"A sincere 'how are you?' is already a sign of acknowledgement that you're there too." - Interview study on the support needs of adolescents and young adults (AYAs) living with a parent with cancer.

PURPOSE: Parental cancer brings changes and challenges which affect the whole family. Evidence shows heightened psychosocial risk among the offspring. Research among adolescents and young adults (AYAs) facing parental cancer has mainly focused on these psychosocial problems. As a reaction, there has been an increase in research on the needs of this population, since this knowledge is crucial for developing appropriate support. Despite this increase, some AYAs are still underrepresented, namely those over eighteen years old and those who have a parent with incurable cancer. Moreover, the factors hampering or fostering access to and receipt of support addressing their needs are under-investigated. Increasing our understanding of these issues is crucial to developing more effective support interventions for these young people. Our aim was therefore to gain insight into the perceived support needs of AYAs who have a parent with cancer, including the mentioned underrepresented subgroups, and the perceived factors facilitating or hindering their use of support. METHODS: We conducted semi-structured interviews with 17 AYAs who have a parent with cancer of any type and stage, which were analyzed using conventional Qualitative Content Analysis (QCA). RESULTS: Six main categories emerged from the data, encompassing various subcategories: 1) Needs surrounding the time of disclosure, 2) Information needs, 3) Informal support needs, 4) Need for effective personal coping strategies, 5) Formal support needs, and 6) Contextual and medical factors affecting support needs. AYAs perceived family members, friends and teachers as important sources of informal support, but lacked contact with peers who also have a parent with cancer. They expressed a need for formal informational and emotional support from their parent's medical team, (onco)psychologists, and their general practitioner. AYAs faced barriers in accessing formal support. A proactive attitude from healthcare providers and information about available support would help them meet their needs. Furthermore, we shed new light on needs and issues in post-secondary education. CONCLUSIONS: AYAs who are living with their parent with cancer experience informational, emotional, and practical needs in multiple contexts, such as the home, school, leisure and hospital environment. They identify their informal and formal network as important key figures in addressing these needs.

Protective factors enhancing resilience in children of parents with a mental illness: a systematic review.

Objectives: A systematic review was conducted to (1) investigate protective factors enhancing resilience in children of parents with a mental illness (COPMI), and (2) examine theoretical and methodological issues in the existing literature. Method: Following guidelines for systematic reviews, searches were performed using Web of Science, Pubmed and Embase. After screening 5,073 articles 37 fulfilled inclusion criteria and were extracted for review. Results of the present review indicate that there are several ways to help build resilience in COPMI. More specifically, five protective factors emerged from the reviewed literature: Information, Support, Family functioning and Connectedness, Child coping, and Parenting. Discussion: Research on protective factors in children confronted with parental mental illness is still scarce and for some factors no clear conclusions can be drawn based on the available evidence. To further our understanding of the building blocks and underlying mechanisms of resilience in COPMI, additional rigorously designed studies are needed.

Siblings Dealing with Pediatric Cancer: A Family- and Context-oriented Approach.

Background: Pediatric cancer is a severe life-threatening disease that poses significant challenges to the life of the siblings. Based on the social ecology model, the current study is aimed at exploring the association between intrafamilial (family functioning, family support) and contextual (network support) resources, and the individual adjustment of siblings facing cancer in their brother/sister. Methods: Participants were 81 siblings of children with leukemia or non-Hodgkin lymphoma. The mean siblings' age was 10.32 years. Siblings completed the Family Environment Scale, the Social Support Questionnaire for Children, the Situation-Specific Emotional Reactions Questionnaire, and the Pediatric Quality of Life Inventory. Data were analyzed using a multi-level approach. Results: Family functioning, family support, and network support proved to be related to siblings' cancer-related emotional reactions post-diagnosis. In addition, the present study suggests taking into account the gender of the ill child and the age of the siblings. Discussion: Our findings led to the conclusion that resources at both the intrafamilial level and the contextual level are important for explaining sibling adjustment post-diagnosis. Interventions targeting the sibling, the family, and the external network are warranted to enhance sibling adjustment.

The family practice of support-giving after a pediatric cancer diagnosis: A multi-family member interview analysis.

