Sociocultural Attunement to Vulnerability in Couple Therapy: Fulcrum for Changing Power Processes in Heterosexual Relationships.

Increasingly, couple therapists are called to promote equity in their clinical practice, yet little research illuminates the intricacy of doing this work. The purpose of this study was to clarify the clinical processes involved when therapists facilitate a more equitable balance of power in couple relationships while utilizing a sociocontextual frame of reference. It is part of larger research explicating Socio-Emotional Relationship Therapy (SERT), an approach that places equity and social justice at the core. The sample included 72 SERT sessions with nine heterosoexual couples in which there was an observable power difference between partners. Using Charmaz's (2014, Constructing grounded theory: A practical guide through qualitative analysis, Sage) grounded theory coding, theoretical sampling, and interpretive methods, we examined therapist/client responses over multiple sessions to explain shifts in the couples' power balance. Analysis identified sociocultural attunement to vulnerability as the core clinical process and detailed five sociocultural expressions: socialized vulnerability, socialized invulnerability, reactive (in)vulnerability, reactive vulnerability, and shared vulnerability. Shifts in power involved each of three therapist stances: (a) identification of the societal power context of vulnerability, (b) therapist leadership and responsive persistence, and (c) facilitating mutual sociocultural attunement to vulnerability to promote shared relational responsibility and influence. Implications address the connections between power and vulnerability in couples work and what therapists can do to more effectively facilitate relational equity.

Cada vez más, se exige a los terapeutas de pareja que promuevan la igualdad en su práctica clínica, sin embargo, existen pocas investigaciones que diluciden la complejidad de hacer este trabajo. El propósito de este estudio fue aclarar los procesos clínicos implicados cuando los terapeutas facilitan un equilibrio de poder más equitativo en las relaciones de pareja y a su vez utilizan un marco de referencia sociocontextual. Este estudio forma parte de una investigación más extensa que expone la terapia relacional socioemocional, un método que ubica a la igualdad y a la justicia social como ejes centrales. La muestra incluyó 72 sesiones de terapia relacional socioemocional con nueve parejas heterosexuales en las cuales había una diferencia de poder visible entre los integrantes de la pareja. Utilizando la codificación en la teoría fundamentada, el muestreo teórico y los métodos interpretativos de Charmaz (2014, Constructing grounded theory: A practical guide through qualitative analysis, Sage), analizamos las respuestas de los terapeutas/los pacientes durante varias sesiones para explicar los cambios en el equilibrio de poder de las parejas. El análisis identificó la adaptación sociocultural a la vulnerabilidad como proceso clínico principal y detalló cinco expresiones socioculturales: la vulnerabilidad socializada, la invulnerabilidad socializada, la (in)vulnerabilidad reactiva, la vulnerabilidad reactiva y la vulnerabilidad compartida. Los cambios en el poder implicaron cada una de tres posturas del terapeuta: (a) identificación del contexto de vulnerabilidad del poder social, (b) liderazgo del terapeuta y persistencia receptiva, y (c) facilitación de la adaptación sociocultural mutua a la vulnerabilidad para promover la responsabilidad y la influencia relacionales compartidas. Las implicancias abordan las conexiones entre el poder y la vulnerabilidad en el trabajo de las parejas y qué pueden hacer los terapeutas para facilitar más eficazmente la igualdad relacional.

Addressing Culture, Gender, and Power with Asian American Couples: Application of Socio-Emotional Relationship Therapy.

Asian Americans juggle the intersections of multiple social identities and societal discourses as they respond to experiences of immigration, marginalization, and patriarchy, integrate collectivist and individualistic family values, and form families and intimate relationships. In this study we examine what we have learned as we apply Socio-Emotional Relationship Therapy (SERT) with heterosexual couples of Asian heritage. SERT begins with sociocultural attunement and the assumption that relationships should mutually support each partner. Drawing on case examples, we illustrate how we practice sociocultural attunement as couples respond to the relational processes that comprise the Circle of Care (mutual influence, vulnerability, attunement, and shared relational responsibility). We emphasize three key socioemotional themes that intersect with gender: (1) intangible loss; (2) quiet fortitude/not burdening others; and (3) duty to the family.

Toward relationship-directed parenting: an example of North American born second-generation Korean-American mothers and their partners.

