This study examines how young Chinese men who have sex with men (MSM) living with HIV navigate the disclosure or concealment of their sexual orientation and HIV status within family contexts shaped by Confucian moral norms. Drawing on in-depth interviews with 24 participants and a constructivist grounded theory approach, the study identifies five disclosure strategies: prior disclosure of sexual orientation followed by HIV disclosure, prior disclosure of sexual orientation with withheld HIV disclosure, simultaneous disclosure of both identities, non-disclosure of both identities, and HIV disclosure with withheld sexual orientation. Findings show that disclosure was not a discrete act but an ongoing relational process through which participants negotiated stigma, filial obligation, and family ties. Participants navigated the unequal moral meanings attached to HIV and sexual minority identity: HIV sometimes became a culturally intelligible condition that elicited care and reduced marriage pressure, whereas sexual minority identity remained more closely associated with filial failure, lineage expectations, and family reputation. To conceptualize these dynamics, the study develops an integrated framework of relational reconfiguration and the ethics of ambiguity. Relational reconfiguration captures how family relationships are reorganized through shifting boundaries, moral expectations, and roles, whereas the ethics of ambiguity refers to the culturally grounded strategy through which such reconfiguration is enabled and sustained. These findings suggest that practitioners should not treat full disclosure as a universal goal; instead, they should support culturally and relationally attuned disclosure planning, including partial, staged, or sibling-mediated pathways that allow individuals to maintain safety, care, and family connection under intersecting stigma.
Despite growing evidence supporting the positive effects of individual-oriented relationship education on romantic relationship outcomes, few studies have explored impacts on child outcomes. This study examined indirect effects of MotherWise, a community-based perinatal program using the Within My Reach curriculum, on child social-emotional well-being. Perinatal individuals from marginalized groups were randomly assigned during pregnancy or within three months postpartum to the MotherWise program (n = 512) or the no-treatment control group (n = 437). Three mechanisms were assessed at 12-months post-enrollment: general conflict management skills, romantic relationship skills, and disapproval of relationship violence. Child problem behaviors and social-emotional competency were measured at 30-months post-enrollment. Path models were tested using Mplus to examine each mechanism individually and then all together in a combined model. Results are consistent with positive indirect effects of MotherWise on child outcomes. Compared to the control group, MotherWise participants reported better conflict management skills, romantic relationship skills, and greater disapproval of relationship violence at 12-months post-enrollment. These enhanced skills and knowledge were, in turn, associated with fewer problem behaviors and greater social-emotional competency for children at 30-months post-enrollment. The combined model supported that disapproval of relationship violence uniquely contributed to MotherWise's indirect effects on both child outcomes, while romantic relationship skills uniquely contributed to children's social-emotional competency. Results showed indirect benefits of individual-oriented relationship education for children and suggest that clinicians and community-based programs serving families can support child well-being by providing relationship education to individual parents.
Emotion regulation is central to managing emotions and interactions, making it essential for effective relationship functioning. Because emotion dysregulation contributes to many presenting problems in couple therapy, understanding it within clinical couples is vital, particularly when one or both partners have a history of adverse childhood experiences (ACEs). While the link between ACEs and adult mental and relational challenges is well-established, research about how ACEs affect the therapy change process is still developing. Most existing research about ACEs has focused on cumulative ACE counts, with less attention to exposure to distinct ACE types (within the family context) and their differential effects on emotion regulation. The current study focuses on emotion regulation difficulty in clinical couples, exploring associations with frequency of exposure to individual ACE types-such as abuse, neglect, and various types of family of origin dysfunction-and levels of emotion regulation difficulty at intake as well as the trajectory of emotion regulation difficulty over 12 sessions of couple therapy. Findings were that emotional maltreatment (abuse and neglect) and mental illness in one's family of origin were associated with higher levels of emotion regulation difficulty at intake. Also, greater frequency of emotional neglect in childhood was associated with faster rates of change in emotion regulation difficulty over 12 therapy sessions. Findings suggest that assessing the frequency of family-of-origin adversity may be clinically relevant in couple therapy contexts and that individuals with histories of neglect may experience improvement in emotion regulation within supportive relational environments characteristic of couple therapy.
