The Clinical Generational Interview. An instrument for family assessment.

Interviews are the privileged tool for carrying out qualitative research and clinical assessments on family relationships. Nevertheless, there are limited examples of interviews in clinical and psychosocial literature that are explicitly aimed at the evaluation of relational-family constructs. This paper presents the essential characteristics of the Clinical Generational Interview (CGI): an original tool for investigating and evaluating family relationships, that aims to combine the complexity of the subject being studied with the systematic and rigorous approach. It was created according to the following criteria: a flexible qualitative approach, the production and relational reading of information, intersubjective measurability and control of the inferential/interpretative process, and clinical use. Although it is organized in a structured and well-defined form and provides a precise system for encoding information, it is not a test, nor an algorithm that can be used in a mechanically diagnostic sense; it is a very versatile psychological tool that can be used in two different areas: the first is related to clinical research on family and couple relationships, the second to relational assessments. The contribution illustrates the path of construction and elaboration of the instrument, considering first of all its theoretical foundations and the constructs derived from them and around which the set of items is organized. The criteria for coding and analyzing the information thus produced and the different possible areas of application are then described. Finally, the theoretical and methodological characteristics of the instrument are also considered in relation to the main interviews in the literature in order to highlight differential particularities.

The Conjoint Family Drawing: A Tool to Explore About Family Relationships.

In this article we will present the Conjoint Family Drawing, a graphic-interactive tool developed to evaluate family relationships. This tool allows an analytical and clinical evaluation of families and their relationships while facilitating the understanding of the overall family functioning through a synthetic coding system which distinguishes families from each other. First of all, a presentation of the analytical coding system is provided; such system consists of a grid, formed by two distinct levels of observation: the analysis of the product, which, in turn focuses on two levels, the global-familiar one (given by the overall drawing) and the individual one (given the individual members' drawings), and the analysis of the drawing process (what happens during the realization of the drawing), which is made up of the observations of family interactions at the individual and group level. Consistently with our objectives and the theoretical and methodological literature on family drawing in its various forms and ways of implementation, 10 indicators for product analysis and 9 indicators for process analysis have been identified. A sample of 117 Conjoint Family Drawings was analyzed in order to verify the coding system's applicability and effectiveness. The sample was constituted according to a convenience (not probabilistic) criterion. Following, a computing system was developed to allow the investigation of the overall family functioning through three steps: (1) the analysis of the frequency distribution of each indicator, in order to verify the non-determinability rates and the distribution of the different answer options; (2) a two-step cluster analysis, to determine homogeneous groups of Conjoint Family Drawings and identify, within each cluster (and comparatively between the clusters), the indicators and answer modalities that mostly affect the clusters' aggregation itself; (3) the development of a synthetic system to code the Conjoint Family Drawing, beginning with the indicators that define the typological profiles of the clusters obtained. The synthetic system was developed through a summative and logical-combinatorial method, merging the most discriminating and clinically significant coding items, that is, those that are best associable to specific ways of family functioning. Seven family types emerged from these analyses: families characterized by optimal functioning, families characterized by adequate functioning, families characterized by chaotic functioning, families characterized by fragile paternity, families characterized by separate functioning, families with multiproblematic functioning and residual families. The characteristics of these family types will be outlined in this article.

"Lights and Shadows": An Interpretative Phenomenological Analysis of the Lived Experience of Being Diagnosed With Breast Cancer During Pregnancy.

Cancer diagnosed during pregnancy is a rare event. The most common type of malignancy diagnosed in pregnant women is breast cancer, whose incidence is expected to raise in the next future due to delayed childbirth, as well as to the increased occurrence of the disease at young age. Pregnant women diagnosed with breast cancer are exposed to multiple sources of stress, which may lead to poorer obstetric outcomes, such as preterm birth and low birth weight. In addition, pregnancy involves physiological changes in the breasts that may blur the signs of cancer, with delayed diagnosis and poor prognosis. However, the lived experience of these women was investigated in very few studies. Given this scenario, we conducted this qualitative study to describe and understand women's subjective experience of being diagnosed with breast cancer during pregnancy. The study was conducted following the principles of Interpretative Phenomenological Analysis. Participants were five women with breast cancer diagnosed during pregnancy, purposefully recruited at a public hospital during medical visits and interviewed at treatment initiation. The interview transcripts were analyzed using thematic analysis. The textual analysis led to the identification of three main themes related to: (1) the emotional storm experienced after cancer diagnosis, and the importance of receiving appropriate information and being focused on treatment decisions; (2) physical changes and comparisons with healthy women, associated with feelings of sadness and inadequacy; (3) being positive, feeling free to disclose all kinds of emotions, religion and spirituality as sources of strength. The paradoxical coexistence of pregnancy and cancer represents a stressful experience for women and their loved ones. Adopting a systemic perspective may be important to understand the effects of such a complex condition, also considering its impact on healthcare workers.

Benefits of Expressive Writing on Healthcare Workers' Psychological Adjustment During the COVID-19 Pandemic.

