These responsibilities can include earning money for the family, doing household chores, caring for children, and any other functions the person in pain fulfilled in the past but is now unable to fulfill. As family roles change, each person’s sense of self has to readjust. Mary had stopped working as a nurse to become a full-time mom, and all of a sudden she had to figure out how to earn a living for the family when Jim could no longer work. Jim’s pain changed his identity as the breadwinner, and also caused him to be absent from activities he enjoyed with the kids—soccer practice, helping them study, etc.
With the role shifts, everybody suffers an incremental loss as a little bit is chipped away from their sense of self and the part of them that was defined by their relationship with the person in pain.
A shift you may have experienced is that suddenly ______________ has become the central figure in your life, with everyone else revolving around him or her: running, getting, doing, trying to make things better, compensating for, and trying to fill the vacancies. This can leave you with little time to take care of or enjoy yourself. You may be feeling resentful or depressed, but you may believe that these feelings are inappropriate because you are not the one in pain. You have become less interested in your own needs, because _______________ is the one who needs attention.
Mary’s role as Jim’s caretaker eventually became her primary identity. This continuous sacrificing of her own needs to the needs of another led to her feeling overwhelmed by feelings of anger, sadness, and guilt, which began negatively affecting her own health.
Often with chronic pain, everyone in the family system feels like they’re carrying a burden. Everyone feels victimized by the pain, but may not be communicating their feelings to each other or seeking support to help them cope, at a time when they need support the most.
{exercise} 2.1
Am I Out of Balance? _________________________________________
Please answer “Yes” or “No” to the following questions. Fill in the blanks with the name of your family member who has chronic pain.
| Yes | No | Does your life revolve around _______________? |
| Yes | No | Is your well-being dependent on _______________’s well-being? |
| Yes | No | If _______________ hurts, do you hurt, or are you unable to have fun, concentrate on your work, or take proper care of yourself or others in your life? |
| Yes | No | Do you feel guilty when you are impatient, annoyed, or simply not there? |
| Yes | No | Is your life spinning out of control in your attempts to help? |
| Yes | No | Are you depressed, angry, fearful, anxious, irritable? |
| Yes | No | Are you unable to see any way out of these emotions? |
Taking a Family Systems Approach
Describing the family as a system helps us to better understand the effects of chronic pain on the family as a whole, rather than on each member individually. In a family systems approach, what is important is looking at the family as a functioning unit, in terms of how the actions of each family member affects the rest of the family, both individually and as a whole. Thus, when _______________ developed chronic pain, that change in him or her naturally had effects on every member of the family and on the way the family operates (e.g., interacts or communicates). However, in a family systems approach, your actions and reactions will also affect the family, including _______________.
FAMILY SYSTEMS: A BRIEF INTRODUCTION
While a complete discussion of the many different family systems theories is beyond the scope of this book, a brief discussion of the central ideas common to all of them will be presented here. Reviewing this brief discussion will help you to understand what is going on in your family and how it could be changed.
From a systems perspective, a family is considered to be a system whose members are interdependent. This means that each member of the family can function independently, but they also turn to one another for support and can have effects on one another. Each family can also have several subsystems that have generational links and boundaries, communication networks, coalitions and alliances, rules, secrets, myths, and rituals.
The important or key dimensions and terms include:
1. Adaptability: whether the family is flexible, as opposed to chaotic or rigid, in its functioning and its ability to adapt in order to effectively handle problems as they arise.
2. Cohesion: to what degree the family sticks together and is interdependent, as opposed to being disengaged (i.e., too cut off) from each other or enmeshed (i.e., in each other’s business, codependent, or enabling).
3. Family Communication: how well the family communicates with each other, which can facilitate their adaptability and cohesiveness.
4. Dynamics: how the system interacts, including patterns and the effects of one’s actions on the rest of the system and individual members.
5. Interaction Patterns: related to dynamics. This is how the family members interact with each other. Boundaries, family rules and roles, and nonverbal behavior (e.g., whether closed doors are respected) are important here.
Interaction patterns can involve triangles (a third person intervening to referee a conflict), stable coalitions (two members repeatedly aligned against a third), detouring coalitions (two agree on identifying a third as the source of the problem, which can give others an impression of harmony), triangulation (two members both insist that a third member side with him or her), and splitting (playing two people against each other). In the triangulation scenario, the third member asked to be aligned with two others may develop symptomatic behavior as a result of the conflict of being pulled in two different directions. Boundaries are important here as well (as they are in cohesiveness), and can be either too rigid (blocks interaction between members) or enmeshed (overly open, in each other’s business, codependent, or enabling).
6. Homeostasis: what a family system does to keep functioning “normally”—in the same way it has always functioned, for better or worse (i.e., functional or dysfunctional). For example, dysfunctional families often work hard to keep family secrets from being revealed by creating unspoken rules such as “Don’t ask; don’t tell.”
Thus, a healthy family system is one that is flexible or adaptable, has a well-defined structure, and is cohesive. Healthy families can therefore accommodate changes in the roles and functions of individual members, family subsystems, and the entire family unit. Also, healthy families can accommodate changes within the sociocultural context. By contrast, dysfunctional families have a limited capacity to cope effectively because of rigidity or chaos in their functioning and structure, unhealthy alliances and power balances within the system, and persistent boundary problems.
Before Jim’s injury, he was the breadwinner, Mary was the mom and homemaker, and the kids were unruly teenagers. Their level of adaptability was limited, and much chaos ensued in the family system after Jim was hurt. Their communication
