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Geography of childhood sexual abuse: women's narratives of their childhood environments.
This article explores the geography of childhood sexual abuse by describing characteristics of the home, school, and community environments in which abused girls grew up. Results of this focused life story research involving 20 women survivors who narrated their childhood experiences suggest a topography of 20 distinct characteristics integral to the milieux of these abusive childhood homes. Dynamics of the home environment were reinforced in school and community environments. Implications for prevention and early, environmentally based interventions for girls at risk of abuse and retraumatization are discussed.
Art within analysis: scapegoat, transference and transformation.
Through clinical example and pictorial illustration, the author examines ways in which art offers a particular means of psychological transformation in states which may otherwise be in expressable. A transference to the art work itself is proposed. It is submitted that, mediated within the transference/ countertransference dynamic, this 'scapegoat transference' facilitates a particular process of psychological differentiation. The aesthetic qualities of art presented within analysis will resonate with other countertransference affects. Clinical material demonstrates how observation of this--aesthetic countertransference--leads to a distinction between the 'diagrammatic' and the 'embodied image. The process of integration of shadow material is furthered by the temporary safe-keeping of the art work by the analyst.
Not afraid to blame: the neglected role of blame attribution in medical consumerism and some implications for health policy.
A crucial aspect of medical consumerism has been overlooked in past research and policymaking: how consumers decide whom to "blame" for bad outcomes. This study explores how, in a system increasingly dominated by managed care, these attributions affect consumers' attitudes and behavior. Using data from the experiences of people with serious mental illness, hypotheses are tested regarding the origins and consequences of blaming for medical consumerism. Blame was allocated to health plans in a manner similar, but not identical, to the way in which blame was allocated to health care professionals. Both allocations are shaped by enrollment in managed care, with blame allocation affecting consumers' subsequent willingness to talk about adverse events. Policy implications include the need for more finely tuned grievance procedures and better consumer education about managed care practices.
Psychosocial investigation of individual and community responses to the experience of Ovine Johne's Disease in rural Victoria.
OBJECTIVE: This paper explores the psychosocial outcomes for individuals and communities in rural Victoria who experienced the outbreak of Ovine Johne's Disease (OJD). DESIGN: The study uses a qualitative methodology to analyse the minutes of evidence provided by the inquiry into the control of OJD to identify the psychosocial events, experiences and outcomes associated with the control of this outbreak. The inquiry was undertaken by the Environment and Natural Resources Committee of the Victorian State Government. SETTING: Public hearings were undertaken by the committee across several rural Victorian communities and the state capital, Melbourne. SUBJECTS: The transcripts detail 136 submissions from 98 individuals and 23 organisations. OUTCOME MEASURES: The analysis aimed to provide insight into the impact of the disease on individuals and communities and also to explore the factors individuals perceived as associated with these outcomes. RESULTS: While the paper identifies that aspects of stock loss associated with the outbreak caused substantial emotional and economic distress, for farmers the most significant finding was the impact of the government control program on individuals, families and rural communities. The control program was perceived as having very limited scientific credibility and its implementation was described as heartless, inflexible and authoritarian. Involvement with the program resulted in farmers reporting emotions, such as, trauma, shame, guilt and stigma. Families became discordant and the sense of community within rural townships fragmented. Psychological outcomes of grief, depression and anxiety emerged as prevalent themes within families and communities. CONCLUSIONS: These data highlight the need for significant attention to the management of rural disasters, such as, the OJD program. WHAT THIS PAPER ADDS: There is an acknowledgement in the literature that rural disasters have a significant impact on the well-being of individuals, families and communities. The major focus of the previous research has, however, been on the impact of economic losses with less recognition of the other psychosocial loss experiences that accompany the experience of rural disaster. This paper achieves a clear description of the experiences for individuals (trauma, stigma, sense of personal failure, loss of identity, diminished self esteem and family disruption) and communities (destroyed social cohesion, economic disharmony) caught up in the OJD disaster and explores the factors that individuals perceive as responsible for these outcomes. The mental health outcomes for individuals, such as, loss, grief and depression are also explored within this paper. This paper highlights the psychosocial complexity of the experience of rural disaster for individuals and communities significantly extending the current knowledge base in this area.
The choice of a surviving sibling as "scapegoat" in some cases of maternal bereavement--a case report.
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Transactional theories but individual assessment: a frequent discrepancy in family research.
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Comments on Keeney and Sprenkle's paper.
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My family made me do it: the influence of family therapists' families of origin on their occupational choice.
