Von der Diagnose zur Entscheidung. Eine Analyse von Entscheidungsprozessen für das Austragen der Schwangerschaft nach der pränatalen Diagnose Down-Syndrom

Werdende Elternschaft heute ist ohne das technologisch gestützte Monitoring natürlicher Wachstumsprozesse kaum noch denkbar. Von Tests und Ultraschall erhoffen sich die zukünftigen Eltern Sicherheit für ein gesundes Kind. Wird jedoch eine als schwerwiegend empfundene Diagnose wie das Down-Syndrom gestellt, finden sie sich mit der schwierigen Aufgabe konfrontiert, über Fortsetzung oder Abbruch der Schwangerschaft entscheiden zu müssen. Aus der Subjektperspektive von zehn Frauen, die einer solchen Entscheidungssituation ausgesetzt waren, analysiert die vorliegende Studie die durch die Diagnose ausgelösten psychodynamischen Prozesse und gesellschaftlichen Zugzwänge. Auf der Basis von Fallrekonstruktionen und fallübergreifenden Analysen werden konkrete Problemlagen der Betroffenen sichtbar und Kettenreaktionen im medizinischen, familiären und sozialen Umfeld aufgezeigt. Deutlich wird, wie die stetig perfektionierte Erfassung betroffener Feten dem - zunehmend privatisierten und kommerzialisierten – Medizinbetrieb eine Definitionsmacht darüber eröffnet, was lebenswert und normal ist. Die Handlungsmaxime lautet: Behinderung gilt es zu vermeiden, Normalität hat Vorrang vor Besonderheit. Mit der Analyse von Entscheidungsverläufen gegen den Selektionskonsens erschließt die Studie neue Sichtweisen auf diesen einseitig geführten Diskurs. Biographische Hintergründe der Frauen und ihre personalen und sozialen Ressourcen werden identifiziert und als Anhaltspunkte für eine professionelle Begleitung verstanden. Abgeleitet aus den Erfahrungen und Deutungsperspektiven der Betroffenen wird ein Modell der Beratung nach einer pränatalen Diagnose entworfen. Damit ist das Buch nicht nur für Professionelle aus Sonderpädagogik und Medizin, sondern auch aus Beratung und Therapie von Interesse. (DIPF/Orig.)

Heilsbringer oder Erlösungssucher? Befunde und Thesen zur Problematik von Männern in frühpädagogischen Institutionen

Die Autorinnen schließen in ihrem Beitrag Befunde und Thesen zur Problematik von Männern in frühpädagogischen Institutionen an die Diskurse um die Steigerung des Anteils männlicher Erzieher an, mit denen häufig die Vermutung einer Qualitätssteigerung verbunden ist. Sie fragen anhand von Interviews nach „Auffassungen und Ausgestaltungen der männlichen Geschlechtszugehörigkeit durch Erzieher in ihrer frühpädagogischen Arbeit“. Dabei schildern die Autorinnen große Akzeptanz im Feld und positive Zuschreibungen seitens der Institutionen. Die Erzieher explizieren dabei ihre Funktion als männliche Vorbilder in Form von Varianten wie ‚neue‘ Männer und ‚bessere‘ Väter, nicht zuletzt in Abgrenzung gegenüber den tatsächlichen Vätern der Kindergartenkinder. Augenfällig seien, so die Autorinnen, dass negative eigene Kindheitserfahrungen durch eine Romantisierung und stark emotionalisierende Aufladung der Beziehung zu den Kindern kompensiert werden und dies die notwendige generationale Differenz verwischt. Insgesamt stehen diese vergeschlechtlichten Positionierungen der Erzieher einer vertieften biographischen Selbstreflexion als Kernelement von institutionell zu fordernder Professionalisierung eher im Wege. (DIIPF/Orig.)

Is it all tough talking at the top? A post-structuralist analysis of the construction of gendered speaker identities of British business leaders within interview narratives

This paper uses a feminist post-structuralist approach to examine the gendered identities of a sample of British business leaders in Britain. While recent national surveys offer many material reasons why women are acutely under-represented as business leaders, the role of language is rarely addressed. This paper explores the ways in which ten senior women and men construct their sense of leadership identities through the medium of interview narratives. Drawing upon two poststructuralist models of analysis (Derrida’s 1987 theory of deconstruction and Bakhtin’s 1927/1981 concept of double-voiced discourse), the paper shows how both females and males are able to shift pragmatically between interwoven corporate discourses, which demand competing cultural allegiances from one moment to the next, allegiances constantly tested by the rapid change and uncertainty that characterise global business. While male leaders experience a relative freedom of movement between different cultural discourses, female leaders are circumscribed by negative and reductive representations of female speech and behaviour. In sum, senior women are required constantly to observe, review, police and repair their use of leadership language, which potentially undermines their confidence and authority as leaders.

