College Faculty Member Grief Over Deaths of Current and Former Students.

This article is an autoethnographic exploration of college faculty grief. Over a career, a college teacher is likely to encounter deaths of current and former students. The rich connections that can develop in a faculty-student relationship can make for strong grief. Issues that can complicate faculty grief include regrets that might be unique to faculty-student relationships and information about the deceased that the faculty member feels obligated to keep confidential and cannot mention while processing their grief with others. Faculty members may rarely have the benefit of attending funeral or memorial services for students and former students, but with the deaths of current or recent students, a faculty member is likely to have colleagues and students who knew the deceased with whom to talk. With deaths of students from long ago, a faculty member is likely to be limited to processing grief with people who never knew the deceased.

"The child is our focus": On couple issues in child oncology treatment.

OBJECTIVE: This study explored the perspectives of child oncology professionals and parents about the attention professionals should give to the parent couple relationship during treatment of the child. METHODS: We employed a qualitative research design, framed within the approach of consensual qualitative research (CQR), gathering data from four focus groups with 20 professionals and from nine in-depth interviews with 16 parents. Thematic analysis of the focus group and interview data was done with MaxQda software, using two coders and member checks to strengthen confidence in the analysis. FINDINGS: Both professionals and parents talked about an elevated tension in the partner relationship during oncology treatment of the child. However, explicit attention to the partner relationship in this context felt inappropriate to professionals and parents. All emphasized the importance of the professional helpers' openness to conversation and an attuned response to the parental couple relationship. CONCLUSION: During treatment, the child is the primary focus for parents and professionals. The parents' focus on supporting their child makes talking about their own emotions or about issues in the partner relationship potentially disruptive and unhelpful. Therefore, it is crucial for professionals to support the parents in their parents' role, but with an openness to converse about issues in the partner relationship at the moments when these issues might threaten their focus on the child.

"We Hardly Ever Talk about It": Emotional Responsive Attunement in Couples after a Child's Death.

Within Western cultural traditions, the idea that parents should talk about the death of their child with each other is deeply rooted. However, across bereaved parent couples there are wide variations in communication about their grief with each other. In this study, we explored the experiences of bereaved couples related to the process of talking and not talking. We used a thematic coding approach to analyze 20 interviews with 26 bereaved parents (11 interviewed as couples, four as individuals). Four main meanings emerged out of our analysis: not talking because of the inadequacy and pointlessness of words in grief, not talking as a way to regulate emotions in daily life, not talking as an expression of a personal, intimate process, and not talking because the partner has the same loss but a different grief process. In addition, we found that the process of talking and not talking can partly be understood as an emotional responsive process on an intrapersonal and interpersonal level. In this process partners search for a bearable distance from their own grief and their partner's, and attune with their relational context. A better understanding of this process is sought in a dialectical approach, emphasizing the value of both talking and not talking in a tense relationship with each other. Implications for clinical work are described.

Silence and Memories of War: An Autoethnographic Exploration of Family Secrecy.

A personal journey and a scientific challenge, this is an autoethnographic study about my own family's secrecy. I knew my grandfather had been a German prisoner of war during World War II. We all knew. But nobody talked about it. Then one day I decided I wanted to do systematic research on the issue of family secrecy around my grandfather's war experiences. Researching one's own family can be called autoethnography. It could be said that autoethnography is an approach to research that aims to describe and systemically analyze (graphy) personal experience (auto) to understand social and cultural phenomena (ethno). This scientific approach is quite new in the field of family therapy. This study has been an important personal quest, but it also led to important reflections on silences in families, on my own professional development, and on methodological issues concerning autoethnographical research. For one thing, it highlights some of the positive aspects of family secrecy and silences, and invites us-when confronted with family secrecy in clinical practice-to carefully consider the potential destructive and life-giving aspects of the silence.

A phase II trial of bevacizumab and everolimus as treatment for patients with refractory, progressive intracranial meningioma.