Historically, parenting has been constructed hierarchically; however, contemporary parenting models frequently emphasize parenting as relationship (Siegel & Hartzell [2004] Parenting from the inside out: How a deeper self-understanding can help you raise children who thrive; Tuttle, Knudson-Martin, & Kim [2012] Family Process, 51, 73-89). Drawing on interviews with 20 North American born second-generation Korean-American mothers and their partners, and sensitized by TP-CRO, a social constructionist framework for conceptualizing parent-child relational orientations, this grounded theory analysis identified three main processes that facilitate relational connection as a parenting orientation rather than the rule-directed approach historically associated with first-generation immigrant Asian families. These include: (a) emphasizing dominant culture values; (b) inviting open communication; and (c) promoting mutuality. Results also show how parents integrate collectivist cultural values of their first generation immigrant parents' traditional culture into North American parenting ideals with which they primarily identify. The study demonstrates the usefulness of the TP-CRO for understanding parent-child relationships within multicultural parenting contexts and offers suggestions for working with second-generation Korean families.

Parenting as relationship: a framework for assessment and practice.

Parenting tends to be framed as a set of actions directed toward the child rather than as a relationship. This article helps therapists, parent-educators, and researchers conceptualize parenting as a socioculturally embedded relationship. The authors apply the relational orientations typology (Silverstein, Bass, Tuttle, Knudson-Martin, & Huenergardt, 2006) to parent-child relationships. The typology addresses two dimensions: whether the focus is on the child's meeting parental expectations or on expectations of mutuality and whether power between parent and child is expected to be symmetrical or asymmetrical. Four relational orientations are described: (1) rule directed, (2) position directed, (3) independence directed, and (4) relationship directed. These relational orientations describe the nature of the reciprocal relationship between parent and child and offer a framework from which to address parenting issues. A case illustration shows how the relational orientations framework helps therapists incorporate a larger systems/relational perspective into what was originally framed primarily as a child behavior problem.

Human Colon Cancer-Derived Clostridioides difficile Strains Drive Colonic Tumorigenesis in Mice.

Defining the complex role of the microbiome in colorectal cancer and the discovery of novel, protumorigenic microbes are areas of active investigation. In the present study, culturing and reassociation experiments revealed that toxigenic strains of Clostridioides difficile drove the tumorigenic phenotype of a subset of colorectal cancer patient-derived mucosal slurries in germ-free ApcMin/+ mice. Tumorigenesis was dependent on the C. difficile toxin TcdB and was associated with induction of Wnt signaling, reactive oxygen species, and protumorigenic mucosal immune responses marked by the infiltration of activated myeloid cells and IL17-producing lymphoid and innate lymphoid cell subsets. These findings suggest that chronic colonization with toxigenic C. difficile is a potential driver of colorectal cancer in patients. SIGNIFICANCE: Colorectal cancer is a leading cause of cancer and cancer-related deaths worldwide, with a multifactorial etiology that likely includes procarcinogenic bacteria. Using human colon cancer specimens, culturing, and murine models, we demonstrate that chronic infection with the enteric pathogen C. difficile is a previously unrecognized contributor to colonic tumorigenesis. See related commentary by Jain and Dudeja, p. 1838. This article is highlighted in the In This Issue feature, p. 1825.

Stimulating reflective practice using collaborative reflective training in breaking bad news simulations.

Medical simulation has long been used as a way to immerse trainees in realistic practice scenarios to help them consolidate their formal medical knowledge and develop teamwork, communication, and technical skills. Debriefing is regarded as a critical aspect of simulation training. With a skilled debriefing facilitator, trainees are able to go beyond a rote review of the skills and steps taken to explore their internal process and self-reflect on how their experience during the simulation shaped their decision making and behavior. However, the sense of vulnerability is an aspect of experiential training that can raise a trainee's defensiveness. Anxiety increases when trainees anticipate being evaluated for their performance, or when the simulation scenario pertains to complex interpersonal activities such as learning how to break bad news (BBN), a commonly encountered aspect of medical practice with inadequate training. Thus, collaborative reflective training (CRT), developed out of ideas based in family therapy, was designed as an approach for facilitating open dialogue and greater self-reflection while receiving training in BBN. This article will discuss the conceptual framework of CRT, explain how it was developed, and describe the nature of how it was used with a team of neonatology and pediatric fellows and medical family therapy interns. (PsycINFO Database Record

Fostering self-awareness in collaborative reflective training: Commentary response.

Replies to comments by DeCaporale-Ryan, Dadiz, and Peyre (see record 2016-27364-002) on the original article by Kim, Hernandez, Lavery, and Denmark (see record 2016-18380-001). The current authors thank DeCaporale-Ryan, Dadiz, and Peyre for presenting a rich theoretical counterpoint to their article and respond to issues they raised regarding their collaborative reflecting team (CRT) model.