YOTH 1501 - Working with Youth and Families Midterm

What is a family?

• A social unit, usually some concept of someone dwelling esp if there's children  

  • Children need caregivers  

• Care and love, Support, stability  

• Purpose of needs (ex. Financial needs) 

• Provides guidance/caregiving to children 

  • Beyond this it's nurturing and providing the groundwork for children to enter society  

  • For the purposes of development 

• Negative side  

  • Dysfunction, trauma, obligation  

• Fam is a basic social unit consisting of parents and their children whether they're dwelling together or not (in the case of separation or divorce) 

• Social unit has to have one or more adults with the childrne that they're caring for 

  • One can be a single parent 

  • Self identified social unit consisting of ppl joined together by choice  

• Any group of individuals related by blood can form a fam or any group of 2 or more ppl living together whether or not they're related by blood 

• Families are constantly changing and evolving 

• They involve ppl who come from different perspectives, cultures, ideologies, experiences within the same culture 

• The fam can be defined according to the individual's closest network 

  • One of the first questions we ask client is "who is important to you? Who do we need to consider? Who is your family?" 

• We should never assume we know who a person's fam is  

Purpose of a family 

• One purpose that has been traditional for a lot of years is reproduction  

  • To add family members through birth, adoption, marriage (blended fams)  

• Physical needs 

  • Nurturing (food is part of that), finances, shelter, Maslow's basic needs  

• Emotional and supportive development 

  • Something that is a secure base for the emotional expression and regulation  

  • Children first learn the meaning of emotional regulation when they have siblings, and they enter kindergarten (experience sharing conflict with other children) 

    • Without family members and caregivers guiding them  

  • Nurturing, love, comfort; their self-esteem starts through the purpose of the fam 

• Family is the blueprint for bonding, interpersonal skills and how they relate to others  

• Financial support 

  • Goods and services needed by the fam 

• Connection and belonging 

  • Where we encounter a client who has had a disruption in the connecion they had with caregivers or sense of belonging  

  • Important for us to have that belonging/sense of relationship

• Social aspects 

  • Prepare children to gain independence as they grow towards adolescnece  

  • Teaching skills, knowledge, values, things that are societal norms  

How are families changing? 

• Single parent households are more common now 

  • Joint custody, access, etc 

  • Complicated ot mainitnan the relaitonship of both parents 

• Half sibligns more common/blended fam 

  • Chidlrne from two different households or chidlrne that come from that blended union as well  

• Increase of found fam 

  • Ebcause in western society, we had in inds who grew up in a household, they grew and left home  

• Onset of feminism 

  • Big movement in terms of women 

  • Higher educaiton in uni, which delay fams and relationships 

  • Grew up in a fam and then moved out 

  • As women entered the workforce more, they chose to delay havig fams (today that’s the norm) 

  • Ppl were staying home and weren't moving out in the past  

• Repordocution of women is giong down 

  • With going to school, and working 

  • Reproductive ability of couples who chose to have children, it's not happening the same way as the past  

• Same-sex marriages  

• Multigenerational house 

  • Sometimes older adults will move back into children's home 

  • In western cilture we didn’t have multiple gens living together 

    • In other cultures or immigrant famiies, this is more common  

    • Also doing it now for financial reasons 

• Movement to have a sense fo community  

  • Something in the seventies as well 

    • Came with flower children and the hippies  

    • Coming back/forced by financial situation 

  • Single mothers moving into each other  

Changing families 

• Families change every year 

  • Ex. Social media allows a single mom to see what other single moms are doing and to share needs  

• Canadian fams are more adverse than ever before 

  • As clinicians we need to approach working with inds with a certain level of cultural sensitivity  

  • Cultural sensitivity – asking the questions, trying to get to know

  • Have to respect inds, heir backgrounds, where the come rom 

• Fam life is diverse and complex 

  • One of the things about fams that clinicians don’t give them credit for is that they’re extremely adaptable 

• Need to be careful, can't generalize fams  

• Living longers 

  • 4 gen fams in a household (even if not living under the same roof) 

• Fam sizes are smaller,  

  • fam of 4-6 is a large fam today  

• Mimber of cohaviting couples is up 

  • Ppl are not entering a formal partnership like marriage at earlier ages anymore 

• Single parent led fams and blended fams are becoming the norm  

Changing families: The stats

• Stats taken from the 1950s 

• As of 2021, there should be new stats coming out form Stats Can on some of these things 

• White numbers are stats from 2016, yellow are stats from 2021 

  • 14% of adults over the age of 15 live alone  

  • Singel parent fams has gone from 9% to 15% in 5 years 

  • First one went down, adults over 65 live as couples 

    • The separations and divorce are continuing up to this point as well  

  • Dif groups that are reflected of this 

    • Baby boomers are basically the generation that takes us up to the oldest inds 

    • Then we have gen z, gen x, millennials (stood for a lot of diverse thinking to the norm) 

    • Millennials are 40 yr old tax papers, have the same things the prev gen was working towards 

    • Baby boomers have retired to be the wealthiest gen 

  • Gender roles 

    • Shift in values and attitudes, less clearly defined roles 

    • Roles that were traditionally male and female are now up to the couple ot decide 

      • A lot of it was around manners, men took up garbage, women did not (in the 50s) 

      • Today there's a discussion/more negotiation as to who will take up the garbage, etc

      • Part of what upset this is part of the feminist movement  

      • Increasing women in the workforce, the home responsibilities are shared 

        • Stats tell us that women still bare the majority of those roles and there are dif thoughts on why 

          • Some ppl think its because male members of households assert a certain male privilege 

          • Others say the females in those homes have how they want things to be  

• Cultural diversity 

  • In Can 2.2 million children raised within an immigrant fam in 2016 

    • In 5 years that became 8.3 

  • 26.7% children have at least one foreign born parent in 2016 

    • Now 31.5% 

    • Estimating that by 2036 children in immigrant fams will rise between 39 and 49% 

    • What a child learns in school is shaped by what's practiced at home  

    • Many advantages come like languages, cultural stressors which may make it more stressful for that child 

• Same-sex parents 

  • Studies have shown that children raised by same-sex parents are just as well adjusted and psychologically healthy as those raised in homes with het couples 

  • However, some studies have shown that when children are raised by same-sex parents, they face higher levels of discrimination than their peers

• Single parents 

  • When a former partner or current spouse, extended fam all contribute to that nurturing of the needs of the children, children will thrive 

    • When theres a lack of support, there's poverty  

      • Canada is the 3^rd highest rate of hcild poverty in the developed world. US is first, Italy is second  

Family risk & protective factors newcomer families 

• Risks 

  • Poverty, substance abuse issues, school failure, bullying, slide shows all the risks that can come in addition to trauma, and parental conflict

• Protective factors 

  • Risks vs. Protective factors and strenghrs 

  • Protective factor exmaple – woman who is 7 months pregnant, a protective fator in her motication for wanting to deal with her addiction is her unborn chidlren (the child is a protective factor or strength we can work with) 

  • Strong bonds with family, prid ein cultural coping ability, rituals and spiritual values, culturally sensitive services, extended family, senseof hope for the future, good health, being able to speak Enligsh, positive roel models within the culture and peer support 

System's theory: Overview

• Talks abt the fact that an ind's behaviour is influenced from a number of factors 

• No one thing creates a behaviour, all of these factors work together to create a system 

• In this theory, clinicians are gonna observe and assess what's going on with  all the systems involved in an ind's behaviour  

  • you as a clinician will work to strengthen those systems 

• Fam therapy is the approach that you will all take in counselling with families  

  • You're gonna look at the relationships ppl have in their fams and networks and those that may cause an ind to be challenged or may be strengths you want to build on 

    • Will look at these and how these relationships and ppl interact 

• We don’t exist as inds without a pattern of interactions 

System theory: 4 facts 

• 1) a system is greater than the sum of its parts 

  • All it means is that the collective emerges from the actions of the indiviuals  

  • The outcome of the sytem is more than each component  

• 2) The parts are dynamically interrelated and interdependent 

  • No element can ever be understood in isolation bc it never functions independently form its parts 

• 3)Systems are highly organized 

  • We can break them up into smaller systems 

  • Each one can be analyzed and understood and see how it functions 

• 4) Systems have boundaries 

• The boundaries separate them from the environment  

System theory: 3 principals 

• Systems have circular causality  

  • The system is non-linear 

  • Not a=b=c 

    • A has an effect on b but b has an effect on a  

• Systems will always seek stabtility and try to maintina equilibrium 

  • Concept is homoeostatsis  

    • Fro a system to survive, its going to constantly try to maintina equiibrium 

  • If a fam is dealign with chemical addiction in dependecy and strugglign around that and changing thigs to survive, its maintian ing a certain elvel of homoestatsis  

• All systems are goal directed 

  • Must have a common goal  

System theory: how did it apply to families? 

• 1950 – a lot of things we're doing today have roots in this time  

• Systems were divided into component parts (scientific fact) 

• Wasn’t until 1950 when Ludwig came along and introduced general systems theory to social sciences and psychology 

  • Proposed systems thinking as a way to discover how smt interacts with its environment 

  • Proposed a general theory of systems that would create a coherent theoretical model of relevance to all living systems 

    • Theoretical model that could be studied and was relevant to every living thing  

  • Systems are characterized by the interactions of its components 

Multigenerational history 

• Dr. Murray Bowen  

  • Theory still stands the test of time today and is the basis of systemic family therapy 

  • He was the one who brought in the science of systems and how they work and brought them into psychodynamic theory 

    • Brought them into the social aspect of ppl, how they interact and are systems in themselves 

  • Also called transgenerational or Bowenian therapy 

Multigenerational: basic premise + how problems develop

• Looking at the fam as an emotional system 

• We are emotional systems and that is what we understand the fam to be 

• We look at the history of that fam to know the context of what we're dealing with 

• The system is organized in patterns and repetitive behaviours 

  • That's what we initially will assess 

• System has an impact on everyone's behaviour 

  • Symptoms of that behaviour and the emotions that they hold 

• How problems develop

  • Balance of two forces - the need for togetherness and the need for autonomy 

  • Most ppl we see, come to see us because they have problems  

  • How problems develop are in systemic theory, a balance between two forces/two opposites 

  • The need for ppl to belong, need to be attached, togetherness, balanced with a need to be autonomous 

    • Polar opposites but most of us have both and that’s the basis of every problem you will find 

    • Inds who can't balance the behaviours bc they need to be together and need autonomy will pass that need down through the gens  

      • A parent who has been unable to balance togetherness and autonomy will pass that down (Child will inherit this) 

  • Pressure, stress, and anxiety: 

    • Those problems manifest themselves bc of pressure ppl feel, stress, and anxiety 

    • The problems the fam has are there attempts to cope with these 3 things within the system 

      • As anxiety foes up, the emotional connection between fam members becomes more stressful  

      • Starts to challenge an ind  

Bowen's multigenerational 8 key interlocking concepts 

• Interlocking concepts (called interlocking bc they don’t deal in isolation, cannot separate them other than to say they're existing but several things exist in a fam unit) 

  • 1) Differentiation of self/fusion 

  • 2) triangles 

  • 3) nuclear family emotional system 

  • 4) family projection process 

  • 5) emotional cutoff 

  • 6) multigenerational transmission process 

  • 7) sibling positions 

  • 8) social emotional process (societal regression) 

1) Differentiation of Self/Fusion (Bowen's multigenerational 8 concepts)

• Part of the autonomy that exists with inds 

• Any variance when someone is trying to differentiate themselves is the look to others for approval  

