FRED C. GINGRICH
Much of the trauma literature emphasizes the impact of trauma on the individual. However, the literature addressing resilience supports the critical role of relational networks as a key factor in an individual’s recovery from trauma. Even in an increasingly disconnected contemporary culture, family relationships, including marriages and extended family, are often a victim’s primary healing community, whether they live in individualistic or collectivist cultures. The focus of this chapter is the contribution of family systems theory, assessment, and therapy to the understanding and treatment of the impact of trauma on families in general, with examples given of families with high stress and high potential for trauma (e.g., missionary and military families). The Christian mental health professional has much to offer traumatized families, rooted in a rich integration of psychological and biblical/theological resources.
For families of faith, the reality of stress, trauma, and hardship come as no surprise. Scripture details the challenges and trials that will come to people of faith (e.g., 1 Thess 3:3) and points us to the healing community that we find in the body of Christ, the church. A relational focus on resiliency, as the way people learn to cope and maintain hope in the face of trauma, is consistent with the description of the Christian life in Romans 8. The passage proclaims that in Christ “we are more than conquerors” (Rom 8:37, italics added), suggesting that together we are able to overcome the adversities and challenges of life.
From this foundation of the reality of family life and the hope that families have in their spiritual and community resources, in this chapter I review the concept and types of family trauma and make the case for endorsing the lens of family resilience in working with traumatized families. I then utilize concepts from family systems theory to inform our work with families in crisis.
Traumatic experiences and their impact on families fall into the following broad, though not distinct nor exhaustive, categories (Catherall, 2004):
Simultaneous trauma: Family members are directly affected by a traumatic event (e.g., auto accident, home invasion, natural disaster).
Secondary or vicarious traumatic stress: Family members witness or hear about trauma experienced by another member (e.g., rape, chronic illness, accident of another family member).
Intergenerational trauma: Family members are affected by the trauma experienced by the previous generation (e.g., children of POWs, second generation Holocaust survivors, immigration; see Hollander-Goldfein, Isserman, & Goldenberg, 2012; Rowland-Klein, 2004; Wolynn, 2016).
Intrafamilial trauma: Family members are traumatized by a member of the family (e.g., incest, domestic violence, alcoholism).
While distinct dynamics are associated with each type of trauma, and specific interventions are needed, these nuances are beyond the limitations of this chapter. However, I will focus on unfolding the implications of this core idea: The healing dynamics linked to resilience are often found in the “we,” not in the “I,” and they arise through the process of connecting with each other in relationship (Shem & Surrey, 1998).
Southwick and Charney (2012) identify a number of resiliency factors in the literature. These include optimism (belief in a brighter future); facing fear (as an adaptive response); maintaining a moral compass, ethics, and altruism (doing what is right); religion and spirituality (drawing on faith resources); social support and role models; physical and brain fitness; cognitive and emotional flexibility; and meaning, purpose, and growth. What is missing from this list as an explicit factor supporting resilience is the crucial role of one’s closest (typically family) relationships. Of course, as Boss (2016) points out, there is always a dialectic between individual and family stress and coping; both need to be considered.
However, the family systems and resilience research in support of the family resilience lens is compelling (Catherall, 2004; Hollander-Goldfein et al., 2012; Lebow & Rekart, 2004; Price, Bush, & Price, 2016; Saxe, Ellis, & Brown, 2016; Southwick & Charney, 2012). To give one example of this research evidence, Simpson (2010) found that a sense of acceptance and belonging to a family was one of the most significant protective factors for an individual in the aftermath of trauma.
Boss (2016) addresses the question of whether helping a person or family in the aftermath of a traumatic experience is a matter of coping with stress, adapting to stressful circumstances, being resilient (or tough) in response to stress, or managing stress. As the name of her book implies, management is Boss’s preferred conceptual framework, as it recognizes the implicit and ubiquitous presence of ambiguity in all traumatic situations. The ambiguities of trauma cannot be avoided and should not be simply endured; both the negative impact and the potential for posttraumatic growth and change need to be managed.
I prefer the word resilience when discussing a family’s management of trauma. In an earlier book, Boss (2006) defines resilience as “the ability to stretch (like elastic) or flex (like a suspension bridge) in response to pressures and strains of life” (p. 48). Resilience includes one’s response to “normative stress from everyday hassles, expected family transitions of entries and exits (including births and deaths) across the lifespan. It also includes the stress and trauma from unexpected crises and catastrophes” (p. 48). Resilience is the ability to bounce back to previous, or even higher, levels of functioning. It also means the ability to live relatively comfortably with ambiguity and uncertainty in the face of what are often life-changing and confusing losses.
The analogy of a bridge (Boss, 2006) suggests that resilience is like a bridge bending from a heavy weight but without negative effects; it can continue to absorb pressure without harm to the bridge. Stress is akin to the bridge absorbing the weight (pressure) and functioning as it was built to do. The bridge begins to show strain by shaking or even “groaning” but holds for now. A crisis results in the bridge beginning to collapse.