PURPOSE: Pediatric cancer presents many challenges to the life of the child diagnosed with cancer and his/her family. Among the studies investigating risk and protective factors, social support has emerged as an important construct. However, little is known on how family members support each other in this particular context. METHOD: In order to further explore this process, interviews were performed separately with mothers, fathers and siblings. For the purpose of this study (as this is part of a larger project), data from four families in which both parents and at least one sibling participated, were used. Multi Family Member Interview Analysis was used as the methodological framework to analyze the individual interviews, allowing a detailed and systematic analysis of shared family experiences. RESULTS: The analysis of the data revealed three themes: Being together matters: the families identified the need of being physically together; Finding support in (not) talking: the complexity of sharing emotions was explained and Working together as a team: the families described working together as a team in order to get everything organized. CONCLUSIONS: This study broadens our understanding of the interpersonal process of family support-giving when facing pediatric cancer. When meeting with families, families should be invited as a unit in order to best capture family level experiences. Also, clinicians should be sensitive to the different cancer-related communication needs within the family (i.e., the need to talk or not to talk) and incorporate this knowledge into their care.

Family Adjustment When Facing Pediatric Cancer: The Role of Parental Psychological Flexibility, Dyadic Coping, and Network Support.

OBJECTIVES: Pediatric cancer is a life-threatening disease that poses significant challenges to the life of all family members (diagnosed child, parents, and siblings) and the family as a whole. To date, limited research has investigated family adjustment when facing pediatric cancer. The aim of the current study was to explore the role of protective factors at the individual (parental psychological flexibility), intrafamilial (dyadic coping) and contextual level (network support) in explaining family adjustment as perceived by parents of children with leukemia or non-Hodgkin lymphoma. In addition, we were interested to see whether these protective factors could be predictive for family adjustment at a later time point. METHOD: Participants were 70 mothers and 53 fathers (80 families) of children with leukemia or non-Hodgkin lymphoma. Mean time since diagnosis was 5.26 (T1) and 18.86 (T2) months post-diagnosis. Parents completed the Acceptance and Action Questionnaire II (to assess psychological flexibility), Dyadic Coping Inventory, a network support questionnaire, Impact on Family Scale and the Family Adjustment Scale. Both concurrent and prospective association models were tested. RESULTS: Psychological flexibility, dyadic coping and network support proved to be cross-sectionally and positively related to parents' perception of family adjustment post-diagnosis; psychological flexibility and dyadic coping proved to predict better family adjustment over time. CONCLUSION: Our findings led to the conclusion that protective factors at all three levels (individual, intrafamilial and contextual) are important for explaining family adjustment as perceived by parents facing a diagnosis of cancer in their child. Interventions targeting the individual, couple, as well as family level are warranted to enhance family adjustment.

Siblings' Experiences of Everyday Life in a Family Where One Child Is Diagnosed With Blood Cancer: A Qualitative Study.

BACKGROUND: Childhood cancer not only presents challenges to the life of the child with cancer but also to the siblings' daily family life. The aim of the current study was to gain a better understanding of siblings' experiences of living in a family where one child has been diagnosed with blood cancer. METHOD: Ten siblings of children with leukemia or non-Hodgkin lymphoma completed a semistructured interview about their everyday family life experiences postdiagnosis. The verbatim transcripts of the interviews served as the data for an interpretative phenomenological analysis. RESULTS: The results showed that overall the siblings experienced a continuity in many aspects of their family life: they still experienced their family as an important source of support and information/communication, as warm and loving and as a safe harbor where family members aim to protect each other. However, at the same time, the participating siblings also expressed that some things felt unmistakably different postdiagnosis: They felt that their family as a whole had been ripped apart, with a greater focus on the diagnosed child and changing responsibilities for each family member. CONCLUSION: This study informs parents and clinicians about the daily family life experiences from the siblings' perspective, a perspective that is often overlooked. A focus on challenges as well as continuities within family life, the wish for connection expressed by the siblings, and the uniqueness of every sibling's experiences is what can be taken away from this study by psychosocial workers in the field.

Social Support, Adjustment, and Psychological Distress of Help-Seeking Expatriates.

