The double sides of hope: The meaning of hope among amyotrophic lateral sclerosis (ALS) patients.

Hope is an important factor in coping and adjusting to life-threatening disease. In this study, we examined the meaning of hope among people with amyotrophic lateral sclerosis (ALS). Semi-structured interviews with 12 people revealed that hope had two contradictory meanings. For some, hope was considered an obstacle to achieving control and to actively cope with the disease. Alternatively, other people with ALS regarded hope as a crucial resource, which empowered their coping and control. These findings are discussed in the context of research and theoretical literature about hope and coping processes.

The Dialectic of Chaos and Control in the Experience of Therapists Who Work With Sexually Abused Children.

The aim of this study is to contribute to the understanding the interaction between the emotionally destructive intensity of the trauma and forces that foster growth in therapists who treat sexually abused children. Data were collected through in-depth semistructured interviews with 14 experienced social workers. Content analysis reveals two emotional poles. At one pole, the dominant experiences are anxiety, turmoil, and intrusion that disrupted the order in the interviewee's secure world. At the opposing pole, the dominant experiences are positive, such as hope and faith. These formed the basis of empowering meaning construction that engendered a sense of control, enabling the therapists to trust the value of intervention with sexually abused children. The discussion uses a dialectical perspective to examine how interaction between these two poles enhances our understanding of the emotional and existential threats inherent in working with children who have experienced sexual abuse and on the potential for positive change.

Coping With Stillbirth Among Ultraorthodox Jewish Women.

Stillbirth is a traumatic prenatal loss with personal, familial, and social implications. We explored the meaning of stillbirth for ultraorthodox Israeli women for whom grieving for prenatal loss derived from the power of faith. We conducted semistructured interviews with ten ultraorthodox women, ages 26 to 55, in a qualitative study that was focused on thematic content analysis and influenced by the phenomenological-hermeneutic tradition. The loss of the fetus was experienced as a test to the women's belief in God, and was perceived as a way to experience God's love. The women's faith became stronger and provided relief, calm, and confidence in God as benefactor. The meanings they attributed to their losses enabled them to move on. Findings are discussed in the context of research and theoretical literature on coping, bereavement, and mourning processes, and meaning for pregnancy-related losses. Awareness of ethnic meanings of stillbirth promotes implementation of culture-sensitive psychosocial interventions.

Between the empowered self and the social costs: Arab abused women's perceptions of their relationship with social workers in community health clinics in Israel.

Abused women seek help from medicine services extensively. Qualitative interviews were conducted with 12 married Arab-Israeli abused women about their relationships with social workers in community health clinics. Analysis reveals that women's evaluation of the impact of encounters with social workers is bipolar. On one pole are the difficulties and stressors derived from the cultural limitations that are placed on their ability to bring changes. On the other pole are the benefits--awareness in coping with repressive social powers and empowerment as competent choosers. The discussion elaborates the conflicts and paradoxes inherent in the nature of the interventions with abused women in a collectivistic culture.

From hope to despair, and back: being the wife of a patient in a persistent vegetative state.

In this study we examined the meaning of being the wife of a vegetative patient over time. The research was based on semistructured interviews with 12 wives of husbands who were diagnosed with persistent vegetative state between 1 year 2 months and 10 years prior to the interview. We found that there were two contradicting forces common to all of the wives across time. First, there was a process of finding significance in the situation based on acceptance of the husband's condition and focusing on positive emotions and values such as love, commitment, and loyalty. Second, the wives described an increase in negative emotions such as sadness, pain, loneliness, loss, and grief. These findings are discussed in the context of research and theoretical literature about coping processes and the meaning of caring for patients in a persistent vegetative state.

Parents' experience of their child's first psychiatric breakdown: "welcome to hell".

Clinicians and researchers have emphasized the importance of helping the primary caregivers of persons going through the first outbreak of psychiatric illness in order to mitigate the negative consequences of the illness on the patient and the caregivers. The aim of the current qualitative, retrospective study is to examine the experiences, challenges, and difficulties faced by Israeli parents during the outbreak of psychiatric illness in their children. In-depth, semi-structured interviews were conducted with 10 parents who participated in a psycho-educational group in a family mental health center. Several themes regarding parents' experience of the first outbreak of their children's psychiatric illness emerge from the content analysis of the interviews--the perception of sudden onset of the illness, feelings of being mired in distress, intense pain stemming from guilt and helplessness with concomitant anger, and isolation. The themes are then discussed in light of the concept of ambiguous loss and the existential approach. The findings indicate psycho-social services in the Israeli mental health system provide only a partial response to the needs of parents during this critical period.

Arab Women at the Police Station in Israel: Cultural Crisis and Empowerment.

In the collectivist Arab society, seeking police intervention violates a cultural norm. This qualitative study was based on in-depth interviews with 12 Muslim Arab abused women, who sought help at police stations where police officers and social workers cooperate. Interviews analysis revealed a conflict between the women's desire to stop the violence and the implications of violating cultural norms. Interviewees' emotions ranging from a positive sense of empowerment to negative feelings derived from insensitive, alienating conduct. The encounters with social workers empowered the women in facing social pressures. The discussion focuses on the meaning of integrating the police and welfare services in a collectivist-patriarchal community in a society with a dominant individualist orientation.

