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In this paper we examine how couple and family therapists, in accounting for the moments of their first therapeutic encounters identified as meaningful, invoke asymmetric affiliations with their clients in the Interpersonal Process Recall (IPR) dialogues. Applying Conversation Analysis and drawing on Membership Categorization Analysis, we analyze how these invoked (dis)affiliations are constructed in the fine interactional details of the interview and in/through the categories mobilized by the participants. The findings show therapists’ explicit affiliation with one spouse and often concurrently disaffiliation with the other in yet another interactive format. Consequently, the asymmetric affiliations are further strengthened by remaining unrecognized, unaddressed and ultimately unreflected in the IPR dialogue. The interviewer’s key role in promoting or constraining the therapist’s recognition of the asymmetric relations is discussed.

O czym traktuje sztuka Szekspira Poskromienie złośnicy? Czy jest tylko prostą do odczytania komedią? Co mówi współczesnym czytelnikom, widzom? Artykuł przedstawia refleksje formułowane z perspektywy psychoterapeutki wrażliwej na kwestie wnoszone przez nurt feministyczny i studia genderowe. Autorka dzieli się swoim odczytaniem tekstu, zwracając uwagę na definiowanie pozycji kobiety i mężczyzny w kulturze patriarchalnej, wynikające z niej relacje władzy w relacjach intymnych, w rodzinie, w społeczeństwie, na trudności w osiąganiu autonomii przez kobiety. Zatrzymuje się nad znaczeniem języka, narracji w definiowaniu tożsamości, w definiowaniu relacji, także tych przemocowych. Komentuje uwięzienie w stereotypowych opisach płci, które wydaje się znajdować odzwierciedlenie także w sposobie klasyfikowania i przeżywania emocjonalności kobiet i mężczyzn przez psychoterapeutów, psychiatrów i psychologów. Wreszcie rozważa możliwe hipotezy dotyczące dynamiki relacji w rodzinie głównych bohaterów sztuki Szekspira. Podjęte wątki dotykają kwestii kluczowych na każdym poziomie: indywidualnym, relacyjnym i społecznym, co czyni ją wciąż aktualną.

Cel pracyW artykule zaprezentowano rezultaty projektu badawczego poświęconego ocenie zmian w procesie systemowej terapii rodzinnej prowadzonej w grupie klinicznej młodzieżowych pacjentów psychiatrycznych.MetodaDo oceny wykorzystano polską wersję kwestionariusza SCORE–15. Badanie przeprowadzono na grupie 109 rodzin, które wypełniły kwestionariusz przed pierwszą sesją. Przed czwartą sesją ankietę wypełniły 73 rodziny; a po ostatniej sesji ukończyło ją 28 rodzin.WynikiWyniki konsensualnych analiz jakościowych ujawniły zmiany w opisie rodziny, a także w opisie problemu. Analizy statystyczne wyników kwestionariusza SCORE–15 wykazały znaczące zmiany między pierwszą, czwartą i ostatnią sesją. Zmiany zostały zidentyfikowane w skali SCORE Total, a także w skalach VAS. Wskaźnik RCI wykazał 5 popraw i 2 pogorszenia po trzech sesjach oraz brak pogorszeń i 13 popraw pod koniec procesu terapii.WnioskiUzyskane wyniki wskazują na wiele istotnych zmian w badanych obszarach po przejściu rodzin przez systemową terapię. Badanie wykazało także, że spójna analiza jakościowa materiału opisowego może być bardzo użyteczna i może wzbogacić zarówno rozumienie procesu terapeutycznego, jak i sposób przekazywania rodzinom informacji o zmianach w ramach terapii.

