Navigating intercultural misunderstandings: An examination of emotion brokering.

OBJECTIVES: Communication difficulties are inevitable when individuals interact with members of a different culture. The experience of such communication barriers may be particularly salient for those from immigrant families who need to navigate multiple cultures. Youth from immigrant families are known to serve as cultural brokers to help their families navigate communication with those in the host culture. Most brokering research has examined language brokering (i.e., interpreting language for others). An unstudied brokering process and the focus of the present research is emotion brokering: the interpretation of emotion norms for others. In this investigation, we examined the occurrence of emotion brokering for close family members in a sample of Latinx college students. METHOD: We conducted an exploratory survey to identify situations where participants perceived intercultural emotion-based misunderstandings and reported emotion brokering (Study 1). We then employed a more focused survey to further understand the contexts in which individuals brokered emotions (Study 2). RESULTS: Results revealed that many participants encountered intercultural emotion-based misunderstandings and experienced brokering emotions (Studies 1 and 2). Furthermore, the findings illustrated the typical contexts and emotions involved in the emotion brokering experience. CONCLUSIONS: The findings provide insight into a distinct form of cultural brokering. In addition, findings illustrate how cultural variation in emotion impacts daily social interactions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Parent affective responses to observed adolescent disclosures in the context of type 1 diabetes management.

Rates of Type 1 diabetes are rising, and diabetes management often deteriorates during adolescence. Adolescent disclosure to parents is a key factor for effective diabetes management, and parent affective responses to disclosures affect the timing of future disclosures in healthy populations, but no studies to our knowledge have examined parent affective behaviors that facilitate or inhibit disclosure in the context of managing Type 1 diabetes. The present study examined how observed parental affective responses to adolescent disclosures predict the timing of subsequent disclosures during a discussion task in a sample of adolescents with Type 1 diabetes and their parents (N = 66 dyads). Generalized linear mixed models were used to test whether increased or decreased levels of parent affect relative to their emotional baseline response to adolescent disclosures predicted the timing of subsequent disclosures. Adolescents took longer to disclose again when parents responded to prior adolescent disclosures with higher levels of anger and of positive affect relative to their baseline levels of these emotions. Findings suggest that parental affective responses to disclosures have implications for adolescent disclosure in the context of chronic illness management. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Division of Type 1 Diabetes Responsibility in Latinx and Non-Latinx White Mother-Adolescent Dyads.

Incidence rates of type 1 diabetes are increasing faster in Latinx youth than other ethnic groups, yet this population remains understudied. The current study (1) tested differences in division of diabetes-related responsibility (adolescent alone, mother alone, and shared) across Latinx and non-Latinx White families (N = 118 mother-adolescent dyads, 56 = Latinx dyads, Mage=13.24 years), and (2) examined associations between diabetes responsibility and adolescent health (HbA1c, diabetes self-management behaviors, and depressive symptoms). Latina mothers reported more shared and less adolescent responsibility than non-Latinx White mothers, but there were no ethnic differences in adolescent reports of responsibility. Independent of demographic and illness-related characteristics, mother- and adolescent-reports of shared responsibility were associated with higher self-management behaviors, while individual responsibility (adolescent or mother alone) was generally associated with lower self-management behaviors. Shared responsibility associations with higher mother-reported self-management behaviors occurred among Latinx families, but not non-Latinx White families. Shared and individual responsibility were not associated with HbA1c or depressive symptoms. The findings suggest the importance of shared responsibility for diabetes management in adolescence, particularly in Latinx families.

Parents' Empathic Accuracy: Associations With Type 1 Diabetes Management and Familism.

OBJECTIVE: To (1) test associations between parents' empathic accuracy for their adolescents' positive and negative emotions and adolescents' physical and mental health (HbA1c, diabetes self-care, and depressive symptoms) in a predominantly Latinx sample of adolescents with type 1 diabetes and their parents, and (2) explore how familism values were associated with parent empathic accuracy and adolescent physical and mental health in this population. METHODS: Parents and adolescents engaged in a discussion about a topic of frequent conflict related to the adolescents' diabetes management. Parents and adolescents subsequently completed a video recall task in which they rated their own and their partner's emotions once per minute; parents' empathic accuracy was calculated from an average discrepancy between parent and adolescent ratings of the adolescent's emotions. Adolescents reported on their depressive symptoms and both parents and adolescents reported on adolescents' diabetes self-care and their own familism values; HbA1c was obtained from medical records. RESULTS: Results from structural equation modeling revealed that parents' empathic accuracy for adolescents' negative (but not positive) emotions was uniquely associated with adolescents' HbA1c, self-care, and depressive symptoms. There was limited evidence that familism was related to parent empathic accuracy or adolescent physical and mental health. CONCLUSIONS: Promoting parents' empathic accuracy for adolescents' negative emotions in the context of type 1 diabetes management may have important implications for adolescents' mental and physical health.