Identifying psychotic defenses in a clinical interview.

The Defense Mechanisms Rating Scales (DMRS), one of the most widely used and validated instruments in the study of defense mechanisms, does not include psychotic defenses. The Psychotic-DMRS (P-DMRS) has been developed to include 6 psychotic defense mechanisms: psychotic denial, autistic withdrawal, distortion, delusional projection, fragmentation, and concretization. We discuss psychotic defenses, including the difference between psychotic defenses and psychotic symptoms. Six clinical illustrations demonstrate how the 6 P-DMRS defenses can be identified in patients' narratives selected from the transcripts of dynamic interviews. Implications with respect to patient evaluation and treatment are discussed.

Mediated action, narratives of risk-taking, and identity formation in adolescents with a visual impairment

The purpose of this project was to discern the inherent tension present in narratives told by adolescents with a visual impairment as they attempted to make sense of their experiences, specifically those surrounding risk. Mediated action, based on the foundational work of Vygotsky and Bakhtin, was used as both a theoretical and methodological approach; it is the theory that there are two components that constitute any human action: the "agent," or the person who is doing the acting, and the "mediational means" that he or she is using to accomplish the action in question. Tension ensues as neither is able to fully explain human behaviour. Ten adolescents with a visual impairment participated in a narrative interview, revealing numerous counter-narratives surrounding risk-taking, including "experimentation undertaken using good judgment." Participants offered examples of how they engaged, appropriated, resisted and transformed the dominant narratives of disability and adolescence in their identity formation.

Socially anxious mothers’ narratives to their children, and their relation to child representations and adjustment

Anxious mothers’ parenting, particularly transfer of threat information, has been considered important in their children’s risk for social anxiety disorder (SAnxD), and maternal narratives concerning potential social threat could elucidate this contribution. Maternal narratives to their pre-school 4-5 year-old children, via a picture book about starting school, were assessed in socially anxious (N=73), and non-anxious (N=63) mothers. Child representations of school were assessed via Doll Play (DP). After one school term, mothers (CBCL) and teachers (TRF) reported on child internalizing problems, and child SAnxD was assessed via maternal interview. Relations between these variables, infant behavioral inhibition, and attachment, were examined. Socially anxious mothers showed more negative (higher threat attribution), and less supportive (lower encouragement) narratives, than controls, and their children’s DP representations, SAnxD and CBCL scores were more adverse. High narrative threat predicted child SAnxD; lower encouragement predicted negative child CBCL scores and, particularly for behaviorally inhibited children, TRF scores and DP representations. In securely attached children, CBCL scores and risk for SAnxD were affected by maternal anxiety and threat attributions, respectively. Low encouragement mediated the effects of maternal anxiety on child DP representations, and CBCL scores. Maternal narratives are affected by social anxiety, and contribute to adverse child outcome.

Recall, verbatim memory and remembered narratives

Memory is central to investigative interviews with witnesses and suspects, yet decades of research have shown that remembering is subject to constructive and reconstructive processes that can adversely impact the reliability of accounts that are elicited at interview. In this chapter we first outline research concerning our memory for events (‘episodic memory’) before moving on to discuss the ways in which our attempts to validate and communicate those memories can bias what is eventually reported. We then focus on some of the implications this can have for investigative interviews, specifically the problem of ‘skill fade’ in interviewing, the impact of implicit beliefs about memory and issues surrounding the reliability of recollections of direct speech. We conclude that appropriately structuring the retrieval context is the key to achieving best memory evidence.

Patterns in personal experience narratives: storytelling at cod harbour - a Newfoundland fishing community

This study is concerned with storytelling as a part of the folk culture of a fishing community on the north east coast of Newfoundland. The study is based on field work done in the community throughout the summer of 1969 during which I tape recorded oral narratives along with other folklore and folklife material . The principal genre discussed is the personal experience narrative which is an account of the experiences of either the narrator, someone in his kin network, orhis friends. It was found that a large number of community residents communicate in narrative form and that the narratives function to substantiate conversation preceeding the narrativei have a didactic function; function as a means of entertainment~ and reflect the narrators' and the community's value system. The methods employed in collecting the material were the directive and the non-directive interview techniques and participant observation. Collecting was done mainly among fishermen between fifty and eighty years of age and who, on -the average, had not gone beyond the sixth grade in school. Since the narratives are so much a part of the environment, I give an account of the community culture. The principal things that I deal with are the community's history, economy, education, religion, and social life which includes rites of passage, calendar customs , social events, visiting patterns, and gossip. Information in each of these categories is based primarily on oral reports, narratives and documented materials. After a discussion of the storytelling process in the community, I deal specifically with four male narrators. For each I give biographical information, discuss his repertoire, telling situations, style, and give a sampling of his narratives. The fourth narrator is discussed in more detail than the first three. The narratives of the latter comprise the final chapter in the study, and have been analyzed to show what they tell us about the narrator's style, his value system, and the community culture.