This study is an empirical test and exploration of the folklore about family life correlates of family therapists' occupational choice. The folklore is translated into systems concepts, including role complementarity and the mutually determining effect of process and roles. Fifty-nine family therapists, 49 siblings of the therapists, and 51 undifferentiated, non-helping professionals were compared on FACES (29), The Complementary Role Questionnaire, and on demographic data. Inconsistencies in the results led to a critique of the clinical faithfulness of current systems measures. Family therapists did not differ on FACES, but did differ in aspects of roles from their siblings and from the control professionals.
Mis-taken love: conversations on the problem of incest in an Irish context.
An emotive consciousness of the issues surrounding incest frequently calls forth revulsion, outrage, fear, concern, and competition. Such responses often legitimate a range of actions that include the protection of children, the blaming of mothers, and the punishment of fathers. This article explores a "systemic" dis-position in conversations on father-daughter incest. The notion of a "Fifth Province" (from Celtic mythology) is invoked wherein all emotions, judgements, and descriptions can find acceptance, and whereby a language of control and competition, implicitly negating individuals and their relationships, is suspended as a rationale for action.
Social system responses to Huntington disease.
Huntington disease (HD) is an adultonset, genetic disorder with major psychosocial implications. Although many of the psychiatric symptoms of the disorder have been attributed to the HD gene, systems factors may also account for the disorder's manifestations. Three illustrative issues--patient preselection, the denial of symptom onset, and suicide induction--are discussed from the vantage point of family systems thinking. Recently developed capacity for presymptomatic testing of HD despite the current absence of treatment or cure makes it likely that family therapists increasingly will be involved in clinical work with individuals and families in which HD occurs.
Repatterning an ineffective mother-daughter attachment.
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Parental accounts of blaming within the family: a dialectical model for understanding blame in systemic therapy.
The aim of this study was to further understanding of blame in systemic therapy. Five families were chosen by their therapeutic team as engaging in blaming of a kind that the therapists found difficult to work with. Couples from each of the five families participated. A video extract from therapy identified by therapists as typifying blaming within the family was used as a focus for semistructured interviews with each parent. Transcripts were analyzed according to the procedures of grounded theory. On the basis of this inductive qualitative analysis, a framework of understanding emerged from the data consisting of the core category, "dialectical understanding," and an accompanying set of overarching themes. These themes capture the way in which participants oscillated among 13 dialectics in their discussion of blame within their family and within family therapy. The model provides a framework for analyzing the style and content of therapy conversations with a view to helping therapists facilitate therapeutic change in this difficult client group.
Moving beyond the blame game: toward a discursive approach to negotiating conflict within couple relationships.
The concept of discourse is an important tool in negotiating conflict and facilitating conversations within therapy. This article offers a useful framework for negotiating conflict in a couple relationship by highlighting the manner in which individual's expectations are mutually emergent from particular discursive positions. Specific discursive practices and approaches that make more visible the cultural production of conflicts are presented via a case illustration. These practices provide more freedom to couples in relationships to explore conflicts with less totalizing descriptions of the other as blameworthy. In addition, a discursive analysis of conflict invites therapists to be more intentional, reflexive, and socially responsible in their work.
Psychiatric reflections on the death penalty.
Capital punishment is outdated, immoral, wasteful, cruel, brutalizing, unfair, irrevocable, useless, dangerous, and obstructive to justice. In addition, psychiatric observations reveal that it generates disease through the torture of death row; it perverts the identity of physicians from trials to prison wards to executions; and, paradoxically, it breeds more murder than it deters.
Humour in group psychotherapy.
The role of humour in group psychotherapy has received scant attention from both clinician and researcher. We have identified, and attempted to classify, several uses to which humour can be put in a group. We also point out the destructive potential of humour, and categorize its misapplications. We hope our scheme will serve as a framework within which systematic research can be conducted.
Diagnosing "vulnerable system syndrome": an essential prerequisite to effective risk management.
Investigations of accidents in a number of hazardous domains suggest that a cluster of organisational pathologies-the "vulnerable system syndrome" (VSS)-render some systems more liable to adverse events. This syndrome has three interacting and self-perpetuating elements: blaming front line individuals, denying the existence of systemic error provoking weaknesses, and the blinkered pursuit of productive and financial indicators. VSS is present to some degree in all organisations, and the ability to recognise its symptoms is an essential skill in the progress towards improved patient safety. Two kinds of organisational learning are discussed: "single loop" learning that fuels and sustains VSS and "double loop" learning that is necessary to start breaking free from it.
Will the future continue to repeat the past?
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