This study examines how divorced single parents make sense of their parenting and co-parenting experiences during the COVID-19 pandemic and the February 6, 2023, Kahramanmaraş-centered earthquakes in Türkiye. Using an interpretative phenomenological analysis design, the study draws on two-stage, semi-structured online interviews with 23 divorced parents who had been officially divorced for 1-5 years, lived with at least one child under the age of 18, and had experienced the crisis conditions addressed in the study, including direct exposure to the February 6, 2023, earthquakes. The analysis generated four interrelated themes: the fragility of co-parenting under crisis, the asymmetrical concentration of parenting burdens, the child's emotional burden within interparental tension, and the boundary-based reorganization of co-parenting. The findings show that crises did not simply add external stress to post-divorce family life; rather, they reactivated unresolved tensions around child-centered coordination, caregiving responsibilities, information sharing, boundaries, and decision-making with the former spouse. Participants' narratives further indicate that, although crises intensified relational fragility and parenting stress, they also prompted some parents to establish more limited, functional, and child-centered forms of communication. By making visible the intersection of divorce, crisis, and co-parenting in the Türkiye context, the study suggests that post-divorce support services should include crisis-responsive guidance on boundary-setting, child-centered information exchange, and gender-sensitive distribution of parenting responsibilities.
Couples in conflict often become trapped in recursive cycles of complaint and defensiveness, leading to demoralization and disconnection. This is a problem for the couple and the therapist. This paper offers the idea that when couples engage in conflict, it is often a response to not being able to connect or feel understood, empowered, and supported in their values. Couples' complaints show up directly and indirectly: they complain directly with words and indirectly with distressed emotion, behavior, and physiological dysregulation. To enable the therapist to help the couple interrupt the conflict and form a working alliance around a shared goal, we propose that therapist identify a relational need that resonates with each partner. The couple impasse creates urgency for these relational needs to be met, at the same time that it prevents the couple from meeting them. This paper offers a way to maintain engagement and direction when couple conflict threatens the couple bond and can disempower the therapist.
This study examined how legal status differences shape comparison, caregiving, emotional strain, and solidarity among siblings in mixed-status immigrant families. Siblings play a critical role in immigrant family life, yet research has largely focused on parent-child dynamics. In mixed-status households, siblings hold different legal statuses, creating unequal opportunities and responsibilities that shape their relationships. A qualitative interpretive meta-synthesis was conducted on 13 studies of US-connected mixed-status and transnational families, identified through systematic searches of four databases and forward and backward citation searching. Eligible studies used qualitative or mixed methods and reported on sibling experiences. Analysis involved quotation-level coding, constant comparison, and the development of third-order constructs. The evidence spanned the life course and predominantly represented families of Mexican origin, with Central American, Colombian, and Brazilian families also represented across U.S. and transnational contexts. Four overarching themes emerged: (a) legal status awareness and sibling comparisons; (b) emotional burden and relational strain; (c) parentification and unequal responsibilities; and (d) sibling solidarity, support, and adaptation. Sibling relationships in mixed-status families are shaped by legal status in ways that generate both strain and resilience. Siblings act as key agents of documentation status socialization, caregiving, and advocacy. Programs that include siblings, not only parents, are needed. Community-based supports can build on sibling solidarity while addressing emotional strain tied to status disparities. Clinical interventions should attend to power, privilege, and loss linked to unequal mobility.