Another helpful conceptual perspective is used by Hollander-Goldfein, Isserman, and Goldenberg (2012) in their 20-year, in-depth qualitative study of Holocaust families. “Transcending trauma” may sound a little optimistic, but in their research they identified a number of family factors that resulted in traumatized families being able to transcend or heal and grow beyond their traumatic experiences:
Pretrauma lives with significant attachment figures, relationships with family members; sharing of values, rituals, meaning, individual strengths prior to the war
Mediating influence of positive parental attachment patterns (closeness–distance, empathy–self-centeredness, validation–criticalness, expressive of positive emotion–negative emotion, open–closed communication, tolerance–intolerance)
Role of faith and ritual
Impact of family communication and trauma narratives on children
Intergenerational transmission of trauma from survivors to their children and grandchildren
These factors are both protective in the face of trauma and restorative in the aftermath of trauma; combined they describe what it means for a family to be resilient.
It is evident that experts are beginning to appreciate the value of the family systems lens in responding to trauma. The following references each support the family systems perspective of trauma: Boss (2016); Catherall (2004); Johnson (2002); Kiser (2015); Kilmer, Gil-Rivas, Tedeschi, and Calhoun (2009); Lanktree and Briere (2016); Nason-Clark, Fisher-Townsend, and Fahlberg (2013); Phillips and Kane (2008); Price, Bush, and Price (2016); Saxe, Ellis, and Brown (2016); and Walsh (2006, 2016).
Family systems theory stresses that what matters most in life is not what happens within or inside people but what happens between them. Thus, family resilience is more about relational processes than traits or competencies that individuals in a family either have or do not have. Resilience itself is relational, and self-repair happens better in families working together to family-repair. This perspective is highly optimistic regarding the vast resources that families possess to respond to crises and distress. In addition, thinking systemically encourages us to consider sociocultural contexts and solutions in contrast to what some consider the limiting intrapsychic perspective that predominates the therapeutic world. This perspective is poignantly illustrated in the preface to Boss’s (2006) book:
My work in New York [9/11], in Kosovo, and with people affected by the 2004 tsunami has solidified my views about including family- and resilience-based approaches in treating loss and trauma. The common focus on individual treatment and pathology after loss and trauma must be broadened to include safeguarding natural family and community struggles and rebuilding resiliency. (p. xx)
Table 8.1 summarizes the primary distinctions between a focus on healthy families, dysfunctional families, and resilient families. While each perspective has benefits, the reality is that healthy families, as described in the table, do not really exist. All families experience levels of stress and have problems. In subtle ways, our culture, often reinforced by a particular view of spirituality, suggests that there is something wrong with ordinary families who are struggling to cope with their current reality. The family systems perspective suggests that stressful events, developmental challenges, and even trauma are normal life experiences and do not constitute family dysfunction or pathology. On the other extreme, viewing families simply through the lens of dysfunction and pathology does not acknowledge the myriad of strengths and resources that families have, which are easily hidden beneath current traumatic experiences. In a similar way, a common Christian perspective is that there is a healthy, biblical model of family, and it is the ideal toward which all Christian families need to strive. The prototype of such a family is a “traditional” nuclear family with two parents (male-female married couple) and their children living in a male-led authority structure; the family is career/ministry focused, with well-behaved, authority-responsive children, and has regular (preferably daily) family devotions (cf. Clapp, 1993). So when a Christian family is struggling, the belief is that the family is not following Jesus closely, is not living in the freedom and power of the Spirit, is not utilizing their spiritual resources, is not implementing spiritual leadership appropriately, or is not a truly Christian family. A family systems perspective rooted in a biblical worldview, and taking seriously the multitude of challenged families presented in Scripture, rejects this perspective of the healthy Christian family and acknowledges the norm of highly stressed, traumatized families trying to follow God amidst their own and the world’s fallenness (cf. Garland & Garland, 2007).
Table 8.1. The focus on family resilience
Healthy Families |
Resilient Families |
Dysfunctional Families |
Assumption of success across all dimensions |
Bounce-back ability in times of stress |
Coping mechanisms are usually faulty |
Stable over time and across situations |
Trauma/problems can occur at any time |
Pathological in most circumstances |
Specific characteristics to emulate |
Relational processes that can be learned |
Specific characteristics to avoid |
Ideal model of family |
Real families |
Negative model |
No need for intervention |
Targeted support and education needed |
Therapy/treatment required to improve |
Often desire to be like these families |
Develop patterns that respond well to crises— a less lofty goal |
Try to avoid being like these families |
The family systems perspective also requires us to reject the view that there is one universal model of the healthy family, that there is one set of family values that all families need to adopt, that there are ways of living and being family that fit all families, and that there is one organizational structure for the healthy family. In brief, systems theory presents a focus that allows for diversity of family models, deals with the reality of family dynamics and challenges, and encourages a focus on covenant, grace, empowerment, and intimacy (Balswick & Balswick, 2014) through faith in God and the support of God’s people. This highlights the contrast between ideal, God-honoring families and dysfunctional, fallen families. The focus on real families that are resilient in the face of struggles is consistent with the overarching perspectives of family presented in Scripture
A family resilience lens offers a number of helpful perspectives regarding the understanding and treating of families affected by trauma. Together the following points explain why a family resilience perspective distinctively adds to our appreciation of the complexity of trauma.
