Parents’ needs for physician-parent communication in the face of life-threatening illness: qualitative analysis

   Introduction. Parents of a child diagnosed with a life-threatening illness often experience the state of cognitive and emotional disorganization. The key factor determining parents-physicians cooperation is the quality of their relations. That is why physicians should be familiar with conditions that may help or disturb parents to manage this extreme situation. Competent communication leads to more effective treatment as well as fewer medical malpractice claims and lawsuits filed against doctors. Material and methods. The aim of this paper is the description and analysis of the needs of 23 parents whose children were diagnosed with life-threatening illnesses that led to death. The deceased children were treated mainly in hospitals or in hospices. The study was conducted in the period of one up to four years following the death of a child. A semi-structured interview was constructed and used for the purpose of this research. The transcription was analysed according to the rules of Qualitative Content Analysis with applying NVivo 9 software. Results. The results have revealed five categories of parents’ needs addressed to physicians: 1) a greater intensity of direct parent-physician contact; 2) experience of doctors’ thorough knowledge about the child and their illness; 3) a greater doctors’ involvement in the search for the causes of the disease and further treatment; 4) parents’ established position in the healthcare system, especially when the treatment lasted for a long time 5) more clear information about the applied treatment and condition of the child. Conclusions. The research indicates that the challenge of communication with parents is not only clear information about the course of a disease, providing facts about functioning of the entire health care system and this is particularly important for the parents whose child has been undergoing a long-term treatment. A physician should emphasise the meaning of palliative care as an integrated system of support. Parents’ decision-making about medical treatment on the early stage of an illness may cause too heavy strain to some of them

How Couple Therapists Manage Asymmetries of Interaction in First Consultations

The study demonstrates how asymmetries in therapists' affiliations with spouses emerge and are addressed in couple therapy. A total of 4 video-recorded couple therapy first sessions were subjected to conversation analysis. The moment-by moment interactions that contribute to one sided affiliation, as well as the therapists' ways of managing such asymmetry, are described in detail. Asymmetries of affiliation regularly co-occur with the exclusion of 1 spouse from the interaction. Asymmetries of affiliation and participation can be addressed by 2 types of action by the therapist: (a) In counterbalancing moves, the therapist shifts their affiliation back to the spouse that was neglected. (b) In systemic couple-directed interventions, the therapist creates symmetry of affiliation and participation not only by attending to the individual spouses but also by addressing the couple as a single social unit. The observations are discussed in the light of the concept of split alliance and alliance ruptures, as well as in the context of research into affiliation as a generic property of social interaction.Peer reviewe

Antycypowana utrata: przekształcanie więzi z osobą bliską w sytuacji zaawansowanej choroby

A paper describes the possibility of clinical work with families and couples in a situation of one spouse’s incurable illness. There are references to bond theory and the anticipatory loss in order to describe phenomena that are characteristic to family interactions in this particular period of family life. Four examples of families were depicted who came to consultation in a situation of incurable illness of one member of the family paying attention to key aspects of therapeutic work in the context of anticipatory grief. Clinical experiences that were described indicate that family openness to talk about relationships and unresolved matters in a situation of advanced illness can give an opportunity for experiencing close emotional bond before the patient’s death. Family consultations in a situation of advanced illness support transforming of the bond into experiencing it in psychological and spiritual categories.W artykule przedstawiono możliwość pracy klinicznej z rodzinami i parami w sytuacji nieuleczalnej choroby jednego z jej członków. W tekście odniesiono się zarówno do teorii więzi, jak i do pojęcia antycypowanej utraty, celem opisu charakterystycznych, rodzinnych interakcji w tym szczególnym okresie życia. Przedstawiono przykłady pracy z czterema rodzinami, które zgłosiły się na konsultację w sytuacji nieuleczalnej choroby jednej z osób, zwrócono uwagę na kluczowe elementy terapii rodzin w kontekście antycypowanej utraty. Przytoczone doświadczenia kliniczne wskazują, że otwarcie rodziny na rozmowy o swoich relacjach i nierozwiązanych sprawach w sytuacji zaawansowanej choroby daje szansę niektórym rodzinom na przeżywanie bliskiej więzi w okresie poprzedzającym śmierć osoby bliskiej. Konsultacje rodzinne w sytuacji zaawansowanej choroby wspierają przekształcanie więzi w kierunku przeżywania jej w kategoriach psychologicznych i duchowych

Understanding the externalizing behavior of school-age boys : the role of a mothers mentalization and attachment

Objectives Externalizing behavior problems are considered to be a serious impediment to a child’s development, and therefore it is important to identify their predictors. In this study, we investigated the connections between school-aged boys’ externalizing problems, the mother’s reflective functioning (RF) and the mother’s perception of her childhood relationship with her own caregivers. Methods The study sample comprised 39 school-age boys diagnosed with externalizing behavior problems together with their mothers. A child’s psychopathology was assessed using the Child Behavior Checklist and Teacher Report Form. Our assessment of the mothers’ mentalizing capacities was based on the Adult Attachment Interview and Reflective Functioning Scale. The perception of a mother’s childhood relationship with her parents was assessed using the Parental Bonding Instrument. Results The analysis revealed that more severe cases of aggressive and rule-breaking behavior in boys were associated with lower RF in mothers, as well as with a mother’s perception of her childhood relationship with her own parents as less autonomous. More aggressive behavior in boys was also associated with a mother’s perception of herself as experiencing a higher degree of care from her father during her own childhood. Conclusions These are only preliminary findings and we have discussed them with a view to understanding the possible ways in which a mother’s RF and the intergenerational context of relationship quality are associated with externalizing behavior problems in middle childhood

