Provide a case example of a family in which one member has a medical illness (details in rubric).
Respond to the following questions:
Rolland discusses the need for clinicians to consider the ethnic, religious, and cultural beliefs and norms of families as they can vary. How do you see this model working with various beliefs and norms of other cultures?
What barriers do you see?
Discuss the illness as it related to Rolland’s FSI model.
Case Example
Description of the illness and patient (demographic factors, background information,
identified problem)
Chronic disease: Cerebral Vascular Event (CVE). “Luis” is a 42 Latino man, he has
been separated from his wife for almost a year and a half, yet they are not divorced, they
share custody of two children (male 6, female 3). He currently lives in Mexico City and
remains unemployed. Luis requested therapeutic assistance two years after the CVE, his
intention to seek help was to “get my family back”. During the interview, it could also be
noticed some features of depression and anxiety. Two years ago, before the CVE Luis was
experiencing high levels of stress regarding financial problems; he just had his new baby
and the oldest was about to start kindergarten. Moreover, he had invested a lot of money in
a new business and was struggling to pay his house and his car beside the family expenses.
It was during this time of stress when Luis presented the CVE, which left him unable to
work. The CVE occurred in the cerebellum area, causing paralysis and later motor
impairment on the right side of the body. After being discharged from hospitalization, he
attended physical therapy, language therapy, and orientation to reinstatement to
employment at the National Institute of Rehabilitation. When he returns home, he begins to
worry about family expenses and debts, consequently, he stops buying his medicines and
attending physical therapy. His neurologist tells him about the risk of abandoning his
treatment, due to the possibility of presenting another stroke, and advises him to leave his
home to reduce stress. Therefore, his parents decide to take him to live in their house, and
his brothers are the ones who support him in his personal expenses and rehabilitation.
Family system
The nuclear family is integrated by Luis (42), his wife (39), and his two children (6,
3). They have been married for 7 years, and have lived apart for a year and a half.
Luis’s family of origin is integrated by his father (68), his mother (67) and his two older
brothers (48, 45), and his younger sister (40).
Luis’s parents are already retired and they live by their social security income. His older
brothers work in a private company as package deliverers. His wife is in charge of the
family business, which is a beauty salon. Overall, Luis represents a low-middle
socioeconomic status.
Application of Rolland’s FSI model
Psychosocial Type of the Illness
In terms of the psychosocial description of Luis’s illness, it can be divided into
three: onset, course and outcome, and the needs and expectations of each aspect. Regarding
onset; Luis’s illness had an acute onset, which prompted the family to make practical
changes in a short period of time, also it required more rapid mobilization of the family
system to manage the crisis. In this phase, the family of Luis needed to be helped to tolerate
and assimilate this highly charged emotional situation, yet they weren’t assisted. Thus, all
the changes and adaptations that they did were quick and with the intention to “solve the
problem”. Yet, they didn’t take that much time to assimilate the emotional impact of the
situation. Considering the course of the illness, it could be determined as a constant course,
where this single initial event (CVE) caused some degree of impairment (paralysis and later
motor impairment on the right side of the body) with an expectation of full recovery.
Therefore, the family readapted new roles to assist the identified family member, however,
the family also experiences to some extent a certain degree of uncertainty that it will
happen again, which increases the levels of stress. Finally, in terms of outcome, the range
of affection to a life span after a CVE can be defined as unpredictable, since this illness can
shorten the life span with a moderate good prognosis, but at the same, it can lead to sudden
death. In this aspect, evaluating the expectations of Luis’s family and his own, they
perceive the illness as life-threatening, yet they expect with the hope that after attending the
medical interventions and counseling therapies Luis’s condition could improve and thus
become out of danger. It is important to highlight that both Luis and his family are fervent
Christians whose faith in God keeps them hopeful. The degree of disability of Luis’s illness
combines both cognitive and motor deficits causing Luis to abstain from working. Luis’s
impairment has caused major stress in his family, first of all, because they are concern
about having enough income to cover Luis’s illness expenses. On the other hand, they are
also worried about Luis’s emotional state, which they believe has a great influence on
Luis’s recovery, since they hold the idea that it was the high levels of stress what caused the
CVE. Finally, there is a disagreement about the desire for Luis to get back with his wife;
his family considers that his wife wasn’t supportive during the episode and hasn’t be
supportive since then in any way (financially or emotionally). They hold the belief that if
Luis gets back with her, he will again experience stress which could lead to another CVE.
