Coping Behavior and Child-Parent Relationship in Mothers and Children in Alcoholic Families

The paper presents the findings of the research on family stress and coping in alcoholic families. The authors demonstrate similarities between reactions of mothers and their children in a crisis: lack of adequate actions, prevalence of emotion-oriented behavior patterns, self-blame and aggression. There has been found a correlation between coping behavior and such features of family upbringing as uncertainty in raising a child, excessive demands, preference to child-like features in a child. The authors analyze the attitude of mothers to their children that is characterized with controversy and ambivalence, which also is a sign of a systemic crisis in a family. The authors conclude that non-productive coping behavior turns into a psychological problems of family members and may result in long-lasting traumas.

Introduction

1. Introduction and Problem statement

Family, family processes and phenomena have long been an acute research object in theoretical and practical psychology [7, 12]. One of the prospective directions in family studies is family stress and coping behaviour. This field includes those aspects of family life that either provide for its longevity and constructive development, or, on the contrary, lead to the crisis and collapse.

Since stress as coping with life difficulties is an important part in the life of an individual or a group, its role is ambivalent and varies from construction to destruction. Stress can help mobilize the current resources and push to find new ones to solve the problem. However, severe stress of long duration can lead to the loss of health, well-being and unity in the family.

All family stressors can be divided into several types in accordance with the degree of their severity and duration.

1. Trauma – a short in duration, but severe event or phenomenon (death, unexpected divorce, accident, catastrophe);
2. Life event – a longer significant influence on further life (birth or loss of a family member, moving houses, change in life conditions);
3. Chronic role stressors (tension) – those, first of all, include accumulation and seemingly unsolvable conflicts resulting from the current social roles;
4. Everyday stresses – difficulties resulting from daily interpersonal relationships in a family or micro stressors. These are slight exposures that can increase, accumulate and turn into a substantial difficulty (e.g. chronic lack of money, bad housing conditions etc.) [1].

One of the most negative consequence of severe and long stress is a family crisis. It is the inability of a family to restore stability in the situation of constant rigid requirements that change the family structure and the ways of cooperation among its members. A family crisis can be defined as an irreparable change in the family, when previous habitual roles become unacceptable and the previous behavior models collapse [1].

A family in the situation of an external or internal crisis is especially interesting for research on family stress. A vivid example of such a family is an alcoholic family in the crisis when a child is removed from the family [4, 5, 8]. We are considering a temporary removal and placement in a rehabilitation centre as a turning point in the life of a dysfunctional family. The family has two ways out of the crisis: either the family collapses, the parents lose the custody and the children are removed from the family permanently or the parents reject the previous lifestyle, reconsider their priorities and values, search for resources to cope with stressors, as a result of which the family reunites [9, 11, 13].

By default, an alcoholic family where one or both parents are alcohol-addicted is the holder of chronic stress. The influences of this stress are destructive; they result in psychological traumas in adults and children and have long-lasting negative consequences [2, 16].

In our opinion, we should talk about the specifics of family stress in an alcoholic family. Alcoholization of a family member/s in its development should be considered as an important life event – an impact that has a lasting and significant impact on the future life of its members. In modern studies, the development of alcoholism is considered not only from the individual point of view, but also as a family (group) approach. Hence the emergence of concepts of “family alcoholism”, “alcoholic family”, “spousal alcoholism”, which reflects a systemic view of the problem [3, 6, 14]. The dependent (alcoholic) behaviour of a family member changes the entire family system, forming a special relationship – the relationship of co-dependency. The co-dependent is dependent on the mood and behaviour of the addict, is constantly in stress caused by anxiety for the addict’s life and attempts to change it. Co-dependency is interpreted as a complex, polydeterminate personality disorder that manifests itself at the cognitive, emotional and behavioural level [6, 14, 19].

Thus, in the alcoholic family, two strong stress-generating factors are simultaneously represented –dependence, as a chemical addiction, and co-dependency of family members, as a behavioural addiction. This leads to the development of chronic family stress, characterized by constant psychological pressure, excessive neuropsychic stress, tension, anxiety, frustration of basic needs for security.

Since this stress, as a rule, is long-lasting, it becomes a factor in the personal development in the family. In modern studies, there is plenty of data on the conditioning of adolescent alcoholism by parental addiction; the development of suicidal and non-suicidal auto aggressive patterns in adult children of alcoholics; about the repetition of the life scenario of the daughters of alcoholics.

Alcoholic family members is a chronic stress that triggers the mechanisms of protective and coping behaviour of family members and  acts as their situational determinant.

