1 Families John Sargent, M.D.. 2 Learning Objectives 1) Learn about the structure, organization and...

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FamiliesFamilies

John Sargent, M.D.John Sargent, M.D.

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Learning ObjectivesLearning Objectives

1) Learn about the structure, 1) Learn about the structure, organization and functioning of organization and functioning of familiesfamilies

2) Learn about the unique stresses 2) Learn about the unique stresses associated with families of varying associated with families of varying compositioncomposition

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There are a variety of ways of There are a variety of ways of knowing and understanding knowing and understanding

families:families:A.A. AnthropologyAnthropology

views the family as the source views the family as the source and carrier of cultureand carrier of culture

B.B. Social Psychology Social Psychology sees families as small groups sees families as small groups

with tasks to successfully with tasks to successfully mastermaster

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Understanding Families (cont.)Understanding Families (cont.)

C.C. Developmental psychologyDevelopmental psychology studies the environment within studies the environment within

which children are raised and which children are raised and grow into themselvesgrow into themselves

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D.D. Clinical Psychology and PsychiatryClinical Psychology and Psychiatry As the environment within As the environment within

which normal or abnormal which normal or abnormal behavior begins, takes hold and behavior begins, takes hold and becomes the patterns enacted becomes the patterns enacted by childrenby children

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E.E. As the base for all members to As the base for all members to experience connection and experience connection and

belonging belonging while each experiences while each experiences simultaneously simultaneously the push toward the push toward autonomy and autonomy and independence independence

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F.F. As the environment within As the environment within which which children learn to know, children learn to know, experience and experience and modulate their modulate their emotions through emotions through relationships relationships with attachment figureswith attachment figures

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G.G. As a system where the whole is As a system where the whole is greater greater than the sum of the parts than the sum of the parts and where and where each individual affects each individual affects and is affected and is affected by every other by every other individualindividual

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Families offer:Families offer:

An experience of connection with An experience of connection with historyhistory

Stories of ancestors which offer Stories of ancestors which offer meaning and value to livesmeaning and value to lives

A sense of identity through A sense of identity through identification with family membersidentification with family members

1010

Families offer (cont.):Families offer (cont.):

A safe haven in which to relax and A safe haven in which to relax and experience acceptance and regardexperience acceptance and regard

A set of relationships within which A set of relationships within which one experiences care and guidance one experiences care and guidance and the opportunity to care for and and the opportunity to care for and guide othersguide others

1111

Families are also places within Families are also places within whichwhich

Physical intimacy among some Physical intimacy among some members is sanctionedmembers is sanctioned

And is also forbidden among other And is also forbidden among other membersmembers

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Families have very specific Families have very specific tasks:tasks:

Gathering enough resources to ensure Gathering enough resources to ensure survival survival

Procreation and looking after Procreation and looking after immature childrenimmature children

Promoting maturation and successful Promoting maturation and successful aging and lossaging and loss

Providing enough empathetic Providing enough empathetic connection to encourage attention to connection to encourage attention to the above tasksthe above tasks

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Variables of interest in Variables of interest in understanding families:understanding families:

Functional collaborationFunctional collaboration Gender expectationsGender expectations PowerPower ResponsibilityResponsibility WarmthWarmth Positive supportPositive support Cultural background and differenceCultural background and difference

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Family CoherenceFamily Coherence

Basic Building Blocks of Family LifeBasic Building Blocks of Family Life– CoherenceCoherence– OrganizationOrganization– CommunicationCommunication– Values and BeliefsValues and Beliefs

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CoherenceCoherence

A sense of uniqueness and identity of A sense of uniqueness and identity of the familythe family

A sense of membership, inclusion and A sense of membership, inclusion and belongingbelonging

A sense of personal space and voiceA sense of personal space and voice A recognition of developmental status A recognition of developmental status

and skills and skills Accommodation to individual Accommodation to individual

differencesdifferences

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Coherence (cont.)Coherence (cont.)

A secure base for emotional expression A secure base for emotional expression and regulationand regulation

A recognition of the shared effort to pursue A recognition of the shared effort to pursue family activities such as providing safety, family activities such as providing safety, nurturance and socializationnurturance and socialization

The shared capacity to resolve conflictThe shared capacity to resolve conflict To reflect on family strengths, capacities To reflect on family strengths, capacities

and areas of difficulty and areas of difficulty To reflect upon the family as members see To reflect upon the family as members see

it.it.