• A person with a poor differentiation of self

  • Those who depend very much on acceptance and approval from others 

  • They are very quick to adjust what they think, say, behave, so they can reduce the pressure on themselves and have other's approval  

  • Bullies depend on approval and acceptance just as much as those who are constantly changing and looking for approval 

    • Bullies push others to agree with them rather than agreeing with others 

  • Rebels are also poorly differentiated 

    • Bc they pretend to be "a self" but routinely opposing others 

• A person with a well-differentiated self:

  • Someone who recognizes that they have some dependence on others but they're calm, clear headed when there's conflict, criticism or rejection 

    • Distinguish their thinking rooted in carefully assessment of facts rather than clouded by emotionality  

  • The ability to separate your thoughts, feelings, and actions and be able to respond to what comes your way as opposed to reaction 

  • The ability to hold the opinions of others without losing your sense of self in the process 

    • Ex. Teenager 

      • That young person who is wanting more independence 

      • A time where there's conflict in families bc the teen feels that they're not getting autonomy  

• A parent that is well-differentiated will pass this onto their child and will give up control 

• Poorly differentiated parent is not going to give up control and will repeat what happened to them whether it’s the same situation, there'll be a pattern 

  • As a clinician, wanna find out the history of your client and determine whether they've been well-differentiated 

2) Triangles (Bowen's multigenerational 8 concepts)

• The smallest stable relationship system in the fam  

  • Ex. Two sides are in harmony and one is in conflict 

• Known as triangulation  

  • A three person relationship system, two ppl are in harmony and have prob gotten together and are in harmony bc they wanna reduce the tension in the fam and it puts one person at odds 

    • Triangle can contain tension without involving another person and can shift around three relationships  

• If the tension is too high for one triangle to contain, it spreads to a series of interlocking triangles 

  • This stabilizes a system, but nothing gets resolved, and relationship damage typically results  

  • Example 

    • Mother and child complain all the time abt dad drinking (mother and son are in harmony, dad is out 

    • Or two siblings are complaining about the parent 

• Quite often two ppl in the family align and complain about someone else 

  • Reduces the tension but doesn’t fix it  

• Two are aligned and are relating and one isn't  

  • You will assess every triangle as a standalone  

    • Can have a triangle within a triangle  

    • Person A will have a triangle, and person B and Person C  

    • Say they're going out for dinner 

    • Person who comes later realizes that they got there and the other two ordered for two and shared for two 

    • But that person might be close to one of them in smt else 

• The subsystem of the triangle manages the tension with the other members and they reach out with someone to manage that tension 

  • Doesn’t resolve it or say how come im not your best friend  

  • Instead of managing the conflict in a direct and honest way, the ind they're in conflict with, the tension gets shifted in the triangle  

• Example 

  • Mom and dad are fighting about chores, creates instability, dad might complain to son abt how demanding mom is  

    • Son and dad start exchanging stories abt how mom nags all the time 

    • Tension for son and dad is less bc they feel heard, but the relationship with mom and dad also has less tension because dad gets to complain and aren't having fights  

  • But isn't changing the situation  

3) Nuclear Family Emotional Systems (Bowen's multigenerational 8 concepts)

• Divided into 4 components:

  • 1) Marital conflict 

    • When tension increases and the partners are getting more anxious each one externalizes their anxiety into the relationship  

      • Each focuses on what's wrong with the other and tries to control the other, and each resists the other's efforts of control  

    • When doing separation or divorce conflict, usually as a result of marital conflict 

      • They usually say, everything would be fine if the other were to do smt 

      • They find a fault in each other  

      • Each one of them is wanting to control the other  

    • Focusing on each other, control each other, or change each other but each is resisting the change/control 

      • That's the breakdown and the conflict  

  • 2) Dysfunction in one of the spouse 

    • One of the partners pressures the other to think or act in ways that they would want them to, and that person would yield to the pressure 

    • Both accommodate to preserve the harmony but one does more of it  

    • The one that yields is the one that's been pressured into acting how the other one wants  

      • Ex. Mom and dad are both working, may have an equal share or they may not 

      • Research tells us that women are still doing more, they're doing things that are necessary but this is how they want their how 

      • The male partner that says they don’t need that chore but the woman wants it done  

    • One person is doing more and doing more yielding to the pressure  

  • 3) Impairment of one of the children 

    • Where the parents focus their own anxiety on one or more of their children and the more the parent focuses on a child the more the child reacts to those anxieties of the parents  

      • Self-defining (fulfilling?) prophecy is similar to this 

    • Can be more than one child, but the impairment of the child is, bc they're being focused on, the parents then see dysfunction in the child  

    • Constant focusing on that, the child will react to that (desirable behaviour) or it can be behaviours that are undesirable or socially acceptable  

      • Ex. A teen suspected of doing all sorts of things may end up doing them bc no one believes them 

      • Someone taking drugs, parent says "we know you're doing them" 

        • Focusing on that teen may eventually try drugs, bc there's so much abt it, it'll escalate their curiosity 

        • Impairment in one child 

  • 4) Emotional distance 

    • Ppl who take distance away from each other to reduce the intensity fo a relationship 

    • Risk – may distance themselves too much that they don’t gave these relationships 

      • Extended fam who comes once a month for a dinner, if there's a lot of tension in the air in the relationships, there may be a fam member who doesn’t go cause they wanna emotionally distance themselves 

        • When there's constantly conflict, this is the person who distances themselves 

        • Won't argue, will distance themselves from what's going on 

    • More of a psychological thing than an emotional thing 

4) Family projection process (Bowen's multigenerational 8 concepts)

• The transmission of emotional problems from a parent to a child  

• Children may inherit various problems and/or strengths through the relationships they have with their parents 

• If the projection is intense, children develop stronger relationship sensitivities than their parents 

• The sensitivity can work not that child being vulnerable in having symptoms for behaviours that escalate chronic anxiety in the relationship (What the parents had)

• The relationship sensitivities you might notice are things like 

  • More need for approval  

    • Not bc they're poorly self-differentiated, but because of the anxiety they have  

    • Maybe it manifests itself in having difficulties managing expectations  

    • Or a tendency to blame themselves  

    • Feeling responsible for other ppl's happiness rather than your own 

      • Can be seen in adults through a marital breakdown and feels that bc their partner is unhappy and living with depression (it's all because of them) 

      • Child may think they must be everyone's happiness 

    • Might feel impulsive to relieve the anxiety of the moment rather than tolerating anxiety and acting thoughtfully  

• Projection process follows three steps: 

  • 1) The parent focuses on a child out of fear that something is wrong with the child; 

    • Because they're concerned smt is wrong with the child 

  • 2) The parent interprets the child's behaviour as confirming the fear; and 

    • Because the child is gonna react 

  • 3) The parent treats the child as if something is really wrong with the child 

    • Becomes cyclical  

    • Self-fulfilling prophesy  

5) Emotional Cutoff (Bowen's multigenerational 8 concepts)

• Reducing or cutting off emotional contact and can be emotional and physical  

• Can be someone who has to move away from the fam (goes to another province, etc) and doesn't have contact with them 

  • Or may be a psychological cutoff where they can be around family members but not engage them emotionally  

    • Either way is problematic 

• Their response is part of the emotional reactivity of the fam 

  • Instead of getting involved in what's going on in the fam and potentially getting swept up in the fam anxiety, they back out 

  • Yet it is an emotional reaction based on their feeling system rather than a chosen response from their intellectual system  

• As opposed to begin swept away from all that anxiety they back out 

• The anxiety and tension they release themselves from, will often appear in their new relationships (bc multigenerational) 

• When this person enters a new relationship, the anxiety/tension they backed out of will often repeat themselves 

  • Ex. Being overinvested in how your partner thinks, feels, and behaves  

    • Haven't learned how to deal with someone's problems 

6) Multigenerational Transmission Process (Bowen's multigenerational 8 concepts)

• Small differences in the levels of differentiation between parents and their children  

• Any small difference in the levels of differentiation between the parents and children will play out across generations until they're dealt with 

  • Ex. If we have a parent who has a fear of smt (I.e. heights) 

  • If that translates to the pt, and they wanna become a pilot, at some point, that fear of being in a closed space will okay out and they'll ave to deal with it 

    • Won't see it coming until it's there all of a sudden  

• Several interconnected levels that can be conscious, automatic or unconscious relationship, genetically transmitted, all come out in the ind's self 

• The combo of parents shaping the development of their children, after the period where the children were dependent, it results in ppl developing different levels, similar to the their parent's levels  

7) Siblings Positions (Bowen's multigenerational 8 concepts)

• First person to discover that he order of siblings make a different and play a role in adult relationships 

• Noticed there were certain properties like the eldest was someone who led towards leadership in later life 

  • Had a lot of responsibility in being the oldest 

• The youngest, because they had a leader, tended to be more followers 

  • Played out in careers and relationships  

• Research in middle child, caught not having specific characteristics, backing off on this bc they usually gravitate to one of the positions 

• In a work situation 

  • If a boss is an older child, they work really well with their close assistance who were younger children 

  • The siblings of the parents are important to consider 

• An oldest child whose parents are both youngest encounters a dif set of parental expectations than an oldest child whose parents are both oldest 

8) Social Emotional Process/Societal Regression (Bowen's multigenerational 8 concepts)

• The emotional system that governs behaviour happens on a society level  

• Can be progressive and regressive in society  

• Bowen noticed that while treating youth in trouble, the fams gave a message to their children that we love you no matter what you do  

  • In the midst of them committing crimes 

• The concept of societal emotional process describes how the emotional system governs behaviour on a societal level promoting both progressive and regressive periods in society 

  • Cultural forces are important in how society functions but are insufficient to explain the ebb and flow in how well societies adapt to challenge 

• Bowen drew the parallel between familial and societal emotional functioning through observing the tx of families with juvenile delinquents  

  • The parent sin such families give the message we love you no matter what  

• Despite impassioned lectures abt responsibility and sometimes harsh punishments, the parents give in to the child more than they hold the line 

  • Similar changes occur in other institutions such in schools and governments 

• The downward spiral in fams dealing with delinquency is an anxiety driven regression in function 

  • In regression ppl act to relieve the anxiety of the moment rather than act on principle and a long term view  

• Human societies undergo periods of regression and progression in their history 

• The current regression seems related to factors such as the population explosion a sense of diminishing frontiers and the depletion of natural resources  

Structural Family Therapy

• Salvadore Minuchin

• Structural fam therapy is a tx that addresses patterns of interaction that create problems within fams

• MH and addiction issues are viewed as signs of a dysfunctional fam; therefore, the focus of tx is on changing the fam structure rather than changing ind fam members

• Goal:

  • improve communications and interactions among fam members and to highlight appropriate boundaries to create a healthier fam structure by solving problems, achieving the fam’s goals, and changing an ind’s dysfunctional or problematic behaviours

• There is structure to a family system involving 7 central concepts: 

  • 1) Homeostasis 

  • 2) Hierarchy 

  • 3) Subsystems 

  • 4) Boundaries 

  • 5) Patterns/dynamics 

  • 6) Rules 

  • 7) Feedback loops 

• We try to focus on problems on a structural level 

  • Structural therapy aims to make shifts by focusing on problems within the families at the structural level  

• The IP – identified patient is contextualized as part of a large system and structure  

• May not be the cause of all the problems but their behaviours will show the symptoms that there's a problem within he family  

• We're creating or maintaining family structures, but we need to invite the fam to create behavioural changes that'll influence the structure to create desired change  

1) Homeostasis (Minuchin's structural family therapy)

• Families try to balance stability and change  

  • Fams are always changing but they wanna remain stable 

  • Survival of fam system requires stability, order, and consistency 

  • The status quo is what fams struggle to maintain homeostasis 

• Any problem that presents itself to the fam is seen as a fams attempt to maintain homeostasis 

• Can be a good thing but not necessarily 

  • Fam trying to maintain balance 

2) Hierarchy (Minuchin's structural family therapy)

• Wanna know who's in charge in the fam, where the power lies  

• Fam's will establish a form of hierarchy (distribution of power) 

  • Effects a lot of interpersonal dynamics 

  • How things get decided on, how they're looked at, what rules get established, who gets attention in the fam  

• In a lot of fam's dad is in charge 

  • But as a clinician, don’t wanna know self-claimed or who everyone says, wanna know where the power lies 

  • Is it the dad's income that drives how the fam spends their money? 