Although the implications of parental smartphone use for parenting have been discussed among researchers and practitioners, prior studies have mostly focused on the between-person associations of problematic smartphone use with negative parenting behaviors. Therefore, using 5 days of daily diary data, the present study examined whether day-to-day fluctuation in maternal problematic smartphone use was associated with day-to-day fluctuation in maternal hostility as well as warmth toward children, on the same day and on the following day. Data were collected from mothers of 74 fourth graders (mean age = 9.20 years; age range = 8-10 years; 69% were girls) studying in five elementary schools in Hong Kong, China. On each of five consecutive days, mothers filled in an online questionnaire in the evening on their own smartphone use and their parenting behaviors during the day. Random intercept multilevel linear models within the Bayesian framework revealed that on days when mothers used smartphones more problematically (compared to their cross-day averages), they showed more hostility and less warmth toward their children (compared to their cross-day averages) on the same day, even controlling for fluctuation in parenting on the previous day. However, no evidence of lagged-day associations was found. Theoretically, findings pointed to the potential role of parents' problematic smartphone use in understanding daily variation in both negative and positive parenting behaviors. Practically, findings underscored the possible utility of using community education and intervention programs to help parents monitor their smartphone use and foster positive parenting.
Maternal depressive symptoms, especially given their severity and chronicity, can pose risks to children's peer competence. Yet, there is a potential for positive family expressions to buffer this effect. Guided by a developmental cascades framework, this study focused on a three-way interaction among children's peer competence at school entry, positive family expressions, and maternal depressive symptoms in predicting children's peer skills over the elementary school years among U.S. families (N = 1364). Peer competence and positive peer interactions were measured through parental reports and school observations, respectively, in Grades 3 and 5. Positive family expressions were assessed by two caregivers in Grades 3, 4, and 5, and maternal depressive symptoms were self-reported in Grades 1, 3, and 5. A path model revealed a three-way interaction: children with higher peer competence in Grade 1 showed lower positive peer interactions in Grade 5, only under high levels of maternal depressive symptoms and high positive family expressions. In addition, maternal depressive symptoms predicted lower peer competence in Grade 5 under high positive family expressions. The findings underscore person-environment interactions in peer competence development and suggest a nuanced understanding of the role of positive emotion socialization in contexts of high maternal depressive symptoms. These findings emphasize the need for family-based interventions addressing maternal depressive symptoms and children's social competence.
Parents play an important role in adolescents' gratitude development, yet little is known about whether and how fluctuations in parents' gratitude (i.e., gratitude lability) over time are associated with adolescents' socioemotional adjustment. Using three-wave data spanning 16 months, this study examined the longitudinal associations between parents' gratitude lability and adolescents' socioemotional outcomes, including depressive symptoms, life satisfaction, and prosocial behaviors, in 537 Chinese parent-adolescent dyads (MChild age = 10.25 years, SD = 0.69; 57.3% girls). Adolescents' gratitude lability was tested as a possible explanatory mechanism, and adolescent gender was examined as a moderator. Results showed that parents' gratitude lability was positively associated with adolescents' gratitude lability across waves, which in turn was related to adolescents' depressive symptoms and prosocial behaviors. Furthermore, for girls, parents' gratitude lability was indirectly associated with adolescents' prosocial behaviors via adolescents' gratitude lability. However, for boys, this indirect effect was nonsignificant. These findings underscore the value of a dynamic perspective for understanding the intergenerational transmission of gratitude and its developmental correlates. Future intervention research may benefit from examining whether more consistent parental expressions of gratitude can support adolescents' stable gratitude development, well-being, and prosociality.
Our article is testimonios from the perspective of three Black, female MFTs. We explore various results of the intersecting pandemics that we have ourselves experienced and continue to navigate. A recurring narrative that has been amplified during this time is that therapy and therapists should not be political and human. Not only is there an expectation that clinicians should not express or maintain a political stance, but we are also expected to hold space for clients to express their discriminatory or marginalizing views. This notion reflects the repeated pattern of clinicians showing up for clients regardless of any personal turmoil. Clinicians are expected to intentionally consider the context of intersecting pandemics on the populations we serve and give grace to students we teach, yet the same context is disregarded when considering the clinician's wellbeing and expectations regarding productivity. We see this habit manifest in academia as well and it contributes to an internal disconnect and lack of work/life balance. Overall, we have found that clinicians impacted by the ongoing pandemics are unable to find time to reflect on and process what is happening. Our article features our experiences, the lessons we have learned as a result of continuing to survive, and how we intend to use our agency, autonomy, and voices to create change for ourselves and our communities. We hope that readers develop a better understanding of how to recognize and respect the humanity of mental health clinicians.
