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PubMed1991

Midwife/client relationship: midwives' perspectives.

This study set out to explore midwives' understanding of the factors which affected the development of a therapeutic relationship with clients. A qualitative approach was adopted for the study to avoid placing predetermined categories upon midwives' perceptions. Because of the qualitative nature of the study in-depth interviews were conducted to allow midwives to explore in depth their perceptions of the research topic. Themes identified within the interview data indicated conflicting needs/interests which in turn seemed to cause dilemmas for the midwives interviewed. It seemed appropriate therefore to take the data analysis one step further by utilising dilemma analysis. Consideration of the situations in which the midwives experienced 'good' or 'poor' relationships revealed a complex picture of the factors affecting relationships with clients. Four main issues were identified: the nature and value of the midwives' role; recognition of authority/autonomy in practising this role; emotional involvement with clients; and maintaining personal integrity. From dilemma analysis of the data it appears that when midwives were successful in managing these issues then the relationship became 'special' and therapeutic for clients. Mismanagement of these issues in contrast led to dilemmas which then inhibited development of meaningful relationships between the midwives and clients. In view of the fact that clients and midwives value this 'special' relationship a case is made for midwives to be prepared educationally to manage effectively issues which are raised in their everyday practice. Only then will the midwife/client relationship become therapeutic.

Clinical Nursing Research↗
PubMed2002

Relationship between pain and vertebral motion in chronic low-back pain subjects.

OBJECTIVES: To investigate the relationship between intervertebral motion, intravertebral deformation and pain in chronic low-back pain patients. DESIGN: This study measured vertebral motion of the lumbar spine and associated pain in a select group of chronic low-back pain patients as they performed a standard battery of motions in all planes. BACKGROUND: Numerous studies have demonstrated that individuals with low-back pain have impaired spinal motion, yet few studies have examined the specific relationship between pain and motion parameters. Although it is accepted that the pain in mechanical low-back patients is due to specific spinal motions, no studies have related specific motions to pain measures. METHODS: Percutaneous intra-pedicle screws were placed into the right and left L4 (or L5) and S1 segments of nine chronic low-back pain patients. The external fixator frame was removed following the clinical external fixation test. The 3D locations of the pedicle screws and the level of pain were recorded as the subjects performed a battery of motions. The relationship between the pain and motion parameters was assessed using linear discriminant analysis and neural network models. RESULTS: The neural network model showed a strong relationship between observed and predicted pain (R(2)=0.997). The discriminant analysis showed a weak relationship (R(2)=0.5). CONCLUSIONS: Vertebral motion parameters are strongly predictive of pain in this select group of chronic low-back pain patients. The nature of the relationship is nonlinear and involves interactions; neural networks are able to effectively describe these relationships. RELEVANCE: Specific patterns of intervertebral motion and intravertebral deformation result in pain in chronic low-back pain patients. This substantiates the mechanical back pain aetiology.

Adult↗
PubMed2001

The doctor-nurse relationship: how easy is it to be a female doctor co-operating with a female nurse?

The doctor-nurse relationship has traditionally been a man-woman relationship. However, in recent years, the number of women studying medicine has increased in all West-European countries, and in 1997, 29% of active Norwegian doctors were women. The doctor-nurse relationship has often been described as a dominant-subservient relationship with a clear understanding that the doctor is a man and the nurse is a woman. This article examines what happens to the doctor-nurse relationship when both are women: how do female doctors experience their relationship to female nurses? It is based on two sets of data, qualitative interviews with 15 doctors and a nationwide survey of 3589 doctors. The results show that in the experience of many doctors, male and female, the doctor-nurse relationship is influenced by the doctor's gender. Female doctors often find that they are met with less respect and confidence and are given less help than their male colleagues. The doctors' own interpretation of this is partly that the nurses' wish to reduce status differences between the two groups affects female doctors more than male, and partly that there is an "erotic game" taking place between male doctors and female nurses. In order to tackle the experience of differential treatment, the strategies chosen by female doctors include doing as much as possible themselves and making friends with the nurses. The results are considered in light of structural changes both in society at large and within the health services, with emphasis on the recent convergence of status between the two occupational groups.