  • If you have ppl competing, it's not necessarily a hierarchy  

• A dysfunctional fam may have a hierarchy where the child or older youth is in charge bc the parents may both have addictions, mental health issues, and they're not running the fam 

3) Subsystems (Minuchin's structural family therapy)

• A fam belongs to larger social systems and encompasses many subsystems

• Any group within the fam where the members of the subsystem have particular rules, responsibilities, age or relationship 

• Subsystem ensures that the fam knows their roles 

• 3 most common are: 

  • 1) Spousal 

    • Their purpose is intimacy, support, to help each other grow, and personal development 

  • 2) Parental 

    • Raises the children, gives them guidance and nurturance, helps in emotional regulation, limit setting, role modeling, discipline 

  • 3) Sibling 

    • First peer group a child encounters, first place they start to learn negotiation, sharing, cooperation, competition, mutual support, and someone to confide in 

    • Those inds may actually go on to preschool, kindergarten, etc  

• Inds in a fam may be part of several subsystems and may have a dif role in each one 

• Their ability to perform the function of that subsystem contributes to the overall health of that fam 

• Example 

  • Mother may be a daughter, partner in her fam of choice, mother 

  • Has a dif role in each one 

  • How successfully she plays each role contributes to the health of the systems 

4) Boundaries (Minuchin's structural family therapy)

• Gonna be one of three: 

  • 1) Rigid 

    • Or closed  

  • 2) Diffused (enmeshed) 

    • In between they may be diffused 

  • 3) Clear  

    • Or will be clear or open 

• The separation between two systems 

  • Your boundaries are aligned between you and the environment you're in or the ppl you're with 

  • The maintenance of proper boundaries are clear in a fam 

  • Boundaries in families are sometimes invisible or subtle 

    • Serve as a gate keeping function 

    • They protect the ind members from outside influences and intrusions into the fam  

• The ease that the subsystem allows info to flow in and out relates to the permeability of boundaries 

• permeability leads to change over time  

  • Open system 

    • If there's a lot of info being exchanged to and from that’s an open system 

  • Closed system 

    • If there's very little info, that’s a closed system 

• Consequences of having boundaries that are too permeable/not permeable enough 

  • When something's too open, someone will go too far, not knowing cause you didn’t stop them 

  • Result?  

    • I thought this was okay, but now you're telling me it's not 

    • Problem solving 

• If they're too closed? 

  • It can push ppl away, ppl will be less likely to associate with you, might cause ppl to over rebel, can stop info and functioning knowledge, detriment to interpersonal relationships  

• Continuum of permeability: Boundaries 

  • Fam with addiction 

    • Could be on both ends 

• Parenting and boundaries 

  • 1) Your boundaries are gonna be authoritarian 

    • rigid ones 

    • My way or the highway 

  • 2) Opposite of that are indulgent  

    • cool parent 

    • Anything you want  

  • 3) Balance in there is authoritative 

    • flexible but firm 

    • Boundaries that kids will have around them and will learn 

• Boundary issues will lead to  

  • Helicoptering, sharenting (fb parents taking pics of everything their children did), or tiger moms 

5) Patterns and Dynamics (Minuchin's structural family therapy)

• Relationships are not linear they're circular 

• Linear would say that A has an effect on B 

• Circular causality 

  • Places interaction patterns within a context of patterned family relationships  

    • A influences B which in turn influences A 

    • This is generally referred to as circularity 

• When ppl interact with each other we're looking at how ppl are communicating rather than what their words are  

  • Process vs. Content 

  • Focus is on process not on content (when you're working as a clinician) 

    • How things happen  

    • Why gives us a story/narrative  

    • You want to focus on what 

      • What is going on, not why it happened but what is it and what is the problem, what is feeding the problem and continuing it  

• Circular causality 

  • You can enter at any point 

  • Anywhere you go in the circle it just goes on and on 

  • Wherever you enter the cycle of child abuse 

    • Parent hits child, causes behaviour in child where they get nervous, gets hit again 

• The patterns and dynamics of how we interrelate are circular  

6) Rules (Minuchin's structural family therapy)

• A fam operates with a set of rules  

• Rules are used to/can: 

  • To establish expected behaviours in the fam 

  • To stabilize patterns of interaction 

  • To inherit and adapt rules based on experiences with family of origin 

  • Can become entrenched and unexamined (e.g. gendered division of labour)  

  • Rules can be explicit (where they're actually talked about) or they can be implicit (you're just supposed to know) 

  • Meta rules 0 rules about rules  

  • All families have rules  

7) Feedback Loops (Minuchin's structural family therapy)

• There is positive and negative feedback to the system 

  • Remember – the system likes to stay balanced 

• Positive feedback says things are changing  

• Negative feedback says everything's stable and there's no change 

• When there is repeated feedback that things are changing, the system has less moments when it’s stable (less negative feedback)

Family development 

• Families go through different stages of development and dif collections of ppl  

  • In order to successfully go through these stages as a fam, each fam member must adapt to changing needs and demands and attend to tasks that are necessary to ensure fam survival 

• When working with a fam we'll be able to identify that someone never really completed a certain stage of their life  

  • Helps identify if someone hasn’t successfully finished on of the stages, so we can help them move on successfully to the next stage 

Family life cycle model 

• There's no universal term for this. Based on nuclear fams, primarily in western culture 

  • Not every fam does this but you'll recognize certain things 

• 3 phases 

  • Coupling, expansion, contraction 

• 6 stages 

  • Young adult, middle age, older adult  

• Biggest part and challenge when going from one stage to the next is the transition 

  • Change and transition isn't always smooth, the smoother it is, the best for the next stage 

  • Transition is where we see most of the stress 

• Each stage has the roles that ppl play, the rules that they follow, and tasks 

  • Certain things need to be complete, and each one has challenges 

  • Particular challenges to individual fams  

• “Normal” development 

  • As with all models, need to reflect on fit 

  • Not universally applicable bc of variations  

    • Changing fams, what constitute a fam, etc 

    • Multiple variations in life cycle of families 

    • Based on life cycle of middle income, nuclear fam – a couple with one or more children 

    • Culture, fam structure, ongoing stress, crises, etc., impact life cycle of families 

  • Won't fit all families but can be foundation for understanding fam development  

Family life cycle: Stage 1 (Single young adult)

• Occurs when adults leave home  

  • They don't necessarily leave home as soon as they did 40 years ago  

    • Up until about in the 70s when it started to change, young adults went through secondary school and left either to further education or to work, but society in general didn’t really feel that they needed to stay home  

• Goal 

  • Self-differentiation in relation to family (one of Bowman's concepts)  

  • They either leave or even if they stay at home they need to go through this stage

• Tasks 

  • Need to develop their own identity (their solid self) 

  • Take responsibility for their own life and actions 

  • Establish themselves with work and financial independence 

    • May be concurrent to being in school  

    • Might work while in school 

  • Shift from their family to their peers  

  • Where inds are looking for a romantic partner  

• Challenges 

  • Differentiating is hard to do 

  • Difficult to emotionally and physically separate one's self from their family of origin 

    • Parents reaction to that self-differentiation has a huge impact 

    • Sometimes the single young adult may lack the social skills to establish significant relationships with others outside of family of origin 

Family life cycle: Stage 2 (New Couple)

• Tasks 

  • Now joining two family systems 

  • They are coming with two sets of parents or maybe more if they both came from a blended fam  

    • Point is they're joining these systems 

  • Establishing their identity as a couple 

  • Relationships with family and friends now include a partner 

    • All those relationships are needing some adjustment  

  • Also where ppl are making decisions abt having children  

    • May have discussed it before but now there are decisions to be made 

• Challenges 

  • Enmeshment 

    • If you have not separated totally from fam of origin and have self-differentiated, you are still quite enmeshed with your fam of origin 

      • Too connected 

  • Distancing 

    • Not staying connected with your fam of origin 

      • Not connected enough  

  • Difficulty adjusting to living with someone else 

    • Hard part is staying together, going through changes, learning who that person is  

      • Living together as a couple sees those things 

  • Difficulty with relatives, either family of origin or in-laws 

    • Could be fam of origin or in laws 

    • May have two parents you're self-differentiating in one stage, this stage you have 4 parents  

      • E.g. Mother in law syndrome  

        • Mothers who don't like their son's life  

        • More common than mother's who don't like their daughter's husband and fathers who don't like their daughter's husband  

        • Expectations that aren't necessarily fair or realistic 

          • Might result in distancing in the fam of origin when that bond in the relationship should be strengthened 

        • Idea of a momma's boy also falls in this  

        • Mother in law's have a bad rep 

  • Deciding whether (or when) to have children 

    • Those decisions become more pressing bc in-laws and fams of origin are saying that they want children  

      • Natural tendency to want to see another gen come in  

  • If they didn’t self-differentiate successfully, it just adds to their difficulties  

Family life cycle: Stage 3 (Families with young children)

• Because we had the decisions before, we'd naturally move onto this stage 

  • Exceptions, maybe there aren't any children 

  • Still a stage to go through  

  • If no children what's happening with fam of origin and partner's in-laws 

  • Usually what happens when a couple first has their children 

• Goal 

  • Accept a new gen into that fam system and what it means  

• Tasks 

  • This young couple who is no a fam with young children, just as they were working through their relationship, now they have to adjust it again, cause now they have responsibilities as caregivers/parents 

  • Bc they're entering their middle stages, they need to protect their relationship 

  • Have to negotiate childcare responsibilities 

    • Big one – in school, might be a young child in kindergarten, what happens when the child is sick, someone has to pick up that child – has to be negotiated, can't assume it's one parent or the other 

    • Who cooks for their child, who's home when the child is home? 