A relational (systemic) emphasis. As previously suggested, family systems theory is concerned about the “between” dynamics of families in contrast to the internal dynamics of individuals. In support of this perspective, research on resilience in vulnerable children has increasingly linked resilience to key protective processes in family and social relationships (Goff & Schwerdtfeger, 2004). The family system and the family’s ability to function within social and cultural systems (including political, economic, and medical) contribute to augmenting or reducing the resilience of families. Family resilience is not just the presence or absence of individual hardiness or specific personality traits (e.g., easygoing temperament, higher intelligence, positive bias, or learned optimism); it is the processes themselves that families develop to cope with life. These family processes mediate the impact of stress for all members and can influence the course and outcome of many crisis events.
Ordinary and growth oriented. Families commonly demonstrate resilience. While some traumas can destroy family bonds (e.g., the death of a child; abandonment and extreme dislocation), families frequently draw on resources they were not aware of without professional intervention. Resilience refers to the ability to adapt well in the face of life’s adversities, traumas, tragedies, threats, and stress. Beyond mere containment, coping, problem-solving, or crisis management, resilience points to the possibilities for positive transformation and posttraumatic growth for the family in the midst of the challenges and beyond.
The goal is not to avoid or become numb, nor to be self-sufficient and to breeze through the trauma unscathed, but rather to have the courage and hope to struggle well with suffering. Even though trauma will likely involve considerable emotional distress, which can overwhelm commonly used coping patterns, a crisis can become a positive turning point for an individual or a family. As many have discovered, resilience is forged through adversity, not despite it (Walsh, 2006, 2012a). Resilience research exactly parallels the teaching of Scripture with respect to dealing with life’s challenges. For example, Joseph, after the maltreatment by his brothers, says, “You intended to harm me, but God intended it for good to accomplish what is now being done, the saving of many lives” (Gen 50:20). This and other passages affirm the biblical value of resilience as the norm for the Christian life (2 Cor 4:8-9; Rom 8:28; Jas 1:2-5).
Developmental considerations. Resilience depends on developmental factors that are at times easy to overlook. Families typically consist of children and adults, aging members and preverbal infants, each with unique developmental strengths and vulnerabilities (McGoldrick, Preto, & Carter, 2015; McGoldrick & Shibusawa, 2012). Families experience normal family transitions (e.g., the first child goes to school) accompanied by levels of stress that are usually managed effectively (Cowan & Cowan, 2012). In the presence of traumatic stress, the developmental strengths of each family member are often an underutilized resource, as well as a potential complicating factor.
In traumatic situations, the intersection of individual development and family development can also be a strength or a challenge. Developmental theorists tell us that no single coping response is invariably successful over time, and that both individual and family development is too complex to make identifying a single helpful response possible. However, events that occur out of sync with chronological or social expectations (e.g., sibling death during childhood; early widowhood) are more difficult to cope with (McGoldrick, Preto, & Carter, 2015). Furthermore, a family strength at one stage might not be considered a strength at another time. For instance, a grandmother living with a family might not be particularly stressful and may even be helpful at reducing family stress when her grandchildren are infants, but her presence in the household might become more stressful for the family when the children are adolescents.
Thus, it appears that resilience is diminished when crises are developmentally unexpected (e.g., terminal illness diagnosed in a young family), when crises are more severe or persistent than developmentally expected (e.g., lengthy separation due to employment), when stressful individual transitions collide (e.g., midlife parent and adolescent child), or when multiple stressors within a developmental time frame produce cumulative effects (e.g., a young family with a sick newborn and unemployment). Resilience is fostered when there is an expectation that some level of stress typically accompanies each stage of family life (e.g., a family with an adolescent in “trouble”). The intersection of developmental psychology, family systems theory, spirituality, and resilience to trauma provide a critical foundation for counselors’ efforts to respond compassionately and competently to the impact of trauma on people’s lives.
Personal and family histories do not necessarily determine the present. The widely held belief that the impact of early and severe individual or family trauma cannot be altered is being challenged by resilience research with the recognition that not only can there be recovery from some trauma, but the end result can be increased strength (Walsh, 2006). People and families with difficult pasts have the potential to improve their lives later in their development. This, of course, in no way is intended to minimize the incredible pain and long-term consequences of trauma. Complex traumatic pasts erode the coping mechanisms that healthy people assume everyone has the ability to use. It is clear that the ability to be resilient decreases with the amount, type, and chronicity of the trauma.
However, attachment theory (Bowlby, 1988; Cassidy & Shaver, 2008), while recognizing that insecure infant attachment and trauma can lead to difficulties in adulthood, suggests that attachment styles can change over the lifespan. Some more optimistic perspectives have begun to provide empirical evidence that developing secure relationships as adults (through friendship, romantic, family, or therapeutic relationships) can repair early attachment deficits (Johnson, 2002). Such perspectives acknowledge that while separation from primary contexts of safety and security is inherently traumatizing, the establishment of safety and security in primary attachment relationships can be curative. In other words, we are not lifelong victims of traumatic experiences; secure relationships in the present are an antidote.