Maternal psychological control and mother-adolescent conflict discussion quality: Different perceptions are key.

Parental psychological control is associated with poor adolescent outcomes, but little research has examined discrepancies between observed and perceived psychological control in predicting conversational outcomes. The present study used a multimethod, multi-informant approach to examine whether independent and joint associations between observer, adolescent, and mother perceptions of maternal psychological control during mother-adolescent conflict discussions were associated with adolescents' and mothers' perceptions of the quality of these conversations. Mother-adolescent dyads (N = 123 dyads) participated in a conflict discussion and subsequently reported on their satisfaction with the process and outcome of the discussion. Mothers' behavior was coded for psychological control and mothers and adolescents separately reported on mothers' psychological control during the discussion. Findings indicate that higher adolescent-perceived psychological control was associated with poorer adolescent- and mother-reported discussion quality controlling for overall relationship discord. Central to our hypotheses, observer, adolescent, and mother perceptions of psychological control significantly interacted with one another to predict discussion quality, though the specific pattern of findings varied across mother- and adolescent-reported discussion quality. Findings suggest that adolescent perceptions of discussion quality are poorest when adolescents attribute psychologically controlling behavior to mothers, particularly when mothers and outside observers report relatively lower levels of psychological control. This study highlights the importance of adolescent perceptions of parents' behavior and of obtaining information about behavior during parent-adolescent conversations from multiple reporters (observers, adolescents, and parents) to develop targeted interventions with parents and adolescents managing conflict. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Associations Between Sleep and Mental Health Among Latina Adolescent Mothers: The Role of Social Support.

Adolescent mothers experience poorer sleep than adult mothers, and Latina adolescent mothers are at greater risk of postpartum depression compared with other racial/ethnic groups. However, social support may be protective against the negative effects of poor sleep in this population. The current study examined (1) associations between the quality and quantity of Latina adolescent mothers' sleep and mental health (depressive symptoms and anxiety), and (2) whether social support buffered the effects of poor sleep on mental health. A sample of Latina adolescent mothers (N = 84) from an agricultural region in the United States reported on their sleep duration/quality, social support from family, friends, and significant others, and their depressive and anxiety symptoms. Results showed that adolescent mothers reported poorer sleep than pediatric recommendations, and poorer sleep quality was associated with greater depressive and anxiety symptoms. Interestingly, when adolescent mothers reported better sleep, they had fewer depressive symptoms in the context of high support from friends compared with low support from friends. Sleep is important for mental health in Latina adolescent mothers, and better sleep combined with strong social support has positive associations with mental health in this population. Findings hold implications for improving mental health in adolescent mothers.

Horizontal Collectivism Moderates the Relationship Between in-the-Moment Social Connections and Well-Being Among Latino/a College Students.

Sleep problems and poorer well-being may be particularly salient for Latino/a college students as they tend to experience sociocultural adjustments during this transitory time. Social connections, a correlate of health, change moment-to-moment for college students and may be experienced differently for people who more strongly endorse horizontal collectivist cultural values. We used ecological momentary assessment (EMA) to examine how in-the-moment social connections influence in-the-moment health, and how horizontal collectivism moderates the moment-to-moment associations. Self-identified Latino/a college students (n = 221) completed a demographic information and cultural values questionnaire and then responded to EMA measures on their social connections, affective and subjective well-being, and sleep for 14 consecutive days. Better in-the-moment social connections associated with better health. Horizontal collectivism moderated some, but not all associations between social connections and health. Social connections are multidimensional and differently predict in-the-moment health among Latino/a college students who more strongly endorse horizontal collectivistic values. We discuss implications for identifying vulnerable well-being moments among this understudied population.