The present study aimed to explore the interrelations between support processes, adjustment, and psychological distress within a sample of help-seeking expatriates. Specifically, we examined (1) the association between expatriates' cross-cultural adjustment (i.e., work, interaction and general adjustment) and levels of psychological distress (i.e., depression, anxiety and stress), (2) the association between expatriates' perceptions of socioemotional and instrumental support availability and their level of cross-cultural adjustment, and (3) the moderating role of expatriates' socioemotional and instrumental support needs in the latter association. Findings showed that lower levels of expatriates' work adjustment were associated with higher levels of psychological distress. Further, perceived availability of socioemotional support was positively linked to expatriates' interaction and work adjustment. Finally, instrumental support needs moderated the relationship between instrumental support availability and general adjustment such that higher levels of instrumental support availability were associated with better general adjustment, but only for expatriates reporting high needs for instrumental support. Our study represents a novel contribution to the expatriate literature by shedding light on expatriates' vulnerability for psychological distress and understanding the type of social support that is considered most beneficial for help-seeking expatriates. Suggestions are made for clinical interventions for expatriates in need of support.

Expatriate Family Adjustment: An Overview of Empirical Evidence on Challenges and Resources.

The current theoretical paper presents a comprehensive overview of findings from research attempting to understand what happens with expatriates and their families while living abroad. Our paper draws on research on adjustment of individual family members (expatriates, their partners, and children) and families as a whole, across different literatures (e.g., cultural psychology, family psychology, stress literature). The key challenges of expatriation are discussed, as well as family members' resources. Our findings lead to the following conclusions: First, there is lack of systematic research as studies are either missing a theoretical background or largely neglect the multi-informant approach. A comprehensive theory of expatriate family adjustment integrating multiple theoretical perspectives, including the culture identity formation and the impact of home country and host country culture, is called upon. Second, the majority of studies paid little attention to define the concept of family or failed to take into account the cultural aspect of relocation. Third, there is a call for more longitudinal studies including all family members as adjustment is a process that unfolds over time and therefore cannot be sufficiently explained by cross-sectional studies. Suggestions for future research and practical implications are provided, with a special focus on how families could be assisted during their adjustment process.

Parents' Perspectives of Changes Within the Family Functioning After a Pediatric Cancer Diagnosis: A Multi Family Member Interview Analysis.

Pediatric cancer is a life-threatening disease that challenges the life of the diagnosed child, the parents, and possible siblings. Moreover, it also places considerable demands on family life. The aim of this study was to explore changes in the family functioning after a pediatric cancer diagnosis. Ten couples who had a child with leukemia or non-Hodgkin lymphoma were interviewed individually about their experiences. Interviews were semistructured, and the data were analyzed using Multi Family Member Interview Analysis. Three themes emerged from the data: (a) Family Cohesion: Strengthened Versus Fragmented; (b) Educational Norms and Values: Overindulgence Versus Being Stricter, and (c) Normality: Loss Versus Preservation. The conflicting dynamics present in these emerging themes exemplify the complexity of this process of family adaptation. This study illustrates the need to take into account the family level, as well as the conflicting feelings parents may experience after a pediatric cancer diagnosis.

Helpers' Self-Assessment Biases Before and after Helping Skills Training.

Several studies have shown that therapists are generally biased concerning their performed helping skills, as compared to judges' ratings. As clients' ratings of therapists' performance are better predictors of psychotherapy effectiveness than judges' ratings, this study examined the validity and effectiveness of a helping skills training program at reducing novice helpers' self-enhancement biases concerning their helping skills, in comparison to their clients' ratings. Helping skills were assessed by three objective measures (a knowledge multiple choice test, a video test and a role play), as well as by a self- and peer-reported questionnaire. In addition, some performed helping skills' correlates (relationship quality, session quality, and helpers' therapeutic attitudes) were assessed both by helpers and their simulated helpees. Seventy-two sophomores in psychology participated to this study, 37 being assigned to a 12-h helping skills training program, and 35 to a control group. Helpers were expected to assess the aforementioned performed helping skills and correlates as being better than their helpees' assessments at pretest, thus revealing a self-enhancement bias. At posttest, we expected that trained helpers would objectively exhibit better helping skills than untrained helpers while beginning to underestimate their performance, thus indexing a self-diminishment bias. In contrast, we hypothesized that untrained helpers would continue to overestimate their performance. Our hypotheses were only partly confirmed but results reflected a skilled-unaware pattern among trainees. Trained helpers went either from a pretest overestimation to a posttest equivalence (performed helping skills and performed therapeutic attitudes), or from a pretest equivalence to a posttest underestimation (performed session quality and performed therapeutic relationship), as compared to helpees' ratings. Results showed that trained helpers improved on all helping skills objective measures and that helpees' perceptions of their performance had increased at posttest. In conclusion, helping skills training leads helpers not only to improve their helping skills but also to have more doubts about their skills, two variables associated with psychotherapy outcome.