This scoping review provides an overview of empirical research and practice-based literature that addresses direct clinical practice with chosen families-familial relationships that are not based on biology or law. Given the prevalence of chosen family among sexual and gender minorities as well as the amount of research that underlines chosen family as an important social support, this paper aims to synthesize recommendations for clinical work with chosen families and to highlight gaps in the literature. Using the five-step Arksey and O'Malley (2005) scoping review process, four electronic databases were systematically searched to identify papers that address working with chosen family in care-related fields, including social work, couple and family therapy, and nursing. Twenty-seven articles were included in this review and seven themes were identified by these authors that culminated in recommendations for clinical practice: (a) educate oneself about diverse family forms and address biases; (b) invite self-definition of "family"; (c) proactively include chosen family; (d) consider legal and policy barriers; (e) refer chosen family members to sources of support; (f) encourage people to create or maintain chosen family; and (g) engage in sexual and gender minority affirmative practices generally. The existing literature focuses primarily on individual services that involve chosen family as needed, but do not explicitly focus on dynamic and systemic needs. Further research into systemic work with chosen family is needed.
Research on Attention-Deficit/Hyperactivity Disorder (ADHD)-related stigma has centered on individuals with the diagnosis. Evidence concerning caregivers exists but has not been brought together in a way that clarifies its scope, correlates, and implications, despite caregivers' central role in navigating services, supporting daily functioning, and treatment engagement. The present study therefore to systematically review the empirical literature on the stigmatization of caregivers of children with ADHD. Following PRISMA guidelines, we searched PubMed and PsycINFO for studies between 2013 and 2024. Of the 4136 articles, 15 studies examining affiliate and courtesy stigma met criteria. Across studies, affiliate stigma was consistently linked to higher levels of caregiver depression, anxiety, and distress, as well as coping strategies and parenting styles. Higher education levels among caregivers were associated with lower affiliate stigma. The severity of the child's ADHD symptoms and internalizing/externalizing problems significantly associated with the level of stigma experienced by caregivers. Courtesy stigma was associated with several factors, including negative attitudes (e.g., anger or blame directed at children with ADHD) among members of the general public. These findings highlight the multifaceted associations of stigma on caregivers. The association between affiliate stigma and caregiver psychological distress underscores the need for targeted interventions, however only one intervention study met inclusion criteria for this review. The association between negative attitudes and courtesy stigma indicates the importance of addressing public perceptions. Future research should focus on developing and testing interventions that aim to reduce stigma and improve the well-being of caregivers and their families. Trial Registration: Prospero registration number: CRD42024527305.
The article describes a first psychological support project for families living in the seam zone between Israel and areas controlled by the Palestinian Authority. Since October 7th, the proximity to the border and potential of terrorist infiltration into communities have generated heightened anxiety among residents, alongside concern for family members enlisted to reserve duty or on mandatory service. Therefore, the Family Therapy Unit of Menashe Regional Council initiated a psychological support program designed to strengthen families' resources and enhance their ability to cope with the ongoing stress and anxiety. The intervention was based on an integration of the narrative approach and emotionally focused therapy (EFT). These approaches were chosen for their grounding in positive and humanistic psychology, which highlights family resilience and can be applied in a focused, short-term intervention. The intervention protocol and a case example are described in detail. Additionally, an attempt to evaluate the project under wartime conditions is described, including its limitations. The evaluation method included a quantitative component and a content analysis of one open-ended question focused on the family's experiences with the intervention. The results indicated a significant reduction in parents' stress and in their perceptions of children's stress, but no significant difference in family resilience. Consistent with previous studies, participants experienced the therapeutic relationship as the most meaningful factor rather than the techniques employed. The article concludes with a call for further evaluation of such interventions in war zones and disaster-affected regions across diverse sociocultural and political contexts.