Cel pracyCelem badania było rozpoznanie specyfiki pojawiania się osobistych wątków uruchomionych w umyśle terapeuty w trakcie prowadzenia psychoterapii i ich relacji z profesjonalnym działaniem – myśleniem terapeuty. Badanie polegało na dokonaniu nagrań, a następnie przeprowadzeniu analizy sesji terapii rodzin lub par, jak również wywiadów z terapeutami.MetodaRozmowy z terapeutami zostały przeprowadzone za pomocą wywiadu przywołującego procesy mające miejsce w trakcie sesji terapeutycznej (Interpersonal Process Recall, IPR [1]). Dokonano porównania pomiędzy analizowanymi przykładami, wykorzystując studium przypadków (multiple case study). Wybrane fragmenty, w których zidentyfikowano autobiograficzne odniesienia, zostały poddane analizie dialogowej (dialogical analysis), wyodrębniając „ja doświadczające” i „ja profesjonalne” terapeuty [2] oraz zachodzące pomiędzy nimi relacje. Następnie przeanalizowano siedem wywiadów IPR z psychoterapeutami przeprowadzonych bezpośrednio po pierwszej konsultacji: czterech rodzin i trzech par, skierowanych do terapii z różnych powodów — zaburzeń odżywiania, konfliktów rodzinnych, uzależnień czy zaburzeń zachowania. Wszyscy terapeuci pracowali w nurcie systemowym, byli certyfikowanymi terapeutami i superwizorami.WynikiDokonana analiza pozwoliła zidentyfikować pięć fragmentów dotyczących osobistych skojarzeń i myśli terapeuty, które zostały przytoczone przez terapeutę w trakcie wywiadu IPR. Przeprowadzona analiza dialogowa ujawniła, że uruchomione doświadczenie autobiograficzne, głos osobisty, w każdym przypadku wywołuje w dalszej kolejności pojawienie się głosu profesjonalnego reflektującego świadomość osobistej perspektywy w trakcie konsultacji (matapozycja obserwatora własnych uczuć i myśli). W połowie przykładów świadomość ta była powiązana z analizą możliwego wpływu głosów osobistych na przebieg terapii.WnioskiUruchomione wątki biograficzne w sesji terapeutycznej mogą mieć jedynie formę dostrzeżenia podobieństwa doświadczeń terapeuty i rodziny, ale także mogą wiązać się z pogłębioną refleksją dotyczącą ich znaczenia dla procesu terapeutycznego. IPR jest użytecznym narzędziem do badania zjawiska głosów osobistych..

Artykuł ma na celu przedstawienie refleksji związanych z wprowadzaniem w naszym kraju zmian w dotychczasowych regulacjach dotyczących psychoterapii, w tym psychoterapii dzieci i młodzieży. Autorzy analizują omawiany proces w kontekście kryzysu psychiatrii wieku rozwojowego i diagnozy postawionej przez inicjatorów reform, stawiając pytanie, na ile proponowane rozwiązania przyczynią się rzeczywiście do poprawy sytuacji, a na ile będą źródłem nowych problemów i napięć, w tym m.in. na ile skomplikują praktykowanie terapii tym psychoterapeutom, którzy wykształcili się w dotychczasowym systemie monitorowanym przez towarzystwa naukowe. Omawiane zagadnienia przedstawione są z kilku perspektyw: perspektywy klinicznej pracy z dziećmi, młodzieżą i ich rodzinami w publicznym systemie opieki zdrowotnej; perspektywy naukowo-badawczej ukazującej, poprzez przegląd piśmiennictwa, aktualny stan refleksji nad sposobem definiowania skuteczności psychoterapii, poszerzony o aktualne, międzynarodowe wskazania jej stosowania w pracy z rodzinami; oraz perspektywy szkoleń zzakresu psychoterapii i ewentualnych konsekwencji proponowanych zmian dla tego obszaru. Autorzy podnoszą kwestie budzące w obecnym czasie sporo kontrowersji środowiska psychoterapeutów, starając się przedstawić je w świetle skłaniającym do refleksji.

The issue of power is an important area of reflection in family and couple therapy, as well as afrequent object of practical impact. The article focuses on two fundamental perspectives showing power as acomplex phenomenon: systemic and gender, which in combination allow amore holistic approach to the issue. The article discusses the contemporary systemic approach to the discussed problem by outlining the limitations associated with the early understanding of circularity and neutrality. On the other hand, it presents agender perspective -increasingly visible in family therapy - which emphasizes the cultural discourses of femininity/masculinity, recognizes the privileges and limitations associated with them, and describes the inequalities of the position of women and men in society reproduced in relationships and in the family. In this sense, the struggle for power, usually translated into difficulties in the family, is not only an expression of the difficulties of the couple, related to experiences from families of origin, but also reflects cultural messages, internalized expectations about relations between sexes and their functioning in gender roles.

