This mutation has a wider geographic distribution than originally presumed and haplotype analysis suggests a common origin of the Arg200Trp mutation in the 4 families, but it still remains to be established if it has arisen independently of the Chuvash population. (

Nyasaland is a narrow strip of land 40,000 square miles in extent. It lies approximately between latitude S. 9’ 45” and 17’ 15”, and longitude E. 33’ and 36’. It is bounded on the North by Tanganyika Territory, on the East by Lake Nyasa and Portuguese East Africa, and on the West by Northern Rhodesia and Portuguese East Africa.

This article presents a review of the interface of family systems theory and therapy with religious, spiritual, or faith perspectives, with particular emphasis on Christian theology and Scripture. A brief review of the literature shows the relative paucity of work in this area to date. It is argued that family therapy is a particularly fertile ground for the integration of theological, religious, and spiritual considerations. Three points of intersection between family systems theory and biblical concepts—context, legacy, and body life—are discussed to illustrate the considerable promise of family systems theory for future integrative work. Implications for practice are discussed within a framework outlining three means of including religion or spirituality in the clinical work of family therapy—as resource, as culture, or as context. Borrowing from the family systems theory emphasis on epistemology, a definition of “second-order integration” is suggested, which may help to clarify the field's “thinking about thinking” about integration.

This paper addresses a growing need for cost-effective, outcome-based assessment in family therapy training. We describe the ROSCE, a structured, evidence-informed, learner-centered approach to the assessment of clinical skills developed at the University of Rochester Medical Center. The ROSCE emphasizes direct observation of trainees demonstrating clinical competencies. The format integrates both formative and summative assessment methods. It can readily be adapted to a wide variety of educational and training settings.

The call was a sobering one. Mrs. Sullivan asked for individual therapy for her daughter, Joanna, age 13. She said Joanna seemed unhappy because of a deteriorating relationship with Joanna's older sister, Margo, age 18. Mrs. Sullivan said she herself had benefited from psychotherapy and wanted the same for Joanna. While scheduling an appointment for Joanna, Mrs. Sullivan said offhandedly that she wondered whether Joanna's unhappiness related in any way to the young girl's diagnosis of muscular dystrophy 3 years earlier. Joanna's older sister, Margo, was wheelchair bound with the same disorder and had recently entered college and acquired a new health aide. The family's perspective was that Joanna's "normal" life was a blessing in comparison. When asked who suggested my name (S.H.M.), Mrs. Sullivan said the therapist she and her husband had seen when they were separated last summer. Without hesitation, I scheduled two assessment sessions: one for the family and another for Joanna and Margo, who wanted to come in together. I asked for permission to talk to the Sullivans' marital therapist and made a note to ask permission from the girls to talk with their physician. It was unclear at the time whether I would need to assess Joanna individually; it was clear that her difficulties were embedded in a complex web of family stress, loss, and physical strain.' A critical component of assessment is the evaluation of both presenting problem and context. The family-systems view of human behavior pays particular attention to context and its reciprocal, often hidden, impact on the presenting complaint. The value of family assessment is not limited to relational disorders. With any patient, regardless of the presenting complaint, family meetings can open up new vistas of understanding that sud-'The cases described i n this chapter are actual cases treated by the authors. The names and details of the cases have been changed to preserve anonymity.