Relational recovery after infidelity as a dual process: A model based on the experiences of female injured partners.

In the literature, relational recovery after infidelity is often described as a process going through different consecutive stages towards a reconciliation. We interviewed 25 injured partners and invited them to look back and talk about what helped them to recover from the pain and the conflicts caused by the relational infidelity of their partner. From their stories-through thematic analysis-four themes emerged: 1. talking, 2.the truth, 3. trust and 4. ethical imbalance. It furthermore struck us how the participants described their recovery process as an experience of being oscillated between connection and disconnection. These findings pointed us in the direction of developing a dual process model that fits with our participants' experiences of recovering after infidelity, while emphasizing the dynamic nature of their stories.

Silencing or silent transmission? An exploratory study on trauma communication in Kurdish refugee families.

Trauma communication in refugee families is increasingly recognized as an important relational dynamic influencing psychosocial well-being, yet studies exploring interactional dynamics and meaning making at play in intra-family trauma communication remain scarce. This article reports on a qualitative study with Kurdish refugee families including parents (N = 10) and children (N = 17) resettled in Belgium, aiming to explore practices on trauma communication within refugee family relationships. In a multiple-phased qualitative design, semi-structured family interviews and participant observation administered in the homes of the participant families are followed by parental interviews involving a tape-assisted recall procedure to investigate observed intergenerational trauma communication and parent-child interactions. Data analysis shows parents and children seldom explicitly talked about the families' lived experiences of trauma. This silence was especially related to parental wishes to avoid their children's future involvement in violence. However, findings also indicate how the intra-family transmission of memories of collective violence occurs in many subtle ways. Four modes of indirect trauma communication could be distinguished: (1) focusing on the repetition of violence in the present; (2) transmission of the collective trauma history; (3) family storytelling; and (4) interaction with meaningful objects of the past. These findings shed light onto the interwoven nature of personal-familial and collective trauma and loss and illuminate the meanings of silence and disclosure in the context of the Kurdish diaspora. In the final section, we discuss our findings and outline its clinical implications for family therapeutic practices in refugee trauma care.

Emotion regulation of the family therapist.

Outcome research highlights the importance of the therapeutic alliance for the outcome of therapy. Meta-analyses suggest that in family therapy, the therapeutic alliance is even more important than in individual therapy. In family therapy, however, the alliance is more complex than in individual therapy. Through empathy, authenticity and hopefulness the therapist can contribute to an effective alliance. Sometimes during the session, a therapist may experience strong emotions that are in tension with his/her therapeutic aspirations of empathetic listening, authenticity and hopefulness. A therapist might experience boredom instead of curiosity, irritation instead of acceptance, shame instead of authenticity. There is need for some kind of emotion regulation to protect the alliance. Furthermore, as some authors suggest, the therapist's emotions - even the emotions that are first glance seem harmful to the alliance - may also be useful for the therapist. Several case stories illustrate the different ways in which family therapists can deal with their emotions in the session.

Using questionnaires as conversational tools to bolster the therapeutic alliance in family therapy practice.

In this clinical paper, the focus is on the use of questionnaires in family therapy practice. Psychotherapy research has indicated that the quality of the therapeutic relationship is the most robust predictor of therapeutic change. While the therapeutic relationship is even more important in family therapy than in individual therapy, it is also more complex. As will be illustrated in this paper, questionnaires can be useful in clinical practice to deal with the complex alliances in family therapy. In this paper, we will introduce two questionnaires: the Worries Questionnaire and the Dialogical Feedback Questionnaire. As illustrated in detailed case stories, we use these questionnaires in our practice as conversational tools rather than measuring instruments. They serve as the starting point for the therapist's reflection and for dialogues with family members.

The Dual Process of Intuitive Responsivity and Reflective Self-supervision: About the Therapist in Family Therapy Practice.

