The Parent-Child Open Communication Dilemma

"Overall, parents of African-American youth residing in urban public housing developments tended to underestimate the extent to which their children were exposed to acts of violence and suffered from distress symptomatology.  This was seen for acts of direct victimization (i.e., attacked with a knife), as well as events youth witnessed.  Most striking was the tendency for parents to underestimate youth distress.  Rather than being a new finding, this proclivity for parents to underreport symptoms their children experience is a replication of findings derived from studies of childhood psychiatric disorders.  Multiple explanatory models have been posited to account for this effect, including parental denial or minimalization of symptoms, or particularly with older youth, children's increasing concealment of distress."

O'Donnell, D.A., Schwab-Stone, M.E., & Muyeed, A.Z. (2002).  Multidimensional Resilience in Urban Children Exposed to Community Violence, Child Development, 73(4), 1265-1282.

Parents don't know.

Kids don't tell them.

Parents have a hard time hearing it - it is painful to know your child is suffering and you don't know what to say or do.

It is hard to see your parent suffer when you tell them what you've seen or experienced.  It doesn't help when parents get mad and lecture you about what happened (because they are scared).  Next time, you just skip telling them.

It's sad and painful for everyone to talk about it.  Even if talking about it and listening (really listening with your head and heart) is exactly what will help.

Family Resilience

"I've long been interested in the concept of resilience.  I grew up in a family challenged by many adversities.  I was often viewed as hardy, despite my family experience.  I later came to see that those challenges made me stronger.  It took a long time to appreciate my parents' struggles and their remarkable courage, perseverance, and resourcefulness.  In my young adulthood, their deficits loomed large.  Traditional psychotherapy dredged up all the negative experiences of childhood and elaborated on parental failings.  The field of mental health was so heavily skewed toward pathology that it might more aptly have been called the field of mental illness.  My clinical training taught me how to diagnose disorders, but gave no attention to healthy functioning or how practitioners might recognize and promote it."

--Froma Walsh, Strengthening Family Resilience

Please share your stories - how do you recognize and promote healthy functioning in your clients and their families, even in the most adverse circumstances?

The Effect of Parental Behavior on Trauma Recovery

In a study in Poland:

"Parental overprotectiveness moderated the effect of trauma, thus augmenting the impact of stress experienced during the disaster on the level of PTSD symptoms.

The findings suggest that excessive parental control and infantilization of children for a long time after a disaster are harmful for adolescents' health and could be an obstacle in the recovery process.

Parental overprotectiveness could be conceptualized as another manifestation of liabilities of parental social support because it involves excessive and unnecessary parental protection that is uncalled for given the child's developmental age.  In a review of the literature, Holmbeck et al., (2002) characterized parental overprotectiveness as a tendency for infantilization, toward excessive physical and social contact with a child, extreme fear associated with the fulfilling of parental functions, unwarranted control, intrusiveness, and continuous attempts at impeding the child's independence."

"An additional family factor that might moderate the relationship between trauma exposure and PTSD symtomatology may be the level of conflict within the family.  A home atmosphere with arguments and conflicts may be perceived by adolescents, who are disaster victims, as an indication of lack of family support.  Research on negative responses of support providers, such as engaging in arguments, blaming or showing disinterest responses at times referred to as 'negative social support,' strongly documented their potential to impede recovery from all traumas."

Bokszczanin, A. (2008).  Parental support, family conflict, and overprotectiveness:  Predicting PTSD symptom levels of adolescents 28 months after a natural disaster.  Anxiety, Stress & Coping, 21(4), 325-335.

Infantilizing anyone, besides an infant, is disempowering - not good.

Components of Family Resilience

In her theoretical overview of family resilience, based on a clinical orientation to family functioning, Walsh (1998) outlined key family processes that operate as protective factors. While this framework is meant to reflect the “core” components of the concept of family resilience and the protective factors that contribute to it, it does not imply that to be deemed “resilient” families must demonstrate all of these characteristics at all times and in all situations.

These include:

• Family belief systems
• Family organisational processes
• Family communication processes

Family belief systems are further organised into three areas:

(1) making meaning of adversity (e.g. normalising or contextualising adversity and distress, seeing crises as meaningful or comprehensible, achieving a sense of coherence)

(2) affirming strengths and possibilities (e.g. maintaining courage and hope, remaining optimistic)

(3) transcendence and spirituality (e.g. seeking purpose in faith, rituals, creativity).

Family organisational processes are organised into three sub-areas:

(1) Flexibility refers to families’ ability to rebound and reorganise in the face of challenge and to maintain continuity through disruption.