Spirituality is an important dimension of family resilience. In addition to the explicitly Christian literature on families and faith (e.g., Balswick & Balswick, 2014), a number of secular authors have recognized the importance of spirituality in helping families (e.g., Barrett, 2009; Walsh, 2012b, 2016) and particularly the significance of religion and spirituality in terms of working with most ethnic families (McGoldrick, Giordano, & Gracia-Preto, 2005). Blume’s (2006) model of family therapy describes spirituality as one of five key dimensions that affect how assessment and treatment should be conducted. Most religious systems value family, and while some distorted forms of spirituality can be toxic for individuals and families (e.g., VanVonderen, 2010), overall the consensus is that spiritual values improve individual and family functioning. This factor is probably even more significant in the face of trauma. If Boss (2006) is correct in her assertion that finding meaning after trauma is a significant part of the healing journey, then faith in a sovereign God, finding acceptance and comfort in the midst of loss, experiencing forgiveness, or finding meaning in the artistic expressions, symbols, and rituals associated with many religions can be powerfully positive dimensions of responding to trauma (Boss, 2006). For Christians, the more tangible resources of Scripture, prayer, and community provide meaning and purpose, not only for individual believers, but for families of faith.
Walsh (2006, 2012a, 2016) provides a thorough description of the relational processes that support families during and after traumatic events. The model consists of three primary processes that overlap and intersect in more of a circular (systemic) fashion than a linear sequence. These factors focus a clinician’s attention to processes that a family in crisis may not exhibit, putting the family at risk for traumatic disruption. It also provides a set of principles on which mental health professionals can base interventions in premarital counseling, parent training, and counseling in the aftermath of traumatic experiences. Table 8.2 summarizes the processes that are expanded on in succeeding subsections.
Table 8.2. Walsh’s model of family resilience (2012a, p. 406)
Family Processes |
Descriptors |
Belief systems |
• Making meaning of adversity • Positive outlook • Transcendence and spirituality |
Organizational patterns |
• Flexibility • Connectedness • Social and economic resources |
Communication/problem solving |
• Clear, consistent messages • Open emotional expression • Collaborative problem solving |
Family belief systems. Families may not be aware of their implicit belief system (e.g., “we believe in God”) and rarely identify, discuss, or exhibit it. Even if a family is aware of and makes explicit acknowledgments of their beliefs (e.g., “we value living as a Christian family”), they may not be able to articulate them in a way that all members of the family understand. Whatever the case, belief systems can provide relational processes and resources that help a family to be resilient in the face of trauma. Belief systems, particularly religious ones, provide meaningful explanations for the events of life and a sense of coherence, a sense that all the pieces fit together even if one does not experience it right now. Belief systems provide hope, a positive outlook (optimistic bias), and courage to do what is possible now while accepting what cannot be changed. Frequently, a belief system also includes beliefs about transcendent values and purposes far beyond the limitations of the current resources of the family, along with a spirituality that offers inspiration, faith, rituals, and spiritual resources such as prayer, Scripture, and community support.
Organizational patterns. Flexible organizational processes are necessary to handle crises. Rigid patterns of life and relationships severely limit responses and can destroy families or, at the least, intensify traumatic stress. Flexibility entails the ability to rebound, reorganize, and adapt to new challenges while maintaining a sense of stability through the disruption. This sense of stability includes the need for continuity, dependability, rituals, and routines. Strong leadership can help provide the necessary nurturance, protection, and guidance, but when the leadership is inflexible or located in only one person, the family is vulnerable if the leader experiences trauma that limits or immobilizes his or her responses. Therefore, varied family forms such as cooperative parenting, sibling caregiving, and distributed leadership functions can help a family adapt to changing and critical situations.
Organizational patterns that foster attachment, are committed and dependable, provide mutual support, are collaborative, and respect individual needs, differences, and boundaries are essential. When a family is relationally threatened, previously developed family patterns that model and encourage seeking reconnection, forgiveness, and reconciliation can sustain families through crises. Family patterns that make good use of social and economic resources in stable times are more likely to foster resilience in tumultuous times. Families that can mobilize kin, social, community, and institutional networks when in distress and who have the financial resources to continue to provide basic needs will be more resilient in the aftermath of trauma.
Communication processes. How families talk to each other matters. Clear, consistent messages (words and actions), the freedom to ask for information to clarify ambiguous and confusing experiences, and the desire to seek truth and speak truth are characteristic of communication patterns that foster family resilience. Open emotional expression, sharing the range of feelings (joy and pain, hopes and fears) with mutual empathy and respect for differences, also fosters resilience. Taking responsibility for one’s own feelings and behavior and avoiding blame are key communication skills for families. Pleasurable interactions, recreation, and humor are also important. Gottman’s (1999) research identifies that a five to one ratio of positive to negative expressed sentiments is as important for families as it is for couples.
Included in these communication processes are a range of ideas such as creative brainstorming, resourcefulness, collaborative problem solving, shared decision making, conflict resolution skills, negotiation skills, fairness, reciprocity, focusing on family goals, defining concrete next steps, building on success, and learning from failure. Overall, a proactive stance toward preventing problems, averting crises, and preparing for future challenges is helpful.