    •   How does eating happen? Who takes care of diapers, who dresses the child, takes them for walks, all the things that the need to take place  

      • Has to be an understanding and agreement between the partners (negotiation) 

      • If not, it causes conflict 

• The boundaries open, bc the roles of the extended fam members come in  

• Challenges 

  • Maintaining boundaries with grandparents  

    • Spoil the children, and necessarily listening to what the parents want  

    • Having boundaries, opened up to include them, but boundaries to set the rules 

    • If a multigen fam living in the fam house, even more important to have those boundaries 

  • Lack of parenting experience may interfere 

  • Working out division of labour 

  • Decision-making 

    • Maybe they're trying to make a downpayment on a house, once there's a child, decision making becomes more strict  

  • Finances 

  • Balancing work, family obligations and leisure/social pursuits  

    • More difficult to manage these things bc it looks like there's very little time for leisure/social pursuits  

  • Disabilities 

    • If child has extra needs and may need more caregiving, or may cost more, may challenge the decisions of the child 

Family life cycle: Stage 4 (Families with adolescents)

• Same fam, children get older, now we see the cycle beginning  

• With the teen/young adult/adolescent, they start to test boundaries and self-differentiate 

  • Start again with the single young adult coming out of their fam  

• Goal 

  • Family boundaries, boundaries of parents have to expand and open to allow for that adolescent independence 

  • Now we add the grandparent's dependence starting  

  • Dependent parent sand self-differentiated children  

  • Beginning of the process 

  • Adolescent child has learned through their experience to push their parents boundaries  

• Tasks 

  • Adjusting their boundaries, opening them up, having to refocus on midlife, career and marital issues 

    • Midlife crisis occur here bc this is when the adult has a number of years (?) in their career, are either wanting to go forward and seek promotion, may be wanting more money in their job 

      • Have kids who wan to go to uni 

  • Marital – couple is going through the challenges and seeing those adolescents leaving in a few years 

    • have the pressure of wanting to prepare those adolescents for leaving them which gets in the way of self-differentiating  

    • See more adults as clinicians, in this stage than any other stage  

  • Many inds upgrade to a bigger home, just before the children leave 

    • Pressures – ppl go and upgrade their house usually at this stage 

  • Beginning to shift towards caring of older generation  

  • One o the most stages for a couple to lean on their challenges 

    • A lot of ppl get stuck here and break down  

  • You'll see the most inds in this stage 

• Challenges 

  • Relinquishing control for that adolescents autonomy 

  • Parents having dif points of view  

    • Now one want curfew to be at midnight, one says there doesn't need to be a curfew  

      • Means someone didn't self-differentiate very well bc they're passing that onto their child 

  • Being 'sandwiched' 

    • Stress related to caring of their children aging parents simultaneously 

    • Sandwich gen 

  • Midlife crisis  

    • Difference between male and female mid-life crisis was abt 10 yrs, but its now moving into the same timeframe 

    • Most ppl int his stage should be questioning their career and how its going  

      • Don’t have to be saying what do I do now 

      • Should be questioning how's our relationship 

      • If someone if those things don’t come on top then there's a problem  

Family life cycle: Stage 5 (Launching children)

• Launching children 

  • When your first child leaves home, there might still children in the home but someone has left the fam of origin 

• Goal  

  • Adapting to multitude of entries and exists into fam system  

  • Changes all the fam dynamics and they have to adjust to that 

• Tasks 

  • Re-adjusting to marital system as a dyad 

  • Developing the adult to adult relationships between their child and the children's parents and partners 

    • It's adult to adult, no longer adult to child  

  • All your relationships here are going to have to be re-align (with children, partners, in-laws, any grandchildren) 

  • Dealing with death or disability, diseases, moving into dif accommodation 

• Challenges 

  • Empty nest 

    • The children moving out (first one) 

  • Parents know how to adapt to hat departure, re-negotiate all their roles, what the system looks like 

  • Letting go of parental responsivities 

    • The ind who is going to couple next as the cycle goes, and you're not parenting them anymore  

  • Illness or death of the elderly parents 

  • Allowing that partner's fam into that system when maybe you don’t approve of them  

    • All the things that the couple dealt with, now you're the one dealing with them 

  • Re-negotiating couple relationship without children  

Family life cycle: Stage 6 (Families later)

• Families in later life 

  • Last phase of the fam life cycle 

• Goal 

  • Accepting the shift of the fam generations 

• Tasks 

  • Had children, now they're gone, task is now to adjust  

  • adjustment to aging 

  • Shifting from caring for others to being cared for 

    • Was in change, made up the rules, now you may be subject to other ppl's rules 

  • Might have been multiple losses (friends, career, health, spouse, siblings, peers, etc) 

  • Review your life and accept it  

  • Coming to terms with your mortality  

• Challenges 

  • Multiple losses 

  • Financial insecurity 

  • Dependence on adult children 

  • Feeling a sense of regret, failure 

    • Failure go through all the tasks of earlier stages successfully  

    • Dissatisfaction with how fam turned out  

Disruptions in the life cycle 

• Divorce 

• Early death of a partner 

• Death of a child 

• Unplanned adolescent pregnancy 

• Remarriage/blended fam 

• Illness (physical and/or mental) 

• Financial problems 

• Migration/deportation 

• Adutlt children moving back home 

• Substance abuse  

Youth development 

• Any experience that a youth has in their developmental stages into adolescence, their next stage is adulthood, and later adulthood  

• The things that can be effected by any of these stages are 

  • Mental health 

  • Use of substances 

  • How well they cope, are they resilient? 

  • Stress exposure (social determinants of health) and are they going to be reacting to these things 

• Stages of youth development 

  • Early adolescence (10-14 yrs of age)

    • These early ones, there's a lot of influence from the peer group 

    • When an adolescent starts thinking of careers, schools are prompting this, caregivers, etc 

    • Starting to think what they're interested in 

    • Starting to have their first job 

    • Maturing biologically  

      • Girls are a bit ahead of the boys 

    • Start to put some direction on where they're going 

      • Establish moral rules and limits 

  • Middle adolescence (15-16 yrs of age) 

    • Where inds are much more aware of their appearance, how they appear to others, their body image, sexual attractiveness 

      • Where parents have difficulty getting their younger children to shower daily, hit this stage, and all of a sudden they're showing 3 times a day 

    • Starting to pull away from their parents a bit 

    • Increase in their intellectual pursuits 

      • Getting more serious at school  

    • Looking for ideal role models 

      • Quite susceptible if a role model like a gang member comes in, start to idolize them 

      • Looking for ppl to model themselves after 

  • Late adolescence (17-21 yrs of age)

    • Delayed gratification 

      • Able to do this, some ppl can do this earlier  

      • Different form whether they wanna do it or not 

    • Emotionally, much more stable 

    • Making independent decisions as much as their parents allow them to, making them regardless of whether their parents are agreeing to it 

    • Defined work habits 

      • Work academically + any jobs that they may have 

    • Looking at relationships in a more serious sense than just their sexual attraction towards others 

    • Following through with goals that they can set  

Childhood development factors: 1) Biological 

• Fairly obvious to us but there is the biological sex/sex of origin  

• Chronological age  

• Braid development 

  • Decision making 

    • More modern research in the last 10 yrs where we study the adolescent brain and can see, but biologically, that brain is gonna have a big impact on the decision making function (prefrontal cortex/executive functioning)  

      • If we layer things on top of each other (multitasking)  

    • Where we look at the controls we put on ourselves 

  • Research on risk taking 

    • 25/26/27 - when the brain is fully developed/no longer impulsive  

    • Delayed gratification 

    • Logic and reasoning 

• Physical development 

• Sexual development  

Childhood development factors: 2) Psychosocial 

• Gender 

  • Where gender comes in  

  • The construct of gender is social and historical 

  • Assigned at birth, but it’s a psychosocial factor/not a biological factor in terms of how we study it  

• Culture 

  • Big C culture 

    • Somewhere else the world 

  • Small c culture 

    • The culture of that person and their peers/network/neighbourhood 

• Family (interactions) 

  • A number of factors affecting fam 

• Physical environment (safety, resources) 

  • The actual shelter they reside in to their physical environment 

  • Makes a big difference in their safety and the resources that they have  

• Income (poverty)  

  • Adequate, more than needed, poverty 

• Education 

  • Quite a bearing 

• The sense of belonging  

  • Are inds connected? Is that adolescent connected with anyone or anything? 

  • V important of developmental stages 

• Time of experimentation in various activities 

  • Among them some potentially harmful activities 

    • I.e. may drink alcohol, take drugs, risky sexual behaviour  

    • Is it experimentation or move towards a social regular use 

  • The risk of moving beyond experimentation to a chemical dependence/addiction and mental health issues that will play out in later life and affect that person in terms of their relationships, etc 

  • Health and development 

    • Are they engaging in risky or problematic behaviours 

• Erikson – Psychosocial Theory 

  • Personality, how it's formed, social influences on it 

  • Parental impact as well as social infleunces on child's personality development  

Childhood development factors: 3) Psychoanalytical

• Used to be studied more, still exist, but we don’t tend to spend much time on them anymore 

• Development happens at dif stages, the conflicts between a person's biology and the social expectations and how that person overcomes it is where Freud comes in with Ego, Id, superego to explain how that concept plays out  

  • Some of the students of Freud (I.e. Yung and Adler) have taken it further so it makes sense in terms of how we're dealing with ppl 

• Freud – Psychosexual Theory 

  • Focus on identify formation (sexual tensions) 

  • Child's personality formed by parental management of sexual and aggressive drives 

Childhood development factors: 4) Social 

• Environment, how it plays on the adolescent development, and how important it is that that adolescent has been, is, and continues to be nurtured 

• 3 main places we take this from:

  • Watson – Behaviourism 

    • Children as being passive beings to be molded by parents and society 

  • Skinner – Operant conditioning 

    • Children learn by interacting with and operating on their physical and social environments 

  • Bandura – Social learning theory 

    • Children learn by observation and imitation of behaviours that result in valued outcomes (including praise); importance of reward/punishment  

• These all combine here to form the development of the adolescent  

Childhood development factors: 5) Cognitive 

• This is looking at how children learn 

• Piaget  

  • Children learn through social involvement and interactions 

• Vygotsky 

  • Chidlren's learning as social constructed with more knowledgeable members of society (social and cultural environment as shaping child's development, re. Values, beliefs, etc 

Childhood development factors: 6) System 

• Multidimensional and no one single theory explains what's going on in the system 

• Bronfenbrenner  

  • Ecological systems shape environment and inter-relationships among the systems -> reciprocal 

  • One of the 4 runners on circular causality that we talked abt 

    • Example of Stan and his boss from last week  

    • Stan made mistakes, boss talked to him, gets nervous and continues to make mistakes  

    • Ecosystem 

      • Microsystem, mesosystem, macrosystem 

Attachment Theory: Significant theorists 

• John Bowlby 

  • Looking at the behaviorus of chidlren and how they were attached to their caregivers and how close they were  

  • Ift here was anythign that disupted that, the behvaiours in the chidlren  

• Mary Ainsworth,  

  • Divided this thoery into 4 stules 

• Sue Johnson 

  • Linked adult relaitonshps to the forms of attachment  

  • When we find out what kind of atachemnt styles our client or significant others have, it helps us understand some of the behaviours casue these attachment styels move into adulthood 

  • If attachment style isnt helpful for that perosn, we can work with it  

Attachment Theory 

• Dif styles of attachment all depending on the connection of the child to their caregiver  

  • Any disruption will move into adult relationships and possible be a difficult thing 

  •  e.g. a couple that comes in to see you, they want to stay together or come apart, if they have dif attachment styles, that could be one of the big things as opposed to he said she said  

• This theory drives EFT (emotional focused therapy)  

  • Attachment feeds into that  

• Circle of security

  • You have a child describing attachment 

  • Can enter the circle at any point bc it’s a circle 

  • The child neess to be protected and comforted, wants caregiver to delight in them and be responsive 

    • Safe haven and secure base 

  • Parent/caregiver needs to support the things that the caregiver wants to explore as well as needing to be avialable when the child approaches them  

Secure attachment (4 types of attachment)

• Overview:

  • "I'm okay, you're okay" 

  • Self sufficient 

  • Comfy with intimacy 

  • Wants interdependent relationships  

• When we determine that a client comes from a secure attachment background, not too worried about exploring that further 

