Silencing or silent transmission? An exploratory study on trauma communication in Kurdish refugee families.

Trauma communication in refugee families is increasingly recognized as an important relational dynamic influencing psychosocial well-being, yet studies exploring interactional dynamics and meaning making at play in intra-family trauma communication remain scarce. This article reports on a qualitative study with Kurdish refugee families including parents (N = 10) and children (N = 17) resettled in Belgium, aiming to explore practices on trauma communication within refugee family relationships. In a multiple-phased qualitative design, semi-structured family interviews and participant observation administered in the homes of the participant families are followed by parental interviews involving a tape-assisted recall procedure to investigate observed intergenerational trauma communication and parent-child interactions. Data analysis shows parents and children seldom explicitly talked about the families' lived experiences of trauma. This silence was especially related to parental wishes to avoid their children's future involvement in violence. However, findings also indicate how the intra-family transmission of memories of collective violence occurs in many subtle ways. Four modes of indirect trauma communication could be distinguished: (1) focusing on the repetition of violence in the present; (2) transmission of the collective trauma history; (3) family storytelling; and (4) interaction with meaningful objects of the past. These findings shed light onto the interwoven nature of personal-familial and collective trauma and loss and illuminate the meanings of silence and disclosure in the context of the Kurdish diaspora. In the final section, we discuss our findings and outline its clinical implications for family therapeutic practices in refugee trauma care.

Relational recovery after infidelity as a dual process: A model based on the experiences of female injured partners.

In the literature, relational recovery after infidelity is often described as a process going through different consecutive stages towards a reconciliation. We interviewed 25 injured partners and invited them to look back and talk about what helped them to recover from the pain and the conflicts caused by the relational infidelity of their partner. From their stories-through thematic analysis-four themes emerged: 1. talking, 2.the truth, 3. trust and 4. ethical imbalance. It furthermore struck us how the participants described their recovery process as an experience of being oscillated between connection and disconnection. These findings pointed us in the direction of developing a dual process model that fits with our participants' experiences of recovering after infidelity, while emphasizing the dynamic nature of their stories.

Using questionnaires as conversational tools to bolster the therapeutic alliance in family therapy practice.

In this clinical paper, the focus is on the use of questionnaires in family therapy practice. Psychotherapy research has indicated that the quality of the therapeutic relationship is the most robust predictor of therapeutic change. While the therapeutic relationship is even more important in family therapy than in individual therapy, it is also more complex. As will be illustrated in this paper, questionnaires can be useful in clinical practice to deal with the complex alliances in family therapy. In this paper, we will introduce two questionnaires: the Worries Questionnaire and the Dialogical Feedback Questionnaire. As illustrated in detailed case stories, we use these questionnaires in our practice as conversational tools rather than measuring instruments. They serve as the starting point for the therapist's reflection and for dialogues with family members.

Emotion regulation of the family therapist.

Outcome research highlights the importance of the therapeutic alliance for the outcome of therapy. Meta-analyses suggest that in family therapy, the therapeutic alliance is even more important than in individual therapy. In family therapy, however, the alliance is more complex than in individual therapy. Through empathy, authenticity and hopefulness the therapist can contribute to an effective alliance. Sometimes during the session, a therapist may experience strong emotions that are in tension with his/her therapeutic aspirations of empathetic listening, authenticity and hopefulness. A therapist might experience boredom instead of curiosity, irritation instead of acceptance, shame instead of authenticity. There is need for some kind of emotion regulation to protect the alliance. Furthermore, as some authors suggest, the therapist's emotions - even the emotions that are first glance seem harmful to the alliance - may also be useful for the therapist. Several case stories illustrate the different ways in which family therapists can deal with their emotions in the session.