Motywacją do napisania artykułu była potrzeba zreflektowania doświadczeń z pracy zespołu psychoterapeutów w wyjątkowym czasie od marca 2020 do marca 2021. Psychoterapeuci, którzy, wcześniej tego nie planując, opuścili swoje gabinety i usiedli przed ekranami, przeszli szybki kurs IT i uczestniczyli wspólnie z pacjentami w wielkim eksperymencie: psychoterapia w pandemii COVID-19. W zebraniu i opracowaniu materiału badawczego autorzy posłużyli się metodą zespołowej autoetnografii (collective autoethnography). Jest to metoda badań jakościowych właściwa do eksploracji nowych zjawisk społecznych, wywołujących silne emocje i mających wpływ zarówno na jednostki, jak i na grupy. Badania pokazały, że zarówno adaptacja do pracy wpandemii, jak i powrót do gabinetów ma charakter procesualny, indywidualnie (dla pacjentów i psychoterapeutów) zróżnicowany w tempie i rytmie. Pojawienie się transgresji, czyli twórczego przekształcenia myślenia, działania i otoczenia, wymaga sprzyjającego kontekstu, w którym kluczowe jest oparcie w zespole. W psychoterapii zdalnej zbieramy inny rodzaj informacji o rodzinach i pacjentach indywidualnych, wymagający dopasowania sposobów opracowania i rozumienia, settingu i kontraktu. Wprowadzenie psychoterapii on-line w większym zakresie, niż to było przed pandemią, pozwoli skorzystać z tej formy leczenia osobom, dla których była niedostępna lub dla których dostęp do niej był utrudniony. Otwarcie się psychoterapeutów na konsultacje w zespole czy w szerszym środowisku, na pracę interdyscyplinarną jest wspierającym czynnikiem w procesach adaptacji i transgresji. Praca zdalna wiąże się z przeciążeniem fizycznym i psychicznym psychoterapeutów, stąd szczególnie ważne jest dodatkowe zadbanie o superwizję i własny komfort. The incentive to write the article was to record the work experiences of a psychotherapists' team in an exceptional time from March 2020 to March 2021. Psychotherapists who, without planning it beforehand, left their offices and sat in front of the screens, took a quick IT course and participated, together with their patients, in a great experiment: Psychotherapy in the Covid-19 pandemic. The authors used the Collective Autoethnography method to collect and develop the research material. It is a qualitative research method, appropriate for the exploration of new social phenomena that evoke strong emotions and affect both individuals and groups. The research has shown that both, adaptation to work in the pandemic and return to offices are processual in nature, varying in pace and rhythm individually (for patients and psychotherapists). The emergence of transgression, i.e., a creative transformation of thinking, acting and environment, requires a favorable context, in which the key is the team support. In on-line psychotherapy, we collect different types of information about families and individual patients, requiring adjustment of developing and understanding of setting and contract. Introducing on-line psychotherapy to a greater extent than it was before the pandemic will allow us to use this way of treatment for those people, who found it unavailable or difficult to access. Opening up to consultations in a team, a wider environment and interdisciplinary work of psychotherapists is a supporting factor in the processes of adaptation and transgression. Remote work involves physical and mental overload of psychotherapists, hence additional attention needs to be paid to supervision and personal comfort.

Aim of the studyPandemic outbreak of Coronavirus Disease 2019 (COVID-19) had significant impact on medical education across Europe. Due to the lockdown-type control measures Universities were forced to adapt to new conditions by unexpectedly switching to on-line teaching. The aim of the study was to explore medical students’ needs, problems, expectations, views on positive aspects of current situation, and attitudes toward on-line teaching, and academic administration during early stages of lock-down.Subject or material and methodsInvestigators created an online survey which received 289 students responses. Survey contained quantitative and qualitative questions. Qualitative data was analyzed using Consensual Qualitative Research (CQR) methodology.Results20.76% participants responded they needed assistance or help, 49.83% of students reported that situation worsened their studying conditions, 57.79% requested more interest from University administration in current situation, 5% of the students reported being deprived of social support. Following categories has been extracted from qualitative data: struggles students face during pandemic, worries and concerns students report, positive aspects of current situation, students’ hopes and expectancies, on-line classes opinions. Frequencies of most common answers within abovementioned categories were calculated.Discussion-ConclusionsTo our best knowledge this is the first study presenting complex quantitative and qualitative evaluation of medical students’ situation during COVID-19 pandemic outbreak. According to the acquired data, students faced an anxiety and stress provoking situation that required undertaking special measures. This data is useful in gaining insight into students’ experiences of pandemic and may help as a guidance for planning intervention.

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.

Complex and changing social conditions engender the need to find a language to describe the phenomena and to elucidate their mechanisms. One possibility is the language of psychotherapy, which in itself is complex because it combines the various currents which have emerged in psychotherapy’s more than one hundred years of history. The author’s aim is to analyze the relations between culture, social reality (including Poland’s), and psychotherapy. On the one hand, she attempts to view psychotherapy as a cultural discourse, and on the other, to understand culture and social phenomena from the perspective of a psychotherapy office.

The study demonstrates how motherhood gender‐related discourse is intertwined with the ways in which the systemic techniques and systemic thinking are realised in the session. This research explores the consequences of gender‐related discourse commonly co‐constructed by participants in couple therapy and not recognised or challenged by the therapist. Video‐recorded data from a couple therapy session containing unrecognised gender‐related discourse were subjected to conversation analysis (CA). The interview (Interpersonal Process Recall) transcript was analysed according to the rules of dialogical analysis. Gender assumptions held unchallenged by a therapist can be manifested through: placing one spouse in the position of the person accountable for the gender‐related choices, the therapist's mirroring of one participant's lexical choices only, sharing normative expectation of one person. Unrecognised gender discourse create difficulty in introducing circular thinking. The obstacles on the therapist's side can render power issues connected with gender invisible and thus unavailable for introduction into the therapeutic conversation.

