Family Resilience: A Framework For Clinical Practice - Theory And Practice

Family resilience: a framework for clinical practice - Theory and Practice

This article presents an overview of a family resilience framework developed for clinical practice, and describes its advantages. Drawing together findings from studies of individual resilience and research on effective family functioning, key processes in family resilience are outlined in three domains: family belief systems, organizational patterns, and communication/problem-solving. Clinical practice applications are described briefly to suggest the broad utility of this conceptual framework for intervention and prevention efforts to strengthen families facing serious life challenges.

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Fam Proc 42:1-18, 2003

A FAMILY RESILIENCE FRAMEWORK

The concept of family resilience extends our understanding of healthy family functioning to situations of adversity. Although some families are shattered by crisis or chronic stresses, what is remarkable is that many others emerge strengthened and more resourceful.

Resilience--the ability to withstand and rebound from disruptive life challenges--has become an important concept in mental health theory and research over the past two decades. It involves dynamic processes fostering positive adaptation within the context of significant adversity (Luthar, Cicchetti, & Becker, 2000). These strengths and resources enable individuals and families to respond successfully to crises and persistent challenges and to recover and grow from those experiences (Cowan, Cowan, & Schultz, 1996). Some who have suffered trauma become blocked from growth or trapped in a victim position. In contrast, resilience involves key processes over time that foster the ability to "struggle well," surmount obstacles, and go on to live and love fully.

The Relational Context of Individual Resilience

Most research to date has focused on individual resilience. In the 1980s, increasing evidence was found that the same adversity may result in different outcomes, which challenged the prevailing deterministic assumption that traumatic experiences, especially in childhood, are inevitably damaging. In surveying these findings, Rutter (1987) noted that no combination of risk factors, regardless of severity, gave rise to disorder in more than half the children exposed. Although many lives were shattered, others overcame similar high-risk conditions and were able to lead loving and productive lives and to raise their children well. Studies found, for instance, that most abused children did not become abusive parents (Kaufman & Ziegler, 1987).

To account for these differences, early studies focused on personal traits for resilience, or hardiness, reflecting the dominant cultural ethos of the "rugged individual" (Luthar & Ziegler, 1991; Walsh, 1996). Initially, resilience was viewed as innate, as in the character armor of "the invulnerable child," who, like a "steel doll," was thought to be impervious to stress (Anthony & Cohler, 1987). Researchers moved toward recognition of an interaction between nature and nurture in the emergence of resilience, yet tended to hold a pessimistic, narrow view of family influence. Most studies focused on individuals who thrived despite a parent's mental illness or maltreatment (Wolin & Wolin, 1993) and tended to dismiss the family as hopelessly dysfunctional and to seek positive extrafamilial resources to counter the negative impact. Thus, families were seen to contribute to risk, but not to resilience.

As research was extended to a wide range of adverse conditions, such as growing up in impoverished circumstances, dealing with chronic medical illness, or recovering from catastrophic life events, trauma, and loss, resilience came to be viewed in terms of an interplay of multiple risk and protective processes over time, involving individual, family, and larger sociocultural influences (Garmezy, 1991; Masten, Best, & Garmezy, 1990; Patterson, 2002; Rutter, 1987). Individual vulnerability or the impact of stressful conditions could be outweighed by mediating influences.

In a remarkable longitudinal study of resilience, Werner (1993; Werner & Smith, 1992) followed the lives of nearly 700 multicultural children of plantation workers living in poverty on the Hawaiian island of Kauai. By age 18, about two thirds of the at-risk children had done as poorly as predicted, with early pregnancy, needs for mental health services, or trouble in school or with the law. However, one third of those at risk had developed into competent, caring, and confident young adults, with the capacity "to work well, play well, and love well," as rated on a variety of measures. In later follow-ups through midlife, all but two were still living successful lives. Many had outperformed Kauai children from less harsh backgrounds; more were stably married and employed, and fewer were traumatized by a hurricane that destroyed much of the island. Of note, several who had been poorly functioning in adolescence turned their lives around in adulthood, most often crediting supportive relationships or religious involvement. These findings showed that despite troubled childhood or teen years, there is potential for developing resilience across the life course.

Notably, Werner's research and other emerging studies of resilient individuals all remarked on the crucial influence of significant relationships with kin, intimate partners, and mentors, such as coaches or teachers, who supported their efforts, believed in their potential, and encouraged them to make the most of their lives. Still, the prevailing focus on parental pathology blinded many to the family resources that could be found and strengthened, even where a parent's functioning is seriously impaired. A family resilience perspective recognizes parental strengths and potential alongside limitations. Furthermore, grounded in a systemic orientation, it looks beyond the parent-child dyad to consider broader influences in the kin network, from sibling bonds to couple relationships and extended family ties. This approach fundamentally alters the deficit-based lens from viewing troubled parents and families as damaged and beyond repair, to seeing them as challenged by life's adversities, with potential for fostering healing and growth in all members.

Family Stress, Adaptation, and Resilience

The concept of family resilience extends beyond seeing individual family members as potential resources for individual resilience to focusing on risk and resilience in the family as a functional unit (Walsh, 1996). A basic premise in this systemic view is that serious crises and persistent

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