Parent-Child Conflict Profiles in Chinese American Immigrant Families: Links to Sociocultural Factors and School-Age Children's Psychological Adjustment.

Research suggests that parent-child conflict is a salient family process in Asian immigrant families and often a stressful experience for Asian American youth due to value discrepancies between Asian and Western cultures. The present study examined ratings of parent-child conflict across conflict topics from parents' and children's perspectives in a sample of Chinese American immigrant families with school-age children (N = 239; age = 7.5-11 years). Latent profile analyses identified three parent-rated conflict profiles and four child-rated conflict profiles. Parent and child conflict profiles were unrelated to each other and differentially related to family sociocultural factors and children's psychological adjustment. Parents' moderate conflict profile scored highest on parent-rated child behavior problems and had the highest household density and lower parent Chinese orientation. Children's moderate-specific and high conflict profiles scored higher on child-reported behavior problems than the low conflict profile. These results highlight the need to assess family conflict from both parents' and children's perspectives and target parent-child conflict communication as a pathway to prevent or reduce behavioral problems in Chinese American children of immigrant families.

Las investigaciones sugieren que el conflicto entre padres e hijos es un proceso familiar destacado en las familias de inmigrantes asiáticos, y generalmente una experiencia estresante para los jóvenes estadounidenses de origen asiático debido a las discrepancias de valores entre las culturas asiáticas y occidentales. El presente estudio analizó las evaluaciones del conflicto entre padres e hijos entre varios temas de conflicto desde las perspectivas de los padres y los hijos en un muestra de familias de inmigrantes sinoestadounidenses con niños en edad escolar (N = 239; edad = 7.5 a 11 años). Los análisis de perfiles latentes identificaron tres perfiles de conflicto evaluados por los padres y cuatro perfiles de conflicto evaluados por los niños. Los perfiles de conflicto de los padres y los hijos no se relacionaron entre sí, y estuvieron asociados diferencialmente con los factores socioculturales familiares y con los resultados de la adaptación de los niños. El perfil de conflicto moderado de los padres tuvo el puntaje más alto en los problemas de comportamiento de los niños evaluados por los padres, tuvo la densidad familiar más alta y una menor orientación china de los padres. Los perfiles de conflicto alto y moderado-específico de los niños tuvieron un mayor puntaje en los problemas de comportamiento informados por los niños que el perfil de conflicto bajo. Estos resultados destacan la necesidad de evaluar el conflicto familiar tanto desde las perspectivas de los padres como desde las de los niños y se centran en la comunicación de conflictos entre padres e hijos como vía para evitar o reducir los problemas de comportamiento en los niños sinoestadounidenses de familias inmigrantes.

Mother-adolescent emotion dynamics during conflicts: Associations with perspective taking.

Parent-adolescent emotion dynamics are central to psychosocial adjustment during this developmental period. Perspective taking-the ability to take another's point of view into consideration-develops significantly during adolescence and is important for successful interpersonal functioning in contexts such as conflicts between family members. We used grid-sequence analysis (Brinberg, Fosco, & Ram, 2017) to examine interdyad differences in mother-adolescent emotion dynamics during a conflict discussion, and whether interdyad differences were associated with maternal and adolescent perspective taking. Mothers and their typically developing adolescents (N = 49, Mage = 14.84 years) were video-recorded during a 10-min conflict discussion. We identified patterns of multistep chains of expressed emotions that unfolded during the conflict and how interdyad differences in those patterns were associated with maternal and adolescent perspective taking. Dyads differed with respect to whether they showed turn taking in validation and interest behaviors, or whether they showed patterns of reciprocated negative affect. Higher adolescent but not maternal perspective taking was associated with dyadic turn taking of validation and interest. Maternal and adolescent perspective taking were not associated with the pattern of reciprocated negative affect. Taken together, results highlight the importance of examining the complex process of emotion dynamics in parent-adolescent interactions. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Timing of adolescent emotional disclosures: The role of maternal emotions and adolescent age.

