Families
John Sargent, M.D.
1
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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2
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
3
Understanding Families (cont.)
C. Developmental psychology
 studies the environment within
which children are raised and grow
into themselves
4
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
5
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
6
Understanding Families (cont.)
F.
As the environment within which
children learn to know, experience and
modulate their emotions through
relationships with attachment figures
7
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
8
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

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



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
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
 Negotiation
family
 Negotiation
intensity
 Negotiation
activities

of cultural integration
of connection to extended
of location and career
of sexual behavior and leisure
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
 Infant’s social responsiveness
connects the child with caretakers
26
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
27
Nurturance Requires (cont.)
F.
Absence of compelling consistent
concerns (addiction, severe poverty,
depression, spouse abuse, severe
marital disruption)
28
II. Structure Requires
A.
B.
Capacity to appreciate developmental
abilities
Avoidance of polarized adult
interactions
29
Structure Requires (cont.)
C.
D.
Acceptance of responsibility for child
Willingness to distance from the child
enough to set a limit
30
Structure Requires (cont.)
E.
F.
Capacity to define the child’s world so
that competence develops
Utilizing the child’s 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.
B.
The capacity to know the child
Creating a coherent picture of the child
33
Affiliation Requires (cont.)
C.
D.
Willingness to accept and appreciate
the child as he/she is
Appreciation of the child’s affective
responses as legitimate
34
Affiliation Requires (cont.)
E.
Willingness to respond to the child’s
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.
D.
Recognition that stress can be dealt
with socially and affectively
Synchrony exists between connection,
calming, safety and competence
37
Variations in Family Structure
Single-parent family
 Divorcing family/postdivorce 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 exspouse(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/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

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 child’s 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
parent’s 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 child’s
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
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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
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63
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
64
Common Stresses and Concerns of
Gay and Lesbian Families (cont.)
Dealing with the children’s questions
and preferences throughout
development
 Dealing with naturally occurring parentchild 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 children’s relationship with
both parents
 Recognizing children’s responses to
changes in the relationship either
toward greater permanence or toward
separation

68
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

69
Common Stresses and Concerns
of Bicultural Families
Establishing family culture
 Appreciating individual parental cultural
differences, traditions, and expectations
 Recognizing children’s need for selfdefinition 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
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72