Reflexiones sobre la alianza terapéutica en adolescentes con anorexia nerviosa y sus familias / Reflections on the therapeutic alliance in adolescents with anorexia nervosa and their families

La alianza terapéutica en pacientes con Anorexia Nerviosa constituye un desafío debido a la gravedad de muchos de estos pacientes, a la falta de conciencia de enfermedad que poseen y a la resistencia al cambio, tanto del paciente como de sus familias. Frecuentemente, existe un desconocimiento por parte de los equipos médicos, de dicha patología y de su manejo. Diversos autores han aportado elementos necesarios para una adecuada alianza terapéutica y proponen estrategias que faciliten la construcción de esta alianza. En este artículo se lleva a cabo una revisión de las observaciones ofrecidas por varios autores, desde donde se reflexiona acerca de la importancia de la alianza terapéutica en pacientes con Anorexia Nerviosa y sus familias.

The therapeutic alliance in patients with Anorexia Nervosa constitutes a challenge due to several factors such as the severity of the illness that most of these patients suffer, their lack of awareness of disease, and the resistance to change in the patient and their family. Medical teams are frequently ignorant of this pathology and its treatment. Various authors have contributed in terms of the necessary elements for an adequate therapeutic alliance and in terms of delivering strategies to facilitate this alliance. In this article we will review several authors and reflect on the importance of the therapeutic alliance in patients with Anorexia Nervosa and their families.

Eliciting Stance and Mitigating Therapist Authority in Open Dialogue Meetings.

Open Dialogue is a collaborative systemic approach to working with families in crisis. A core feature is the creation of dialogue through the elicitation of a multiplicity of voices. Using conversation analysis, we studied 14 hr of Open Dialogue sessions. We found that therapists recurrently produced utterances containing "I'm wondering." These utterances topicalized particular issues and invited stance positions from other participants while also allowing the therapist to mitigate their deontic authority and present potentially disaligning stances. Therapists thus exercised authority in eliciting stances, but provided recipients with multiple avenues for responding. These findings illustrate that therapist authority is not necessarily antithetical to dialogue and, in well-crafted forms, may even be necessary for the creation of polyphony through the elicitation of multiple stances.

Treating systemic issues in families affected by cystic fibrosis: A solution-focused approach.

Cystic fibrosis (CF) presents with various symptoms that impair day-to-day functioning and require lifelong treatment. Due to the chronic and severe nature of this disease, families are often impacted by the stress associated with treatment, complications of the disease, and the understanding that their loved one will one day die from CF. This article seeks to address a perceived gap in the literature for providing a model-specific approach to address psychosocial stress in families affected by CF. We provide a rationale for using solution-focused brief therapy (SFBT) to work with this population based on its empirically supported effectiveness, versatility, and capacity to be brief in nature. We describe how SFBT interventions can be used by practitioners working with this population, present a fictitious case illustration depicting the clinical use of specific SFBT interventions, and offer suggestions for future research. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Effect of a Family-Based Lifestyle Education Program on Dietary Habits, Hepatic Fat and Adiposity Markers in 8-12-Year-Old Children with Overweight/Obesity.

Healthy lifestyle education programs are recommended for obesity prevention and treatment. However, there is no previous information on the effects of these programs on the reduction of hepatic fat percentage. The aims were (i) to examine the effectiveness of a 22-week family-based lifestyle education program on dietary habits, and (ii) to explore the associations of changes in dietary intake with percent hepatic fat reduction and adiposity in children with overweight/obesity. A total of 81 children with overweight/obesity (aged 10.6 ± 1.1 years, 53.1% girls) and their parents attended a 22-week family based healthy lifestyle and psychoeducational program accompanied with (intensive group) or without (control) an exercise program. Hepatic fat (magnetic resonance imaging), adiposity (dual energy X-ray absorptiometry) and dietary habits (two non-consecutive 24 h-recalls) were assessed before and after the intervention. Energy (p < 0.01) fat (p < 0.01) and added sugar (p < 0.03) intake were significantly reduced in both groups at the end of the program, while, in addition, carbohydrates intake (p < 0.04) was reduced exclusively in the control group, and simple sugar (p < 0.05) and cholesterol (p < 0.03) intake was reduced in the exercise group. Fruit (p < 0.03) and low-fat/skimmed dairy consumption (p < 0.02), the adherence to the Mediterranean Diet Quality Index for children and teenagers (KIDMED, p < 0.01) and breakfast quality index (p < 0.03) were significantly higher in both control and intervention groups after the intervention. Moreover, participants in the exercise group increased the adherence to the Dietary Approaches to Stop Hypertension (DASH) diet (p < 0.001), whereas the ratio of evening-morning energy intake was significantly lower exclusively in the control group after the program (p < 0.02). Changes in energy intake were significantly associated with changes in fat mass index (FMI) in the exercise group, whereas changes in sugar-sweetened beverages (SSB) consumption was associated with percent hepatic fat reduction (p < 0.05) in the control group. A 22-week family-based healthy lifestyle program seems to be effective on improving diet quality and health in children with overweight/obesity and these should focus on SSB avoidance and physical activity.

