Week Five: Special Topics
PSRT 4271: The Family Role in Rehabilitation
1
The Mystery of the Hereafter and The Peace of God that Passeth Understanding (1891)
Adams Memorial, Rock Creek Cemetery
Augustus Saint-Gaudens
2
Augustus Saint-Gaudens
3
Grave of Henry Adams’s wife
4
The Mystery of the Hereafter and The Peace of God that Passeth Understanding (1891)
Adams Memorial, Rock Creek Cemetery
Augustus Saint-Gaudens
5
6
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Avoidance
Not reality!
7
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Avoidance
Not reality!
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Confrontation
Harsh reality
8
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Avoidance
Not reality!
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Confrontation
Harsh reality
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Accommodation
New reality
9
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Theory of chronic sorrow
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A trigger for grief…
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What is vs. what might have been
(Eakes et al., 1999)
10
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4 focus groups

8 per group

90 minutes each
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Children ages: 17 to 31
11
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Epiphany:
“nightmares”
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Action:
from “shattering tension”
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Deluge:
“emotional shredding”
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Fear:
of everything… exhausting
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Anguish, Guilt, Sequelae…
12
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Caregivers must know grief dynamics
◦ Not dysfunction
◦ Rather: understanding
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Refer families to programs that can help…
◦ NAMI Family to Family, etc.
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14
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Up to 60% live with, receive care from families
15
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Objective
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Subjective
16
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Abuse
Mood swings
Offensive public behavior
Conflicts
Squandering of money
Poor hygiene
Property damage
Disruptive sleep patterns
Rejection of medications
17
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5 categories

9 processes
(Bowers, 1987)
(Schumacher et al., 2000)
1.
2.
3.
4.
5.
1.
2.
3.
4.
5.
6.
7.
8.
9.
Anticipatory
Preventative
Supervisory
Instrumental
Protective
Monitoring
Interpreting
Deciding
Acting
Adjusting
Caring (hands-on)
Assessing (resources)
Collaborating
Negotiating
18
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Monitoring
Managing
Maintaining
Encouraging
Socializing
19
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Information!
◦
◦
◦
◦
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Medications
Symptoms
Resources
“Everything!”
Where?
◦ Support groups
◦ Education programs
20
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Understanding of family impacts
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Inclusion in treatment planning
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Understanding of family time devoted
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Understanding of family frustration
21
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23
http://www.youtube.com/watch?v=Dgrr2jDcXAs
24
http://www.youtube.com/watch?v=qMDssBTWgJ4
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26
Laura’s Law
http://www.youtube.com/watch?v=GOAoI5-0l9o
27
“…if a person has
severe mental illness
without substance
abuse and history of
violence, he or she has
the same chances of
being violent during
the next 3 years as any
person in the general
population.”
http://www.youtube.com/watch?v=wCeFEr5ioqo
28
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http://www.npr.org/player/v2/mediaPlayer.html?action=1&t=1&islist=false&id=192996785&m=192996772
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30
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A mark, brand, or label
An interactive social
process
Both
31
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Lack of recognition of prodomal symptoms
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Shame  less assessment, treatment
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Less funding, lower reimbursements
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Low status, marginal priority
32
Besides public cues…
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Cognitive
(stereotypes)
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Emotional
(prejudice)

Behavioral
(discrimination)
33
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Individual

Community

Societal
34
4 sources of “iatrogenic” damage:
1.
Avoidant or recriminant responses
2.
Double-bind messages
3.
Interventions that alienate
4.
Provocative family-provider interactions
35
Role conflicts:
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72%: had psychotherapy, but…
26%: strong reluctance to discuss…
90%: overheard colleague disparagements
36
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ID by diagnosis (“bi-polar kid”)
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Focus only on deficits instead of strengths
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Focus on condition instead of whole person
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Planning without them or their families
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Facilities: subpar, difficult to access
37
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Stigma by association
38
President Obama, June 3, 2013
http://www.youtube.com/watch?v=UqnF3UicuQs
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