Attitude of Health Personnel↗
PubMed2003

Eating disturbances in girls with diabetes: the contribution of adolescent self-concept, maternal weight and shape concerns and mother-daughter relationships.

BACKGROUND: This study examined the relative contribution of adolescent self-concept, maternal weight and shape concerns (WSC), and mother-daughter relationships to eating disturbances among girls with type 1 diabetes mellitus (DM). METHOD: Eighty-eight adolescent girls (mean = 15.0 years, S.D. = 2.2) and their mothers completed self-report measures of disordered eating and weight control behaviours, with teens also reporting on disturbed eating and body attitudes. Based on reported symptoms, adolescents were classified as highly (N = 18), mildly (N = 30) and non-eating disturbed (N = 40). Self-concept was assessed by adolescent self-report. Mother-daughter relationships were assessed by adolescent self-report and by observed mother-daughter interactions that were rated using a macroanalytic coding system that assesses intimacy and autonomy in these relationships. RESULTS: Hierarchical regressions illustrated that adolescent self-concept deficits, maternal WSC, and impaired mother-daughter relationships significantly predicted eating disturbances in girls with DM, accounting for 57% of the variance. Mothers who engaged in dieting and binge-eating were more impaired in their ability to support their daughters' emerging autonomy. The quality of mother-daughter relationships partly mediated the influence of maternal WSC on adolescent eating disturbances. Moreover, the impact of maternal WSC and mother-daughter relationships on eating disturbances was mediated by adolescent self-concept. CONCLUSIONS: Findings illustrate two pathways through which mother-daughter relationships may impact upon risk of eating disturbances in girls with DM and highlight the need to evaluate family-based interventions specifically tailored for this high-risk population.

Adolescent↗
PubMed1999

Longitudinal relationships between lifestyle and cardiovascular and bone health status indicators in males and females between 13 and 27 years of age; a review of findings from the Amsterdam Growth and Health Longitudinal Study.

UNLABELLED: The Amsterdam Growth and Health Longitudinal Study is longitudinal co-hort study on 181 males and females initially aged 13 years, with follow-up measurements at ages 14, 15, 16, 21 and 27 years. METHODS: Anthropometrical, biological and lifestyle parameters, and age 27 also bone mineral density (BMD) of the lumbar spine (L2-L4), were measured repeatedly. Adolescent dietary intake and physical activity was related to adult cardiovascular and bone health status indicators by MLR; longitudinal relationships between physical activity and dietary intake, and cardiovascular health status indicators were assessed hy GEE-analysis. RESULTS: Adolescent physical activity was not related to most of the indicators of adult cardiovascular health status, with the exception of a positive relationship with the waist-to-hip in females; in males 'energetic' adolescent physical activity contributed significantly to adult BMD; both in males and females, when taking the entire longitudinal period into account, peak strain physical activity was a relatively more important predictor of adult BMD than 'energetic' physical activity; calcium intake during adolescence was not a significant predictor of bone health status measured at age 27, both in males and females; a consistent significant positive longitudinal relationship was found between physical activity and serum HDL-cholesterol and significant negative longitudinal relationships were found with the subscapular skinfold and with body fat mass; a positive longitudinal relationship was found between serum total cholesterol (TC) and cholesterol intake, saturated fat (SFA) intake and the Keys-score; a negative longitudinal relationship was found between TC and polyunsaturated fit and total energy intake; for HDL a positive longitudinal relationship was found with SFA intake; low tracking was found for physical (in-) activity and dietary intake variables.

Adolescent↗
PubMed2002

Boundary conditions for the Swain-Schaad relationship as a criterion for hydrogen tunneling.