Does a mindfulness-augmented version of the German Strengthening Families Program reduce substance use in adolescents? Study protocol for a randomized controlled trial.

BACKGROUND: Mindfulness training (MT) for parents of adolescents has been shown to improve mental health and stress-related outcomes in individuals and their families. Studies of MT among young people are mainly delivered in educational or clinical settings, and there is a need for controlled studies on both parent-directed and adolescent-directed approaches. It is unclear whether MT has preventive effects for substance use outcomes. The primary objective of this trial is to evaluate the effectiveness of family-based MT targeting both adolescents and their parents to prevent adolescent substance use and enhance neurobehavioral self-regulation skills that play a major role in addiction development and mental health. METHODS/DESIGN: The trial design is a superiority, two-arm, randomized controlled trial in which families will participate either in the full curriculum of the evidence-based Strengthening Families Program 10-14 (SFP 10-14, German adaptation) or in a mindfulness-enhanced version of this program (SFP-Mind). Both seven-session interventions are highly structured and will each be delivered over a period of approximately 7 weeks. The experimental intervention SFP-Mind is a modified version of the SFP 10-14 in which some elements were eliminated or changed to enable the inclusion of additional parent-directed and adolescent-directed mindfulness components. The primary outcome is adolescent self-reported alcohol use based on an alcohol initiation index at 18-month follow-up. Dispositional mindfulness, impulsivity, and emotion regulation will be included as secondary outcomes and potential mechanisms of action. The study will recruit and randomize 216 adolescents, aged 10-14 years, and their parents who will be followed up for 18 months. DISCUSSION: This trial aims to evaluate the effectiveness of SFP-Mind for family-based prevention of substance use and promoting mental health in adolescence. TRIAL REGISTRATION: German Register of Clinical Studies, DRKS00015678. Registered on 25 February 2019.

The development of a family participatory dignity therapy programme for patients with haematologic neoplasms and their family caregivers in China: A feasibility study.

OBJECTIVE: To develop a communication prompt based on dignity therapy to facilitate effective conversations between patients with haematologic neoplasms and their family caregivers and to improve the programme and preliminarily explore the benefits and challenges of family participatory dignity therapy (FPDT). METHODS: A mixed-methods approach was applied to develop and revise the programme. The FPDT was developed and validated using the Delphi survey, and its further improvement was explored with a simple one-group pre- and post-trial and semi-structured in-depth interviews. RESULTS: Most of the FPDT items were endorsed by experts and patient-family dyads. The Content Validity Index was 93.6% in the first round of the Delphi survey and 100% in the second round. The "hope level," "spiritual well-being" and "general health" scores of pre- and post-testing increased from 33.60 ± 4.30 to 37.70 ± 5.10 (t = 3.99, p = .003); from 30.30 ± 3.65 to 38.80 ± 7.29(t = 4.13, p = .003); and from 41.67 ± 8.78 to 53.33 ± 8.05 (t = 3.50, p = .007) respectively. The qualitative data also indicated that the project was meaningful and well received. CONCLUSIONS: We showed that FPDT was a valuable and feasible means of improving communication between patients with haematologic neoplasms and their family caregivers in China by raising the hope level and spiritual well-being and promoting general health.

Cancer-related communication during sessions of family therapy at the end of life.

