Ladislav Valach

Coping and psychosocial adaptation: longitudinal effects over time and stages in breast cancer.

Objectives This study examined the relationship between coping and psychosocial adaptation in cancer patients over time and across distinct clinical events. Methods In a prospective longitudinal study 74 patients with breast cancer were observed for 3 to 5 years at 3- to 6-month intervals. A total of 684 interviews were conducted at different observation points. Three rating scales were used to assess coping and adjustment: first, the Bernese Coping Modes, an observer rating scale devised to elicit 26 coping modes aggregated in this paper as the five Basic Coping Strategies of support, self-control, denial, diverting, and negative-emotional; second, an observer rating scale to ascertain psychosocial adaptation; and third, a self-rating scale as a measure of either emotional distress or well-being. Results a) When aggregated in illness stages, coping and distress data on the observed clinical time points showed greater variability than time measures alone (analysis of variance (ANOVA) for repeated measures p <.001). b) A significant relationship between the Basic Coping Strategies and psychosocial adaptation was demonstrated using discriminant and correlational analysis. Furthermore, in stage-dependent Pearson r correlations (p <.05 to .001), a clear-cut relationship was found for hospitalization, chemotherapy, and rehabilitation, but not for convalescence and metastasis. c) A positive relationship was demonstrated between psychosocial adaptation and strategies that can be generally categorized as good forms of coping such as support and self-control, and, to a lesser degree, diverting and denial. Conversely, poor coping exerted a negative effect on almost all illness stages and on most criteria of adjustment. Conclusions In long-term studies on psychosocial adaptation and coping, stage-related measures should be preferred to time measures alone. The implications of different strategies for the psychological treatment of cancer patients are discussed.

Coping with breast cancer over time and situation.

This study examines the variability and stability of coping in cancer subjects over time and situation. In a prospective longitudinal design 74 breastcancer patients have been followed for 3-5 yr at 3-6 monthly intervals. A variety of measures related to coping and adjustment were taken. This report limits itself to the findings of an instrument developed for this study, the Bernese Coping Modes in which 26 coping modes were rated by observers. Results confirm arguments in favour of both variability and stability in coping activity over time and situation. Two measures support stability: rank values and a multivariate measure (MDS) with three constant dimensions: (1) support and acceptance; (2) denial; (3) diversion by thought and action. Evidence for variability is: the potential range of coping modes and a large variety of additional modes at most observation times. Subsequently time measures of coping were attributed to eight predefined illness stages as distinct clinical situations. Thus variability or richness of coping further increased. The implications of these findings for measurement in coping research are discussed.

Career development in adolescence as a family project

This study conceptualizes and investigates career-relevant parent-child conversations and other actions over time as a family project. Dyads composed of a parent and an adolescent from 20 families participated in a videotaped career-related conversation to determine a family career-development project that was subsequently monitored for a 6-month period and followed up with a 2nd videotaped conversation. On the basis of a systematic qualitative analysis, several dimensions were identified as facilitating the family career-development project, including joint goals, communication, goals-steps congruence, and individuation. These family career-development projects were organized as part of broader relationship, identity, parenting, and cultural projects that also played a decisive role in the success of the family career-development projects themselves.

An exercise in improving suicide reporting in print media.

This study was conducted to support the publication of guidelines for media reporting on suicide. First, quantitative and qualitative aspects of suicide reporting in Swiss print media were surveyed over a time span of 8 months. The results were presented at a national press conference, and written guidelines for suicide reporting were sent out to all newspaper editors. The results of the survey and the guidelines were discussed in a personal meeting with the Editor-in-Chief of the main tabloid. After the publication of the guidelines a second, identical survey was conducted. The main variables regarding frequency, form, and content of the newspaper reports before and after the press conference were compared. The number of articles, on the one hand, increased over the 3 years between the first and second survey, but the quality of reporting clearly improved on the other. The personal contact with the editor of the tabloid was probably the most effective means of intervention.

The Action-Project Method in Counseling Psychology.

The qualitative action-project method is described as an appropriate and heuristic qualitative research method for use in counseling psychology. Action theory, which addresses human intentional, goal-directed action, project, and career, provides the conceptual framework for the method. Data gathering and analysis involve multiple procedures to access information from 3 perspectives: manifest behavior, internal processes, and social meaning. The method has a number of advantages, including its conceptualization, which is close to human experience; its systematic data gathering and analysis procedures; its usefulness in describing processes of interest to counseling psychologists: and its uniqueness among qualitative research methods.

