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Experiencing a situation of extreme danger can lead to serious stress disorders (such as PTSD) that can affect both the victims and the professional helpers. Military operations in Ukraine in the first half of 2022 started an ongoing migration crisis, resulting in the displacement of approximately 3.5 million people to Poland. It is indicated that post-traumatic stress disorders may affect up to one third of adult refugees. Exposure to traumatic stress related to assault, limitation of basic resources, fear, insecurity, death, and a sense of injustice affected the entire population of the country. As a result, refugees, healthcare professionals, uniformed services, volunteers, and NGO workers constitute a group at risk of developing stress-related disorders, including post-traumatic stress disorder (PTSD). The presented recommendations were developed by an interdisciplinary team of experts in the field of psychiatry, clinical psychology, psychotherapy, and family medicine to present systematic guidelines for diagnostic procedures in medical and psychological practice.

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Post-traumatic stress disorder (PTSD) is a mental distress that occurs after participation in traumatic event such as the experience of natural disaster, car accident, terrorist attack or armed conflict, being a victim of sexual assault, tortured, physically abused, traumatized or being in any other life-threatening situation. The trauma victim does not always have to be in the position of the o directly threatened with physical harm. The disorder may be developed also as a result of an acute reaction to stress caused by participation in situation in which another person suffer so unimaginable that the further normal life of witness becomes impossible. Patients are often convinced that they lose previous ability to exist irretrievably. Globally PTSD is an increasingly recognized disorder. It can be predicted that in Europe, due to the ongoing war in Ukraine and the migration crisis, the frequency of severe disorders related to traumatic stress will systematically increase. In recent years, there has been a significant progress in knowledge and the development of methods for counteracting PTSD. The empirically confirmed forms of treatment include psychotherapeutic and pharmacotherapeutic interactions. The presented recommendations were developed by a team of experts in the field of psychiatry, clinical psychology, psychotherapy and primary care in order to proposed guidelines for therapeutic procedures in medical and psychological practice. The position statement of the working group have been developed in line with evidence-based practice as a part of three-stage procedure including: literature review, the issue discussion and development of the unified expert position.

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OBJECTIVES: The aim of the presented study was to analyse associations between drug-resistant depression and the way the illness is described by patients and members of their families. In particular, a hypothesis to be verified was that being ill may be a factor stabilising the family system, and consequently treatment of this kind of depression may encounter additional difficulties and enforce "drug-resistance" by "sustaining depression" by the family. METHODS: The study included 20 patients and their families. The consultations that were conducted with each of the families constituted data for the presented research. Initial results indicate an explicit association between the way the patient and his or her family define circumstances of the illness and treatment and the type of interactions between them that are manifested verbally and nonverbally. RESULTS: Results of qualitative analysis indicate that if a patient during consultation reflects on how to describe his or her situation and precipitating factors of the illness, it usually takes place in opposition to other members of the family of origin. On the other hand, if a patient manifests depressive symptoms, he or she assumes a dependent role, while the rest of the family express an attitude of warmth towards him or her. CONCLUSIONS: Drug resistance depression should be considered, also with the context of the patient's family.

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AIM: The aim of this study was to carry out a comparative analysis of selected psychopathological and personality variables in patients with allergic and non-allergic asthma, as well as an attempt to determine the significance and strength of these variables in the clinical picture of both forms of the disease. METHODS: In all patients structured anamnesis, basic spirometry, and dyspnea measure- ment were carried out. The level of anxiety was determined using Spielberger's questionnaire. The intensity of depression was evaluated with Beck's Inventory. Neuroticism and extroversion-introversion were assessed by Eysenck's Inventory. The I-E scale was used to determine the perception of the locus of control. RESULTS: The lack of significant differences in the area ofpsychopathological and personality variables was found between the two types of asthma. The gender differentiated patients with respect to psychopathology. The intensity of extroversion correlated with the duration of the disease. In the case of neuroticism, the clinical form of the disease was associated with blurring the differences between genders. The intensity of dyspnea and the spirometric results correlated with the psychological background of the disease. CONCLUSIONS: No significant differences in the area of psychopathology and personality dimensions between the groups of patients with allergic and non-allergic asthma were found although psychological variables are associated with the course of asthma in adults.

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The authors of the present article describe the historical context of family therapy in Poland and current issues in the field. They highlight the fact that Polish therapists first began to develop the field after coming into contact with family therapy leaders from the United States and Western Europe. With the political breakthrough of 1989, there were new opportunities for multilateral cooperation, attendance at international conferences, and the exchange of experiences. Currently, the work of Polish family therapists, the place of family therapy among other forms of psychotherapy, and the related problems and challenges do not differ from other European nations.

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The authors present Michail Bachtin's and Hubert Herman's concept of "dialogical self" which was used by family therapists to create a new conceptual tool of understanding the family therapy process. The paper shows Peter Rober's and his co-workers works that use this concept in order to understand phenomena occurring during therapeutic meeting.

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The authors show how to use the concept of a "dialogical self' to conduct therapy, supervision and qualitative research of the process of psychotherapy. They pay special attention to usefulness of the presented concept and to investigate what happens to a therapist during a family meeting, i.e., the so called "inner conversation of the therapist".