OBJECTIVES: A goal of family-focused therapies in oncology is to help families communicate effectively about illness and its management. Yet there has been no examination of whether and how conjoint sessions are conducive to this process. In this study, we (a) described the extent of cancer-specific communication during family sessions at the end of life; (b) identified characteristics associated with SC; and (c) determined the association between SC and longer-term family bereavement outcomes. METHODS: Data were collected as part of a randomized controlled trial of Family Focused Grief Therapy (FFGT) for advanced cancer patients and their families. Demographics, depressive symptoms, and family functioning were assessed at baseline. Cancer-specific communication, perceived responsiveness to communication, and therapeutic alliances were reported after each session. At 13-month bereavement, surviving families were assessed for symptoms of depression and prolonged grief disorder (PGD). RESULTS: Participants were 257 advanced cancer patients and family members receiving FFGT at the end of life. On average, participants perceived significantly more cancer-related communication in session (SC) than at baseline. Both therapist-family and within-family alliances were associated with SC, especially for those with more severe depressive symptoms at baseline. Long-term outcomes were moderated by perceived responsiveness to in-session communication: for those who perceived high responsiveness, SC was associated with fewer depressive and PGD symptoms in bereavement. CONCLUSIONS: Conjoint family sessions can effectively increase communication about cancer at the end of life. Clinicians should consider key contextual factors in their effort to facilitate this process: perceived responsiveness, family role, alliances with therapist, and within-family.

Parenting after Weight Loss Surgery: A Conceptual Model and Two Case Reports.

The ways families approach eating, shape, and weight can result in stress for individual family members and challenge the overall functioning of the family. This is further complicated among families with a parent who has history of obesity or undergone weight loss surgery (WLS). Although WLS can positively impact other family members, it can also exacerbate conflicts regarding feeding and weight. Such conflicts can involve uncertainty regarding the extent to which the entire family should make the dietary changes recommended for the post-WLS parent. Conflict might also center on the appropriate level of concern regarding the children's risk of developing (or maintaining) obesity. This paper uses two case examples to describe the application of a specialized, time-limited intervention: Parent-Based Prevention following Bariatric Surgery (PBP-B). The program was developed to address the unique challenges and concerns that arise after, or are exacerbated by, WLS. Each detailed case example illustrates a common child-feeding challenge and the employment of key PBP-B strategies throughout the course of treatment. In the first case, the parent who had undergone WLS believed the family's current eating behaviors were the same as those that had led to her own overeating, obesity, and co-occurring psychiatric symptoms, while her husband disagreed. In the second case, both parents were concerned about their son's weight, yet due to their prior eating histories, they felt unable to construct boundaries around the feeding experience. Both cases follow families through the entire intervention and illustrate key points and challenges. These cases underscore the need for novel treatment modalities to support families following parental WLS.

Las maneras en las que las familias abordan la alimentación, la figura y el peso pueden causar estrés en los integrantes individuales de la familia y poner a prueba el funcionamiento general de la familia. Esto es aun más complicado entre las familias con un padre que tiene antecedentes de obesidad o que se sometió a una cirugía para adelgazar. Aunque la cirugía para adelgazar puede repercutir de manera positiva en otros miembros de la familia, también puede exacerbar conflictos con respecto a la alimentación y al peso. Dichos conflictos pueden consistir en la incertidumbre con respecto al grado en el cual toda la familia debería hacer los cambios alimentarios recomendados para el padre que se ha operado para adelgazar. El conflicto también podría centrarse en el nivel adecuado de preocupación en relación con el riesgo de los niños de desarrollar (o mantener) la obesidad. Este artículo utiliza dos ejemplos de casos para describir la aplicación de una intervención especializada y limitada temporalmente: "La prevención basada en los padres después de una cirugía bariátrica" (Parent-Based Prevention following Bariatric Surgery, PBP-B). El programa se desarrolló para abordar los desafíos y las preocupaciones particulares que surgen después de la cirugía para adelgazar o que son exacerbados por esta. Cada ejemplo de un caso detallado ilustra un desafío común con respecto a la alimentación de los niños y al empleo de estrategias fundamentales de la PBP-B a lo largo del transcurso del tratamiento. En el primer caso, la madre que se había sometido a la cirugía para adelgazar creía que los comportamientos alimentarios actuales de la familia eran los mismos que los que la habían conducido a su propia sobreingesta, obesidad, y síntomas psiquiátricos concomitantes, mientras que su esposo no estaba de acuerdo. En el segundo caso, ambos padres estaban preocupados acerca del peso de su hijo, sin embargo, debido a sus antecedentes alimentarios previos, se sentían incapaces de establecer límites en torno a la experiencia alimentaria. Ambos casos siguen a las familias durante toda la intervención e ilustran puntos clave y desafíos. Estos casos subrayan la necesidad de incorporar modalidades innovadoras de tratamiento orientadas a apoyar a las familias después de la cirugía para adelgazar de uno de los padres.