The objective of this study was to describe the narrative themes that emerged in Mexican American couples' stories about their relationship challenges at the beginning of the COVID-19 pandemic-during lockdown-and to examine how those themes related to their relationship satisfaction. We surveyed 58 male-female married couples (n = 116 participants; 73.33% Mexican American) recruited from the Southwest United States and enrolled in a longitudinal study of relationship functioning. Spouses wrote stories about the greatest COVID-19-related challenges they were facing as a couple. To explore associations between relationship satisfaction and the lived experience of COVID-19, stories were coded for established narrative identity themes (agency, communion, affect, meaning-making) and themes developed to account for the context of marital challenges (challenge outcomes, couple stress responses, familismo, overriding positive regard). Relationship satisfaction was associated with six narrative themes for wives (0.29 ≤ |r| ≤ 0.56) and three themes for husbands (0.29 ≤ |r| ≤ 0.40). Actor-partner interdependence modeling showed six actor effects and one partner effect for wives but no significant effects for husbands. This research provides novel insight into the challenges faced by Mexican American couples during the pandemic and suggests great promise for using narrative identity research to understand how individuals' narrations of couple stories are linked to relationship satisfaction. Further, our findings suggest that the narrative themes characterizing how conflict is storied by partners within the couple therapy room might be directly targeted as a means to improve relationship satisfaction.
Black American families are aware of the precarious nature of police interactions. Black people are disproportionately killed by the police at such levels that police violence is now categorized as a public health issue among the Black population. Black children and youth are not exempt from police violence and tend to be adultified or perceived as older than their biological age. In recognition of police violence, Black families engage in a context-specific socialization process, commonly referred to as "the Talk" to adequately prepare their children for potential police interactions. To explore this socialization process, we conducted a scoping review summarizing the existing literature to provide further insight into the content of this process, with a key focus on identifying the strategies that Black parents in the United States employ to insulate their children from harm. The review utilizes Arksey and O'Malley's framework for scoping studies. We searched five databases using a literature-informed search strategy, which resulted in the identification of 7736 records, of which 20 articles met the inclusion criteria. Findings of this review show that strategies used by Black parents emerged in four types: regulatory, consciousness raising, system-engaged, and beyond our control. Parental strategies focused on behavioral regulation, racial consciousness education, engagement and collaboration with systems, and reliance on faith and other-worldly protection. Implications for policy and practice call for the acknowledgment of additive labor performed by Black families, and the necessary provision of support and services that address the harm caused by discriminatory policing.
Relationship distress and dissolution are reported by about one-third of couples in the United States. Despite evidence that couple therapy is an effective treatment for relationship distress, many couples encounter barriers (e.g., cost, time, transportation, childcare) to accessing this kind of relationship help. The Relationship Checkup is a two-session, individualized intervention where each couple receives evidence-based suggestions to address specific relationship concerns. The Relationship Checkup was delivered as a home visitation intervention in the Southeastern region of the United States. The current study (N = 1298 individuals; N = 649 couples) uses Dyadic Latent Growth Curves models to examine associations between short-term (i.e., pre-intervention to 1-month post-intervention) change in an indicator of relationship quality (i.e., constructive communication, intimate safety, and relationship aggression) and longer-term change (i.e., pre-intervention to 6-months post-intervention) in relationship satisfaction. Specifically, we examine how change in one's own indicator of relationship quality influences changes in one's own and one's partner's relationship satisfaction. Across all indicators of relationship quality, short-term change for Partner A (i.e., the partner who requested the Relationship Checkup) is associated with longer-term change in satisfaction for self and partner. For Partner B, short-term change in each indicator is associated with longer-term change in satisfaction for self, but not for partner. Supplemental analyses indicate improvements are generally maintained for relationship aggression, while improvements for intimate safety and constructive communication generally decelerate following the intervention. Attuning to the identified areas of concern for the partner requesting the Relationship Checkup may be an effective approach to practice.
