor, warmth and even humor such painful topics as death and dying and the crises in intimate relationships brought about by a terminal illness. The sharing of confidences and fears enables participants to pool their 'collective intelligence' about many things, from how to cope with swelling, to how to think about end-of-life issues, to how to improve social policy.

Adolescent↗
PubMed2001

The relationship between insight and social skill in persons with severe mental illness.

The relationship of insight with the social behaviors of outpatients with severe mental illness (SMI) was investigated. Participants' engaged in two social interactions (i.e., stigmatizing and nonstigmatizing), each with a different research confederate. The participant's behavior was later coded for the presence of various self-presentation and social skill variables. Results indicated that greater insight was associated with better overall social skill, less observed strangeness, and greater self-disclosure of one's mental illness. Furthermore, the three measures of insight, one based on self-report and two interview-based, were all highly intercorrelated, suggesting that they are measuring a similar construct. Finally, consistent with previous research in the area, greater insight was associated with less severe psychiatric symptoms. Implications of these findings for future research are discussed.

Adult↗
PubMed1993

Parental disclosure from the perspective of late adolescents.

Although parental relations are considered influential in adolescents' transition to adulthood, we know little about lessons that parents provide through self-disclosure. This study explored the content and extent of parents' disclosure, from the perspective of their children in late adolescence. College students were asked to indicate how much each parent had shared about various matters in their lives, to characterize the quality of each parent's disclosure to them and their disclosure to each parent, and to recall each parent's most meaningful, awkward and first disclosures. Based on previous research regarding adolescents' disclosure to parents, gender differences in disclosure, and reciprocity of disclosure, it was predicted that greater disclosure would be exchanged with mothers than with fathers. Results confirmed initial predictions, indicated some of the functions that parental disclosure may serve, and suggested a model by which intra-family disclosure might evolve.

Adolescent↗
PubMed2006

Social anxiety, depressive symptoms, and post-event rumination: affective consequences and social contextual influences.

Using a self-presentation perspective, we hypothesized that during social interactions in which social attractiveness could be easily appraised by others, more socially anxious individuals would be more prone to ruminate and rumination would have more adverse emotional consequences. After assessing social anxiety and depressive symptoms, unacquainted college students participated in 45-min structured social interactions manipulated to induce personal self-disclosure or mimic superficial, small-talk. Affective experiences were assessed immediately after and 24h after social interactions. Results found that social anxiety was associated with negative post-event rumination more strongly among those with elevated depressive symptoms. Further, at higher levels of social anxiety, post-event rumination was associated with increases in NA following personal disclosure interactions and decreases in NA following small-talk interactions. Individuals with more depressive symptoms experienced increases in NA following small-talk interactions, but not personal disclosure interactions. Contrary to expectation, positive relations between social anxiety and rumination were not mediated by self-presentation concerns during interactions. Fitting with relevant theory, findings implicated symptom and social contextual variables that moderate the affective consequences of rumination.

Adult↗
PubMed2001

The coming-out process and its adaptational and health-related associations among gay, lesbian, and bisexual youths: stipulation and exploration of a model.

A model is proposed and explored that links the coming-out process to the psychological functioning (i.e., self-esteem and distress) and sexual behaviors of gay, lesbian, and bisexual youths recruited from gay-focused community-based and college organizations in New York City. The coming-out process is multidimensional, consisting, as defined here, of involvement in gay/lesbian activities, attitudes toward homosexuality, comfort with homosexuality, self-disclosure of sexual identity to others, and sexual identity. The coming-out dimensions were related to self-esteem, distress, and unprotected sexual behaviors. In addition, the relations between the coming-out dimensions and unprotected sexual behaviors were explained by psychological functioning. In particular, limited involvement in gay/lesbian activities was associated with more unprotected sex. Negative attitudes toward homosexuality were related directly to more unprotected sex, and they were related indirectly to more unprotected sex by means of increasing emotional distress. These and other findings have implications for designing preventive interventions to increase the youths' psychological functioning and reduce their unprotected sexual behaviors.

Adolescent↗
PubMed1992

Selective responsiveness of chronically ill children to assessments of depression.

Many investigators have noted that depression is a common symptom among pediatric cancer patients. However, prevalence rates vary widely across studies. This variation in prevalence rates may be due, in part, to selective reporting of patients based on measures used and environmental cues. In this study, we evaluated 50 chronically ill pediatric patients (19 cancer and 31 diabetic patients) for their use of selective reporting of depression. Factors in the 2 x 2 design were Intervention (disclosure videotape and cartoon videotape) and Examiner (familiar examiner and unfamiliar examiner). In the Intervention manipulation, subjects were shown either a videotape prompting the child that self-disclosure was appropriate or a tape of a cartoon (control condition). In the Examiner manipulation, subjects were administered the experimental measures by either a familiar (parent) or unfamiliar (research assistant) examiner. Dependent variables were the Children's Depression Inventory (CDI; Kovacs, 1981), the Depression scale of the Roberts Apperception Test for Children (RATC; McArthur & Roberts, 1982), and a depression measure taken from the Child Behavior Checklist (CBCL; Achenbach & Edelbrock, 1983). As hypothesized, the Examiner x Intervention interaction revealed that children who did not view the disclosure videotape and who were tested by an unfamiliar examiner gave significantly lower self-reports of depression on the CDI than children in the other conditions. However, parent and child projective reports of depression did not vary as a function of experimental condition. The results are interpreted as selective responding on the part of pediatric patients. Limitations of assessing internal psychological states in children are discussed.