Adolescent disclosure is a positive feature of parent-adolescent relationships, though disclosure to parents typically declines across adolescence. However, little is known about parental emotions that facilitate or inhibit real-time adolescent disclosures about their emotions and how parents respond to such disclosures during parent-adolescent interactions. The present study tested (1) whether maternal emotions were associated with the time to adolescents' spontaneous emotional disclosures and (2) whether these associations varied as a function of adolescent age. Adolescents (N = 49, Mage = 14.84 years) and their mothers participated in a 10-min conflict discussion. Adolescent emotional disclosures and maternal emotions were coded moment-to-moment. Results from survival analysis demonstrated that older adolescents whose mothers expressed high levels of negative affect or high levels of validation were more likely to make emotional disclosures earlier in the discussion than were older adolescents whose mothers expressed low negative affect or low validation. There were no differences in associations between maternal emotions and the timing of emotional disclosures for younger adolescents. Findings suggest that a range of maternal emotions (validation and negative affect) might be features of high-quality mother-adolescent relationships in older adolescence, when parent-adolescent relationships are more egalitarian and negative emotions may be more readily expressed. Implications for applying observational methodologies and dynamic statistical techniques to the adolescent disclosure literature are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Intrusive Parenting in Chinese American Immigrant Families: Relations with Cultural Orientations and Children's Adjustment.

This multi-method study examined associations between observed and parent- and child-reported intrusive parenting, parent and child cultural orientations, and children's adjustment in a socioeconomically diverse sample of Chinese American immigrant families. Participants were 239 Chinese American school-aged children (M age = 9.19 years, range = 7.49 to 10.96 years) and their parents from first- and second-generation immigrant families. Parents and children reported on parents' intrusive parenting, their own cultural orientations, and parents and teachers reported on children's internalizing and externalizing problems. Observed intrusive parenting behaviors were coded from videotaped parent-child conflict discussions. Findings from path analysis indicated that there was a unique positive association between child Chinese orientation and child-reported intrusive parenting, a unique negative association between parents' American orientation and child reported intrusive parenting, and a unique positive association between child American orientation and observed intrusive parenting. Intrusive parenting was negatively associated with child adjustment, but associations varied depending on measurement. Findings suggest that different measures of intrusive parenting are differentially associated with children's adjustment in Chinese American immigrant families.

Adolescent Information Management and Parental Knowledge in Non-Latino White and Latino Youth Managing Type 1 Diabetes.

Objectives: The objective of this study is to examine associations between adolescents' regulation of information about their type 1 diabetes (adolescent disclosure, secrecy), parental knowledge about their adolescent's diabetes management, diabetes outcomes (adherence, HbA1c), and depressive symptoms in Non-Latino White and Latino families. Methods: In all, 118 adolescents (56 = Latino, 62 = Non-Latino White) completed surveys of disclosure to and secrecy from parents, parental knowledge of adolescent diabetes management, adherence, and depressive symptoms, and mothers completed measures of maternal knowledge and adolescent adherence. Glycemic control was extracted from medical records. Adolescents also completed structured interviews about parental knowledge about their diabetes-related problems. Results: Interviews revealed that adolescent disclosure is the primary method by which parents gain knowledge about adolescent diabetes management problems. Adolescent disclosure to and secrecy from parents were uniquely associated with diabetes management and depressive symptoms independent of parental knowledge across ethnic groups; maternal reports of knowledge about her adolescent's diabetes care activities were associated with diabetes management independent of adolescent disclosure and secrecy. Conclusions: Adolescent information management strategies are a primary means by which parents gain knowledge about diabetes, which may facilitate more effective management.

Adolescent Disclosure to Parents and Daily Management of Type 1 Diabetes.

Objective: To examine how adolescents' daily disclosure to parents about type 1 diabetes management may foster a process whereby parents gain knowledge and are viewed as helpful in ways that may aid diabetes management. Methods: A total of 236 late adolescents (M age = 17.76) completed a 14-day diary where they reported daily disclosure to, and solicitation from, their parents, how knowledgeable and helpful parents were, and their self-regulation failures and adherence; blood glucose was gathered from meters. Results: Multilevel models revealed that adolescent disclosure occurred in the context of greater parent solicitation and face-to-face contact and was positively associated with adolescents' perceptions of parental knowledge and helpfulness. Disclosure to mothers (but not to fathers) was associated with better diabetes management (fewer self-regulation failures, better adherence). Conclusions: Adolescent disclosure may be an important way that parents remain knowledgeable about diabetes management and provide assistance that serves to support diabetes management.