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INTRODUCTION: The literature provides ambiguous information concerning the associations between asthma and psychopathology. The concept of the locus of control (LOC) can shed some light on the psychosomatic aspects of asthma. OBJECTIVES: The aim of the study was to analyze the relationship between dyspnea perception and psychopathological symptoms in asthma. We also tested how a tendency to attribute the LOC affects the relations between psychopathology and dyspnea. PATIENTS AND METHODS: We examined 111 consecutive, unselected asthma patients, including 74 women and 37 men. The mean age was 49.79 ± 14.19 years, with no significant differences between sexes. There were mainly patients with level 2 (38.7%) and level 4 (35.1%) of asthma severity according to the Global Initiative for Asthma classification. Sociodemographic data were collected and the General Health Questionnaire (GHQ) by Goldberg and the Locus of Control questionnaire by Rotter were applied. The level of dyspnea was assessed by patients on the 10-point Borg scale. Spirometry tests were performed. RESULTS: Gender, education, and LOC differentiated patients according to psychopathological symptoms. There were no differences in psychopathology between the groups with different levels of asthma severity. In women, there was a significant correlation between intensity of dyspnea and higher scores on all GHQ scales; in men, the correlation was observed only for the depression subscale and the general scale. CONCLUSIONS: Psychopathological disorders are more significantly associated with subjective asthma symptoms than with asthma severity. Gender, education, and a tendency to attribute the LOC internally may be significant for this association.

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The authors present basic information about qualitative research along with its theoretical frame as a useful approach in the study of many issues in the area of psychiatry and psychotherapy. According to the authors, the quantitative methodology--dominant in psychiatry nowadays--seems insufficient to address all issues to be studied in this area. After a short introduction of the theoretical background of qualitative research, the authors present methods of collecting and analysing qualitative data and possible ways of using them in practice. In psychiatry, there are many complex psychotherapeutic methods used, their effects depending on many conditions, such as feelings and actions of patients and therapists. Hence, qualitative methods--which enable researchers to study the complexity of human interactions--seem to be well suited for psychiatric research. However, the authors conclude, the reason for choosing one or the other method should be practical rather than ideological; the methods indeed very often complete, rather than exclude each other, in research practice.

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The aim of therapeutic help in marital crisis is to break the vicious circle of mutual hurtful accusations. The method that the authors present below involves a group of couples working within a closed cycle of meetings. In the course of successive group meetings, the various couples act as reflecting teams (RTs) for each other. This achieves two objectives: the couple recounting their crisis receives nonthreatening feedback, which helps them to implement positive changes and break out of the self-perpetuating destructive interaction. In addition, the couples acting as the RT learn nonjudgmental, nontheorizing and affirmative communication.

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We studied the relationship between the intensity of dyspnea and psychopathological and personality dimensions in 74 women and 38 men (mean age 49.7 years) with asthma. The women had higher values for the following variables: depression, anxiety-trait, and neuroticism, and they proved to have a greater external control location than the men. After checking the spirometry results, body mass index (BMI) and gender, it was found that dyspnea correlated with anxiety-trait and anxiety-state, neuroticism, and depression. In the men, anxiety-trait modified the relationship between dyspnea and the duration of the disease. This effect was not found in the women. A high level of anxiety-trait seems to be responsible for the escalation of dyspnea during the progression of the disease in men, whereas low anxiety may protect them against the increase of dyspnea. FEV(1), BMI, and anxiety-trait were predictors of dyspnea.

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The role of music therapy as a supportive treatment is not well defined. The music therapy cannot be estimated as the isolated method it is often only the part of the complex therapy. The aim of this study was to evaluate the influence of music therapy on anxiety level in hospitalized asthmatic patients. The patient group was consisted of 36 patients with bronchial asthma (23 women and 13 men). In all patients we evaluated the level of anxiety (attribute and state) according to Spielberger and intensity of dyspnoe according to Borg scale at the first day of examination and after 10 days of rehabilitation program. Moreover we performed spirometry. The respiratory rehabilitation program included: exercise of breath control, correction of respiratory pattern, training of diaphragm and additional respiratory muscles. The duration of music therapy lasted 15 min. After 10 days rehabilitation with or without music therapy we found the reduction of anxiety (state) (p<0.0001). However we did not observe the difference between two studied groups with or without music therapy in diminishing of anxiety (p = 0.55). In conclusion, we believe that the music therapy can play important role in treatment of somatic disease but our study did not confirm its additive positive meaning in patients with bronchial asthma.

