Adaption And Resiliency

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Boss research: Mind body family connection

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measurement of human reactivity during intensely stressful situations

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Boss research: family resilience

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a process that implies families becoming stronger after a stressful experience with greater emphasis on context.

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Boss research: role of spirituality and faith

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3. increased emphasis on the role of spirituality and faith.

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Boss resrach: postraumatic stress disorder

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4. Increase in the recognition of posttraumatic stress disorder

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Boss: Disaster teams

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5. Increased use of “disaster” teams that are deployed immediately after a catastrophe. more emphasis is placed on crisis instead of stress.

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Boss: Stress from caring for an individual

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6. increased emphasis on stress resulting from caring for an individual with long term illness or disability (including the elderly).

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Boss: demants of balancing work and family

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7. recognition that the demands created by balancing work and family result in high stress levels in many families (such as parents and children rarely being home, overwork, and time bind).

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Boss: perceptions interpretations and beliefs

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8. emphasis on individuals’ and families’ perceptions, interpretations, and beliefs about stress producing situations/events.

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Boss: Social constructionism

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9. adaptation of social constructionism. Helps families reframe, restory, and construct a new narrative that helps them manage stress.

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Boss: Narrative analysis

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10. increase in use of narrative analysis, in which distressed people tell their story, their truth, and their interpretation of what they believe about their situation.

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A in abcx

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Stressors, they may be small or large events, isolated or interconnected, ongoing (economic) or one-time occurrences (death), predictable or unpredictable (anticipated)

* A) “A stressor event is an occurrence that provokes a variable amount of change in the family system.” Pg 7 in (Families & Change)

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B in abcx

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Resources, anything that helps a family adapt (positive or negative). Resources will only be tapped to the extent that the family perceives ( C ) the sources as available

* B) Almost anything that helps a family adapt is a resource (Lecture PP slides Week 2). Resources are a buffer or moderator for family stress in this model. The lack of resources often increases the degree of stress.

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C in abcx

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Perception, often more predictive of outcomes than the actual fact, a single event (A) may be perceived ( C) differently by different systems (family vs. extended)

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x in abc x

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Degree of stress

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10 dimensions of family stress or events

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nternality vs. externality: was the source of the crisis internal or external to the social system affected?

2. Pervasiveness vs. boundedness: does the crisis affect the entire system or only a limited part?
3. Precipitate onset vs. gradual onset: the degree of suddenness with which the crisis occurred: was it with or without warning?
4. Intensity vs. mildness: the degree of severity of the crisis
5. Transitoriness vs. chronicity: the degree to which the crisis represents a short- or long-term problem
6. Randomness vs. expectability: the degree to which the crisis could be expected or predicted.
7. Natural generation vs. artificial generation: the distinction between crises that arise from natural conditions vs. those that arise through technological or other human-made effects.
8. Scarcity vs. surplus: the degree to which the crisis represents a shortage or overabundance of vital commodities (human, material, and nonmaterial).
9. Perceived solvability vs. perceived insolvability: the degree to which those involved in the crisis believe the situation can be reversed or resolved.
10. Substantive content: allows analysts to determine whether the substantive nature of the crisis is primarily in the political, economic, moral, social, religious, health, or sexual domain or any combination thereof.

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Internality vs. externality

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was the source of the crisis internal or external to the social system affected?

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Pervasiveness vs. boundedness

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does the crisis affect the entire system or only a limited part?

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3. Precipitate onset vs. gradual onset:

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the degree of suddenness with which the crisis occurred: was it with or without warning?

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ntensity vs. mildness

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the degree of severity of the crisis

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Transitoriness vs. chronicity

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the degree to which the crisis represents a short- or long-term problem

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Randomness vs. expectability

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the degree to which the crisis could be expected or predicted.

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Natural generation vs. artificial generation

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he distinction between crises that arise from natural conditions vs. those that arise through technological or other human-made effects.

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Scarcity vs. surplus

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the degree to which the crisis represents a shortage or overabundance of vital commodities (human, material, and nonmaterial).

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Perceived solvability vs. perceived insolvability

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the degree to which those involved in the crisis believe the situation can be reversed or resolved.

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Substantive content

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allows analysts to determine whether the substantive nature of the crisis is primarily in the political, economic, moral, social, religious, health, or sexual domain or any combination thereof.

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Importance of perceptions

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Perceptions are important because depending if a family perceives it as positive (catalyst to doing well) or negative (puts family at risk), once they start on a path they tend to stay on it

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ABC-X as described by McCubbin and Patterson

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McCubbin and Patterson expanded the ABC-X model by adding postcrisis/poststress factors to explain how families achieve a satisfactory adaptation to stress or crisis.

o A=stressor
o B=Existing resources
o C=Perception of “a”
o All of these, a,b, and c, are involved in the precrisis
o then X= crisis
o Then POSTCRISIS
o a= pileup
o b= existing and new resources
o c= perception of pre-and-post crisis crisis, perceptions, and resources
o combination of all this leads to bonadaptation, adaptation, or maladaptation

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Adaption

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Family adaptation: the degree to which the family system alters its internal functions (behaviors, rules, roles, perceptions) and/or external reality to achieve a system (individual or family)-environment fit. -coping or adjusting to the stressor- may be a negative or positive change- adapt by using the resources available to you.

