By Lynn McDonald, MSW, PhD
University of Wisconsin-Madison
Family stress theory sets forward acute stressors (meaning sudden onset) which when accumulated could lead to family crises, including physical, emotional, or relational crises. Examples of such family crises resulting from family stressors are episodes of domestic violence, substance abuse (relapses), illness from weakened immune systems, divorce, accidents, children being abused, or neglected, etc. The research on stress suggests that significant factors about the stressors to keep in mind are:
the changes in daily routines,
the number of changes in daily routines,
the length of time since there were changes in daily routines, (i.e. the family stressors);
However, their impact can be muted, or buffered with protective factors which help families to survive multiple contextual stressors, and to continue to competently parent despite chronic and acute stressors. These protective factors (Hill theorized that there were basically two of them) buffer the impact of the stressors, and one includes social relationships (B Factor) and the other includes perceptions (C Factor). Social relationships are further distinguished as being within family variables, e.g. attachment, positive family bonds, effective communication, as well as across family variables: i.e. social isolation vs. informal and formal social support networks; Perceptions (C Factor) include the range in cognitions and attitudes between hope and personal effectiveness vs. despair, and helplessness. These two complex factors relate together with the acute stressors and ongoing social context of chronic stressors, to predict family crises.
Hundreds of studies have documented the positive relationship between illness and stress. Individuals who experience too many stressors at one time, i.e., too many changes in their daily routines and circumstances, are at increased risk within one year for having an accident, for becoming physically ill (Ell, 1984), for having an impaired immune system, for becoming violent, or for relapsing (Pianta, Egeland and Sroufe, 1990; Rutter, 1983). Not only individuals, but families that experience too many stressors at one time are at increased risk for experiencing aggravated family crises. However, not ALL families with multiple stresses have crises. Why not? What are the factors which protect a person or family unit from having a family crisis.
Professor Reuben Hill's theory of family stress was formulated after the Great Depression (1947, 1959, 1983, University of Minnesota) based on extensive observations of families who survived contrasted with those whose families did not. Given the economic circumstances of families of today's high risk youth, his theory may have some currency for us. As Hill interviewed families who had lost their jobs and were existing in extreme poverty, he looked for factors which contributed to family survival of these circumstances. From these qualitative data, Hill theorized that there are two complex variables which act to buffer the family from acute stressors and reduce the direct correlation between multiple stressors and family crisis. These were formulated into what he called his ABCX theory of family stress (see Figure I; and Wikler, 1983, for further discussion).
The "B" variable refers to the complex of internal and external family resources and social support available to the family, i.e., the social connectedness within the family, as well as social connectedness outside the family. Hill theorized that social isolation would significantly increase the impact of the multiple stresses on the family functioning; in contrast, positive social supports would minimize the impact. Hill's "C" variable, the perception factor, was the second predictor of the extensiveness of the impact of stress on the family. This second complex factor referred to the shared family cognition and perceptions held about the stressors, e.g., the extent to which the family perceived the changes as a disaster vs. an opportunity. Hill suggested that some families had positive appraisals which they could make of changes, which increased their ability to accept their circumstances. Hill's family stress theory has been significantly expanded upon by McCubbin et al. (1983).
HILL'S ABCX MODEL OF FAMILY STRESS
(B) Internal Family Resources &
Informal/Formal Social Supports
Family (A) ----------------------------------------------------------------- > Family Crisis (X)
(C) Family Perception &
Research studies have since offered support for Hill and McCubbin's theoretical constructs. The combination of high stress with social isolation (the "B" variable) for families has been highly correlated with many forms of dysfunctional family outcomes (Garbarino and Abramowitz, 1982; Belle, 1980; Cyrnic, Greenberg, Robinson and Ragozin, 1984; Egeland, Breitenbucher and Rosenberg, 1980; Ell, 1984; Lindblad-Goldberg, 1987; Marks and McLanahan, 1993; Simons, Beaman, Conger and Chao, 1993; Tracy, 1990; Wahler, 1983). Hill and McCubbin consider the lack of "B" and "C" variables as similarly potent and equally predictive of a family crisis. If a family experiences multiple stressors AND 1) they are socially isolated and emotionally disconnected to one another, AND 2) they are depressed, hopeless, and disempowered, THEN they will be at increased risk for illness, accidents, child abuse and neglect, and substance abuse, delinquency and school failure (Attneave, 1986; Belle, 1980). With a positive set of cognitions, an empowered attitude, and an active informal and formal support network, there would be a reduction in the likelihood that the stressful life experiences would result in a family crisis.