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If the idea of a biopsychosocial model is not going to be merely a phrase, then every clinical diagnosis and therapeutic vision need to consider the familial issues. Taking the family issues into consideration has evident gains; it allows for a better understanding of the patient and allows for actions which reduce the risk of a relapse of illness. The fact that such issues are not part of the therapeutic armament, despite the effectiveness of psychoeducation, is bewildering: on one hand the families are not always invited to co-operate, on the other hand--they often give up this co-operation. In such a situation, the relation between the patient's family and the personnel needs analysis, especially common, often unconscious emotions and prejudices. They can form a dysfunctional 'knot', which does not allow for a therapeutic alliance to be formed. How to come out from such an impasse and make a common positive alliance? Paradoxically, the therapeutic possibilities are bigger when--especially in the initial phase of treatment--the psychiatrist "is able to not know" and is capable of listening into the patient's family perspective, and has an interest in the 'family story'. It is only after the knowledge on the family is gained and the family perspective is accepted, that the deconstruction of that part of the family's story that forms the problem and a common search for "positive changes" are possible. Although it may not appear to be so, such an ordeal can be very difficult for the psychiatrist who is used to controlling the situation through psychiatric theory and diagnosis, psychiatric language and the psychiatric institution. The issue presented appears to be part of a universal dilemma: what is the range of "the language power" of the psychiatrist and when is the sharing of this power with the patient and the family beneficial for the therapy.

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Basing on the example of one patient and her family, the advantages and disadvantages of a systemic consultation are presented. The patient was hospitalised due to schizophrenia. In the given example the psychiatrist was an observer of the consultation conducted by a therapist from the ward. A systemic consultation allowed a "multiple-picture" to be obtained: the family members and the patient presented their own understanding of the situation, their "stories" This new and multi-perspective description, showing the patient's symptoms functionality caused diagnostic uncertainty in the psychiatrist--how far is the diagnosis of schizophrenia a justifiable one. The possibility to empthasize with the existential, psychological and family problems of the patient caused a scepticism in the psychiatrist, towards the stigmatizing diagnosis. The authors stress the danger arising in the systemic consultation, which broadens and deepens the knowledge on the patient's situation. According to the authors, the systemic consultation is necessary to understand the social context of the patient and to formulate a complex treatment plan. At the same time however, the multiple layered perspective (which contains the psychological, social and existential domains of the patient) should not over-shadow the psychopathological domain. For the therapeutic team, the consideration of the given levels of systemic reality description remains a challenge.

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In the first part of the paper, authors describe some research tools for the assessment of family functioning, concentrating mainly on self-report questionnaires of the family members. Advantages and methodological limitations of such methods are discussed. Several questionnaires of self-report type are described such as e.g. the Family APGAR, Family Environment Scale, Mc Master Family Assessment Device, as well as Family Assessment Measure (FAM) of Skinner and Steinhauer. Manfred Cierpka Family Assessment Measures are a modification of this last questionnaire. In the second part of the paper authors present in details Cierpka Family Assessment Measures. They describe seven dimensions of the family functioning such as task accomplishment, role performance, communication, emotionality, affective involvement, control and values and norms. Family Assessment Measures consist of three questionnaires such as General Scale, Dyadic Scale and of Self-Rating Scale. General Scale focuses on how individual member views the family as a whole, The Dyadic Scale assesses specific relationship dyads within the family and Self-Rating Scale addresses how an individual member views his or her functioning within the family. At the end, psychometric properties of these questionnaires are presented, as well as the general description, how they should be used in the process of the assessment of the family for research and in clinical practice of family therapy.

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In this article we present some of the more important findings from research aimed at the validation and normalisation of the Family Assessment Questionnaire (Dyadic Questionnaire, Family Questionnaire, Self-Estimation Questionnaire), which is the Polish adaptation of Manfred Cierpka's and Gabriele Frevert's "Familienboegen". In the presented study 1511 individuals from 557 families took part. Of these 658 individuals (including 162 children) came from 248 families which had no clinical health or adjustment problems, while 853 individuals (including 305 children) came from 309 families with problems due to schizophrenia, anorexia nervosa, coronary heart disease or family crisis. A new method of analysing raw results from the questionnaire scales was formulated and verified. This method was based on the criterium of sufficient satisfaction regarding the aspect of family life measured by the scale. The original scales of all the questionnaires (Task Completion, Role Performance, Communication, Emotionality, Affective Involvement, Control, and Values and norms) were characterised by average or low reliability; the general scales were characterised by high reliability (the Dyadic Questionnaire with very high reliability). As a result of factor analysis new scales were created with acceptable or high reliability. These were the scale of Positive statements, the scale of Negative statements in the dyadic and family questionnaires, and the scales of kindness, care and resentment in the Self-Estimation Questionnaire. The general scales and the factor scales generally significantly differentiated between the sub-samples selected due to the type of family problems present and relationship. On the other hand the 7 original scales did so only sporadically or weakly. Better results were obtained by families without health or adjustment problems while the worst results were obtained by families in crisis.

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The paper presents the role of systemic consultation in the diagnostic and therapeutic process of the people hospitalised for the first time because of a psychotic episode. The following questions are going to be put: What is the role of systemic family consultation in the diagnostic and therapeutic process on the inpatient ward? What are the differences between systemic consultation and others forms of family interventions f.e. family interviews, psycho--education, systemic therapy? What are possibilities and limitations of consultation? What does it invite to? These are only some of those questions, which are typical for daily clinical practice, in which the family consultation takes an important part. In this paper according to our clinical experience, we would like to share some of our thoughts on the questions put. In spite of difficulties the family consultation confronts us with, we are deeply convinced that it has an important part in therapeutic and diagnostic process.

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