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How is Adaption acheived-2 factors

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Through reciprocal relationships where... 1) system demands/ needs are met by resources from the environment AND 2) environmental demands are satisfied through system resources.
*demands: normative and non-normative stress or events, needs of individuals, families, social institutions and communities.
*Resources: individual (education, psychological stability..), family, and environmental attributes.

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Adaption vs. Adjustment

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Adjustment: short-term response by a family that changes the situation momentarily
Adaptation: change in the family system that evolves over time or is intended to have long-term consequences involving changes in family roles, rules, patterns of interactions, and perception.

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Boss on adaption

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Boss (researcher cited in textbook) cautions against the use of the term “adaptation” and prefers the use “managing” to refer to the coping process that results from the family’s reaction to stress or crisis. This is because she believes systems naturally experience discontinuous change in the cycle of change and sometimes dramatic change must occur for individual and family well-being.

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Theoretical Model

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* (page 98)- Theoretical Model of Illness and Families Integrating Aspects of the Double ABC-X Model, Family Resilience, and the Vulnerability-Stress-Adaptation Model
o Health stressors are linked to individual and family outcomes through adaptive processes (figure 5.1 has a model of this)

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Where health stressors come from

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* stress differs by Onset (timing, if it’s expected or not), duration, and ways that a particular illness can impact families (What does this mean?) It means that the way illness comes upon a family like if they find out suddenly or if they know it’s coming, whether it’s a short term problem or something that they will deal with the rest of their lives will affect the impact of the stressor on the family.
* Children with chronic illness: emotional, behavioral, and school-related problems
* Parents of a child with chronic illness: psychological stressors (dealing with insurance and employer conflicts, being isolated from peer and social networks, grieving losses due to illness, making difficult medical decisions, communicating to the ill child about the illness) men care more about financial side and building realtionship with sick child, mother focuses on taking care of the child and taking them to the appointments and stuff.

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Common enduring characteristics of families strugglign with illness

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* Age, race, gender, SES, parenting styles, and family structure
o Studies indicate that the risk of children having a chronic illness increases with age and is higher for African Americans, boys, and in families with an income below poverty. Family structure (single-parent homes...) also seems to be predictive of increased risk, though the risk may be indicative of lower incomes.

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Adaptive processes when spouses are ill

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* Illness mechanisms (life changes due to illness: finances, division of household labor)
* illness-prompted resources (resources that emerge as a result of illness: knowledge about illness, shared diet plan, medical professionals)
* couple coping (communication)
* caregiving processes (the un-ill spouse will in some way need to help care for the ill spouse, whether in a controlling way or a supportive way)

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Health stressors of children

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* Most illnesses are considered in a noncategorical approach where a variety of illnesses often have similar strains on families.
* Children with chronic illness often encounter emotional, behavior and school related problems.-more likely than mother or siblings to report concerns about school performance in the presence of health symptoms
* Children with chronic illness may experience unique stressors including feelings of differential treatments resulting from imbalance of time from parents.
* Illnesses that require daily management but healthy siblings under a greater risk.
* sibling relationships tend to grow closer with illness, usually resulting in compassion and companionship.
* Parent stressors: psychological stressors (insurance employer conflicts, isolated from peer and social networks, grieving loss due to illness, making difficult medical decisions, communicating with the child about the illness.
* Often stress is so severe that some parents experience post traumatic stress.

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How parent factors influence both child and adolescent substance use

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* Behaviors of parents (alcohol-specific effects)--parental use on the substance.
* Non-alcoholic-specific effects (these exclude influences of the parents) I.e. a parental divorce and remarriage reflect the operation of non-substance-specific influences.

* Inherited roots: Family history of addiction increases the risk for addiction
* Parental autonomy: How much agency is given regarding choices
* Parental behavioral control: The degree of barriers or opportunities for children to engage in a behavior (curfew...)
* Parental monitoring: How much monitoring of activities and behaviors is taking place (what do you know, what do they tell you, how proactive is your monitoring)
o builds resources (communication)
o Psychological behavioral “control” for child’s behavior (if they know you will be checking up on them they are less likely to engage in those behaviors)
* What DOES NOT WORK: Coercive control (“because we said so”)
* What DOES WORK: High parental monitoring

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Prevention and treatment of addiction

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* Individually:behavioral therapy plus treatment of underlying mental illness
* Family:
o eliminating negative patterns
o repair relationships-reintegrating abuser
o helping families tap resources (i.e. financial, in the community, etc.)
o overcoming over-under functioning relationships (imbalance in relationship)
+ over-under: releasing role from individual-putting more on other family members and then reluctant to give back role when individual back on track.
* page 151-- parenting styles (quality of parent-child communication) Parental support is important. There must be a combination of supervision and acceptance (an authoritative parenting style)

