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Family Wellness and Recovery presentation

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Tom Pyle

on 26 March 2013

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Transcript of Family Wellness and Recovery presentation

Family Wellness & Recovery Presentation for
Institute of Wellness and Recovery Initiatives Tom Pyle
Family Member Family "Lived Experience": 6 stages The
“Awareness
Spiral" 2. Storm Instability, Recurrence
Anger, Grief, Loss
Questing
Depletion ($)
Dissatisfaction
Stigmatization 3. Drift Regain “control”
Manage feelings
Change expectations
Manage symptoms
React --> Act 4. Realignment Develop expertise
Increase supports
Manage better
Share with others
Maintain control
Navigate The System 5. Mastery Empowerment
Advocacy
Transcendence 6. Growth Exacerbation
Confrontation
Distress
Suppression
Depletion Concern Alarm! Help-
seeking Negation Recognition Family Wellness and Recovery A presentation for
Institute for Wellness and Recovery Initiatives Tom Pyle
Family Member Family Burden 1. Warning
2. Storm
3. Drift
4. Realign
5. Mastery
6. Growth History of What Some Thought... The Schizophrenogenic Mother 1845: SMI as brain pathology (Griesinger)
1896: Dementia praecox: organic (Kraepplin)
1911: SZ as autism (Bleuer)
1913: SZ as hereditary (Freud)


1931: American psychiatrics break away

Harry Stack Sullivan:

SZ: from painful early relationships
Maternal behavior causality
Contrary to Freud’s biological basis The Schizophrenogenic Mother Frieda Fromm-Reichmann

Established rapport with those with SZ
"Insight therapy"
The SZ pathogen: “environmental” Mother of the Schizophrenogenic Mother 1950s: chlorpromazine (Thorazine)
1980s: clozaril
1990s: “atypicals”

Positive symptoms addressed
Fewer side effects
Expectations change Pharmacological advances Psychoanalysis emphasized, then discredited
Transference out; collaboration in
Trust; therapeutic alliance
Skills development emerges

Psychoeducation
Behavior tailoring
Relapse prevention
Coping skill training Psychosocial developments 1990s: Psychiatric Rehabilitation

Out: training, treating, changing

In: inclusion, integration, normalization, resilience, strengths- based, recovery, hope

Patient-centered services
Skills and supports development
Early engagement
Integration with clinical services
(One goal: Better relationships with families) Psychosocial, 3 1. Warnings 1960s: Rise of biopsychiatry

Neuroleptic medications
Family “balance of power”
Women’s liberation movement
Civil Rights movement

1967: Transmission of SZ Conference
Hereditary basis Etiology: Coming to the light… Family work
Education, support, coping
Evidence-based results:
Reduced anxiety, less stress,
fewer relapses, less hospitalization

Comorbidities
Integrated modalities
Outreaches Psychosocial, 2 1. Empathize with families.

2. Recognize what families want and need.

3. Learn how to support families.

4. Help families help their loved ones.

5. Teach families how help themselves. Objectives Getting Started... ...the impact on the family is like… What happens when ill child has children?

Custodial, co-resident, nonresident…
Child’s exposure to mother’s illness

Financial impact
Isolation
Role conflicts
Divided loyalties Grandparents (Seeman, 2009) One step removed…

Reactions to illness
Strategies for coping
Whether, how to intervene?
Setting limits?
Resentment, anger, hopeless?
Efforts to obtain services
Wish for validation
Efforts to help themselves Siblings (Lukens, Thorning & Lorher, 2002) Reflection on roles
Devastation and vulnerability
Sadness and loss
Frustration with the system
Admiration for the child
Personal growth and learning Fathers (Wiens & Daniluk, 2009) Feelings
Powerless, voiceless, anxious, frustrated, isolated, tired, desperate, trapped, guilty, worried, scared, sad, grief, confused

“Internal factors”
Sense of safety
Perception of care ability
Contingencies and consequences
Maternal love and obligations Mothers (Copeland & Heileman, 2011) law, mental health practitioners, and often the ill person reject their right to do so.” Disenfranchisement

“When parents try to assume responsibility for an ill adult-child with schizophrenia, the Overall (Milliken & Northcott, 2003) Acknowledge; connect; engage

Offer coping mechanisms

Comprehensive involvement at discharge

Instill hope Providers: How to help?
(Clarke & Windsor, 2010) Ways of Coping Meaning

Support

Validation

Information

Balance Needs (Power & Dell Orto, 2004) Denial
Grief
Guilt
Isolation
Anger
Depression
Coping
Acceptance Effects: 8 “themes” (Power & Dell Orto, 2004) Threat

Incapacity

Fear

Discomfort

Disequilibrium Characteristics of those in crisis The Family Crisis Moment Needed… Information!
Medications
Symptoms
Resources
“Everything!”

Where?
Support groups
Education programs Wanted from professionals…
(Doornbos, 2001)
Understanding of family impacts

Inclusion in treatment planning

Understanding of family time devoted

Understanding of family frustration Effects of the Lived Experience Components of Wellness Modalities Family education (FE)

Family psychoeducation (FPE)

Family consultation (FC)

Family therapy

Family self-care Disability Philosophy Traditional view: Tragedy
Debilitation
Chronicity
Families at fault

Modern view: Opportunity
Enjoy life
Affirm values
Determine lifestyle So… Disability: whose definition?

Tragedy  Opportunity

Adapt & Assist Critical Issues Marital matters
Sibling reactions
Substance abuse
Work deterioration
Financial pressures
Diminishing social support
Changed lifestyle prospects
LT endurance FPE: A Behavior Management Model
Education

Communication training

Problem-solving training

Coping techniques training Pyramid of Family Care
(Mottaghipour & Bickerton, 2005) Family Psychoeducation SAMHSA'S 8 Dimensions of Wellness Modalities to Wellness So, in conclusion... www.psychodyssey.net General systems theory (Boulding, 1956) Psychodynamic
Group of interlocking individual psychodynamics at different stages
Family
Independently operating units from which individual pyschodynamics
General
A system with things similar to all other systems, within hierarchies, e.g. civilizations  societies  individuals  psyches, etc.
Cybernetic
System of circular information flow and regulatory mechanisms
Ecological
“Co-evolutionary ecosystem in an evolutionary timespace” Family systems: 5 paradigms (Auerswald, 1987) Reduce anxiety by…
Understanding how family systems work
Increasing “differentiation”

8 Elements
Fusion and Differentiation
Triangles
Nuclear Family Emotional System
Family Projection Process
Emotional Cutoff
Multigenerational
Transmission Process
Sibling Positions
Societal Evolution Bowen Family Theory (Brown, 1999) When the illness comes... 2013 Walk: May 18
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