copyright 2008 Cheryl K. Hosken, BSN, MS Psych.
The family is the basic unit of social order in most of the world. This is not surprising, since God created man and woman to live together and mutually support one another. Genesis 2:20-25 tells us how God feels about marriage, and this same instruction was preached by Christ (Matthew 19:5-6, Mark 10:7-8) and the apostles, especially Paul (1 Corinthians 6:16, Ephesians 5:25-31). The family structure provides stability and strength as well as providing for human needs. Through families, the race reproduces itself and offspring are nurtured. Children are protected, housed, fed, and educated. They also grow to be social beings through family ties and the affection shown them by their parents. The feeling of belonging comes from related goals and shared convictions of kindred groups.
Family patterns and dynamics have changed with cultural systems. Clans and tribes have been replaced by systems of government for protection and education. Often the interdependency of a large family has been replaced when children move to larger cities for education and employment. Children have been raised outside the family since their mothers are working. Most people today live in urban centers and their family ties are not as close as they have been in the past. There are usually smaller families and a small group of friends in large cities.
However, through family nurturing children build the personal strength needed to adjust to life's complications at whatever age. This also means disability. Understanding how the family influences its members is essential for diagnosis, counseling, and rehabilitation planning. What happens in a family greatly affects the outcome of rehabilitation. Developing work habits through family chores is an important part of assuming responsibility in later life and also affects a person's recovery from injury.
Agricultural life with extended family offered opportunity to contribute through all kinds and levels of work activity. Children helped as well as impaired and aged kinfolk: there was work for the cousin with Down Syndrome, the alcoholic uncle, and the aged grandmother. The dependent members of the family were accepted and helped by the able-bodied members of the family. The family included those who were aged and "different". There was a communal atmosphere. There are a few communal Christian groups in Europe and America known as the Bruderhof. In these communities, everyone has a job, even the elderly and the disabled.
Meditate Word By Word On These Verses:
1 Tim. 5:4-8.
Due to changes in society, there are now professional resources for the family having problems. Governmental agencies offer education on family care. Marriages are disrupted by disability. The interrelationship between the problems of disability and marriage may bring a couple to a marriage counselor. The marital relationship of a client has special meaning to us since family support and involvement are often critical to readjustment. Rehabilitation involves the whole family, but the critical relationship is between husband and wife.
Marital Counseling
This is the process of helping a couple before they marry or resolving problems after they are married. There are a variety of people who counsel including psychologists, religious counselors, and physicians. Marital, family and sexual counseling is not readily isolated into marriage, family or sexual adjustment. Counselors try to work with the family unit and may include other members of the family because poor functioning in one area affects the whole family unit. In fact, other family members may be the cause or contribute to marriage problems.
The purpose of marital counseling is to assist couples in maximizing their strengths and resources to cope with crises and stresses. One of the large obstacles in marriage when disability happens is that expectations from the husband and wife are not met. For example, a wife may be able to adequately work and care for the home. Then as she retires from her job, her husband has a stroke. The expectation of living at the summer cottage and enjoying life without the pressures of a job is gone. The wife may become the caregiver of an invalid husband, and this is not her view of the future. This may cause anger: anger at her husband for being sick, anger because of the extra work she does, frustration at not being able to go out of the house when she desires, etc.
As a couple meets with the counselor, the problems are identified and goals are set for solution during the first session. Agreement between husband and wife on the purpose of counseling helps avoid conflict in subsequent sessions. The most frequent presenting problems are lacks in interpersonal communication, infidelity, sexual difficulties, disciplining of children, physical abuse, alcoholism, and finances. The counselor tries to involve both individuals and gain perception and agreement about what are the major problems are listed earlier.
Marriage counseling usually requires a series of sessions. However, a single meeting may result in enough insight and improved communication so that a couple carry can on without help. All too often, counseling begins too late and the marriage is not saved.
Clients come to the counselor filled with emotion: anger, fear, dejection, or anxiety. Negative feelings should be reduced before constructive work on problems begins. Often these sessions are focused on crisis. The first task is to help the couple discuss their problem. One solution is to teach communication techniques as we discussed earlier in this course: active listening, etc. Spouses may be seen individually or together, and in groups with others. The counselor himself/herself is a model of communication skills for the couple.
1. What is the goal of marriage counseling?
(Only one of the following answers is correct.)
a. to solve a problem between a husband and wife,
b. to help a husband and wife understand one another better and to solve problems,
c. to identify the problem between them.
There are many approaches to counseling a couple and they include:
- acceptance of client feelings and actions without censure,
- recognition and encouragement of positive efforts and improvements,
- clarification of feelings - asking the client if he feels anger because his physical abilities are limited,
- interpretation that leads to insight of behavior,
- suggestions for alternative courses of action,
- structuring for focus and setting priorities between the couple,
- information on factual matters - budgeting, anatomy of the body, psychological needs.
A counselor may use bibliotherapy (assigned reading of a book), audiovisual tapes of the couple interacting, or behavioral techniques to help a couple.
2. Acceptance of a client's feelings means:
(Only one of the following answers is correct.)
a. letting him talk for hours,
b. accepting that he has many feelings that he may not understand,
c. listening to his feelings and his frustrations so that he rids his mind of them.
Counseling a Family With a Disabled Person
Disability creates problems for the family. The tranquility of family life is strained and sometimes torn apart by the emotions the disability causes - anxiety, guilt, hostility, unexpressed fears, and anger. When these feelings can be expressed by all the family members, everyone will benefit.