Meningiomas that progress after standard therapies are challenging with limited effective chemotherapy options. This phase II trial evaluated the efficacy of everolimus plus bevacizumab in patients with recurrent, progressive meningioma after treatment with surgical resection and local radiotherapy when appropriate. Patients with recurrent meningioma (WHO grade I, II, or III) following standard treatments with surgical resection and radiotherapy received bevacizumab (10 mg/kg IV days 1 and 15) and everolimus (10 mg PO daily) each 28 day cycle. Evaluation of response occurred every 2 cycles. The primary endpoint was progression-free survival (PFS). Secondary endpoints included response rate, overall survival and safety. Seventeen patients with a median age of 59 years (29-84) received study treatment. WHO grades at study entry included: I, 5 (29 %); II, 7 (41 %); III, 4 (24 %); unknown, 1 (6 %). Patients received a median of 8 cycles (1-37); all patients are off study treatment. A best response of SD was observed in 15 patients (88 %), and 6 patients had SD for >12 months. Overall median PFS was 22 months (95 % CI 4.5-26.8) and was greater for patients with WHO grade II and III compared to grade I tumors (22.0 months vs 17.5 months). Four patients discontinued treatment due to toxicity (proteinuria, 2; colitis, 1, thrombocytopenia, 1). However, other grade 3 toxicity was uncommon, and no patient had grade 4 toxicity. The combination of everolimus and bevacizumab was well-tolerated, and produced stable disease in 88 % of patients; the median duration of disease stabilization of 10 months (2-29). The median PFS from this prospective trial was similar to previous retrospective reports of bevacizumab in the treatment of recurrent meningioma.

"It's Hard to Talk When Your Child Has a Life Threatening Illness": A Qualitative Study of Couples Whose Child Is Diagnosed With Cancer.

When parents are confronted with something as fundamental as a cancer diagnosis for their child, it is generally assumed that sharing the emotional impact of it, in the form of talking about it with the partner, is helpful and necessary to cope as an individual and a couple. However, couple communication in the context of childhood oncology is often challenging. In this qualitative research, we aimed for a better understanding of how partners experience their couple communication during treatment of their child. Thematic coding was done on in-depth interviews with 16 parents (7 couples interviewed together and 2 mothers). We found that the circumstances of the treatment period affected couple communication. In the interviews, parents provided three main meanings to their limited talking: (a) because of the hospital and treatment context; (b) for self-care/self-protection related to the value of blocking emotions; and (c) because of each other. These findings invite us to rethink emotional closeness being equated with frequent or intense emotional communication in couples with a child who has cancer. This research, framed in a dialectic approach, emphasizes the value of both talking and not talking in the tense and challenging couple situation of dealing with a child's cancer diagnosis and treatment. Rather than advocating for the general promotion of open communication, our study suggests the value of hesitations to talk at certain points in the process, while also taking into account the degree of marital difficulties in offering interventions aimed at improving couple communication.

Providing therapy can be therapeutic for a therapist.

In this paper, the case is made that providing therapy to a client can be therapeutic for the therapist. Therapist change is not intentionally sought nor professionally delivered, but is from those client interactions experienced as healing. The possible mechanisms of change for the therapist include exposure of much about him- or herself being "on the line" in therapy, and the therapeutic relationship as a collaborative, two-way system. In the collaborative system, much might affect a therapist, including how the client understands and reacts to the therapist's disposition, motivation, self-disclosure, and skill and what the client reveals about his or her life that may lead the therapist to a new sense of her or his own life.

Stereotactic radiation techniques in the treatment of acoustic schwannomas.

Medical decision-making is based on benefit-to-cost analysis. Optimally, treatment obtains a high degree of benefit while minimizing the physical, social, and financial costs. The goals of the treatment of acoustic schwannomas are prohibiting tumor growth and alleviation of symptoms caused by damage to local structures. These symptoms-tinnitus, ataxia, and hearing loss--secondary to eighth nerve dysfunction, as well as symptoms arising from damage to adjacent structures such as the facial nerve, trigeminal nerve, or pons, can be caused by tumor growth or treatment. Determination of optimal therapy must also take into account an understanding of the natural history of the disease, because acoustic schwannomas are slow-growing benign tumors that when left untreated, usually enlarge over time and cause problems.