Adaptation, Psychological↗
PubMed2006

Analytic impasse and the third: clinical implications of intersubjectivity theory.

The author examines the notion of the third within contemporary intersubjectivity theory. He utilizes a variety of metaphors (the triangle, the seesaw, strange attractors, and the compass) in an effort to explain this often misunderstood concept in a clear and readily usable manner. An argument is made to the effect that intersubjectivity theory has direct implications for clinical practice, and that the notion of the third is particularly useful in understanding what happens in and in resolving clinical impasses and stalemates. Specifically, the author suggests that certain forms of self-disclosure are best understood as attempts to create a third point of reference, thus opening up psychic space for self-reflection and mentalization. He provides a clinical case as well as a number of briefer vignettes to illustrate the theoretical concepts and to suggest specific modifications of the psychoanalyst's stance that give the patient greater access to the inner workings of the analyst's mind. This introduces a third that facilitates the gradual transformation from relations of complementarity to relations of mutuality.

Humans↗
PubMed1987

Internalized homophobia and lesbian identity.

This paper presents suggestions for therapists working with women who are having difficulty accepting their attractions to other women, lesbian behavior and identity, or both, with the goal of promoting self-acceptance and reducing internalized homophobia. After a discussion of the therapeutic relationship, several coping strategies which have been used successfully by many women are described and therapeutic applications are offered. These strategies include cognitive restructuring, avoiding a negative identity, adopting an identity label, self-disclosure, meeting other lesbians, and habituation to lesbianism. Finally, behavioral indications of success or failure to achieve the goal of self-acceptance are presented.

Adaptation, Psychological↗
PubMed2003

The mediating effects of attitudes toward homosexuality between secure attachment and disclosure outcomes among gay men.

Past research has found that a stronger secure attachment style, developed in childhood, enhances one's ability to acknowledge negative feelings, cope with negative life events, and develop satisfying social relationships. Because an integral part of the "coming out" process for gay men is the ability to seek support from the gay community in order to reevaluate negative beliefs toward homosexuality, a gay man's attachment style may strongly impact this critical stage of his life. Results demonstrated that men who more strongly endorsed a secure attachment style reported more positive attitudes toward their own homosexuality, and that these more positive attitudes could mediate the relation between more secure attachment style, greater levels of self-disclosure regarding their homosexuality, and greater self-esteem. Implications of these data for internalized homophobia, the coming-out process, and effective social functioning are discussed.

Adaptation, Psychological↗
PubMed1988

Five domains of interpersonal competence in peer relationships.

In three studies we investigated the utility of distinguishing among different domains of interpersonal competence in college students' peer relationships. In Study 1 we developed a questionnaire to assess five dimensions of competence: initiating relationships, self-disclosure, asserting displeasure with others' actions, providing emotional support, and managing interpersonal conflicts. Initial validation evidence was gathered. We found that self-perceptions of competence varied as a function of sex of subject, sex of interaction partner, and competence domain. In Study 2 we found moderate levels of agreement between ratings of competence by subjects and their roommates. Interpersonal competence scores were also related in predictable ways to subject and roommate reports of masculinity and femininity, social self-esteem, loneliness, and social desirability. In Study 3 we obtained ratings of subjects' competence from their close friends and new acquaintances. Relationship satisfaction among new acquaintances was predicted best by initiation competence, whereas satisfaction in friendships was most strongly related to emotional support competence. The findings provide strong evidence of the usefulness of distinguishing among domains of interpersonal competence.

Assertiveness↗
PubMed2003

Identification of Aboriginal and Torres Strait Islander women using an urban obstetric hospital.

OBJECTIVES: To determine the accuracy of routine identification of Aboriginal and Torres Strait Islander women confining at King George V (KGV) Hospital, located in Sydney, Australia. DESIGN: Interviewer-administered survey. PARTICIPANTS: Consecutive sample of women who delivered live, well infants from May to July 1999. MAIN OUTCOME MEASURE: Comparison of hospital documentation compared with confidential self-disclosure of Aboriginal or Torres Strait Islander status to a female Aboriginal health professional. RESULTS: Of 536 women in our sample, 29 (5%) self-disclosed as being Aboriginal or Torres Strait Islander. Only 10 of these were identified as Aboriginal or Torres Strait Islander in hospital records (p<0.001). While specificity as determined by us was 100%, sensitivity was low (34.5%). Those Aboriginal and Torres Strait Islander women referred by another organisation were significantly more likely than those who self-referred to the hospital to be correctly identified (p=0.011). Only 1% of non-Aboriginal women indicated they would have objected to an explicit question by staff about their Aboriginal or Torres Strait Islander status. CONCLUSIONS: Routine identification significantly under-represents Aboriginal or Torres Strait Islander women giving birth at an urban obstetric hospital. We recommend the development and use of a sensitive but also specific series of questions to ensure women always are given the opportunity to disclose their status, especially as few women appear to mind such questions.