Our earlier studies have shown that there is a clear specificity of the protective and coping behaviour of deviant mothers and their children during the period of temporary removal of the child from the family. This behaviour is characterised by its unproductiveness, which further aggravates the stress load and does not let family members resolve the crisis. For example, mothers have difficulty understanding their experiences in the context of a given situation. The mechanisms of psychological defence prevail over coping (which enables adaptation, acceptance, coming to terms with a traumatic situation), but does not provide an opportunity to change it constructively. The specific feature of deviant mothers lies in their situational use of those problem-oriented coping strategies, the purpose of which is to understand the reasons for what happened. However, they never use real proactive strategies. All their attempts to cope are reduced to analysing and understanding the causes of the current situation. Added to this there are emotional coping strategies focused on self-blame and rejection of feelings. In general, this defensive-coping behaviour makes adult women helpless and powerless to change life circumstances. The core of children’s defensive behaviour is a compensation mechanism that enables the child to switch from assessments and analysis of the traumatic experience of relations with the mother to other events. In children deprived of parental care, this is more often manifested through deviant behaviour: aggressiveness, drug addiction, vagrancy [14, 17].

Research questions: in this subject field, a number of problematic issues arise that need to be addressed, namely: what is the role of coping behaviour of parents and children from alcoholic families in resolving a systemic crisis? Is coping with family members a key psychological factor in the constructive or destructive resolution of a crisis in an alcoholic family? How is coping behaviour in an alcoholic family related to the quality of parent-child relationships?

Research object: parent-child relationships and coping behaviour in alcoholic families.

Aim of the research: Studying the connection between parent-child relationships and the specifics of coping behaviour of mothers and children with a family crisis – the removal of a child from the family and temporary placement in a rehabilitation centre

Method

The methodological tools of the study included:

1. Questionnaire for collecting socio-demographic information.
2. Drawing of a family in order to determine family positions and the “I-concept” of the subject [18].
3. Analysis of family relationships (E.G. Eidemiller, V.V. Yustitskis, 1999), a questionnaire for parents to identify the main features (violations) of the upbringing process in the family [3].
4. Questionnaire of coping methods (OSS) (adapted by T. L. Kryukova, 2004) [9].
5. Questionnaire of coping behaviour in stressful situations (N. Endler and J. Parker (1990) adapted by T.L. Kryukova, 2004) (Kryukova, 2007).
6. Questionnaire of coping strategies for schoolchildren by I.M. Nikolskaya, R.M. Granovskaya [15].

Statistical processing of the data obtained was made with the SPSS Statistics 15.0 software package. At the preliminary stage, descriptive statistics were carried out. Differences between groups were assessed with Mann-Whitney U-test. To assess the correlations between the indicators, the Spearman rank R coefficient was used.

Participants of the research

The research was carried out in small towns of the Kostroma region. The study sample consisted of thirty families with alcoholic mothers: 30 mothers and 34 children. Mothers deny their alcohol addiction, are indifferent to medical and psychological assistance. Alcoholism has not been officially diagnosed. In 22 families, both parents drink alcohol. Families were studied at the stage of administrative procedures to deprive mothers of parental rights, which we considered as an objective indicator of the family crisis. Based on the data from the questionnaire, the following characteristics of the sample were identified: age of children – 6-15 years (M = 8, ó = 1.9); parents’ age – 24-48 years (M = 35, ó = 3.5); duration of alcoholism period from 1 to 7 years; 53% of families have one child; 40% of families have two children; 7% of families have three children; education of mothers – higher 7%, vocational – 23% of respondents, secondary – 43%, general secondary – 27%; officially employed – 27%; do not work officially – 73%.

In accordance with the Federal Law “On Personal Data” of July 27, 2006 N 152-FZ, the respondents were notified of the purpose of the study and provided informed consent to participate in this study.

Results

• Features of experiencing a crisis event and coping behaviour of children and parents in alcoholic families

At the first stage, we studied the emotional attitude of mothers and children to an actual event (temporary placement of a child in a rehabilitation centre) and coping strategies in this situation.