Hydrogen quantum mechanical tunneling has been suggested to play a role in a wide variety of hydrogen-transfer reactions in chemistry and enzymology. An important experimental criterion for tunneling is based on the breakdown of the semiclassical prediction for the relationship among the rates of the three isotopes of hydrogen (hydrogen -H, deuterium -D, and tritium -T). This is denoted the Swain-Schaad relationship. This study examines the breakdown of the Swain-Schaad relationship as criterion for tunneling. The semiclassical (no tunneling) limit used hereto (e.g., 3.34, for H/T to D/T kinetic isotope effects), was based on simple theoretical considerations of a diatomic cleavage of a stable covalent bond, for example, a C-H bond. Yet, most experimental evidence for a tunneling contribution has come from breakdown of those relationship for a secondary hydrogen, that is, not the hydrogen whose bond is being cleaved but its geminal neighbor. Furthermore, many of the reported experiments have been mixed-labeling experiments, in which a secondary H/T kinetic isotope effect was measured for C-H cleavage, while the D/T secondary effect accompanied C-D cleavage. In experiments of this type, the breakdown of the Swain-Schaad relationship indicates both tunneling and the degree of coupled motion between the primary and secondary hydrogens. We found a new semiclassical limit (e.g., 4.8 for H/T to D/T kinetic isotope effects), whose breakdown can serve as a more reliable experimental evidence for tunneling in this common mixed-labeling experiment. We study the tunneling contribution to C-H bond activation, for which many relevant experimental and theoretical data are available. However, these studies can be applied to any hydrogen-transfer reaction. First, an extension of the original approach was applied, and then vibrational analysis studies were carried out for a model system (the enzyme alcohol dehydrogenase). Finally, the effect of complex kinetics on the observed Swain-Schaad relationship was examined. All three methods yield a new semiclassical limit (4.8), above which tunneling must be considered. Yet, it was found that for many cases the original, localized limit (3.34), holds fairly well. For experimental results that are between the original and new limits (within statistical errors), several methods are suggested that can support or exclude tunneling. These new and clearer criteria provide a basis for future applications of the Swain-Schaad relationship to demonstrate tunneling in complex systems.

Alcohol Dehydrogenase↗
PubMed2002

The Same Old Song?-Stability and Change in Relationship Schemas From Adolescence to Young Adulthood.

Relationship schemas are core elements of personality that guide interpersonal functioning. The aim of this study is to examine stability and change in relationship schemas across two developmental epochs-adolescence and young adulthood-in the stories that people tell about their interactions with others. Using the Core Conflictual Relationship Theme Method, relationship themes were coded from semistructured interviews conducted in adolescence and again at age 25. The sample consisted of 40 participants in a longitudinal study of adolescent and young adult psychological development. There was considerable stability in the frequency with which particular themes were expressed in the narratives of adolescents and young adults. Significant changes from adolescence to young adulthood included a decrease in the perception of others as rejecting and of the self as opposing others. Young adults saw themselves and others more positively, and used a broader repertoire of themes in their relationship narratives than they had as adolescents. The basic continuity and particular changes in relationship schemas found in this study are consistent with knowledge about the adolescent-to-young-adult transition derived from other empirical and clinical findings. Relationship schemas may be rich units of study for learning about the development of interpersonal functioning.

Journal Article↗
PubMed1999

Childhood peer relationship problems and young people's involvement with deviant peers in adolescence.

Using prospective longitudinal data from the Christchurch Health and Development Study, this article examined the relationship between children's peer relationship problems in middle childhood and their subsequent risk of forming deviant peer affiliations in adolescence. The analysis proceeded in three steps. First, a structural equation model demonstrated a moderate association between early peer relationship problems and later deviant peer affiliations (r = .27). Second, the model was extended to include a latent variable measure of early conduct problems. This analysis revealed that when the confounding effects of concurrently measured conduct problems were taken into account, peer relationship problems in middle childhood were no longer significantly related to young people's choice of deviant peers in adolescence. Third, the model was further extended to include lagged variables, permitting an examination of possible reciprocal relationships between early conduct problems and peer relationship problems. Results suggested that both early peer relationship problems and adolescent deviant peer involvement are symptomatic of early child behavioral adjustment. The implications of these findings for explanations of deviant peer selection are discussed.

Adolescent↗
PubMed2003

Sibling relationships when a child has autism: marital stress and support coping.

Family systems theory was employed to study sibling relationships in 50 families with a child with autism. Typically developing siblings expressed satisfaction with their sibling relationships. Parents were somewhat less positive about the sibling relationship than were the siblings themselves. As hypothesized, stress in the marital relationship was associated with compromised sibling relationships. Informal social support buffered the deleterious effects of marital stress on positive, but not negative, aspects of the sibling relationship. Contrary to predictions, families experiencing high marital stress who sought greater support from formal resources external to the family had typically developing siblings who reported a higher level of negative sibling behaviors than families who sought low levels of formal support. Findings reinforce the importance of considering family context as a contributor to the quality of the sibling relationship.

