CARING FOR SELF AND OTHERS: THE CRITICAL CHALLENGES FOR PARENTS TED BOWMAN FAMILY AND GRIEF EDUCATOR

Transcription

1 CARING FOR SELF AND OTHERS: THE CRITICAL CHALLENGES FOR PARENTS TED BOWMAN FAMILY AND GRIEF EDUCATOR

2 FAMILY AS EDUCATOR The family is an arena in which virtually the entire range of human experience can take place. Warfare, violence, love, tenderness, honesty, deceit, private property, communal sharing, power manipulation, informed consent, formal status hierarchies, egalitarian decision-making - all can be found within the setting of the family. And so, also, can a variety of educational encounters, ranging from conscious, systematic instruction to repetitive, moment-to-moment influences at the margins of awareness. Moreover, since almost everyone has had profound experiences within one or more families, judgments of the family are often deeply felt and charged with emotion. Leichter

3 FAMILY SYSTEMS: RESEARCH AND THEORY BASIC PRINCIPLES THE WHOLE IS GREATER THAN THE SUM OF ITS PARTS EVERY PART OF A SYSTEM AFFECTS AND IS AFFECTED BY EVERY OTHER PART OF THE SYSTEM INTERDEPENDENCE / INTERRELATED

4 FAMILY SYSTEMS CONTINUED ATTENTION TO AND UTILIZATION OF A FAMILY SYSTEMS APPROACH DOES NOT REQUIRE ONE TO SEE WHOLE FAMILIES. SUCH AN APPROACH MEANS THAT ONE MUST THINK ABOUT SYSTEMS AND THEIR IMPLICATIONS EVEN WHEN WORKING WITH ONE OR FEW MEMBERS OF THE FAMILY.

5 PRODUCTS OF FAMILY SYSTEMS THEORY AND PRACTICE AWARENESS OF HIERARCHIES BOUNDARIES COALITIONS AND TRIANGLES OPEN AND CLOSED SYSTEMS

6 FAMILY SYSTEMS: STILL MORE INTRA - WITHIN THE HOUSEHOLD UNITS OR WITHIN THE WHOLE FAMILY SYSTEM INTER - BETWEEN SYSTEMS: DIFFERING HOUSEHOLDS AND BETWEEN A FAMILY AND OTHER SYSTEMS, e.g.,medical AND MENTAL HEALTH PROVIDERS WHOLE PERSON: MIND, BODY, EMOTIONS, SPIRIT

7 HOW TO APPLY? WHO IS NOT AT THE TABLE THAT SHOULD BE? HOW WILL YOU SHARE THIS INFORMATION WITH OTHER FAMILY MEMBERS? WHO IS THERE FOR YOU? WITH WHOM CAN YOU SHARE THIS? HOW DOES YOUR FAMILY MAKE THEIR BEST DECISIONS? WHAT VALUE/BELIEF OR PERSON IS INFLUENCING THIS DECISION? TELL ME ABOUT ASKING FOR HELP IN YOUR FAMILY.

8 FAMILY FACTORS AND ILLNESS KIND OF ILLNESS Possible vs. Probable vs. Inevitable Loss Threat of: Death vs. Disability vs. Suffering Physical vs. Cognitive Loss STAGE OF ILLNESS STAGE OF FAMILY / INDIVIDUAL LIFE CYCLE MULTIGENERATIONAL EXPERIENCE WITH ILLNESS/LOSS/ADVERSITY John Rolland FAMILY BELIEF SYSTEMS

9 SIGNS OF HEALTH IN FAMILIES communicates and listens affirms and supports one another teaches respect for self and others develops a sense of trust exhibits a sense of shared responsibility rituals and traditions abound has a shared religious/spiritual core admits to and seeks help with problems From many sources

10 GOOD PARENTING 1. What you do matters 2. You cannot be too loving 3. Be involved in your child's life 4. Adapt your parenting to fit your child 5. Establish rules and set limits 6. Help foster your child's independence 7. Be consistent 8. Avoid harsh discipline 9. Explain your rules and decisions 10. Treat your child with respect Steinberg

11 FAMILY RESILIENCE Family Belief Systems making meaning out of adversity positive outlook transcendence and spirituality Organizational Patterns flexibility connectedness social and economic resources Communication Processes clarity open emotional expression collaborative problem solving Walsh