Selective disclosure in a first conversation about a family death in James Agee's novel A Death in the Family.

The first conversation of a family about a family death is a neglected but potentially important topic. In a first conversation in James Agee's (1957/ 2006) novel A Death in the Family, the member who knows the most about the accidental death of another member discloses information selectively. The first conversation in Agee's novel suggests that communication and caring in the first family conversation about a death is attuned to family member emotions, particularly those of the family member considered most vulnerable, and that the aim is not a shared narrative that is true, but one that people can live with.

Recovery following bereavement: metaphor, phenomenology, and culture.

The concept of recovery following bereavement can be both useful and misleading. As a metaphor, the concept of recovery highlights some aspects of bereavement and obscures others. Bereaved people interviewed in 3 different studies typically did not bring up the term recovery so it did not seem to be a term that described their experience. Across cultures, the concept of recovery can be irrelevant or even misleading in understanding what goes on following bereavement. Arguably, a postmodern perspective in which no single concept is considered relevant for framing what goes on or what is desirable following bereavement might be best.

Stereotactic radiation techniques in the treatment of acoustic schwannomas. 2007.

Medical decision-making is based on benefit-to-cost analysis. Optimally, treatment obtains a high degree of benefit while minimizing the physical, social, and financial costs. The goals of the treatment of acoustic schwannomas are prohibiting tumor growth and alleviation of symptoms caused by damage to local structures. These symptoms-tinnitus, ataxia, and hearing loss-secondary to eighth nerve dysfunction, as well as symptoms arising from damage to adjacent structures such as the facial nerve, trigeminal nerve, or pons, can be caused by tumor growth or treatment. Determination of optimal therapy must also take into account an understanding of the natural history of the disease, because acoustic schwannomas are slow-growing benign tumors that when left untreated, usually enlarge over time and cause problems.

South African Zulu widows in a time of poverty and social change.

Interviews were carried out with 16 South African Zulu widows. Much of what the widows had to say seemed like what one might hear from widows in economically developed countries, but there were also striking differences. All the widows lived in poverty, and for some their grief seemed much more about the poverty than about the husband's death. Most widows observed a year of traditional ukuzila mourning practices, which made them a threat to others and which is difficult to carry out in the social upheaval of modern South Africa. Widowhood was in some cases a struggle with witchcraft--as cause of the death or as an accusation directed at the widow.

Narratives of grieving African-Americans about racism in the lives of deceased family members.

As part of a comprehensive interview study on African-American grief, the authors explored how racism is incorporated into narratives about a deceased family member. To the extent that experiences of racism are pervasive in African-American life and to the extent that narratives about a person who has died generally account for the life experiences, achievements, character, and challenges faced by the deceased, the authors expected narratives about a deceased African-American to deal with the person's encounters with racism. In fact, most of the 26 African-Americans who were interviewed spoke about racism in the life of the deceased. Many talked about racism blocking the deceased from getting ahead occupationally and in other ways and about how the deceased resisted or stood up to racism. Some people spoke about the ways the deceased taught them to deal with racism. The narratives that indicated that the deceased had rarely or ever talked about racism still made clear that the deceased lived in a racist world but chose not to bring racism into family conversation. The findings suggest that a view of African-American grieving that is insensitive to racism in African-American experience may lead to unhelpful grief support or counseling.

Grieving while driving.

Secondary analysis of data from 84 people in 2 interview studies shows that some bereaved people grieve actively while driving. The grief can be intense, even years after a death. Grief while driving may erupt spontaneously or be set off by a wide range of reminders. Some bereaved people seem to save their grieving for times when they drive, because that is when they have the time and privacy to think and feel, but it would be safer for them and others if they would avoid driving while grieving intensely.