Family Dynamics and Nursing Response

1. Family Dynamics and Nursing Response Collete L. Hoglund, PhD Clinical Psychologist 8/17/11

2. Learning Objectives • Increase understanding of family dynamics • Boundaries • Communication • Increase understandingof family dynamics in the workplace • Codependency • Develop ways to assist patients & families

3. Relationship Boundaries • Physical Boundaries • Personal space or bubble • Separate bodies, define where I end and you begin • Psychological Boundaries • Limits we set and maintain with others in our life to protect ourselves • Limits include what we are willing to accept, tolerate, believe or do • Define where my problem ends and your problem begins • Disengaged-----------Healthy-----------Enmeshed

4. Types of Relationship Boundaries • Disengaged - “I” • Rigid and Inflexible Boundaries • Minimal closeness • High Independence • Too many boundaries • Minimal interest and involvement • Examples in families • Lack of investment, neglect • Lack of affection, support and caring • Abandonment, lack of empathy

5. Types of Relationship Boundaries • Healthy – “I and We” • Intact and Flexible Boundaries • Separation and Connection • Interdependence • Reasonable boundaries • Stays in own “business” • Examples in families • Balance between togetherness and being alone • Tolerance for differences of opinion • Supportive, Respect • Clear roles, Equality

6. Types of Relationship Boundaries • Enmeshed – “We” • Fluid Boundaries • Excessive closeness • High Dependence • Few boundaries • Excessive interest and involvement • In other’s ”business” • Examples in families • abuse, incest, no privacy, intrusiveness • mind reading, projection, control, manipulation • codependency, smothering

7. Boundaries and Psychological Disorders • Schizophrenia – poor identity and self boundaries, may be anxious about touch, misinterpret touch • Bipolar Disorder – intrusive when manic • PTSD, history of trauma – touch can trigger re-experiencing symptoms (ie. flashbacks, dissociation) • Sexual Addictions – fluid boundaries • Borderline Personality Disorder – misinterpretation of other’s intentions, fluid boundaries, manipulation • Schizoid Personality Disorder – rigid boundaries

8. Boundaries and Work • Poor Boundaries with Coworkers or Patients • Being unable to say “no” • Internalizing critical opinions, negativity of coworkers • Taking work related stress home • Overextending self with patients • Blurring Professional and Personal Roles • Making friends with patients • Looking to coworkers to meet unmet needs from childhood

9. Communication Styles in Families • Passive -----Assertive-------Aggressive • Passive Aggressive • Triangulation - gossip • Mixed messages • Double Binds • Mind reading • Secrets – don’t talk

10. Codependency • Definition: Tendency to behave in overly passive or excessively caretaking ways that negatively impact one’s relationship and quality of life • It often involves being excessively preoccupied with the needs of others, while putting one’s needs at a lower priority • It goes beyond normal self-sacrifice or caretaking

11. Codependency • Boundaries are often enmeshed • Communication is often passive or passive aggressive • There is often an attempt at controlling others since the codependent individual believes they know what is best for another • There is often an attempt at changing and rescuing others • Seeking approval • Need a relationship to validate self-worth

12. Codependency • Rescuing people from their responsibilities • Enabling is a destructive form of helping • The enabling individual may take responsibility for another person’s behavior and allowing them to continue maladaptive behaviors with few consequences

13. Codependency - Roles

14. Codependency with Patients & Families • Codependency is common in helping professions • Examples: • Self-disclosing to patients too much, so you are liked • Attempting to solve patients problems for them • Trying to rescue patient from uncomfortable emotions or grief • Taking patient problems home • Unable to say “no” to patients • Trying to be the savior or hero to patients • Trying to change patients

15. Codependency and Work • Getting saddled with another person’s responsibilities • Overfunction so someone may underfunction • Working too much overtime • Poor planning on your part does not constitute an emergency on my part • Difficult coworker • You only have the power to change yourself. You can’t change someone else. • Misplaced priorities • Saying no to unimportant tasks, realize limits

16. Assisting Patients & Families • Be Aware of your own Family Dynamics • Be Aware of your motivation for doing something • Strive to find a balance between caring for yourself and caring for others • Maintain healthy communication • Practice assertiveness • Avoid triangulation • Avoid making assumptions and mind reading • Listen and understand, don’t fix emotions • Offer suggestions and options

17. Assisting Patients and Families • Maintain healthy boundaries • Develop a clear sense of self and identity • Develop limits about what you can do • Minimize self-disclosure • Respect patients boundaries, ask permission to touch patients when possible • Inform patients about procedures before performing • Ask patient to do something or ask them to try doing something rather than telling unless it is an immediate safety issue • Maintain professional distance, do not become enmeshed, avoid being friends with patient

18. Assisting Patients & Families • Empower vs. enable family members • Offer information on psychological disorders • Encourage family members to take care of themselves • Encourage families to try stress management • Further Reading • Beattie, Melody (2009). The New Codependency. • Cloud, Henry & Townsend, John (1992). Boundaries.