Families

John Sargent, M.D.

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

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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

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

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 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

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 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

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

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 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

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 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

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 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

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

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 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

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

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 Family Coherence
 Basic Building Blocks of Family Life
– Coherence
– Organization
– Communication
– Values and Beliefs

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 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

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

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 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

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 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

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

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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

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

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 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

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

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

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 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

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 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

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

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

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

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 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

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 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

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

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 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

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

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 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

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

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

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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

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 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

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 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

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

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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

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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

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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

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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

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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

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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

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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

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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

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 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)

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 Common Stresses and Concerns
of Foster Care Families (cont.)
 Ensuring adequate economic resources for
family life
 Dealing with the child’s reaction to
parental loss and relocation
 Providing information to the children
about reasons for and duration of foster
care

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 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
parent’s involvement

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 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

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 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

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 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

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 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

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 Common Stresses and Concerns
of Adoptive Families (cont.)
 Appreciating and responding to child’s
experience of not “belonging” to the
adoptive family throughout development
 Responding to naturally occurring
adoptive parent-child conflicts and
disagreements

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 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

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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

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 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

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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

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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

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Common Stresses and Concerns of
Gay and Lesbian Families (cont.)
 Responding to discriminatory or
misunderstanding comments by family,
community members, ex-partners,
school personnel, health or mental
health providers, or children’s peers

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Common Stresses and Concerns of
Gay and Lesbian Families (cont.)
 Dealing with the children’s questions
and preferences throughout
development
 Dealing with naturally occurring parent-
child conflicts, recognizing how they
may be altered by parental lifestyle

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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

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 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

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 Common Stresses and Concerns
of Unmarried Couples (cont.)
 Facilitating children’s relationship with
both parents
 Recognizing children’s responses to
changes in the relationship either
toward greater permanence or toward
separation

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 Common Stresses and Concerns
of Unmarried Couples (cont.)
 Assisting the children’s response to
separation should that occur and
considering possibility of child’s continued
involvement with separated partner if
mutually acceptable
 Acknowledging and responding to
difficulties associated with others’ reaction
to unmarried status

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 Common Stresses and Concerns
of Bicultural Families
 Establishing family culture
 Appreciating individual parental cultural
differences, traditions, and expectations
 Recognizing children’s need for self-
definition and exploration of both
parents’ cultures

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 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

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 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

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