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How gender affects mental illnesw

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GENDER
Women more likely to suffer from:
· Affective and anxiety disorders
· Sadness, guilt, worthlessness
· Attempt suicide 2 to 3 times more often
· More likely to pursue treatment from primary care or outpatient services
Men more likely to suffer from:
· Substance abuse, impulse control, antisocial personality disorders
· Fatigue, sleep, irritability
· Loss of interest in job or leisure activities
· Self-medicate w/alcohol or drugs
· 4 times more likely to succeed at suicide
· Seek specialists and inpatient care
- Men who receive in-patient treatment have higher rates of recovery

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How age affects mental illness

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AGE
Highest rates of mental illness—between ages 25 and 34
· Incidence in children and adolescents: from 9% to 13%
· Autism: 3.4 per 1,000 ages 3 to 10 (4 times greater in boys)
· Suicide rates among young adults—disproportionately high
· Suicide 3rd leading cause of death in 10-24 year olds

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How race affects mental illness

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RACE
Compared to Caucasians: Most rates of mental disorder are lower for Latinos and African Americans
· Mexicans are at higher risk for anxiety and depression compared to Cubans, Puerto Ricans, and other Latinos
· Lifetime prevalence rates lower for anxiety, depression and social phobia, and substance use for non-US born Latinos vs. those born in the US

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How SES affects mental illness

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“Objective Burdens” measured in terms of economic hardships faced by a family
· Calculated in amount of money the illness has cost
· These “burdens” are observable and tangible stressors
- 3/4 of population will not seek out help because of perceptions or lack of resources
o Payments and co-payments, transportation, food, clothing, and insurance

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How family environment influences illness: Causation of illness

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Etiology (Causation) of Mental Illness

* Family heritage shown to influence, so must discuss the psychopathology of at least one parent
* The biopsychosocial model):
o Biological predispositions
o Genetic and psychological vulnerability
o Stressful Family or life events

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How family environment influences illness: Genetic linkage research

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Studies suggest that genetic links are important elements in the onset of mental illnesses - but could vary depending on the mental disorder (twin and adoption studies)Ho

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w family environment influences illness: family environment research

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* Family stressors, conflict, support, relationship quality, expressed emotion, and more have been linked to development of mental disorders
* Interrelationships among maternal physical and mental health, divorce, parental death, and everyday hassles have been shown to be linked
* 1/2 mothers in sample of 285 families of adolescents reported 2 or more family stressors
o Adolescents with multiple stressors showed more depressive symptoms 6 yrs later
* Higher levels of parenting stress & lower levels nurturing behaviors are positively associated with level of symptom severity in mothers diagnosed with a serious mental illness
* Family conflict, parenting approaches, and family members’ relationship quality
o Internalizing and Externalizing disorders (especially internalizing for adolescents who argued with parents a lot in early adolescence)
o Harsh discipline & feeling frustrated, angry, or impatient in the parents towards the child is associated with antisocial behaviors in children
o 40% of families with 2 children with ADHD can be accounted for because of family conflict
* Less supportive family environments & less facilitative behavior during problem-solving discussions associated with adolescent depression
o Low family cohesion & attachment relationships associated with adolescent substance abuse
o Depressed adolescents report poorer-quality relationships with parents and siblings
o Boys: major depression, conduct disorder, ADHD, and alcohol use
o Girls: major depression, conduct disorder, ADHD, operational defiant disorder, and PTSD

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How family environemnt influences illness: expressed emotion

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* Expressed emotions coincides with the C of ABC-X, it represents perceptions
* EE comprised of two factors:
o Level of emotional (over)involvement among family members
o The level family members show critical attitudes or hostile comments towards the person with the mental illness
* Emotional overinvolvement has been shown in intrusiveness, distress, and self-sacrificing behaviors towards the person with the mental illness
* Those with high EE family members have a higher rate of relapse to their mental disorder
* Shown high EE relatives tend to blame mentally ill family members for their abnormal behavior, low EE relatives perceive the individual’s behavior as out of their control & a product of mental illness
* Relatives need to be educated on the severity and origins of the member’s symptoms to decrease EE
* Goal of family treatment should be to neither attribute all the patient’s behavior as out of the patient’s control nor assume that the patient could control the symptoms (“flexible attributional stance”) - help the family to act less critical towards the patient
* stress diathesis: stress may trigger mental illness in a pre-disposed individual

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How families affect mental illness: genetic linkage and environment

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A person might have a genetic predisposition to mental illness, but the likelihood that the illness will show is largely determined by environmental and family influences

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How various community resources might help families struggling with mental illness

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he best thing for the families are for them to have education about the particular mental illness and what it means. Then the family may feel proactive in coping, helping families to be on the same page. One of the best ways that families can be resilient is to take away that ambiguity and having the knowledge they need. In general community settings you can set up support groups and ways that you can help. Behind that you have the stress-diathesis model (explains behavior as a result of biological and genetic factors and life experiences- nature and nurture interact to affect who you are). One of the reasons to teach families these skills is so that the family doesn’t become more of the cause and control the family environment/system to lower the stress on the individual.