Traditional gender roles translating into behaviors within adolescents' romantic relationships / Roles tradicionales de género traducidos en comportamientos en las relaciones románticas de los adolescentes / Papéis tradicionais de gênero que se traduzem em comportamentos nas relações românticas dos adolescentes

Abstract While several studies suggest that traditional gender ideologies are strongly embedded in Latino populations, little is known about the way they operate in adolescent's romantic relationships. This mixed-methods study was carried out with adolescents in Cuenca, Ecuador. In the quantitative component, we assessed adolescents' support for traditional gender ideologies in a sample of 562 adolescents (n = 309 girls). It was identified that the majority of adolescents were "uncritical" towards traditional ideologies involving masculinity (82%) and femininity (79%). In the qualitative component, the narratives of a sample of 20 adolescents reflected existing discourses on traditional gender roles and revealed how these ideologies are translated into specific behaviors. In this context, romantic relationships can become negative and dysfunctional spaces that affect adolescents' development.

Resumen Si bien varios estudios han sugerido que las ideologías de género tradicionales están fuertemente arraigadas en las poblaciones latinas, aún se sabe poco sobre la forma en que estas operan en las relaciones románticas de los adolescentes. Este estudio de método mixto se realizó con adolescentes de Cuenca en Ecuador. En el componente cuantitativo, evaluamos el apoyo a las ideologías tradicionales de género en una muestra de 562 adolescentes (n = 309 niñas). Se encontró que la mayoría de los adolescentes podrían ser clasificados como «acríticos¼ hacia las ideologías tradicionales de masculinidad (82%) y feminidad (79%). En el componente cualitativo, las narrativas de una muestra de 20 adolescentes reflejaron los discursos existentes sobre los roles tradicionales de género y revelaron cómo estos se traducen en comportamientos específicos. En este contexto, las relaciones románticas pueden convertirse en espacios negativos y disfuncionales que pueden afectar el desarrollo de los adolescentes.

Resumo Embora vários estudos tenham sugerido que as ideologias tradicionais de gênero são fortemente endossadas nas populações latinas, ainda pouco se sabe sobre a forma como operam nas relações românticas dos adolescentes. Este estudo de métodos mistos foi realizado com adolescentes de Cuenca, no Equador. No componente quantitativo, avaliamos o endosso de ideologias tradicionais de gênero em uma amostra de 562 adolescentes (n = 309 meninas). Verificouse que a maioria dos adolescentes pode ser classificada como "acrítica" em relação às ideologias tradicionais de masculinidade (82%) e feminilidade (79%). No componente qualitativo, as narrativas de uma amostra de 20 adolescentes refletiram os discursos existentes sobre os papéis tradicionais de gênero e revelaram como estes se traduzem em comportamentos específicos. Nesse contexto, os relacionamentos amorosos podem se tornar espaços negativos e disfuncionais que podem afetar o desenvolvimento dos adolescentes.

The Dual Process of Intuitive Responsivity and Reflective Self-supervision: About the Therapist in Family Therapy Practice.

Psychotherapy research shows that-in individual therapy as in family therapy-some therapists are more effective than others. This highlights the crucial role the therapist plays in a client's improvement. Furthermore, it seems that training may make a difference, as deliberate practice can improve the therapist's effectiveness. In the context of the current renewed awareness of the importance of the person of the therapist in the psychotherapy field, this paper's focus is specifically on the therapist in family therapy practice. There is a long tradition of reflecting on the person of the therapist in the family therapy field, often inspired by the metaphor of the wounded healer. In contrast, focusing on the person op the therapist in the present moment of the therapy session is fairly new. In this paper, we use of the dual process models from cognitive psychology as a frame to reflect on the person of the therapist. We review these dual process models and propose that the intuitive responsivity of the therapist relies on the fast, implicit cognitive system (system 1) and the therapist's self-reflection on the slow, deliberate system (system 2). The therapist's actions in therapy practice then emerge moment-by-moment as an echo of the way these two cognitive systems balance each other. It is optimal if the therapist, attuned to the family's rhythm, can flexibly oscillate between the two systems. In the concluding comments of this paper, reflective questions are posed about what this perspective may mean for family therapy practice, training, and supervision.