Death and grief in the family : terapeutic work

Autorki przedstawiają główne etapy pracy terapeutycznej z rodzinami pozostającymi w żałobie po śmierci jednego z jej członków. Opisują różne sposoby radzenia sobie ze śmiercią bliskich osób, łącznie z zaprzeczaniem, powodującym zablokowanie procesu żałoby. Prezentują główne kierunki pracy terapeutycznej z rodzinami, zwłaszcza w sytuacji niemożności przeżywania żałoby.The authors describe the dynamics of family life after a death of the family member. They show the main steps of therapeutic work with a family. The paper discusses death in the family, one that is connected with the impossibility of experiencing grief. They point the possible consequences and indicate the main direction of therapeutic work

The experience of the impasse in the therapy of the couples of persons with primary defense mechanisms domination : between helplessness and a chance for the change and development

Artykuł ilustruje znaczenie uwzględniania w procesie psychoterapii, szczególnie w sytuacjach impasu, różnych paradygmatów. W oparciu o przykłady kliniczne autorzy opisują źródła i mechanizmy trudności napotykanych w terapii par. Niezwykle istotne może być wówczas dostrzeganie i rozumienie pojawiających się reakcji przeciwprzeniesieniowychThe authors address their article to the understanding of the impasse in the work with the couples in which we have to deal with the defense mechanisms like splitting, or projective identification, often connected with personality disorders. This kind of couples is characterized by recurrent acting out of conflicts. The paper presents systemic and psychoanalytic (mainly in the object relation theory) perspectives as the basic theoretical framework for the analysis of described phenomena. It presents to the concept of personality disorders diagnosis in the setting of the couple therapy. It presents how the relation can change the diagnostic impressions of the personality structure and how it leads to problematic clinical situations. The paper presented case vignettes illustrates changing role of the therapist in consecutive stages of the therapy. They show the impasse in the therapeutic process and the ways how the therapist is dealing with the problem. The therapist of these couples struggles with many dilemmas and a recurrent question concerning the continuation of the treatment. In the summation authors conclude on the practical use of the systemic and psychoanalytic paradigm in the analyzed clinical situations

Recognizing the importance of sex and gender among Polish psychotherapists

W artykule podejmowany jest rzadko badany temat odnoszenia się psychoterapeutów w procesie psychoterapii i superwizji do własnych doświadczeń związanych z płcią biologiczną i kulturową. Okazuje się, że znaczenie dla prowadzenia superwizji czy psychoterapii ma nie tylko własna płeć, ale także płeć i atrakcyjność pacjenta/klienta, a także faza życia terapeuty. Badanie jakkolwiek ma charakter eksploracyjny, jest przeprowadzone na znaczącej próbie polskich psychoterapeutów i może inspirować do weryfikacji nie stawianych dotąd hipotez.Objectives: Gender is the fundamental dimension of identity and therefore defining femininity/ masculinity and the related roles by psychotherapists seem to be especially important in psychotherapy practice. The presented research is one of the first of this kind in Poland and therefore is rather exploratory and descriptive in nature. The purpose of the study was to find the answer to the question whether Polish psychotherapists, in the understanding their patients, refer to their own gender and sex-related experiences in the process of psychotherapy and supervision and - if yes-how they reflect them. Methods: The authors prepared a questionnaire including 20 closed and one open-ended question. The study involved 144 heterosexual psychotherapists (70% of females, 30% of males). Results: The findings showed that psychotherapists in individual, family and couples psychotherapy refer to their gender-related experience particularly as a daughter/son, woman/man (younger therapist), mother/father (older therapist). For younger female and male heterosexual psychotherapists (up to 40 years old) working with an opposite sex, attractive patient is a challenge, which - in the case of male therapists - disturbs the process of psychotherapy, while in the case of female therapists may both disturb or - as they claim - facilitate it Conclusions: The life cycle of therapists and their sex seem to significantly influence the way they experience their patients and refer to gender issues of their patients. The results confirm the necessity of supervision due to the inner voices of psychotherapist related to sex and gender activated during psychotherap

Practices of Claiming Control and Independence in Couple Therapy With Narcissism

Four couple therapy first consultations involving clients with diagnosed narcissistic problems were examined. A sociologically enriched and broadened concept of narcissistic disorder was worked out based on Goffman's micro-sociology of the self. Conversation analytic methods were used to study in detail episodes in which clients resist to answer a therapist's question, block or dominate the development of the conversation's topic, or conspicuously display their interactional independence. These activities are interpreted as a pattern of controlling practices that were prompted by threats that the first couple therapy consultation imposes upon the clients' self-image. The results were discussed in the light of contemporary psychiatric discussions of narcissism; the authors suggest that beyond its conceptualization as a personality disorder, narcissism should be understood as a pattern of interactional practices.Peer reviewe