(2) Connectedness is demonstrated in family members’ commitment to each other, while maintaining a balance with respect for individual needs and differences. It might also be demonstrated in co-operation in caregiving and other types of family partnerships.

(3) Mobilisation of social and economic resources - Social and economic resources are made available through processes such as the mobilisation of kin and community support networks in times of need, provision of support to vulnerable family members through the creation of multigenerational or multifamily groups and building of financial strength while balancing work and family life.

Family communication processes involve the concepts of clarity, open emotional expression and collaborative problem solving. Effective family functioning is achieved when messages are clear, true and consistent, when family members share a wide range of feelings and tolerate differences, using
humour and avoiding blame, and when problems are identified creatively and decisions are shared responsibly, with a proactive focus on goals and building on success.

From Family Resilience and Good Child Outcomes: A Review of the Literature, a New Zealand Report by Ariel Kalil

Family Protective Factors

Garmezy (1991) identified a set of categories of protective factors that have since been widely cited:

(1) dispositional attributes of the child (including temperament and intelligence)
(2) family cohesion and warmth; and
(3) availability and use of external support systems by parents and children.

From Family Resilience and Good Child Outcomes: A Review of the Literature, a New Zealand Report by Ariel Kalil

General Family Resilience Factors

“General family resilience factors” serve families by playing multiple roles as protective and recovery factors. These include such things as:

• family problem-solving strategies
• effective communication processes
• equality
• spirituality
• flexibility
• truthfulness
• hope
• social support
• physical and emotional health

From Family Resilience and Good Child Outcomes: A Review of the Literature, a New Zealand Report by Ariel Kalil 

Family Protective and Recovery Factors

McCubbin et al. (1991, 1997) did not specify a comprehensive set of parenting behaviours or modes of family interactions that they explicitly deem to be indicative of resilience.

Rather, the factors they deemed important were culled from different investigations of families facing different crises. The most prominent family protective factors they identified include:

• family celebrations
• family time and routines
• family traditions

The most prominent recovery factors include:

• family integration
• family support and esteem building
• family recreation orientation
• family optimism

From Family Resilience and Good Child Outcomes: A Review of the Literature, a New Zealand Report by Ariel Kalil   

Family Resilience

Families can respond to risk in ways that can be characterised as resilient and they can marshal protective factors to assist in successful engagement with a range of stressful circumstances.

Families might be considered resilient when they cope successfully with significant adversity or stress or when they successfully re-orient their patterns of functioning to face future challenges (Mangham et al.1995).

According to one recent definition, family resilience:

“describes the path a family follows as it adapts and
prospers in the face of stress, both in the present and
over time. Resilient families respond positively to these
conditions in unique ways, depending on the context,
developmental level, the interactive combination of
risk and protective factors, and the family’s shared
outlook” (Hawley and DeHaan 1996, p. 293).

From Family Resilience and Good Child Outcomes: A Review of the Literature, a New Zealand Report by Ariel Kalil 

Support & Resilience for the Whole Family

Abstract:

A non-experimental pilot study examined child, mother and family outcomes of a 10-session multi-family group intervention designed to reduce risk and promote resilience for mothers with depression and their families.

Positive changes following the Keeping Families Strong intervention included:

• mother-reported decreases in child behaviour and emotional problems
• mother-reported improvements in the quality of family interactions and routine
• mother-reported improvements in their own well-being and support from others
• children (9–16 years) reported decreased internalizing symptoms
• children reported improved coping
• children reported increased maternal warmth and acceptance and decreased stressful family events
• attendance and mother-reported satisfaction were high, indicating the perceived value of the intervention

Valdez, C. R., Mills, C. L., Barrueco, S., Leis, J. and Riley, A. W. (2011), A pilot study of a family-focused intervention for children and families affected by maternal depression. Journal of Family Therapy, 33, 3–19.

Talking & Laughing

In her recent documentary, Joan Rivers said the point of comedy is to face the tragedy by talking and laughing about it.  The funny lady has a serious point.

Pennebaker (1986) found that writing about emotional experiences, both the facts and the feelings, leads to improved physical health.

Bowlby (1988) told us that when mothers are able to talk about their happy or unhappy childhoods with detail, organization and coherence, bringing up the good and the bad, they were more likely to have secure attachments with their own children.

Open communication in families is linked to family resilience.  Parents talking about emotions is also related to children's social interactions and relationships with peers, and children's emotional resilience and ability to cope constructively with challenging situations.  Parents who are aware of emotions, particularly negative emotions, can talk about and accept these emotions in themselves. These parents also are aware of emotions in their children and have the ability to assist their children in understanding their emotions.