ASSESSING HILL'S "B" AND "C" FACTORS AS PROTECTIVE FACTORS
Family based prevention research for children at risk for neglect could increase our understanding of the definition, the development, and the maintenance of Hill's two complex protective factors: the "B and "C" factors. We can assume that the family of each high-risk youth involved in a prevention program has experienced multiple chronic and acute stresses; how do these interact with the protective factors for families? How do these two variables modify the impact of the stressors on parental functioning? What is the interactional process of the two factors? How does the social support network affect the positive family perception, or vice versa.
We know that people who are depressed stop reaching out socially, and that isolation further affects the depression. How does depression increase vulnerability to chronic or acute stresssors, and then to parenting? Are the two factors actually equally potent in predicting parenting behaviors of families under stress? Does the building up of the two complex buffer factors identified by Hill and McCubbin's theory, really wrap a significant protective-factor shawl around the family and the high-risk youth that can be described in pathway models? Is a family with strong "B" and "C" factors a resilient family as it copes with current circumstances and structural stresses over time?
A current review of prevention research (Institute of Medicine, 1994) criticized the field for its confusing range of concepts, terms and outcome criteria; they called for an effort to conceptualize prevention as either the building of protective factors or the reducing of risk factors to enhance child resiliency, for the sake of building a coherent prevention field. They also called for expanding the knowledge base for preventive interventions, and conducting well-evaluated preventive interventions and urged that this be done across all relevant federal agencies.
Hill has specified two theoretically derived multi-variable, buffer factors for families of high risk youth; this is one step removed from the protective factors of the high risk youth; by identifying, understanding and ultimately strengthening the family protective factors -- i.e. positive social connections and an empowered, positive outlook -- high-risk youth and their families should better survive the multiple chronic and acute stresses of poverty and neighborhood disorganization over time, and reduce their drug dependency and associated crime.
THE FAST PROGRAM BUILDS FAMILY RESOURCES AND POSITIVE PERCEPTIONS
Each of FAST's multi-family program activities deliberately build the "B" and "C" factors. Identified in Hill’s family stress theory. Positive bonds and social relationships (B Factor) are directly promoted on six distinct levels of the child's social ecology (Bronfenbrenner; Garbarino): at-risk child-to-parent bond, family unit bonds, parent-to-parent bond, parent to self-help group bonds, parent affiliation to school, and parent linkages to community treatment/counseling agencies. Each of these specified relationships is systematically altered with highly structured, mental health research-based interactive activities to decrease the impact of family stress on the family functioning.
The routine activities are: 1)a family meal; 2)creating a family flag; 3)singing as a large group; 4)drawing as a family and taking turns talking; 5)acting out feelings in a charades game as a family and taking turns talking; 6)buddy time--listening and talking with one other adult; 7) self-help parent group; 8)child initiated, non-directive, parent-child play time; and 9) lottery prizes and hosting the meal; and 10)a closing circle with personal achievement announcements. FAST ends after 8 weeks with a multi-family graduation ceremony.
The 2 1/2 hours, weekly meetings are process oriented, i.e. structuring the participants for each of the interactional units: 1) family table based activities for one hour; 2) adults pair up in dyads for 15 minutes; 3) adults meet in a self-help group for 45 minutes; while 4) children build peer connections in age appropriate activity groups for 1 hour; 5) parent and high-risk youth spend 15 minutes of quality time together; and, finally, 6)the whole group assembles for lottery prizes, personal achievement announcements, and a final goodbye ritual.
The multiple strategies are tightly sequenced to produce change at multiple levels of functioning in the family and between families. Conflict and criticism are explicitly blocked through instructions to the parent and support for the parent. The activities consistently promote laughter and sharing within families, as well as across families; they are non-verbal as well as verbal, allowing multi-age participants, with multi-levels of literacy, to enjoy them together. The synergy of multiple interventions in each family adds to the program impact.
