Henry Grunebaum

Children of depressed and schizophrenic mothers

A sample of psychotic mothers and their children who were five years or younger when first recruited for our study of high risk children was followed up five years later. The current sample, obtained from our previous work, consisted of 18 schizophrenic, 12 depressed and psychotic, and 22 well mothers and their six to 12 year old children. The mothers were equated for education and age, and the children for sex and age. Cognitive style tests and interviews measuring social adjustment and functioning were given to both the parents and the children.

Family deviance and family disruption in childhood: Associations with maternal behavior and infant maltreatment during the first two years of life

A structured childhood history interview was administered to 50 low-income mothers of infants. Three levels of risk for infant maltreatment were represented in the sample, including 10 maltreatment cases. Maternal behavior at home was rated and factor analyzed when the infants were 12 months and 18 months old, yielding separate factors labelled maternal involvement and hostile-intrusiveness. Risk for maltreatment was strongly correlated with the overall adversity of the mothers childhood history. Maternal hostile-intrusive behavior was best accounted for by psychiatric disorder in the mothers own mother and poor peer relationships in childhood. Maternal involvement was negatively associated with a separate cluster of variables indexing family disruption and lack of supervision. The emergence of two separate clusters of associations — positive affective involvement and negative affective involvement — is related to similar two-dimensional results in studies of self-reported mood, infant attachment relationships, and peer relationships. Implications of a two-dimensional affective construct for future theorizing in developmental psychopathology are discussed.

A Model for Evaluation in Child Custody Disputes.

Abstract Over one million children in the United States were involved in child custody decisions in the past year (Glick, 1979). Mental health professionals have been increasingly employed in such decisions. In this paper, we will delineate a model for clinicians to use in evaluating the family with respect to custody and will describe the values which guide our methods and recommendations.

Family-oriented patient care through the residency training cycle.

ObjectiveBecause family oriented patient care improves patient outcome and reduces family burden, clinical family skills of communication assessment alliance and support are part of core competencies required of all residents. Teaching residents to “think family” as part of core competencies and to reach out to families requires change in the teaching environment.MethodsThis article advocates teaching residents family skills throughout the training years as an integrated part of routine patient care rather than in isolated family clinics or a course in “family therapy.” It reviews family skills required of residents in all treatment settings and family skills that are specific to inpatient, emergency room, outpatient, and consultation-liaison services.ResultsFamilies can be seen in multiple treatment settings throughout resident training using recent research to support appropriate interventions for patients and caregivers.ConclusionThe process of establishing change in the training environment requires a commitment on the part of the training faculty to include families, but is possible within the current training framework.

Social role performance and psychopathology among recently hospitalized and nonhospitalized mothers. II. Correlates with life stress and self-reported psychopathology.

Greater impairment in the performance of the roles of housewife, wife, mother, friend and neighbor, and daughter in ones own parental family, as measured by the Social Role Performance Instrument (SRPI), was believed to be associated with greater life stress and greater expressions of psychological distress, as measured by MMPI content scales. Within a group of mothers recently discharged from a psychiatric hospital, the predicted relationship between life stress and impaired role performance did not appear, although this relationship was found within a sample of non- hospitalized mothers in the community. A somewhat different relationship between psychological symptoms and impaired role performance was found within each of the two groups. Social withdrawal and psychotic symptoms, in particular, were more often associated with impaired role performance among former patients than among controls.

Thinking Like a Family Therapist

This paper will deal with two interrelated subjects; first, the nature of the family therapy training program we have developed in response to the setting in which we work; and second, the theoretical framework which is the cornerstone of our training program. Family therapy training at the Cambridge Hospital exists in what may be thought of as an educational marketplace of ideas and techniques, and in an institution mandated to care for any and all patients who require service. These two forces have caused us to emphasize theory rather than technique in our training program.

Contraception for the severely psychiatrically disturbed: Confusion, control, and contraindication

Summary Provision of contraceptive assistance to sexually active female patients in mental institutions continues to be a worthwhile goal. Nonetheless, in keeping with what appears to be the dominant value system of the society, we have taken the position that sometimes the risk of pregnancy can be accepted in the interests of protecting the principle of voluntarism. We found that as the burden of coping with the severely impaired psychiatric patients sexuality and fertility was shared, hospital staff seemed to become more accepting of this view. For our part, we learned how, in some lives, effective choice is narrowed to being among the lesser of evils: losing the right of self-determination or bearing the consequences of poor judgment.

Staff attitudes toward a family planning service in the mental hospital

Staff attitudes toward an innovative family planning and gynecological service offered to patients in three psychiatric hospitals were assayed. Despite structural differences between hospitals, generally similar and favorable reports were obtained at all sites. However, comparison of verbal responses and actual utilization of the family planning service suggests that a theoretical position held by a minority as well as scattered personal biases militate against fullest cooperation with the program.

A Discouraging Description of Introducing Family Therapy in an Institution: Discussion of Dr. Goodrich’s Paper

Dr. Goodrich has given us an excellent description of the two major ways that family therapy training can get introduced into psychiatric training. I want to delineate three main influences that impact on this change: (a) There is the administrative and financial support that is available and the commitment to it of the training director and the person in charge of the institution. (b) It will be influenced by the population of patients being served and the commitment of the institution to that population. (c) It will be determined by certain aspects of the ideology of the institution.