The family has a direct influence on the attitudes and behavior of the handicapped person. In fact, family relationships may determine the outcome of rehabilitation. Successful rehabilitation rarely takes place without active participation of the family. And it is obvious that some families of disabled persons need professional help in understanding the handicapped person. Family is especially important when a handicapped person is changing to different therapies (such as being discharged from the intensive care unit to a regular floor for further treatment) or having surgery. The family can participate and learn to care for their handicapped member. Sometimes relationships within the family are so disturbed that rehabilitation is slowed. These conflicts need to be resolved so that the disabled person has a life outside the hospital setting.
Family Reaction to Trauma
Just as a traumatic event usually strikes the person without warning, the family is also poorly prepared for the event and it consequences. The family's reactions are almost parallel to those of the disabled person. The accident or disability has multiple effects on the family. Financial resources are strained and if the husband is disabled, his wife may have to become the financial provider for the family. Income will be decreased and adjustments made to a different lifestyle. Former patterns of decision-making may change since the disabled person may not be able to make good decisions. The purposes for family: rearing of children, providing emotional support, and maintenance of home, now mean a change in the whole family group.
3. The family has a positive influence on the outcome of rehabilitation when:
(Only one of the following answers is correct.)
a. the family shows its acceptance of the person with disability,
b. the family is the main support of the disabled person,
c. the disabled person feels he can depend on his family for emotional and physical support.
There are four stages that a family may have in adjusting to disability. Not every family experiences these four stages, but there may be some experiences they have that are similar to the ones below:
1. The Acute Stage
In this stage, the family may be in a panic after the accident or injury. They begin to realize the long-term implications that this disability will have on their lives. The family may turn to those who promise easy answers or fall prey to exploiters. During this time, a routine needs to be followed because routine gives people a sense of meaning and direction. Also, the rehabilitation team needs to start its work with the injured person as soon as possible. At this stage, most family members cooperate and work with one another to meet the challenge of caring for the disabled.
2. Reconstruction Stage
This is the period when the disabled person tries to recover as much of his physical function as possible. This may include doing surgery, different types of therapies, and counseling. It is at this time family members become more realistic in their assessment of their family member's abilities. Perhaps the details of future life become more clear: confinement to the home, limited physical capacity, and social isolation.
The disabled person also begins to realize that his status in life has changed. He may want to withdraw from the world. However, the rehabilitation team needs to help him discover what he can do and how he can contribute to family life. The family and disabled person need motivational help to recover as much as possible of what has been lost. There will be barriers to overcome.
3. Plateau Stage
When all possible constructive means have been done, the disabled person enters a plateau stage. The life goals are now to maintain the physical strength the person has and compensate for the skills or strength lost. This stage may be the most difficult for the family because there now is little hope for improvement, finances may have decreased, and emotional support is weakened.
If the person is confined to the home, the caregiver must give of his/her own mental and physical strength for the disabled. Sometimes the caregiver does not give enough attention to his own life and sacrifice his own health. Sometimes there is tension between the caregiver and the disabled person because of frustration over the unchanging situation. When this happens, perhaps the rehabilitation worker can suggest a few changes that may break the tension. For example, the disabled person needs to be taught to do as much as he can for himself. If he needs a drink of water at night, the caregiver can put a glass of water at his bedside so that the caregiver's sleep is not disturbed.
4. Deterioration Stage
This stage may be the termination of a disabled person's life or simply giving in to demands of other people, not trying to be responsible in doing the activities he can do. He may have complications of his disability that make his health worse or simply give up the desire to be part of life and exist in his own little shell. If all decisions are made for him, the family may unknowingly encourage this stage of dependency. They often do not realize that complete dependency causes more work for themselves.
4. The plateau stage of adjustment to disability is:
(Only one of the following answers is correct.)
a. when a person relaxes at home,
b. when the disabled person has done all he can do to recover from his illness,
c. when he travels on the steppes of Russia.
Client's Responsibility to the Family
The disabled person needs to understand how others of his family feel. He should try to put other people at ease and not demand a greater amount of attention than he needs. Also, other family members may have guilt feelings about the disabled person's situation - guilt because the disabled person is disabled and not they themselves. The disabled person can help these people by not bemoaning his condition to them and by engaging them in conversation that does not always center around the disability.
Also, if a client is inconsiderate of others in the family, the rehabilitation worker needs to intervene to stop behavior that is destructive to the family members. This work between the family and disabled person should start early after the injury so that people are more perceptive and sensitive about their relationship with one another.
Basic Needs
The disabled person and his family have basic needs that must be answered if the family and the person is to survive. They are:
EDUCATION - This is obvious, but cannot be stressed enough. Questions need to be answered and they need to know as much about their disabled family member as they can. They need factual information, definition of medical terms, clarification of what is known, and what to expect. If there is new information or new products to help the disabled person, we should be a source of that information.
EMOTIONAL SUPPORT - This does not mean pity, it means giving the family an opportunity to express feelings and have someone understand what they are living through. As a rehabilitation worker it will be one of the most difficult tasks to do.
IDENTIFICATION OF REALISTIC ALTERNATIVES - Emotional involvement of the family can obscure judgment and logic. Rehabilitation workers need to listen to what the family wants to do, evaluate that information and give feedback on the question the family has. For example, a family may consider some type of new curative treatment, the rehabilitation worker can ask questions about the cure rate, the cost of treatment, and how long the curative treatment lasts. These questions might help the family members to not just accept the offered cure, but to evaluate its potential results and whether it is worthwhile to spend extra money on the offered cure.
NEEDED SERVICES - Chronic problems or disability will always need ongoing assistance. This may mean an extra caregiver from outside the family, extra treatments by other medical personnel, and transportation. In most countries these problems are not new. This is where the Church can have a ministry of love and care.
5. The disabled person has responsibility to his family for:
(Only one of the following answers is correct.)
a. treating them with respect and consideration,
b. helping himself as much as he can within his limitations,
c. learning about how to care for himself.