Protective self-presentation style: association with disordered eating and anorexia nervosa mediated by sociocultural attitudes towards appearance.

OBJECTIVE: We tested the hypothesis that a protective self-presentation style (Lennox and Wolfe, 1984) is associated with eating pathology and anorexia nervosa (AN) and that this association is mediated by sociocultural attitudes towards appearance emphasizing the thin ideal. METHOD: We compared the protective-presentation style of women with AN (N=17), partially recovered women (N=110), fully recovered women (N=73), and female controls (N=374). RESULTS: Ill women had a more protective self-presentation style than partially or fully recovered women, who in turn had a more protective self-presentation style than controls. Sociocultural attitudes towards appearance fully mediated the association between protective self-presentation and disordered eating. CONCLUSIONS: Protective self-presentation may therefore be a risk factor for AN and/or a prognostic factor. Implications for therapy and prevention are discussed.

Family support and acceptance, gay male identity formation, and psychological adjustment: a path model.

While heterosexist family undermining has been demonstrated to be a developmental risk factor in the life of persons with same-gender orientation, the issue of protective family factors is both controversial and relatively neglected. In this study of Israeli gay males (N = 114), we focused on the interrelations of family support, family acceptance and family knowledge of gay orientation, and gay male identity formation, and their effects on mental health and self-esteem. A path model was proposed based on the hypotheses that family support, family acceptance, family knowledge, and gay identity formation have an impact on psychological adjustment, and that family support has an effect on gay identity formation that is mediated by family acceptance. The assessment of gay identity formation was based on an established stage model that was streamlined for cross-cultural practice by defining three basic processes of same-gender identity formation: self-definition, self-acceptance, and disclosure (Elizur & Mintzer, 2001). The testing of our conceptual path model demonstrated an excellent fit with the data. An alternative model that hypothesized effects of gay male identity on family acceptance and family knowledge did not fit the data. Interpreting these results, we propose that the main effect of family support/acceptance on gay identity is related to the process of disclosure, and that both general family support and family acceptance of same-gender orientation play a significant role in the psychological adjustment of gay men.

A framework for the formation of gay male identity: processes associated with adult attachment style and support from family and friends.

We propose a novel conceptual framework for the study of gay male identity formation in relation to the person's self, family, and social relations. The three basic processes of gay male identity are defined--self-definition, self-acceptance, and disclosure--and theoretically linked to attachment style and social support. The results, based on an Israeli sample of gay men (n = 121), indicated that self-acceptance and friends' support predict secure attachment in close adult relationships, and that self-definition and support from family and friends predict disclosure. Supportive family attitudes toward same-sex orientation mediated the effect of general family support on disclosure. These results suggest that the independent assessment of identity processes provides a flexible alternative to stage models' assumption of a single linear developmental process, that the formation of gay identity is associated with inner models of adult relationships, and that support of family and friends have a different role in the coming out process and in the formation of one's adult attachment model.

Cultural systemic therapy on the kibbutz: community and family-based treatment of anorexia nervosa.

A cultural approach to therapy assumes that community organization and social ideology can contribute to the genesis and maintenance of mental health problems, and also to their resolution. Cultural systemic therapy applies this insight to all relevant levels of the family-community ecosystem. This is demonstrated by focusing on the treatment of anorexia nervosa in the Israeli kibbutz. We analyze the confluence of cultural characteristics with the anorectic syndrome and then illustrate in a case study of how these characteristics can be employed in therapy. Two particular interventions are delineated to document the powerful impact that can be achieved when this approach is applied to severe and long-term disorders: the establishment and ongoing collaboration with an expanded community/family team and a home confinement program.

Psychosocial adjustment and mental health two months after coronary artery bypass surgery: a multisystemic analysis of patients' resources.

Resources related to cardiac patients' sense of self, marital quality, and social support were assessed before their first planned bypass surgery to determine their relationship with later psychosocial functioning. Six female and 45 male cardiac patients, 45-70 years old, answered self-report instruments 1 week before and 8-10 weeks after the operation. Regression analyses indicated that only the marital relationship variables made independent contributions to the prediction of functioning. Since self-report measures of resources can be affected by negative affectivity, a second level of analysis predicted change scores while controlling for initial levels of functioning. Marital flexibility and support were found to make an independent contribution to recovery. These results highlight the importance of marital resources in coping with the acute phase following bypass surgery and have implications for prevention and clinical practice.

