Family Issues in RehabilitationFamily Issues in Rehabilitation

What is the family? Who is the What is the family? Who is the family?family? Impact on the family?Impact on the family? Functional/dysfunctional Functional/dysfunctional adjustmentadjustment Assessing families Assessing families Treatment considerationsTreatment considerations

Learning ObjectivesLearning Objectives

1.1. To increase awareness of students about To increase awareness of students about the ways in which disability in one family the ways in which disability in one family member can impact all family members.member can impact all family members.

2. To increase knowledge and awareness of 2. To increase knowledge and awareness of students about the strategies that can be students about the strategies that can be used with clients and their relatives that used with clients and their relatives that may be helpful and facilitative of the may be helpful and facilitative of the entire rehabilitation process.entire rehabilitation process.

  

What is the Family?What is the Family?

A social group in which people A social group in which people learn to love, care for others, and learn to love, care for others, and get their own needs met.get their own needs met.

The functioning of this primary The functioning of this primary social group affects the manner in social group affects the manner in which the individuals within it which the individuals within it develop and grow.develop and grow.

Who is the Family?Who is the Family?

NuclearNuclear ExtendedExtended Step-familyStep-family Single-parent Single-parent BlendedBlended CohabitationCohabitation Foster FamilyFoster Family Adoptive FamilyAdoptive Family GuardianshipGuardianship

The Family as a SystemThe 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 Family System like a MobileMobile

Demonstration of Family as a System:Demonstration of Family as a System:

• Healthy connection to each otherHealthy connection to each other

• Balance or HomeostatisBalance or Homeostatis

• InterdependencyInterdependency

• DisruptionDisruption

• Differentiation versus fusion or symbiosisDifferentiation versus fusion or symbiosis

ILLNESS AND FAMILY IMPACTILLNESS AND FAMILY IMPACT

Daily routinesDaily routines Care giving responsibilitiesCare giving responsibilities Emotional reactionEmotional reaction New ways of independenceNew ways of independence Energy to maintain “normal” lifeEnergy to maintain “normal” life

Functional Family Functional Family CharacteristicsCharacteristics

– Respect for each otherRespect for each other

– Enjoy each other's companyEnjoy each other's company

– Adapt to change; flexibleAdapt to change; flexible

– Sense of hopefulnessSense of hopefulness

Dysfunctional Family Dysfunctional Family CharacteristicsCharacteristics

– Unresolved power issuesUnresolved power issues– Avoid responsibility for selfAvoid responsibility for self– Many family myths and secretsMany family myths and secrets– Members less differentiated, more Members less differentiated, more

enmeshedenmeshed– Stereotypical rolesStereotypical roles– Closed communicationClosed communication– Denial of feelingsDenial of feelings– Misinterpretation of eventsMisinterpretation of events

Family DynamicsFamily Dynamics

MoodMood Seating positionSeating position SpeakingSpeaking CoalitionsCoalitions Conflicts resolvedConflicts resolved PowerPower Previous crisesPrevious crises View of problemView of problem

Informational Areas During Informational Areas During IntakeIntake

Family compositionFamily composition

Family response to illness/disabilityFamily response to illness/disability

Current knowledge/information needsCurrent knowledge/information needs

Services neededServices needed

Family strengthsFamily strengths

Family StrengthsFamily Strengths

Listening Skills Listening Skills Shared RealityShared Reality Shift RolesShift Roles Problem-solveProblem-solve Care for self and othersCare for self and others Focus on presentFocus on present

Family Strengths-Family Strengths-continuedcontinued

Support one another Support one another Open communication Open communication Sense of belonging Sense of belonging HopefulnessHopefulness Change is possibleChange is possible

Case StudyCase Study

Woman, 42 years old, diagnosed two years ago withWoman, 42 years old, diagnosed two years ago withMultiple Sclerosis. She lives with her husband (age 44)Multiple Sclerosis. She lives with her husband (age 44)for the past 17 years, two children (ages16 and 12 for the past 17 years, two children (ages16 and 12

yearsyearsold), and her biological mother. The patient's motherold), and her biological mother. The patient's motherhas been living with her daughter's family for the pasthas been living with her daughter's family for the pastfour years since her husband died. Patient takes carefour years since her husband died. Patient takes careof home and assumes major responsibility of raisingof home and assumes major responsibility of raisingboth children and, when necessary, her mother.both children and, when necessary, her mother.Husband has been working as an architect for the pastHusband has been working as an architect for the past20 years. Current complaints includes numbness and20 years. Current complaints includes numbness andtwitching of both legs as well as general weakness andtwitching of both legs as well as general weakness andfatigue. fatigue.

Case Study QuestionsCase Study Questions

1. What do you need to know about this family? 1. What do you need to know about this family?

2. What are some basic questions that you might 2. What are some basic questions that you might want to raise in the first intake session? want to raise in the first intake session?

3. Who would you want to interview during the 3. Who would you want to interview during the intake? intake?

4. What services might you provide?4. What services might you provide?

Case Management Case Management ConsiderationsConsiderations

Cultural UniquenessCultural Uniqueness Respect for homeostasisRespect for homeostasis Support groupsSupport groups Communication stylesCommunication styles Schedule disruptionSchedule disruption InterventionsInterventions Client permission and trust issueClient permission and trust issue Mistrust and psychological adjustmentMistrust and psychological adjustment

ReferencesReferences

Curtis, O. (1999). Curtis, O. (1999). Chemical Dependency: A Family Chemical Dependency: A Family AffairAffair. New . New

York: Brooks Cole Publishing.York: Brooks Cole Publishing.

Roessler, R. & Rubin, S. (1998). Roessler, R. & Rubin, S. (1998). Case Management and Case Management and

Rehabilitation Counseling: Procedures and Rehabilitation Counseling: Procedures and TechniquesTechniques. .

Austin, Tx: Pro-Ed Publishers.Austin, Tx: Pro-Ed Publishers.