So if talking about it is so great, does timing matter?  Hobfoll (2007) writes:

• "a major reason why psychological debriefing (such as Critical Incident Stress Debriefing) has been criticized in recent years is that it serves to enhance arousal in the immediate aftermath of trauma exposure.  It has been suggested that requiring people to ventilate in the immediate aftermath of trauma can increase arousal at the very time that they are required to calm down and restore equilibrium after the traumatic experience."  

Referring to PTSD treatment, Hobfoll (2007) writes:  "Open communication and exposure therapy come later and end with a sense of relief and calm."

So what helps immediately after a traumatic event?  Studies (Holbrook, 2010; Bryant, 2009) have found that the use of morphine during trauma care may reduce the risk of developing PTSD after a serious injury. Laughter is like morphine - the body produces endorphins when we laugh that act like "natural" morphine. 

So go ahead - you have been given permission (and empirical support) to talk about it, laugh about it even.  It's not too soon to laugh about it - the sooner the better.  Cheers, to funny stories for our health in the Happy New Year - Salud!

Bryant, R.A., Creamer, M., O’Donnell, M., Silove, D., & McFarlane, A.C. (2009) A Study of the Protective Function of Acute Morphine Administration on Subsequent Posttraumatic Stress Disorder. BIOL PSYCHIATRY, 65, 438–440.

Hobfoll, S.E., Watson, P., Bell, C.C., Bryant, R.A., Brymer, M.J., Friedman, M.J., Friedman, M., Berthold, P.R., Gersons, J.T.V.M.J., Layne, C.M., Maguen, S., Neria, Y., Norwood, A.E., Pynoos, R.S., Reissman, D., Ruzek, J.I., Shalev, A.Y., Solomon, Z., Steinberg, A.M., Ursano, R.J. (2007).  Five Essential Elements of Immediate and Mid-Term Mass Trauma Intervention: Empirical Evidence. Psychiatry, 70(4), 283-306.

Holbrook, T.L., Galarneau, M.R., Dye, J.L.,  Quinn, K., & Dougherty, A.L. (2010).  Morphine Use after Combat Injury in Iraq and Post-Traumatic Stress Disorder. N Engl J Med, 362, 110-117.

Family Resilience Framework

This article presents an overview of a family resilience framework developed for clinical practice, and describes its advantages. Drawing together findings from studies of individual resilience and research on effective family functioning, key processes in family resilience are outlined in three areas:

• family belief systems,
• organizational patterns, and
• communication/problem-solving

Clinical practice applications are described briefly to suggest the broad utility of this conceptual framework for intervention and prevention efforts to strengthen families facing serious life challenges.

"Most studies focused on individuals who thrived despite a parent's mental illness or maltreatment and tended to dismiss the family as hopelessly dysfunctional and to seek positive extra-familial resources to counter the negative impact. Thus, families were seen to contribute to risk, but not to resilience."

I wonder if this is why - related to family engagement - we give up before we even get started? How many times is "enough" when it comes to reaching out to parents of children with mental illness or pyschosocial problems?

Families Can Talk About It

Studies have demonstrated the importance of open communication about emotions within the family to socio-emotional competence in children.

Parental discourse about emotions is also related to children's social interactions and relationships with peers, and children's emotional resilience and ability to cope constructively with challenging situations.

Differences have been described in parents' capacity to assist their children with emotional expression. It has been observed that parents who are aware of emotions, particularly negative emotions, can talk about and accept these emotions in themselves. These parents also are aware of emotions in their children and have the ability to assist their children in understanding their emotions.

Openness in discussing one's emotions is often described as an essential component in coping with anxiety that may be associated with distressful events.

Many theoretical perspectives, such as psychodynamic and cognitive-behavioral theories, hypothesize a direct relationship between healthy coping and openness in disclosing information about one's emotions and feelings.

Research supports the theoretically defined relationship between disclosure of emotions and healthy coping.

Talking about feelings associated with traumatic or distressing events is linked to psychological well-being, improved functioning, better self-reported health, and better immune responses.

The presence of open communication styles in individuals can support or enhance their ability to accurately process and cope with distressing events, which are key aspects to successful resolution of distressing experiences.

Indeed, communicating openly about one's feelings and emotions is commonly recommended and encouraged by mental health professionals for both adults and children who are coping with frightening events. This enables adults and children to reflect on their emotions aroused by the event and perhaps allows them to engage challenging situations more effectively.

In this way, open discourse about emotions is considered an important characteristic of protective processes that underlie resilience in stressful times (Lutz, 2007).