The majority of mothers perceived the withdrawal of a child as an unexpected event, entailing a change in the usual way of life, habitual relationships and an increase in tension. In connection with the placement of the child in a rehabilitation centre, 69% spoke of anxiety for the child.  However, they were worried not about his emotional state, but about formal aspects: education, nutrition, etc. Another 60% of the mothers talked about feelings of guilt and shame.  This event was regarded by women as a threat to their status, which indicates the social dependence and conformity of women, while this situation in 54% of mothers caused confrontation with the problem, irritation and aggression towards the guardianship authorities, which in this case were perceived as the culprits of the situation. The mothers’ responses an ambivalent attitude towards themselves as a mother (69%): on the one hand, they characterized themselves as strict and authoritative parents, on the other hand, their responses testified to educational uncertainty, inconsistency, low self-esteem and dissatisfaction with the role of the mother. These data confirm the existence of a mythical, distorted idea of oneself in the role of an alcoholic mother that has nothing in common with the real situation [5, 11]. It should also be noted that a crisis event usually performs as an incentive, a motivating function for active actions. However, in our case, about a third of mothers declared a desire to return the child, but they did not take real steps, and 30%, while experiencing negative feelings, did not see the situation as a crisis and gave the children away with ease.

We analysed the ways in which the respondents cope with this crisis event. The respondents filled out a special form in which the crisis and the removal of a child from the family was described as a difficult situation.

The most pronounced is the strategy of escape/avoidance of solving the problem, which manifests itself in the hope of a miracle, that everything will somehow be resolved by itself, fantasizing, as well as in improving the physical condition with food, drink, medicine. This strategy is combined with planning a solution to the problem, which, however, does not translate into real action, high self-control and confrontational coping. Least of all, the mothers take responsibility for what is happening. These data are confirmed by the analysis of coping styles (Table 1).

Despite the fact that the results are presented by average values, there is a slight decrease in indicators on the scale of problem-oriented coping. The expressiveness of emotionally-oriented coping turns out to be higher – that is, instead of real cognitive or behavioural actions, a woman blames herself, wallows in her suffering, experiences tension and irritation, “freezes” and becomes dejected. This is caused by the lifestyle in an alcoholic family: the habit of not solving problems, but leaving them, to alcohol. Such a combination of behaviours is recorded in other dysfunctional families: difficulties are overcome not with real efforts, but with an inadequate emotional response [4, 16, 19].

Children experience this situation quite painfully. Describing the situation, children (about 56%) spoke of resentment against their mother, experienced anger and aggression. The study of children’s coping behaviour showed that most often children try to stay alone, avoid communication with adults and peers. They prefer to be alone, on their own (60%), walk, watch TV or listen to music, dream, 10% – withdraw from everyone. Emotionally oriented strategies are also manifested, especially among younger schoolchildren and pre-schoolers (“I bite my nails and crack the joints of my fingers”, “I tease people,” “I scream and shout,” “I’m going crazy,” “I hit, break and throw “,” I am crying, sad “), which testifies to the high tension and low self-control of the subjects. Often children blame themselves for what is happening, or on the contrary, leave the responsibility with the parents (“I don’t care,” “let (the parents) figure it out for themselves”).

In general, there is a similarity in the response of mothers and children in this situation: the lack of adequate actions, the predominance of emotionally oriented ways of behaviour, self-blame and aggression.

Research on parent-child relationships in alcoholic families and their correlation with coping strategies. At the second stage of the research, we studied the specificity of parent-child relationships. The analysis of the family’s drawings and the content of the conversation in the process of drawing made it possible to reveal the specifics of intra-family relations, first, the relationship of the mother to the child and the child to the mother. Most of the subjects (50%) experienced uncertainty during the study (they redrew themselves and family members several times), which, in our opinion, indicates the complexity and uncertainty of self-perception and perception of other family members by the respondent. 2% of children also showed indifference to the tasks, 30% initially refused to draw, even showed aggression.

As seen from Table 2, in the drawings of women, dark tones prevail, the figures are at a considerable distance, away from each other, there is no contact between them, which may indicate the current crisis. In addition, an important characteristic of relationships is manifested in the drawings – a lack of warmth, emotionality and a lack of bodily contact. The features of the drawings enable us to speak about the “blurring” of one’s own “I”, the absence of self-identification.

This is reflected in the position of the woman in relation to the man in the drawings. The husband often takes a position in the middle of the sheet and is of the impressive size, the woman draws herself in the distance, the children – in small figures. 20% of women did not paint themselves. A child is missing in 25% of the drawings; in 70% of cases, his figure is disproportionately small. This fact speaks about the dependence of women on drinking husbands, about their own egocentric position, typical for the addict, while the child is “abandoned” and “forgotten”. Strong pressure, shading and specific details (fangs, wounds, grin) testify to negative emotions and aggression.   The analysis of children’s drawings (Table 2) suggests reduced social competence and distorted self-perception.