The Effect of Filial Therapy on Depressive Symptoms of Children with Cancer and Their Mother's Depression, Anxiety, and Stress: A Randomized Controlled Trial.

BACKGROUND: Childhood cancer is an overwhelming life event that can completely change the lives of the sufferers and their parents. Todays, advances of medical science have shifted the fetal nature of childhood cancer to chronic one exposing children and their family to behavioral and psychosocial problems. The aim of this study was to investigate the effect of filial therapy on children's depressive symptoms and their mother's stress, anxiety, and depression. MATERIALS AND METHODS: In this randomized controlled trial, 32 mothers with their children who suffered from cancer were recruited (16 in each group). During a 10-week training sessions, filial therapy group underwent child-parent relation therapy (CPRT). Training sessions were held once a week. Control group received no training and only individual counseling sessions were held for them we needed. Both groups were assessed before and after the intervention using depression, anxiety, and stress questionnaire-21 (DASS-21), children depression inventory (CDI), and Wong-Baker faces pain rating scale (WBFPRS). Sample randomization and data analysis were conducted by using SPSS (version 20) and running independent t-test and chi-square test. P value< 0.05 was set as the significant level. RESULTS: Mothers in the filial therapy group experienced significant decrease in their level of depression, anxiety, and stress in the posttest (p < 0.001). In contrast to filial therapy group, mothers in the control group did not show an improvement in their level of depression, anxiety, and stress. Moreover, the results of the current investigative showed that depression of children in the filial therapy group significantly reduced at post-test (p < 0.001). On the other hand, the mean of children's depression in the control group remained steady. CONCLUSION: The findings of the present study revealed that using filial therapy could reduce the depression of children with cancer and their parent's depression, anxiety, and stress. Accordingly, we suggest filial therapy programs as a routine for addressing psychosocial problems of children with cancer and their families.

Percepção de familiares sobre a reabilitação psicossocial de alcoolistas / Percepción de la familia sobre la rehabilitación psicosocial de los alcohólicos / Family Perception about Psychosocial Rehabilitation of Alcoholic Patients

RESUMO Introdução: No contexto da Reforma Psiquiátrica Brasileira, a família tem sido convocada a ser corresponsável pela assistência aos usuários de álcool e outras drogas. Objetivo: Compreender a percepção de familiares sobre a reabilitação psicossocial de alcoolistas. Métodos: Estudo fenomenológico, fundamentado no referencial de Maurice Merleau-Ponty, desenvolvido no período de outubro a novembro do ano de 2013, por meio de entrevistas semi-estruturada com sete familiares de alcoolistas usuários de um Centro de Atenção Psicossocial Álcool e outras Drogas (CAPS ad), no estado da Bahia, Brasil. Utilizou-se a técnica Analítica da Ambiguidade para a compreensão dos dados. Resultados: Os resultados evidenciam que a família ao mesmo tempo em que espera a reabilitação e reinserção do alcoolista, não se identifica como corresponsável pelo cuidado; e a depender da postura, poderá tanto contribuir como interferir na efetivação do processo. Conclusões: É imprescindível o desenvolvimento de ações que reforcem a ruptura com a exclusão social nos planos de intervenção frente ao Alcoolismo, o que deve incluir o contexto familiar(AU)

RESUMEN Introducción: En el contexto de la Reforma Psiquiátrica Brasileña, la familia ha sido convocada a ser corresponsable por la asistencia a los usuarios del alcohol y otras drogas. Objetivo: Comprender la percepción de los familiares sobre la rehabilitación psicosocial de los alcohólicos. Métodos: Estudio fenomenológico basado en el studio de Maurice Merleau-Ponty, desarrollado en el periodo de octubre a noviembre de 2013, a través de entrevistas semi-estructuradas con siete familiares de pacientes alcohólicos atendidos en el Center for Psychosocial Care Alcohol and Other Drugs en el estado de Bahía, Brasil. Se usó la técnica analítica de ambigüedad para comprender los datos. Resultados: Los resultados evidencian que la familia al mismo tiempo que espera la rehabilitación y reinserción de su familiar alcohólico, no se identifica como corresponsable por el cuidado; y en dependencia de la postura, podrá tanto contribuir como interferir en la efectividad del proceso. Conclusiones: Es imprescindible el desarrollo de acciones que refuercen la ruptura con la exclusión social en los planes de intervención frente al alcoholismo, lo que debe incluir el contexto familiar(AU)