The coping experience of parents of a child with retinoblastoma-malignant eye cancer.

The authors explored 12 couples' coping with their children's diagnosis and treatment of retinoblastoma using a semistructured interview, with qualitative, descriptive, narrative-interpretative analysis. Findings showed that the parents' experienced increased distress with the physician's first suspicion that something was seriously wrong. Distress was ameliorated when they arrived at a specialty treatment center but increased as they tackled treatment decisions. Distress decreased again after they consented to enucleation but increased after hospital discharge. The parents' strength, their ability together and individually, to separate and split between cognition and emotion contributed to coping. Parents need support from a multidisciplinary staff and parents who coped with retinoblastoma.

Subjective experience of family stigma as reported by children of Alzheimer's disease patients.

In this study we explored the subjective experience of family stigma as reported by children of persons with Alzheimer's disease (AD). Our data indicated that family stigma in the area of AD was primarily experienced in three dimensions: caregivers' stigma, lay public's stigma, and structural stigma. We found that in all these dimensions family stigma follows a process characterized by three core elements: cognitive attributions, emotional reactions, and behavioral responses. Findings of this study highlight the profound stigma confronting caregivers of persons with AD. What emerges is a poignant picture of adult children living with stigmatic beliefs while providing care for their parents with AD. We suggest that swift steps be taken to deal with these stigmatic beliefs. Mainly, structural discrimination must end if all citizens are to receive truly fair and equitable health care services and benefits.

The unifying difference: dyadic coping with spontaneous abortion among religious Jewish couples.

In this study we examined the meaning of abortion in the religious Jewish sector on both the individual and the couple levels. In a qualitative, descriptive, interpretive-narrative study, semistructured interviews were conducted with five religious couples. Both members of each couple were interviewed separately. The findings show that although both members of the couple experienced spontaneous abortion as a loss, each expressed it in different ways and thus perceived it differently in the couple relationship. Men who demonstrated the ability to bypass their own pain and made an effort to respond to their partners' distress motivated the women's exit from the isolation cycle, and contributed to a sense of dyadic cohesion and to creating a meaning for their "togetherness." These findings are discussed in the context of research and theoretical literature that deal with bereavement and mourning processes, and with constructing meaning for a pregnancy-related loss.

Incest Survivors' Life-Narratives.

This article analyzes the narratives of survivors of father-daughter incest using 20 in-depth interviews with women, each asked to choose a title for her life-story and reflect on its meaning. Three narratives emerged: "Surviving" tells of a struggle for personal achievement in an independent life alongside intensely traumatic experiences and negative feelings, "Fighting Back/Seeking Vengeance" tells of aspiring to strength by acting on their will to fight back and desire for revenge, and "Growing" reflects the wish to fight and win a place in the world through a "rebuilding" process. The conceptualization of incest survivors' life-narratives is based on the dialectical perspective.

Between the professional and the private: the meaning of working with intimate partner violence in social workers' private lives.

This qualitative study examines the impact of working with intimate partner violence on therapists' marital relationships and gender identity. Data were collected by in-depth semistructured interviews with 14 experienced women social workers working in domestic violence treatment centers in Israel. Findings indicate that the boundaries between workers' private and professional lives are blurred and work experiences influence their intimate relationships and gender role identities, leading to overall questioning of their relationships. This newly rediscovered consciousness reshapes the meaning of workers' couple relationships. Such shift between private and professional should be considered when training workers to intervene with intimate partner violence.

Experiencing the relationship with a sibling coping with mental health problems: Dilemmas of connection, communication, and role.

Prolonged mental health problems of one family member influences the whole family system, including sibling relationships. The current research focuses on the way siblings of persons with mental health problems experience the relationship. The findings identify the challenges and difficulties these siblings face and can help mental health practitioners support siblings as well as their brothers and sisters with mental health problems. This qualitative research employs the Interpretative Phenomenological Analysis method. Data were collected through in-depth semi-structured interviews with 14 adult siblings of persons coping with prolonged mental health problems. The sample included seven men and seven women, between the ages of 20-55. Three main themes were identified: (a) Connection: Between involvement and distance; (b) Communication: Controlled confrontation or cautious vagueness; (c) Role: Positioning in the sibling relationship. The discussion introduces the Relational Dialectics Theory in order to understand contradictory statements that arise from the interviewees' experience of dialectal tensions between: involvement versus distancing; direct confrontation versus cautious vagueness; and opposing positions in relation to the sibling coping with mental health problems. A multi-voiced discourse allows for dialogue that incorporates the contradictory poles of the dialectic, thus enabling the siblings to balance the tension in the relationship. In addition, the concept of ambiguous loss is used to interpret the findings. The study is limited by the small homogeneous sample. The results highlight the need for practitioners to give special attention to siblings of persons with mental health problems in order to help them process and cope with the challenges in the relationship, thus providing an opportunity for growth and empowerment.

