Candyce S. Russell

Invisible and Visible Symptoms of Multiple Sclerosis : Which Are More Predictive of Health Distress?

&NA; The purpose of this study was to examine whether it is the invisible or the visible symptoms or signs of multiple sclerosis (MS) that are associated with greater health distress. Visible symptoms include the use of assistive devices, problems with balance, and speech difficulties, while invisible symptoms include fatigue, pain, depression, and anxiety. In a sample of 145 adults with MS, participants reported on these symptoms and their current level of self‐reported health distress. Hierarchical regression analyses were used to determine whether invisible or visible symptoms were more predictive of health distress. When visible symptoms were added as the first step in the regression, 18% of the variance in health distress was explained. When invisible symptoms were added as the first step, 53% of the variance was accounted for. The invisible symptoms of pain and depression were the most significant predictors of distress. For a subset of the sample that had had MS for more than 11 years, pain and depression continued to be important predictors, but assistive‐device use and fatigue were also important. Nurses should be aware that invisible symptoms may be more troubling to patients than visible symptoms and should ensure that adequate screening and treatment are provided for those with MS.

Technological Implications for Clinical Supervision and Practice

Abstract This paper will review and describe the use of ‘virtual’ (i.e., persons interacting in different geographic locations) technologies in clinical supervision. First, a rationale for using such technologies as a tool for doing clinical supervision will be presented. Second, a review and description of available technological resources will be offered. These include: e-mail, computer-mediated communication (CMC), videoconferencing (VC), Internet or World Wide Web, and WebTV. Third, some of the settings that have utilized such technological resources in conducting clinical supervision (i.e., psychiatry, medicine, education) and therapy will be reviewed. Ethical issues in using these technologies and implications for supervision will be explored.

THE ESSENTIAL ELEMENTS OF SUCCESSFUL MARRIAGE AND FAMILY THERAPY: A MODIFIED DELPHI STUDY

Abstract Recent empirical literature provides support for the efficacy of marriage and family therapy (MFT) without convincingly identifying the principal components necessary for successful MFT outcomes. One way to identify these essential elements is to ask experts in the field to identify such variables. To this end, a panel of AAMFT Approved Supervisors generated 771 variables thought to be fundamental to positive MFT outcome and rated 217 of these variables as very important to the successful outcome of MFT. The variables were collapsed into five categories and further condensed into 34 conceptual clusters. The existing literature supporting the studys results and its implications for theory, practice, and research are discussed.

A feminist critique of solution-focused therapy

Abstract Applying the feminist critique to solution-focused therapy highlights the strengths and weaknesses of this model from a feminist perspective. Although solution-focused therapy and feminist approaches share an emphasis on competence and strengths, solution-focused therapy tends to overlook gender and power differences. In general, the model falls prey to what R. T. Hare-Mustin (1987) referred to as beta-prejudice-neglecting differences.

Mother-blaming in family therapy: An empirical investigation

Abstract This study tested two hypotheses derived from the feminist critique of family therapy in a sample of AAMFT members. The stimulus was a brief vignette of an initial therapy session with a family presenting a teen-aged child as the identified patient. It was hypothesized that family therapists would rate the mothers in the vignette as more dysfunctional than fathers. It was also hypothesized that mothers would be asked to bear more of the burden of change in treatment plans written by subjects. Neither hypothesis was supported. However, respondents did rate the concerned parent, regardless of sex, as more dysfunctional. Since this is a role often occupied by women, this finding may indicate some gender bias.

From Family Symptom to Family System: Review of Family Therapy Research.

Abstract Recent empirical outcome literature on family therapy is reviewed with special attention to the link among presenting symptom, assessment of system dynamics and effective outcome. The authors recommend that future researchers include a focus on underlying system dynamics in addition to the more frequent focus on symptom. Finally, a research design is offered which links symptom via functional system consequence to family process and to therapy outcome.

Reliability and validity of the Kansas Family Life Satisfaction Scale in a predominantly middle-aged sample.

In a predominantly middle-aged sample of 182, the four items of the Kansas Family Life Satisfaction Scale demonstrated adequate internal consistency. Further evidence of construct validity was found, as well as limited discriminant validity. The scale was positively correlated with Edmondss measure of marital conventionalization, and a pattern of unequal variance at different levels of social desirability was found.

How do Subjects Interpret Items in Olson's Family Adaptability and Cohesion Evaluation Scales (FACES)?

Most items in the FACES inventories may, from a laypersons perspective, reflect an underlying linear model—the more cohesion or adaptability, the better for marital or family functioning. If so, modifying the FACES items to clearly place the balanced or functional response at the midpoint with the dysfunctional responses at both extremes might convey the intent of the circumplex model to subjects with less ambiguity. A comparison of modified and regular FACES II items yielded some support for the hypothesis that some subjects who saw themselves as having balanced levels of cohesion or adaptability on the modified format would report extreme levels of cohesion or adaptability on the regular format. Recent revisions of FACES that have attempted to improve the validity of the scales have failed to address this particular issue.

What Would You Say? Expressing the Difficulties of Living With Multiple Sclerosis

ABSTRACT This article used a mixed method approach to analyze qualitative and quantitative responses from individuals with multiple sclerosis (MS) to determine differences when patients’ perceived stress levels and perceived quality of support are taken into account. Understanding the differences in these responses can help us understand how illness, specifically MS, may influence the relational messages sent by patients to their loved ones. Responses to both quantitative and qualitative questions were obtained from 145 persons who have been diagnosed with MS. Participants responded to scale questions measuring daily stress levels and levels of social support and were divided into four groups on the basis of their scores (low/low, high/low, high/high, and high/low). Thematic analysis was performed on the qualitative responses, and differences were analyzed based on participants’ grouping. Additional outcome variables measuring quality of life, anxiety, depression, helplessness, and acceptance were also analyzed to determine the similarities and differences between the groupings. The information presented in this article both informs and supports the idea that patients’ levels of stress and perception of support are two major variables that impact their responses to their loved ones and their scores on several outcome variables.

Utilizing Process and Content in Designing Paradoxical Interventions.

Abstract The authors develop a strategy for intervening into rigidly homeostatic systems. Central to the task is the identification of system rules, which often reveal themselves around “nodal themes.” The authors describe four types of nodal themes and offer clues to identifying them within families. Finally, they suggest ways of using system rules and nodal themes in the development of paradoxical interventions.