ABSTRACT Introduction: In the context of the Brazilian Psychiatric Reform, the family has been summoned to be co-responsible for providing assistance to consumers of alcohol and other drugs. Objective: To understand the perception of family members about the psychosocial rehabilitation of alcoholic patients. Methods: Phenomenological study based on the Maurice Merleau-Ponty study, developed in the period from October to November 2013, through semi-structured interviews with seven relatives of alcoholic patients who received care in the Center for Psychosocial Care Alcohol and Other Drugs in the state of Bahia, Brazil. The analytical technique of ambiguity was used to understand the data. Results: The results show that the family, while waiting for the rehabilitation and reintegration of their alcoholic relative, does not identify itself as co-responsible for the care; and depending on the position, it can both contribute and interfere in the effectiveness of the process. Conclusions: It is essential to develop actions that reinforce breaking with social exclusion as part of intervention plans against alcoholism, which should include the family context(AU)

O diálogo aberto e os desafios para sua implementação - análise a partir da revisão da literatura / Open Dialogue and the Challenges for its Implementation - an analysis based on a review of the literature

Resumo O Método Diálogo Aberto foi desenvolvido na Finlândia para atender crises psíquicas graves utilizando diálogo e inclusão da rede social. Este artigo pretende, através de uma revisão da literatura sobre o Método do Diálogo Aberto, identificar seus princípios e contribuições para processos de desisntitucionalização. Método: As bases utilizadas neste artigo de revisão foram: PubMed (365), PsycInfo (134) e Lilacs (nehuma publicação encontrada), além de 2 livros, incluídos por referência cruzada. Foram selecionadas 34 publicações que atendiam ao objetivo proposto. A busca foi realizada em outubro de 2015. Os descritores selecionados foram: open dialogue, crisis, first episode psycosis, schizophrenia, terapy family, need adapted approach. Resultados: Foram encontrados 3 artigos de revisão, 5 estudos teóricos, 21 estudos qualitativos e 5 estudos quantitativos. Destes, 2 foram escritos em italiano, 1 em francês e 31 em inglês. Com relação ao país de origem dos autores temos: Noruega, Estados Unidos, Finlândia, Austrália, Reino Unido, Bélgica, Canadá e Polônia. As produções foram agrupadas para análise em: Concepções e princípios do Diálogo Aberto; Contribuições do diálogo Aberto; Desafios para implementação do Diálogo Aberto em outros países, realidades e contextos.

Abstract The Open Dialogue Method was developed in Finland in order to deal with severe psychotic crises using dialogue and social network inclusion. By means of a review of the literature on the Open Dialogue Method, this article sought to identify the principles and contributions for deinstitutionalization. Method: The PubMed (365), PsycInfo (134), Lilacs (no articles found) databases and 2 books were consulted. Thirty-four publications that fulfilled the requirements of this review were selected. The search was conducted in October 2015. The key words used were: open dialogue, crisis, first psychotic episode, schizophrenia, family therapy, need-adapted approach. Results: There were 3 reviews, 5 theoretical studies, 21 qualitative studies and 5 quantitative studies. Two of them were written in Italian, one in French and thirty-one in English. The authors were from Norway, the United States, Finland, Australia, the United Kingdom, Belgium, Canada and Poland. The publications were grouped for purposes of analysis into the following categories: Open Dialogue concepts and principles; Open Dialogue contributions; Challenges for Open Dialogue implementation in other countries, realities and contexts.

Aspectos metodológicos y psicológicos para asesorar y acompañar a las personas con VIH/sida / Aspectos metodológicos e psicológicos para aconselhar e acompanhar pessoas com HIV/AIDS / Methodological and psychological aspects to advise and accompany people with HIV/AIDS

Introducción: El proceso de asesoría para las personas con VIH/sida es específico y particular, por ello, hay ciertos aspectos muy importantes a tomar en cuenta. Objetivo: Proponen algunos aspectos metodológicos y psicológicos para asesorar y acompañar a las personas que viven con VIH/sida. Método: Se consideraron criterios de varios autores y la revisión bibliográfica según los métodos del nivel teórico de la investigación: análisis-síntesis, inducción-deducción, modelación y enfoque sistémico. Resultados: Se tuvieron en cuenta elementos esenciales según la práctica profesional como: depresión, sentimientos de culpas, indefensos, ansiedad, pobre expectativa de vida, deterioro de la relación de pareja, esperanza de vida, nivel de aceptación, fatalismo o poco optimismo y que no se tienen en cuenta algunos de los aspectos cuando sabemos que debemos hacerlo y para esta labor se sigue también una metodología concreta y particular. Conclusiones: Según lo explicado anteriormente se recomienda iniciar sesiones individuales con las personas que soliciten ayuda. Las reuniones terapéuticas son muy eficaces para disminuir el sufrimiento y la ira que presentan los miembros de la familia(AU)