CelAnaliza powiązań pomiędzy oceną bieżących relacji rodzinnych w rodzinach pacjentek z diagnozą zaburzeń odżywania się a oceną relacji w rodzinach pochodzenia ich rodziców.Metoda54 pacjentki z anoreksją restrykcyjną, 22 pacjentki z anoreksją żarłoczno-wydalającą, 36 pacjentek z bulimią. Uwzględniono 2 grupy kontrolne: 36 pacjentek z zaburzeniami depresyjnymi oraz 85 uczennic ze szkól krakowskich. Badaniem objęci byli również rodzice dziewcząt. Metoda: Skala Rodziny Pochodzenia oraz Kwestionariusz Oceny Rodziny FAM (wersja polska).WynikiW rodzinach uczennic szkół krakowskich lepsza ocena doświadczeń autonomii i bliskości z rodzin pochodzenia rodziców badanych dziewcząt wiązała się z ich oraz ich dzieci korzystniejszą percepcją relacji w obecnej rodzinie nuklearnej. Szczególnie znacząca okazała się transgeneracyjna percepcja doświadczeń ojców. We wszystkich grupach klinicznych zaobserwowano jedynie kilka istotnych statystycznie korelacji. U rodziców badanych pacjentek widoczny jest nikły związek oceny bieżących relacji małżeńskich z doświadczeniami transgeneracyjnymi, oraz istotny związek doświadczeń transgeneracyjnych z oceną relacji z córkami.WnioskiStwierdzono brak specyficznych powiązań pomiędzy oceną relacji transgeneracyjnych rodziców i percepcją bieżących relacji w rodzinie nuklearnej w grupie zaburzeń odżywania się. Wyniki w grupie zaburzeń odżywania się sugerują, że relacje rodziców z córkami charakteryzują się większą intensywnością niż relacje małżeńskie.

Celem artykułu jest przybliżenie modelu terapii wielorodzinnej zastosowanego w pracy z rodzinami z problemem przemocy. Inspiracją do napisania tekstu był udział autorów artykułu w projekcie europejskim UE Daphne III: Multi-Family Training Pack for Professionals Working with Abusive and Violent high risk Families (MFT-V), mającym na celu opracowanie podręcznika i materiałów szkoleniowych dla profesjonalistów prowadzących terapię rodzin, w których identyfikowana jest przemoc wobec dzieci. Projekt podstawowo wykorzystywał doświadczenia pracy wielorodzinnej Marlborough Family Center w Londynie, ośrodka, który od wielu dekad twórczo rozwija tę ideę terapii i ma szczególne doświadczenia w prowadzeniu kompleksowych oddziaływań wobec rodzin z problemem przemocy. Szczególną charakterystyką modelu londyńskiego, bazującego na terapii systemowej i psychodynamicznej terapii grupowej, jest wykorzystanie w pracy grupowej obejmującej rodziców i dzieci wielu technik, w tym technik warsztatowych ułatwiających przepracowanie trudnych problemów w relacjach rodzinnych. Doświadczenia zespołu londyńskiego stanowią propozycję, która ze względu na swoją oryginalność może być interesująca dla wielu zespołów terapeutycznych nie tylko konfrontujących się z problemem przemocy w rodziny.

Background Disturbances in various elements of transgenerational family functioning patterns are not uncommon in studies of eating disorders. We examined the relationship between patients’ perception of autonomy and intimacy in their families of origin and that of their parents in their own families of origin. Material/Methods The sample consisted of 112 girls who had a diagnosis of an eating disoder and their parents; 54 of the girls were diagnosed with anorexia nervosa restrictive subtype, 22 as anorexia nervosa binge/purge subtype, and 36 were diagnosed with bulimia nervosa. We had 2 control groups: 1 group consisted of 36 girls diagnosed with a depressive episode, dysthymia, or adjustment disorder with depressed mood and the other group was 85 female students from schools in Cracow, Poland and their parents. We used the the Family of Origin Scale to assess perception of family relationships. Statistical analysis was performed with the Statistical Package for the Social Sciences (SPSS 20.0.PL; Chicago, IL, USA). Results There was a significant association between daughters’ and fathers’ perceptions of autonomy in their families of origin in all groups. There was no significant association between daughters’ and mothers’ perceptions in all groups. The strongest correlation was between the non-clinical sample of girls and their fathers and for the bulimic group. Conclusions We did not detect any link indicating the specificity of transgenerational transmission of autonomy and intimacy in eating disorders. The results point to the importance of the father figure in studies of family systems, including the context of family transmission.