Psychotherapy research shows that-in individual therapy as in family therapy-some therapists are more effective than others. This highlights the crucial role the therapist plays in a client's improvement. Furthermore, it seems that training may make a difference, as deliberate practice can improve the therapist's effectiveness. In the context of the current renewed awareness of the importance of the person of the therapist in the psychotherapy field, this paper's focus is specifically on the therapist in family therapy practice. There is a long tradition of reflecting on the person of the therapist in the family therapy field, often inspired by the metaphor of the wounded healer. In contrast, focusing on the person op the therapist in the present moment of the therapy session is fairly new. In this paper, we use of the dual process models from cognitive psychology as a frame to reflect on the person of the therapist. We review these dual process models and propose that the intuitive responsivity of the therapist relies on the fast, implicit cognitive system (system 1) and the therapist's self-reflection on the slow, deliberate system (system 2). The therapist's actions in therapy practice then emerge moment-by-moment as an echo of the way these two cognitive systems balance each other. It is optimal if the therapist, attuned to the family's rhythm, can flexibly oscillate between the two systems. In the concluding comments of this paper, reflective questions are posed about what this perspective may mean for family therapy practice, training, and supervision.

La investigación sobre psicoterapia indica que, tanto en la terapia individual como en la familiar, algunos terapeutas son más eficaces que otros. Esto destaca el papel fundamental que desempeña el terapeuta en el entorno de un paciente. Además, parece que la capacitación puede marcar una diferencia, ya que la práctica deliberada puede mejorar la eficacia del terapeuta. En el contexto de la conciencia actual renovada sobre la importancia de la persona del terapeuta en el ámbito de la psicoterapia, este artículo se centra específicamente en el terapeuta durante la práctica de la terapia familiar. Hay una larga tradición de reflexionar sobre la persona del terapeuta en el campo de la terapia familiar, generalmente inspirada por la metáfora del sanador herido. Por el contrario, centrarse en la persona del terapeuta en el momento presente de la sesión de terapia es bastante nuevo. En este artículo usamos los modelos de proceso dual de la psicología cognitiva como marco para reflexionar sobre la persona del terapeuta. Revisamos estos modelos de proceso dual y proponemos que la capacidad de respuesta intuitiva del terapeuta depende del sistema cognitivo implícito y rápido (sistema 1) y de la autorreflexión del terapeuta sobre el sistema lento y deliberado (sistema 2). Las acciones del terapeuta en la práctica de la terapia surgen momento a momento como eco de la manera en la que se equilibran estos dos sistemas cognitivos. Es óptimo si el terapeuta, adaptado al ritmo de la familia, puede fluctuar con flexibilidad entre los dos sistemas. En los comentarios concluyentes de este artículo se plantean preguntas reflexivas sobre qué puede significar esta perspectiva para la práctica, la capacitación y la supervisión en terapia familiar.

Family Secrecy in Family Therapy Practice: An Explorative Focus Group Study.

The aim of this focus group study was to explore the experiences of family therapists working with family secrecy. Our study highlights that family secrets present important and compelling challenges for family therapists. Furthermore, our study reveals that there seem to be some basic strategies family therapists use in dealing with these challenges in therapy sessions. One basic strategy is that family therapists try to guard their position of being a trustworthy therapist for each family member by avoiding becoming stuck in family secrecy. Furthermore, therapists explore ways to guide the family toward the disclosure of the secret in order to alleviate the toxicity of the secrecy. This highlights the importance of the systemic model and how influential this perspective is in family therapy practice. Some participants, however, have in addition a second strategy they sometimes use: talking with the family about secrecy without aiming to disclose the secret. In the discussion section of the article we reflect on the possibility that in the strategic choices family therapists make conceptual issues might be involved. Furthermore, we stress the importance of further research.

El propósito de este estudio de un grupo focal fue analizar las experiencias de los terapeutas familiares que trabajan con el secreto familiar. Nuestro estudio destaca que los secretos familiares presentan desafíos importantes y emocionantes para los terapeutas familiares. Además, nuestro estudio revela que parece haber algunas estrategias básicas que usan los terapeutas familiares a la hora de manejar estos desafíos en las sesiones de terapia. Una estrategia básica es que los terapeutas familiares tratan de proteger su postura de ser un terapeuta confiable para cada miembro de la familia evitando atascarse en el secreto familiar. Es más, los terapeutas analizan maneras de guiar a la familia hacia la revelación del secreto a fin de aliviar la toxicidad del misterio. Esto destaca la importancia del modelo sistémico y cuán influyente es esta perspectiva en la práctica de la terapia familiar. Sin embargo, algunos participantes tienen además una segunda estrategia que a veces usan: hablar con la familia acerca del secreto sin pretender que se revele el secreto. En la sección de debate del artículo, reflexionamos sobre la posibilidad de que en las elecciones estratégicas que hacen los terapeutas familiares podrían estar implicados aspectos conceptuales. Por otro lado, subrayamos la importancia de continuar investigando.