Adolescent↗
PubMed1998

Therapist physical attractiveness: an unexplored influence on client disclosure.

Existing research indicates that clients perceive facially attractive therapists as more competent, trustworthy, genuine, and effective than less attractive therapists. No studies exist to help explain how the therapist's attractiveness influences a client's self-disclosure. Participants (n = 241) were randomly assigned to one of eight experimental groups to test the interaction of the therapist's attractiveness, client's gender, the nature of presenting problem, and the client's comfort with disclosing in a hypothetical couple therapy scenario. Analysis of variance procedures established that most participants reported feeling more comfortable disclosing a benign (communication) problem than a potentially embarrassing (sexual) problem, and more comfortable disclosing problems to an attractive than to a less attractive female therapist. Therapists are encouraged to understand the power attractiveness may have in their own and their clients' lives.

Adolescent↗
PubMed1987

Developing positive intimacy cognitions in males with a history of nonintimate sexual experiences.

Traditional male sexual socialization is based on assumptions and cognitions which are antithetical to adult intimate relationships. The double standard scenario, initial sexual experiences, the way of talking about sex with peers, cognitions around automatic and autonomous functioning, the criterion of perfect performance, orgasm-orientation, and emotional separateness from females are strongly overlearned and reinforced in the young male subculture. A cognitive-behavioral strategy is used to increase intimacy among couples as well as males without partners. The focus is on increasing comfort, self-disclosure, and increasing the range of emotional and sexual expression.

Cognition↗
PubMed2006

The relevance of psychodynamic psychotherapy to understanding therapist-patient sexual abuse and treatment of survivors.

Regardless of the therapy modality, research continues to point to the therapeutic relationship as a major salient factor in clinical success or failure. When a patient is sexually abused by his or her therapist, this therapeutic relationship is cynically exploited in a way that does not properly serve the essential needs of the patient. When this patient then seeks reparative therapy, the subsequent therapist needs to pay close attention to issues of the relationship which were breached by the previous clinician. In this article, two case studies showing very different dynamics will be presented in order to demonstrate: (1) relevant factors related to transference, countertransference, projective identification, and the analytic third pertaining to the former, abusive therapy; and (2) needs versus wishes, and issues related to boundaries and self-disclosure in the corrective therapy.

Attitude↗
PubMed1991

Dilemmas and countertransference considerations in group psychotherapy with adult children of alcoholics.

This article will explore special leader issues that emerge in psychodynamically oriented therapy groups with adult children of alcoholics. Particular focus will be on countertransference feelings that get stirred up in group leaders and techniques for dealing with some of these special dilemmas. Specific issues include (a) assumption of sameness between the therapist and the patient (the therapist assuming that he or she "understands" because of having also grown up in an alcoholic family); (b) the "will to restore," which may be destructive when the therapist, whose own self-esteem is dependent on the patient's progress in therapy, forces a "rush to recovery" on the patient; (c) other personal issues in the life of the therapist that may also resonate with experiences of the patient; (d) "countertransference goodness and availability" as it affects therapists' abilities to set reasonable limits on their patients, as well as reasonable expectations for themselves; and (e) special issues regarding therapist transparency and self-disclosure.

Adult↗
PubMed2004

Does sex of client affect counselors' evaluation?

This study examined whether clients' positive or negative self-disclosure and sex affected counselors' evaluation of the clients. 80 counselors (30 certified, 45 master's and five doctoral trainees; six men and 74 women), after viewing a video-taped counseling interview in which the client self-disclosed either largely positive or negative contents responded to the Clinical Impression Scale which contained 8 clinical characteristics of clients (assertiveness, overall coping skills, anxiety, attitude toward counseling, motivation to change, self-esteem, insight, and depression). When the client self-disclosed largely negative content about self, counselors evaluated male client more negatively, i.e., less assertive, poor coping skills, higher anxiety, more negative attitude toward counseling, less eager to change, lower self-esteem, less insight, and higher depression) than female client. However, when the client self-disclosed largely positive content, there was no statistically significant sex difference between the two groups. The implications are discussed.

Adult↗
PubMed2002

Factors influencing children to self-disclose sexual abuse.

Self-disclosure by victims of child sexual abuse (CSA) is critical to initiate legal and therapeutic intervention. Unfortunately, research indicates that lengthy delays in disclosure and even nondisclosure are common. A comprehensive review of the clinical and research literature on CSA and an overview of related bodies of literature was conducted. Areas addressed include the context of sexual abuse as it relates to disclosure, the context and elements of children's disclosures, motivational factors inhibiting disclosure, and models of the disclosure process. Ancillary and analogue research on secrecy and disclosure are also reviewed. Implications for future research and practice are discussed.

Child↗