Families

John Sargent, M.D.

Learning Objectives
1)

Learn about the structure,

organization and functioning of
families
2) Learn about the unique stresses
associated with families of varying
composition

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

Understanding Families (cont.)

C. Developmental psychology
studies the environment within
which children are raised and
grow into themselves

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

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

Understanding Families (cont.)

F.

As the environment within which

children learn to know, experience
and
modulate their emotions
through
relationships with
attachment figures

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

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

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

10

Families are also places within

which
Physical

intimacy among some

members is sanctioned
And is also forbidden among other
members

11

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
12

Variables of interest in
understanding families:
Functional

collaboration
Gender expectations
Power
Responsibility
Warmth
Positive support
Cultural background and difference
13

Family Coherence
Basic

Building Blocks of Family Life

Coherence
Organization
Communication
Values and Beliefs

14

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
15

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.
16

Family Adaptability and

Reactions to Change
Recognition

of stress or change
Labeling of the challenge
Developing a shared approach to the
problem

17

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

18

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

19

When Family Coherence Fails

The

possibility of multiple definitions

of the family
Too rigidly defined family views
failing to accept individual difference

20

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

21

Partner Relationship: Important

Features
Negotiation

of Interpersonal Distance
Negotiation of roles and tasks
assignment
Emotional tone positive comments
vs. criticism

22

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
23

Significant Components of
Parenting
I.
II.
III.
IV.

Nurturance
Structure
Affiliation
Attachment

24

I. Nurturance requires
A.
B.
C.

Access to resources
Capacity to use them for the child
Own needs being met

25

Nurturance Requires (cont.)

D.)Reinforcement for providing for the
child
Support from important adults
Clear response from the childsatiation, comfort, satisfaction,
quieting
Infants social responsiveness
connects the child with caretakers
26

Nurturance Requires (cont.)

E.) Empathic capacity to infer infants
needs
Appreciation of intentionality of
infant
Reflectiveness on the parents
part leading to an appreciation
of reciprocal selfhood
27

Nurturance Requires (cont.)

F.

Absence of compelling consistent

concerns (addiction, severe
poverty,
depression, spouse
abuse, severe marital disruption)

28

II. Structure Requires

A. Capacity to appreciate
developmental abilities
B. Avoidance of polarized adult
interactions

29

Structure Requires (cont.)

C. Acceptance of responsibility for
child
D. Willingness to distance from the
child enough to set a limit

30

Structure Requires (cont.)

E. Capacity to define the childs
world so
that competence
develops
F.
Utilizing the childs responsiveness
to limits to reinforce future
adherence

31

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

32

III. Affiliation Requires

A. The capacity to know the child
B. Creating a coherent picture of the
child

33

Affiliation Requires (cont.)

C. Willingness to accept and
appreciate the child as he/she is
D. Appreciation of the childs
affective
responses as legitimate

34

Affiliation Requires (cont.)

E. Willingness to respond to the
childs affective expression with
knowledge and neither
dismissiveness, anxiety nor
disorganization

35

IV. Attachment Requires

A.
B.

Capacity for affect expression and

modulation
Sense that relationships provide
knowing, definition, safety and
ultimately self-expression and selfawareness

36

Attachment Requires (cont.)

C. Recognition that stress can be
dealt with socially and affectively
D. Synchrony exists between
connection,
calming, safety and
competence

37

Variations in Family Structure

Single-parent

family
Divorcing
family/post-divorce
family
Blended family
Grandparent-or kinheaded family
Foster care family

Adoptive

family

Gay

and
lesbian parents
Unmarried
couple as
parents
Bicultural
family
38

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
39

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
40

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

41

Common Stresses and

Concerns
of Single-Parent
Families (cont.)

Negotiations

with school, child care

providers, and community supports
Dealing with cultural and community
attitudes

42

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
43

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

44

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

45

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

46

Common Stresses and

Concerns of Grandparent/Kinheaded Families

Appreciating

the stress associated with

relocating the child
Dealing with grandparent (kin) reactions to
natural parents 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
47

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
48

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

49

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

50

Common Stresses and

Concerns of Foster Care
Families

Ensuring

foster care family

availability, certification, training, and
adequacy of living situation
Establishing collaborative relationship
among foster family, social service
agency, mental health professionals,
and the children (as appropriate)

51

Common Stresses and

Concerns of Foster Care
Families (cont.)