• May be other issues with ppl they work with or live with 

• Person who is comfy with intimate relationships, closeness, and autonomy 

• Might say it's easy for them to become emotional close to others 

• Comfy depending on others and having others depend on them 

• Don’t worry about being alone or having others not accept them 

• Promoted by a caregiver who is emotionally available (not just physically available) and appropriately responsive (response has to match and be appropriate) to any behaviour that child has and be able to regulate their positive and negative emotions  

Anxious/preoccupied attachment (4 types of attachment)

• Overview:

  • "I'm not okay, but you're okay" 

  • Over-dependence and involvement 

  • Wants excessive intimacy 

  • Clings to relationships 

  • Doesn’t accept separation when one person wants it or leaves 

• Preoccupation with the actual relationship they're in 

• Reactive emotionally and they might say "I want to be completely emotionally intimate with others but often find others are reluctant to get as close as I would like and I'm uncomfy being without a close relationship, but I sometimes worry that others don’t value me as much as I value them 

• Ind looking for a lot of intimacy, usually more than their partner is giving 

• Constantly looking for approval and responsiveness from their parents 

• Value their intimacy so much so that they become dependent on their partners and their reactions 

• Preoccupied, manifests itself in a partner in adult realtionships is extrmely jelly  

• Ppl who end up stalking other ppl, can backtrack to this style 

• Total preoccupation, can't think beyond it  

Avoidant/Dismissive attachment (4 types of attachment)

• Overview:

  • "I'm okay, you're not okay" 

  • Counterdependent 

  • Is uncomfy with intimacy 

  • Sees relationships as unnecessary  

  • Some kind of break in attachment during childhood 

• Dismissing attachments, might say I'm comfy without close emotional relationships 

• Imrpotant for them to feel independent and self sufficient 

• Refer not to depend on others or have others depend on them 

• Seeing themselves as self-sufficient and invulnerable to feelings 

• Deny a need for close relationships 

• Have a defensive reaction to close relationships  

Fearful/Disorganized attachment (4 types of attachment)

• Overview:

  • "I’m not okay, you're not okay" 

  • Wants approval from others  

  • Is fearful of intimacy 

  • Sees relaitonships as painful  

• Polar oppiosute of secure 

• This person is afraid of intimacy and rejection  

• Don’t think theyr'e deserving of being accepted and they react emotinoally to a lot of things 

• Might say they're somewhat unxomdy wit hgetting close others 

  • Want close realtionships but find it idfifcult to trust others compeltely or depend on them 

• Sometimes worry that they will be hurt if they allow myrslef to become too close to others 

• Ppl with this attachment style, are ambivalent 

  • Have mixed feeligns abt being close ot others 

  • Want to be emotionally clsoe but they’re uncomfy 

  • View themsleves as being uneorthty of those reposnses from their partners and don’t trust the intenitons of their partners 

  • Looking for hidden agendas of ppl who are nice to them 

Forming attachments + attachment style stats

• We all need to develop attachments so that we can have relationships that are healthy and can deal with emotional and psychological issues  

• Attachment can be something we work with, can be strengthened and weakened over time through relationships 

  • Quite often someone with one attachment style may spend a lot of time with someone with a dif attachment style and help them overcome some of the background they had as a child 

• Disruptions can impact how we relate to others, can lead to relational, health, emotional and psychological issues 

• Adult attachment inventory: can help assess attachment injuries, styles 

• Wouldn’t just work with attachment with someone but may use it as a base 

• Healthy attachment 

  • Healthy attachment: ARE 

  • ARE – relationship, healthy between caregiver and child that moves into adulthood 

    • A – accessible 

      • Is the caregiver accessible? 

    • R – responsiveness 

      • Not just accessible but are going to respond 

    • E – engagement 

      • The thing in the cycle that is delight me, don’t just notice me, hug the child, actually watch what the child is doing, encourage them, do things with them  

• Attachment style by population 

  • The Canadian population breaks down to this 

    • Secure – 60% 

    • Disorganized – 15% 

    • Avoidant – 15% 

    • Ambivalent –10% 

• We can heal through our therapeutic relationships with ppl 

• Therapy can rebuild bonds with others 

• We can look at multigenerational patterns (like in Bowen's theory) 

  • Those patterns can impact attachment 

• Trauma can impact attachment 

• We know there's different styles  

• Some biological impacts as well that can come from the caregiver  

Family development: life history model 

• Daily routines 

  • When referring to families the life history model looks at 2 things 

    • Routines 

    • Rituals 

  • They're dif in that routines is a daily structure, and that's everyday life 

    • Things like meal times, bed times, chores, etc those are all routines 

    • Substance use can change how compatible those routines are to allowing of the substance use and can change what parents are doing for instance if mom is drinking the children might become responsible for household chores (disruption in the daily routine) 

• Family rituals 

  • Behvaiours that the family enagges in and they repeat, they usually have some kind of special meaning to the fma (I.e. birthday party, holidays, thanksgiving dinner) 

  • Rituals whre the dfam and extended fam get together to perform this ritual on an ongoign basis not a dialy routine fam functions  

  • When chidlrne becom adults there might be a gathering once a month 

  • Substance use can take the chemically dpeendant person out of the ritual or if that person is part of the ritual it can disrupt how it goes  

• With addictions 

  • We have a tendency to overreact to the things that are developmental challenges that most fams will fix 

  • We often tend to blame others and focus on the problems with avoids doing anything abt them 

• Short term problem solving 

  • Accommodation and adaptation to chemical dependency means a focus on short-term stability  

  • Accommodates and adapts to a substance use dependency  

  • Day to day problems that are easily affected by that substance use, nothing changes 

  • Theres tension, anxiety, rather than any kind of resolution 

Family development life history model: chemically dependent family  

• Families may take one of four primary paths: 

• When there's chem dependency in the fam, can go 4 ways  

  • 1) use continues 

    • The person's use can continue and all the patterns that allow that person to have an addictive identity will get passed down and that use will continue  

  • 2) use continues 

    • But an ind can move away from that use as the identity  

    • Focusing on the identity, assuming it or the exact opposite, moving on  

  • 3) use stops 

    • If use stops, can have rules and patterns made during that use, can continue on even though the use has stopped 

  • 4) use stops 

    • Or all of those patterns shift away from those addictive behvaiours and things stabilize 

The chemically dependent family: survival roles 

• Roles:

  • 1) enabler 

  • 2) hero 

  • 3) scapegoat 

  • 4) lost child 

  • 5) mascot 

• These roles are so an ind can survive the problems of their fam 

• An effort to cope with the emotional pain from substance use, members will take on these roles 

• Help with momentary dysfunction but not permanent solutions and may be consequences in the future when someone is playing a role as an adult when  

• Prevents inds from being who they really are 

• Roles can change over time 

• Can have someone in the fam who is playing more than one role 

• Most common roles :

  • Co-dependent 

  • Hero 

  • Scapegoat 

  • Lost child  

  • Fam mascot 

• A note about roles 

  • When doing assessments can look to what roles someone may be fulfilling in their fam 

  • Helpful to understanding the possible identities ppl may have 

  • Helps us explore how they themselves see their behaviours and what they're doing 

  • Roles can overlap, someone can play a couple of roles, or they may change   

The chemically dependent member 

• An ind might not be able to take full responsibility for their actions and might project that elsewhere 

• Roles of the chem dependent person can take on a defensive behaviour and characterizes as a result of their disease 

  • May see denial, rationalization of what's going on and then minimization of that 

  • Other defenses: 

    • Irrational behaviour 

    • Charm 

    • Threats 

    • Hostility 

    • And depression 

• The person who can internalize feelings of shame, guilt, feel they're inadequate, fear, and loneliness 

  • Will use defensive behaviours to hide these things 

  • The person using substances in the fam  

  • Becomes their role 

The Co-dependent (Chemically dependant family survival roles)

• This person is usually the person who is the closest to the chemically dependent 

• They're actively involved in accommodating them 

• First to react in their own way as dysfunctional bc of the chemically dependent person's behaviour 

• Protective of that member, make excuses for them, rationalizes their behaviour and tends to make personal sacrifices for them 

• Assume responsibility for their emotional well-being and decision making  

• The co-dependent's self-worth is correlated with the dependent's chemical use  

• This member thinks they're the reason for the use 

  • If I caused it, I can cure it - that’s what they think 

• Feel guilt and self-blame when the substance use increases 

  • If only I had done smt abt this 

• They feel lonely, emotional pain, anger, and low self-esteem 

• May drive them to become more obsessive and compulsive in their co-dependency 

• Where the circles interacts  

  • A person who tries to control someone else' behaviour 

• Needing to be needed is an interesting concept 

  • Theres a profession that characterizes this (social work) 

  • Is somewhat comfy in that role but is in a lot of emotional pain  

The Enabler (Chemically dependant family survival roles)

• Enabling is anything that's done to protect the chemically dependent perosn from the consequences of their own behaviour 

• May make allowances for their own behaviour  

• Note:

  • Unlike the codependent, this person consumes themselves with an is very close with the dependent , they don’t need to have the ongoing relationship  

    • Not necessarily close to them 

    • They become a victim of the disease 

  • Both of them prevent the dependent from acknowledging the severity of their behaviour  

    • e.g. Driving someone to the liquor store, giving someone money for drugs, picks up person from the bar 

  • Easier to work with an enabler to get them to recognize their behaviour and encourage them to stop 

    • Much more difficult to work with a co-dependent 

The Hero (Chemically dependant family survival roles)

• The achiever 

• The responsible child, good, model child 

• Often the first born 

• They escape the dysfunction of the fam, through personal achievement 

  • See a lot of this through school 

• Feel responsible for the fam, often neglect their own needs 

• Can feel miserable, hurt, resentful, guilty 

• Vulnerable to alcohol or drug issues in interpersonal relationships  

The Scapegoat (Chemically dependant family survival roles)

• The role that gets fam members to look at smt other than their problems 

• Gets blamed for the fam's dysfunction and has disruptive behaviour (cyclical) 

• Demand urgent attention form the fam but will do it by externalizing their behaviours rather than internalizing it  

The lost child (Chemically dependant family survival roles)

• The fam member who often is invisible  

• Starts as a child who identifies with the pain and dysfunction in the fam but doesn’t want to increase it, wants to decrease that tension so they will disconnect emotionally, withdrawal emotionally, and build a private world 

• Feel lonely, inadequate and depressed 

• At high risk for suicide  

• Quite often it’s the young child, not old enough to take on personal achievement/be a hero  

The Mascot (Chemically dependant family survival roles)

• The one who brings lightness, happiness, and laughter to the fam system 

• Meant to distract from the fam system, avoids pain, use humour and fun 

• The fam pet  

• Can be hyperactive, super cute, does anything to get a laugh or be at the center of attention  

  • Desperate to do this, goes out of their way 

• Distracts the fam from the tension and stress going on 

• Works momentarily, btu in later life, if they continue this role, may not be ideal for their adult relationships or work relationships  

Resiliency 

• Goes with stamina 

• What we learned that ppl in helping professions need 

• To be able to cdeal with the ongoing issues and challenges that ppl bring us 

• A fam's resiliency 

  • Don’t often get credit form clinciians, but they're very resiliat to all the pressures they experience 

• The ability and wehther it's a fam or ind – the abilituy to recoveyr quikcly and bounce back from difficulties 

• Modern approaches such as solution focused therapy and narrative therapy recognize and work with resistance to tx and they will consider the fam's resilience specifically  