Adaptation, Psychological↗
PubMed2004

Intimacy and sexual behavior among HIV-positive men-who-have-sex-with-men in primary relationships.

Unprotected anal intercourse among men-who-have-sex-with-men (MSM) occurs more frequently between partners in a primary relationship than between nonprimary partners. Although research supports the role of social support in risky sex, findings also suggest that the reasons associated with risky sex differ depending on both the relationship status and HIV-serostatus of MSM. This study assessed whether level of intimacy within a primary relationship helps to explain risky sex among a sample of 78 HIV-positive MSM currently involved in a primary relationship. Findings suggest that both drug use prior to sex and HIV status of the primary partner moderate the relationship between intimacy and sexual risk behaviors. Under levels of low drug use, greater intimacy functioned as a protective factor within seroconcordant relationships whereas it functioned as a risk factor within serodiscordant relationships. Implications for educational and clinical interventions are discussed.

Adult↗
PubMed1994

Intimate relationships and depression: is there a causal connection?

The causal pathways that link depression and dissatisfaction in intimate relationships were estimated in 115 patients during the first 12 weeks of treatment with cognitive-behavioral therapy for depression. Depression severity, as measured by the Beck Depression Inventory, was negatively correlated with relationship satisfaction at intake and at 12 weeks. However, structural equation modeling was not consistent with the hypothesis that depression severity has a causal effect on relationship satisfaction levels and suggested that relationship satisfaction may have only a weak reciprocal effect on depression severity. As predicted, married patients were substantially less depressed 12 weeks after the beginning of treatment, when controlling for initial depression severity. Contrary to expectations, marital status predicted improvement even when relationship satisfaction was controlled. Unexpectedly, dysthymia at intake was associated with low relationship satisfaction after 12 weeks, when initial relationship satisfaction was controlled, suggesting that chronic, low-level depression may have a stronger association with interpersonal problems than other forms of depression, such as major depressive episodes. The theoretical and clinical implications of the findings are discussed.

Adolescent↗
PubMed1986

Keeping track of needs in communal and exchange relationships.

Keeping track of needs in communal and exchange relationships was investigated in two experiments. In both, subjects could check to see if another person needed help. The first experiment tested the hypotheses that When there is no opportunity for the other to reciprocate in kind, keeping track of the other's needs will be greater if the person desires a communal relationship with the other than if the person desires an exchange relationship with the other. If the person desires an exchange relationship with the other, keeping track of the other's needs will be greater when an opportunity for the other to reciprocate in kind exists than when it does not. If a communal relationship is desired, the existence of an opportunity for the other to reciprocate in kind will not influence keeping track of the other's needs. The results of the first experiment supported all three hypotheses. The second experiment tested and found support for the hypothesis that even when nothing can be done to help the other, keeping track of the other's needs will be greater if a communal relationship is desired with the other than if an exchange relationship is desired.

Dependency, Psychological↗
PubMed1994

Attachment style, gender, and relationship stability: a longitudinal analysis.

Adult attachment styles in 354 heterosexual couples in serious dating relationships were examined. Principal findings included the following: (a) male and female attachment styles were nonrandomly paired, for example, no anxious-anxious or avoidant-avoidant pairs were found; (b) male and female styles related to concurrent relationship ratings of both partners in different but theoretically meaningful ways; (c) male and female styles contributed significantly to longitudinal prediction of relationship stability and status, even when prior duration and commitment to the relationship were statistically controlled; (d) specifically, relationships of avoidant men and of anxious women were surprisingly stable over 3 years, particularly in light of the relatively poor ratings of these relationships by both partners at Time 1. Discussion focuses on the need to integrate gender role considerations and relationship dynamics and processes into theorizing on adult attachment.

Adult↗
PubMed1999

Ideals in intimate relationships.