While all families are at risk for trauma, missionary and humanitarian workers’ families are a unique subset of families that illustrate high levels of chronic family stress, trauma, and resilience. In a parallel way, albeit with some differences, diplomatic families and international business families also fit this profile. A major difference between these two categories of families that live crossculturally is the degree of access to economic resources when faced with trauma. The history of missionary families is filled with stories in which economic challenges compounded the response and effects of trauma.
Another group of families, immigrant families and culturally diverse families (Gardano, 1998; Zagelbaum & Carlson, 2010), experience similar pressures and potential for trauma as a result of living in culturally unfamiliar contexts. Such families are at high risk for levels of trauma that families more connected to familiar contexts and networks of support do not often experience.
My experience with missionary families is that they have typically lived through one or more of the following incidents. None of these incidents are by themselves necessarily experienced as traumatic, but the blending of them can result in devastating trauma for missionary families.
Extreme and frequent geographical transitions
Bridging multicultural contexts; always being the “foreigner”
Personal and family safety concerns related to unstable political conditions, criminal victimization, natural disasters, animosity, and suspicion
Limited communication access and challenges even with familiar people and safe relationships
Complex, highly unpredictable gender roles
A sense of isolation while being in frequent contact with people
Few indicators of success as a family and in ministry
The challenge of repatriation
The overwhelming significance of the task
Specifically applying Walsh’s model to missionary families, it is likely that such families have strengths in the area of a belief system. More than many other types of families, the entire family’s network of relationships perceives that the family shares a common purpose. Thus, in the face of crosscultural stress, educational challenges, precarious financial situations, and isolation from kinship networks, there is often a common family definition of purpose, “God’s call” to missionary service. Even in the event of severe traumas such as robberies, kidnappings, car accidents, natural disasters, and political uprisings, families share a way of talking about the stress and about God’s and the mission’s overarching purposes being served.
Missionary families, especially from conservative religious backgrounds, tend to have fairly rigid organization with male-oriented authority structures. Flexibility in terms of interaction with the culture and openness to explore its language and values does not necessarily translate into flexibility within the family. Thus, in the event of traumatic experiences (e.g., a father’s health crisis), the family may not have the adaptability within the family organization to be resilient. In the past, missionary family support and interconnectedness was considerably higher because of the “mission station” practice in which missionary families would live together on a compound, somewhat protected from the broader culture. With the trends toward urbanization and the increased focus on directly engaging the culture, mission stations are no longer the norm. My observation is that the downside of this trend is a potential isolation and loss of connection and support for missionary families.
Communication in missionary families is fostered by the religious values of responsibility, honesty, respect, and compassion. Yet other characteristics of missionary families work against communication processes that foster resilience. For example, simply because family members believe in Christ does not give them the same skills of emotional expression, empathy, and problem solving that Christ portrayed. Some aspects of missionary families, such as distance from family members, chronic stress, and isolation from extended family relationships, work against communication. Technology can help but also tends to create the illusion of connection and masks the absence of deep intimacy.
One of the tragic stories in the history of the missionary movement is the treatment of missionary children. One sad example is documented in the film All God’s Children (Solary & Westphal, 2008). The traditional belief was that missionary children were best handled by placing them in boarding schools either in the home country or in a regional boarding school (e.g., in West Africa). This allowed both parents to devote their time to the ministry. However, because of the abuse experienced by the children in the absence of their parents, the imposed isolation of children from parents (rigid organizational patterns) with restricted and monitored contact (limited open communication), and the assumption that everyone must sacrifice for the mission (unhealthy belief system), these families experienced intense trauma without the resources to process it effectively. The consequences for individual children, their families, the mission, and the ministry were devastating. Families with members living apart from each other often find that when trauma occurs, there are few family resources to cope with it.
The member care movement (e.g., O’Donnell & O’Donnell, 2011) is responding to the unique circumstances and vulnerabilities of missionary families. Mission organizations are paying more attention and responding more specifically to families, not just individuals (Andrews, 2004; Gingrich, 2016). The family resilience literature, however, does point to the need to build resilience by fostering relational processes in families, not simply responding to crises after the fact.
In a similar way, military families are at high risk for trauma. Life-giving sacrifices are required of military families. A unique constellation of stressors rarely found in other occupations results in changes to military family structures, which particularly affect children and make them even more vulnerable to stress (Castro, Adler, & Britt, 2005; Moore, 2011).
Military families particularly at risk are families who are alone (without affiliation networks), young and inexperienced families (especially pregnant couples and couples with young children), and families with a pile-up of stressors, additional challenges, or traumas (accumulation of stressors; Wiens & Boss, 2005).
Protective factors for military families include having flexible gender roles (e.g., shifting roles during deployment), actively developing coping strategies, and accessing community and social supports versus maintaining an independent, detached lifestyle both within and outside the military context (Wiens & Boss, 2005).
Military families typically do not have the strong religious belief systems of missionary families, though their commitment to the cause of defending one’s country and its values does provide meaning for their sacrifice. Organizational patterns in military families may reflect the dominant patterns of authority and structure in military life and, therefore, may not promote flexibility in the face of trauma. With long deployments, connections can be tenuous for spouses and partners with each other and parents with their children. A year-long absence can be incredibly significant in the developmental growth of a young child.