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Family Adaptability and Family Adaptability and Reactions to ChangeReactions to Change

Recognition of stress or changeRecognition of stress or change Labeling of the challengeLabeling of the challenge Developing a shared approach to the Developing a shared approach to the

problemproblem

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Family Adaptability and Family Adaptability and Reactions to Change (cont.)Reactions to Change (cont.)

Utilizing the family as a focal point Utilizing the family as a focal point for developing and evaluating stress for developing and evaluating stress management strategiesmanagement strategies

The role of family coherence in these The role of family coherence in these family actionsfamily actions

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Family Coherence and Family Coherence and Individual ResilienceIndividual Resilience

The role of belongingThe role of belonging Family attachment as an affect monitor Family attachment as an affect monitor

and mediator of emotional expressionand mediator of emotional expression The role of family mythsThe role of family myths The role of family competence in building The role of family competence in building

individual self-esteemindividual self-esteem The role of ritual and celebrationThe role of ritual and celebration

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When Family Coherence FailsWhen Family Coherence Fails

The possibility of multiple definitions The possibility of multiple definitions of the familyof the family

Too rigidly defined family views Too rigidly defined family views failing to accept individual differencefailing to accept individual difference

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When Family Coherence Fails When Family Coherence Fails (cont.)(cont.)

The role of individual temperamental The role of individual temperamental factors and non shared environmentfactors and non shared environment

Family behavior amplifying affective Family behavior amplifying affective responses, leading to isolation and responses, leading to isolation and scapegoatingscapegoating

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Partner Relationship: Important Partner Relationship: Important FeaturesFeatures

Negotiation of Interpersonal DistanceNegotiation of Interpersonal Distance Negotiation of roles and tasks Negotiation of roles and tasks

assignmentassignment Emotional tone – positive comments Emotional tone – positive comments

vs. criticismvs. criticism

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Partner Relationship: Important Partner Relationship: Important Features (Cont.)Features (Cont.)

Negotiation of cultural integrationNegotiation of cultural integration Negotiation of connection to Negotiation of connection to

extended familyextended family Negotiation of location and career Negotiation of location and career

intensityintensity Negotiation of sexual behavior and Negotiation of sexual behavior and

leisure activitiesleisure activities

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Significant Components of Significant Components of ParentingParenting

I.I. NurturanceNurturance

II. II. StructureStructure

III.III. AffiliationAffiliation

IV.IV. AttachmentAttachment

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I. Nurturance requiresI. Nurturance requires

A.A. Access to resourcesAccess to resources

B.B. Capacity to use them for the Capacity to use them for the childchild

C.C. Own needs being metOwn needs being met

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Nurturance Requires (cont.)Nurturance Requires (cont.)

D.)D.) Reinforcement for providing for Reinforcement for providing for the the childchild Support from important adultsSupport from important adults Clear response from the child-Clear response from the child-

satiation, comfort, satisfaction, satiation, comfort, satisfaction, quietingquieting

Infant’s social responsiveness Infant’s social responsiveness connects the child with connects the child with caretakerscaretakers

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E.)E.) Empathic capacity to infer Empathic capacity to infer infant’s infant’s needsneeds Appreciation of intentionality of Appreciation of intentionality of

infantinfant Reflectiveness on the parents’ Reflectiveness on the parents’

part leading to an appreciation part leading to an appreciation of reciprocal selfhoodof reciprocal selfhood

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

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II. Structure RequiresII. Structure Requires

A.A. Capacity to appreciate Capacity to appreciate developmental developmental abilitiesabilities

B.B. Avoidance of polarized adult Avoidance of polarized adult interactionsinteractions

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Structure Requires (cont.)Structure Requires (cont.)

C.C. Acceptance of responsibility for Acceptance of responsibility for childchild

D.D. Willingness to distance from the Willingness to distance from the child child enough to set a limitenough to set a limit

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E.E. Capacity to define the child’s Capacity to define the child’s world so world so that competence that competence developsdevelops

F.F. Utilizing the child’s Utilizing the child’s responsiveness to responsiveness to limits to limits to reinforce future adherencereinforce future adherence

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G.G. Providing a sense that limits Providing a sense that limits occur occur through knowledge of the through knowledge of the child and the child and the capacity to capacity to appreciate his/her skills and appreciate his/her skills and needsneeds

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III. Affiliation RequiresIII. Affiliation Requires

A.A. The capacity to know the childThe capacity to know the child

B.B. Creating a coherent picture of Creating a coherent picture of the childthe child

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Affiliation Requires (cont.)Affiliation Requires (cont.)

