1 Family, Disability, and Lifespan Development, RC 631 Dr. Julia Smith Summer, 2009

2 RC 631 Family, Disability, and Lifespan Development

3 Syllabus Review

4 What is a typical family?  Divide into pairs and sketch a picture of a typical U.S. family

5 What is the Definition of Family  2-parent biological family (mono- nuclear family)  Single parent family  Blended family  Extended family  Partners without children

6 U.S. Census Definitions  Family Group: A family group is any two or more people (not necessarily including a householder) residing together, and related by birth, marriage, or adoption.

7  Family Household: A family household is a household maintained by a householder who is in a family (as defined above), and includes any unrelated people (unrelated subfamily members and/or secondary individuals) who may be residing there.

8 What makes up a family?  Cultural influences WASP families (mono-nuclear) African-American families (include kin and community) Italian families (include grandparents and godparents) Chinese and other Asian families (include ancestors and future descendants) Native American families (include tribal group and community)

9 Erikson’s Psychosocial Stages of Development

10

11 1. Infancy or Oral-Sensory  Ages – Birth to 18 months  Basic Conflict – Trust vs. Mistrust  Important Events - Feeding  Important for child to develop trusting relationship with caregiver

12 Infants and Disability  Severe disabilities identified prenatally or at birth Abortion?  Hospitals will screen for 30 metabolic and genetic diseases  Grief cycle  How should information be shared with parents?

13 2. Early Childhood or Muscular- Anal  Ages – 18 months to 3 years  Basic Conflict – Autonomy vs. Shame/Doubt  Important Events – Toilet Training  Development of control over physical skills

14 Early Childhood and Disability  Disabilities are identified as child matures  Participation in early intervention programs  IDEA (Individuals with Disabilities Education Act) Part C (from birth to age 3)  Emphasis on family involvement

15 3. Preschool or Locomotor  Ages – 3 to 6 years  Basic Conflict – Initiative vs. Guilt  Important Events – Exploration/Independence  Assertion of control/power over environment

16 4. School Age or Latency  Ages – 6 to 12 years  Basic Conflict – Industry vs. Inferiority  Important Event – School  Learning new social and academic skills

17 School Age and Disability  Child’s special needs are apparent  Parents begin to develop a vision for child’s future  Professionals can strongly influence how parents develop this vision  Discuss mainstream vs. separate classes

18 RC 631 Family, Disability, and Lifespan Development

19 5. Adolescence or Latency  Ages - 12 to 18  Basic Conflict – Identity vs. Role Confusion  Important Event – Social Relationships  Develop sense of self and personal identity

20 Adolescence and Disability  Strongly influenced by cultural context values  Increased family stress  Increased isolation  Sexuality education  Expanding self-determination skills

21 6. Young Adulthood  Ages – 19 – 40  Basic Conflict – Intimacy vs. Isolation  Important Events – Relationships  Forming of intimate relationships

22 Young Adulthood and Disability  Off-time transitions  Issues of independence and dependence  Separation issues  Relationship issues  Identifying appropriate transitions Postsecondary educational programs and support Accessing supported employment options

23 7. Middle Adulthood  Ages – 40 to 65  Basic Conflict – Generativity vs. Stagnation  Important Events – Work and Parenthood  Creation of something that will continue

24 Mid-Life and Disability  Employment issues  Social support  Family support

25 8. Maturity  Ages – 65 to death  Basic Conflict – Ego Integrity vs. Despair  Important Events – Reflection on Life  Look back on life and experience feelings of success or failure

26 Old Age and Disability  Disability is more common in the elderly  Disability is more frequent in lower socioeconomic groups  Lifestyle predicts disability (70%) compared with genetics (30%)  Cognitive and sensory decline  Increase in ADL care (activities of daily living) Eating, bathing, dressing, using the toilet

27 RC 631 Family, Disability, and Lifespan Development

28 FAMILY LIFE CYCLE  Independence  Coupling or Marriage  Parenting: Babies through Adolescents  Launching Adult Children  Retirement or Senior Years

29 Independence Stage  Separation and individuation  Identity  Develop intimate relationships  Establish career

30 Coupling Stage  Develop new family system  Interdependence  Create life-style values Finances Recreational activities/hobbies Friendships

31 Parenting: Babies through Adolescents  Deciding to have a baby  Develop parenting role  Maintain individuality as well as family commitments  Allow for individuality with adolescents  Mid-life issues  Caring for older family members