12 GRIEF IS A WHOLE BODY RESPONSE TO LOSS: EMOTIONAL COGNITIVE SPIRITUAL VISCERAL L O S S REFERS TO BEING DEPRIVED OF OR CEASING TO HAVE SOMETHING THAT ONE FORMERLY POSSESSED OR TO WHICH ONE WAS ATTACHED

13 FACTORS THAT EXACERBATE LOSSES LOSS OR STRESS ACCUMULATION/OVERLOAD LOSS OF CONTROL OR POWER LOSSES WHICH BREAK NORMATIVE RULES LOSSES WHICH VIOLATE "MORAL" EXPECTATIONS LOSSES WHICH REINFORCE OR PRECIPITATE FAMILY CONFLICT DISENFRANCHISED LOSSES LOSSES WHICH CONTINUE TO REQUIRE ADJUSTMENT AFTER ONSET AMBIGUOUS LOSSES LOSS OF DREAMS

14 AMBIGUOUS LOSS PSYCHOLOGICAL PRESENCE AND PHYSICAL ABSENCE PHYSICAL PRESENCE AND PSYCHOLOGICAL ABSENCE Pauline Boss

15 DIALECTICAL INTERVENTIONS When working therapeutically with families facing ambiguous loss, the both/and approach is essential. In the absence of clear information, we cannot say, for example, that a person is disabled or not, or psychologically here or not here. With both/and thinking, people can understand more easily that a loved one with cerebral palsy is both normal and living with disabilities Such situations call for dialectical interventions Whatever your clinical discipline, I recommend the both/and approach for finding meaning, as there may be no other way to gain the resilience needed to deal with ambiguous loss. Boss adapted by Bowman

16 PSYCHOLOGICAL FAMILY A PSYCHOLOGICAL FAMILY IS COMPRISED OF THOSE PEOPLE WHO ARE THERE WITH CONTINUITY OF SOCIAL SUPPORT. BECAUSE MANY FAMILIES ARE NOW SPREAD FAR AND WIDE (GEOGRAPHICALLY AND EMOTIONALLY), THE CREATION OF PSYCHOLOGICAL OR SURROGATE FAMILIES IS MORE COMMON.

17 CONFLICT OCCURS WHEN TWO OR MORE PEOPLE DIFFER AND AT LEAST ONE OF THEM THINKS IT MATTERS. HOW PEOPLE RESPOND TO CONFLICT: ESCALATION UNDERGROUND CONSTRUCTIVE JOHN CONBERE

18 TWO KINDS OF CONFLICTS TASK CONFLICT - ABOUT FACTS, PROCESS, HOW TO DO THINGS IN THE BEST WAY EMOTIONAL CONFLICT - ABOUT FEELINGS, ANGER, JEALOUSY, FEAR

19 APPRECIATIVE INQUIRY ASSUMPTIONS In every family, some things work well. What we focus on becomes our reality. Asking people questions influences the group. People have confidence in the journey to the future when they carry forward parts of the past. If we carry parts of the past into the future, they should be what is best about the past. It is important to value differences. The language we use creates our reality. Families are heliotropic. (botanical term - plants lean toward the sun. Families lean toward the source of energy whether positive or not) Outcomes should be useful. All steps are collaborative.

20 SHATTERED DREAMS LOSING AN EMOTIONALLY IMPORTANT IMAGE OF ONESELF, ONE'S FAMILY, ONE'S LIFE, ONE S WORK, EVEN ONE S DEATH LOSING THE POSSIBILITIES OF "WHAT MIGHT HAVE BEEN" ABANDONMENT OF PLANS FOR A PARTICULAR FUTURE THE DYING OF A DREAM

21 SHATTERED DREAMS AND CHRONIC CONDITIONS the dream of health a healthy life body image the dream of continuity the dream of how a home should be the dream of caring for others the dream that the couple/family relationship could withstand any stress or challenge the dream of the "normal life" the specific dreams related to career, to travel, retirement, education, etc.

22 INQUIRIES ABOUT SHATTERED DREAMS When you pictured this time in your life, what did you picture? When you thought about being, what did you picture? If and when you thought of losses in your family, how did you think it would be, how would it happen? What was your early picture of dementia? Tell me about the plans you and (the name of the person had?