Perhaps the major distinction between missionary and military families is the access military families have to economic and social resources. Military families typically live on or close to a military base with access to social support and the extensive resources of the military for all types of care (housing, familiar foods, medical services, mental health services, options for worship and spiritual support, etc.).
Given the significance of the military in the United States and in many other countries, as well as the a high percentage of military personnel returning from deployment with some diagnosable condition of acute stress disorder or posttraumatic stress disorder, it is a global concern to develop strategies and resources to assist families with the primary trauma and the secondary trauma experienced by family members. Some research is beginning to suggest particular methods for dealing with the negative effects of military-family stressors by creating systemic responses, such as training leaders to recognize and accommodate family stress, and by developing family-friendly organizational policies and practices (Everson & Figley, 2010; see also chap. 17 in this volume).
There is always a danger in generalizing to the group and losing the uniqueness of individual families. However, in order to illustrate the use of Walsh’s (2006) model and how it might be used in assessment and treatment, I will risk stereotyping the characteristics of missionary and military families. Table 8.3 assesses these two groups of families in terms of the resiliency processes they might typically exhibit.
Table 8.3. Contrast between missionary and military families
Family Processes |
Missionary Families |
Military Families |
Family belief systems |
High |
Mid |
Making meaning of adversity |
High |
High |
Positive outlook |
Mid |
Mid |
Transcendence and spirituality |
High |
Mid |
Organizational patterns |
Low |
Mid |
Flexibility |
Low |
Low |
Connectedness |
Mid |
Low |
Social and economic resources |
Low |
High |
Communication processes |
Mid |
Low |
Clarity |
Mid |
Mid |
Open emotional expression |
Mid |
Low |
Collaborative problem solving |
Low |
Low |
Characterizing family types as high, midrange, or low on each of these processes risks minimizing the uniqueness of each specific family. Yet in most cases missionary families would share a strong set of beliefs that compel them to live the way they do. This may be true of some military families but is likely not as much a family strength for all military families. The other resiliency factors could be assessed and contrasted in a similar way. Research would need to be conducted to confirm whether these hypotheses are in fact valid.
It could be argued that family systems theory is as interested in building resilience in families as it is in working with families to repair relationships in the wake of trauma. While therapy is a primary application of family systems theory, prevention is equally stressed. The problem is that so often the opportunity to work with families comes after they have realized that they are not coping well with trauma. Nevertheless, building resilience is the goal, and even in distressed families, building resilience for the future by means of interventions is as much the objective as is helping families cope with the current crisis (second-order, rather than first-order, change in systems theory). Therefore, the following recommendations lean toward second-order change, rather than focusing primarily on responding to the current stress and symptoms (the focus of first-order change).
Including trauma/crisis experiences in family assessment. Conducting family assessment, not only individual adult, individual child, or marital assessment, is a difficult and complex procedure. In some respects, assessment of each of the individuals, the couple dyad, the nuclear family, the extended family, and the community and culture systems is necessary (Gingrich, 2016; Heffer & Snyder, 1998; Lebow & Stroud, 2012; Williams, Edwards, Patterson, & Chamow, 2011). Family therapy itself is intimidating for many clinicians, who might fear the multiple dynamics in the room and instead prefer the one-on-one assessment procedures of individual counseling. However, with the entire family in the room, exploring how a family has experienced previous traumatic experiences is a powerful method of assessing current resources and relational processes available for coping and healing.
Techniques such as family interviews, family enactments, and experiential activities (e.g., tasks, games, projects, sandtray) are common in the family therapy literature because they can bypass rigid relational patterns that restrict free expression. Reviewing how the family has dealt with previous crises is beneficial. Taking individual inventories and compiling and contrasting individual results can also be useful.
One of the most popular assessment models of family functioning is the Circumplex Model included as part of the PREPARE/ENRICH assessment instrument (www.prepare-enrich.com). The related FACES IV is a validated instrument used to specifically assess families on the dimensions of cohesion and adaptability (Olson, 2011). A helpful use of the instrument is to compare pretrauma family functioning with posttraumatic functioning, as well as to compare current and ideal functioning. The instrument can also be used intergenerationally to assess changes or similarities over generations. Other instruments are reviewed in Lebow and Stroud (2012).
Strengthening the family’s belief system. The danger in addressing belief systems is that it is difficult for caregivers, in their desire to help, not to impose their own meanings onto a crisis situation. Christian therapists may have a tendency to believe that they know God’s mind in situations and then ask questions and make comments about the meaning of the family’s adversity. The role of the clinician is to help the family discover what is meaningful for them in the crisis.