La investigación sobre psicoterapia indica que, tanto en la terapia individual como en la familiar, algunos terapeutas son más eficaces que otros. Esto destaca el papel fundamental que desempeña el terapeuta en el entorno de un paciente. Además, parece que la capacitación puede marcar una diferencia, ya que la práctica deliberada puede mejorar la eficacia del terapeuta. En el contexto de la conciencia actual renovada sobre la importancia de la persona del terapeuta en el ámbito de la psicoterapia, este artículo se centra específicamente en el terapeuta durante la práctica de la terapia familiar. Hay una larga tradición de reflexionar sobre la persona del terapeuta en el campo de la terapia familiar, generalmente inspirada por la metáfora del sanador herido. Por el contrario, centrarse en la persona del terapeuta en el momento presente de la sesión de terapia es bastante nuevo. En este artículo usamos los modelos de proceso dual de la psicología cognitiva como marco para reflexionar sobre la persona del terapeuta. Revisamos estos modelos de proceso dual y proponemos que la capacidad de respuesta intuitiva del terapeuta depende del sistema cognitivo implícito y rápido (sistema 1) y de la autorreflexión del terapeuta sobre el sistema lento y deliberado (sistema 2). Las acciones del terapeuta en la práctica de la terapia surgen momento a momento como eco de la manera en la que se equilibran estos dos sistemas cognitivos. Es óptimo si el terapeuta, adaptado al ritmo de la familia, puede fluctuar con flexibilidad entre los dos sistemas. En los comentarios concluyentes de este artículo se plantean preguntas reflexivas sobre qué puede significar esta perspectiva para la práctica, la capacitación y la supervisión en terapia familiar.

Coping Strategies of Adolescent and Young Adult Survivors of Childhood Cancer: A Qualitative Study.

BACKGROUND: Many adolescent and young adult (AYA) survivors of childhood cancer are dealing with late effects of the cancer and its treatment. OBJECTIVE: The aim of this study was to explore how AYA survivors cope with their childhood cancer experience and its long-term consequences. METHODS: This is a descriptive qualitative study in which 21 semistructured interviews with AYA survivors of childhood cancer were conducted. A thematic analysis was conducted by a multidisciplinary research team and supported by NVivo 10. RESULTS: Five coping strategies, which facilitated in living a normal life, of which some were developed during their cancer experience, were identified: (1) focusing on the "here and now," (2) refraining from discussing the cancer experience, (3) recalling and preserving positive memories, (4) redefining the impact positively, and (5) consolidating and preserving a sense of togetherness. CONCLUSIONS: Even long after completing treatment, the cancer experience remained deeply ingrained in AYA survivors' lives. Although they did not perceive their survivorship as a large problem in their current lives, coping with being a childhood cancer survivor did take effort. The deployment of specific coping strategies helped them to remain focused on the positive outlook in life and to deal with the long-term physical and psychosocial consequences of the cancer experience aimed at ultimately leading a normal life. IMPLICATIONS FOR PRACTICE: This study emphasizes the current individual frame of reference of the AYA survivor as the point of departure for psychosocial support. Healthcare professionals are advised to acknowledge and respect the value and function of the AYA survivors' coping strategies used.

"It's Hard to Talk When Your Child Has a Life Threatening Illness": A Qualitative Study of Couples Whose Child Is Diagnosed With Cancer.

When parents are confronted with something as fundamental as a cancer diagnosis for their child, it is generally assumed that sharing the emotional impact of it, in the form of talking about it with the partner, is helpful and necessary to cope as an individual and a couple. However, couple communication in the context of childhood oncology is often challenging. In this qualitative research, we aimed for a better understanding of how partners experience their couple communication during treatment of their child. Thematic coding was done on in-depth interviews with 16 parents (7 couples interviewed together and 2 mothers). We found that the circumstances of the treatment period affected couple communication. In the interviews, parents provided three main meanings to their limited talking: (a) because of the hospital and treatment context; (b) for self-care/self-protection related to the value of blocking emotions; and (c) because of each other. These findings invite us to rethink emotional closeness being equated with frequent or intense emotional communication in couples with a child who has cancer. This research, framed in a dialectic approach, emphasizes the value of both talking and not talking in the tense and challenging couple situation of dealing with a child's cancer diagnosis and treatment. Rather than advocating for the general promotion of open communication, our study suggests the value of hesitations to talk at certain points in the process, while also taking into account the degree of marital difficulties in offering interventions aimed at improving couple communication.