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FAAR Model

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The teeter totter diagram with family demands on one side and family capabilities on the other. Family meaning pushing on both ends of the teeter totter.

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Family Demands in FaAr model

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normative/non-normative stressors; ongoing strains/daily hassles

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family capabilities in faar model

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tangible/psychosocial resources (what the family has), coping behaviors (what the family does)

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family meaning in faar model

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Family Meaning: families’ definitions of their demands and capabilities; their identity as a family (how they see themselves); their world view (how they see themselves in relationship to suprasystems; how the family shapes the nature and extent of the risk

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4 constructs in faar model

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In the FAAR model, four central constructs are emphasized: families engage in active processes to balance family demands with family capabilities as these interact with family meanings to arrive at a level of family adjustment or adaptation.

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family demands compromised of: Faar model

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Family demands are comprised of (a) normative and nonnormative stressors (discrete events of change); (b) ongoing family strains (unresolved, insidious tensions); and (c) daily hassles (minor disruptions of daily life).

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family capabilities compriesed of. faar model

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Family capabilities include (a) tangible and psychological resources (what the family has) and (b) coping behaviors (what the family does). There are some obvious parallels between risk factors (resilience language) and demands, as well as between factors and capabilities. Both demands and capabilities can emerge from three different levels of the ecosystem: (a) individual family members (b) family unit, and (c) from various community contexts.

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3 levels of family meanings in far model

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Three levels of family meanings have been described in the FAAR Model: (a) families’ definitions of their demands (primary appraisal) and capabilities (secondary appraisal); (b) their identity as a family (how they see themselves internally as a unit); and (c) their world view (how they see their family in relationship to systems outside of their family. These meanings shape the nature and extent of risk, as well as the protective capacity of a family.

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How is faar model similar to the abc-x

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Family demands are the same as A (or stressors) in the abc-x model and family capabilities are the same as B (or resources). The difference between abc-x and faar is that faar does not have perspective in its model. (Really? Meaning is basically perception; it’s how the family defines their capabilities (resources) and sees how they can overcome (adapt) the demands to return to an equilibrium) So, ABC-X is perception in terms of personal/individual and FAAR is family meaning collectively.

The FAAR Model is similar to the ABC-X model in the following ways: (Refer to diagram on lecture powerpoint on conceptual frameworks)
- The “family demands” equate to the “event or perception” (A) part of the ABC-X model. These are the aspects that cause family stress, whether large or small.
-The “family capacities” equate to “family resources” (B). These include a variety of skill sets the family utilizes to help balance the “family demands.”
- Both “family demands” and “family capacities” stand on a balance and have “family meanings” influencing how the stress and resources are viewed. The “family meanings” equate to “perception” (C).
- The “family adaptation” equates to the “degree of stress” (X). This is how the family reacts to the stress.

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Main findings of addiction study

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Discrepancies (differences in use) in husband and wife cigarette smoking and heavy alcohol use were related to significant reductions in marital satisfaction. Couples who were discrepant on both cigarette smoking and heavy alcohol experienced the greatest declines in marital satisfaction over time.
No Discrepancy = Husband and wife both smoke and/or drink heavily OR both do NOT smoke/drink

Study was looking at discrepancies over time.
Discrepancies in smoking were predictive longitudinally of decreased marital satisfaction; this is true among both husbands and wives.
Discrepancies in husbands’ and wives’ heavy drinking were predictive longitudinally of decreased levels of marital satisfaction. Couples in which only one member was a heavy drinker had steeper declines in marital satisfaction compared to couples in which both were heavy drinkers or neither were heavy drinkers.
Couples who were discrepant on both heavy drinking and smoking had greater declines in marital satisfaction compared to other couples.
Notion of compatibility theories: Couples who are more similar across a multitude of domains will exhibit better outcomes. (it all comes down to perception)
See Figures 1 and 2 in Hommish article, page 1206, for visual description!

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Article on Mental illness: how having a sibling with mental illness influences individual distress and well being

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* Significant (p<.05) main effect for the the Disability group for life time history of depression; the prevalence of an individual ever having a depressive episode was higher for siblings of individuals with a mental illness (M=31) (comparison group M=19).
* No differences in the groups for current depressive symptoms.
* Significant interaction (p<.05) between the Disability Group and the Target Gender group;Siblings of brothers (because they are more expressive in their illness) with mental illness had significantly lower well being scores then that of the comparison group (sibling of brothers)
* Siblings of individuals with mild intellectual deficits did not deviate from the norm in areas of psychological distress or well-being

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Mental illness article: Authors explanation of findings

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* The author’s findings came from ANCOVA tests computed to make comparisons between groups. Overall, the tables indicated that a sibling with a mental illness doesn’t affect their sibling’s decision to marry and have children but they do affect their sibling’s mental health.
* The authors explain many of their findings give support to previous research.
* Both genetic and non-genetic factors contributed to the personality of siblings and the individuals with major depression
* Cross-sectional nature doesn’t allow conclusions that the adult with disability is the cause of group differences
o Siblings with disabilities grow up in more strained family environments
o Further studies needed to define impacts of genetic predisposition and family environment
* There are long lasting effects on the entire family when one member of the family has a mental illness. (was it family stress/environment or genetic predisposition?)