The following are suggested practices for strengthening family belief systems:
Normalizing distress as a part of life, particularly as a part of the Christian’s life
Recounting generational or biblical stories of family crises and how adversity led to new possibilities
Having developmentally and age-appropriate conversations about the family’s meaning and purpose
Cultivating transcendence and spirituality by helping the family connect to a faith community
Teaching and modeling coping as a relational strategy, that the family coping together is better than a group of individuals each hanging on in relative isolation through difficult situations
Focusing on the “redemptive possibilities” (Benner, 1998) in suffering and crisis, though not imposing this perspective prematurely or insensitively
Encouraging a positive outlook by being hope-focused (“what if things were different or better?”), identifying family strengths and potential, and encouraging persistence
Providing or encouraging families to access external resources for couples and families within their faith communities and societies
Using religious/spiritual genograms (Frame, 2000)
Suggesting the use of age-appropriate spiritual disciplines as a family
Developing family rituals, symbols, or memorable objects related to the trauma that point to transcendent dimensions
Engaging in service projects as a family related to particular trauma experiences (e.g., supporting nationals working in the area from which the family was evacuated)
Strengthening the family’s organization patterns. In a society deeply committed to democratic leadership, the issue of authority in the family is complicated. In some ways, the benevolent dictator works well as a leadership model in terms of decision making and efficient operations in the family. However, regardless of the authority structure, and even in families from non-Western cultures, some collaboration and flexibility in roles can help families be more resilient in the face of crises.
The importance of social connectedness with people outside the family cannot be overestimated. The relationally isolated family is not much better off than the individual who is isolated from family and friends. Of particular significance is encouraging families to stay connected to extended families despite the high mobility of modern life. The Social Network Map (Tracy & Whittaker, 1990) is a method for helping families to explore their relationships and locations of support.
However, it is also important for families to connect with others who are themselves stable and healthy and who will provide beneficial support in the midst of a crisis. Hawkins and Manne (2004) identified three cautions regarding dependence on others during a crisis: (a) contact with victims makes people feel more vulnerable themselves (vulnerability contagion); (b) many people have little experience with trauma and are uncertain how to react to victims, which increases anxiety (helplessness anxiety); and (c) there are misconceptions, and at times somewhat contradictory information, regarding how best to react and help in times of crisis (misguided assistance). In addition, finding people who are supportive can be challenging when those around are all experiencing the same crisis, as in natural disasters and other examples of mass trauma.
Numerous other interventions and suggestions for helping families with their organizational processes exist in the family therapy and family enrichment literature. For instance, identifying and modifying family structures is one of the therapeutic skills and tasks in structural family therapy (Colapinto, 1988; Minuchin, Nichols, & Lee, 2006). This approach involves techniques such as boundary making between parts of the system, realigning power in the family, restructuring transactions, and unbalancing.
Strengthening the family’s communication patterns. The massive amount of information available to help individuals, couples, and families communicate more effectively would suggest that we know a lot about what constitutes good communication, what the essential skills are, and how to resolve conflict. However, knowing how is not the same as implementing the skills in the midst of very intense, intimate, and conflictual conversations. Learning communication skills requires not only knowledge regarding how best to communicate but the ability to implement and use the skills even in the midst of crises. Speaking of marriage and family in general, Solle (2000) states, “marriage isn’t at all a game of luck. The research is clear and compelling—marriage is a skill-based relationship.” In support of marriage and family education rather than counseling, Solle (2006) comments that in counseling there is “too little emphasis on learning skills. [Counseling is] still more focused on ‘internal constructs’ . . . ‘to know you is to achieve marital success.’” The value of learning skills versus knowing about healthy communication continues to be one of the significant debates in the relationship counseling field.
What is clear is that families need ways to provide safety from external threats and also safety to share pain, fears, and challenges within the family. Creating this safe context will aid families in working through the inevitable crises of life. Identifying and affirming strengths (i.e., communicating), while recognizing vulnerabilities, is a process that fosters resilience.
Contemporary families are in some ways a lot more connected than families of previous generations. Technology has allowed families to stay connected frequently and personally. Not only reading letters but hearing people’s voices and seeing their faces on the screen can create a stronger bond. However, there is also an increasing awareness that technology has significant limitations in maintaining and extending attachment dimensions such as affection, touch, and sexual connection.
Berger and Hannah (1999) review a number of empirically validated communication training programs, many of which were developed as psychoeducational programs and later applied to therapeutic contexts. The skills, or “processes,” as Walsh (2006) refers to them, typically involve listening, speaking, and facilitation/negotiation skills. While the research is mixed on the effectiveness of these training programs (e.g., see Gottman, 1999, for a critique), it appears that the processes by which people have conversations, especially in intimate relationships, matter immensely to building resilience in family life.
Additional considerations related to strengthening family resilience. There is a need for families to recognize and provide support for members who experience secondary trauma. While a family member may not be a primary victim of trauma, the secondary impact must be considered for anyone who witnesses, helps with, or in some way is affected vicariously by trauma. This is particularly significant for children because adults, in the midst of their efforts to cope, are not always attuned to the impact that seemingly minor components of an event can have on children. Children do not have the sophisticated cognitive abilities of adults and cannot make the distinctions adults make, such as an event being witnessed versus being experienced firsthand.
Another concern in the emerging research pertains to families who are at particularly vulnerable phases of family development. In recent years Gottman and Gottman (2007) have focused on the critical time period for a marriage surrounding the birth of the first child. The research shows that the decline of marital satisfaction commonly experienced at this time sets up patterns for couples that undermine long-term resilience.
