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Comments on the article, ""Stimulating Reflective Practice Using Collaborative Reflective Training in Breaking Bad News Simulations," by Kim, Hernandez, Lavery, and Denmark (see record 2016-18380-001). Kim et al. are applauded for engaging and supporting the development of simulation-based education, and for their efforts to create an interprofessional learning environment. However, we hope further work on alternate methods of debriefing leverage the already inherent activation of learners that builds on previous experience, fosters reflection and builds skills. What is needed is the transference of learning theories into our educational research efforts that measure the effectiveness, validation, and reliability of behavior based performance change. The majority of breaking bad news (BBN) curricula limit program evaluations to reports of learner satisfaction, confidence and self-efficacy, rather than determining the successful translation of effective and humanistic interpersonal skills into long-term clinical practice (Rosenbaum et al., 2004). Research is needed to investigate how educational programs affect provider-patient-family interaction, and ultimately patient and family understanding, to better inform our teaching BBN skills. (PsycINFO Database Record [ABSTRACT FROM AUTHOR]

Objective: The "critical comments" dimension of the expressed emotion (EE) construct has been found to predict the illness course of patients with bipolar disorder, but less is known about the "emotional overinvolvement" component. The goal of this study was to evaluate whether relatives' observed appropriate and inappropriate emotional involvement (intrusiveness, self-sacrifice, and distress about patients' well-being) moderated the effectiveness of a family-based intervention for bipolar disorder. Method: 108 patients with bipolar disorder (mean age = 35.61 years, SD = 10.07; 57% female) and their relatives (62% spouses) from 2 clinical trials completed 10-min problem-solving interactions prior to being treated with pharmacotherapy plus family-based therapy (FBT) or brief psychoeducation (crisis management [CM]). Patients were interviewed every 3-6 months over 2 years to assess mood symptoms. Results: When relatives showed low levels of inappropriate self-sacrifice, CM and FBT were both associated with improvements in patients' manic symptoms over 2 years. When relatives showed high levels, patients in CM became more manic over time, whereas patients in FBT became less manic. Group differences in mania trajectories were also observed at high levels of inappropriate emotional response but not at low. When relatives showed high levels of appropriate self-sacrifice, patients in both groups became less depressed. At low levels of appropriate self-sacrifice, patients in CM did not improve, whereas patients in FBT became less depressed. Conclusions: Future studies of bipolar disorder should consider the prognostic value of the amount and appropriateness of relatives' emotional involvement with patients in addition to their critical behaviors. [ABSTRACT FROM AUTHOR]

Longitudinal data from the New Hope Project—an experimental evaluation of a work-based antipoverty program in Milwaukee, Wisconsin—was used to explore concurrent and lagged associations of non-standard schedules and variable shifts with parental psychological well-being, regularity of family mealtimes, and child well-being among low-income families. Working a combination of variable shifts and nonstandard hours was associated concurrently with lower teacher-reported school performance and engagement and higher levels of externalizing behavior problems. Fixed nonstandard schedules were associated with lagged decreases in parent-reported school performance, whereas working variable shifts was associated with lagged increases in parent-reported school performance. [ABSTRACT FROM AUTHOR]

The authors examined siblings' dyadic and differential experiences of parental warmth from 7 to 19 years of age. Participants were first- and second-borns from 201 families who reported on their warmth with each parent in 4 home interviews spaced over 5 years. Supporting an individual development hypothesis, multilevel model analyses revealed declines in parental warmth from early through midadolescence but no changes or increases in warmth in middle childhood and later adolescence. Consistent with a learning-from-experience hypothesis, declines in paternal warmth were less pronounced for second-bores than for firstborns. The results also suggest gender intensification in differential warmth for parents of mixed-gender sibling dyads. Within-family comparisons of youth provide unique insights about family relationship development. [ABSTRACT FROM AUTHOR]

The authors examined siblings' dyadic and differential conflict frequency with mothers and fathers from 7 to 19 years of age. Participants were first- and second-borns from 201 families who reported their conflict with each parent in 4 home interviews spaced over 5 years. Multilevel models examining trajectories of conflict frequency across age and year of study revealed that (a) consistent with a spillover hypothesis, elevation in parent-offspring conflict frequency was timed to firstborns' transition to adolescence for both siblings; and (b) consistent with a learning-from-experience hypothesis, there was no increase in conflict frequency at second-borns' transition to adolescence. These findings highlight the importance of studying the development of parent-offspring conflict within the larger family system. [ABSTRACT FROM AUTHOR]