Ambiguous Loss in Transnational Families' Adolescents: An Exploratory Study in Ecuador.

In psychosocial migration literature, the perspective of ambiguous loss has been relevant to articulate personal and relational experiences in the context of transnational families and ongoing separation. Most studies have focused on adult members' experiences of transnational families, but research exploring ambiguous loss in adolescents whose parents have migrated is still lacking. The present study aimed to explore adolescents' lived experiences of parental migration. In a pilot explorative study, 14 adolescents with at least one parent who migrated were interviewed about their lived experiences of transnational parent-child relationships and ongoing parent-child separation. Data analysis identified four themes in participants' accounts: practices of separation creating confusion; current relationship with migrant parents permeated by ambiguity; distrustful representations of migrant parents; and family and social dynamics reactivating the pain of loss. The findings reveal how in the context of parental migration, patterns of separation and ongoing relational processes, compounded by the uncertainty of reunification and an exclusionary social fabric, constitute core elements that shape adolescents' lived experiences of parent-child relationships characterized by ambiguity.

En la bibliografía sobre las consecuencias psicosociales de la migración, la perspectiva de la pérdida ambigua ha sido relevante para expresar las experiencias personales y relacionales en el contexto de las familias transnacionales y la separación constante. La mayoría de los estudios se han centrado en las experiencias de los miembros adultos de las familias transnacionales, pero aun faltan investigaciones que analicen la pérdida ambigua en los adolescentes cuyos padres han emigrado. El presente estudio tiene como finalidad analizar las vivencias de los adolescentes de padres migrantes. En un estudio piloto exploratorio, se entrevistó a 14 adolescentes con al menos un padre que emigró acerca de sus vivencias con respecto a las relaciones transnacionales entre padre e hijo y la separación constante entre padre e hijo. Los análisis de datos identificaron cuatro temas en los informes de los participantes: las prácticas de separación que generan confusión; la relación actual con los padres emigrantes impregnada por la ambigüedad; las representaciones desconfiadas de los padres emigrantes; y la dinámica familiar y social que reactiva el dolor de la pérdida. Los resultados revelan cómo, en el contexto de la migración parental, los patrones de separación y los procesos relacionales constantes, agravados por la incertidumbre de la reunificación y una estructura social exclusivista, constituyen elementos fundamentales que moldean las vivencias de los adolescentes en las relaciones entre padres e hijos caracterizadas por la ambigüedad.

Living as a Cancer Survivor: A Qualitative Study on the Experiences of Belgian Adolescents and Young Adults (AYAs) after Childhood Cancer.

PURPOSE: Insight was sought in how a childhood cancer experience plays a role in daily life of adolescents and young adults (AYA) survivors. DESIGN AND METHODS: A qualitative research in which semi-structured interviews were held with 21 AYA survivors of childhood cancer between the ages of 14 and 25. The AYA survivors were recruited from two pediatric oncology departments of two university hospitals in Belgium. RESULTS: The current situation and behavior of AYA-survivors who have been treated for childhood cancer are covered in 5 categories: The Feeling of Being Different while Aiming for Normalcy in Relationships, Living with Existential Uncertainty, The Conscious Protection of Health, The Attachment to the Parent(s) with Whom the Cancer Experience was Shared, and The Desire to Be Meaningful to Others. CONCLUSIONS: The AYA survivors did not feel that their cancer experience dominated their current daily life, yet, the cancer experience had an important impact on their functioning. PRACTICE IMPLICATIONS: The findings of the study can be used to optimize holistic psychosocial care of AYA survivors. By starting from the key elements in their current functioning, health care professionals can tailor their support to the way in which AYA survivors have integrated their cancer experience into their everyday lives.