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ARticle: Same SEx ATtract;ion-description of stage models of sexual iddentity

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Underlying Awareness (possible disclosing Integration of
Sexual Identity --> of --> identity ) --- Sexual Identity into
genetic Identity Self

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Differences between essentialism and social constructionist viewpoint

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Social Constructionist:
-two way-interaction between the individual and the environment
-sexual identity develops as a dynamic interchange between genetics and environment
---you can choose not to arrive at underlying outcome (you have a choice)
Essentialism: sexual orientation is established early in life and defines the real or true sexual being. sexual identity involves learning what one “really is” and that homosexuality is a form of being.
from essentialist point of view, homosexuality is viewed as an essential, predetermined, and static (fixed) aspect of the individual. If the individual makes the choice not to engage in same-sex relationships, or express homosexuality, they essentially reject this aspect of self.

“The social constructionist perspective holds that the process of identity formation is a continual, two way interactive process between the individual and the social environment, and that the meanings the individual gives to these factors influence the development of self-constructs and identity. Sexual identity develops within this textual framework and because it is influenced by continual interaction, is fluid over time and experience, throughout ones life. Our model does not rely on the existing developmental models of homosexual identity; rather, our model looks at desire, behavior, and identity as three separate constructs related to sexual identity”

“When applied to human sexual experience, a social constructionist perspective posits that sexual identity is maintained through social interaction. In distinct contrast to the linear or stage models, in which the individual is in the process of gaining cognitive awareness and acceptance of his or her “real” sexual identity is fluid and can change according to the individual and social interaction.”
(Found in the Horowitz article and from the slides.)

* Essentialism: This refers to a theoretical orientation that the stage models come from. The idea is that “sexual orientation is established early in life and defines the real or true sexual being; sexual identity involves learning what one ‘really is’; and that homosexuality is a form of being.” When it is viewed as essential, predetermined, and static, then the choice not to express it means that you are rejecting this part of you. “In the stage models, this rejection signifies a non-legitimate identity outcome” because there is no stage for it. The bottom line is that being homosexual is an essential part of you.
* Social constructionist: This refers to the viewpoint that “people actively construct their identities and perceptions and use their social context to do so...the individual plays an active role in constructing his or her identity through a continual, recursive interaction between oneself and one’s environment.” The environment includes the historical and social context. because the experiences of people are different in their environment, then “the experience of sexuality and sexual orientation can be different for each person.” It is not static, could change over time (its fluid). “The social constructionist perspective, when compared to the essentialist perspective, empowers the individual with a more active role in the development of a healthy sexual identity. As opposed to the essentialist model, in which the sexual identity is fixed and the individual is merely discovering it, the individual in the social constructionist model is actively making meaning and constructing identity.” You have some choice in how you develop and in the expression of your identity, but still your degree of choice may vary “depending upon other factors such as biological influences and socially oppressive contexts.”

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ARticle: infertility: main findings with infertility and life satisfaciton

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Past research shows lower life satisfaction among those seeking help for infertility. Several studies have found that infertility is associated with more psychological distress, and has a negative impact on subjective well-being and global life satisfaction. (see pg 960 of article)
but this specific article didn’t find statistical significance in the correlation of life satisfaction and infertility for women- hence question #2---what went wrong with their research to make it different?
study found that:
-infertility is only a problem when trying to get pregnant
-employment ameliorates effects of stress from infertility
In the article some of the main findings were:
“Life satisfaction is significantly lower for women who perceive a problem and are currently blocked from motherhood but not for those who became mothers” 975
However, findings on negativeness of infertility depend on characteristics of the person and how stressful and they perceive the situation. “Life satisfaction is more of a trait and that personality is one of the strongest predictors of subjective well-being” 975
“Mothers have higher life satisfaction than nonmothers” 974 (even though this could just be a result of role fulfillment not directly infertility)
“Marriage is more directly associated with life satisfaction than either motherhood or infertility” 974
All in all it seems like infertility is not directly associated with life satisfaction as much as: a blocked goal like the importance of becoming a mother (biggest factor – where it would decrease life satisfaction), perceived situational stress (if it is viewed as a problem), marriage, and personality. “…it is perceiving a problem and failing to achieve biological motherhood that matters most for life satisfaction” 976

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How infertility article is limited