The family career development project in Chinese Canadian families

Abstract Based on an action-theoretical conceptualization, this research examined the family career development project in Chinese Canadian families. Six families, each composed of a parent and adolescent, participated in a videotaped conversation to determine a family career development project that was subsequently monitored over a 6-month period and followed up with a second videotaped conversation. The further analysis of these data from a larger data set of 20 Chinese Canadian and European Canadian families resulted in the delineation of several properties of the career development project in Chinese Canadian families, including the importance of the parental agenda, the adolescent’s involvement, parental communication of convincing reasoning, and the adolescent’s withholding and withdrawing response. The findings also indicated that a family career development was central to other higher order projects in the family, including the relationship and cultural projects. The data supported the understanding of project as joint goal-directed action over time and as the basis on which career development influence was organized in these families.

The Future of Career: Reconceptualising career theory and research: an action-theoretical perspective

The thesis of this chapter is that career can be reconceptualised as an interpretative construct used by people and heuristic for counselling practice. This reconceptualisation is responsive to the current context in which both the viability of the construct of ‘career’ as well as ‘careers’ themselves have been challenged (e.g. Hall & Associates, 1996; Richardson, 1993). The reconceptualisation of career espoused here can be seen as representing one of several approaches Savickas (1995) identified as contributing to the reform of vocational psychology as an interpretative discipline (Carlsen, 1988; Cochran, 1990, 1991, 1992, 1997; Collin & Young, 1986, 1988; Csikszentmihalyi & Beattie, 1979; Neimeyer, 1988; Ochberg, 1988; Peavy, 1992; Savickas, 1993, 1994; Young, 1988). Many of these authors have attempted to address problems that have arisen in our traditional understanding of career from what can be understood as a postmodern perspective, although not all explicitly refer to their perspectives as such. Before making a case in favour of the reconceptualised view, and thus supporting the viability of the career construct, it is pertinent to review briefly the issues that have contributed to the death of career as it has been largely understood (e.g. Hall & Associates, 1996), and then to identify the salient constructs and trends that have emerged in the discussion of career from an interpretative perspective. The reconceptualised view presented in this chapter addresses the issues relevant to the death of career, uses and extends constructs that have emerged in other interpretative approaches, and provides a conceptual framework to foster renewed research and practice in the career domain.

Contacts of suicide attempters with GPs prior to the event: a comparison between Stockholm and Bern

The aim of this study was to investigate patterns of contact made with GPs by subjects in two cities prior to attempting suicide, in order to determine whether differences in the health care systems could be a possible factor influencing the help‐seeking behaviour of people experiencing suicidal crises. Structured interviews were conducted with suicide attempters from geographically defined catchment areas in two countries with private and national health care systems, respectively. The subjects were suicide attempters, admitted consecutively, aged ≥15 years and living either in Stockholm (n=202) or in Bern (n=66). Patients living in Bern had seen their GPs more regularly and more frequently throughout the year. There was an increase in the number of visits to the GP prior to the suicide attempt in both cities, but it was greater in Stockholm than in Bern. However, in Stockholm fewer patients who saw their GP in the week before the attempt talked about their suicidal thoughts. The differences in help‐seeking behaviour between the two patient samples may be related to the higher number of practising GPs and a more personal and consistent patient‐doctor relationship in Bern. It is possible that the private medical care system in Switzerland lowers the threshold enabling patients to talk to their GP about their suicidal plans. The results suggest that in both cities there is scope for improving communication of the suicidal patient with his or her doctor.

Therapist Sensitivity Towards Emotional Life-career Issues and the Working Alliance with Suicide Attempters

This study investigated the usefulness of an action theoretical model of suicide in interviewing suicide attempters. Eighteen interviews were video-recorded and transcribed. The patients’ narratives were reconstructed and life-career issues relevant for the patients suicidality formulated. Skin conductance response was used to determine narrative content associated with actualized emotions. Scores of the patients’ ratings of helping alliance experienced in the interview were positively associated with the therapists’ sensitivity towards emotionally relevant life-career issues. Furthermore, relationship satisfaction was related to a narrative interviewing style. We conclude that working alliance in clinical interviews with suicide attempters can be improved when the interviewer uses apatient-oriented approach aimed at understanding the patients suicidality in the context of personal life-career, or identity issues.

Addiction as a complex social process: An action theoretical perspective

This article introduces an action theoretical perspective of addiction. The view that addiction resides solely within the individual continues to foster significant limitations across addiction theorizing, research, and treatment. Exclusive focus on an individual neurobiological level of analysis precludes important additional layers of understanding, for example, the roles of individual and joint human actions, the socially constituting processes of addiction, and the role of gender. Our perspective is that a neurobiological view on addiction is insufficient without consideration of goals, intentionality, relationships, and meaning. Using a composite case scenario, we offer an action theoretical framework for understanding individual and joint addiction processes over time and within the context of other life processes. This integrative framework considers manifest behaviors, internal and communicative processes, and the social meaning of addiction. This article offers a practical application of the theory and draws broad implications for the conceptualization and subsequent language of addiction.