What Is Good Advance Care Planning According to Hospitalized Palliative Patients and Their Families? An Explorative Study.

BACKGROUND: Advance care planning is not well implemented in Belgian hospital practice. In order to obtain successful implementation, implementation theory states that the adopters should be involved in the implementation process. This information can serve as a basis for creating better implementation strategies. AIM: For this study, we asked hospitalized palliative patients and their families what they experienced as good advance care planning. METHODS: Twenty-nine interviews were taken from patients and families, following the Tape Assisted Recall procedure of Elliot. These interviews were analyzed using content analysis based on grounded theory. To improve reliability, 3 independent external auditors audited the analysis. RESULTS: Results show that hospitalized palliative patients and families want to have advance care planning communication about treatment and care throughout their disease and about different aspects: social, psychological, physical, practical, and medical. They prefer to have these conversations with their supervising physician. They report 4 important goals of advance care planning communication: establishing a trustful relationship with the physician, in which they feel the involvement of the physician; giving and receiving relevant information for the decision process, making a personal decision about which treatment and care are preferred; and finding consensus between the preferred decision of the physician, the patient and the family concerning the treatment and care policy. CONCLUSION: This study can contribute to advance care planning implementation in hospital practice because it gives in insight into which elements in advance care planning patients and families experience as necessary and when advance care planning is necessary to them.

Ambiguous Loss in Transnational Families' Adolescents: An Exploratory Study in Ecuador.

In psychosocial migration literature, the perspective of ambiguous loss has been relevant to articulate personal and relational experiences in the context of transnational families and ongoing separation. Most studies have focused on adult members' experiences of transnational families, but research exploring ambiguous loss in adolescents whose parents have migrated is still lacking. The present study aimed to explore adolescents' lived experiences of parental migration. In a pilot explorative study, 14 adolescents with at least one parent who migrated were interviewed about their lived experiences of transnational parent-child relationships and ongoing parent-child separation. Data analysis identified four themes in participants' accounts: practices of separation creating confusion; current relationship with migrant parents permeated by ambiguity; distrustful representations of migrant parents; and family and social dynamics reactivating the pain of loss. The findings reveal how in the context of parental migration, patterns of separation and ongoing relational processes, compounded by the uncertainty of reunification and an exclusionary social fabric, constitute core elements that shape adolescents' lived experiences of parent-child relationships characterized by ambiguity.

En la bibliografía sobre las consecuencias psicosociales de la migración, la perspectiva de la pérdida ambigua ha sido relevante para expresar las experiencias personales y relacionales en el contexto de las familias transnacionales y la separación constante. La mayoría de los estudios se han centrado en las experiencias de los miembros adultos de las familias transnacionales, pero aun faltan investigaciones que analicen la pérdida ambigua en los adolescentes cuyos padres han emigrado. El presente estudio tiene como finalidad analizar las vivencias de los adolescentes de padres migrantes. En un estudio piloto exploratorio, se entrevistó a 14 adolescentes con al menos un padre que emigró acerca de sus vivencias con respecto a las relaciones transnacionales entre padre e hijo y la separación constante entre padre e hijo. Los análisis de datos identificaron cuatro temas en los informes de los participantes: las prácticas de separación que generan confusión; la relación actual con los padres emigrantes impregnada por la ambigüedad; las representaciones desconfiadas de los padres emigrantes; y la dinámica familiar y social que reactiva el dolor de la pérdida. Los resultados revelan cómo, en el contexto de la migración parental, los patrones de separación y los procesos relacionales constantes, agravados por la incertidumbre de la reunificación y una estructura social exclusivista, constituyen elementos fundamentales que moldean las vivencias de los adolescentes en las relaciones entre padres e hijos caracterizadas por la ambigüedad.

