Family Issues in Rehabilitation What is the family? Who is the family? Impact on the family? Functional/dysfunctional adjustment Assessing families Treatment considerations

Learning Objectives To increase awareness of students about the ways in which disability in one family member can impact all family members. 2. To increase knowledge and awareness of students about the strategies that can be used with clients and their relatives that may be helpful and facilitative of the entire rehabilitation process.  

What is the Family? A social group in which people learn to love, care for others, and get their own needs met. The functioning of this primary social group affects the manner in which the individuals within it develop and grow.

Who is the Family? Nuclear Extended Step-family Single-parent Blended Cohabitation Foster Family Adoptive Family Guardianship

The Family as a System System= a group of interacting interrelated or interdependent elements forming or regarded as forming a collective entity. Functions separately and in reliance on and influenced by the interrelated interaction or functioning of the other elements within the system

Family System like a Mobile Demonstration of Family as a System: Healthy connection to each other Balance or Homeostatis Interdependency Disruption Differentiation versus fusion or symbiosis

ILLNESS AND FAMILY IMPACT Daily routines Care giving responsibilities Emotional reaction New ways of independence Energy to maintain “normal” life

Functional Family Characteristics Respect for each other Enjoy each other's company Adapt to change; flexible Sense of hopefulness

Dysfunctional Family Characteristics Unresolved power issues Avoid responsibility for self Many family myths and secrets Members less differentiated, more enmeshed Stereotypical roles Closed communication Denial of feelings Misinterpretation of events

Family Dynamics Mood Seating position Speaking Coalitions Conflicts resolved Power Previous crises View of problem

Informational Areas During Intake Family composition Family response to illness/disability Current knowledge/information needs Services needed Family strengths

Family Strengths Listening Skills Shared Reality Shift Roles Problem-solve Care for self and others Focus on present

Family Strengths-continued Support one another Open communication Sense of belonging Hopefulness Change is possible

Case Study Woman, 42 years old, diagnosed two years ago with Multiple Sclerosis. She lives with her husband (age 44) for the past 17 years, two children (ages16 and 12 years old), and her biological mother. The patient's mother has been living with her daughter's family for the past four years since her husband died. Patient takes care of home and assumes major responsibility of raising both children and, when necessary, her mother. Husband has been working as an architect for the past 20 years. Current complaints includes numbness and twitching of both legs as well as general weakness and fatigue.

Case Study Questions 1. What do you need to know about this family? 2. What are some basic questions that you might want to raise in the first intake session? 3. Who would you want to interview during the intake? 4. What services might you provide?

Case Management Considerations Cultural Uniqueness Respect for homeostasis Support groups Communication styles Schedule disruption Interventions Client permission and trust issue Mistrust and psychological adjustment

References Curtis, O. (1999). Chemical Dependency: A Family Affair. New York: Brooks Cole Publishing. Roessler, R. & Rubin, S. (1998). Case Management and Rehabilitation Counseling: Procedures and Techniques. Austin, Tx: Pro-Ed Publishers.