Développement de capacités narratives des enfants bilingues: l’acquisition de l’espagnol dans le contexte suisse-allemand

La présente contribution vise à analyser les capacités langagières d’enfants bilingues espagnol-suisse allemand à l’occasion de la production orale de récits d’expériences personnelles. En se focalisant sur la production orale en espagnol avant le début de l’école primaire, cette étude explore le développement précoce des capacités narratives considérées comme un important précurseur de l’alphabétisation initiale des enfants (Dickinson & Tabors, 2001, entre autres). Notre étude se base sur un échantillon de textes produits par 24 enfants répartis en deux groupes d’âge, 3 et 5 ans. Nous analysons également un questionnaire soumis aux familles des enfants participants, questionnaire qui interroge les pratiques linguistiques à la maison et la biographie langagière de ces enfants. L’étude menée révèle des différences entre les deux groups d’âge ainsi qu’un lien entre la performance discursive des enfants et les pratiques langagières familiales. Elle a en outre permis de repérer des capacités en espagnol qui potentiellement pourraient favoriser les capacités narratives dans la langue de l’entourage – le suisse-allemand, d’abord, et ensuite l’allemand standard. Enfin, ces résultats nous amènent à réfléchir aux conditions qui favorisent la conservation de la langue de la migration et ses apports potentiels à la scolarisation. (DIPF/Orig.)

INTERACTIVE AND IMMERSIVE: Factual transmedia narratives around experiences of displacement and migration.

This article will examine how media organisations are increasingly experimenting and innovating with interactive transmedia forms to explore issues around displacement and the ongoing migration crisis. I plan to interview a number of key industry figures with a view to understand how and why journalists and producers are expanding the scope of factual storytelling beyond traditional media platforms. It will include a number of industry case studies.

The interpersonal and mental health implications of the coherence of coming out narratives for a sample of gay men in committed romantic relationships

The coming out process has been conceptualized as a developmental imperative for those who will eventually accept their same-sex attractions. It is widely accepted that homophobia, heterosexism, and homonegativity are cultural realities that may complicate this developmental process for gay men. The current study views coming out as an extra-developmental life task that is at best a stressful event, and at worst traumatic when coming out results in the rupture of salient relationships with parents, siblings, and/or close friends. To date, the minority stress model (Meyer, 1995; 2003) has been utilized as an organizing framework for how to empirically examine external stressors and mental health disparities for lesbians, gay men, and bisexual individuals in the United States. The current study builds on this literature by focusing on the influence of how gay men make sense of and represent the coming out process in a semi-structured interview, more specifically, by examining the legacy of the coming out process on indicators of wellness. In a two-part process, this study first employs the framework well articulated in the adult attachment literature of coherence of narratives to explore both variation and implications of the coming out experience for a sample of gay men (n = 60) in romantic relationships (n = 30). In particular, this study employed constructs identified in the adult attachment literature, namely Preoccupied and Dismissing current state of mind, to code a Coming Out Interview (COI). In the present study current state of mind refers to the degree of coherent discourse produced about coming out experiences as relayed during the COI. Multilevel analyses tested the extent to which these COI dimensions, as revealed through an analysis of coming out narratives in the COI, were associated with relationship quality, including self-reported satisfaction and observed emotional tone in a standard laboratory interaction task and self-reported symptoms of psychopathology. In addition, multilevel analyses also assessed the Acceptance by primary relationship figures at the time of disclosure, as well as the degree of Outness at the time of the study. Results revealed that participant’s narratives on the COI varied with regard to Preoccupied and Dismissing current state of mind, suggesting that the AAI coding system provides a viable organizing framework for extracting meaning from coming out narratives as related to attachment relevant constructs. Multilevel modeling revealed construct validity of the attachment dimensions assessed via the COI; attachment (i.e., Preoccupied and Dismissing current state of mind) as assessed via the Adult Attachment Interview (AAI) was significantly correlated with the corresponding COI variables. These finding suggest both methodological and conceptual convergence between these two measures. However, with one exception, COI Preoccupied and Dismissing current state of mind did not predict relationship outcomes or self-reported internalizing and externalizing symptoms. However, further analyses revealed that the degree to which one is out to others moderated the relationship between COI Preoccupied and internalizing. Specifically, for those who were less out to others, there was a significant and positive relationship between Preoccupied current state of mind towards coming out and internalizing symptoms. In addition, the degree of perceived acceptance of sexual orientation by salient relationship figures at the time of disclosure emerged as a predictor of mental health. In particular, Acceptance was significantly negatively related to internalizing symptoms. Overall, the results offer preliminary support that gay men’s narratives do reflect variation as assessed by attachment dimensions and highlights the role of Acceptance by salient relationship figures at the time of disclosure. Still, for the most part, current state of mind towards coming out in this study was not associated with relationship quality and self-reported indicators of mental health. This finding may be a function of low statistical power given the modest sample size. However, the relationship between Preoccupied current state of mind and mental health (i.e., internalizing) appears to depend on degree of Outness. In addition, the response of primary relationships figures to coming out may be a relevant factor in shaping mental health outcomes for gay men. Limitations and suggestions for future research and clinical intervention are offered.