Family Secrecy in Family Therapy Practice: An Explorative Focus Group Study.

The aim of this focus group study was to explore the experiences of family therapists working with family secrecy. Our study highlights that family secrets present important and compelling challenges for family therapists. Furthermore, our study reveals that there seem to be some basic strategies family therapists use in dealing with these challenges in therapy sessions. One basic strategy is that family therapists try to guard their position of being a trustworthy therapist for each family member by avoiding becoming stuck in family secrecy. Furthermore, therapists explore ways to guide the family toward the disclosure of the secret in order to alleviate the toxicity of the secrecy. This highlights the importance of the systemic model and how influential this perspective is in family therapy practice. Some participants, however, have in addition a second strategy they sometimes use: talking with the family about secrecy without aiming to disclose the secret. In the discussion section of the article we reflect on the possibility that in the strategic choices family therapists make conceptual issues might be involved. Furthermore, we stress the importance of further research.

El propósito de este estudio de un grupo focal fue analizar las experiencias de los terapeutas familiares que trabajan con el secreto familiar. Nuestro estudio destaca que los secretos familiares presentan desafíos importantes y emocionantes para los terapeutas familiares. Además, nuestro estudio revela que parece haber algunas estrategias básicas que usan los terapeutas familiares a la hora de manejar estos desafíos en las sesiones de terapia. Una estrategia básica es que los terapeutas familiares tratan de proteger su postura de ser un terapeuta confiable para cada miembro de la familia evitando atascarse en el secreto familiar. Es más, los terapeutas analizan maneras de guiar a la familia hacia la revelación del secreto a fin de aliviar la toxicidad del misterio. Esto destaca la importancia del modelo sistémico y cuán influyente es esta perspectiva en la práctica de la terapia familiar. Sin embargo, algunos participantes tienen además una segunda estrategia que a veces usan: hablar con la familia acerca del secreto sin pretender que se revele el secreto. En la sección de debate del artículo, reflexionamos sobre la posibilidad de que en las elecciones estratégicas que hacen los terapeutas familiares podrían estar implicados aspectos conceptuales. Por otro lado, subrayamos la importancia de continuar investigando.

'We need a physician who is a human being too': exploration of barriers and facilitators for hospitalised palliative patients and their families to discuss advance care planning.

BACKGROUND: Advance care planning (ACP) is not well implemented in hospital. Implementation theory stresses the importance of knowing what hospitalised palliative patients and their families experience as barriers or as facilitators in the uptake of ACP with their treating physician. AIMS: This study aimed to gain an in-depth understanding of what hospitalised palliative patients and their families experienced as barriers or facilitators for having ACP conversations. METHODS: We used a tape-assisted recall procedure to conduct 29 videotaped interviews with hospitalised patients and their families. We used content analysis based on grounded theory principles. RESULTS: Four major fields of tension were discovered: not knowing what to expect from the treating physician; not being sure the treating physician can be a trusted partner; daring to speak about ACP; and staying loyal to one's own wishes. CONCLUSIONS: Patients and families need physicians who are accessible and can be trusted ACP partners throughout the disease process.

Living as a Cancer Survivor: A Qualitative Study on the Experiences of Belgian Adolescents and Young Adults (AYAs) after Childhood Cancer.

PURPOSE: Insight was sought in how a childhood cancer experience plays a role in daily life of adolescents and young adults (AYA) survivors. DESIGN AND METHODS: A qualitative research in which semi-structured interviews were held with 21 AYA survivors of childhood cancer between the ages of 14 and 25. The AYA survivors were recruited from two pediatric oncology departments of two university hospitals in Belgium. RESULTS: The current situation and behavior of AYA-survivors who have been treated for childhood cancer are covered in 5 categories: The Feeling of Being Different while Aiming for Normalcy in Relationships, Living with Existential Uncertainty, The Conscious Protection of Health, The Attachment to the Parent(s) with Whom the Cancer Experience was Shared, and The Desire to Be Meaningful to Others. CONCLUSIONS: The AYA survivors did not feel that their cancer experience dominated their current daily life, yet, the cancer experience had an important impact on their functioning. PRACTICE IMPLICATIONS: The findings of the study can be used to optimize holistic psychosocial care of AYA survivors. By starting from the key elements in their current functioning, health care professionals can tailor their support to the way in which AYA survivors have integrated their cancer experience into their everyday lives.