23 SIBLINGS AND DEVELOPMENTAL DISABILITIES 1. Explain facts about your child s condition and what caused it to well-siblings. It s okay to say, I don t know how this happened. 2. Reassure children that they won t catch their sibling s condition. 3. Keep communication open. Have periodic family meetings to get a handle on everyone s feelings. 4. Give megadoses of love. 5. Acknowledge and accept the well-siblings feelings, even the negative ones. Let family

24 6. Allow the child to have time and space for himself away from his affected sibling. 7. Stop harmful behavior between siblings. 8. Spend special time with your well-sibling. 9. Find sibling support groups, peers, counselors, friends. 10.Maintain normalcy. For example, let the youngest be the youngest. Establish routines that are your normalcy. 11.Expand social behavior options when with the child with special needs. Adapted by Ted Bowman from recommendations in Special kids need special parents (2001) by Judith Loseff Lavin. New York: Berkley Books, p. 57.

25 UNUSUAL CONCERNS OVERIDENTIFICATION EMBARRASSMENT GUILT ISOLATION, LONELINESS, AND LOSS RESENTMENT INCREASED RESPONSIBILITIES PRESSURE TO ACHIEVE

26 UNUSUAL OPPORTUNITIES MATURITY SELF-CONCEPT AND SOCIAL COMPETENCE INSIGHT TOLERANCE PRIDE ADVOCACY LOYALTY From Sibshops by Meyer and Vadasy

27 STORYING AND RESTORYING INVOLVES GRIEVING THE OLD STORY BEFORE CREATING THE NEXT (NOT NECESSARILY NEW) STORY ---- LISTEN FOR MAJOR COMPONENTS/THEMES/VALUES OF THE OLD STORY HOW CAN THEY BE REFRAMED IN THE NEXT STORY

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29 FORMS OF SOCIAL SUPPORT EMOTIONAL INFORMATIONAL TANGIBLE/INSTRUMENTAL SPIRITUAL ESTEEM LINKAGE TO COMMUNITY/ RESOURCE

30 HOPE INCLUDES A FUTURE STORY HOPE INCLUDES A SHARED STORY HOPE INCLUDES STORIES OF MEANING HOPE INCLUDES AN AFFIRMATIVE STORY HOPE INCLUDES THE REAL STORY

31 HELPER CARE To me, the practice of a healer, therapist, teacher, or any helping (person) should be directed towards him or herself first, because if the helper is unhappy, he or she cannot help many people. We practice enjoying the positive elements in life in order to nourish the flower in us, and we practice in order to transform the seeds of suffering in us. Otherwise, we cannot succeed in our work helping other people. Thich Nhat Hanh

32 COMPASSION FATIGUE SEEMS TO HAVE MORE TO DO WITH THE AGENDAS WE BRING (CHEER UP, MAKE IT BETTER, IMPOSED TREATMENT PLANS, LIFT THE SPIRITS) THAN THE STORIES WE HEAR

33 RESPONSES TO THE STRESS OF COMPASSION FATIGUE 1.self-care 2. nurturing activities 3. escape 4. recognition (formal and informal - spontaneous and planned) 5. talking about it/being heard 6. taking something off your plate (assuming your plate is full)

34 ADDRESSING EROSION OF THE SPIRIT 1. Create meaning/maintain the value-based reasons for what you do 2. Infuse a current activity with meaning (find resiliency, hope, plant seeds, be human, do your best) 3. Recognition (formal and informal - spontaneous and planned) 4. Challenge your negative beliefs and assumptions(e.g. nihilism, cynicism, and despair) 5. Participate in community-building activities, especially in workplace teams or groups, formal and informal

35 S T R E T C H E D PRACTICAL SUGGESTIONS SELF-CARE (respite, sleep, good food, body care, exercise) ROUTINELY ENGAGE IN NURTURING ACTIVITIES (music, nature, things of beauty) ESCAPE (books, hobbies, friends who don t talk about caregiving) RECOGNITION (cultivate friends and professionals who give up feedback) TALK ABOUT IT/BE HEARD ASK FOR HELP MULTIPLY CHOICES (be creative, seek creative options)

36 S T R E T C H E D More Suggestions MAKE DECISIONS WITH BEST INFO AT THAT TIME AND THEN MOVE ON ENGAGE IN SPIRITUAL PRACTICES SO NO TO SOME THINGS SO THAT YOU CAN YES TO OTHERS CHALLENGE NEGATIVE BELIEFS AND ASSUMPTIONS PLAN AHEAD (advanced directives of all kinds) PARTICIPATE IN COMMUNITY BUILDING ACTIVITIES

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