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

2. 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.

3. 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.

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

5. 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

6. 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

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

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

9. 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

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

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

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

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

14. 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.

15. 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?

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

17. 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.