Accepting disability: the parenting experience of fathers with spinal cord injury (SCI).

This qualitative study describes and analyzes the perceptions and experiences of fathers with spinal cord injury (SCI) regarding their relationship with their children, in the context of social attitudes toward parenting by persons with SCI. The study was conducted within the phenomenological-constructivist paradigm. The sample included 12 males with SCI. All participants were paraplegic Type D1-D12; 2 have incomplete injury to D11 and D12. Data were collected through in-depth semistructured interviews designed to understand participants' meanings. Interviews included a brief questionnaire containing sociodemographic items and an interview guide based on the research topics. The model addresses how fathers with SCI cope with negative social attitudes toward their parenting and their actions to facilitate their children's acceptance of and adjustment to the father's disability.

Attitudes Toward Domestic Violence and Corporal Punishment Among Former Soviet Union Immigrants in Israel.

The study regards attitudes of Russian immigrants in Israel toward wife abuse and corporal punishment. The sample consisted of 1,028 participants, based on a multistage cluster sampling. The study used a questionnaire related to immigration, acculturation, and attitudinal issues. The findings indicate a dual-causal model, in which corporal punishment attitudes contribute to wife abuse attitudes and vice versa. However, the effect of attitudes supporting corporal punishment was stronger than the effect of wife abuse attitudes, indicating that the attitudinal system as a precursor of violent behavior is already merging the two types of violence.

The stress and coping of Israeli emergency room social workers following terrorist attacks.

The authors of this qualitative study analyze Israeli hospital social workers' emotional responses to working with civilian casualties in the wake of an unprecedented surge of terrorist violence. Data are based on four focus groups conducted with 38 hospital social workers in relation to their experience with clients in the emergency room. Three themes were identified: (a) Restoring a lost sense of personal security as a necessary stepping-stone toward resuming professional performance, (b) Meeting the families'pain and responding to it, and (c) Disconnecting emotionally in the service of the professional self. The authors discuss the findings in light of the literature on peritraumatic dissociation among helpers.

Battered women's entrapment in shame: a phenomenological study.

The present study is part of larger research aimed at understanding the impact of the family of origin on battered women's lives, world views, and emotional setup in the context of dyadic life in violence. The sample constitutes 20 Jewish Israeli battered women. Every woman was interviewed in depth for 3 hr. This was done in 3 sessions. Shame was found to be prevalent in battered women's phenomenological biographies. This cuts across both the family of origin and the subsequent intimate dyadic relationship. Shame traps the battered women, having a pervasive influence on the self, relationships with others, and emotional experiences (shame as emotional abuse), and becomes an obstacle in leaving the violence. Implications for intervention are suggested.

Between normality and deviance: the breakdown of batterers' identity following police intervention.

With the transformation of intimate violence from private trouble to social problem, police intervention in domestic violence cases became more prevalent. Research has focused mainly on battered women's perception of police intervention, their evaluations, and their level of satisfaction with the intervention. However, there is little research examining the perpetrators' subjective perceptions of such interventions. The purpose of this study is to describe and analyze battering men's perceptions of police intervention. The study is based on semistructured, in-depth interviews with 20 batterers who had repeated encounters with police. Findings show a continuum of self-management, ranging from attempts to preserve a normative identity in the first encounter to struggling against criminalization in the second encounter and adopting a victim identity in the third encounter. The findings are discussed in the context of gender identity and power relations.

From violence to hope: the construction of professional knowledge in treating imprisoned male batterers in Israel.

The treatment of incarcerated batterers has not been as thoroughly studied as that of men who take part in community treatment programs. The current study describes and analyzes the "practice wisdom" of professionals in a special unit that focuses on treating batterers in an Israeli prison. The analysis is based on in-depth semistructured interviews aimed at facilitating a self-reflective process among the participating social workers. In understanding the construction of tacit knowledge by the social workers, we observe four major dialectical themes in their construction of their practice knowledge: (a) the dialectics of behavior modification and psychodynamic change, (b) the paradoxical use of authority in the service of treatment, (c) the multiple meanings of gender, and (d) the question of change--what really makes the difference? While such opposites might never be fully reconciled, the tension and changes can contribute to construction of professional knowledge.

Re-Experiencing Motherhood: Transformation of Relationships Between Formerly Abused Women and Their Children.

Little knowledge exists on abused women's experience of motherhood following divorce. This qualitative study examined perspectives of 12 formerly abused Israeli women, using in-depth interviews. Findings revealed how women managed an ongoing dialogue between former motherhood in violence and significant changes in mother-children relationships after years of victimization and emotional concealment. All women were determined to repair the impact of violence on the mother-children bond. Some succeeded, whereas others could not reconcile painful relationships. The study findings suggest that understanding the familial dynamics is essential: mothers' new roles and children's potential reactions in this context. Implications for practice are discussed.