APPLYING FAMILY SYSTEMS THEORY TO STRENGTHEN THE FAMILY UNIT: PROTECTIVE FACTOR OF STRONG FAMILY UNIT BY INCREASING FAMILY STRENGTHS: COHESIVENESS, FAMILY UNITY, FAMILY PRIDE
By Lynn McDonald, MSW, PhD
University of Wisconsin-Madison
Based on family systems theory, FAST applies family systems theory to strengthen all families.
Each week each family participates at the multi-family FAST group session, graduates after 8 sessions, and then continues participation at the FASTWORKS monthly sessions for 2 years. The activities and instructions to the team for facilitating the multi-family groups are based on family therapy techniques developed by Dr. Salvador Minuchin, Dr. James Alexander, Ms. Virginia Satir, Dr. Gerald Patterson, Drs. Wolin and Wolin, and Dr. Nancy Boyd-Franklin. Each of these family systems theorists contributed to the underpinning of the FAST activities.
These techniques were developed for individual family systems work, but were altered and adapted by Dr. Lynn McDonald, in order to be able to be administered without diagnostic assessment, and without individualizing the intervention. Instead, each of the family systems writers were studied extensively, and their principles and strategies were extracted to identify which would be helpful for every family to experience. The concept was for each and every family to have the support and benefit of experiencing a “Family Tune-Up” rather than coming from the traditional diagnosis-intervention model of family therapy.
Examples from each of the systemic theorists are included below from the multi-family group process oriented curriculum.
1. Structural family therapy experiential activities include supporting the parent to experience being in charge of her children successfully, each week for 2 1/2 hours for 8 weeks at FAST sessions; FAST coaches support the children to serve their parent the meal to differentiate hierarchy; FAST coaches are taught to relate to the family only through the parent; FAST coaches are taught to give instructions and information only to the parent, which elevates the parent in the child's eyes. The parent is put in charge of the family repeatedly by the activities and team at FAST. (Minuchin)
3. Functional family therapy experiential activities include helping families to have structured communication in which each person takes a turn to speak, each person makes positive inquiry to other family members, and practices listening with respect. Conflict is blocked here, to help develop experience of successful family communication. These experiences will help the family to be capable of resolving and mediating family conflicts in the future. (Alexander)
4. Communication family therapy measures health in optimum functioning families, by the communication style of each family member with one another. If each family member can authentically and congruently say: I want, I think, and I feel, to one another, the family is considered strong. Experiential exercises at FAST help each family unit to practice these three communications every week in feeling charades and in scribbles. Differentiation of self within the family as well as clear boundaries between two separate dyads, and two small groups, is repeatedly practiced through communication in the family exercises (Satir).
5. Family systems therapists agree that over time all families repeat interactional routines which can become destructive. Rather than focusing on the specifics of the potentially destructive routines which might have become familiar to families, FAST offers all families the same opportunities to repeatedly rehearse a totally positive set of family routines. In addition to taking place in a public hall, which in itself blocks most negative routines for families, the FAST structure provides positive ways for families to have fun together, play together, laugh together, and singing together. This happens throughout each week, routinely, at FAST.
6. Have family routines/rituals together; this will bring families closer and will reduce substance abuse risks over time. FAST activities are routines which
are repeated every week. There is a FAST song, and a FAST closing circle (Wolin and Wolin).
7. Have meals together. McDonald says families that eat together, stay together.
At FAST, each family sits at a family designated table, and shares a meal. SAT research shows that the single predictor of high SAT scores is eating a family meal, spending time together chatting and connecting over the food.
8. Win together. Families naturally feel a benefit from being a unit. This is made feeling of being a unit is explicitly and repeatedly structured into the activities at FAST. At its most overt and over the top, is when each family Wins the Lottery. Winning is celebrated loudly, but is totally fair: each family wins once. But the drama is that family does not know which week they will win, and the children are not told that the lottery is rigged to be fair (instead the parents are told and they tell the children with confidence that their family will also win once).
9. Work together--the FAST meal each week is planned, purchased, and prepared by the family that won the lottery the previous week--in a reciprocal exchange, the child learned that you win, and then you pay back. Nothing comes for free--always there is respectful exchange of give and take. The family hosts the meal (money is provided by FAST) and is publicly recognized for it. (Dunst)
10. Build family pride as a family unit, with the
l. Family flag activity
2. Family picture
3. Family Graduation Certificate
4. Family Introduction--Hello