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  1. Families John Sargent, M.D.

  2. Learning Objectives • 1) Learn about the structure, organization and functioning of families • 2) Learn about the unique stresses associated with families of varying composition

  3. There are a variety of ways of knowing and understanding families: A. Anthropology • views the family as the source and carrier of culture B. Social Psychology • sees families as small groups with tasks to successfully master

  4. Understanding Families (cont.) C. Developmental psychology • studies the environment within which children are raised and grow into themselves

  5. Understanding Families (cont.) D. Clinical Psychology and Psychiatry • As the environment within which normal or abnormal behavior begins, takes hold and becomes the patterns enacted by children

  6. Understanding Families (cont.) E. As the base for all members to experience connection and belonging while each experiences simultaneously the push toward autonomy and independence

  7. Understanding Families (cont.) F. As the environment within which children learn to know, experience and modulate their emotions through relationships with attachment figures

  8. Understanding Families (cont.) G. As a system where the whole is greater than the sum of the parts and where each individual affects and is affected by every other individual

  9. Families offer: • An experience of connection with history • Stories of ancestors which offer meaning and value to lives • A sense of identity through identification with family members

  10. Families offer (cont.): • A safe haven in which to relax and experience acceptance and regard • A set of relationships within which one experiences care and guidance and the opportunity to care for and guide others

  11. Families are also places within which • Physical intimacy among some members is sanctioned • And is also forbidden among other members

  12. Families have very specific tasks: • Gathering enough resources to ensure survival • Procreation and looking after immature children • Promoting maturation and successful aging and loss • Providing enough empathetic connection to encourage attention to the above tasks

  13. Variables of interest in understanding families: • Functional collaboration • Gender expectations • Power • Responsibility • Warmth • Positive support • Cultural background and difference

  14. Family Coherence • Basic Building Blocks of Family Life • Coherence • Organization • Communication • Values and Beliefs

  15. Coherence • A sense of uniqueness and identity of the family • A sense of membership, inclusion and belonging • A sense of personal space and voice • A recognition of developmental status and skills • Accommodation to individual differences

  16. Coherence (cont.) • A secure base for emotional expression and regulation • A recognition of the shared effort to pursue family activities such as providing safety, nurturance and socialization • The shared capacity to resolve conflict • To reflect on family strengths, capacities and areas of difficulty • To reflect upon the family as members see it.

  17. Family Adaptability and Reactions to Change • Recognition of stress or change • Labeling of the challenge • Developing a shared approach to the problem

  18. Family Adaptability and Reactions to Change (cont.) • Utilizing the family as a focal point for developing and evaluating stress management strategies • The role of family coherence in these family actions

  19. Family Coherence and Individual Resilience • The role of belonging • Family attachment as an affect monitor and mediator of emotional expression • The role of family myths • The role of family competence in building individual self-esteem • The role of ritual and celebration

  20. When Family Coherence Fails • The possibility of multiple definitions of the family • Too rigidly defined family views failing to accept individual difference

  21. When Family Coherence Fails (cont.) • The role of individual temperamental factors and non shared environment • Family behavior amplifying affective responses, leading to isolation and scapegoating

  22. Partner Relationship: Important Features • Negotiation of Interpersonal Distance • Negotiation of roles and tasks assignment • Emotional tone – positive comments vs. criticism

  23. Partner Relationship: Important Features (Cont.) • Negotiation of cultural integration • Negotiation of connection to extended family • Negotiation of location and career intensity • Negotiation of sexual behavior and leisure activities

  24. Significant Components of Parenting I. Nurturance II. Structure III. Affiliation IV. Attachment

  25. I. Nurturance requires A. Access to resources B. Capacity to use them for the child C. Own needs being met

  26. Nurturance Requires (cont.) D.) Reinforcement for providing for the child • Support from important adults • Clear response from the child-satiation, comfort, satisfaction, quieting • Infant’s social responsiveness connects the child with caretakers

  27. Nurturance Requires (cont.) E.) Empathic capacity to infer infant’s needs • Appreciation of intentionality of infant • Reflectiveness on the parents’ part leading to an appreciation of reciprocal selfhood