This research examined lay relationship and partner ideals in romantic relationships from both a social-cognitive and an evolutionary perspective. Studies 1 and 2 revealed that the qualities of an ideal partner were represented by 3 factors (partner warmth-trustworthiness, vitality-attractiveness, and status-resources), whereas the qualities of an ideal relationship were represented by 2 factors (relationship intimacy-loyalty and passion). A confirmatory factor analysis in Study 3 replicated these factor structures but found considerable overlap across the partner and relationship dimensions. Studies 4 and 5 produced convergent and discriminant validity evidence for all 5 factors. Study 6 indicated that the higher the consistency between the ideals and related assessments of the current partner and relationship, the more positively the current relationship was evaluated.

Adolescent↗
PubMed2000

Couples' shared participation in novel and arousing activities and experienced relationship quality.

Using a newspaper questionnaire, a door-to-door survey, and 3 laboratory experiments, the authors examined a proposed effect of shared participation in novel and arousing activities on experienced relationship quality. The questionnaire and survey studies found predicted correlations of reported shared "exciting" activities and relationship satisfaction plus their predicted mediation by relationship boredom. In all 3 experiments, the authors found predicted greater increases in experienced relationship quality from before to after participating together in a 7-min novel and arousing (vs. a more mundane) task. Comparison with a no-activity control showed the effect was due to the novel-arousing task. The same effect was found on ratings of videotaped discussions before and after the experimental task. Finally, all results remained after controlling for relationship social desirability. Results bear on general issues of boredom and excitement in relationships and the role of such processes in understanding the typical early decline of relationship quality after the honeymoon period.

Adolescent↗
PubMed2000

Ideals, perceptions, and evaluations in early relationship development.

This research examined partner and relationship perceptions and ideal standards in 100 individuals over time, from the 1st to the 12th month of their dating relationships. As expected, the results revealed that (a) individuals evaluated their relationships on both distinct evaluative components and global evaluative dimensions, (b) higher ideal-perception consistency was associated with higher perceived quality of relationships and partners, (c) more positive perceptions of partners and relationships at earlier points in time were associated with more importance being placed on relevant ideals over time but not vice versa, and (d) higher levels of ideal-perception consistency predicted lower rates of relationship dissolution but were mediated through perceptions of relationship quality. These results support the ideal standards model (Fletcher & Simpson, in press).

Adolescent↗
PubMed2003

Prediction of treatment outcome from relationship variables in child and adolescent therapy: a meta-analytic review.

Results from 23 studies examining associations between therapeutic relationship variables and treatment outcomes in child and adolescent therapy were reviewed with meta-analytic procedures. Results indicated that the overall strength of the relationship-outcome associations was modest and quite similar to results obtained with adults. This modest association was moderated by 1 substantive factor, type of patient problem, and 5 methodological factors, timing and source of relationship measurement, type and source of outcome, and shared versus cross-source measurement of relationship and outcome variables. Type, mode, structure, and context of treatment did not moderate associations between relationship variables and outcomes. Findings indicated that the association between the therapeutic relationship and treatment outcome was consistent across developmental levels and across diverse types and contexts of child and adolescent therapy. Recommendations for future process research on the therapeutic relationship in child psychotherapy are offered.

Adolescent↗
PubMed2006

The therapeutic relationship in the brief treatment of depression: contributions to clinical improvement and enhanced adaptive capacities.

Using data from the National Institute of Mental Health Treatment for Depression Collaborative Research Program, the authors examined the impact on treatment outcome of the patient's perception of the quality of the therapeutic relationship and contribution to the therapeutic alliance. Shared variance with early clinical improvement was removed from these relationship measures. Multilevel modeling demonstrated that a perceived positive therapeutic relationship early in treatment predicted more rapid decline in maladjustment subsequent to the relationship assessment. This effect occurred equally across all 4 treatment conditions. A positive early therapeutic relationship also predicted better adjustment throughout the 18-month follow-up as well as development of greater enhanced adaptive capacities (EAC). Controlling a wide range of patient characteristics did not eliminate the effects of the therapeutic relationship on rate of improvement during treatment and on EAC. Thus, independent of type of treatment and early clinical improvement, the therapeutic relationship contributes directly to positive therapeutic outcome.

Adaptation, Psychological↗