32 Parenting: Empty Nest  Re-define relationship with children  Re-define relationship with spouse  Establish new relationships with adult children’s families

33 Senior Stage  Freedom  Physical and mental challenges  New roles with family and society  Dealing with loss/death  Reviewing life

34 Family Life Cycle Summary  Families need to be seen from a multigenerational perspective.  Changes in one generation complicate adjustments in another.  Families often develop problems at transitions in the life cycle. Environmental Developmental

35 Discussion Questions  Describe the challenges at the 8 different developmental stages. Give an example of each.  What are off-time or off-cycle transitions? Give examples of off-time transitions at the different stages.  How has your role in your family changed as you have gone through different developmental stages?

36 Family Structure  Family patterns of interaction are predictable.  Family subsystems are determined by generation, gender, common interests, and function.

37 Family Subsystems  Marital Subsystem  Parental Subsystem  Sibling Subsystem  Extended Family Subsystem

38 Family Genogram/Mapping

39 RC 631 Family, Disability, and Lifespan Development

40 FAMILY COUNSELING THEORIES  Psychoanalytic Family Therapy  Bowen Family Systems Therapy  Experiential Family Therapy  Cognitive-Behavioral Family Therapy  Narrative Family Therapy

41 Psychoanalytic Family Therapy  Focus on uncovering and interpreting unconscious impulses and defenses  Focus on basic wants and fears  Sexuality and aggression drives behaviors  Couples focused

42 Psychoanalytic Family Therapy  Self-Psychology Every human longs to be appreciated  Object-Relations We relate to others based on expectations formed by early experiences “Internal objects” form the core of the personality

43 Psychoanalytic Therapy Techniques  Listening Attend to clients’ fears and longings  Empathy  Interpretations Clarify hidden aspects of experience  Analytic Neutrality Don’t worry about solving the problem

44 Psychoanalytic Therapy Techniques  Focus on: Internal experience The history of that experience How the partner triggers that experience How the context of the session and the counselor’s input contribute to experience between partners

45 Important Names in Psychoanalytic Family Therapy  Jill and David Scharff – Object- Relations  John Bowlby – Attachment Theory  Ivan Boszormenyi-Nagy – Contextual Therapy

46 Bowen Family Systems Therapy  Focus on multigenerational family systems Major problem is emotional fusion Major goal is differentiation  Focus on subsystems Focus on the triangle  Focus not on solving family issues but on learning individual roles in the family and how system operates

47  “A therapist can only progress as far with a family as he/she has progressed with their own family relationships.” Bowen

48 Systems Therapy Techniques  Genograms  The Therapy Triangle  Process Questions  Relationship Experiments  Coaching  “I” Position

49 Important Names in Systems Family Therapy  Murray Bowen – Systems Theory  Milton Erickson – Strategic Theory  Jay Haley – Communication Model  Salvador Minuchin – Structural Theory

50 Experiential Family Therapy  Developed in reaction to psychoanalysis Freedom and immediacy vs. determinism Focus on fulfillment vs. “accepting” neurosis  Focus on emotional well- being/experience of individuals vs. problem solving

51 Experiential Therapy Techniques  Family sculpting/choreography  Clarify communication  Role-play Envision difficult situation  Experience your feelings  Imagine child’s feelings or other’s feelings  Imagine being observer

52 Important Names in Experiential Family Therapy  Carl Whitaker – Experiential Theory  Virginia Satir – Experiential Theory

53 Cognitive-Behavioral Family Therapy  “Behavior is maintained by its consequences.”  Family behavior will change when reinforcements change  Focus on identifying behavioral goals, learning new techniques, and using social reinforcers

54 Cognitive-Behavioral Family Therapy Techniques  Operant conditioning Reinforcers used may be tangible or social (not just money or candy) Shaping (small steps toward goal) Token economy (system which rewards) Contingency (contracts/agreements) Time-out

55 Important Names in Cognitive- Behavioral Family Therapy  Gerald Patterson - Parent Training  Robert Liberman - Role rehearsal and modeling  Richard Stuart - Contigency contracting (focus on increasing positive behavior using reinforcement recriprocity)

56 Narrative Family Therapy  Narrative Therapy Assumptions People have good intentions People are profoundly influenced by discourse around them People are not their problems People can develop alternative, empowering stories

57 Narrative Family Therapy  Narrative Family Counselors Show strong interest in family’s story Search for times when family was strong or resourceful Use questions to respectfully understand story Never label individuals – see each as unique Support alternative life stories

58 Narrative Family Therapy Techniques  Deconstruct unproductive stories  Reconstruct new and more productive stories  Look for strengths and talents  Family problem is separate from individuals  Re-author new story  Reinforce new story

59 Important Names in Narrative Family Therapy  Michael White – Founder of Narrative Movement  David Epston – from Auckland, New Zealand

60 RC 631 Family, Disability, and Lifespan Development

61 Discussion Questions  When would you recommend individual counseling vs. family counseling?  What are the trade offs of focusing on the system vs. focusing on the individual?