  • Work on strengths, recognize these things 

• Reframing 

  • A technique that reduces resistance and increase resiliency 

  • Oen of those things that's a really cool thing to do 

  • Has an enormous impact on clients for v low effort 

  • Once you get the hang of it and know that you're doing, you're gonna do it 20 times a day  

  • Called restructuring in CBT 

Reframing 

• Looks at an ind or a situation from a dif perspective than what's being presented and helps us as clincian in helping solve issues, making deciison, and elarnign more abt the person 

• It's constructive 

  • Enables someone tomove beyond a situation wheter they may be stuck or confused 

• Empowers that perosn to act and elarn by shifting their persepctive ontheir own situation or themsleves 

• Considers the positive opporutnity avialabel to that ind wather than the negative problem 

  • Most ppl will have negative issues that thye bring us, but what's the positive oporitnity in that, lets reframe it 

    • A weakness can be seen as a stength 

    • An impossibility as a distant possibility 

    • A distant possibility as a ear possibility  

    • Oppression (against me) as neurtral (doesn’t care abt me) 

    • Unkindness as lack of understansing  

Social issues in chemically dependent families 

• Word critical means they have to be addressed: 

  • Physical abuse (of a child/senior) 

    • The children with the subtrance abuse in one or both parents are at increased risk of experinecing violence  

    • Those children, there's a high correlation to truamatic brain injuries (TBIs) 

  • Emotional maltreatment/abuse (of a child/senior) 

    • Keeping a child feelign safe and secure may be effected and thos ehicldrne may be taking on additional repsonsibilites that parents normally did 

      • Can come into the emoitnal piece 

    • Parentificaiton of chidlren  

  • Neglect (of a child/senior) 

  • Sexual abuse (of a child/senior) 

    • All of the above, you are mandated to report if they involve a child 

    • These apply to senior's as well. Senior abuse is against the law and is reportable just like child abuse  

    • Keeping a child feelign safe and secure may be effected and thos ehicldrne may be taking on additional repsonsibilites that parents normally did 

      • Can come into the emoitnal piece 

    • Parentificaiton of chidlren  

  • Witnessing of domestic violence

    • With regard to chidlren, chidlren can witness pgsycial violence in hoems where ther eis substance use at play 

    • Chdilren can be truaatize hwen tey see at elast one of those parents being hurt 

    • Biggest piece of research – the chidlrne dontnecessairly get damadged bc of physcial violence, but they can be accientally hurt by the violence  

    • childrne can be truaamtized by witnessing one parent bing hurt 

  • Mental illness 

    • Mentla illness and addiction go hand in hand, can't have one without the other  

    • The link here is truama and addcition 

    • Substance use is one of thr factors that rlads to mentla ehalht problems  

Critical issues in chemically dependent families: child maltreatment 

• Child maltreatment can be effected by chronic substance use 

• Always need to be assessing for risk bc it affects our tx 

• Risk can come up in sessions inadvertently  

• Can effect your therapeutic relationship  

Issues in chemically dependent families: domestic violence 

• Frequent co-occurance of substance sbuse and domestic violence is well-docuemnted 

  • Correlation does not mean casuality 

    • One deosnt cause the other but thye are linked 

• Male abusers haevicnrease icnidences of substance use isues' often attmept ot justify abuse thorugh the substance use 

• Women with substance use problems are also at an icnrease likleihood of abusive bhevaiour 

• Asssessing for instances of witnessing, expriencing or perpetuating violence is aprt of assessing susbtance use

Unique stressors for addicted families 

• Increased risk 

  • Research tells us that there's more risk of physical violence, sexual abuse, financial crises, divorce, mental health issues, effects on children 

  • Fams will worry and attempt to cope to maintain homeostats but that adds additional challenges 

• Lack of social support 

  • If the fam has a lack of social support, may be a member of the fam that is chemically dependent and may put some strain on the systems that support the fam (could be extended fam)  

  • Social support is hard to attain 

  • Clinicians tend to be critical of the fam 

    • Fams are resilient, but as clinicians we don’t always give them credit  

  • When a fam member comes to you, you're looking for strengths, what's working 

• Looking at the specific unique stressors that happen within fams  

• Things you deal with as clinicians 

• At the center is power and control 

  • Hierarchy, who has that power and control 

  • Ppl seeking this fall into this circle 

• Have physical and sexual  

• Categories 

  • Using coercion and threats 

  • Using intimidation  

  • Economic abuse 

    • Financial strains, is someone holding onto the money in the fam and using that to coerce someone into doing or not doing smt 

  • Emotional abuse  

    • Verbal abuse falls into this category now 

    • Constantly being put down, being told they're stupid, fat, ugly 

    • When it's constant/a pattern 

  • Using male privilege  

  • Isolating someone  

  • Using children  

  • Minimizing denying and blaming 

    • The ind who doesn’t take responsibility for their actions, blames others 

• Most of these categories cross over and several of them are going on in fams 

• This circle is where we might often start analyzing what's going on in the fam 

• Your client may come to you as an ind but some of this may have gone on in their background  

  • May be that this is within their own fam  

Therapeutic benefits in addictions: family systems vs the individual 

• Substance use is often referred to as a career burden that the fam has  

  • Fams are going to influence the users use  

    • Quite often is indirectly 

• Research tells us that tx will be much more effective and recovery to be sustained is when the fam is involved 

  • Not just treating the ind but also the fam  

• All fam members have a stake in a successful outcome 

• Working with the fam as opposed to the ind 

  • e.g. the child says to a parent "if you'd only treat me more like mom/dad does" 

• Individual oriented therapist 

  • Hears in this statement that the child is frustrated and has anger towards one parent 

    • Might encourage the client to not be mad at parent 

• Systems oriented therapist 

  • But if you're systems oriented, you'll hear the above statement but that there may be a relationship triangle existing between the child and the parents or hears indirectly abt the conflicting relationship between the two parents 

    • Got all sorts of dynamics to discover 

      • Where the parents came from in their fams of origin, how that plays out in relationships  

• Individual oriented therapist highlights 

  • The ind therapist is gonna look at feelings, thoughts, and behaviours of that person 

• Systems oriented therapist 

  • Will look at patterns, repetitive sequences of actions and reactions between all ppl 

  • Client will get more out of this 

• Why is a fam systems approach important or helpful in treating addiction? 

  • When looking at addiction, the demands and consequences of addiction are complex and fams need support in their own right 

• The research shows that when we involve the fam in the tx plan, it's likely going to be more effective  

• System vs. The ind 

  • The outcome for the client, improves 

  • It increases clients coming into tx  

  • While in tx it sustains their engagement into what we're trying to do and their retention 

    • They don’t walk out bc there's smt there that may be helpful 

  • This approach reduces relapse (doesn’t eliminate it) 

  • The psychosocial functioning of everyone in the fam improves to a certain extent 

• None of these outcomes are as enhanced if you're dealing with just the ind 

Effects of addiction on the fam 

• Fam members may distance themselves from the chem dependent person 

  • Not wanting the world to see them associated, not being able to relate to that person themselves 

• Can lead to a message of not caring between the spouses that might be communicated or from parent to child 

• Emotional trauma effects bonding and attachment 

• Fam members carry the extra burdens 

  • Could be the children doing smt or fam members having to do more 

    • e.g. dad loses job bc of drinking, mom picks up extra jobs, child picks up the slack 

• The stress that the fam deals with bc of addiction can lead to arguments and violence  

• Other actions that the fam member might take 

  • Might have an affair 

  • May lead to separation 

  • separation continues and it becomes a divorce 

• Roles ppl play in fams may become distorted 

  • Roles that may have been functional might become dysfunctional and passed inter-generationally  

• Categories we normally see when there's addiction in the fam 

  • Emotional stress and taxation on fam members 

  • Financial strain 

    • Maybe someone has lost a job, but just to support the extra drinking and substance use costs a lot 

  • Psychological 

    • Happens on each fam member 

  • Social  

    • May be where someone has distanced themselves 

    • Socially, how do you interact when there's someone in the fam who has that chem addiction  

Early detection of addiction in fams (physical/mental health or appearance)

• When we're counselling fams of addiction, can look at early signs  

  • Maybe signs a fam has already noticed, not guaranteed that these all mean addiction 

  • Esp if these are all paired up 

• May see physical appearance of someone or there may be mental health: 

  • Person might show confusion  

  • Unexplained memory loss 

  • Paranoia that suddenly appears 

  • Delusional thinking 

  • Hallucinations 

• All of these can lead s to hypothesize if this person is showing signs of chemical dependance 

Early detection of addiction in fams (Occupational or educational status)

• Another sign could involve occupational work they're doing or maybe they're in school 

  • Poor performances at work 

    • Would be changes (not that they have performed poorly from the start) 

    • If early in career, will be on probation, you get feedback in your learning but it gives the agency ability to terminate you without cause  

  • Job termination  

  • Declining grades in school 

    • Grades were much higher before and have declines 

  • Neglect of fav school activities 

    • Or activities in general, social things that someone might do, friends, hobbies 

    • All of a sudden, things that person may have been passionate abt before, but no so much any more 

  • Absenteeism at work or school 

    • Not showing up  

  • Peer conflict  

    • Could be a change in peers too at school or at work 

    • But starting to be argumentative, engaging conflict 

      • Could be bc of others noticing and critiquing, and denial sets in  

Early detection of addiction in fams (psychological changes)

• Irritability  

• Mood swings 

  • Cause a lot of concern with friends and fam bc they're not always rooted in an event 

• Unjustified outbursts of anger 

• Tearfulness or sadness 

  • Out of context/not in the normal presentation of that person  

• Expressions of hopelessness 

• Giddiness or irrational laughter 

• Social isolation  

• Key thing 

  • Changes in their normal presentation 

  • Why are there these changes? 

The two main goals of fam therapy for addiction 

• 1) Provide helpful support for the ind in tx 

  • Fam therapy decreases that ind's chance of relapse 

  • To develop positive behaviorus and attitudes towards change and maintain those behaviours 

  • Coping strategies that may have been part of their history get relapsed with more positive ones that promote long-term recovery from substance abuse 

• 2) Improve the emotional health of the fam as a whole 

  • To help the fam members establish trust 

  • Forgive from past behaviours  

    • As someone moves towards recovery whether through harm reduction or total abstinence, fam members who have gone through everything we talked abt earlier, can they forgive those behaviours? 

  • Fam therapy extinguishes the sense of ongoing crisis and encourages participants to let go of negative emotions  

Multicultural considerations in fam counselling 

• Counsellor awareness of own cultural values and biases 

  • We need to be aware of our own values and biases 

  • In counselling, you have your values and biases, but you have to put them on the chair outside of the room, no place for them in counselling 

    • You're there for the client and to help them 

    • Not to impose what you think or your biases 

  • Knowing cultural values is not only helpful but you really need to be aware that there are cultural things going on that influence the values and biases of the client  

• Your job is to figure out how the client perceives the world 

  • That’s your sensitivity is building your skills by getting to know them  

  • Your job is to get to know as much as possible how they view the world 

  • Ongoing – how does the client perceive smt 

    • Questions you're always asking 

  • Most ppl wanna tell you how they view things 

• This is a model called RESPECTFUL 

  • It's all the dif things that if you're understanding of them, you’ve done a good job at looking at the cultural client world view 

The R-E-S-P-E-C-T-F-U-L model 

• 
  1) R – Religious-spiritual identity  

  • The spiritual identity that a client has 

  • Maybe as a result of the region in the world that they lived in  

  • Any experiences they've taken beyond that in their life 

  • They may have no religion or spirituality identity in their lives 

• 2) E – Economic class background 

  • Referred to class structures 

  • Some countries sin the world that look at dif levels of the population and ppl will fit into a level and will denote how they act and are treated  

  • The standards an roles someone identifies with bc of their SES 

  • How does the client look at themselves 

    • What are their strengths, how do they express themselves sin the economics of their background in their current situation? 