It is worth noting that in 80% of children, fear is a constant feeling, which, first, is expressed in the image of alcohol abusers, “bestial” people instead of their father or mother, and the prevalence of dark colours in the images. 30% painted themselves as “tiny” figures, far from their parents, which emphasizes insecurity and low self-esteem; 20% depict themselves indistinctly, the contours are blurred, which indicates such a feature of alcoholic families as the blurring, indistinctness of the boundaries of the child’s “I”.

Thus, in the respondents’ drawings, the image of the “I” is distorted: it is small, replaced by the image of an animal, or completely absent. Parents are depicted disproportionately large with details that do not exist in reality. This indicates the complexity in the perception of family members and self-perception. The majority of children from alcoholic families reflect in the drawings the aggressive position of their parents and their own subordinate position. Dark colours are often used, which indicates the presence of depressive tendencies. It is important that in the drawings of parents and children there are no signs of community, solidarity and support, the family is perceived as a source of negative emotions.

An analysis of the characteristics of family upbringing enables us to speak about its specific characteristics (Fig. 1), which in turn indicates a failure of the educational function by the family and mothers. Firstly, the highest values of mothers are shown on the scale of Undeveloped parental feelings. Outwardly, this manifests itself in the mother’s unwillingness to deal with the child (adolescent), in the poor tolerance of his/her company, superficial interest in their life. It is important that mothers, as a rule, do not realize this feature, project their own shortcomings onto the child (the scale, projection of their own undesirable qualities). This defensive reaction gives mothers an excuse to reject their own child, justifies antipathy and irritation. Secondly, it is important that mothers show similar indicators on ambivalent scales (for example, both excessiveness and lack of parental protection are equally represented). This speaks of the instability and inconsistency of parenting. This situation in everyday interaction increases the stress load of the child. This is caused by the immaturity of the maternal position and the lack of parental reflection. Being addicted and co-dependent at the same time, they focus on their own needs and the needs of alcoholic husbands, ignoring the needs of the child.

Note: G+ – hyper protection, G- – hypo protection, U+ – satisfying child’s needs, U- – ignoring child’s needs, D+ – too many demands and responsibilities, D- – too few demands, Z+ – excessive demands and responsibilities (dominance), Z – lack of demands and requirements to the child, S+ – too many sanctions, S – – too few sanctions, H- shaky style of upbringing, PFE – parental feeling expansion, PCF – preference of child-like features, UU – uncertainty in upbringing, LF – phobia of a child loss, UPF – undeveloped parental feelings, PUF – projection of own undesirable features onto the child, SC – spousal conflicts influence upbringing, PFF – preference of female featyres, PMF – preference of male features.

Another important fact is the presence of differences in the severity of parenting options in relation to younger children and older children (Table 3). So, in relation to the younger, neglect of the child’s needs, inadequacy of requirements (insufficient responsibilities of the child in the family), excessive demands-prohibitions, preference for children’s qualities and the projection of their own undesirable qualities onto the child are manifested more often. Hyper protection is also clearly seen, while in relation to the adolescent child, hypo protection prevails. In this situation, the child seems to “be out of sight.”

In addition, regardless of the age of the child, one can talk about the emotional rejection of children. This is manifested in low protection, low satisfaction of the child’s needs, and a low number of child responsibilities. Interestingly, the needs of a teenager are taken into account more often than of younger sibling, but at the same time teenagers are assigned more responsibilities.

Analysing the features of the relationship between the styles and strategies of coping behaviour of mothers and the characteristics of family upbringing, the following facts should be noted.

First, the strategy of seeking social support (r = 0.472, p = 0.03) is positively correlated with the uncertainty of parents in terms of upbringing methods, but negatively – the problem-oriented style of coping (r = –0.6, p = 0.01) and the strategy of self-control (r = – 0.467, p≤0.037). These connections seem very logical: the maternal maturity enables mothers to take active actions to find a way out of a crisis and to control their behaviour and emotions better. Maternal immaturity and uncertainty in upbringing make them rely more on external help, including professional help.

Second, excessive demands-prohibitions (S + scale) are negatively correlated with problem-oriented coping (r = –0.58, p = 0.01), and excessive sanctions (S + scale) are negatively associated with avoidance-oriented coping. (r = –0.63, p = 0.01). It should be noted once again that in alcoholic families, along with connivance, relationships are characterized by the mother’s desire to tightly control not only the alcoholic husband, but also the child, which creates inconsistency in parental behaviour: on the one hand, the mother does not avoid the situation, but on the other hand, she does not solve it. She tries to compensate for real actions by thinking, searching for the causes of what is happening and who is to blame, and is stuck at the stage of analysis instead of active actions. In the same vein, we can analyse the relationship between the underdevelopment of parental feelings and an increase in the likelihood of avoiding solving the problem (r = 0.54, p = 0.01), when the lack of emotional closeness and love for the child accounts for the absence of efforts to change the situation and an indifferent attitude to the withdrawal of the child from the family.

