Paul D. Steinhauer

The Process Model of Family Functioning

The Process Model of Family Functioning differs from the McMaster Model of Family Functioning and their common source, the Family Categories Schema, by its increased emphasis on the dynamic interaction between the major dimensions of family functioning, and by its stress on the interface between intrapsychic subsystems and the interpersonal dimensions of the family system. A model of family process rather than family structure, it defines six universal criteria of family functioning. It describes the processes involved in each along with the content components and the critical aspects of each. A self-report test developed from the model (FAM-III) is being widely used both as a research tool and as a clinical adjunct. Tests to define its validity and reliability continue.

Psychological aspects of chronic illness.

With improvements in the treatment of infectious diseases and the ever-increasing ability to sustain life, the practicing pediatrician is increasingly relied on to aid with management of the child who is severely and chronically ill. In this capacity he may be able to control the rate of progression or the frequency and severity of complications, may help the child compensate for some of the more destructive effects, and may help child and family to face the limitations, anxieties, and discouragements which accompany the disease-all of which require an understanding of what the illness means to the child and the family.

Criteria and methodology for assessing credibility of sexual abuse allegation

This paper will consider three types of interview that are held with sexually abused children. After discussing common problems in technique, it will suggest a methodology designed to help determine a childs credibility and assist in forming and demonstrating a reliable expert opinion for court purposes. Next, it will describe three types of data crucial in investigating allegations of sexual abuse, and will suggest clinical criteria useful in distinguishing true from false allegations. Finally, it will examine the validity of these criteria, comparing them to those of other workers in the field.

Psychological Problems of the Child and His Family

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Assessing the credibility of young children's allegations of sexual abuse: Clinical issues.

In assessing the credibility of young childrens (ages 2–7) allegations of sexual abuse clinicians need to know how dynamics of sexual abuse affect disclosure, what situations are most commonly associated with fictitious allegations and how the childs developmental stage affects disclosures. Understanding these issues allows for clear decision making. A clear decision making process flows naturally from an understanding of these issues.

The Foster Care Research Project: summary and analysis.

This paper analyzes and summarizes five more detailed papers describing the Foster Care Research Project (F.C.R.P.). This compared two (individual and group) models of foster care as to their effects on foster parent satisfaction, placement breakdowns and several indices of childrens adjustment in care. The group model is described and contrasted with other “extended family” models, and the results of the project, which were mixed, are summarized. A critique of the experimental design suggests why clinical gains noted in the children were not borne out experimentally. Following a clinicians analysis of the process by which the group model operated (illustrated by clinical vignettes), the paper ends by describing the content and process of two support groups for the natural children of the foster parents.

The Integrated Use of Individual and Family Psychotherapy

For almost thirty years after the development of family therapy, the concurrent use of family and individual psychotherapy was seen as incompatible by leading proponents of each modality. Although recently the literature has revealed an increased willingness to utilize family and individual therapies concurrently, the decision for or against any such combination has been left largely to the intuition or bias of the individual clinician. This paper suggests the concurrent use of family and individual psychotherapies when disturbances of family structure and interaction co-exist with, reinforce, and are maintained by largely ego-syntonic internalized psychopathology (that is, the character defences of individual family members). It provides a rationale for integrating the concurrent therapies, and uses clinical examples to illustrate how each can potentiate the other. There is a discussion of indications and contraindications for the integrated use of concurrent family and individual therapy. From their attempts to apply these principles, the authors conclude that the experience for the family, the individual and the therapists is that the selective and integrated use of concurrent family and individual therapies can achieve more than can either therapy alone — the whole is greater than the sum of the parts.

The psychiatric training of medical students.

Undergraduate psychiatric education should be concerned mostly with those aspects of psychiatry required for the proper practice of medicine. Psychiatric concepts and techniques are applicable to all medical practice and relevant to the daily work of every physician or surgeon. Therefore, in the psychiatric training of medical students the focus should be primarily on teaching “psychiatry of medical practice” and much less on teaching “specialty psychiatry. “ The teaching of psychiatry for medical practice will be best accomplished by selecting patients who are more like those the student will see later on as a practising physician. A systematic effort should be made to develop joint teaching with other departments, if we are to hope that students will carry over the approach we teach them to other subjects of medicine. Counselling and psychotherapy are essential skills for every physician or surgeon; medical students should be taught these skills by psychiatrists who are not just skilled psychotherapists but are also comfortable in their role as physicians in view of the importance of this role for the development of the identity of the medical student as a physician. The quality of the psychiatric training of medical students is dependent to a large extent on the priority accorded to undergraduate teaching by the department of psychiatry; competing activities, however, can result in undergraduate teaching being given less than top priority. Long-standing difficulties which psychiatry and psychiatrists experience in the medical school may impede undergraduate psychiatric education; these difficulties can be lessened by the closer involvement of psychiatrists with other physicians in the clinical and educational programs.

Teaching child psychiatry to medical-undergraduates

This article describes the findings of a survey of undergraduate curricula in the 16 Canadian medical schools in the areas of growth and development, behavioral sciences, and clinical child psychiatry. It identifies principles upon which such programs may be based and includes issues in integration of child and adult psychiatry.

The Preventive Utilization of Foster Care

There is a general, but unproven, belief that long-term foster care is inherently unstable and consistently damaging. This paper discusses eight biological, psychological and social factors that the literature considers responsible for the failures of long-term fostering. It then summarizes the clinical picture presented by such failures, pointing out how changes in the nature of children coming into care have necessitated shifts in the type of foster care required to meet their needs. The major part of the paper uses this knowledge to derive seven keys and associated practical strategies for preventing psychological and social deterioration for children in care.