Do children cope better than adults with potentially traumatic stress? A 40-year follow-up of Holocaust survivors.

Anecdotal reports suggest that child survivors of the Nazi persecution are functioning well as adults. Ratings of their parents by a randomly selected community sample of young adult Ashkenazi Jews on a scale that measured Schizoid, Paranoid, Depressive/Masochistic and Type A/Normal Aggressive symptoms permitted verification of these reports. Among the parents were groups who were children, adolescents, or young adults in 1945, at the end of World War II. Child-survivor parents did not differ from native-born parents on these measures 40 years later, whereas, consistent with the empirical findings of others, survivors who were adolescents or young adults at the end of the war manifested more paranoid and depressive/masochistic symptoms than native-born parents. To explain this possible greater long-term resilience among those who were child survivors, reference is made to later caretakers, endowment, cognitive and social development, and psychodynamics.

Evaluation of some criteria used to select patients for brief psychodynamic therapy.

BACKGROUND AND OBJECTIVES: The effectiveness of brief psychotherapy is established, but criteria for the selection of patients remain elusive. This study examines the usefulness of some widely used criteria for the selection of patients for brief psychodynamic therapy (BPT). METHODS: A checklist of 39 criteria often used in a teaching hospital to screen patients for BPT was constructed. Scores derived from a principal components analysis of this checklist provided one set of predictor criteria. A second measure was derived from the consensual agreement of the independent ratings by 3 prominent advocates of BPT. A third predictor was derived from a similar analysis of items from the checklist on which consensual agreement for their relevance was obtained from the independent ratings of 23 BPT teachers in 16 university-affiliated hospitals. Reliable chart-based ratings of improvement in symptoms, increased insight, and improvement in general functioning of a convenience sample of 43 patients treated with BPT in the outpatient clinic of a teaching hospital served as outcome measures. RESULTS: No correlation between any of the derived predictors and any of the measures of outcome was significant after a Bonferroni correction. CONCLUSION: Teachers and clinicians still do not have good criteria for the selection of patients who will benefit from BPT. Exclusion of severe behavior disorders may, however, improve outcome rates by more than 15%.

The unraveling of a treatment paradigm: a followup study of the Milan approach to family therapy.

A 2-year followup study was conducted to determine the efficacy and degree of satisfaction with Milan-style family therapy with families refractory to other treatment interventions. Fourteen families and 5 couples who received Milan-style family therapy participated in the study. Family outcome was found to be improved in 56% of parents and 89% of identified child-patients at followup. Improved self-outcome at followup was reported by 56% of fathers, 67% of mothers, and 78% of identified child-patients. A substantial percentage of fathers (68%) and mothers (59%) reported that at least one family member sought further therapy posttreatment. Factors associated with either parent's positive perception of the treatment in general included the time interval between sessions, experiencing the treatment as brief rather than long, and positive feelings for the group behind the mirror. Mothers who reported liking the treatment reported better family outcome. For mothers, disliking the treatment was related to family members seeking further treatment. The more negative the mothers' and fathers' spontaneous comments about therapy were, the more likely that a family member would seek further alternative psychotherapy. The outcome results are explained in terms of the treatment families' negative reactions to some aspects of the therapist's stance and to the group behind the one-way mirror, as in Milan-style therapy. The importance of modifying Milan-type therapy to foster a positive attitude toward the treatment procedures and the therapist's interventions is discussed.

Grandchildren of survivors: can negative effects of prolonged exposure to excessive stress be observed two generations later?

Some studies have demonstrated negative psychological repercussions on children of parents who experienced extreme, prolonged stress. To determine whether such effects might continue in the third generation, we examined the presenting complaints of patients in a child psychiatry clinic who could be reliably identified as: (i) children whose parents were native born but who had at least one grandparent who was a survivor of the Nazi persecution (Index 1, N = 58); (ii) other children who had at least one parent and one grandparent who was a survivor (Index 2, N = 11); (iii) children of other immigrant grandparents (N = 28); (iv) children with four native born grandparents (N = 30). All other grandparents and parents were native born. All families were of the same ethnic group. Index 2 children manifested more difficulties related to school performance, but the small size of the sample precludes generalization. Although the Index 1 children did not have different types of behavioural disturbances, the size of the Index (1 + 2) group (N = 69) relative to the comparison groups was 300% greater than expected on the basis of community population estimates. Implications of this finding are discussed.

