What would you say? Expressing the difficulties of living with multiple sclerosis.

This article used a mixed method approach to analyze qualitative and quantitative responses from individuals with multiple sclerosis (MS) to determine differences when patients' perceived stress levels and perceived quality of support are taken into account. Understanding the differences in these responses can help us understand how illness, specifically MS, may influence the relational messages sent by patients to their loved ones. Responses to both quantitative and qualitative questions were obtained from 145 persons who have been diagnosed with MS. Participants responded to scale questions measuring daily stress levels and levels of social support and were divided into four groups on the basis of their scores (low/low, high/low, high/high, and high/low). Thematic analysis was performed on the qualitative responses, and differences were analyzed based on participants' grouping. Additional outcome variables measuring quality of life, anxiety, depression, helplessness, and acceptance were also analyzed to determine the similarities and differences between the groupings. The information presented in this article both informs and supports the idea that patients' levels of stress and perception of support are two major variables that impact their responses to their loved ones and their scores on several outcome variables.

Invisible and visible symptoms of multiple sclerosis: which are more predictive of health distress?

The purpose of this study was to examine whether it is the invisible or the visible symptoms or signs of multiple sclerosis (MS) that are associated with greater health distress. Visible symptoms include the use of assistive devices, problems with balance, and speech difficulties, while invisible symptoms include fatigue, pain, depression, and anxiety. In a sample of 145 adults with MS, participants reported on these symptoms and their current level of self-reported health distress. Hierarchical regression analyses were used to determine whether invisible or visible symptoms were more predictive of health distress. When visible symptoms were added as the first step in the regression, 18% of the variance in health distress was explained. When invisible symptoms were added as the first step, 53% of the variance was accounted for. The invisible symptoms of pain and depression were the most significant predictors of distress. For a subset of the sample that had had MS for more than 11 years, pain and depression continued to be important predictors, but assistive-device use and fatigue were also important. Nurses should be aware that invisible symptoms may be more troubling to patients than visible symptoms and should ensure that adequate screening and treatment are provided for those with MS.

Multiple sclerosis patients talking with healthcare providers about emotions.

The purpose of this study was to consider multiple sclerosis (MS) patients' experiences of talking with healthcare professionals about emotions and their emotional well-being both at the time of diagnosis and while they are living with the illness. Relationships between talking about emotions and positive outcomes were examined. The 145 respondents completed a paper-and-pencil survey, an Internet survey, or a telephone interview. Forty-four percent of respondents indicated that a healthcare provider had discussed their emotional well-being at the time of their diagnosis. Fifty-six percent of respondents reported that their healthcare professional had talked with them about their fears, sadness, and anger related to living with their illness. For those respondents who wanted to talk with their healthcare professional, doing so appeared to be associated with several positive outcomes. The small number (N = 22) of respondents who did not want to talk with a healthcare professional about emotions were also doing well on several measures. Nurses can help MS patients deal with their uncertainty and emotional challenges by being willing to inquire about emotions and emotional well-being.

Responding to remediation and gatekeeping challenges in supervision.

Thirty faculty in randomly selected Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE) programs representing four geographical regions of the United States were asked to respond to a survey that included seven brief vignettes depicting gatekeeping and remediation challenges supervisors may face when working with therapists-in-training. Research participants were asked to select from among a range of 17 response options and were also asked to provide a rationale for the selection of their responses. The response rate for the mailed survey was 34%. Telephone interviews were conducted with three respondents who had provided especially detailed responses to the open-ended portions of the mailed survey and who also volunteered to be questioned regarding how supervision decisions are made. Results support the conclusion that COAMFTE faculty take their gatekeeping function seriously as they balance commitments to multiple stakeholders. When presented with hypothetical "bare-bones" vignettes, the supervisors in our study consistently recommended talking with the student in order to more fully understand the context of the student's performance problem before deciding how to proceed. Supervisors recommended a variety of remediation efforts, but reserved the most severe consequences, such as probation, dismissal, and filing an ethics complaint, for the vignette involving dishonesty and lack of personal integrity.

Student impairment and remediation in accredited marriage and family therapy programs.

This research addresses the extent of student impairment in Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE) accredited marriage and family therapy programs, indicators of impairment used by program directors, faculty time devoted to impaired students, and the frequency of student dismissal. The data come from a survey of 44 COAMFTE program directors that was conducted during the spring of 2001, as well as responses to an open-ended items asking for a description of "the most troublesome student" to come to the attention of the respondent. The authors discuss the findings with respect to similar studies in counseling psychology and the larger literature on clinical training. Finally, the authors offer suggestions for future research.

Emotional processes following disclosure of an extramarital affair.

In-depth interviews with individuals who had experienced marital infidelity revealed a three-stage process following disclosure of an affair. The process starts with an "emotional roller coaster" and moves through a "moratorium" before efforts at trust building are recognized. Implications for the literature on forgiveness and the process of change in couples therapy are discussed as well as implications for future research and for practice.