Conclusions

1. Thus, the results obtained allow us to make the following generalizations. The situation of the removal of a child from the family is, on the one hand, a non-normative crisis event in the life of the family. On the other hand, it is a manifestation of a more general systemic crisis of a dysfunctional family. This situation is experienced by members of the alcoholic family as a traumatic, unexpected event that threatens illusory security, leading to abrupt and painful changes, and as a turning point in life.
2. A manifestation of the systemic crisis is the relationship between mothers and children. The attitude of alcoholic mothers towards children is contradictory and ambivalent. Insensitivity and an inability to understand the psychological needs of the child is combined with excessive parental care and over control, the main goal of which is not safety and well-being, but submission and obedience of the child. The decrease in the level of parental care to hypo protection of teenagers is seen by mothers as a normative process, the recognition of the child’s adulthood – “he is already an adult, independent.” Visible “involvement” and formal fulfillment of parental functions lead mothers to the cognitive illusion of the relative normality of the family. This illusion is the reason for a feeling of injustice, “illegality”, when it comes to the removal of the child from the family.
3. The destruction of the old family structure entails the need to change the direction of further development. It is an important period for changes and personal transformation. However, alcoholic families do not have sufficient resources for this. The most important problem in this situation is the “double” dependence of mothers – their own (overt or latent) alcohol dependence and co-dependency on an alcoholic husband. The subjective effect of “double” dependence is the experience of helplessness, powerlessness, impossibility to change the situation, despair, hopelessness, forced acceptance of family breakdown, adaptation.
4. An important psychological indicator of life event experience is the specificity of coping behaviour manifested by members of alcoholic families. A very important common characteristic of both adults and children is the rejection of their own traumatic feelings. In mothers, this is combined with auto-aggression and self-blame. In children, this is compensated for by strategies of external aggression, distraction, “withdrawal” into their inner world.

Thus, unproductive coping behaviour itself becomes a psychological problem for members of alcoholic families, leading to family breakdown and long-term traumatic consequences.

Highlights:

• This study is devoted to the analysis of coping with the crisis in alcoholic families.
• The situation of the removal of a child from the family is considered as a crisis.
• The perception of the family situation and the coping behavior of mothers and children are compared.
• It is concluded that younger children are more vulnerable than older ones.

Author contributions:

M.V. Saporovskaya developed the theory, prepared the initial draft;
S.A. Khazova performed calculations, checked analytical methods, visualization, description of the results.

All the authors have read the published version of the manuscript and agreed with it.

Conflict of interest
The authors declare no conflict of interest.

