Pain Recovery for Families. Robert Hunter

terms of how the actions of each family member affects the rest of the family, both individually and as a whole. Thus, when _______________ developed chronic pain, that change in him or her naturally had effects on every member of the family and on the way the family operates (e.g., interacts or communicates). However, in a family systems approach, your actions and reactions will also affect the family, including _______________.

       FAMILY SYSTEMS: A BRIEF INTRODUCTION

      While a complete discussion of the many different family systems theories is beyond the scope of this book, a brief discussion of the central ideas common to all of them will be presented here. Reviewing this brief discussion will help you to understand what is going on in your family and how it could be changed.

      From a systems perspective, a family is considered to be a system whose members are interdependent. This means that each member of the family can function independently, but they also turn to one another for support and can have effects on one another. Each family can also have several subsystems that have generational links and boundaries, communication networks, coalitions and alliances, rules, secrets, myths, and rituals.

      The important or key dimensions and terms include:

      1. Adaptability: whether the family is flexible, as opposed to chaotic or rigid, in its functioning and its ability to adapt in order to effectively handle problems as they arise.

      2. Cohesion: to what degree the family sticks together and is interdependent, as opposed to being disengaged (i.e., too cut off) from each other or enmeshed (i.e., in each other’s business, codependent, or enabling).

      3. Family Communication: how well the family communicates with each other, which can facilitate their adaptability and cohesiveness.

      4. Dynamics: how the system interacts, including patterns and the effects of one’s actions on the rest of the system and individual members.

      5. Interaction Patterns: related to dynamics. This is how the family members interact with each other. Boundaries, family rules and roles, and nonverbal behavior (e.g., whether closed doors are respected) are important here.

      Interaction patterns can involve triangles (a third person intervening to referee a conflict), stable coalitions (two members repeatedly aligned against a third), detouring coalitions (two agree on identifying a third as the source of the problem, which can give others an impression of harmony), triangulation (two members both insist that a third member side with him or her), and splitting (playing two people against each other). In the triangulation scenario, the third member asked to be aligned with two others may develop symptomatic behavior as a result of the conflict of being pulled in two different directions. Boundaries are important here as well (as they are in cohesiveness), and can be either too rigid (blocks interaction between members) or enmeshed (overly open, in each other’s business, codependent, or enabling).

      6. Homeostasis: what a family system does to keep functioning “normally”—in the same way it has always functioned, for better or worse (i.e., functional or dysfunctional). For example, dysfunctional families often work hard to keep family secrets from being revealed by creating unspoken rules such as “Don’t ask; don’t tell.”

      Thus, a healthy family system is one that is flexible or adaptable, has a well-defined structure, and is cohesive. Healthy families can therefore accommodate changes in the roles and functions of individual members, family subsystems, and the entire family unit. Also, healthy families can accommodate changes within the sociocultural context. By contrast, dysfunctional families have a limited capacity to cope effectively because of rigidity or chaos in their functioning and structure, unhealthy alliances and power balances within the system, and persistent boundary problems.

      Before Jim’s injury, he was the breadwinner, Mary was the mom and homemaker, and the kids were unruly teenagers. Their level of adaptability was limited, and much chaos ensued in the family system after Jim was hurt. Their communication skills were limited, so they couldn’t make sense of the enormous changes. Most of the family rules in that household were unspoken, and after a while no one talked with anyone about what was occurring. Mandi escaped from the environment with relief when she went off to college. Ross started using pot, and his grades dropped. Mary could barely keep her head above water, and just let it happen; she felt she had no choice.

      As Amy became less functional, Chris became more and more isolated—from her and from others. He was terribly embarrassed by Amy’s limitations and behaviors, so he stopped calling and interacting with friends. Whereas previously they were a balanced, self-assured couple, the two of them became more enmeshed, and because of her progressive drug dependence, she became totally dependent on him for any support.

       {exercise} 2.2

       Identifying Effects of Chronic Pain on Your Family System ___________

      1. Describe your family’s functioning in terms of the following (refer to the definitions provided in the previous section):

       ADAPTABILITY

      (Circle the word that best describes how adaptable your family is.)

      Rigid Flexible Chaotic

       COHESIVENESS

      (Circle the word that best describes how well you stick together.)

      Disconnected Interdependent Enmeshed/Codependent

      INTERACTION PATTERNS (Are there any of the following?)

      Triangles Coalitions Triangulation Splitting

      BOUNDARIES (Circle the word that best describes how boundaries are within your family.)

      Rigid Flexible Chaotic Nonexistent

      FAMILY ROLES (Describe the roles that each of your family members plays.)

      ______________________________________________

      ______________________________________________

      ______________________________________________

      ______________________________________________

      ______________________________________________

      ______________________________________________

       FAMILY RULES

      (Describe any rules that control the actions of family members. How have the rules changed?)

      ______________________________________________

      ______________________________________________

      ______________________________________________

      ______________________________________________

      ______________________________________________

      ______________________________________________

      2. Describe how the family responded when _______________ was first injured or developed pain problems.

      3. As _______________’s pain became chronic or unchanging, how did the family seem to respond?

      4. Comparing how things are now (refer to your answers to the first question in this exercise) to how your family functioned before the onset of _______________’s chronic pain problems, describe the most noticeable differences.

       Codependent