Background: The goal of this study was to assess the relationship between sociocultural factors and clinical eating disorders during the intensive process of Westernisation in Poland that occurred after 1989. The study population included girls diagnosed with an eating disorder according to DSM-IV criteria (n = 47 anorexia nervosa restrictive type [ANR], n = 16 anorexia binge/purge type [ANBP], n = 34 bulimia nervosa [BN], n = 19 eating disorder not otherwise specified [EDNOS]) who received consultation for the first time between 2002 and 2004 in the Department of Clinical Child and Adolescent Psychiatry, University Hospital, Kraków, Poland. The study included an age-matched normal control group [NOR] of 85 schoolgirls from Kraków. Methods: Relationships between two given qualitative features were investigated using the chi-square test or Fisher’s exact test. Correspondence analysis was applied to graphically explore the relationship. The Kruskal-Wallis test with the Bonferroni was performed to compare quantitative results across groups. Results: Objective sociodemographic variables and responses to the 62-item Questionnaire of Socio-cultural Context were measured. The mothers of ANBP and BN patients were less professionally active than mothers of ANR patients and NOR subjects. Subjective socio-cultural factors were more relevant for the BN group than the ANR group. Questionnaire responses in the ANBP group were more similar to those in the BN group than to those in the ANR group. The most unambiguous and specific characteristic of the ANR group was a sense of belonging to the middle class. Variables that differentiated the BN group from the NOR group included the importance attached to thinness treated as an expression of power and control over one’s self, as well as a multifaceted negative evaluation of one’s own family, including a negative assessment of the position of women and parental lack of concern for appearance and principles of nutrition. All patients, regardless of diagnosis, identified with other people with similar problems and considered anorexia and bulimia to be a major issue of their generation and social environment. Conclusions: The results of this first in Poland exploratory study of socio-cultural context of eating disorders indicate the importance of both objective and subjective socio-cultural factors in eating disorders in the group studied.

Source of support: The presented research is part of a larger research project entitled “Socio-cultural, familial, and individual factors in anorexia and bulimia nervosa”, which is financed by a scientific grant from the State Committee for Scientific Research (Grant Number: 6 POSE 09021) Summary Background: The aim of this study was to assess attitudes towards eating as measured by the Eating Attitude Test (EAT26) among mothers of girls diagnosed with various types of eating disorders, in comparison with mothers of depressive girls and their relationship with daughters’ results 14 years after the beginning of the Polish political and cultural transformation of 1989. Material/Methods: The data of 68 mothers and their daughters were used in statistical analysis (anorexia nervosa restrictive type: 18, anorexia nervosa binge/purge type: 12, bulimia: 14, depression: 24). The mean age in the group of mothers was 43.5 (SD 5.3), daughters: 16.7 (SD 1.4). Results: In the group of mothers, the results of EAT26 test were lower than results of the general population of Polish females or patients’ mothers obtained in a different cultural context. Results from girls with an eating disorder diagnosis considerably exceed the mean result of Polish population studies of teenagers. There were no statistically significant differences between the EAT26 results of mothers of girls with various types of eating disorders and mothers of depressive girls. Sociocultural variables such as education and place of residence of mothers also did not differentiate the studied groups and did not have a significant influence on attitudes towards weight and body shape presented by the studied mothers. Conclusions: The obtained results may suggest that in the studied population, the social background of mothers and disturbances of their own mothers’ attitudes towards weight and body shape were not an important and specific risk factor in the development of their daughters’ eating disorders.

To assess the correlations between the perception of relations in parents' families of origin and the assessment of the current family by the parents and their daughters suffering from eating disorders. STUDIED GROUP: Statistical analyses were applied to the results obtained from 54 patients diagnosed with restrictive anorexia nervosa, from 22 with binge-purge anorexia, from 36 with bulimia and from two control groups: 36 patients diagnosed with depressive disorders and 85 Krakow schoolgirls. The study also covered the parents of the investigated girls.Family of Origin Scale and Family Assessment Questionnaire (FAM Polish version) were used in the study.The procreative family assessment made by the mothers was correlated with the assessment of their own generational family and the assessment of own generational family made by their husbands. Procreative family assessment made by the fathers was correlated only with their assessment of their family of origin. Family of origin assessment made by patients with diagnosed eating disorders, particularly bulimia, was correlated only with the family of origin assessment made by their fathers. The last correlation did not occur in the control groups.The research shows a correlation between the experience of the families of origin and the current functioning of the family. They show the impact of the fathers' trangenerational experience on the perception of family relations of daughters with diagnosed anorexia and bulimia nervosa.