On the other hand, Luis believes that if he gets back together with his wife and feels “loved
and supported” by her, his emotional state could improve.
Time Phase of Illness
Although there have been two years from the CVE, it could be recognized that
Luis’s family is transitioning from the crisis phase to the chronic phase. There are still some
aspects that need to be resolved, understood, and agreed upon in order to be fully in the
chronic phase. The family hasn’t experienced the terminal phase, since Luis is not yet
identified as a terminally ill member or hasn’t been diagnosed with time remaining.
Following there is a brief description of Luis’s family phases.
Crisis Phase
Chronic Phase
Terminal Phase
Family members have understood the illness and its repercussions on
Luis’s physical and emotional health. They have reorganized roles in
order to assist Luis and promote family competence (Luis’s brothers
are in charge of the expenses, and his parents in charge of his physical
care). The family has also acknowledged possibilities of further loss
while sustaining hope. They have also adapted to treatments,
symptoms, healthcare settings, and demands. Finally, the members
have learned to collaborate as a unit to provide support
Family members have learned how to maximize autonomy given
constraints of illness (Luis’s brothers keep working and doing his
daily routines, and his parents try to keep their previous activities
while caring for Luis, even Luis himself has been encouraged to keep
his autonomy by doing things on “his own”). Family members have
also developed mindfulness of the possible impact of the illness on
current or future family life cycles. However, there are aspects that
still need to be done to be fully in this phase; for instance, family
members need to learn and manage how to live with anticipatory loss
and uncertainty. The family needs to especially pay attention to
balance open communication and proactive planning. Luis’s family
has the tendency to avoid conflict, therefore there are issues that still
need to be talked openly with the family, such as the desire of Luis to
getting back to his wife. Including Luis’s wife in this dynamic will
also be important in order to understand her perspective and role in
the family system. Considering Luis’s reintegration into his nuclear
family (wife and children) should also be discussed in order to
planned or readjust roles.
Still to be experienced.
Family system variables to promote functionality
According to Rolland, there are at least 4 aspects to understand the family system: family
structure, communication processes, multigenerational patterns, and belief systems.
Like most Latino families, Luis’s family is characterized as being collective and exhibits
high levels of cohesion. Despite the multigenerational gaps between the members, they all
shared respect and demonstrate loyalty to their families. There are differences between the
sub-families around Luis’s nuclear family; for instance, there are families with adolescents,
another experiencing the “empty nest”, and Luis’s parents who are at the final of the
Lifecycle. Yet, all the members are included when one family member experiences a crisis,
in this case, Luis. In the past, every time that a family member was diagnosed with an
illness the whole system moved to assist and support the member. They perceive the family
as the main support for any problem. Their communication demonstrates validation, caring
and it’s constant, yet they avoid conflict and therefore there are issues within the family that
are not discussed. They tend to express their opinion and disagreement in a more subtle and
indirect manner, this leads sometimes to personal assumptions that cause tension. Their
belief system about death and illness is mostly positive; They are all Christians who believe
in God, and therefore remain hopeful about the future, trusting that “God’s will it’s always
perfect”, therefore even if there is death they sustain that God will provide consolation.
Reflection of the model (cultural competency, limitations and practice).
Chronic illness and family systems have rarely been combined, in fact, there is evidence
that just a few healthcare facilities have integrated family when treating a patient. In this
context, Rolland’s FSI Model is very beneficial and competent not only to assist families
with a diagnosed member but also to promote better recovery and family resilience. In my
opinion, this model is effective because it proposes a systemic view that is more integrative
and holistic, plus a normative and preventive framework very suitable for psychoeducation,
evaluation, and intervention in the family context. One of the main strengths that I identify
in this model is the improvement of family resilience; every family is unique with different
strengths and vulnerabilities. Therefore, identifying and acknowledging a family’s qualities
and functionality to overcome the crisis and to adapt to new circumstances could make a
great difference in the maintenance of health and foster recovery. In addition, this model
adapts to the family no the other way around, which allows the family to keep its own
characteristics and inner culture to keep functioning. Therefore, in terms of cultural
competence, this model is one of the few that keeps the cultural aspects of the family and
its context in perspective when providing intervention. I believe that health professionals
should achieve an adequate knowledge of family dynamics and functioning, the potential
risks they face, and the protective factors in order to assist a person experiencing chronic
disease. As a clinical psychologist, this model would be beneficial for my own practice,
since including the family in the understanding of an illness will not only benefit the ill
member but the whole system.
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