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see “Measures” section of article (pg 964). The scale they used was not good. They used words like “I would change almost nothing,” (participants in the study will agree because of the word almost) , “so far, I have gotten the important things I want in life.” (participants still have hope so they will agree to this statement)
Also, they misquoted the scale from the Diener and Diener article- there was another question omitted from the questionnaire they used. They also cited the wrong article (wrong authors and year). Omitted “the conditions of my life are excellent”

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Adoption article: main findings on factors that contribute to parental stress

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Results indicated that children's behavior problems were highly associated with parenting stress for both mothers and fathers

-fathers- reported more mood and social isolation problems
-mothers- reported more problems with depression

Children’s behavior problems were highly correlated with parental stress, in the article it says it is the most important correlate of parental stress. The quantity of problem behaviors was positively correlated with an increase in parental stress. In their analyses family demographics, length of time spent in orphanage, number of medical problems, and number of developmental delays were not significantly correlated with parental stress.

The study also mentioned that fathers found their child’s excessive crying, withdrawal, and depression to be more stressful than mothers did. The article also found that mothers had more problems with depression and a sense of competence and fathers had more problems with social isolation.

In class and also in the article perceptions were important to consider. In the article it talks about how each parent may perceive their experience with their child differently and that perceptions of problem behaviors may influence it’s impact on parental stress. In the article they said that more parents were concerned about medical issues or developmental delays and because they were not expecting the behavioral problems, those problems may be more stressful. In class Dr. W related the perception of behavioral problems to chronic vs. mental illness. Chronic illness is more stressful because it is easier to see and easier to think that they have no control over it. Mental illness, and similarly behavioral problems, are more abstract and it is easier to perceive that the child is acting out on purpose. These perceptions can cause the problems to be more stressful to adoptive parents.

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Internal Stress

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: Individual feelings of anxiety and anxiousness derived from the perception that an event/person/source is troubling or challenging.

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External Stressor

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An external event/person/source which could be troubling or challenging and cause anxiety and anxiousness

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adaptation

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is the process through which families and individuals change their behaviors, thoughts, values, and tendencies in reaction to stress.

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resiliency

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refers to individuals and families that benefit from stressful events.

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Conceptual Framework

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: a map of abstract concepts which help us interpret and analyze given occurrences

Conceptual frameworks give us:
Terminology
Interpretations
Expectations

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Family stress

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Family stress is the unique stress placed on the entire family system

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Key aspects of systems theory

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The family unit is greater than the sum of its parts

A change in one person effects the entire family unit

The family unit has a unique societal, cultural, and developmental purpose

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boundaries

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: who is in and who is out of the family system

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subsystems

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individuals, dyads, groups within the family system

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Suprasystems

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larger systems the family interacts with

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Systems perspective of family stress

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From a systems perspective, family stress is caused when the family equilibrium is disrupted.
Change is inherently stressful as it is inherently destabilizing

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abcx

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An event or stress (A) interacts with the family’s perception of the event (C) and their resources to deal with the stress (B) to create a reaction to the stress (X)

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perception

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Perceptions are often more predictive of outcomes than actual fact
Pluralistic ignorance, marital conflict, class enjoyment

A single event may be perceived differently by different systems (family vs. extended family) or by individuals within the family


Negative perceptions – “Chain of Risk”

Positive perceptions – “Chain of Protective Mechanisms”
Positive recasting
Different than unhealthy denial

Front 79

resources

Back 79

Almost anything that helps a family adapt is a resource

What are some resources that might be used by a family?

Resources will only be tapped to the extent that the family perceives an event as stressful and they perceive the resources as available.
Example: Strained extended family

Front 80

Faar model

Back 80

Family demands and capacities come from three sources:
Individuals
Families
Communities

The ability (or inability) of families to balance demands and capacities lead to the degree of stress a family feels
Notice the importance again of perception

Front 81

boundary ambiguity

Back 81

Boundaries are a key aspect of family systems.
Who is in and out of the family system

Sometimes these boundaries become undefined
Confusion regarding who is in and out
Divorce
Death
Illness

The theory of boundary ambiguity (Boss) conceptualizes what happens when boundaries are unclear

Front 82

Aspects of boundary ambiguity

Back 82

Applicable when stress leads to boundary changes

Family stress is caused by unclear or undefined boundaries

Unclear or undefined boundaries lead to undefined role and task assignments which undermine family functioning

Front 83

addiction

Back 83

Addiction is the compulsive need to engage in a behavior

Addiction leads to family stress when:
The compulsion interferes with individual and family functioning
The behavior results in negative individual and family outcomes


The Addiction Process (how does addiction develop?)