The goal of this study was to assess the perception of marital relationship and its mutual connections by parents of(female) patients diagnosed with eating disorders. Data from: 54 (female) patients diagnosed with restrictive anorexia nervosa (ANR), 22 with binge-purge anorexia nervosa (ANBP), 36 with bulimia (BUL), and two control groups: 36 (female) patients diagnosed with depressive disorders (DEP) and 85 Krakow schoolgirls (NOR).The study employed the Dyadic Relations Scale, a part of the Family Assessment Measure (Polish version).Wives in the BUL group, compared to wives in the NOR group, rated their husbands worse when assessing their husbands in terms of how well they functioned in the marital relationship, their performance of duties, affective involvement, and the integrity of values and rules of conduct. Wives in the ANR group, compared to wives in the NOR group, negatively rated the affective involvement of their husbands in the marital relationship. Husbands in the DEP group, compared to husbands in the NOR group, rated their wives worse when assessing their wives' general functioning in the marital relationship, degree of communication within it, degree of understanding, how well they performed their spousal duties, and the coherence of their system of values and rules of conduct. The image of the marital relationship held by parents of Krakow schoolgirls was characterized by a strong correlation, in contrast to the image of the relationship held by parents of (female) patients, regardless of the nature of the diagnosis.Comparison of the results of parents of(female) patients with eating disorders and parents of(female) patients with a diagnosis of major depressive disorder revealed no difference in the image of the marital relationship, whether in the mutual assessment of spouses towards each other or in connection with the assessments.

Aim of the studyThe aim of the study was to assess outcome of patients with eating disorders in the Polish socio-cultural context.Subject or material and methodsRe-assessed after 6.72 years (SD 0.99 years, min 4.58 years, max 8.81 years) 47 of 112 patients consulted initially in the outpatient clinic of the Child and Adolescent Psychiatry Unit between 2002/2004 in Krakow, Poland with one of the eating disorders.ResultsComplete remission (absence of symptoms for three months) took place in 55% of patients from the restrictive anorexia nervosa group, 27.3% patients from the bulimia nervosa group. A full range of symptoms was observed in 10% of patients from the restrictive anorexia nervosa group and 36.4% of patients from the bulimia nervosa group. In both groups, the longer the follow-up study, the worse outcome was observed.DiscussionSmall size of group in the follow-up study caused a significant limitation.ConclusionsConclusion: The remission rates indices for restrictive anorexia nervosa are similar to these presented in other follow-up studies. In the case of bulimia nervosa they are lower than average. An analysis of diagnosis variability between the initial and the follow up assessment indicates low cross-over rate from anorexia nervosa to bulimia nervosa group.

Aim of the studyThe aim of this study was to assess factors associated with outcome of eating disorders in Polish teenage patients.Subject or material and methodsAnalyses covered the data of 47 patients diagnosed with any of the eating disorders according to DSM IV consulted for the first time in the outpatients clinic of the Child and Adolescent Psychiatry Unit between 2002/2004 in Krakow (DGN1), Poland and then followed-up between 2009/2011 (DGN2). The influence of the number of variables collected at DGN1 on outcomes were analysed.ResultsThe outcomes of anorexia nervosa and bulimia nervosa are influenced by some aspects of clinical picture, patients’ objective family situation, their self-image and the perception they have of their family relations. The co-occurrence of depressive symptoms and younger age of parents proved to be the most clinically important negative outcome predictors in whole group of eating disorders.DiscussionSmall size of group in the follow-up study is the most important limitating factor.ConclusionsConclusion: Outcomes in eating disorders are affected by several psycho-bio-social factors common for all patients and specific for diagnosis type they initially present.

The aim of the study was to assess the relationship between depressive symptoms and girls' assessment of their family relations in a group of (female) patients with a diagnosis of various subtypes of eating disorders in comparison with (female) patients with a diagnosis of depressive disorders (episode of major depression, dysthymia, adjustment reaction with depressive mood) and female students in Krakow, Poland schools.Data from 54 (female) patients with a diagnosis of restrictive anorexia (ANR), 22 with a diagnosis of binge-purge anorexia (ANB), 36 with a diagnosis of bulimia (BUL), 36 with a diagnosis of depressive disorders (DEP) and a 85 (female) Krakow school students (CON) were used in the statistical analyses. There were no significant differences between age of the girls in studied groups. In analyses, results of the Polish version of the Beck Depression Inventory (BDI) and also the Family Assessment Questionnaire (KOR) were used.In the CON group, correlations attesting to a link between depressiveness and a negative assessment of the family were observed on all scales of the questionnaire with the exception of the Values and Norms scale. In the DEP group, such a dependence was ascertained on scales: Completing Tasks, Communication, Emotionality, Control, Defence, Positive Statements. In the case of the ANR group, no statistically significant relationship between results of the questionnaires was noted. In group ANB, correlations attesting to a link between depressiveness and a negative picture of the family were ascertained on scales: Communication and Defence. The same dependence was ascertained in the BUL group on scales: Completing Tasks, Emotionality, Emotional involvement, Control, General result, Negative Statements.An increase in depressiveness is linked in a significant way with a worsening assessment of the family relations amongst girls with a diagnosis of bulimia, depressive disorders and students.