"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.

Unraveling the Mobilization of Memory in Research With Refugees.

In this article, we explore how narrative accounts of trauma are co-constructed through the interaction between researcher and participant. Using a narrative multiple-case study with Kurdish refugee families, we address how this process takes place, investigating how researcher and participants were engaged in relational, moral, collective, and sociopolitical dimensions of remembering, and how this led to the emergence of particular ethical questions. Case examples indicate that acknowledging the multilayered co-construction of remembering in the research relationship profoundly complicates existing deontological guidelines that predominantly emphasize the researcher's responsibility in sensitively dealing with participants' alleged autobiographical trauma narratives. Instead, our analysis invites qualitative researchers to engage in a continued, context-specific ethical reflection on the potential risks and benefits that are invoked in studies with survivors of collective violence.

Toward Hospital Implementation of Advance Care Planning: Should Hospital Professionals Be Involved?

In Belgium, Advance Care Planning (ACP) is not well implemented in hospital practice. One of the premises for successful implementation is involving the adopters in the implementation process. In hospital, important adopters of ACP are physicians, nurses, social workers, and psychologists. First, this study wants to understand what the characteristics are of ACP in hospital, according to professionals. Second, this study aims to give an insight in the experienced value of ACP. Third, the experienced barriers to have ACP conversations are explored. Twenty-four interviews were taken and analyzed with Content Analysis based on Grounded Theory. Three independent external auditors surveilled the analysis. ACP in hospital exists by the grace of the initiative of the actors involved in the case. Professionals perceive fields of tension between one another; barriers to ACP communication. ACP is mainly considered valuable because it is a process that creates time for exploration and reflection.

"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.

Addressing the Person of the Therapist in Supervision: The Therapist's Inner Conversation Method.

In this study a method of retrospective case supervision is presented aimed at helping the supervisee to become a better self-supervisor. The method pays special attention to the therapist's self-reflection and has the therapist's inner conversation as a central concept. The starting point of the method is an assignment in which the supervisee reflects on a case using a tape-assisted recall procedure. The method helps trainees to develop experiential expertise to become more flexible and effective therapists. A case example of one training group of novice family therapists illustrates the use of the method.

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.

Remembering Collective Violence: Broadening the Notion of Traumatic Memory in Post-Conflict Rehabilitation.

In the aftermath of war and armed conflict, individuals and communities face the challenge of dealing with recollections of violence and atrocity. This article aims to contribute to a better understanding of processes of remembering and forgetting histories of violence in post-conflict communities and to reflect on related implications for trauma rehabilitation in post-conflict settings. Starting from the observation that memory operates at the core of PTSD symptomatology, we more closely explore how this notion of traumatic memory is conceptualized within PTSD-centered research and interventions. Subsequently, we aim to broaden this understanding of traumatic memory and post-trauma care by connecting to findings from social memory studies and transcultural trauma research. Drawing on an analysis of scholarly literature, this analysis develops into a perspective on memory that moves beyond a symptomatic framing toward an understanding of memory that emphasizes its relational, political, moral, and cultural nature. Post-conflict memory is presented as inextricably embedded in communal relations, involving ongoing trade-offs between individual and collective responses to trauma and a complex negotiation of speech and silence. In a concluding discussion, we develop implications of this broadened understanding for post-conflict trauma-focused rehabilitation.

The impact of stressful life events on highly religious Chinese Christians living in Belgium.

While there has been considerable inquiry into how religion may help Christians deal with stressful life events (SLEs), only limited research has been conducted on the impact SLEs might have on religion. This study's purpose was to provide an in-depth analysis of this relationship in a sample of highly religious Christians of Chinese origin. In-depth qualitative interviews were conducted with 11 Chinese couples residing in Belgium, and a conceptual model was created to describe how SLEs impact religiosity and how religion influences people's coping processes. Results indicated that for highly religious Chinese Christians, an SLE may represent a faith-growth opportunity.

"Cycling around an emotional core of sadness": emotion regulation in a couple after the loss of a child.

