Structural Ecosystems Therapy (SET) is a theoretically derived intervention that builds on the basic tenets of human ecology and structural family therapy. The term ecosystems reflects a belief in the influence of the context on the individual, with family comprising the most significant system in human ecology. """"""""Structural"""""""" concepts refer to a focus on patterns of interactions that occur within and between systems. The major focus of the (SET) intervention is to identify patterns of interactions--and then to strengthen those interactions that support the individual and her family and correct those interactions that are problematic. SET is thus targeted at the social systems (or more precisely interactions with these ecosystems) which are the most relevant contexts for these women: intrapersonal, family, and environment, as well as the interactions among these systems. The model builds on over two decades of family-oriented research with minority families by the investigators. The primary aims of this study are to investigate the efficacy of Structural Ecosystems Therapy, and to describe some of its theoretical mechanisms. This will be achieved by randomizing 264 HIV+ African American women to one of three conditions: SET, Attention Control, or Community Control. The Attention Control condition is operationalized in the form of Person-Centered Therapy. The Community Control is intended to reflect the baseline level and mix of services usually utilized by these women. Considerable rigor is introduced into four levels of controls to ensure fidelity to conditions. Outcomes are linked to family processes derived from observational ratings. SET is hypothesized to have a beneficial effect on family functioning and supportiveness, distress, maladaptive coping, perceived control, and perceptions of hassles. Proposed analyses include RMANOVA, RANOVAS, multiple regression, and structural equations modeling.
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