Principle: Being “whole of family” minded 

A traumatic injury doesn’t just happen to an individual, but to a family system.

Being ‘whole of family minded’ is another way of saying that we treat traumatic injury as happening to the whole family system. 

Everyone within this system is affected in some way by the injury. Different family members will have different needs in their ability to understand what has happened, depending on their age and how close they were to their injured relative. Traumatic injury can affect the roles family members carry out, the interactions that they have with each other, and the expectations and beliefs they hold. Each member of the family system may cope differently with the distress and adjust/adapt to the changes at a different pace and in different ways.

 

The whole family

Here is the who's who for the three families you have been introduced to in this module.

Angela and her husband. Steven who has the injury has an older brother and two younger sisters.

Cheryl is the wife of Peter who had the Spinal Cord injury. Cheryl and Peter have two adult children.

Jonathan, his mother, his father, his brother.

Each of the people describes the impact on the family system in one of their video clips. The video clips highlight some aspects of the family systems. It is useful to make family systems and dynamics explicit when working with families.

Think about the different people in these three families. Cheryl is a spouse of an injured partner. Cheryl and Peter have two children who were teenagers at the time of his spinal injury. Angela and her husband were parents of Steven who was a teenager. Steven had two younger sisters who were under 10 years of age at the time of his injury. Jonathan also had a brother as well as his parents.

Being ‘whole of family minded means appreciating that the whole family is affected when a relative sustains a traumatic injury:

(i) different members of the family will have a different understanding and different information needs about the traumatic injury based on their age and their relationship to the relative who was injured;

(ii) each member of the family has a different set of roles and relationships with the other family members which are changed by the impact of the injury; and that

(iii) each member of the family will have a different way of coping and different support needs based on their age and their relationship to the relative who was injured.

So when thinking about families it is useful to think about:

(i) The information needs of siblings who are still children, siblings who are adolescents, of frail-aged grandparents, of adult children, of parents, of spouses, and of friends. How will they learn about the injury? How much do they need to know? What is the best way to communicate this information? Who is best situated to do this? What support might family members need to be able to communicate effectively about the injury and its’ consequences to other members of the family? How can we support this process over time as things change and evolve?

(ii) The different roles/relationships among family members.

(iii) The different coping responses and support needs for family members of different ages and relationships to the relative who has been injured.

 

Rate your work with this client?

We are not connected with family members (or hardly connected at all), just focus on the person with the injury
We focus mainly focus on the person with the injury but do have some interaction with another family member, usually the prime carer or support person
We focus on the person with the injury, but have interaction on a semi-regular or regular basis with a range of family members
We collaborate with family members and the person with the injury in our work
Our primary work is with families and helping them in their role to support their relative with the traumatic injury

 

How could the work with this client be improved if a "Whole of family" approach was used?

The impact on the whole family (1 min 23 sec)

Cheryl talks about the impact on her family.

The video may take a few moments to load. .

Dealing with conflict

One of the most challenging aspects of our work with families can be dealing with families who are in conflict, when the family system is out of balance.

There are all sorts of reasons why family members are in conflict.

Some common reasons are:

• disputes about who should be the decision maker
• family members disliking each other
• family members suspicious of each others’ behaviour (i.e. accusation of misuse of finances)
• history of long standing conflict within the family
• parents of injured person have separated or divorced

Dealing with conflict is difficult for a service provider because often a relationship is formed with both the injured person and their family.

Staff ideally want to be able to maintain positive relationships with everyone in the family system. This can be hard to achieve. Family members may try to encourage staff to take sides.

Sometimes staff can relate to a client’s situation or have empathy with them, especially if they are caught in the middle of a family conflict situation. Like in every family, there are different sides of the story depending on who you speak to.

It is important for staff to stay neutral and avoid over identifying with a particular family member, and instead keep the focus of everyone on the person with the injury.

 

Strategies to help manage family conflict

Remember that the goal is not to solve the conflict, but to manage it in such a way so family resources can be used to the benefit of the person with the injury.

Stay Neutral

• You can maintain neutrality in a situation by providing the same information to all people involved, not taking sides, clearly defining your role and remaining calm

Decline/deflect invitations to join sides

• Redirect or deflect attention back to person with the injury
• Manage invitations to give opinions by repeating simple statements like ‘I’m here to do therapy with ……./ or help……….. with the laundry. I’m sorry things have been stressful for you but I really need to get on with what I’m here to do.

Avoid team division

• Be clear about team member roles
• Maintain clear communication in all interactions
• Close co-operation between team members, communicate issues and concerns with each other, where possible all should agree on a treatment approach to avoid team splitting

Don’t give an opinion

• It is not your role to fix or provide a view on who is at fault/not at fault

Determine who has the legal right

• In the case when families are providing conflicting directions or requests, the first step is to listen to the person with the injury and develop an understanding of their opinions and preferences
• In cases where the person with the injury is severely cognitively impaired and is not able to make key decisions, then it is important to ascertain who has the legal right to make decisions on behalf of the client
• However, it is still important to try and keep avenues open with all key family members who have a role in the life of your client.

Consider whether an umpire is needed?

• Consider Guardianship Tribunal involvement if conflict cannot be resolved

In working with families in conflict, it is important to ... (tick TWO responses)

Try to ignore fighting family members and focus my efforts on the client
Work out which family member is right and give them my support
Encourage family members to redirect their focus onto the needs of the client
Confront the family and tell them to stop the conflict
Try to remain neutral and decline invitations by family members to take sides
Suggest that family members go and see a family counsellor
Help the family members sort out their problems