In contrast to the traditional view of working through grief by confronting it, recent theories have emphasized an oscillating process of confronting and avoiding the pain of loss. In this qualitative study, we sought a better understanding of this process by conducting a detailed case study of a bereaved couple after the loss of their infant daughter. We employed multiple data collection methods (using interviews and written feedback) and an intensive auditing process in our thematic analysis, with special attention to a recurrent metaphor used by this bereaved couple in describing their personal and relational experience. The findings suggest the presence of a dialectic tension between the need to be close to the deceased child and the need for distance from the pain of the loss, which was evidenced on both individual and relational levels. For this couple, the image of "cycling around an emotional core of sadness" captured their dynamic way of dealing with this dialectic of closeness and distance.

Voices of dialogue and directivity in family therapy with refugees: evolving ideas about dialogical refugee care.

In this article, we reflect on our evolving ideas regarding a dialogical approach to refugee care. Broadening the predominant phased trauma care model and its engaging of directive expertise in symptom reduction, meaning making, and rebuilding connectedness, these developing dialogical notions involve the negotiation of silencing and disclosure, meaning and absurdity, hope and hopelessness in a therapeutic dialogue that accepts its encounter of cultural and social difference. In locating therapeutic practice within these divergent approaches, we argue an orientation on collaborative dialogue may operate together with notions from the phased trauma care model as heuristic background in engaging a polyphonic understanding of coping with individual and family sequelae of forced displacement. This locating of therapeutic practice, as informed by each perspective, invites us to remain present to fragments of therapeutic positioning that resonate power imbalance or appropriation in a therapeutic encounter imbued with a social context that silences refugees' suffering. In a clinical case analysis, we further explore these relational complexities of negotiating directive expertise and collaborative dialogue in the therapeutic encounter with refugee clients.

The shift from monologue to dialogue in a couple therapy session: dialogical investigation of change from the therapists' point of view.

As part of a larger research project on couple therapy for depression, this qualitative case study examines the nature of dialogue. Drawing on Bakhtinian concepts, the investigation shows how the conversation shifts from a monologue to dialogue. Among the findings are: first, the process of listening is integral to the transforming experience. That is, the careful listening of the therapist can evoke new voices, just as the experience of one of the partners' "listening in" to the conversation between the other partner and the therapist can create movement and new trajectories. The latter is a qualitative difference between dialogic therapy with a couple and that with an individual. Second, the therapist not only acts as creative listener, but as the dialogue unfolds, actively contributes to meaning-making. Third, the study upholds having a team of researchers as a polyphonic forum and the usefulness of Bakhtinian concepts in clinical research on dialogue in multi-actor sessions.

Coping Strategies of Adolescent and Young Adult Survivors of Childhood Cancer: A Qualitative Study.

BACKGROUND: Many adolescent and young adult (AYA) survivors of childhood cancer are dealing with late effects of the cancer and its treatment. OBJECTIVE: The aim of this study was to explore how AYA survivors cope with their childhood cancer experience and its long-term consequences. METHODS: This is a descriptive qualitative study in which 21 semistructured interviews with AYA survivors of childhood cancer were conducted. A thematic analysis was conducted by a multidisciplinary research team and supported by NVivo 10. RESULTS: Five coping strategies, which facilitated in living a normal life, of which some were developed during their cancer experience, were identified: (1) focusing on the "here and now," (2) refraining from discussing the cancer experience, (3) recalling and preserving positive memories, (4) redefining the impact positively, and (5) consolidating and preserving a sense of togetherness. CONCLUSIONS: Even long after completing treatment, the cancer experience remained deeply ingrained in AYA survivors' lives. Although they did not perceive their survivorship as a large problem in their current lives, coping with being a childhood cancer survivor did take effort. The deployment of specific coping strategies helped them to remain focused on the positive outlook in life and to deal with the long-term physical and psychosocial consequences of the cancer experience aimed at ultimately leading a normal life. IMPLICATIONS FOR PRACTICE: This study emphasizes the current individual frame of reference of the AYA survivor as the point of departure for psychosocial support. Healthcare professionals are advised to acknowledge and respect the value and function of the AYA survivors' coping strategies used.