Some determinants of individual differences in the behaviour of children of parentally deprived parents.

Parents who had been placed in an orphanage as children rated the behaviour of all their children who were between the ages of 6-18 years on a children's behaviour survey instrument. All families were intact and the parents had not requested professional help for marital problems. A significant number of relationships were found between parental background variables and higher reported levels of conflict with siblings and with parents, dependent-unassertive behaviour, and undemandingness in the children. Although sampling difficulties preclude generalization, the results suggest that repercussion of events in the lives of the first and second generation that are usually pathogenic may be seen in the third generation, even when the second generation may not be grossly adversely affected. These events most frequently related to individual differences in the third generation in the area of undercontrol of aggression directed toward parents and siblings.

Mutual involvement and alienation in families of Holocaust survivors.

Clinical studies suggest that children of Holocaust survivors remain enmeshed with their families or alienated from them. To examine the applicability of these observations to a nonclinic population, questionnaire responses of a randomly selected community sample of adult children (ages 19-36) of Holocaust survivors (COS) were compared to those of children of other immigrants (COI), and of children of native-born parents (CON). The clinical findings were not supported in most of the wide range of possible manifestations of ties to or distance from the family. COS did, however, report more dissatisfaction with some aspects of the cross-sexed parents' disciplinary habits in the past. Male COS continued to feel that way in the present, wishing their mothers would be more permissive. Documented negative consequences of prolonged, severe victimization may affect only small segments of the second generation.

Stability of coping style 33 years after prolonged exposure to extreme stress.

Respondents who were in hiding or in the armed resistance movement in Nazi occupied Europe are assumed to have had avoidant and confronting coping styles, respectively. Responses to questionnaire items tapping behavior, attitudes and perceptions were examined in the two groups for the persistence of these same traits 33 years after World War II, in a study of randomly selected community sample of Jews. Taken as a whole, but not individually, responses to the questionnaire items suggested that the traits did persist (P less than 0.001). The results highlight the importance of distinguishing individual differences in coping style when studying the long-term effects of prolonged, stressful experiences.

Empirical study of self-rated defense styles.

A self-administered questionnaire that would indicate a person's perception of his or her habitual defensive style was constructed and tested. The hypotheses assessed were that defenses cluster so as to constitute "styles" and that these styles can be ranked as more or less adaptive. The sample comprised 98 psychiatric patients and 111 nonpatients. The tools used were (1) a questionnaire measure of self-appraisal of defensive style, (2) a questionnaire measure of ego adaptation, and (3) a sentence completion measure of ego development. The results, which argued strongly for the validity of a questionnaire measure of perceived defensive style, also showed that such defenses tend to cluster into styles that can be ranked on a developmental continuum, from "maladaptive action patterns," through "image-distorting" defenses, "self-sacrificing" defenses, and "adaptive" defenses.

Impairment in Holocaust survivors after 33 years: data from an unbiased community sample.

The authors compared the psychiatric status of 135 survivors of the Holocaust with that of control subjects. This study stands apart from most previous reports in that the two groups were generated by a random sample survey of all heads of households in a community (Montreal). Survivors were more likely to have mild psychiatric symptoms regardless of the age at which they experienced the Holocaust. The difference between survivors and controls in levels of mild psychiatric symptoms was greatly amplified in those respondents who perceived a recent increase in anti-Semitism in Montreal.

Teaching family psychodynamics in a family practice center: one experience.

This paper describes a method of teaching family psychodynamics in a new family practice center. Initially, there were difficulties in engaging staff because of inappropriate teaching methods and personal and professional identity conflicts. Ultimately, a sequential program of video playbacks, live interviews and case conferences was developed. The residents' four-month rotation in psychiatry proved essential for developing comfort with psychological and familial aspects of psyical illness.

Problems in measuring the success of family therapy in a common clinical setting: impasse and solutions.

Families treated in conjoint therapy in the outpatient clinic of a general community hospital for about a year and other families that refused further contact with the same clinic after no more than two interviews were followed up about four and a half years later. The main difference found was that the treated group reported more new symptoms. The complexities of interpreting the data obtained are used as a basis for discussing problems that confront, and may deter, clinics attempting to evaluate their clinical work by means of controlled, nonfactorial or related designs. Process or correlational studies are suggested as an alternate choice.