Introduction: The counseling process for people with HIV/AIDS is specific and particular, so there are certain very important aspects to take into account. Objective: They propose some methodological and psychological aspects to advise and accompany people living with HIV/AIDS. Method: Criteria of several authors and the literature review were considered according to the methods of the theoretical level of research: analysis-synthesis, induction-deduction, modeling and systemic approach. Results: Essential elements were taken into account according to professional practice such as: depression, feelings of guilt, helplessness, anxiety, poor life expectancy, deterioration of the couple's relationship, life expectancy, level of acceptance, fatalism or poor optimism and that some of the aspects are not taken into account when we know that we must do it and, for this work, a specific and particular methodology is also followed. Conclusions: Therapeutic meetings are very effective in reducing the suffering and anger that family members present. It is recommended to start individual sessions with people who ask for help(AU)

Introdução: O processo de aconselhamento para pessoas com HIV/AIDS é específico e particular, portanto, há certos aspectos muito importantes a serem levados em consideração. Objetivo: Eles propõem alguns aspectos metodológicos e psicológicos para aconselhar e acompanhar as pessoas que vivem com HIV/AIDS. Método: Foram considerados critérios de vários autores e a revisão da literatura de acordo com os métodos do nível teórico da pesquisa: análise-síntese, indução-dedução, modelagem e abordagem sistêmica. Resultados: Elementos essenciais foram considerados de acordo com a prática profissional, tais como: depressão, sentimentos de culpa, desamparo, ansiedade, baixa expectativa de vida, deterioração do relacionamento do casal, expectativa de vida, nível de aceitação, fatalismo ou pouco otimismo e que alguns dos aspectos não são levados em consideração quando sabemos que devemos fazê-lo e, para este trabalho, uma metodologia específica e particular também é seguida. Conclusões: As reuniões terapêuticas são muito eficazes na redução do sofrimento e da raiva que os membros da família apresentam. Recomenda-se iniciar sessões individuais com pessoas que solicitam ajuda(AU)

Luto em Santa Maria: estudo da tragédia sob um olhar sistêmico / Mourning in Santa Maria: a study of the tragedy under a systemic vision

O resultado do trabalho de luto da perda de um filho depende muito de como a família está encarando essa perda e de qual o ciclo de vida pelo qual o sistema familiar está passando. A presente pesquisa aborda alguns aspectos teóricos importantes relacionados às observações feitas em dois dias de acompanhamento das atividades da Associação dos Familiares de Vítimas e Sobreviventes da Tragédia de Santa Maria (AVTSM), no município de Santa Maria, estado do Rio Grande do Sul, nos dias 11 e 12 de abril de 2017, bem como procede à análise de conteúdo de seis entrevistas realizadas com mães e pai de vítimas. O trabalho realizado pela AVTSM é de fundamental importância aos pais e às mães que participam, pois, além de proporcionar atividades psicossociais para os membros e fortalece o vínculo coletivo entre eles. Além disso, tais atividades têm caráter terapêutico e incentivam os envolvidos a melhorar e a resgatar a vontade de viver e de se adaptar à realidade cruel que é viver sem seus filhos.(AU)

The outcome from the elaboration of mourning of the loss of a son largely depends on how the family is facing this loss and what life cycle the family system is going through. The present research addresses some important theoretical aspects related to observations made in two days of monitoring from the activities of the Association of Families of Victims and Survivors of the Santa Maria's Tragedy (AVTSM), in the city of Santa Maria, in the Rio Grande do Sul State, on 11 and 12 of April in 2017. Together with the analysis of the content of six interviews made with parents of the victims. The work made by AVTSM is of fundamental importance to mothers and fathers that participate in it, because it not only proportionate psychosocial activities to the members, it also strengthens the collective bond between them. Moreover, these activities have a therapeutic character and encourages the involved to get better and recover the will to live and adapt to the cruel reality that is living without their children.(AU)

Family Intervention Based on the FOCUS Program Effects on Cancer Coping in Iranian Breast Cancer Patients: a Randomized Control Trial