The authors show how to use the concept of a "dialogical self' to conduct therapy, supervision and qualitative research of the process of psychotherapy. They pay special attention to usefulness of the presented concept and to investigate what happens to a therapist during a family meeting, i.e., the so called "inner conversation of the therapist".

The authors present Michaił Bachtin's and Hubert Herman's concept of "dialogical self" which was used by family therapists to create a new conceptual tool of understanding the family therapy process. The paper shows Peter Rober's and his co-workers works that use this concept in order to understand phenomena occurring during therapeutic meeting.

The authors of the present article describe the historical context of family therapy in Poland and current issues in the field. They highlight the fact that Polish therapists first began to develop the field after coming into contact with family therapy leaders from the United States and Western Europe. With the political breakthrough of 1989, there were new opportunities for multilateral cooperation, attendance at international conferences, and the exchange of experiences. Currently, the work of Polish family therapists, the place of family therapy among other forms of psychotherapy, and the related problems and challenges do not differ from other European nations.

To assess cultural attitudes and beliefs among (female) patients being treated for various kinds of eating disorders in comparison with (female) patients diagnosed with depression and healthy girls.Version II of the Cultural Questionnaire by M. Pilecki and B. Józefik referring to issues linked with those aspects of dulture whose importance is described as significant in the development of eating disorders.Data from patients with the following diagnoses were used in the statistical analyses: 54 (female) patients with a diagnosis of restrictive anorexia (ANR), 22 with a diagnosis of binge-purge anorexia (ANB), 36 with a diagnosis ofbulimia (BUL) and 40 with a diagnosis of depressive disorders (DEP) and also 74 female pupils from Kraków schools (KON).Groups ANB and BUL obtained high scores, indicating the greater significance of 'ideals of thinness' in their lives than in groups KON, DEP and ANR. The BUL group was characterised by a sense of yielding to fashion pressure and also by a sense of the environmental and generational significance of the disorders in relation to groups KON and DEP. The females in group KON assessed that their parents attached greater importance to appearance than did (female) patients in group ANB. A negative evaluation of the position of women in the family was given by all the studied (female) patients in comparison with group KON.The obtained results may indicate the greater significance of cultural mechanisms in bulimia than anorexia nervosa. They may also be an expression of the limited possibility of introspection of girls with a diagnosis of restrictive anorexia. A negative perception of femininity in the family and culture accompanies not only eating disorders, but also depressive disorders.

The article discusses the preliminary results of a follow-up study carried out in 2009-2010 on former patients with a diagnosis of anorexia nervosa and bulimia nervosa, first seen in 2001-2004 at the Department of Child and Adolescent Psychiatry, the Jagiellonian University Medical College in Krakow. At that time they had been taking part in a research project, whose aim was to define the relationships among the psychopathological picture of eating disorders, self-image and family relations and also the influence of socio-cultural factors. The aim of the current study is to attempt to define factors influencing the course and prognosis of eating disorders in the studied group.Results from the Eating Disorder Inventory Questionnaire (EDI) and the Polish version of Family Assessment Measure (KOR) in the first study were juxtaposed with the clinical state and parameters of psychosocial functioning of the studied women assessed on the basis of the follow-up study.In the studied group, 13 girls suffered from anorexia nervosa--restricting type, 6 from anorexia nervosa binge-eating/purging type, and 6 from bulimia. In the studied group, there was complete symptomatic improvement in 12 persons (48%), subclinical symptoms continued to be observed in 9 persons (36%), and 4 persons (16%) met full diagnostic criteria for eating disorders. The most favourable course was observed in the group with a diagnosis of anorexia nervosa restricting type. The least favourable was observed in the group with a diagnosis of bulimia. Results. In the studied group, 13 girls suffered from anorexia nervosa - restricting type, 6 from anorexia nervosa binge-eating/purging type, and 6 from bulimia. In the studied group, there was complete symptomatic improvement in 12 persons (48%), subclinical symptoms continued to be observed in 9 persons (36%), and 4 persons (16%) met full diagnostic criteria for eating disorders. The most favourable course was observed in the group with a diagnosis of anorexia nervosa restricting type. The least favourable was observed in the group with a diagnosis of bulimia.The occurrence of symptoms of binging and purging turned out to be a negative prognostic factor in the whole group of patients suffering from eating disorders. A smaller starting declared intensity of aspiring to slimness and level of dissatisfaction with own body by patients measured with the EDI, and satisfaction in the area of communication and emotional commitment on the part of the mother (of the patient) in her relationship with her husband (the father of the patient) measured with the KOR were positive prognostic factors. The significant overrepresentation of patients with a diagnosis of restrictive anorexia in the group of persons with clinical improvement may have an influence on the obtained results.

