Relational Problems

An individual’s psychological health and well-being depend to a degree on the quality of his or her important relationships (i.e., with parents, siblings, children, partner, friends, and colleagues). Problems within these relationships can often lead to clinical symptoms and impaired functioning among one or more members of the relationship. The relationships themselves may also be affected by a member’s general medical or psychiatric illness. Although it is normal for persons in relationships to experience problems, the classification of relational problem is used when the problem is associated with clinically significant impairment. A relational problem may be the focus of clinical attention when (1) a relational unit is distressed and dysfunctional or threatened with dissolution and (2) the relational problems precede, accompany, or follow other psychiatric or medical disorders. There are five categories of relational problems: (1) relational problem related to a mental disorder or general medical condition, (2) parent–child relational problem, (3) partner relational problem, (4) sibling relational problem, and (5) relational problem not otherwise specified.

Relational problems are enduring and may become chronic. They involve painful and potentially life-threatening patterns that are unresponsive to available family, religious, and community supports. Relational problems require a different clinical approach than other disorders. Instead of focusing primarily on the links among signs, symptoms, and the workings of the individual mind, the clinician must also focus on interactions between the individuals involved and how these interactions are related to the general medical or psychiatric symptoms.

Students should study the questions and answers below for a useful review of these problems.

Helpful Hints

Each of the following terms should be defined by students.

communication problems
- negative
- distorted
- noncommunication
divorce and remarriage
dual obligation
environmental factors
family characteristics
family system
family therapy
marital roles
parent–child problem
partner relational problem
physician marriages
physician’s responsibility
polysomnographic findings
premature child
psychotic symptoms
racial and religious prejudice
relational problem due to mental disorder or medical condition
sibling relational problem
sibling rivalry

Questions

Directions

Each of the questions or incomplete statements below is followed by five suggested responses or completions. Select the one that is best in each case.

30.1 Which of the following does not usually define sibling sexual abuse?

A. A sexual act with a sibling younger than the age of 13 years with a perpetrator at least 5 years older

B. The showing or touching of one another’s genitalia for brief periods of same-aged children

C. The use of any kind of deceit, force, or threat to obtain sexual gratification

D. Sexual contact by a perpetrator at least 10 years older than a 13- to 16-year old child or adolescent

E. All of the above

View Answer

30.1 The answer is B

All sibling incest is not sexual abuse. It is important that sibling sexual abuse be distinguished from sibling “sex play,” which is defined as the mutual activities of same-aged children showing or touching each other’s genitalia for brief time periods. Specific definitions of sibling sexual abuse vary depending on state and federal law, but it is usually defined as (1) any sexual act with a sibling younger than the age 13 years with a perpetrator at least 5 years older; (2) sexual contact by a perpetrator at least 10 years older than a 13- to 16-year old child or adolescent; or (3) the use of any kind of deceit, force, or threat to obtain sexual gratification. Sibling sexual abuse may be severe, prolonged, and associated with a high level of force and coercion.

30.2 Mr. K is a 43-year-old man who owns his own contracting company and loves his job. His father recently helped him expand his business by giving him a generous financial contribution. Because of this contribution, his father now feels he is entitled to more of a say in the day-to-day activities of the company. Mr. K is beginning to feel smothered and questions whether he should have accepted the gift from his father. He now dreads going to work because
he knows his father will call with even more changes he would like implemented. He tells you he feels like he is being treated like a child.

Mr. K is being challenged by his father in which of the following areas?

A. Achievement

B. Autonomy

C. Financially

D. Identity

E. Triangulation

View Answer

30.2 The answer is B

Autonomy is a developmental milestone. Generally, autonomy involves a person’s ability to make independent choices. There is no reason to believe Mr. K did not adequately establish autonomy earlier in his life, but his father’s insistence on having control of his life and business is now challenging this concept. Mr. K, by becoming a self-sufficient, successful businessman, has mastered the development of achievement, and this concept is not being challenged here. His identity is also not being challenged in this case because that would indicate that Mr. K does not have a clear sense of his own values, beliefs, goals, and expectations. Identity is usually established in adolescence. Triangulation refers to the process in which conflicted parents attempt to win the sympathy and support of their child, who is recruited by one parent as an ally in the struggle with the partner. Triangulation is not related to the case in question. Financially, Mr. K’s father is contributing to the support of his business and has made possible the expansions that recently occurred. However, Mr. K does not feel challenged in this respect but rather by the changes which have occurred since the financial contribution.

30.3 A 15-month-old toddler is observed in a playroom with her mother. The toddler is actively playing with toys and occasionally engages her mother in the play as well. A stranger enters the room, and the child appears hesitant initially but ultimately plays with the stranger also. When her mother leaves the room, the toddler is visibly upset and cries. When her mother returns to the room, she is happy to see her and gives her mother a hug before returning to play.

This child is exhibiting which type of attachment?

A. Anxious-avoidant attachment

B. Anxious-resistant attachment

C. Insecure attachment

D. Secure attachment

E. Intermediary attachment

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