Therapeutic Intervention with Poor, Unorganized Families

From Distress to Hope

Terry S Trepper, Shlomo A Sharlin

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781135408732
• Edition: 1
• Topic: Medicina
• Subtopic: Teoría, práctica y referencia médicas

Therapeutic Intervention with Poor, Unorganized Families: From Distress to Hope offers you integrated theories, practice, and research to provide you with the tools to be more effective when dealing with families in crisis. Therapeutic Intervention with Poor, Unorganized Families explores the decline of families into extreme distress and helps you to determine the best intervention for that particular family, as no one single method can be prescribed for all families. Therapists as well as clients favor the joint-goal intervention you will discover through this book, which is carried out mostly in the family home where the therapist can delegate authority as a means of strengthening and preserving the family.

Through Therapeutic Intervention with Poor, Unorganized Families, you will receive a plethora of ideas which consist of multiple intervention techniques and alternatives for intervention, including:

• learning to organize institutions in the community to participate in getting families in extreme distress out of their long and perpetual predicament
• teaching you how cooperation between various government organizations, public and private, can be solicited for the welfare of these families
• offering you an anthro-psycho-social model of intervention that you will find effective in your own practice
• examining case studies so you can see how the new model works in real-life settingsTherapeutic Intervention with Poor, Unorganized Families is unique because not only does it offer you help with supervision and training aspects, but because it also ends with a qualitative and quantitative research evaluation of this new model. Comprehensive and thorough, this book deals with the difficulties that may arise to interfere with the effectiveness of the intervention so you can learn from it and prevent further crisis. Therapeutic Intervention with Poor, Unorganized Families is a must for anyone working with families in crisis.

PART I:

INTRODUCTION TO THE PROBLEM

Chapter 1

The Distress: A Social Problem of Families in Extreme Distress and Multiproblem Families

Poverty can be found as far back as the Old Testament: “… but the seventh year thou shalt let it rest and lie fallow that the poor of thy people may eat” (Exodus 23:11). Used as a precursor for the modern welfare state, the term poor has remained with us ever since, never leaving society's agenda. More specifically, we should mention the Poor Laws of 1598 and 1601 and the development of Marxist ideas and ideology to combat poverty and social injustice. Through the centuries, different approaches have been used, but it was only during the second part of the twentieth century that systematic, scientific, and clinical attention was given to this issue.

On the threshold of the twenty-first century, we focus on the second half of the twentieth century in an attempt to understand, clarify, and describe what we have learned during the past fifty years. The term most used during this period to describe the poor has been multiproblem families, first used and introduced by Isaac Hoffman, research director of the Wilder Foundation in St. Paul, Minnesota. He used the term to define families with serious problems in more than one of the following areas: health, economic behavior, social adjustment, and recreational needs (Buell and associates, 1952; Geismar and La Sorte, 1964).

Hoffman's definition of multiproblem families referred more to specific family problems than to family characteristics. However, other descriptive terms have been used in the literature to designate multi-problem families, such as deprived (Pavenstedt, 1965), disorganized (Minuchin and Montalvo, 1968), hard-core (Kaplan, 1986; Schlesinger, 1970; Tomlinson and Peters, 1981), disadvantaged (Aponte, 1994; Lorion, 1978), defeated (Rosenfeld, 1989), and poor families (Tomlinson and Peters, 1981). Each definition points to a different family characteristic, shedding light on different aspects of the same family condition. Together they demonstrate the complexity of this social phenomenon. We will attempt to analyze and understand what has been learned about the phenomenon since the 1940s.

HISTORICAL REVIEW: FROM MULTIPROBLEM FAMILIES TO FAMILIES IN EXTREME DISTRESS (FED)

The 1940s Through the 1960s

After World War II, during the late 1940s, we see the first attempts at analyzing social phenomena from a scientific point of view. Empirical studies of various social problems were vigorously embarked upon, with multiproblem families among them. The basic idea of social problems can be found in Charles Booth's writings. At the beginning of the century, Charles Booth (1903) wrote about poverty in London in the 1880s and 1890s, as well as at the beginning of the twentieth century. He regarded poverty as a central problem and the cause of many others. Although poverty was considered a political issue affecting social policy, it was also associated with personal attitudes such as laziness and indolence. By the same token, society and the government, as well as the poor families themselves, were held responsible for their condition. Consequently, social planning strategies tried to solve all problems stemming from poverty by providing financial assistance.

Isaac Hoffman first introduced the term multiproblem family based on the results of an extensive study carried out in St. Paul, Minnesota, on families receiving social services in that area. The study was called “The Family Unit Report” (Buell and associates, 1952). Conclusions of the study formulated an important equation, which demonstrated that poor families with severe and multiple problems who received help from a variety of social agencies were indeed multiproblem families. Subsequently, to be identified as a multiproblem family, the family had to be considered poor and constantly assisted by various social agencies. This equation remained practically unchallenged for at least twenty years.

Many prominent social analysts of the 1950s and 1960s, such as Chilman (1966), Galbraith (1958), Harrington (1962), Miller (1962), and Lewis (1959, 1961, 1966), examined the concept of poverty from a different perspective. Lewis (1959), for instance, was the first to use the concept of a “poverty culture.” He wrote:

Poverty becomes a dynamic factor which affects participation in the larger national culture and creates a subculture of its own.… It seems to me that the culture of poverty cuts across regional, rural-urban and even national boundaries. For example, I am impressed with the remarkable similarities in family structure, the nature of kinship ties, the quality of husband-wife and parent-child relations, time orientation, spending patterns, value systems and the sense of community.…” (p. 16)

Thus, he did not emphasize the family's financial status, but rather its way of life, interorganization, and relationship with society.