• 3) S- Sexual identity 

  • How an ind identifies sexually influenced their personal development, esp ppl who have experienced some form of oppression bc of their sexuality which reduces their sense of worth 

  • Where does this person come from? 

    • Do they come from somewhere where their sexual identity was outlawed so they have fled 

    • Or do they come from a country where sexual identity is seen as a choice, not fearing death but they may have come across some ppl who are negative 

    • Need to know what their experience is as it effects counselling 

• 4) P – Psychological maturity 

  • Ability for someone to respond to a situation that's occurring in their environment in an appropriate manner 

  • Someone's reaction to smt might be affected by how developed their psyche is  

  • Someone might be stuck at a certain maturity level 

• 5) E – Ethnic-cultural-racial identity  

  • Little c – groups (peer groups) 

    • As the groups come down, how does that person identity? 

  • Big C – culture where are they from regionally? 

  • Some clients experience within group differences which could influence their psychological development 

• 6) C – Chronological  

  • Developmental piece 

  • How an ind develops physically, mentally, psychological skill development 

  • All of this effects how they experience the challenges at dif points in their life  

  • Can be dependent on a lot of things 

    • Trauma from fam 

    • Region of the world that that person comes from 

    • Did they have the ability to develop? 

• 7) T – Trauma and other threat's to one's well-being 

  • Threats to one's well-being  

  • Stress that situations can produce for an ind 

  • They're at psychological risk of danger, their ability to cope becomes ineffective  

  • Can be regional, environment, human based, war or violent conflict 

• 8)  F- Family history and dynamics 

  • Fam can play a role in a person's sense of self, ambition, and prejudices 

  • The modern fam is now one with more diversification, less rigidity, and broadened horizons 

• 9) U – Unique physical characteristics 

  • May experience dissatisfaction  

  • Could include a deformity of some kind here there's a part of a person's anatomy that didn’t develop according to normative standards, that person may not like how that part of them has developed 

• 10) L- Location of residence and language differences 

  • Depending upon the climate patterns, (what's the climate of that region?), the geological terrain, does that ind come from a rice eating country or a potato eating country? 

  • Types of occupations available 

  • Inds will possess various strengths and interests 

  • Be aware of stereotypes and biases associated with inds who speak a dif dialect can defer from inaccurate assumptions  

Best practices in treating addiction in families 

• Benefits of fam therapy 

  • Better understanding of the nature of addiction and how it affects behaviour 

  • Becoming aware of fam dynamics 

  • Improving communication 

  • Regaining trust 

  • Sharing feelings 

  • Setting boundaries 

  • Learning self-care 

• Fams are significantly impacted by addictions and fam involvement in tx can reduce the harms and can also improve tx entry, tx completion and tx outcomes for the ind coping with an addiction 

• Although the benefits of fam-focused practices in addiction have been documented, services continue to have an ind focus and research on this topic is also limited 

• Fam-based approaches to treating adolescent substance abuse highlight the need to engage the fam, including parents, siblings, and sometimes peers in the adolescent's tx 

• Involving the fam is important bc the adolescent is often living with at least one of those parents and be subject to the parent's controls, rules, and/or supports 

• Fam-based approaches generally address a wide array of problems in addition to the young person's substance problems including 

  • Fam communication and conflict 

  • Other co-occurring issues with  

    • Behaviour 

    • Mental health 

    • Learning disorders 

    • School or work attendance 

    • Peer network 

Brief strategies fam therapy 

• Based on the fam system, we have brief strategic fam therapy  

• 12-16 sessions 

• The BSFT counsellors establish a relationship with each fam member, observes how the members behave with one another and assists the fam in changing negative interaction patterns 

• BSFT can be adapted to a broad range of settings 

• Primary intervention used in outpatient interventions, can be used in residential tx or day tx (inds live in the community but come in for aftercare/continued care-service)  

Family behaviour therapy 

• Has been a positive use with both adults and youth 

• Combines behavioural contracting with contingency management for both the substance use and also behavioural problems that might occur 

• The adolescent and at least one parent participate in the tx planning and chose specific interventions from a menu of evidence-based tx options 

• Encourage fam members to use behavioural strategies taught in the sessions and apply their new skills to improve what's happening in the home environment 

  • Goals are reviews and rewarded  

  • Adolescent and parent get to choose what the rewards are 

Functional fam therapy 

• That combines your systems view that you're working on which is based on interactions between fam members that are pretty unhealthy that underline the behaviours that are problematic 

• Behaviorual techniques are used ot improve communication 

  • How the fam views problems, what they do abt them, how they resolve conflict, may also be parenting skills 

    • Come in when there are behaviorual issues at odds with the teen 

• Tx strategies are to: 

  • Engage fams in the tx process and enhancing their motivation for change 

  • Modifying fam member's behaviours using CM techniques more towards communication and problem solving as opposed to changing behaviours 

Multidimensional fam therapy 

• MDFT is comprehensive 

• Usually worked in community tx 

• Outpatients who have gone through a program, also ppl who maybe have never went through a program  

• Looking at adolescents who have used substances and are at high risk for behvaioural problems such as conduct disorder and delinquency 

• Aim is to help the fam learn skills so they feel competent and will collaborate with other systems 

  • Sessions can take place in dif areas and may change 

  • Mayb be in the home, in the clinic, or school setting, maybe in fam court 

• It's been shown to be highly effective with the severity of substance use disorders 

• Helps with reintegration of the youth going back into the community  

• Used in conjunction with some of the justice programs where we hope to deter youth from going into the system  

Multi-systemic therapy 

• Intensive, community based 

• Used when the adolescents have severe problems but they are engaged in delinquent and or violent behaviour 

• Looking at substance use and the fam 

  • Why is the youth using the substance - what's the positive draw for them/what are they getting out of it? What's going on in the fam? 

  • Family - Poor discipline, conflict, parental drug use? 

  • Peers and their positive attitudes towards drug use 

  • School – dropout, poor performance 

  • Neighbourhood – criminal subculture 

Impact of SU and MH issues on youth development 

• Examples of youth mental health issues 

  • Top 6 things we deal with in terms of things that are happening 

    • 1) depression 

    • 2) anxiety 

    • 3) attention deficit disorders 

    • 4) attention hyperactivity disorders 

    • 5) learning disabilities (autism, dyslexia) 

    • 6) suicide (ideation, attempt) 

• The majority of Canadian youth have at least tried alcohol or weed by the time they have completed high school  

• Alcohol is the most common substance that's consumed by youth 

• Over half of youth in grade 7-12 report using in the past year 

• Illicit or prescription drug use is also widespread, with over a third of grade 7-12 students reported use in the past year 

  • Weed and prescription pain killers (e.g. codeine, Percocet) for non-medical purposes are most commonly used  

• Throughout adolescence the rates of alcohol and drug use steadily increase but the majority of youth who use substances as adolescents decrease their use over time without requiring intervention  

• The progression from experimental substance use to developing a disorder is complex and multi-faceted 

• Research tells use that the earlier the onset of alcohol or drug use, the increase that exists in the risk of progressing from experimental use to abuse or dependence 

Risk factors for MH 

• Environmental factors that can increase MH and SU include 

  • Limited parental supervision 

  • Neglect 

  • Trauma 

  • Or other kinds of abuse 

• All significant in terms of aiding the increase of MH and SU 

• Fam history can contribute 

  • Parents, caregivers (e.g. parental substance use , history of psychopathology() influence the genetic vulnerability of developing mental illness or SU in youth 

• Ind personality 

  • Variables associated with the development of MH issues and/or su 

• Traumatic events 

  • Experiencing or witnessing abuse/violence, emotional abuse, etc 

Risk factors for youth depression 

• When we look at risk factors for the #1 issue for youth, depression can look at 

  • Caregiver's use 

  • Depression in the caregivers 

  • Dysfunction in the fam 

    • Poor parenting, rejection (in the attachment styes that the child has) or lack of warmth  

  • Maltreatment or abuse 

  • Youth's own negative self-image 

  • Anxiety 

    • Can contribute to depression 

  • Poor social skills  

    • Impulsive, aggressive, passive withdrawn 

  • Poor social problem solving skills 

  • Apathy 

  • loss 

• Negative life events 

  • Anything that's happened in someone's life that they perceive as negative can cause anxiety 

• Parents with anxiety disorders or have shown a lot of anxiety around childrearing practices 

  • Anxiety never really settles down and for the teen trying to gain independence, this anxiety might be holding them back 

• Parental drug/alcohol use 

• Parental over control and intrusiveness 

  • Parents who are overly present in their youth's lives 

• Shyness 

• Fearfulness 

• Low self-esteem 

• Parental marital conflict 

• Parental unemployment 

• Family conflict (parents and children and/or between siblings) 

• Traumatic experiences (person/social - community/school violence, bullying) 

• Violence  

• Poor physical health 

Risk factors for youth substance abuse 

• Parental and/or sibling drug/alcohol use 

• Permissive parenting  

  • Lack of or inconsistent discipline, lack of supervision  

• Low parental aspirations for the child/youth 

  • Parents who don't have ambitions for their children or don't seem to care 

• Parent – child conflict/lack of attachment 

• Poor impulse control 

• Sensation-seeking 

  • Experimentation  

• Attention deficit/hyperactivity disorder 

• Anxiety 

• Depression 

• Antisocial behaviour 

  • Not just a label, has to be real – meets some diagnostic criteria  

• Child abuse/maltreatment 

• Conduct disorder 

• Failing in school/not college bound 

  • Not fitting in with peers, not following parents expectations 

• Associating with drug-using peers  

Protective factors in youth healthy development 

• Having high self-esteem 

  • Create a situation where there can be higher self-esteem 

• Self-regulation 

  • Particularly around things like impulse control, aggression, etc 

• Adequate socioeconomic resources for the fam 

  • When you gave a rlly dysfunctional fam, if they're socioeconomically stable and have enough resources to sustain the fam, that's a strength bc not everyone has that 

• Reliable support and consistent discipline from parents 

• Extended fam support 

  • Are there grandparents, aunts, uncles who provide support that is a protective factor where the fam isn't  

• Ability to make and keep friends 

  • For the youth that may have isolated or have low self-esteem, do they have that ability or did they once have that ability?  