Patient experiences of a bariatric group programme for managing obesity:a qualitative interview study

Objectives: People with obesity experience a range of physical and psychological ill-health outcomes. This study examined patients’ experiences of a group-based programme for the management of morbid obesity delivered within the UK National Health Service. The focus of the study was on the emerging dynamic of the group and patients’ perceptions of its impact on health outcomes. Design: A qualitative interview study was conducted and involved patients recruited from a Tier 3 bariatric service in South West England. Verbatim transcripts were analysed using thematic analysis. Methods: Twenty patients (12 females) with a BMI ≥ 35 kg/m2 participated in a semi-structured one-to-one interview. Participants had been registered with the bariatric service for at least 6 months. None of the participants had had bariatric surgery. Results: Most participants felt that they had benefited from participating in the group programme and talked about the group as a resource for lifestyle change. Participants’ narratives centred on the emergence of a sense of self based upon their participation in the group: establishing psychological connections to other patients, or shared social identity, was regarded as a key mechanism through which the programme's educational material was accessed, and underpinned the experience of social support within the group. Through interaction with other patients, involving the sharing of personal experiences and challenges, participants came to experience their weight ‘problem’ through a collective lens that they felt empowered them to initiate and sustain individual lifestyle change. Discussion: Bariatric care groups have the potential to support lifestyle change and weight loss and may help address the psychological needs of patients. Nurturing a sense of shared social identity amongst patients with morbid obesity should be a core aim of the care pathway and may provide the foundation for successful translation of dietetic content in group programmes.

Differences in responses to the Oral Health Impact Profile (OHIP14) used as a questionnaire or in an interview

The objective of this study was to compare the completion rates and performance of the Brazilian version of the Oral Health Impact Profile (OHIP14) when applied as an interview or in its original self-reported form. A convenience sample of 74 adult patients was selected in a Dental Clinic (University of Araras, Brazil). One examiner administered the instrument in both formats to participants with an interval of 2 weeks between each administration. Data about dental health condition and socioeconomic status were collected and associated with total OHIP14 scores in both formats using linear regression analyses. No differences were found in the total scores and in each subscale of the OHIP14 according to the form of administration. Higher values of completion were found in the interview format. More severe impacts were recorded in the interview format than in the questionnaire format. Higher values of total OHIP-14 scores in both formats were related to the presence of dental caries. Total OHIP14 scores were not influenced by the method of administration. However, the use of the OHIP14 in the questionnaire format may result in lower completion rates and loss of data.

Validity and reliability of the Structured Clinical Interview for Mood Spectrum: Brazilian version (SCIMOODS-VB)

OBJECTIVE: The aim of this study was to translate the Structured Clinical Interview for Mood Spectrum into Brazilian Portuguese, measuring its reliability, validity, and defining scores for bipolar disorders. METHOD: Questionnaire was translated (into Brazilian Portuguese) and back-translated into English. Sample consisted of 47 subjects with bipolar disorder, 47 with major depressive disorder, 18 with schizophrenia and 22 controls. Inter-rater reliability was tested in 20 subjects with bipolar disorder and MDD. Internal consistency was measured using the Kuder Richardson formula. Forward stepwise discriminant analysis was performed. Scores were compared between groups; manic (M), depressive (D) and total (T) threshold scores were calculated through receiver operating characteristic (ROC) curves. RESULTS: Kuder Richardson coefficients were between 0.86 and 0.94. Intraclass correlation coefficient was 0.96 (CI 95 % 0.93-0.97). Subjects with bipolar disorder had higher M and T, and similar D scores, when compared to major depressive disorder (ANOVA, p < 0.001). The sub-domains that best discriminated unipolar and bipolar subjects were manic energy and manic mood. M had the best area under the curve (0.909), and values of M equal to or greater than 30 yielded 91.5% sensitivity and 74.5% specificity. CONCLUSION: Structured Clinical Interview for Mood Spectrum has good reliability and validity. Cut-off of 30 best differentiates subjects with bipolar disorder vs. unipolar depression. A cutoff score of 30 or higher in the mania sub-domain is appropriate to help make a distinction between subjects with bipolar disorder and those with unipolar depression.