C.C. Willingness to accept and Willingness to accept and appreciate appreciate the child as he/she isthe child as he/she is

D.D. Appreciation of the child’s Appreciation of the child’s affective affective responses as legitimateresponses as legitimate

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Affiliation Requires (cont.)Affiliation Requires (cont.)

E.E. Willingness to respond to the Willingness to respond to the child’s child’s affective expression with affective expression with knowledge knowledge and neither and neither dismissiveness, anxiety nor dismissiveness, anxiety nor disorganizationdisorganization

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IV. Attachment RequiresIV. Attachment Requires

A.A. Capacity for affect expression Capacity for affect expression and and modulationmodulation

B. B. Sense that relationships provide Sense that relationships provide knowing, definition, safety and knowing, definition, safety and ultimately self-expression and ultimately self-expression and

self-self- awarenessawareness

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Attachment Requires (cont.)Attachment Requires (cont.)

C.C. Recognition that stress can be Recognition that stress can be dealt dealt with socially and affectivelywith socially and affectively

D.D. Synchrony exists between Synchrony exists between connection, connection, calming, safety and calming, safety and competencecompetence

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Variations in Family StructureVariations in Family Structure

Single-parent Single-parent familyfamily

Divorcing Divorcing family/post-divorce family/post-divorce familyfamily

Blended familyBlended family Grandparent-or kin-Grandparent-or kin-

headed familyheaded family Foster care familyFoster care family

Adoptive familyAdoptive family Gay and Gay and

lesbian parentslesbian parents Unmarried Unmarried

couple as couple as parentsparents

Bicultural Bicultural familyfamily

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Common Stresses and Common Stresses and Concerns of Single-Parent Concerns of Single-Parent

FamiliesFamilies Economic concernsEconomic concerns Need for social supportNeed for social support Relationship of children with Relationship of children with

noncustodial parentnoncustodial parent Balance among home, child rearing, Balance among home, child rearing,

and workand work Relationship with and support from Relationship with and support from

extended familyextended family

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Families (cont.)Families (cont.) Balance between nurturance and Balance between nurturance and

limit setting for children throughout limit setting for children throughout developmentdevelopment

Maintaining a positive relationship Maintaining a positive relationship with children and between siblingswith children and between siblings

Time pressuresTime pressures Need for fulfilling personal and social Need for fulfilling personal and social

lifelife

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Families (cont.) Families (cont.) Recognizing strengths and Recognizing strengths and

accomplishmentsaccomplishments Accepting and grieving lossesAccepting and grieving losses Collaboration with noncustodial Collaboration with noncustodial

parentparent Added burden of health or mental Added burden of health or mental

health concerns of parent and health concerns of parent and childrenchildren

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Families (cont.) Families (cont.) Negotiations with school, child care Negotiations with school, child care

providers, and community supportsproviders, and community supports Dealing with cultural and community Dealing with cultural and community

attitudesattitudes

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Common Stresses and Common Stresses and Concerns of Blended FamiliesConcerns of Blended Families

Introducing the children to a new Introducing the children to a new adultadult

Parental decision to remarryParental decision to remarry Determine step-parenting roles and Determine step-parenting roles and

responsibilitiesresponsibilities Facilitating relationship between Facilitating relationship between

stepparents and children stepparents and children

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Common Stresses and Common Stresses and Concerns of Blended Families Concerns of Blended Families

(cont.)(cont.) Facilitating relationship between Facilitating relationship between

stepchildrenstepchildren Developing methods of dealing with Developing methods of dealing with

ex-spouse(s)ex-spouse(s) Potential for moving and relocatingPotential for moving and relocating Engaging stepparent in health and Engaging stepparent in health and

mental health treatment for the mental health treatment for the childrenchildren

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(cont.)(cont.) Dealing with adaptation to the new Dealing with adaptation to the new

family, including resolving family, including resolving differences and conflicts in the new differences and conflicts in the new marriagemarriage

Developing relationships with new Developing relationships with new extended familyextended family

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(cont.)(cont.) Preparing for birth of children in the Preparing for birth of children in the

new marriagenew marriage Realizing the potential for dissolution Realizing the potential for dissolution

of the new marriage and the impact of the new marriage and the impact of this on the childrenof this on the children

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Common Stresses and Common Stresses and Concerns of Grandparent/Kin-Concerns of Grandparent/Kin-

headed Familiesheaded Families Appreciating the stress associated with Appreciating the stress associated with

relocating the childrelocating the child Dealing with grandparent (kin) reactions Dealing with grandparent (kin) reactions

to natural parent’s inability to raise the to natural parent’s inability to raise the childchild

