Faculty Bibliography

In 2008, Amanda Lindhout was kidnapped by a group of extremists while traveling as a freelance journalist in Somalia. She and a colleague were held captive for more than 15 months, released only after their families paid a ransom. In this interview, Amanda discusses her experiences in captivity and her ongoing recovery from this experience with Katherine Porterfield, Ph.D. a clinical psychologist at the Bellevue/NYU Program for Survivors of Torture. Specifically, Amanda describes the childhood experiences that shaped her thirst for travel and knowledge, the conditions of her kidnapping, and her experiences after she was released from captivity. Amanda outlines the techniques that she employed to survive in the early aftermath of her capture, and how these coping strategies changed as her captivity lengthened. She reflects on her transition home, her recovery process, and her experiences with mental health professionals. Amanda's insights provide an example of resilience in the face of severe, extended trauma to researchers, clinicians, and survivors alike. The article ends with an discussion of the ways that Amanda's coping strategies and recovery process are consistent with existing resilience literature. Amanda's experiences as a hostage, her astonishing struggle for physical and mental survival, and her life after being freed are documented in her book, co-authored with Sara Corbett, A House in the Sky.

While a growing literature has addressed the psychological consequences of torture and refugee trauma, most studies have focused on homogeneous samples drawn from a single region. Thus, relatively little research has attempted to identify demographic or experiential factors that might help explain different levels of distress in these individuals. We measured depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms in a convenience sample of refugees and survivors of torture seeking treatment in a torture treatment program (N = 325). We found 81.1% of patients had clinically significant anxiety, 84.5% had clinically significant depressive symptoms, and 45.7% had significant PTSD symptoms. Regression analyses revealed that anxiety and depressive symptom were significant higher among women (beta = .08, p = 0.02 and beta = .22, p = 0.0001 for anxiety and depression respectively) and those who reported death threats as part of their traumatic experiences (beta = .10, p = 0.033 and beta = .12, p = 0.036 respectively). Symptoms of PTSD were also predicted by death threats (beta = .22, p = 0.03), but were also influenced by the experience of rape (beta = .33, p < 0.001), family torture experiences (beta = .23, p = 0.022), religion (beta = .21, p = 0.03), and age (beta = -.18, p = 0.004). The clinical implications of these results are discussed

A qualitative, community study of 58 parentally bereaved children and their 35 surviving parents illustrates how families take advantage of forewarning of death to foster connections between children and dying parents and prepare for youngsters' continued attachment to dying parents after the death. Children and parents displayed strong yearnings to remain connected during terminal illness, but fostering connections for attachment after the death was less intuitive and more emotionally fraught as it undermined coping strategies based on denial of impending death. Thus, although some may benefit from interventions aimed at anticipatory relationship facilitation, clinicians should respect limitations on what family members are psychologically able to bear.

This article describes the development and deployment of a framework for measuring parenting capacities in the context of bereavement. Grounded theoretical analysis of interviews with a community sample of 41 bereaved spouses with school-aged children elicited a set of nine bereavement-specific parenting tasks. A corollary coding system (covering all nine parenting tasks) was created to transform interview materials into quantitative data, thus permitting systematic empirical investigation of the parenting capacities of bereaved spouses. Parenting behaviors were coded on a 5-point scale ranging from least child-centered to most child-centered. Sex of surviving parent and circumstances of death proved to be significant mediating variables: mothers were more child-centered than fathers, and parents surviving sudden deaths more child-centered than those surviving anticipated deaths. Lengthy illness was associated with less child-centered parenting. The more child-centered the parenting, the less symptomatic the child as measured by parent report (Child Behavior Checklist) and child self-report (Children's Depression Inventory, Revised Child Manifest Anxiety Scale). Child-centered parenting was associated with more positive and fewer negative perceptions of the surviving parent by the child as measured by the Parent Perception Inventory. Implications of findings are discussed.

