D. F. STANESCU ET AL. 685
ongoing source of distress. Lack of communication, informa-
tion and understanding was prominent in these families. Corre-
lation analyses revealed that only two of the FAD subscales did
not correlate with children and adolescents psychological
symptoms, namely behaviour control and problem solving.
Here, one can assume that by the very nature of the traumatic
event and its consequences for family life, all families will have
to make use of their resources and skills in problem solving and
behaviour control to a maximum degree. Therefore, these two
areas of family function are highly activated in terms of pri-
mary coping requ i r e ments.
Differential family coping strategies could not discriminate
families in which adolescents reported symptoms from those
families with asymptomatic offspring. It has to be noted here
again, that F-COPES data were not available from the adoles-
cents’ perspective. Therefore a bias based on a shift of report-
ing perspectives in the data correlated with each other cannot be
excluded. Data suggest that there is no significant path from
families’ coping strategies to children’s psychological outcome.
However, in both parents’ perspective, common use of reframe-
ing as a coping strategy predicted to an impressive degree high
family function. In fathers’ reporting respectively, seeking so-
cial and/or spiritual support was associated with higher rela-
tional functioning in families.
To sum up, these findings are well applicable to inform fo-
cused concepts for systemic interventions in families with an ill
parent, that are not only geared to utilize the family system as a
supporting resource for the ill parent, but also aim at preventing
mental health problems in children of ill parents. Fostering
family rela t ional functioni ng in crisis can be assumed to equally
serve both goals. Our findings suggest that supporting a family
in finding appropriate ways of reframing the stressful situation
may be especia lly effective in stre ngthening family funct ioning
in crisis. From the child’s perspective, reframing connotations
that are appealing to adult family members may not be equally
helpful, unless they are adequately explained on the child’s
cognitive level. If patients or their relatives report these as their
main coping patterns, this may reflect helplessness rather than
an effective way of self-regulation and stabilization, and thus
may be carefully questioned by health professionals. Further-
more, our data suggest that adolescents with an ill parent are
especially vulnerable for internalizing problems, if families
have a low ability to share feelings and are having weak intra-
familial boundaries with an increased danger of intrusion,
over-involvement or enmeshment (Minuchin, 1998). If one
acknowledges that in families facing the existential threat of
serious parental illness the attachment system is highly acti-
vated and therefore cohesive forces are stimulated together with
all resources and competencies involved in mutual support and
problem solving, which are already evoked to the greatest pos-
sible degree, it becomes plausible that these families have a
specific vulnerability to dysfunctional affective involvement, if
there are not enough intra-familial boundaries to counterbal-
ance the strong cohesive forces. Therefore, systemic interven-
tions, besides encouraging open expression and sharing of feel-
ings between parents and children, should at the same time
focus on strengthening clear boundaries between individuals, so
that children will be able to feel empathy for their ill parents’
harm and distress without getting contaminated by these in their
intra-psychic world.
Despite a number of strengths of this study, it is not without
its limitations. These limitations do not affect its main findings,
but bear on how they are interpreted. Taking into consideration
that this study investigated a novel area in child mental health
(in Romania this was actually the first study on children of
somatica lly ill parents), one could admit that a mere exploratory
approach would suffice. For this study, an important emphasis
on hypothesis testing, which for some research questions was
supplemented by an exploratory analysis. Also, because the
sample size was relatively limited, it was decided to use both
effect sizes and statistical significance in hypothesis testing.
The inclusion criteria established in the project, which ex-
clude the families with problems prior to current illness, or
single parent families, divorced, not legally constituted, could
exclude exactly the kind of family which, perhaps, are in more
need of psychological support for their children than the fami-
lies included in the rese arc h.
The use of data from the other European partners involved in
the project, although highly desirable, was unfortunately im-
possible, primarily due to the fact that the Romanian subproject
was focused on a different type of disease, acute central nerv-
ous system injuries, while our partners were focused on chronic
illnesses like cancer or multiple-sclerosis. Yet, some of the
findings (e.g. affective responsiveness and affective involve-
ment FAD subscales roles in children and adolescents psycho-
logical symptomatology) are mirrored both in German and UK
data (Edwards et al., 2006; Romer et al., 2006), in spite of dif-
ferences in parental illnesses, which is evidence for the fact that,
the life threat or absence of the ill parent, his suffering, depress-
sion and burden on the healthy parent and the need of reorgan-
izing the roles in family are effects encountered across different
designs and samples.
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