Training goals
Systems-based thinking will enable trainees to:
1. Ally with family members to work with the patient to comply with goals of care (for example, taking medications, complying with lifestyle changes, and maintaining sobriety).
- Teachers focus on engagement, joining with families.
2. Help patients understand the influences of their families in their own lives, such as intergenerational transmission of trauma and resilience.
- Teachers focus on the creation of a genogram, and the location of the individual within their family system.
3. Understand that mental health includes the creation and maintenance of healthy relationships.
- Teachers focus on assessing a willingness to listen to others’ points of view and the cocreation of a shared reality and belief system: a belief that relationships can change over time and how to create new family narratives.
4. Understand the impact of illness on the family unit and the impact of the family unit on illness.
- Teachers focus on the concept of a family system, clarifying the roles within the family, including caregiving responsibilities.
5. Assess the family for strengths and weaknesses.
- Teachers focus on how families maintain a healthy emotional climate, allocate roles, decide on rules, problem-solving abilities, and so on.
6. Gather information from multiple informants in the same room.
- Teachers focus on using communication techniques to elicit, guide, and redirect information from multiple individuals of a system with varying perspectives in the same room. Teachers help students understand that there are multiple realities in families and learn how to maintain multidirectional partiality.
Knowledge, skills, and attitudes across all treatment settings
Knowledge: Beginning level
- Healthy family functioning at the various phases of the family life cycle. Systems concepts are applicable to families, multidisciplinary teams in clinical settings, and medical/government organizations. However, family systems are distinguished by deep attachment bonds, specific generational hierarchy, goals of emotional safety and, for many families, child rearing.
- Systemic thinking, unlike a linear cause and effect model, examines the feedback loops by which multiple persons or groups arrive at a specific way of functioning.
- Understanding boundaries, subsystems, and feedback loops is critical to understanding interpersonal connections. Understand how the family affects and is affected by psychiatric and medical illnesses. Impact of interpersonal stress on biological systems. The role of expressed emotion (EE) in psychiatric illness. EE describes the level of criticism, hostility, and emotional overinvolvement in families. It has been studied extensively across the health care spectrum, and cultural variance is significant.
- The components of family psychoeducation, and its associated research in improving patient and family outcomes.
Knowledge: Advanced level
- Principles of adaptive and maladaptive relational functioning in family life and family organization, communication, problem solving, and emotional regulation. Role of family strengths, resilience in reducing vulnerability.
- Couple and family development over the life cycle.
- Understanding multigenerational patterns.
- How age, gender, class, culture, and spirituality affect family life.
- The variety of family forms (for example, single parent, stepfamilies, same-sex parents).
- Special issues in couples and families, including loss, divorce and remarriage, immigration, illness, secrets, affairs, violence, alcohol and substance abuse, sexuality, including LGBTQi. Relationship of families to larger systems, for example, schools, work, health care systems, government agencies.