The current report is a qualitative exploration of the ways in which an adult's childhood experiences with death subsequently influence their parenting of their own parentally-bereaved children. Findings stem from semi-structured interviews with a community sample of 41 bereaved spouses, interviews that are part of a broader, longitudinal investigation of the determinants of the impact upon children of parent death. While some researchers have examined how childhood loss globally affects parenting, none has looked at the unique experience of the impact of such early experiences on parenting during bereavement. Moreover, in contrast to most studies of childhood loss which operate exclusively from an impairment-focused stance, this study also documents the long-term competency-building that may result from the experience of bereavement during childhood.

QUALITATIVE EVIDENCE drawn from a community study of 58 parentally bereaved school-age children and their surviving parents provides a descriptive exploration of one of the most difficult challenges faced by families in anticipated deaths: managing the stress of a child's exposure to the graphic physical, emotional, and mental deterioration of the dying parent. The concept of traumatic stress is broadly defined to include exposure to the "fact" of impending death itself, that is, the anxiety that comes from knowing that one may lose a close other. Included, as well, is an exploration of secondary traumatic stress, defined here to cover the notion of the stress of watching other loved ones in the family succumb to terror and anxiety about the impending death. Emphasis is placed on a child's unique vulnerability to traumatic stressors and on the role of parenting in mediating child exposure to parental decline. In contrast to the anticipatory grief literature which emphasizes the advantages of forewarning in cushioning postmortem adjustment, this study documents the adverse impact of a child's exposure to graphic stimuli. These findings underscore the need for clinicians to attend to the traumatic stress of "ordinary" anticipated deaths, rather than maintaining an exclusive grief orientation.

The experience of losing a parent during childhood has been well-documented to be a stressful and disruptive event in the life of a child. While there has been debate regarding the longterm outcomes of childhood parental loss, there is general agreement that how the surviving parent handles the death and its aftermath with the children will substantially influence the children's adaptation and coping. The current investigation explores, using both qualitative and quantitative methodology, the parenting of a sample of forty-one recently widowed individuals with children between the ages of six and sixteen years. Parents were interviewed extensively about their family's experience of the death, with a particular emphasis on their children's experiences. They also completed self-report measures of adjustment, parental confidence, grief experience, psychological symptomatology, and social support. Children completed a measure concerning their parents' parenting techniques. Using Grounded Theory analytic techniques, parents' narratives were analyzed in an attempt to gain an understanding of the challenging experience of parenting bereaved children in the face of one's own recent widow (er) hood. A model of child-centered parenting in situations of parental bereavement was developed from subjects' rich narratives. This model consisted of the following parenting categories: communication about information, communication about feelings, awareness/responsiveness to children's loss-related reactions and experiences, meaning-making with the child about death, facilitation of the child's ongoing relationship to the deceased parent, handling of the funeral services, handling the child's exposure to the deceased parent, provision of a stable environment after the death, and getting support for children. The relationship of the sample's child-centeredness to various mediating variables and measures of adjustment in the parents and children was explored. Variables that showed significant associations to child-centeredness dimensions included the sex of the surviving parent, whether the death was sudden or anticipated, the time since death, and the loss history of the surviving parent. In a number of categories, surviving mothers showed greater child-centeredness, particularly in areas pertaining to emotional engagement with children. Spouses who lost a spouse suddenly showed higher child-centeredness than individuals with anticipated spousal loss. Subjects' childhood experiences with death and significant separation proved to be predictive of greater child-centeredness in a number of parenting categories. The implications of the findings for clinical intervention with bereaved families are discussed, as are recommendations for further research. The study points to the need for models of parenting that take into account the multivariate aspects of parenting bereaved children.

Twenty families participated in a random assignment trial of two cognitive psychoeducational preventive interventions for families with parental affective disorder. Twelve families were assigned to a clinician-based intervention and eight to a lecture-based intervention, with assessment prior to intervention and an average of 18 weeks following intervention. Both groups were satisfied and believed they received help from the intervention. The clinician-based group was significantly more satisfied overall, and reported significantly more changes in both behaviors and attitudes about their illness from pre- to postintervention. Both groups showed significant decrease in degree of upset over issues of concern from pre- to postintervention. The clinician-based group reported receiving significantly more help with their primary concern. The implications of these findings are discussed.