Systematic Review: Associations Between Family Functioning and Child Adjustment After Pediatric Cancer Diagnosis: A Meta-Analysis.

Objectives: A systematic review and meta-analysis was conducted to investigate associations between family functioning and child adjustment (patient/siblings) after pediatric cancer diagnosis. Methods: Database searches were performed using Web of Science, Pubmed, Cochrane, PsycInfo, and Embase. After screening 5,563 articles, 35 were identified regarding this topic; 30 contributed data for meta-analyses. Pearson's r correlations were the effect of interest. Omnibus and family functioning domain-specific random-effects meta-analyses were conducted. Data are depicted in forest plots. Results: A statistically significant association was found between family functioning and child adjustment (patient/siblings) after cancer diagnosis (r = 0.19; 95% CI: 0.13­0.24). Greater family cohesion, expressiveness, and support and less family conflict were each associated with better child adjustment outcomes. Conclusions Family functioning is associated with patient and sibling adjustment after pediatric cancer diagnosis. Limitations in the existing literature preclude strong conclusions about the size of these effects and potential moderators.

Associations between Relational Pronoun Usage and the Quality of Early Family Interactions.

Our study examined the relationships of relational pronouns used in parental conversation to the quality of early family interactions, as indexed by Family Alliance (FA). We hypothesized that more positive family interactions were associated with the use of more we-pronouns (e.g., we, us, our; we-ness) and fewer I- and you-pronouns (e.g., I, me, you, your; separateness) by both mothers and fathers. Our statistical model using a multilevel modeling framework and two levels of analysis (i.e., a couple level and an individual level) was tested on 47 non-referred families (n = 31 primiparous families; child's age, M = 15.75 months, SD = 2.73) with we-ness and separateness as outcomes and FA functions as between-dyads variables. Analyses revealed that we-ness within the parental couple was only positively associated with family affect sharing while separateness was negatively associated with different FA functions (e.g., communication mistakes). Our main finding suggested that the kinds of personal pronouns used by parental couples when discussing children's education would be associated to the emotional quality of the family interactions.

Demand behavior and empathic accuracy in observed conflict interactions in couples.

The study reported in this research note sought to extend the research on motivated empathic accuracy by exploring whether intimate partners who are highly motivated to induce change in their partner during conflicts will be more empathically accurate than partners who are less motivated. In a laboratory experiment, the partners within 26 cohabiting couples were randomly assigned the role of conflict initiator. The partners provided questionnaire data, participated in a videotaped conflict interaction, and completed a video-review task. More blaming behavior was associated with higher levels of empathic accuracy, irrespective of whether one was the conflict initiator or not. The results also showed a two-way interaction indicating that initiators who applied more pressure on their partners to change were less empathically accurate than initiators who applied less pressure, whereas their partners could counter this pressure when they could accurately "read" the initiator's thoughts and feelings.

Systematic Review: Family Resilience After Pediatric Cancer Diagnosis.

OBJECTIVES: A systematic review was conducted to (1) investigate family resilience in the context of pediatric cancer, and (2) examine theoretical, methodological, and statistical issues in this literature. Family resilience was operationalized as competent family functioning after exposure to a significant risk. METHODS: Following guidelines for systematic reviews, searches were performed using Web of Science, Pubmed, Cochrane, PsycInfo, and Embase. After screening 5,563 articles, 85 fulfilled inclusion criteria and were extracted for review. RESULTS: Findings indicated that most families are resilient, adapting well to the crisis of cancer diagnosis. However, a subset still experiences difficulties. Methodological issues in the current literature hamper strong nuanced conclusions. CONCLUSIONS: We suggest future research with a greater focus on family resilience and factors predicting it, based on available theory, and conducted with attention toward unit of measurement and use of appropriate statistical analyses. Improvements in research are needed to best inform family-based clinical efforts.

When Is Helping your Partner with Chronic Pain a Burden? The Relation Between Helping Motivation and Personal and Relational Functioning.