It is impossible to think about psychotherapy without reference to the cultural context. In order to understand the development of this domain it is helpful to apply the concept of cultural discourse. When we think about the over one hundred years' history of psychotherapy it becomes clear that understanding of a person, his/her difficulties, psychopathology, the role of a psychotherapist, psychotherapy and its limitations have been changing. It depended on the acknowledged epistemological horizon. Therefore it is important to observe the process of creating discourses related to psychotherapeutic "reality". These discourses are not simply descriptive but they participate in creation of reality. They are not neutral, on the contrary, their application has broad practical, theoretical, ethical and legal consequences. An attempt to describe the culture, or better cultures, we are immersed in, is an attempt to describe the identity of contemporary psychotherapists. This article, referring to the constructionists' perspective and works of Michael Foucault, presents how cultural changes influence psychotherapists' ways of thinking, their practice and presence in social space.

The paper presents the attachment theory in relation to eating disorders. In the first part, the classic concepts of anorexia and bulimia nervosa are discussed taking into account assumptions of Bowlby's and his followers' model. In the second part, empirical data on anorexia and bulimia nervosa and attachment patterns are presented. The importance of methodological issues is stressed regarding the attachment model particularly in eating disorders. In the conclusion significant findings correlation of attachment patterns and eating disorders are indicated.

In recent years more and more attention in studies on eating disorders is paid to risk factors and perpetuating mechanisms present in the disorders. Perpetuating mechanisms, most often of intricate character, influence patients' ambivalent attitude to therapy. Recognition of the perpetuating mechanisms, often connected with the patients' family way of functioning, makes the therapy much easier. Essential risk factors and perpetuating mechanisms are discussed.

In the first part of the paper, authors describe some research tools for the assessment of family functioning, concentrating mainly on self-report questionnaires of the family members. Advantages and methodological limitations of such methods are discussed. Several questionnaires of self-report type are described such as e.g. the Family APGAR, Family Environment Scale, Mc Master Family Assessment Device, as well as Family Assessment Measure (FAM) of Skinner and Steinhauer. Manfred Cierpka Family Assessment Measures are a modification of this last questionnaire. In the second part of the paper authors present in details Cierpka Family Assessment Measures. They describe seven dimensions of the family functioning such as task accomplishment, role performance, communication, emotionality, affective involvement, control and values and norms. Family Assessment Measures consist of three questionnaires such as General Scale, Dyadic Scale and of Self-Rating Scale. General Scale focuses on how individual member views the family as a whole, The Dyadic Scale assesses specific relationship dyads within the family and Self-Rating Scale addresses how an individual member views his or her functioning within the family. At the end, psychometric properties of these questionnaires are presented, as well as the general description, how they should be used in the process of the assessment of the family for research and in clinical practice of family therapy.

A lot of research indicates the importance of the family context in the occurrence of Eating Disorders. Authors present results of research in families with an adolescent suffering from Anorexia Nervosa according to ICD-10. The aim of this study was to examine relationships among family members. Anorectic girls (n = 37), their sisters (n = 16) and control girls (n = 41) completed the Polish version of The Family Assessment Measure standardised on a Polish sample. The questionnaire was constructed to measure some aspects of the family life such as task accomplishment, role performance, communication including affective expression, affective involvement, control, values and norms. The study revealed some interesting differences between samples. For example, anorectic girls and their sisters generally express dissatisfaction with the relationship with their parents, particularly with fathers, contrary to the control group of girls. Anorectic girls and their sisters more critically assess functioning of the family as a whole than control group girls. Anorectic girls and their sisters express dissatisfaction with their mutual relationship, contrary to the control group.

The paper presents results of research concerning the parents' perception of family relationships in "anorectic" families (where a daughter meets criteria of ICD 10) and in non-treated group. As a basic tool the Polish Version of Family Assessment Measure standardised on a Polish sample was used. The clinical group consists of 31 mothers and 32 fathers, the control group consist of 42 mothers and 41 fathers. The article present how parents from both groups perceived their marital relationship, their relationship with children, family functioning as a whole system and their individual functioning within the family system. The study revealed some interesting differences between samples. The basic conclusion is that perception of family relationships in the anorectic group is negative and incoherent in comparison with positive, congruent perception of family relationships in the control group. Significant differences are presented and discussed according to the literature.