• Academic achievement/intellectual development 

• Social engagement 

• School practices and policies to reduce bullying 

• Positive teacher expectations 

• High academic standards 

• Good coping and problem solving skills  

• Presence of mentors and support for development of skills and interests 

• Opportunities to engage in school, community, etc 

• Physical and psychological safety  

• Mental health care visit  

  • Females (26.3%) are significantly more likely than males (17.9%) to report a mental health care visit 

Child and youth MH study (2025) 

• Ministry of education does this survey every 2 yrs, doesn’t always change a lot but there are a few things that changed this year 

• Stress and anxiety are our most prevalent emotional issues  

• Emotional challenges are quite acute for youth among grade 9-12 

• What comes into that is poverty and low income 

  • Significant impact that comes into school stressors 

• 1 youth in 5 will have a mental health issue  

  • The challenge to that with adults is that its now 1 in 3  

• Studies embedded in this study 

  • Kutcher 

    • 15-20% of youth suffer from some form of mental disorder 

    • 1 out of 5 youth in the classroom suffer from some form of mental disorder 

  • Manion and Short 

    • Most mental health problems start in early adolescence or early adulthood  

    • 70% of adults who live with a mental illness said onset started before they were 18  

      • 50% said it started before they were 14 yrs old  

• Important that we identify early and intervene 

• Suicide is the second leading cause of death among 16-24 yr olds 

• Society's negative response to ppl who have mental illness 

  • Often described as more disabling than the illness itself 

  • Prevents inds and fams from seeking early identification and tx for a mental illness 

  • Results in inequalities in education, economic, health and other social entitlements  

  • Stigma is a form of oppression that keeps ppl down 

• Self-stigma comes into that, is the internalization of the beliefs and attitudes of society that are particularly negative 

• 79-90% of teachers reported that there were concerns in their school around  

  • Attention deficit disorders 

  • Attention hyperactivity disorders 

  • Learning disabilities (autism, dyslexia)  

  • Stress 

  • Anxiety disorders 

• 7/10 teachers have not received professional development to address student mental illness 

The mental health and well-being of Ontario students study 

• 2% of secondary students were prescribed medication to treat anxiety in the past yr 

• 2% of secondary students were prescribed medication to treat depression 

• 2% were prescribed medication for both anxiety and depression  

• An estimated 5.5% of secondary school students prescribed medication to treat anxiety, depression, or both conditions (43200 secondary students in Ontario) 

• Females (7.9%) are twice as likely as males (3.4%) to report being prescribed medication to treat anxiety, depression, or both conditions 

• There's a significant grade variation showing the highest likelihood is among 11^th and 12^th graders  

• 2% of secondary school students report using a telephone counselling helpline in the past year  

  • 19, 600 students in grades 7-12  

• 1% report seeking help from a website 

  • 14, 000 students 

• In combo, 3.0 report using a helpline or a website or both to seek counselling 

  • 31, 00 students  

• Females (4.2%) more likely than males (1.8%) to seek counselling either over the phone, the internet or both 

• Over one quarter (27.9%) of students report that they wanted to talk to someone abt a mental health problem, but didn’t know where to turn 

  • 288, 300 students 

• Females (37.5%) are more likely than males (19.0%) to report an unmet need for MH support  

• 2013 was when they first started looking at social media and how many hours a day students spent on screen  

  • 10% of students reported symptoms of problematic social media use 

    • Could be preoccupation, tolerance, loss of control, withdrawal, escape, conflict with fam  

• In 2021 there was a significant increase (Covid)  

  • Wasn’t just students, but a lot of schools starting using online, so students were more online and using social media more 

• When you look at dif forms of gambling, sports better, online poker, casino games, its only been in the last year that the increase has soared and daily exposure ot ads abt online gambling over a month 

• Taken together 1-8 (12%) students report any type of online gambling (online sports betting, online poker, online casino games) at least once in the past year 

• One quarter (25, 1 in 4 students) of 7^th and 12^th graders report being bullied in the past year  

  • 256, 200 students in ontario 

• The most prevalant mode of victimization is verbal (21.4%) while 1.7% are typically bullied physically, and 1.9% are typically victims of theft or vandalism 

• Females are more likleu than males to be bullied verbally, whereas males are more likleuy to be bullied physiclaly or victims of theft/vandalism 

• Females are significantly more likley than males to report being cyberbullied  

The MH and well-being of Ontario students: Key findings from 2025 update 

• Stats are starting to come out in terms of the effects of covid  

• Post pandemic rebound 

  • Students (grades 7-12) have shown improvements in psychological distress, self-harm rates, self-rated mental health, and school connectedness compared to the peak pandemic era (2023 survey) 

• Ongoing long term concerns 

  • Since that rebound in covid, almost half (46%) of the students still report moderate-to-serious levels of psychological distress - a figure that has doubled over the past decade 

• Emerging trends 

  • The 2025 report highlights growing concerns regarding online gambling, nicotine pouch use, and elevated social media and video gaming issues among youth 

• Substance use 

  • Overall traditional drug use among students continues to decline, though MH coping mechanisms remain a focus point 

Child and youth MH study stigma and bullying 

• 1/5 (21%) teachers have frequently very frequently seen students with a MH problem being bullied 

• Table 

  • Percentage treated for MH condition reporting some stigma in past year (indicated they were treated negativley or unfairely bc of current or past MH condition) 

• Importance of stigma and discirmniation in prventing help seeking among youth  

Internalizing/externalizing MH disorders 

• MH disorders can be organized by whether its intenrlized or externalized 

  • Internaling disorders include 

    • Deprression, axniety, somatic disorder, andpost-truamatic stress 

  • Externalizing disorders include 

    • Attention-deficit/hyperactivity, conduct and other impulse contorl disorders 

  • Gender differences 

    • Female youth tend ot have higher rates of internalizing problems than male youth 

Major depression and suicidality in adolescents study 

• Depression is typically a recurring disorder with serious morbidity and mortality that commonly begins in adolescence 

• More than 50% of youth who complete suicide have had a form of depression  

  • Link between untreated depression and suicide) 

• Female youth are 2 x more likely than male youth to be depressed  

• Female youth are 3 x more likely than male youth to have suicidality linked to depression, but higher rates of completed suicides in male youth compared to female youth 

  • Males more likely to use lethal means  

  • Why are females less successful? 

    • They more often use things like pills, and will phone someone, they are rescued (don't take enough pills) 

• Reginal differences  

  • But also differences in health care programs, and socioeconomic status by region leading to social determinants  

Youth substance use

• Examples of youth substance use 

  • Tobacco 

  • Alcohol/binge drinking 

  • Cannabis 

  • OTC cough/cold medication 

  • Estasy 

  • LSD 

  • Heroin 

  • Opiod pain relievers 

  • Methamphetamine (crystal meth) 

  • Transquilizers 

  • Cocaine 

  • Prescription meds (I.e. xanax) 

• Levels of susbtance use 

  • Susbtance use occurs on a continuum rnaging from first use and experimentation to a diagnosable substance use  

    • Expeiremntation 

      • First use of a substance, experiemtnign mayb ewith pepers in a social context 

    • Regualr use or social use 

      • Used regualrly in social situations to reduce anxiety or maybe bc everyone else is using it 

    • Problematic use 

      • Used to compensate for smt or change a negative mood, feel good, expeirnce smt new 

    • Substance use disorder 

      • Clinical imapirment, meets the diangositc critera in the DSM of being a problem  

  • When you have a youth and are looking at SU wanna see where they are in terms of the continuum  

Drug use among Ontario students past year

• Tobacco cigarettes 

  • Male – avergae 9% 

  • Female – average 8% 

    • Not much difference between both genders 

  • Grades 

    • 7 - NS 

    • 8 - NS 

    • 9- 4% (13-14 yrs) 

    • 10 – 11% (14-15 yrs old) 

    • 11 – 13% 

    • 12 – 15% 

• Alcohol

  • Drinks in the past yr 

    • Male average – 47% 

    • Female average – 45%  

    • Grades 

      • 7 – 9% 

      • 8 – 16% 

      • 9 – 34% 

      • 10 – 52%  

      • 11 – 67%  

      • 12 – 72%  

  • 5+ drinks on one occasion in past month  

    • Male average – 19% 

    • Female average 16% 

    • Grades 

      • 7 – ns 

      • 8 – ns  

      • 9 – 9% 

      • 10 – 16% 

      • 11 – 30% 

      • 12 – 32%  

• Cannabis

  • Male average – 22% 

  • Female average – 21% 

  • Grades 

    • 7 – ns 

    • 8 – ns 

    • 9 – 10% 

    • 10 –  25%  

    •  11 – 35%  

    • 12 – 37% 

  • 7 yrs now Drug recreational pot now legal in Canada 

    • The cannabis act provides a legal framework for contorlling the distribution, sale and possession of cannabis 

      • 3 goals 

        • 1) keep profits out of the pockets of criminals 

        • 2) protect public health and safety by allowing adults access to legal cannabis 

        • 3) keep cannabis out of the hands of youth 

Medical professionals caution against the use of cannabis among youth 

• The potential for addiction to weed, esp among teens and YA must be addressed 

• We know that 1 in 7 teens who start using cannabis will develop cannabis-use disorder which is significant  

• Cannabis has also been linked to certain ental illnesses  

• The drug's relaitonshp to depression and anxiety is still up in the air; the science has not established a causal relaitnship between the two 

  • Its not celar if ppl smoke pot bc they're depressed and anxious or are anxious and depresed bc they smoke pot  

• Male average – 12% 

• Female average – 13% 

• Grades 

  • 7 - NS 

  • 8 – NS 

  • 9 – 7% 

  • 10 – 12% 

  • 11 – 13% 

  • 12 – 15% 

Trends: youth and non-medical use of prescription drugs 

• One in ten (10%) of students in grades 7-12 (95 000 students in Ontario) report using a prescription opioid pain reliver non-medically in the past year 

• The majority (59%) of past yr users report obtianing the drug from someone at home (e.g. parents' meds) 

• 2% of studnets in grades 7-12 (19, 900) report using a drug typiucally used to treat ADHD in chidlren (e.g. Ritalin, Concerta, Adderall, Dexedrine) without a prescription 

  • e.g. Ritalin, concerta, adderall, dexedrine) without a prescription 

• Among all students, 3.2% used an ADHD drug chemically (31,400 students in grades 7-12) 

What is a concurrent disorder?

• CAMH gives us the working def 

  • Inds who are experiencing co-occurring disorders with addiction and MH 

    • Includes a lot of forms of addiction apart from SU, drugs,, etc 

    • Agencies are starting to get funding to deal with gambling addictions 

• Concurrent disorders are major in health care in Can 

• Half of the ppl who are seekign help for addiciton also have a MH issue 

  • Someo fo the psychoatric facilities (e.g. Ontario Shores) have found that it's up to 80% 

• 15-20% of ppl seeking help from MH services are also living with an addiction  

• Concurrent disorders are also called 

  • Dual diagnosis 

    • Here in Canada the meaning of dual diagnosis means you have addiction, but you also have a mental health issue specific to your cognition 

    • Ppl who have a psychiatric disorder and a chronic mental illness are a c 

    • If they have cognitive delays, that we call dual diagnosis 

• Confusion among terms 

  • The dual diagnosis term in the US refers to persons with severe and persistent mental illness (I.e. persons with psychotic disorders, severe perosnality disorders, and other chronic mental disorders) who also experience a substance use 

  • The dual diagnosis label continues to be used, but is gradually being replaced by concurrent disorders and the more general term of comorbidity 

What is a substance use problem 

• Defined in the DSM 5  

  • Takign a substance in larger amounts than you're meant to  (either by prescription or to be casual or social) means you're wanting to cut down or stop but not able to do that, and you're spenidng. A lot of time getting that usbstance (using it, paying for it) and there are cravings for that substance 

• A problem exisits if a perosn's substance use or the state of ther MH is having an ongoign negativ eimpact on the perosn's life or the ppl who are close ot that person 

• Cravings and urges to use the substance 

• Not managing to do what you should at work, home, or school bc of substance use 

• Continuing to use, even when it causes problems in relationships 

• Giving up important social, occupational or recreational activities bc of substance use 

• Using susbtances again and again, even when it puts you in danger 

• Continuing to use veen when you have been caused or made worse by the usbsrtance 

• Needing more of the sbstance to get the effect you want (tolerance)  

• Developmenta of withdrawl symptoms which can be relieved by takign more of the usbstance