BackgroundThe goal of this study was to assess the relationship between sociocultural factors and clinical eating disorders during the intensive process of Westernisation in Poland that occurred after 1989. The study population included girls diagnosed with an eating disorder according to DSM-IV criteria (n = 47 anorexia nervosa restrictive type [ANR], n = 16 anorexia binge/purge type [ANBP], n = 34 bulimia nervosa [BN], n = 19 eating disorder not otherwise specified [EDNOS]) who received consultation for the first time between 2002 and 2004 in the Department of Clinical Child and Adolescent Psychiatry, University Hospital, Kraków, Poland. The study included an age-matched normal control group [NOR] of 85 schoolgirls from Kraków.MethodsRelationships between two given qualitative features were investigated using the chi-square test or Fisher’s exact test. Correspondence analysis was applied to graphically explore the relationship. The Kruskal-Wallis test with the Bonferroni was performed to compare quantitative results across groups.ResultsObjective sociodemographic variables and responses to the 62-item Questionnaire of Socio-cultural Context were measured. The mothers of ANBP and BN patients were less professionally active than mothers of ANR patients and NOR subjects. Subjective socio-cultural factors were more relevant for the BN group than the ANR group. Questionnaire responses in the ANBP group were more similar to those in the BN group than to those in the ANR group. The most unambiguous and specific characteristic of the ANR group was a sense of belonging to the middle class. Variables that differentiated the BN group from the NOR group included the importance attached to thinness treated as an expression of power and control over one’s self, as well as a multifaceted negative evaluation of one’s own family, including a negative assessment of the position of women and parental lack of concern for appearance and principles of nutrition. All patients, regardless of diagnosis, identified with other people with similar problems and considered anorexia and bulimia to be a major issue of their generation and social environment.ConclusionsThe results of this first in Poland exploratory study of socio-cultural context of eating disorders indicate the importance of both objective and subjective socio-cultural factors in eating disorders in the group studied.

BackgroundDisturbances in various elements of transgenerational family functioning patterns are not uncommon in studies of eating disorders.We examined the relationship between patients’ perception of autonomy and intimacy in their families of origin and that of their parents in their own families of origin.Material/MethodsThe sample consisted of 112 girls who had a diagnosis of an eating disoder and their parents; 54 of the girls were diagnosed with anorexia nervosa restrictive subtype, 22 as anorexia nervosa binge/purge subtype, and 36 were diagnosed with bulimia nervosa. We had 2 control groups: 1 group consisted of 36 girls diagnosed with a depressive episode, dysthymia, or adjustment disorder with depressed mood and the other group was 85 female students from schools in Cracow, Poland and their parents. We used the the Family of Origin Scale to assess perception of family relationships. Statistical analysis was performed with the Statistical Package for the Social Sciences (SPSS 20.0.PL; Chicago, IL, USA).ResultsThere was a significant association between daughters’ and fathers’ perceptions of autonomy in their families of origin in all groups. There was no significant association between daughters’ and mothers’ perceptions in all groups. The strongest correlation was between the non-clinical sample of girls and their fathers and for the bulimic group.ConclusionsWe did not detect any link indicating the specificity of transgenerational transmission of autonomy and intimacy in eating disorders. The results point to the importance of the father figure in studies of family systems, including the context of family transmission.

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The study demonstrates how motherhood gender-related discourse is intertwined with the ways in which the systemic techniques and systemic thinking are realised in the session. This research explores the consequences of gender-related discourse commonly co-constructed by participants in couple therapy and not recognised or challenged by the therapist. Video-recorded data from a couple therapy session containing unrecognised genderrelated discourse were subjected to conversation analysis (CA). The interview (Interpersonal Process Recall) transcript was analysed according to the rules of dialogical analysis. Gender assumptions held unchallenged by a therapist can be manifested through: placing one spouse in the position of the person accountable for the genderrelated choices, the therapist's mirroring of one participant's lexical choices only, sharing normative expectation of one person. Unrecognised gender discourse create difficulty in introducing circular thinking. The obstacles on the therapist's side can render power issues connected with gender invisible and thus unavailable for introduction into the therapeutic conversation.