COVID-19 outbroke in Wuhan, China, in December 2019 and promptly became a pandemic worldwide, endangering health and life but also causing mild-to-severe psychological distress to lots of people, including healthcare workers (HCWs). Several studies have already showed a high prevalence of depression, anxiety, and post-traumatic symptoms in HCWs but less is known about the efficacy of psychological interventions for relieving their mental distress. The aims of this study were: (1) to evaluate the psychological adjustment of Italian HCWs during the COVID-19 pandemic; (2) to investigate the efficacy of an expressive writing (EW) intervention, based on Pennebaker's paradigmatic protocol, on their psychological adjustment; (3) to analyze if outcomes of EW vary in function of individual differences (age, gender, marital status, and baseline values of symptoms). Fifty-five HCWs were randomly assigned to one of two writing conditions: EW (n = 30) or neutral writing (NW; n = 25). Psychological adjustment (in terms of ptsd, depression and global psychopathology's symptoms, perceived social support, and resilience) was assessed before and after three writing sessions. Participants who received the EW intervention showed higher improvements in ptsd, depression, and global psychopathology symptoms. Improvements in EW group varied in function of age, gender, marital status, and baseline values: young, men, married participants and those who had higher baseline scores showed a higher reduction of psychological distress symptoms while women, single and those who had lower baseline value showed increased social support, and resilience. In conclusion, the EW intervention had positive effects which varied in function of individual differences on HCWs' psychological health.

Individual and Relational Well-Being at the Start of an ART Treatment: A Focus on Partners' Gender Differences.

Infertility and ART treatments represent stressful experiences for the couples, impacting on the overall psychological well-being of partners as well as on their couple adjustment. Several variables were analyzed as risk factors for infertility-related distress. The impact of these experiences has been well-documented in both women and men, reporting important gender differences. The aim of this study was to assess gender differences in individual and relational well-being in infertile couples. Gender differences for psychological and medical variables predicting psychological distress were investigated. Two hundred and thirty couples who entered an ART program at a public hospital in Milan were recruited. Each partner completed the following scales: ScreenIVF, Dyadic Adjustment Scale, and Experience in Close Relationship Questionnaire. Findings revealed several gender differences with women reporting higher levels of both anxiety and depressive symptoms, anxiety and avoidance attachment, and helplessness, but lower levels of acceptance than men. Differences emerged also in factors predicting well-being: poor support predicted anxiety in men and depression in women. Furthermore, individual well-being was predicted only for men by attachment anxiety and previous treatment. Finally, in the women subsample, couple's adjustment was predicted by anxiety attachment, while in men predictors were helplessness and type of diagnosis. These results suggest the importance of implementing support interventions for couples which take into consideration the specific needs and fragility of each partner as well as focusing on enhancing a sense of partnership.

Working With Infertile Couples Seeking Assisted Reproduction: An Interpretative Phenomenological Study With Infertility Care Providers.

Although most studies investigated the impact of infertility and its treatment on the couple, a small body of evidence suggested that infertility care providers may experience different sources of stress related for instance to excessive workload, the complexity of the technique, and relational difficulties with patients. The current study aimed at providing further insight into the understanding of the subjective experience of infertility care providers by highlighting their feelings and emotions, personal meanings, challenges, and opportunities. Following the methodological guidelines of Interpretative Phenomenological Analysis, we conducted individual semi-structured interviews with 23 members of two different fertility units. Interviews were audiotaped and transcribed verbatim. Textual analysis was then conducted to identify emerging dominant themes and subthemes. Three main themes were extracted: (i) dealing with infertile patients and their specificities, (ii) performing assisted reproductive technology (ART), (iii) being part of a team. These themes related to participants experiencing: (i) difficulties in establishing an empathic connection and communicating with couples, such that women were sometimes perceived as "particular patients" and men as poorly involved in the process; (ii) difficulties in dealing with a complex procedure in which errors are not allowed (as reported by embryologists), with a growing number of women aged > 40 seeking assisted reproduction, despite the risks for their health; (iii) being part of a team as a resource, although the huge amount of time spent together can involve conflicts and organizational problems. These findings suggested that patients' overpersistence (rather than just dropout) represents an important source of stress for infertility care providers. At the same time, the concept of particular or difficult patient derives from the combination of multiple factors, including providers' own history and subjective experience. The presence of mental health professionals in fertility units is essential to help providers improve the quality of doctor-patient communication and relieve the stress related to organizational issues and conflicts.

Intimate Partner Violence and Child Custody Evaluation: A Model for Preliminary Clinical Intervention.

Intimate partner violence is defined by the World Health Organization as "any behavior within an intimate relationship that causes physical, psychological, or sexual harm to those in the relationship" and it refers to a specific relationship dynamic. In recent decades, an increasing number of studies have focused on this phenomenon, considering its exponential growth over time. Many studies have focused on risk factors for violence within the couple relationship. This paper specifically analyses the association between violence and separation or divorce. Although many interventions have been developed over the years, the effectiveness of extant interventions on violent behaviors is not yet empirically supported. Since clinical experience allows to affirm that both partners can be involved in treatment for intimate partner violence especially during mandated proceedings, the present study focuses on domestic violence in separated couples involved in a child custody evaluation process. In this case, literature supports the need for individualized assessment in order to promote the best intervention according to the specific conditions of each partner, whether the battered one or the perpetrator. However, little research has been done on child custody evaluation in the presence of violent couples. The aim of the present study is to present a model of couple clinical intervention with a separated violent couple in the context of a child custody evaluation. This model can be defined as relational-intergenerational and its main aim is to understand the exchange between familial generations and to search for factors that safeguard and care for family relations. Furthermore, according also to the therapeutic assessment approach, there is an intrinsic connection between assessment and "family transformative potential." This paper presents the specific working methodology underlying this model, through the description of a single clinical case. In particular, the proposed model provides a multi-dimensional assessment comprising three levels: individual, evaluating parents' history through representations, thoughts, and feelings; interpersonal, investigating the different relations; discussion and dialogue with the parental couple about findings.