Ensuring

adequate economic
resources for family life
Dealing with the childs reaction to
parental loss and relocation
Providing information to the children
about reasons for and duration of
foster care

52

Common Stresses and

Concerns of Foster Care
Families (cont.)

Assisting the children with mental

health problems, including responses
to previous trauma or loss
Assisting the children with
reestablishing relationship with natural
parents if that occurs or with
inconsistencies of natural parents
involvement

53

Common Stresses and

Concerns of Foster Care
Families (cont.)

Dealing

with the uncertainty of

placement duration and permanency
planning
Assisting the children with any
moves among foster families

54

Common Stresses and

Concerns of Foster Care
Families (cont.)

Developing

positive attachment with

and emotional support for the
children through developmental
transitions
Establishing effective limit-setting
responses for potentially traumatized
children
55

Common Stresses and

Concerns of Adoptive
Families

Building

attachment and emotional

support for children in adoptive
family
Developing methods of assisting
children with their emotional
responses to change, parental loss,
and possible previous traumatization
56

Common Stresses and

Concerns of Adoptive
Families (cont.)

Dealing with cultural or

temperamental differences between
parents and children
Dealing with parental emotional
response to reasons for adopting
children
Developing effective parenting skills
with often challenging children

57

Common Stresses and

Concerns of Adoptive
Families (cont.)

Appreciating

and responding to
childs experience of not
belonging to the adoptive family
throughout development
Responding to naturally occurring
adoptive parent-child conflicts and
disagreements
58

Common Stresses and

Concerns of Adoptive
Families (cont.)

Developing

methods of recognizing
the value of adoptive parents
decision to raise nonbiologic
children
Identifying and using ratifying and
supportive assistance from mental
health, educational, and social
systems, when necessary
59

Common Stresses and

Concerns of Adoptive
Families (cont.)

Assisting

children with the decision

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

60

Common Stresses and

Concerns of Gay and Lesbian
Families

Reaching

agreement and
commitment to raise children
together
Recognizing strengths, successes,
and capacities of homosexual
parents

61

Common Stresses and Concerns

of Gay and Lesbian Families
(cont.)
Dealing

with the degree to which

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

62

Common Stresses and Concerns

of Gay and Lesbian Families
(cont.)
Developing

a way to explain
parental lifestyle to children
Assisting children with an
explanation of their family for
peers, teachers, coaches, and
others

63

Common Stresses and Concerns

of Gay and Lesbian Families
(cont.)
Responding

to discriminatory or
misunderstanding comments by
family, community members, expartners, school personnel, health
or mental health providers, or
childrens peers

64

Common Stresses and Concerns

of Gay and Lesbian Families
(cont.)

Dealing with the childrens

questions and preferences
throughout development
Dealing with naturally occurring
parent-child conflicts, recognizing
how they may be altered by
parental lifestyle

65

Common Stresses and Concerns

of Gay and Lesbian Families
(cont.)

Assisting children with their own

lifestyle and relationship choices
Dealing with stresses within the
parents relationship

66

Common Stresses and

Concerns of Unmarried
Couples

Maintaining

commitment to the
relationship and to parenting
Determining parental roles in
providing support to the children and
setting limits
Recognizing and responding to areas
of tenuousness, ambivalence, and
insecurity in the parents relationship
67

Common Stresses and

Concerns of Unmarried
Couples (cont.)

Facilitating

childrens relationship
with both parents
Recognizing childrens responses
to changes in the relationship
either toward greater permanence
or toward separation

68

Common Stresses and

Concerns of Unmarried
Couples (cont.)

Assisting

the childrens response to

separation should that occur and
considering possibility of childs
continued involvement with separated
partner if mutually acceptable
Acknowledging and responding to
difficulties associated with others
reaction to unmarried status
69

Common Stresses and

Concerns of Bicultural
Families

Establishing

family culture
Appreciating individual parental
cultural differences, traditions, and
expectations
Recognizing childrens need for
self-definition and exploration of
both parents cultures
70

Common Stresses and

Concerns of Bicultural
Families (cont.)

Appreciating

and responding to
extended family concerns,
questions, and responses
Establishing a dialogue that
recognized the strengths,
possibilities, and uncertainties of
this bicultural synthesis for this
family
71

Common Stresses and

Concerns of Bicultural
Families (cont.)

Assisting

the children with

responses to questions and
potentially insensitive comments
from peers and adults in their lives
Developing family traditions that
respect both cultural heritages

72