PSRT 4271: The Family Role in Rehabilitation Week Four (June 21, 2012) 1

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 “…disruption of psychological homeostatis…”  “…usual coping mechanisms fail…”  “…distress and functional impairment…” 3

 “…subjective reaction…”  “…to stressful life experience…”  Functioning “…seriously compromised...” 4

 Threat  Incapacity  Fear  Discomfort  Disequilibrium 5

There is such a thing… 6

7. Follow up. 6. Make an action plan. 5. Explore alternatives. 4. Deal with feelings. 3. Identify major problems. 2. Establish rapport. 1. Assess lethality. 7

5 determinants: 1. Triggering events 2. Severity of disability 3. Personal influences 4. Contextual influences 5. Stigma; societal reactions 8

 Denial  Grief  Guilt  Isolation  Anger  Depression  Coping  Acceptance 9

 Meaning  Support  Validation  Information  Balance 10

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 Acknowledge; connect; engage  Offer coping mechanisms  Comprehensive involvement at discharge  Instill hope 12

13 (The Raft of Medusa, by Theodore Gericault, 1791–1824)

 Feelings  Powerless, voiceless, anxious, frustrated, isolated, tired, desperate, trapped, guilty, worried, scared, sad, grief, confused  “Internal factors”  Sense of safety  Perception of care ability  Contingencies and consequences  Maternal love and obligations 14

1. Reflection on roles 2. Devastation and vulnerability 3. Sadness and loss 4. Frustration with the system 5. Admiration for the child 6. Personal growth and learning 15

One step removed…  Reactions to illness  Strategies for coping  Whether, how to intervene?  Setting limits?  Resentment, anger, hopeless?  Efforts to obtain services  Wish for validation  Efforts to help themselves 16

What happens when ill child has children?  Custodial, co-resident, nonresident…  Child’s exposure to mother’s illness  Financial impact  Isolation  Role conflicts  Divided loyalties 17

18 Bellevue Inside Out Trailer

Ravi Maharahj, Middlesex County Crisis Screening Center 19