Assisting the child with the emotional Assisting the child with the emotional reaction to loss or inconsistency of reaction to loss or inconsistency of natural parent and previous poor natural parent and previous poor treatment or caretreatment or care

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Common Stresses and Concerns of Common Stresses and Concerns of Grandparent/kin-headed Families Grandparent/kin-headed Families

(cont.)(cont.) Allowing room for involvement of Allowing room for involvement of

natural parent as appropriatenatural parent as appropriate Dealing with economic concerns, Dealing with economic concerns,

including finances for child rearingincluding finances for child rearing Dealing with custody ambiguitiesDealing with custody ambiguities Grandparent health or mental health Grandparent health or mental health

concernsconcerns

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Common Stresses and Concerns Common Stresses and Concerns of Grandparent/kin-headed of Grandparent/kin-headed

Families (cont.)Families (cont.) Dealing with inconsistencies between Dealing with inconsistencies between

natural parent and grandparent or natural parent and grandparent or kin child-rearing practiceskin child-rearing practices

Integrating the children with other Integrating the children with other household membershousehold members

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Common Stresses and Concerns Common Stresses and Concerns of Grandparent/kin-headed of Grandparent/kin-headed

Families (cont.)Families (cont.) Dealing with social service, Dealing with social service,

education, and health and mental education, and health and mental health systems effectivelyhealth systems effectively

Encouraging time and respite for all Encouraging time and respite for all family membersfamily members

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Common Stresses and Common Stresses and Concerns of Foster Care Concerns of Foster Care

Families Families Ensuring foster care family Ensuring foster care family

availability, certification, training, availability, certification, training, and adequacy of living situationand adequacy of living situation

Establishing collaborative Establishing collaborative relationship among foster family, relationship among foster family, social service agency, mental health social service agency, mental health professionals, and the children (as professionals, and the children (as appropriate)appropriate)

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Families (cont.)Families (cont.) Ensuring adequate economic Ensuring adequate economic

resources for family liferesources for family life Dealing with the child’s reaction to Dealing with the child’s reaction to

parental loss and relocationparental loss and relocation Providing information to the children Providing information to the children

about reasons for and duration of about reasons for and duration of foster carefoster care

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Families (cont.)Families (cont.) Assisting the children with mental Assisting the children with mental

health problems, including responses health problems, including responses to previous trauma or lossto previous trauma or loss

Assisting the children with Assisting the children with reestablishing relationship with reestablishing relationship with natural parents if that occurs or with natural parents if that occurs or with inconsistencies of natural parent’s inconsistencies of natural parent’s involvementinvolvement

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Families (cont.)Families (cont.) Dealing with the uncertainty of Dealing with the uncertainty of

placement duration and permanency placement duration and permanency planningplanning

Assisting the children with any Assisting the children with any moves among foster familiesmoves among foster families

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Families (cont.)Families (cont.) Developing positive attachment with Developing positive attachment with

and emotional support for the and emotional support for the children through developmental children through developmental transitionstransitions

Establishing effective limit-setting Establishing effective limit-setting responses for potentially traumatized responses for potentially traumatized childrenchildren

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Common Stresses and Common Stresses and Concerns of Adoptive Concerns of Adoptive

FamiliesFamilies Building attachment and emotional Building attachment and emotional

support for children in adoptive support for children in adoptive familyfamily

Developing methods of assisting Developing methods of assisting children with their emotional children with their emotional responses to change, parental loss, responses to change, parental loss, and possible previous traumatizationand possible previous traumatization

5757


Families (cont.)Families (cont.) Dealing with cultural or Dealing with cultural or

temperamental differences between temperamental differences between parents and childrenparents and children

Dealing with parental emotional Dealing with parental emotional response to reasons for adopting response to reasons for adopting childrenchildren

Developing effective parenting skills Developing effective parenting skills with often challenging childrenwith often challenging children

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Families (cont.)Families (cont.) Appreciating and responding to Appreciating and responding to

child’s experience of not child’s experience of not “belonging” to the adoptive family “belonging” to the adoptive family throughout developmentthroughout development

Responding to naturally occurring Responding to naturally occurring adoptive parent-child conflicts and adoptive parent-child conflicts and disagreementsdisagreements

5959


Families (cont.)Families (cont.) Developing methods of recognizing Developing methods of recognizing

the value of adoptive parents’ the value of adoptive parents’ decision to raise nonbiologic decision to raise nonbiologic childrenchildren

Identifying and using ratifying and Identifying and using ratifying and supportive assistance from mental supportive assistance from mental health, educational, and social health, educational, and social systems, when necessarysystems, when necessary