Objectives Externalizing behavior problems are considered to be a serious impediment to a child’s development, and therefore it is important to identify their predictors. In this study, we investigated the connections between school-aged boys’ externalizing problems, the mother’s reflective functioning (RF) and the mother’s perception of her childhood relationship with her own caregivers. Methods The study sample comprised 39 school-age boys diagnosed with externalizing behavior problems together with their mothers. A child’s psychopathology was assessed using the Child Behavior Checklist and Teacher Report Form. Our assessment of the mothers’ mentalizing capacities was based on the Adult Attachment Interview and Reflective Functioning Scale. The perception of a mother’s childhood relationship with her parents was assessed using the Parental Bonding Instrument. Results The analysis revealed that more severe cases of aggressive and rule-breaking behavior in boys were associated with lower RF in mothers, as well as with a mother’s perception of her childhood relationship with her own parents as less autonomous. More aggressive behavior in boys was also associated with a mother’s perception of herself as experiencing a higher degree of care from her father during her own childhood. Conclusions These are only preliminary findings and we have discussed them with a view to understanding the possible ways in which a mother’s RF and the intergenerational context of relationship quality are associated with externalizing behavior problems in middle childhood.

Cel pracyW artykule zaprezentowano rezultaty projektu badawczego poświęconego ocenie zmian w procesie systemowej terapii rodzinnej prowadzonej w grupie klinicznej młodzieżowych pacjentów psychiatrycznych.MetodaDo oceny wykorzystano polską wersję kwestionariusza SCORE–15. Badanie przeprowadzono na grupie 109 rodzin, które wypełniły kwestionariusz przed pierwszą sesją. Przed czwartą sesją ankietę wypełniły 73 rodziny; a po ostatniej sesji ukończyło ją 28 rodzin.WynikiWyniki konsensualnych analiz jakościowych ujawniły zmiany w opisie rodziny, a także w opisie problemu. Analizy statystyczne wyników kwestionariusza SCORE–15 wykazały znaczące zmiany między pierwszą, czwartą i ostatnią sesją. Zmiany zostały zidentyfikowane w skali SCORE Total, a także w skalach VAS. Wskaźnik RCI wykazał 5 popraw i 2 pogorszenia po trzech sesjach oraz brak pogorszeń i 13 popraw pod koniec procesu terapii.WnioskiUzyskane wyniki wskazują na wiele istotnych zmian w badanych obszarach po przejściu rodzin przez systemową terapię. Badanie wykazało także, że spójna analiza jakościowa materiału opisowego może być bardzo użyteczna i może wzbogacić zarówno rozumienie procesu terapeutycznego, jak i sposób przekazywania rodzinom informacji o zmianach w ramach terapii.

The authors of the present article describe the historical context of family therapy in Poland and current issues in the field. They highlight the fact that Polish therapists first began to develop the field after coming into contact with family therapy leaders from the United States and Western Europe. With the political breakthrough of 1989, there were new opportunities for multilateral cooperation, attendance at international conferences, and the exchange of experiences. Currently, the work of Polish family therapists, the place of family therapy among other forms of psychotherapy, and the related problems and challenges do not differ from other European nations.

UJ CM family therapy child and adolescent psychiatry psychotherapy reform StreszczenieArtykuł ma na celu przedstawienie refleksji związanych z wprowadzaniem w naszym kraju zmian w dotychczasowych regulacjach dotyczących psychoterapii, w tym psychoterapii dzieci i młodzieży. Autorzy analizują omawiany proces w kontekście kryzysu psychiatrii wieku rozwojowego i diagnozy postawionej przez inicjatorów reform, stawiając pytanie, na ile proponowane rozwiązania przyczynią się rzeczywiście do poprawy sytuacji, a na ile będą źródłem nowych problemów i napięć, w tym m.in., na ile skomplikują praktykowanie terapii tym psychoterapeutom, którzy wykształcili się w dotychczasowym systemie monitorowanym przez towarzystwa naukowe. Omawiane zagadnienia przedstawione są z kilku perspektyw: perspektywy klinicznej pracy z dziećmi, młodzieżą i ich rodzinami w publicznym systemie opieki zdrowotnej; perspektywy naukowo-badawczej ukazującej, poprzez przegląd piśmiennictwa, aktualny stan refleksji nad sposobem definiowania skuteczności psychoterapii, poszerzony o aktualne, międzynarodowe wskazania jej stosowania w pracy z rodzinami; oraz perspektywy szkoleń z zakresu psychoterapii i ewentualnych konsekwencji proponowanych zmian dla tego obszaru. Autorzy podnoszą kwestie budzące w obecnym czasie sporo kontrowersji środowiska psychoterapeutów, starając się przedstawić je w świetle skłaniającym do refleksji.