Another consideration is the negative chain reactions that heighten risk in the aftermath of a crisis (Wimberly & Wimberly, 2007). The negative context of a crisis can produce an environment that predisposes a family to experience additional strain from further challenges. Buffering the stress effects, cushioning the impact, and overcoming obstacles produced by one crisis helps a family withstand aftershocks and rebound from setbacks.
The emphasis on family resilience may lead to a conclusion that all parts of the family are equally as pivotal in responding to crisis. However, some suggest that the couple subsystem is primary in the family system. Specifically focusing on couple resiliency in the midst of a crisis may be warranted (Phillips & Kane, 2008; Johnson & Faller, 2011). Family systems theorists have long waged this debate—should the focus be the couple or the family? A simple assessment of most families will point to the significant power, resources, and leadership located in the couple/parental subsystem that demands attention and intervention. However, on the flip side is the tendency to undervalue the role that sibling subsystems and even small children can have in helping a family cope.
Opportunities to engage with families often occur during and in the aftermath of a crisis. While we might like to be able to access families prior to crises and help them build resilience, it is more common to be working with a family during a crisis and at the same time building resilience for the future. Walsh (2006) describes the concurrent processes of strengthening family resilience while responding to crisis situations in the following way (see table 8.4).
Table 8.4. The process of strengthening family resilience (Walsh, 2006, p. 162)
Create safety* |
Draw on spiritual resources |
► |
Introduce possibilities |
|
▼ |
▲ |
▼ |
||
Instill hope* |
Access relational support* |
Problem solve together* |
||
▼ |
▲ |
▼ |
||
Normalize family responses |
Build communication* |
Integrate experience into family |
||
▼ |
▲ |
▼ |
||
De-shame |
► |
Reframe blame |
Stay in touch |
*Major contributors to developing family resilience (Thomlison, 2010, p. 40)
The items in the first column of table 8.4 set the context for intervention by creating a safe therapeutic relationship, building positive expectations and capacities for coping, normalizing the family’s crisis experience, and decreasing the embarrassment associated with having a crisis and needing to seek help. This is followed by a series of possible interventions aimed at moving beyond blame (either of self or others), developing communication competencies, detailing social-support networks, and drawing on spiritual resources. Finally, the helping process actively focuses on exploring new possibilities for ways of being family, problem solving together, pulling this together into a new experience of being family, and staying in touch both with the helper for follow-up and by checking in with each other so that gains in family functioning do not fade.
In the middle of the process is “access relational support.” Of course, relational support can be found within some families and extended families, but for people of faith who have a relationship with a religious community, support can hopefully be found in these relationships. Nason-Clark et al. (2013) discuss how the church and church leaders can work toward strengthening families, as well as proactively working toward ending abuse.
Of course, the process, as with many therapeutic approaches, is a lot easier to describe than to implement. One of the most difficult aspects of this kind of work is dealing with the intense emotion generated by crisis situations both for the family and for the helper. Managing and facilitating the expression of emotion, neither denying nor fixating on the emotion, is a precarious balancing act. Another key distinction is whether the expressed emotion is a signal for further or deeper levels of distress or a part of the healing process and an indication of a beneficial change in the family system.
The emergence of emotionally focused therapy in its individual forms (e.g., Greenberg, 2002; Paivio & Pacual-Leone, 2010), its marital application (e.g., Johnson, 2004), and family variation (Johnson et al., 2005, chap. 11) provides a variety of interventions and a therapeutic process for handling the intensity and range of emotions that can be generated in crisis situations. Dealing with countertransference and the potential for therapist burnout and vicarious traumatization are other aspects of this difficult work.
I appreciate the emphasis of Saxe et al. (2016) in their book on working with child and adolescent trauma victims. Their commitment is to do “whatever-it-takes” (p. 4). Their Trauma Systems Therapy is rooted in the belief that responders and therapists need to be “all in”—“it’s about looking at the reality” rather than “averting our eyes” (p. 4). Can Christians, propelled by the love and compassion of Christ, be this for a world of traumatized families?
A systems perspective not only addresses family relationships but also looks at broader systems within society. Of particular concern is the reality that we live in a violent world in which trauma is in some ways the norm, not the exception. Mollica’s (2013) Healing a Violent World Manifesto, in which trauma is identified as a global reality, suggests that healing is needed not only individually but at all levels of systemic interaction. In this regard I am reminded of the words of one of the grandfathers of family systems theory and therapy, Salvador Minuchin (Minuchin & Nichols, 1993):
As I see families, I am amazed by the variety of resources people have and the ways they can change—that is, use their resources differently. This means accepting the possibilities and limitations in oneself and in others. It means tolerating uncertainties and differences. It also means hope—for new ways of being together. This is the song our society needs to hear: the song of me-and-you, the song of the person in context, responsible to and for others. To hear it, we need the courage to renounce the illusion of the autonomous self and to accept the limitations of belonging. The survival of the species as well as the family lies in accommodation and cooperation. A society that undervalues these capacities is a society in danger—and it may well be a dangerous society. (p. 287)
While the idea of limitations in belonging, on both the individual and global levels, may not be a popular message, it is in that very acceptance of possibilities and limitations in self and in others that families find the strength and courage to develop new ways of responding to the traumatic events life brings them.
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