Helping hospital professionals to implement Advance Care Planning in daily practice: a European Delphi study from field experts.

BACKGROUND: Advance Care Planning (ACP) communication is difficult to implement in hospital. Possibly this has to do with the fact that the concept is not well tuned to the needs of hospital professionals or that they experience implementation barriers in practice. AIMS: The aim of this study was to investigate what is valued in having ACP conversations by hospital professionals (physicians, nurses, psychologists and social workers) and what they experience as barriers and facilitating factors for having ACP conversations with patients. METHODS: A Delphi study consisting of two rounds with respectively 21 and 19 multidisciplinary experts from seven European countries was organised. Data were analysed using content analysis and descriptive statistics. RESULTS: Participants agreed that ACP is valued mostly because it is seen to improve transmural continuation of care, emotional processing of the loss of a patient, and serenity at the end of life. Reported barriers are patient characteristics blocking patient-centred communication and a lack of knowledge to have these conversations. An important facilitator is multidisciplinary cooperation. CONCLUSIONS: There is consensus by experts from different settings and countries suggesting that these results can theoretically be applied to hospital settings in Europe. This study reveals that hospital professionals value ACP in hospital practice, but that they encounter several barriers to its implementation.

What do hospitalists experience as barriers and helpful factors for having ACP conversations? A systematic qualitative evidence synthesis.

BACKGROUND:: Hospitalists seem to struggle with advance care planning implementation. One strategy to help them is to understand which barriers and helpful factors they may encounter. AIMS:: This review aims to give an overview on what hospitalists experience as barriers and helpful factors for having advance care planning conversations. METHOD:: A systematic synthesis of the qualitative literature was conducted. DATA SOURCES:: A bibliographic search of English peer-reviewed publications in PubMed, Embase, CINAHL, Central, PsycINFO, and Web of Science was undertaken. RESULTS:: Hospitalists report lacking communication skills which lead to difficulties with exploring values and wishes of patients, dealing with emotions of patients and families and approaching the conversation about letting a patient die. Other barriers are related to different interpretations of the concept advance care planning, cultural factors, like being lost in translation, and medicolegal factors, like fearing prosecution. Furthermore, hospitalists report that decision-making is often based on irrational convictions, and it is highly personal. Physician and patient characteristics, like moral convictions, experience, and personality play a role in the decision-making process. Hospitalists report that experience and learning from more experienced colleagues is helpful. Furthermore, efficient multidisciplinary co-operation is helping. CONCLUSION:: This systematic review shows that barriers are often related to communication issues and the convictions of the involved hospitalist. However, they seem to be preventable by creating a culture where experienced professionals can be consulted, where convictions can be questioned, and where co-operation within and between organizations is encouraged. This knowledge can serve as a basis for implementation.

The NSSI Family Distress Cascade Theory.

Nonsuicidal self-injury (NSSI) is a complex behaviour and occurs most commonly during adolescence. This developmental period is characterized by the drive to establish an equilibrium between personal autonomy and connectedness with primary caregivers. When an adolescent self-injures, caregivers often experience confusion about how to react. Reports of feeling guilt, fear, and shame are common in the wake of learning about a child's self-injury. This cascade of negative feelings and self-appraisals may lead to hypervigilance and increased caregiver efforts to control the child's behaviour. The adolescent may experience this as an intrusion, leading to worse family functioning and increased risk of NSSI. This cascade is not well acknowledged or articulated in current literature. This article remedies this gap by presenting the NSSI Family Distress Cascade.

"The child is our focus": On couple issues in child oncology treatment.