Background: Breast cancer affects patients' lives. Many breast cancer patients have problems with coping and they need support from their families. Family involvement based on the FOCUS program is designed to support breast cancer survivors within their families. The aim of this study was to investigate the effect of family involvement based on the FOCUS program on coping in breast cancer patients undergoing chemotherapy in academic centers in Urmia in 2016. Methods: In this randomized controlled trial study, sixty breast cancer survivors were randomly assigned into intervention (N=30) and control (N=30) groups. The FOCUS program family-based intervention featured six sessions covering subject areas of family involvement, optimism, cancer coping, uncertainty reduction and symptom management. The instruments used were demographic and cancer coping questionnaires. Data were analyzed with SPSS 20 software. Result: The findings revealed a significant improvement in total cancer coping scores (t= -12/39, p<0.001), in all subscales including individual (t= -11/52, p<0.001), positive focus (t= -7/03, p<0.001), coping (t= -7/28, p<0.001), diversion (t= -11/76, p<0.001), planning (t=-4/91, p<0.001) and in interpersonal (t=-11/14, p<0.001). No significant changes were observed for the control group. Conclusion: The results showed that family involvement based on the FOCUS program increases the ability to cope in breast cancer survivors.

A construção da responsabilidade relacional em terapia familiar / The construction the relational responsibility in family therapy

Este artigo tem como objetivo refletir acerca do processo de produção de sentidos sobre a mudança em terapia familiar na perspectiva da responsabilidade relacional. Utilizando o método da poética social, buscou-se identificar momentos marcantes do processo terapêutico de uma família que enfrentava o grave adoecimento de um de seus membros. Esses momentos compreenderam: (a) O agir no adoecimento; (b) Coconstruindo o cuidado; e (c) O cuidado com a vida. A análise desses momentos permitiu identificar como foi possível a promoção de inteligibilidades relacionais relativas a: (i) Outros internos; (ii) Relações conjuntas; (iii) Relações entre os grupos; e (iv) Processo sistêmico. Esse estudo apontou, assim, a viabilidade do uso e a inovação promovida pela perspectiva da responsabilidade relacional na clínica, gerando novas posições para familiares e terapeuta.(AU)

This paper aims to reflect on the process of producing meanings about change in family therapy from the perspective of relational responsibility. Using the method of social poetics. We sought to identify striking moments in the therapeutic process of family that faced the serious illness of one of its members. These moments comprised; (a) The course of illness, (b) Coconstructing care, and (c) Life care. This analysis of these moments allowed us to identify how it was possible to promote relational intelligibilities related to: (i) Other interns; (ii) Joint elations; (iii) Relationship between groups, and (iv) Systemic process. This study thus pointed to be viability of the used and the perspective of relational responsibility in the clinic generating new positions for family members and therapist.(AU)

Feasibility of a parent education and skills workshop for improving response to family-based treatment of adolescent anorexia nervosa.

OBJECTIVE: Early response to family-based treatment (FBT) is a robust predictor of positive outcomes for adolescents with anorexia nervosa (AN). We introduced a parent education and skills workshop in the first 4 weeks of treatment with the aim of improving changes in parent self-efficacy in FBT and, in turn, patient weight gain. METHOD: Forty-five families who had at least one parent attend the workshop were compared to a matched control of families who did FBT before the workshop was introduced. RESULTS: Among adolescents who were underweight at baseline, weight gain by Week 4 of treatment was higher for adolescents whose parents attended the workshop (M = 90.84% median BMI) than those who did not (M = 88.54% mBMI, p < .05). There was no significant difference in weight at Week 12 or at end of treatment, nor was there a difference in self-efficacy as measured by the Parent Versus Anorexia Scale. Participants reported a high level of satisfaction with the workshop and significant improvements in knowledge and confidence. DISCUSSION: Overall, the workshop was a feasible adjunct for improving early response to FBT.

7-Year follow-up of a lifestyle intervention in overweight children: Comparison to an untreated control group.