Religious disaffiliation, the act of leaving or choosing to no longer affiliate with a religious tradition, has individual and relational consequences. While not every family experiences challenges after the disclosure of religious disaffiliation, many report relational consequences including loss of family and community ties, secret keeping, lying, and tension in family relationships. Although disaffiliation research is becoming more common, there are still large gaps in the literature about the relational impacts of disaffiliation, as well as information about families who navigate these changes well. The current study aimed to begin filling these gaps in the literature by focusing on how families maintain family relationships after religious disaffiliation from the perspective of the disaffiliated individual. Using constructivist grounded theory, 20 individuals in the United States of America were interviewed about their disaffiliation experience and the factors that allowed them to maintain family relationships. The analysis resulted in the development of a dynamic model characterized by two processes: disaffiliated individual actions and perceived joint actions. Both processes are built upon a foundation of love and the desire to maintain family relationships. Clinical implications, such as facilitating perspective taking, communication skills training, and aiding clients in building community, are discussed.
Artificial intelligence (AI) is rapidly entering family life, reshaping how young children learn, play, and interact with technology. Yet little is known about how parents interpret these changes or organize AI use at home. This qualitative study generates a process framework of family AI use in early education and care, capturing Chinese parents' perspectives through inductive thematic analysis. Sixteen parents whose children attended nurseries and kindergartens across nine Chinese cities were purposefully selected for in-depth interviews. Through inductive analysis, we constructed a process framework suggesting that parents first articulate beliefs about AI, which inform the functions they intend AI to serve, and these functions in turn shape their mediation strategies. Parents emphasized both the significance of AI and the irreplaceability of human roles, while envisioning AI as a tool for relieving workload, offering parenting advice, entertaining, and supporting playful learning. Mediation strategies reflected ongoing negotiation, including managing AI's presence, interface, exposure, screen use, and content. This process framework illustrates how families balance opportunity with caution by shaping children's encounters with AI in ways consistent with parental values. It offers a conceptual tool for researchers, practitioners, and policymakers concerned with supporting healthy family engagement with AI in the digital age.
The Family Process Institute (FPI) Writers Fellowship supports the development of scholars who will advance systemic theory, research, and clinical practice grounded in a commitment to social justice. In this introduction to the Writers Fellowship special section, I describe the rationale for and history of this FPI initiative and how these eight authors help expand whose perspectives, interests, and voices are included in the family therapy field's knowledge base. I highlight the broader systemic/relational lenses the authors bring to issues and communities that are often individualized or overlooked and emphasize the value of the personal transparency they bring to their scholarship. Together, these papers illustrate promising contributions of new scholars to the study and application of systemic approaches to research and practice and challenge the status quo.
This paper presents a new framework to account for change mechanisms in Emotion-Focused Therapy for Couples (EFT). Building on Lane et al.'s (2015) integrated memory model, the Relational Memory Reconsolidation model described here posits that EFT reshapes partners' relational memory structures through emotionally intense moments of expressed vulnerability and responsiveness. These vulnerability-responsiveness events allow partners to access and transform memories of past relational experiences (i.e., episodic memory) as well as associated beliefs about themselves and the relationship (i.e., semantic memory). This process of emotional activation and reconsolidation allows maladaptive interaction patterns, which are rigid and stressful, to evolve into more adaptive, emotionally responsive exchanges. These emotional moments activate and transform relational self-states that are responsive to interpersonal cues and can shape partners' self-concepts in a relational context. As therapy progresses and emotionally significant interactions are repeated, the coactivation of adaptive and maladaptive self-states updates neocortical memory traces, leading to changes in higher-order relational semantic structures (i.e., the relational self). These moments foster alignment in partners' perceptions of their shared reality, characterized by mutuality in feelings, practices, memories, goals, and identity. Clinically, the framework highlights the need to elicit one partner's core vulnerable emotions and, within the reconsolidation window, disconfirm related expectations (e.g., rejection) through the other partner's empathic and supportive response. This process may transform key components of partners' relational memory, including relational episodic memories, semantic structures, and procedural emotional responses.