References

1. Bodenmann, G. (2002). Stress, kritische Lebensereignisse und Partnerschaft: Universität Fribourg.
2. Christensen, H., Bilenberg, N. (2000). Behavioural and emotional problems in children of alcoholic mothers and fathers. European Child & Adolescent Psychiatry, 9, 219–226. https://doi.org/10.1007/s007870070046
3. Ejdemiller, E.G., Yustickis, V. (2008). Family psychology and psychotherapy [Psihologiya i psihoterapiya sem’I]. SPb.: Izdatel’stvo «Piter».
4. Ekimchik, O., Kryukova, T.L., Khazova, S.A. (2016). Comparing attachment addictive behavior patterns in women: addicts of intimate relationships and co-dependent mothers of adult sons. Journal of Behavioral Addictions, 5(1), 1-64.
5. Gushchina, T.V. (2005). Protective and coping behavior in a dysfunctional family during a crisis: abstract of PhD thesis in Psychological sciences. [Zashchitnoe i sovladayushchee povedenie v disfunkcional’noj sem’e v period krizisa: avtoref. dis. … kand. psihol. Nauk]. Kostroma, KGU after N.A. Nekrasov. Retrieved from: https://www.dissercat.com/content/zashchitnoe-i-sovladayushchee-povedenie-v-disfunktsionalnoi-seme-v-period-krizisa
6. Ghorbani, (2017). The alexithymia, emotion regulation, emotion regulation difficulties, positive and negative affects, suicidal risk in alcohol-dependent outpatients.  Psychiatry Research, 252, 223–230.
7. Horváth, Z., Orford, J., Velleman, R., Urbán, R. (2019). Measuring Coping Among Family Members with Substance-Misusing Relatives: Testing Competing Factor Structures of the Coping Questionnaire (CQ) in England and Italy. Substance Use and Misuse, 55(3), 469-480.
8. Isachenko, P.V. (2017). Adaptation of the family system to the removal of a child and the specifics of organizing services for parents deprived of parental rights. [Adaptaciya semejnoj sistemy k iz”yatiyu rebenka i specifika organizacii uslugi dlya roditelej, lishennyh roditel’skih prav]. In: Working with the blood family of inmates of institutions for orphans and prevention of social orphanhood. Experience of the Smolensk and Vologda regions: collection of articles / edited by A.S. Omelchenko [Rabota s krovnoj sem’ej vospitannikov uchrezhdenij dlya detej-sirot i profilaktika social’nogo sirotstva. Opyt Smolenskoj i Vologodskoj oblastej: sbornik statej / pod red. A.S. Omel’chenko]. M.; Smolensk: BF «Deti nashi», рр. 63-70.
9. Khazova, S.A., Saporovskaya, M.V., & Kudryashova, O.A. (2020). Removal of a child as a crisis event in the life of an alcoholic family and coping with it [Iz”yatie rebenka iz sem’i kak krizisnoe sobytie v zhizni disfunkcional’noj sem’i: osobennosti sovladayushchego povedeniya]. Bulletin of Moscow Region State University (e-journal), 4, 198-218. https://cyberleninka.ru/article/n/izyatie-rebyonka-kak-krizisnoe-sobytie-v-zhizni-disfunktsionalnoy-semi-osobennosti-sovladayuschego-povedeniya
10. Kryukova, T.L. (2007). Coping Methods: Three Coping Scales. [Metody izucheniya sovladayushchego povedeniya: tri koping-shkaly]. Kostroma: Avantitul, 2007.
11. Kudryashova, O.A. (2016). Child-parent relations and coping behavior in alcoholic families. [Detsko-roditel’skie otnosheniya i sovladayushchee povedenie v alkogol’nyh sem’yah: kval. rabota]. Kostroma. 2016.
12. Kuftyak, E.V. (2014). Coping and psychological protection of spouses during dynamic crises [Sovladanie i psihologicheskie zashchity suprugov v period dinamicheskih krizisov]. Medical psychology in Russia [Medicinskaya psihologiya v Rossii], 6(1), 11. doi:10.24411/2219-8245- 2014-00011
13. Modern family: Rethinking contexts [Sovremennaya sem’ya: pereosmyslenie kontekstov] (2020) / V. V. Gruzdev [et al.]; ed. by S.A. Khazova, O.A. Ekimchik. Kostroma: Kostroma State University. https://elibrary.ru/item.asp?id=46667645 здесь все так
14. Moskalenko, V.D. (2006). Addiction: a family disease [Zavisimost’: semejnaya bolezn’. bolezn’]. M.: PERSE, 2006.
15. Nikol’skaya, I.M., Granovskaya, R.M. (2000). Psychological protection in children. [Psihologicheskaya zashchita u detej]. SPb.: Rech’.
16. Raitasalo, K., Holmila, M., Jääskeläinen, M. et al.(2019). The effect of the severity of parental alcohol abuse on mental and behavioural disorders in children. Eur Child Adolesc Psychiatry 28, 913–922. https://doi.org/10.1007/s00787-018-1253-6
17. Saporovskaya, M.V. (2016). Intergenerational coping in the family: socio-psychological mechanisms and group effects [Mezhpokolennyj koping v sem’e: social’no-psihologicheskie mekhanizmy i gruppovye effekty]. Psychological research [Psihologicheskie issledovaniya], 9(49), 3. URL: http://psystudy.ru (28.09.2022).
18. Surkova, E.G. (2008). Projective diagnostic methods. Psychological counseling for children and adolescents. [Proektivnye metody diagnostiki. Psihologicheskoe konsul’tirovanie detej i podrostkov]. M.: Aspekt Press.
19. Punzi, Е., Lindgren, К. (2019). Relationships, Emotions, and Defenses Among Patients with Substance Use Disorders, Assessed with Karolinska Psychodynamic Profile: Possibilities to use Intensive Short-Term Dynamic Psychotherapy in Substance Abuse Treatment. Alcoholism Treatment Quarterly, 37(4), 481-496.