BACKGROUND & AIMS: We present the 7-year follow-up analysis in overweight children and adolescents, who had participated originally in a randomized control trial of a lifestyle intervention. We compared them to an untreated population-based control group to demonstrate the effectiveness of the intervention. METHODS: Degree of overweight (BMI-SDS) was determined in 32 overweight children (mean age 11.5 ± 1.5yrs, 65.6% females, mean BMI 23.7 ± 1.5 kg/m2) at onset of intervention (T0), end of 6-month intervention (T1), 12 months (T2) and 7 years after end of intervention (T3). A total of 76 overweight children derived from a representative national population survey served as control group. RESULTS: The participants in the intervention group reduced significantly their BMI-SDS between T0-T1 (mean ± standard deviation -0.28 ± 0.28, p < 0.001) and demonstrated no significant changes between T1-T2 (mean ± standard deviation -0.10 ± 0.34) and between T2-T3 (median +0.07; interquartile range: -0.54-0.62). BMI-SDS at T3 was significantly (p = 0.015) lower compared to T0. At T3, 46.8% of the participants in the intervention were normal-weight. The reduction in BMI-SDS between T0-T3 was significantly (p = 0.043) greater in the intervention group (median -0.26; interquartile range -0.87-0.23 BMI-SDS) compared to the control group (mean ± standard deviation -0.05 ± 0.77). CONCLUSIONS: The lifestyle intervention led to a significant reduction of overweight in the 7-year follow-up period. This decrease in BMI-SDS was significantly greater than the changes in BMI-SDS in a control group. This study is registered at clinicaltrials.gov (NCT00422916).

Outcomes of an enhancement study with additional psychoeducational sessions for healthy siblings of a child with cancer during inpatient family-oriented rehabilitation.

OBJECTIVE: Chronic illness of a child puts healthy children of the family at risk of distress. Previous studies have demonstrated that healthy children's psychological symptoms can be reduced when the child knows more about the disease. So far, there is limited evidence of the effectiveness of psychoeducational interventions for healthy children. AIMS: To compare the effectiveness of an inpatient family-oriented rehabilitation program with vs without additional psychoeducational sessions for healthy children of families with children with cancer. PATIENTS AND METHODS: We performed a controlled study in 4 German family-oriented rehabilitation clinics. The outcomes of n = 73 healthy children (mean age: M = 9.55; SD = 3.14; range: 4-18), who participated in 5 additional psychoeducational sessions, were compared with the outcomes of n = 111 healthy children (mean age: M = 8.85; SD = 3.28; range: 4-17), who underwent the usual inpatient rehabilitation program. Primary outcomes were the healthy children's cancer-specific knowledge and their emotional symptoms. Secondary outcomes were family satisfaction and quality of life. RESULTS: Intention-to-treat analyses showed that both groups improved significantly from preintervention to postintervention. Improvements comprised knowledge about cancer (F(1,174) = 11.03, p < 0.001), self-reported emotional symptoms (F(1,135) = 31.68, p < 0.001), and parent-proxy-reported emotional symptoms (F(1,179) = 37.07, p < 0.001). The additional psycho-educational program did not significantly enhance the outcomes. The same pattern of significant improvement in both conditions emerged for all secondary outcomes. The immediate effects of the intervention persisted until 2 months after discharge from the rehabilitation program. CONCLUSIONS: Inpatient family-oriented rehabilitation is effective in improving multiple psychosocial outcomes of healthy children in families which have a child with cancer. Additional psycho-educational sessions did not show any substantial additional improvement.

Outcomes of a family-based HIV prevention intervention for substance using juvenile offenders.

Approximately 80% of all arrested youth are diverted from detention and supervised in the community through probation, specialty courts and other community-based diversion efforts. Justice-involved youth have greater psychiatric impairment, substance use and sexual risk behaviors than their non-justice-involved peers. Family-based interventions to address mental health, substance use and recidivism have been successful in improving these youth outcomes; but the lack of integration of HIV/STI prevention is notable given the co-occurrence of substance use, delinquency and sexual risk-taking behaviors among justice-involved youth. Moreover, emotion dysregulation may be an important and understudied underlying construct of these co-occurring risk behaviors for justice-involved youth. Study participants were 47 caregiver-youth dyads enrolled in a juvenile drug court program. As part of a pilot efficacy trial, dyads were randomized to a 5-session family-based integrated substance use and HIV/STI prevention intervention that relied on affect management strategies for risk reduction or an adolescent-only psychoeducation condition matched for time and attention. Data collected at baseline and 3months post-intervention suggest that a family-based integrated affect management substance use and HIV prevention pilot intervention may lead to justice-involved youths' enhanced motivation to change their marijuana use, decreased marijuana use and decreased risky sexual behavior over time. Future research is required to replicate these pilot trial findings and should also examine family-level mediators and moderators of treatment response, particularly with respect to HIV prevention efforts for these youth.