Involvement, collaboration, and empowerment: a model for consultation with human-service agencies and the development of family-oriented care.

Systems consultation to provider agencies can contribute considerably to the development of a collaborative, family-oriented approach in these agencies. The possibilities for such an undertaking depend on the establishment of working relationships at two interfaces: between the system consultant and the agency, and between the agency and its client families. A framework for developing these relationships in three sequential phases is proposed: involvement, collaboration, and empowerment (ICE). Each phase is characterized by a dominant issue that is processed at the time. It is possible for relationships to begin at a more advanced phase and to work through two or more phases simultaneously. However, premature attempts to do so, which often occur in agencies' work with involuntary clients and "difficult to engage" families, generate resistance and lead to an impasse. The applicability and usefulness of the ICE model is demonstrated by presenting the 6-year development of a family involvement and partnership program in Israel's juvenile correction system.

Bridging individual, family and community care: a comprehensive treatment program for the chronic mentally ill.

For about 25 years an integrated individual-family-community program for chronic mentally ill patients has been implemented in Israel, mostly in the kibbutz setting. The treatment model is based on a combined professional and paraprofessional therapeutic team that designs a structured community program in the following areas: individual and family therapies, life-skills training, medication management, and enhancing performance in work and social spheres and in physical and leisure-time activities. This study reports on the treatment of 124 psychiatric patients who have been followed-up for at least four years. Fifty percent of these chronically incapacitated patients achieved the goals of the community program and were found to be totally or greatly improved in terms of marked improvement of functioning and quality of life, resocialization, work stability and avoidance of rehospitalization. Fourteen percent of the patients were substantially improved, and 36% did not achieve the desired goal of satisfactory integration into community life. A case study that demonstrates the clinical application of the program is presented and the implications of the findings are discussed with respect to the community mental health service delivery system in Israel.

Ecosystemic training: conjoining supervision and organizational development.

Training in systems therapy is itself a systems process that is influenced by the organizational context in which it occurs. Systems trainers need to apply their skills to the interface between them and the agency, otherwise they face the danger that their impact will be eroded by organizational difficulties in "internalizing" their approach. Furthermore, there is much to be gained by working in this domain, especially if the training stimulates and becomes intertwined with organizational development. This coevolutionary process then facilitates integration of the systems model by both the trainees and the agency. Three variables, important for working at this interface, are analyzed: the approach of the supervisor, the composition and dynamics of the training group, and the treatment philosophy and work patterns of the institution. The implementation of this approach is demonstrated through a 4-year project of training and program development with Israel's Youth Protection Authority.

Trauma deepens trauma: the consequences of recurrent combat stress reaction.

This study examines whether a second episode of combat stress reaction (CSR) leads to more or less severe consequences than an initial episode. Two groups of Israeli veterans, all of whom took part in both the 1973 Yom Kippur war and the 1982 Lebanon war, participated in the study. Veterans in the second time CSR group (N = 24) were diagnosed with suffering combat stress reaction (CSR) during both wars; the first time CSR group (N = 39) suffered from CSR only in the second war. The second time CSR group was found to have more severe pathology and a lower level of social functioning than the first time group. Clinicians' interview ratings of the second time CSR subjects showed that their adjustment and symptomatology were significantly worse following the second war than after the first. The two groups also revealed different attitudes towards PTSD and different self-expectations regarding future wars.

Psychological variables and premature labour: a possible solution for some methodological problems.

Two studies on the relationship of psychological variables and premature labour were conducted. The first was a retrospective comparison of psychopathological tendencies, attitudes towards pregnancy, physical complaints during pregnancy and perceived marital and social support, between a group of women who had premature labour and a group of women with term deliveries without premature contractions. Data were collected a few months after deliveries to neutralize bias caused by anxiety for newborns' condition and by proximity in time to the trauma of premature delivery. The second study was a prospective one in which the target category included not only women who delivered prematurely but also women who developed premature contractions but delivered at term. In this study we examined trait and state anxiety, mothers' attitudes towards pregnancy and physical complaints during pregnancy. Results showed that psychopathological tendencies were linked to premature labour and premature contractions. No differences were found concerning perceived social support or mothers' attitudes towards pregnancy.