Front 84

addiction process

Back 84

discovery, experimentation, escalation, compulsion, hopelessness

Front 85

inhereited roots of addiction

Back 85

Individuals with a family history of addiction often are at higher risk for addiction themselves
Strong link found for alcoholism

Front 86

developmental roots of addiction

Back 86

Developmental roots
Age and developmental level are associated with the outcomes and correlates of addiction
College binge drinking

Front 87

substance use in adults/parents

Back 87

Substance use among parents is closely tied to improper attachment development for children

“Parentified” Children

Substance use tends to mature out as adults go through major life course events

Front 88

substance use in children

Back 88

A growing issue:
Almost 20% of fifth graders report regular alcohol use
40% of eighth graders report having consumed alcohol

Childhood abuse is strongly correlated with other stressors (family problems, mental illness, etc).
Substance use is typically an X that leads to another A

Front 89

Key aspects of parenting for substance abuse

Back 89

Parental factors are often strongly linked to the substance use patterns of children.

Key aspects of parenting

Parental autonomy: the degree of agency parents give their children regarding choices

Parental behavioral control : the degree to which parents put barriers or opportunities for children to engage in a behavior

Parental monitoring: the degree in which parents monitor the activities and behaviors of their children.

What doesn’t work: coercive control
What works: high parental monitoring

Front 90

Gambling

Back 90

Pathological Gambling: Inability to resist impulses to gamble that interferes with individual, family and vocational pursuits.

Along with the typical family stress issues associated with addiction, gambling has a high correlation with economic stress.

Key factors to gambling addictions:
Much shorter time table through the addiction process
Highly related to illegal activity (to obtain funds)

Front 91

pornography/sex addiction

Back 91

Traditionally, sex addiction has been linked to :
Extramarital affairs
Use of prostitutes

Pornography: the “crack cocaine” of the internet (Cooper, 1997) – the new outlet for sex addiction

Front 92

The tripe enginge of pornography

Back 92

Availability: Pornography (in any form) is widely available

Affordability: Pornography provides low entry costs and free internet pornography is readily available.

Anonymity : Pornography and the Internet provide sex addicts with almost full anonymity (think back to signs of addiction)

Front 93

effect addiction has on family system

Back 93

Individually: behavioral therapy plus treatment of underlying mental illness

Family:
Working on eliminating negative patterns
Focusing on repairing relationships – reintegrating abuser
Helping families tap resources
Alanon; FA
Overcoming over-under functioning relationships

Front 94

9 aspects of healthy functioning with ill children

Back 94

Balancing illness with other family needs
Maintaining clear boundaries
Developing communication and competence
Attributing positive meaning to situation
Maintaining flexibility
Maintaining family cohesiveness
Engaging in active coping efforts
Maintaining social supports
Developing collaborative relationships with professionals.

Front 95

stage model of sexual identity

Back 95

underlying sexual identity---> awareness of identity--->integration of sexual identity to self

Front 96

social constructionist model of same sex attraction

Back 96

Two-way interaction between the individual and the environment
Sexual identity develops as a dynamic interchange between genetics and environment

Front 97

Family disclosure

Back 97

Only about 50-60% of youth disclose same-sex attraction to their families
Average age around 20
Parents are almost never the first person youth turn to

Although same-sex attraction influences the family system regardless, the effect is often unrecognized
Low disclosure rates
Reaction fear

Front 98

After math of disclosure

Back 98

Disclosure of same-sex attraction has been shown to be very disruptive of family functioning

Youth who disclose have higher rates of:
Verbal abuse
Physical abuse
Substance use
Criminal behavior

Front 99

youth who don't disclose

Back 99

Double-edged sword: Youth who don’t disclose:
Have more feelings of guilt and shame
Have higher rates of depression and other mental health concerns

Front 100

Infidelity

Back 100

Simple Definition: infidelity is any intimate relationship behavior with someone other than your spouse or partner.

Two broad categories:
Physical infidelity
Emotional infidelity

Infidelity as a self-defined event

Front 101

Infidelitly as a level 3 stressor

Back 101

Infidelity as a level 3 stressor
Level 1: Existing resources sufficient (everyday hassles)
Level 2: Family needs new resources but can cope
Level 3: Paradigm shifting/shattering stressor

Front 102

Men vs. women in cheating

Back 102

Men are more likely than women to cheat
25-40% of married men will have an affair once in their life
10-25% of married women
50% of men and women report cheating at least once on a romantic partner

Therapists often list infidelity as the second most damaging event for a relationship (after physical violence)
The most common cause of relationship break-up….worldwide

In national surveys, if they thought they wouldn’t get caught most men say they would have an affair.