  28. Nurturance Requires (cont.) F. Absence of compelling consistent concerns (addiction, severe poverty, depression, spouse abuse, severe marital disruption)

  29. II. Structure Requires A. Capacity to appreciate developmental abilities B. Avoidance of polarized adult interactions

  30. Structure Requires (cont.) C. Acceptance of responsibility for child D. Willingness to distance from the child enough to set a limit

  31. Structure Requires (cont.) E. Capacity to define the child’s world so that competence develops F. Utilizing the child’s responsiveness to limits to reinforce future adherence

  32. Structure Requires (cont.) G. Providing a sense that limits occur through knowledge of the child and the capacity to appreciate his/her skills and needs

  33. III. Affiliation Requires A. The capacity to know the child B. Creating a coherent picture of the child

  34. Affiliation Requires (cont.) C. Willingness to accept and appreciate the child as he/she is D. Appreciation of the child’s affective responses as legitimate

  35. Affiliation Requires (cont.) E. Willingness to respond to the child’s affective expression with knowledge and neither dismissiveness, anxiety nor disorganization

  36. IV. Attachment Requires A. Capacity for affect expression and modulation B. Sense that relationships provide knowing, definition, safety and ultimately self-expression and self- awareness

  37. Attachment Requires (cont.) C. Recognition that stress can be dealt with socially and affectively D. Synchrony exists between connection, calming, safety and competence

  38. Variations in Family Structure • Adoptive family • Gay and lesbian parents • Unmarried couple as parents • Bicultural family • Single-parent family • Divorcing family/post-divorce family • Blended family • Grandparent-or kin-headed family • Foster care family

  39. Common Stresses and Concerns of Single-Parent Families • Economic concerns • Need for social support • Relationship of children with noncustodial parent • Balance among home, child rearing, and work • Relationship with and support from extended family

  40. Common Stresses and Concerns of Single-Parent Families (cont.) • Balance between nurturance and limit setting for children throughout development • Maintaining a positive relationship with children and between siblings • Time pressures • Need for fulfilling personal and social life

  41. Common Stresses and Concerns of Single-Parent Families (cont.) • Recognizing strengths and accomplishments • Accepting and grieving losses • Collaboration with noncustodial parent • Added burden of health or mental health concerns of parent and children

  42. Common Stresses and Concerns of Single-Parent Families (cont.) • Negotiations with school, child care providers, and community supports • Dealing with cultural and community attitudes

  43. Common Stresses and Concerns of Blended Families • Introducing the children to a new adult • Parental decision to remarry • Determine step-parenting roles and responsibilities • Facilitating relationship between stepparents and children

  44. Common Stresses and Concerns of Blended Families (cont.) • Facilitating relationship between stepchildren • Developing methods of dealing with ex-spouse(s) • Potential for moving and relocating • Engaging stepparent in health and mental health treatment for the children

  45. Common Stresses and Concerns of Blended Families (cont.) • Dealing with adaptation to the new family, including resolving differences and conflicts in the new marriage • Developing relationships with new extended family

  46. Common Stresses and Concerns of Blended Families (cont.) • Preparing for birth of children in the new marriage • Realizing the potential for dissolution of the new marriage and the impact of this on the children

  47. Common Stresses and Concerns of Grandparent/Kin-headed Families • Appreciating the stress associated with relocating the child • Dealing with grandparent (kin) reactions to natural parent’s inability to raise the child • Assisting the child with the emotional reaction to loss or inconsistency of natural parent and previous poor treatment or care

  48. Common Stresses and Concerns of Grandparent/kin-headed Families (cont.) • Allowing room for involvement of natural parent as appropriate • Dealing with economic concerns, including finances for child rearing • Dealing with custody ambiguities • Grandparent health or mental health concerns

  49. Common Stresses and Concerns of Grandparent/kin-headed Families (cont.) • Dealing with inconsistencies between natural parent and grandparent or kin child-rearing practices • Integrating the children with other household members

  50. Common Stresses and Concerns of Grandparent/kin-headed Families (cont.) • Dealing with social service, education, and health and mental health systems effectively • Encouraging time and respite for all family members