The longitudinal impact of a family-based intervention on grandchildren of parents with HIV (PWH) is evaluated. Because PWH and their daughters demonstrated gains over 6 years when randomized to a coping skills intervention compared with a control condition, the adjustment of the PWH's grandchildren was also compared across conditions. Grandchildren in the intervention condition reported significantly fewer internalizing and externalizing behavioral symptoms compared with grandchildren in the control condition. There is weak evidence that grandchildren in the intervention condition had higher scores on measures of cognitive development and more positive home environments. These results suggest that there are possibly long-term, intergenerational benefits of an intervention for families coping with HIV. [ABSTRACT FROM AUTHOR]

Behavioural family intervention is effective for the prevention and treatment of a wide range of emotional and behavioural problems in children. There is a growing need to address the accessibility of these services. This paper reviews the literature on self-directed interventions designed to help parents manage difficult child behaviours. Evidence regarding the efficacy of interventions is reviewed, and some of the difficulties associated with self-directed programs are discussed. The Selfdirected Triple P Program is highlighted as an example of an efficacious and effective behavioural family intervention fitting into a larger multi-level model of family intervention. The discussion of the efficacy and effectiveness of self-directed interventions has implications for service delivery of parenting programs. [ABSTRACT FROM AUTHOR]

This study was designed to gain a greater understanding of the effects cancer has on families while simultaneously developing family therapy interventions that are helpful for families experiencing the crucible of cancer. On the basis of an action research paradigm, the authors designed an intensive case-analysis protocol involving reflective interviewing to learn about the personal perspectives of family members who participate in therapeutic treatment for cancer. An integration of reflective insight by the families, their therapist, and the research team ultimately revealed that cancer families face an ongoing struggle (a) between feelings of isolation and connectedness, (b) to make meaning of cancer in their life, and (c) to find ways of incorporating cancer into their current world view. The study also revealed shared experience building and interactive psychoeducation to be the most significant components of the therapeutic treatment process for cancer families. [ABSTRACT FROM AUTHOR]

The vast majority of outcome studies examining the effects of marital and family treatments focus exclusively on indicators of and changes in familial functioning and individual members' psychosocial adjustment, but fail to measure, report, or analyze treatment costs, benefits, cost-benefit ratio, or cost-effectiveness. Because of growing concerns about spiraling health care costs, clinical and economic outcomes constitute equally important and complementary aspects of any evaluation of marital and family treatments. The twofold purpose of this article is to define different components of cost analyses of health-related interventions, including marital and family treatments, and to describe methods for calculating and integrating clinical and cost outcome information when evaluating marital and family treatments. There are significant opportunities to promote the use of such treatments by conducting and reporting the results of cost analyses. [ABSTRACT FROM AUTHOR]

In our field, the study of therapeutic change processes lags behind the study of treatment efficacy. Nonetheless, in the past 10 years major strides have been made in delineating change process mechanisms in couple and family therapy. To focus the efforts of future change process researchers, the authors discuss 5 critical needs: (a) more well-articulated, midrange theory about systemic change processes; (b) more attention to client change processes; (c) more attention to covert intrapersonal processes (emotion, cognition, and clients' experience of the alliance); (d) better articulation of strategies for analyzing data from multiple participants; and (e) more focus on the degree to which various change processes work similarly (or not) for diverse couples and families. [ABSTRACT FROM AUTHOR]

This study examined the relationship between alliance and retention in family therapy. Alliance was examined at the individual (parent and adolescent) and family levels (withinfamily differences). Participants were 34 families who received functional family therapy for the treatment of adolescent (aged 12-18 years) behavior problems. Families were classified as treatment dropouts (n = 14) or completers (n = 20). Videotapes of the first sessions were rated to identify parent and adolescent alliances with the therapist. Results demonstrated that individual parent and adolescent alliances did not predict retention. However, as hypothesized, dropout cases had significantly higher unbalanced alliances (parent minus adolescent) than did completer cases. These findings highlight the importance of alliances in functional family therapy and suggest that how the alliance operates in conjoint family therapy may be a function of systemic rather than of individual processes. [ABSTRACT FROM AUTHOR]