Front 103

Premarital facots that predict infidelity

Back 103

For many couples, the actual act of cheating (physically or emotionally) is the culmination of a negative relationship process
Infidelity as a effect; not a cause

Premarital factors have been shown to predict infidelity (Alenn et al., 2008)
Premarital relationship satisfaction
Premarital sexual satisfaction
Couple communication
Female invalidation in relationship

In the research and in therapy; infidelity is often seen as a symptom of underlying relationship issues.
“Stress-diathesis” model
Stress = context; diathesis = individual characteristics

Front 104

Overcoming Infidelity

Back 104

Infidelity is one of the hardest stresses for a couple to overcome
Affairs end relationships: the question is do you rebuild

Three step process to rebuild (Gordon et al, 2004)
Stage 1: Dealing with the impact of the affair
Stage 2: Process the context of the affair
Stage 3: Summary and moving on

Front 105

Hardest part of infidelity

Back 105

mutual responsibility

Front 106

Moving on from infidelitly

Back 106

Forgiveness as a process
Waiting until both partners are ready

Repairing
Communication
Trust
Love

“Maintenance” tasks: not letting the affair consume the couple

Front 107

Mental Illness: The history

Back 107

Mental Illness, as it is currently defined, is a relatively new phenomena.
It’s also a rather fluid one
DSM-IV-TR

Historically, mental illness was:
Demonic possession

Deinstitutionalizing of the mentally ill
-Greater focus on family care-giving

Front 108

Unique challenges of mental illness

Back 108

Three unique challenges:

The challenge of the ambiguous disease
Lack of outward indicators
Shift to a medical model

The challenge of the uncooperative member
What happens when they don’t want help?

The challenge of cause and effect
Families contributing to mental illness

Front 109

Adapting to mental illness in families

Back 109

Individual: Biopsychosocial (medication, theory, support)

Families: Psycho-educational model
Teaching families practical skills

“Stress-diathesis” model: family and life events are likely to trigger emotional reactions in those suffering with mental illness
Goal is to control family and community environments to reduce stress

Front 110

Depression

Back 110

Causes: mixture of environmental stimulus and brain environment

Learned Helplessness Theory of Depression
Depression worsens over time as individuals reinforce negative emotional, cognitive and relational patterns and beliefs.

Several “flavors”
Major depression
Bi-Polar Disorder

Front 111

Depression and marriage

Back 111

There is a high correlation between depression and marital discord or conflict.
Which direction is the causation?
How does it cause stress on the family?

Systems Perspective
Depression causes “emotional disregulation”
Undermines conflict and family never achieves a new enhance state – continued negative interaction

Attachment Perspective
Depression undermines adult attachment
Lack of “marital attachment”

Sex Role/Feminist Perspective
Power differentials between partners increase depression and marital discord among partners
Based on gender difference in depression rates

Front 112

Adoption: Critical issue 1, background of child

Back 112

The background of an adopted child can vary greatly
Age
Prior location (aka foster care)
Country of origin

Child background influences the likelihood of adoption
Being a white, American baby vs a black, American teenager

Front 113

Adoption: Critical issue 2: Openness in adoption

Back 113

Historically: Closed adoption

Open adoption: any adoption that includes ongoing (or the possibility of ongoing) contact in any form with the biological parents

Benefits of open adoption:
Greater satisfaction with adoption process
Better post-adoption adjustment for birth parents

Front 114

Integrating adopted children into family system

Back 114

Adoption involved the introduction of a new member into the family system.
New family structure

Unlike biological children, adopted children often bring elements of previous systems
Previous biological families
Foster families
Institutional systems

This creates a need to converge systems

Front 115

infertility

Back 115

Infertility: inability to conceive after 12 months of trying without contraceptives

Front 116

Sources of stress in infertility:

Back 116

Sources of stress:
Hope-despair cycle
Delaying/changing life goals
Comparison stress: what happens when we get out of step with peers

Front 117

Infertility and its impacts on individuals

Back 117

Infertility is often associated with depression and negative feelings for individuals
Especially true for women
Master Status Model: Women’s key role in life is to bear children
Agree?

Feelings of Grief
“Grief”: distress felt due to perceived or actual loss

Front 118

Infertility and the impact on couples

Back 118

Gendered reaction:
Men: feelings of disappointment, resentment
Women: feelings of worthlessness/depression

When infertility happens, couples must reshape couple goals and plans
Infertility (stress) causes reactive change

Front 119

Infertility: resource Buffering model

Back 119

Families with more resources can “buffer” the stress associated with infertility
Resources for adoption/fertility treatment
Resources for outside help/support (therapy)

Front 120

role accumulation

Back 120

Couple and individuals with multiple role identities will react better to infertility by focusing energy into other roles.

Front 121

fertility treatments

Back 121

Scientific advancements have allowed many infertile couples to seek fertility treatments

The increase in fertility treatments have created their own series of stressors:
Economic stressors
Increased risk of prenatal and birth complications
Multiple births
Continued grief cycling

Front 122

fertility as an adaptation strategy

Back 122

Evidence may suggest many couples use fertility as a negative adaptation strategy (Baker, 2005)
Despite a low success rate, most couples believe they will conceive
Most continue to struggle envisioning a future without children
Many assume severe economic debt to seek treatment

Front 123

Fertility treatment within systems

Back 123

Fertility treatment typically focuses on the woman (and perhaps her partner).

With a partner:
Discuss how fertility treatments might influence the family system

Discuss how family systems might interact in positive or negative ways with two involved suprasystems