An exploratory analysis of emotion dynamics between mothers and adolescents during conflict discussions.

Dynamic patterns of influence between parents and children have long been considered key to understanding family relationships. Despite this, most observational research on emotion in parent-child interactions examines global behaviors at the expense of exploring moment-to-moment fluctuations in emotions that are important for relational outcomes. Using recurrence quantification analysis (RQA) and growth curve analysis, this investigation explored emotion dynamics during parent-adolescent conflict interactions, focusing not only on concurrently shared emotional states but also on time-lagged synchrony of parents' and adolescents' emotions relative to one another. Mother-adolescent dyads engaged in a 10-min conflict discussion and reported on their satisfaction with the process and outcome of the discussion. Emotions were coded using the Specific Affect Coding System (SPAFF) and were collapsed into the following categories: negativity, positivity, and validation/interest. RQA and growth curve analyses revealed that negative and positive emotions were characterized by a concurrently synchronous pattern across all dyads, with the highest recurrence rates occurring around simultaneity. However, lower levels of concurrent synchrony of negative emotions were associated with higher discussion satisfaction. We also found that patterns of negativity differed with age: Mothers led negativity in dyads with younger adolescents, and adolescents led negativity in dyads with older adolescents. In contrast to negative and positive emotions, validation/interest showed the time-lagged pattern characteristic of turn-taking, and more highly satisfied dyads showed stronger patterns of time-lagged coordination in validation/interest. Our findings underscore the dynamic nature of emotions in parent-adolescent interactions and highlight the important contributions of these moment-to-moment dynamics toward overall interaction quality. (PsycINFO Database Record

Secrecy From Parents and Type 1 Diabetes Management in Late Adolescence.

OBJECTIVES: This study examined (a) associations of parent-adolescent relationship characteristics and adolescent problem behavior with late adolescents' secrecy from parents about type 1 diabetes management, and (b) whether secrecy was associated with diabetes and psychological outcomes independently of these factors. METHODS: Adolescents (N = 247, Mage = 17.76 years) completed survey measures of diabetes-related secrecy from parents, disclosure, parental acceptance, parental knowledge, and conduct problems. Mothers and adolescents reported on adolescent adherence to diabetes regimens and adolescents reported their depressive symptoms. Glycemic control was obtained from HbA1c test kits. RESULTS: Adolescent-reported disclosure to parents was uniquely negatively associated with secrecy from parents. Controlling for relationship variables, conduct problems, and sociodemographic and illness-related variables, secrecy from mothers was uniquely associated with poorer glycemic control and secrecy from both parents was associated with lower adherence. CONCLUSIONS: Secrecy about type 1 diabetes management is uniquely associated with diabetes outcomes independent of other relationship characteristics and problem behaviors.

Chinese American immigrant parents' emotional expression in the family: Relations with parents' cultural orientations and children's emotion-related regulation.

The present study examined 2 measures of Chinese American immigrant parents' emotional expression in the family context: self-reported emotional expressivity and observed emotional expression during a parent-child interaction task. Path analyses were conducted to examine the concurrent associations between measures of emotional expression and (a) parents' American and Chinese cultural orientations in language proficiency, media use, and social affiliation domains, and (b) parents' and teachers' ratings of children's emotion-related regulation. Results suggested that cultural orientations were primarily associated with parents' self-reported expressivity (rather than observed emotional expression), such that higher American orientations were generally associated with higher expressivity. Although parents' self-reported expressivity was only related to their own reports of children's regulation, parents' observed emotional expression was related to both parents' and teachers' reports of children's regulation. These results suggest that self-reported expressivity and observed emotional expression reflect different constructs and have differential relations to parents' cultural orientations and children's regulation.

Associations of parent-adolescent relationship quality with type 1 diabetes management and depressive symptoms in Latino and Caucasian youth.