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Families (cont.)Families (cont.) Assisting children with the decision Assisting children with the decision

to learn more about their birth to learn more about their birth culture or meet their natural culture or meet their natural parentsparents

6161

Common Stresses and Common Stresses and Concerns of Gay and Lesbian Concerns of Gay and Lesbian

FamiliesFamilies Reaching agreement and Reaching agreement and

commitment to raise children commitment to raise children togethertogether

Recognizing strengths, successes, Recognizing strengths, successes, and capacities of homosexual and capacities of homosexual parentsparents

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Common Stresses and Concerns Common Stresses and Concerns of Gay and Lesbian Families of Gay and Lesbian Families

(cont.)(cont.) Dealing with the degree to which Dealing with the degree to which

each parental partner is open each parental partner is open about his or her lifestyle with about his or her lifestyle with extended family, neighbors, and extended family, neighbors, and community; the education system; community; the education system; health and mental health health and mental health resources; and the other biologic resources; and the other biologic parentparent

6363


(cont.)(cont.) Developing a way to explain Developing a way to explain

parental lifestyle to childrenparental lifestyle to children Assisting children with an Assisting children with an

explanation of their family for explanation of their family for peers, teachers, coaches, and peers, teachers, coaches, and othersothers

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(cont.)(cont.) Responding to discriminatory or Responding to discriminatory or

misunderstanding comments by misunderstanding comments by family, community members, ex-family, community members, ex-partners, school personnel, health partners, school personnel, health or mental health providers, or or mental health providers, or children’s peerschildren’s peers

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(cont.)(cont.) Dealing with the children’s Dealing with the children’s

questions and preferences questions and preferences throughout developmentthroughout development

Dealing with naturally occurring Dealing with naturally occurring parent-child conflicts, recognizing parent-child conflicts, recognizing how they may be altered by how they may be altered by parental lifestyleparental lifestyle

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(cont.)(cont.) Assisting children with their own Assisting children with their own

lifestyle and relationship choiceslifestyle and relationship choices Dealing with stresses within the Dealing with stresses within the

parents’ relationshipparents’ relationship

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Common Stresses and Common Stresses and Concerns of Unmarried Concerns of Unmarried

CouplesCouples Maintaining commitment to the Maintaining commitment to the

relationship and to parentingrelationship and to parenting Determining parental roles in Determining parental roles in

providing support to the children providing support to the children and setting limitsand setting limits

Recognizing and responding to Recognizing and responding to areas of tenuousness, ambivalence, areas of tenuousness, ambivalence, and insecurity in the parents’ and insecurity in the parents’ relationshiprelationship

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Couples (cont.)Couples (cont.) Facilitating children’s relationship Facilitating children’s relationship

with both parentswith both parents Recognizing children’s responses Recognizing children’s responses

to changes in the relationship to changes in the relationship either toward greater permanence either toward greater permanence or toward separationor toward separation

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Couples (cont.)Couples (cont.) Assisting the children’s response to Assisting the children’s response to

separation should that occur and separation should that occur and considering possibility of child’s considering possibility of child’s continued involvement with separated continued involvement with separated partner if mutually acceptablepartner if mutually acceptable

Acknowledging and responding to Acknowledging and responding to difficulties associated with others’ difficulties associated with others’ reaction to unmarried statusreaction to unmarried status

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Common Stresses and Common Stresses and Concerns of Bicultural Concerns of Bicultural

FamiliesFamilies Establishing family cultureEstablishing family culture Appreciating individual parental Appreciating individual parental

cultural differences, traditions, and cultural differences, traditions, and expectationsexpectations

Recognizing children’s need for Recognizing children’s need for self-definition and exploration of self-definition and exploration of both parents’ culturesboth parents’ cultures

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Families (cont.)Families (cont.) Appreciating and responding to Appreciating and responding to

extended family concerns, extended family concerns, questions, and responsesquestions, and responses

Establishing a dialogue that Establishing a dialogue that recognized the strengths, recognized the strengths, possibilities, and uncertainties of possibilities, and uncertainties of this bicultural synthesis for this this bicultural synthesis for this familyfamily

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Families (cont.)Families (cont.) Assisting the children with Assisting the children with

responses to questions and responses to questions and potentially insensitive comments potentially insensitive comments from peers and adults in their livesfrom peers and adults in their lives

Developing family traditions that Developing family traditions that respect both cultural heritagesrespect both cultural heritages

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1 Families John Sargent, M.D.. 2 Learning Objectives 1) Learn about the structure, organization and...

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