62 COMMON PROBLEMS OF BEGINNING FAMILY COUNSELORS  I. FAILURE TO ACT Failure to establish structure Failure to show care and concern Failure to engage family members in the therapeutic process Failure to let the family work on its problems Failure to attend to nonverbal family dynamics

63  II. OVER-ACTION Over-emphasis on details Over-emphasis on making everyone happy Over-emphasis on verbal expressions Over-emphasis on coming to too early or too easy resolutions Over-emphasis on dealing with one member of the family

64 What rehab counselor should keep in mind:  Family demographic data (SES, ethincity/cultural background, etc.)  Family communication patterns  Division of labor in the family  Extent of family member’s outside socialization and access to social and cultural experiences  Family health or illness  Characteristics of disability or illness  Impact of disability on the family

65 Also, examine the following:  Family strengths and weaknesses  Family reaction to the disability  Information the family has concerning the disability and expectations held by the family member with a disability  Services needed to enhance rehabilitation

66 Points to remember…  Many families do not openly discuss disability issues with each other  Initial meeting with VR counselor may feel threatening  Explore impact of disability on each family member  Remain neutral toward all family members

67  Carefully examine your own attitudes/biases toward disability to reduce any prejudices in client contacts  Implicit and explicit messages by the counselor can convey disapproval or acceptance of particular family members  The client should be asked which family members would benefit from a family meeting to discuss rehabilitation

68 Family Boundaries  Boundaries are invisible barriers that regulate the amount of contact with others.  Rigid boundaries Disengagement Enmeshment

69  What is the impact of a family member with a disability on the marital subsystem?  What is the impact of a family member with a disability on the parental subsystem?  What is the impact of a family member with a disability on the sibling system?  What is the impact of a family member with a disability on the extended family subsystem?

70  Legitimate source of authority, established and supported over time  Stable rule system established and consistently acted upon  Stable and consistent nurturing behavior  Effective and stable childrearing and marriage-maintenance practices  Set of goals toward which the family and each individual works QUALITIES OF HEALTHY FAMILIES (Turnbull & Turnbull, 2006)

71  Sufficient flexibility and adaptability to accommodate normal developmental challenges as well as unexpected crises  Commitment to the family as well as its individuals  Appreciation of each other (i.e., a social connection)  Willingness to spend time together  Effective communication patterns

72  High degree of spiritual/religious orientation  Ability to deal with crisis in a positive manner (i.e., adaptability)  Encouragement of individuals  Clear roles

73 HEALTHY COPING STRATEGIES OF FAMILIES (Carter & McGoldrick, 2007)  Ability to identify the stressor  Ability to view the situation as a family problem, rather than a problem of one member  Solution-oriented approach rather than blame  Tolerance for other family members  Clear expression of commitment to and affection for other family members

74  Open and clear communication among members and outside the family  Lack of physical violence  Lack of substance abuse  Recognizing that stress may be positive and lead to change  Realizing that stress is usually temporary  Focusing on working together to find solutions  Realizing that stress is a normal part of life

75  Changing the rules to deal with stress and celebrating victories over events that led to stress  Evidence of high family cohesion  Evidence of considerable role flexibility

76 OBSERVING FAMILY INTERACTIONS  1. What is the outward appearance of the family?  2. What is the cognitive functioning in the family?  3. What repetitive, non-productive sequences do you notice?  4. What is the basic feeling state in the family and who carries it?

77  5. What individual roles reinforce family resistances and what are the most prevalent family defenses?  6. What subsystem are operative in this family?  7. Who carries the power in the family?  8. How are the family members differentiated from each other and what are the subgroup boundaries?

78  9. What part of the family life cycle is the family experiencing and are the problem-solving methods stage appropriate?  10. What are the counselor’s own reactions to the family?

79 RC 631 Family, Disability, and Lifespan Development