OBJECTIVE: To examine associations of parent-adolescent relationship quality (parental acceptance and parent-adolescent conflict) with adolescent type 1 diabetes management (adherence and metabolic control) and depressive symptoms in Latinos and Caucasians. METHODS: In all, 118 adolescents and their mothers (56 = Latino, 62 = Caucasian) completed survey measures of parental acceptance, diabetes conflict, adolescent adherence, and adolescent depressive symptoms. Glycemic control was obtained from medical records. RESULTS: Across ethnic groups, adolescent-reported mother and father acceptance were associated with better diabetes management, whereas mother-reported conflict was associated with poorer diabetes management and more depressive symptoms. Independent of socioeconomic status, Latinos reported lower parental acceptance and higher diabetes conflict with mothers than Caucasians. Ethnicity moderated some associations between relationship quality and outcomes. Specifically, diabetes conflicts with mothers (mother and adolescent report) and fathers (adolescent report) were associated with poorer mother-reported adherence among Caucasians, but not among Latinos. CONCLUSIONS: Parent-adolescent relationship quality differs and may have different relations with diabetes management across Latinos and Caucasians.

Parent-child cultural orientations and child adjustment in Chinese American immigrant families.

Direct and indirect/mediated relations of (a) children's and parents' cultural orientations and (b) parent-child gaps in cultural orientations to children's psychological adjustment were examined in a socioeconomically diverse sample of 258 Chinese American children (age = 6-9 years) from immigrant families. Parents reported on children's and their own Chinese and American orientations in language proficiency, media use, and social relationships. Parents and teachers rated children's externalizing and internalizing problems and social competence. Using structural equation modeling, we found evidence for both the effects of children's and parents' cultural orientations and the effects of parent-child gaps. Specifically, children's American orientations across domains were associated with their better adjustment (especially social competence). These associations were partly mediated by authoritative parenting. Parents' English and Chinese media use were both associated with higher authoritative parenting, which in turn was associated with children's better adjustment. Furthermore, greater gaps in parent-child Chinese proficiency were associated with children's poorer adjustment, and these relations were partly mediated by authoritative parenting. Together, the findings underscore the complex relations between immigrant families' dual orientations to the host and heritage cultures and children's psychological adjustment.

Neighborhood characteristics, parenting styles, and children's behavioral problems in Chinese American immigrant families.

Using data from a socioeconomically diverse sample of Chinese American children (n = 258, aged 6-9 years) in immigrant families, we examined the concurrent relations among neighborhood economic disadvantage and concentration of Asian residents, parenting styles, and Chinese American children's externalizing and internalizing problems. Neighborhood characteristics were measured with 2000 U.S. Census tract-level data, parents (mostly mothers) rated their own parenting styles, and parents and teachers rated children's behavioral problems. Path analysis was conducted to test two hypotheses: (a) parenting styles mediate the relations between neighborhood characteristics and children's behavioral problems, and (b) children's behavioral problems mediate the relations between neighborhood and parenting styles. We found that neighborhood Asian concentration was positively associated with authoritarian parenting, which in turn was associated with Chinese American children's higher externalizing and internalizing problems (by parents' reports). In addition, neighborhood economic disadvantage was positively related to children's externalizing problems (by parents' reports), which in turn predicted lower authoritative parenting. The current results suggest the need to consider multiple pathways in the relations among neighborhood, family, and child adjustment, and they have implications for the prevention and intervention of behavioral problems in Chinese American children.

Relations of SARS-related stressors and coping to Chinese college students' psychological adjustment during the 2003 Beijing SARS epidemic.

This study examined the main and interactive relations of stressors and coping related to severe acute respiratory syndrome (SARS) with Chinese college students' psychological adjustment (psychological symptoms, perceived general health, and life satisfaction) during the 2003 Beijing SARS epidemic. All the constructs were assessed by self-report in an anonymous survey during the final period of the outbreak. Results showed that the relations of stressors and coping to psychological adjustment varied by domain of adjustment. Regression analyses suggested that the number of stressors and use of avoidant coping strategies positively predicted psychological symptoms. Active coping positively predicted life satisfaction when controlling for stressors. Moreover, all types of coping served as a buffer against the negative impact of stressors on perceived general health. These findings hold implications for university counseling services during times of acute, large-scale stressors. In particular, effective screening procedures should be developed to identify students who experience a large number of stressors and thus are at high risk for developing mental health problems. Intervention efforts that target coping should be adapted to take account of the uncontrollability of stressors and clients' cultural preferences for certain coping strategies. A multidimensional battery of psychological adjustment should be used to monitor clients' psychological adjustment to stressors and evaluate the efficacy of intervention.