OBJECTIVE: This study explored the perspectives of child oncology professionals and parents about the attention professionals should give to the parent couple relationship during treatment of the child. METHODS: We employed a qualitative research design, framed within the approach of consensual qualitative research (CQR), gathering data from four focus groups with 20 professionals and from nine in-depth interviews with 16 parents. Thematic analysis of the focus group and interview data was done with MaxQda software, using two coders and member checks to strengthen confidence in the analysis. FINDINGS: Both professionals and parents talked about an elevated tension in the partner relationship during oncology treatment of the child. However, explicit attention to the partner relationship in this context felt inappropriate to professionals and parents. All emphasized the importance of the professional helpers' openness to conversation and an attuned response to the parental couple relationship. CONCLUSION: During treatment, the child is the primary focus for parents and professionals. The parents' focus on supporting their child makes talking about their own emotions or about issues in the partner relationship potentially disruptive and unhelpful. Therefore, it is crucial for professionals to support the parents in their parents' role, but with an openness to converse about issues in the partner relationship at the moments when these issues might threaten their focus on the child.

Stories of trauma in family therapy with refugees: Supporting safe relational spaces of narration and silence.

With the sharp increase of refugees' arrival and resettlement in western communities, adequate mental health care forms a pivotal dimension in host societies' responses to those individuals and communities seeking protection within their borders. Here, clinical literature shows a growing interest in the development of family therapy approaches with refugees, in which therapeutic practice engages with the pivotal role of refugee family dynamics in posttrauma reconstruction and adaptation in resettlement and aims at supporting posttrauma reconstruction through strengthening capacities to restore safety, meaning and connectedness within family relationships. In this article, we focus on the narrative restoration of meaning as central mode of posttrauma reparation and explore its specific dynamics and relational complexities in the context of therapeutic practice with refugee families. Hereto, we integrate theoretical and clinical scholarly work on trauma narration and its intersection with empirical findings on trauma communication in refugee families. Furthermore, we develop case reflections to illustrate different processes of engaging with trauma narration in refugee family therapy. This analysis develops an understanding of the multivoiced ways in which refugee families engage with traumatic suffering through different modes of expression that may entail both narration and silence and explores how family therapeutic practices can engage and mobilize voices of narration and silence as relational stories of restoration.

"We Hardly Ever Talk about It": Emotional Responsive Attunement in Couples after a Child's Death.

Within Western cultural traditions, the idea that parents should talk about the death of their child with each other is deeply rooted. However, across bereaved parent couples there are wide variations in communication about their grief with each other. In this study, we explored the experiences of bereaved couples related to the process of talking and not talking. We used a thematic coding approach to analyze 20 interviews with 26 bereaved parents (11 interviewed as couples, four as individuals). Four main meanings emerged out of our analysis: not talking because of the inadequacy and pointlessness of words in grief, not talking as a way to regulate emotions in daily life, not talking as an expression of a personal, intimate process, and not talking because the partner has the same loss but a different grief process. In addition, we found that the process of talking and not talking can partly be understood as an emotional responsive process on an intrapersonal and interpersonal level. In this process partners search for a bearable distance from their own grief and their partner's, and attune with their relational context. A better understanding of this process is sought in a dialectical approach, emphasizing the value of both talking and not talking in a tense relationship with each other. Implications for clinical work are described.

Unraveling the Mobilization of Memory in Research With Refugees.

In this article, we explore how narrative accounts of trauma are co-constructed through the interaction between researcher and participant. Using a narrative multiple-case study with Kurdish refugee families, we address how this process takes place, investigating how researcher and participants were engaged in relational, moral, collective, and sociopolitical dimensions of remembering, and how this led to the emergence of particular ethical questions. Case examples indicate that acknowledging the multilayered co-construction of remembering in the research relationship profoundly complicates existing deontological guidelines that predominantly emphasize the researcher's responsibility in sensitively dealing with participants' alleged autobiographical trauma narratives. Instead, our analysis invites qualitative researchers to engage in a continued, context-specific ethical reflection on the potential risks and benefits that are invoked in studies with survivors of collective violence.