Meta-analysis was used to examine pooled parameter estimates of 9 active compared with 6 control conditions of the Resources for Enhancing Alzheimer's Caregiver Health (REACH) project at 6 months on caregiver burden and depressive symptoms. Associations of caregiver characteristics and outcomes were examined. For burden, active interventions were superior to control conditions (p = .022). Also, active interventions were superior to control conditions for women versus men and for caregivers with lower education versus those with higher education. For depressive symptoms, a statistically significant association of group assignment was found for Miami's family therapy and computer technology intervention (p = .034). Also, active interventions were superior to control conditions for Hispanics, nonspouses, and caregivers with lower education. Results suggest interventions should be multicomponent and tailored. [ABSTRACT FROM AUTHOR]

Families of 180 people with serious mental illness, representing various socioeconomic and ethnic groups, were interviewed about their understanding of their family member's illness, coping with problems caused by the illness, sources of support, effects of medication and substance abuse, and dealing with mental health professionals. Several significant areas of concern emerged, and are explored with attention to differences based on gender, ethnic group, socioeconomic status, and role of the family member. [ABSTRACT FROM AUTHOR]

Family psychoeducational programs are efficacious adjuncts to pharmacotherapy for patients with schizophrenic and bipolar disorders, but little is known about what these programs change about families. The authors assessed changes in face-to-face interactional behavior over 1 year among families of bipolar patients who received a 9-month family-focused psychoeducational therapy (FFT; n = 22) or crisis management with naturalistic follow-up (CMNF; n = 22), both administered with maintenance pharmacotherapy. Members of families who received FFT showed more positive nonverbal interactional behavior during a 1-year posttreatment problem-solving assessment than families who received CMNF, although no corresponding decreases were seen in negative interactional behaviors. The positive effect of family treatment on patients' symptom trajectories over 1 year was partially mediated by increases in patients' positive nonverbal interactional behaviors during this same interval. [ABSTRACT FROM AUTHOR]

Throughout the past Several decades clinical researchers have attempted to clarify the role of family influence in the etiology and course of alcoholism. After a brief historical overview of this literature, both of these research directions are reviewed in some detail, with an emphasis on recent empirical studies and emerging conceptualizations regarding the family alcoholism matrix. A final section of the article describes a number of important research needs, many of which are deemed relevant to the broader field of family studies of psychopathology. [ABSTRACT FROM AUTHOR]

In spite of frequent calls in the literature for a closer integration of family research and family therapy practice, research continues to have a relatively marginal role in the field. This article argues that although attitudes toward research may he slowly changing, a more fundamental change requires a change in the way that we train family therapists. Introducing research to family therapy trainees from the earliest stokes of their training, when they are most receptive to new ideas, can help to instill a sense of curiosity and benign skepticism and show how clinical and research thinking can form an integral whole. The article describes the development of research teaching in one family therapy training program and stresses the importance of an active involvement of trainees in research. [ABSTRACT FROM AUTHOR]

Contrary to popular belief, family psychology training is being offered in a large number of doctoral programs. However, truly comprehensive training in family psychology seems unlikely to develop much further in traditional academic departments. Rather, it will emerge only in the largest and newest of doctoral programs especially in the professional schools. As a blueprint for others, a case example is presented Of what can be accomplished in a professional school. The article concludes with a mandate for the field to broaden its horizons beyond the narrow province of marital and family therapy to include preventive efforts with high-risk families. [ABSTRACT FROM AUTHOR]

The article discusses the development of family psychology as a scientific discipline, as well as the challenges facing family psychologists. Family therapy has achieved significant popularity among contemporary clinicians. Psychologists have also gained significant position in the field of family therapy. It is noted that the establishment of the American Psychological Association was an important step toward the professionalization of family psychology. The article also looks at the diversity of psychological methods as one of the problems facing family psychologists.

Clinicians struggle to understand the relationship of physical ailments and family functioning. This commentary traces one clinician's evolution from the typical linear process to the circular model, which is the basis for describing M. Ochs et al.'s (2005) findings. [ABSTRACT FROM AUTHOR]