OBJECTIVE: Self-determination theory (SDT) may be a useful framework to understand why chronic pain affects partners. SDT postulates that individuals can engage in helping behaviors for different motives varying from more autonomous or volitional motives to more controlled or pressured motives. This article examines the relationship between partners' type of motivation to help (i.e., autonomous vs controlled) and their personal and relational functioning. Furthermore, mechanisms underlying this relationship (i.e., helping exhaustion and relationship-based need satisfaction) were examined. METHODS: In a sample of 48 couples, of which one partner had chronic pain (36 female patients), questionnaires measuring life satisfaction, positive and negative affect, anxiety and depressive feelings, relationship quality and relationship-based need satisfaction were filled out. Individuals with chronic pain (ICPs) also reported on pain intensity and disability whereas partners were requested to report on motives for helping and helping exhaustion. RESULTS: Data analysis with Structural Equation Modeling revealed that autonomous, relative to controlled, motives for helping among partners related positively to partners' well-being and relationship quality, and negatively to distress. The experience of helping exhaustion and relationship-based need satisfaction mediated these associations. Moreover, partners' autonomous helping motivation related positively to patient-reported relationship quality among ICPs high in pain intensity. CONCLUSIONS: Applying SDT in a context of pain provides new insights into why chronic pain affects partners and how partners impact patient outcome. Directions for future research are outlined.

An integrative theory-driven positive emotion regulation intervention.

Over the past fifteen years, positive psychology research has validated a set of happiness enhancing techniques. These techniques are relatively simple exercises that allow happiness seekers to mimic thoughts and behavior of naturally happy people, in order to increase their level of well-being. Because research has shown that the joint use of these exercises increases their effects, practitioners who want to help happiness seekers need validated interventions that combine several of these techniques. To meet this need, we have developed and tested an integrative intervention (Positive Emotion Regulation program - PER program) incorporating a number of validated techniques structured around a theoretical model: the Process Model of Positive Emotion Regulation. To test the effectiveness of this program and to identify its added value relative to existing interventions, 113 undergraduate students were randomly assigned to a 6-week positive emotion regulation pilot program, a loving-kindness meditation training program, or a wait-list control group. Results indicate that fewer participants dropped out from the PER program than from the Loving-Kindness Meditation training. Furthermore, subjects in the PER group showed a significant increase in subjective well-being and life satisfaction and a significant decrease in depression and physical symptoms when compared to controls. Our results suggest that the Process Model of Positive Emotion Regulation can be an effective option to organize and deliver positive integrative interventions.

Empathy and social support provision in couples: social support and the need to study the underlying processes.

Social support researchers and clinicians have repeatedly expressed the need to identify the antecedents of social support provision within close relationships. The aim of the present study is to investigate the extent to which individual differences in cognitive empathy (perspective taking) and affective empathy (empathic concern and personal distress) are predictive of social support provision in couples. Study 1 involved 83 female participants in a relatively young relationship; Study 2 involved 128 married couples. The authors used self-report measures in both studies to assess individual differences in empathy and participants' support provision behaviors. The main findings suggest a significant contribution of the different components of empathy with rather different pictures for each of these components. The authors discuss the present findings in light of existing theory and research on social support in relationships.

Support provision in marriage: the role of emotional similarity and empathic accuracy.

The goal of this investigation was to identify microlevel processes in the support provider that may foster or inhibit the provision of spousal support. Specifically, the authors focused on (a) how emotional similarity between the support provider and support seeker and (b) how empathic accuracy of the support provider relate to support provision in marriage. In a laboratory experiment, 30 couples were randomly assigned to 1 of 2 conditions (support provider: man vs. woman) of a factorial design. The couples provided questionnaire data and participated in a social support interaction designed to assess behaviors when offering and soliciting social support. A video-review task was used to assess emotional similarity and empathic accuracy during the support interaction. As expected, greater similarity between the support provider's and support seeker's emotional responses, as well as more accurate insights into the support-seeking spouse's thoughts and feelings were found to be predictive of more skilful support (i.e., higher levels of emotional and instrumental support and lower levels of negative types of support).

Confirming the three-factor structure of the quality of relationships inventory within couples.

The current study further validates the Quality of Relationships Inventory (QRI; G. R. Pierce, I. G. Sarason, & B. R. Sarason, 1991) by evaluating its factor structure in a sample of 572 partners from 286 couples. Confirmatory factor analysis was used to compare 3 different models of the QRI and to investigate the invariance of the factor structure of the QRI across gender and across relationship satisfaction. Analyses revealed that a 3-factor solution--consisting of 3 different but interrelated factors (a 7-item support factor, a 12-item conflict factor, and a 6-item depth factor)--best accounted for the data. The authors' findings suggest that full metric invariance holds across gender and across relationship satisfaction in the female subsample, whereas only partial metric invariance could be established for relationship satisfaction in the male subsample.