Similar to Lewis, Harrington (1962) also pointed out that multi-problem families, in addition to being extremely poor, also operate with their own sets of values and norms that are totally different from the normative way of life in society at large. Miller (1962) emphasized multiproblem families’ instability and their lack of financial security. Also documented in the literature are the distinct personality characteristics created by poverty. Frankenstein (1969) and Lewis (1966) singled out weak ego, low self-esteem, lack of basic trust, and a dependent personality. Chilman (1968) described a sense of fatalism expressed by people living in severe poverty, which can lead to passivity or to the use of force and aggression.

In spite of the extensive literature about poverty accumulated during the 1950s and early 1960s, it soon appeared that not every poor family, not even the extremely poor, became a multiproblem family. It also became clear that poverty was only one condition among many others that drove a family into a multiproblem existence and that the phenomenon of the multiproblem family was not the result of economic hardship alone. A multiplicity of variables in different areas were instrumental in reaching the high level of dys-function that maintained the extreme distress through time and generations (Gans, 1963). To distinguish between severely poor families and multiproblem families, two important attempts were made at classifying multiproblem families. The first, embarked upon by Community Research Associates, included five criteria (Spencer, 1963b): (1) failure in the functioning of the mother, (2) failure in the functioning of the father, (3) failure in the functioning of the siblings, (4) failure in marital adjustment, and (5) economic deprivation and grossly inadequate housing. The New York City Council Board studied 150 families using the previous classification and concluded that 87 percent of multiproblem families studied failed in at least three categories and 35 percent failed in all five, but the study did not specify which three categories. The second attempt was made by the State Charities Aid Association of New York, which put forward the following classification (Spencer, 1963b): (1) multiplicity of problems, (2) chronicity of need, (3) resistance to treatment, and (4) handicapping attitudes, such as alienation from the community, hostility, and suspicion of authority.

Reissman, Cohen, and Pearl (1964) argued that multiproblem families, in addition to being poor, could not or would not adopt middle-class norms and values and rejected any association with professional unions. Contrary to Lewis (1959), Pavenstedt (1965) stated that, although multiproblem families have many psychological and social problems, as well as high levels of disorganization and pathology, multiple-problem families “do not belong to a ‘culture,’ having neither traditions nor institutions, ethnic ties or active religious affiliations to hold them together. In fact, we speak of Multiproblem Families as a group only because of common family life patterns and a kind of peripheral social existence” (p. 10).

An important publication and a step forward in social research is Schlesinger's book The Multi-Problem Family (1963). This book contains a review of annotated bibliographies from different countries around the world, spanning the late 1940s until the early 1960s. In the first chapter, Spencer (1963b) points out the vagueness of the multi-problem family concept, its tremendous scope, and the difficulty in defining it. It is, therefore, almost impossible to include all the different facets of this social phenomenon in a single, clear, and precise definition. Spencer claims that “The multiproblem family is easier to describe than to define, and the majority of definitions found in literature are in fact descriptions of characteristics derived mainly from observation and experience in the field of social work.… Our knowledge of causation still remains vague and imprecise” (p. 7). Spencer provides a long list of typical multiproblem family characteristics, such as large family size, the high rate of mobility, isolation, alienation, destructive parent-child relationships, and chronic dependence on community services combined with an aversion for help, delinquency, disorganization, instability, and emotional immaturity. Yet, we do not find all of these problems in one family. Different families suffer from different symptoms. The exact combination of problems that creates a multiproblem family is still unclear.

Multiproblem families are recognizable mostly in countries with high living standards, since “… Western society's high standards of wealth and expectations of social welfare services has brought to public attention a difficult social problem that had previously remained concealed” (Spencer, 1963b, p. 3). In a survey of 400,000 families in Great Britain, for example, Scott (1956) found that more than 3,000 families suffered from low intelligence, mental illness, criminal behavior, drinking and gambling, cruelty toward children, repeated hospitalization, persistent quarreling and truancy, overcrowded and intolerable living conditions, and failure to respond to help offered by different social services.

In summary, it was during the 1940s, 1950s, and 1960s that the first attempts were made to analyze, define, and classify the phenomenon of multiproblem families, with an extensive list of characteristics being attributed to such families. However, some questions should be raised in this regard: How long is that list, and which criteria are relevant? Are any of the factors preconditions? From these descriptions, the existence of severe impairment in the functioning of the family and the inability of its members to cope is quite obvious. It is also apparent that multiproblem families suffer from a multiplicity of problems, such as poor relationships among family members, as well as with the immediate community. Most of the literature of the 1960s and 1970s that attempts to address these questions describes projects concerning various poverty issues, especially in the field of social work. It was mainly social workers, employed in diverse social services, who provided descriptions of real-life experiences with their multiproblem clients.

The 1970s

During the 1970s, social scientists started to break down the different categories and descriptions that had been previously coined to define or classify multiproblem families; they then proceeded to elaborate and further explore each of the categories. During this period, new definitions to describe multiproblem families appeared in the literature. We find the terms disorganized, which is used to describe a high level of disorganization (Frairberg, 1978), unmotivated (Frairberg, 1978), self-defeating (Schlesinger, 1970); and hopeless (Frairberg, 1978), describing an atmosphere of apathy and withdrawal. The phrase “hard to reach” refers to multiproblem families’ resistance to treatment (Frairberg 1978; Schlesinger, 1970; Spencer, 1963b). Finally, since they are always on the lowest rung of society, they are also defined as disadvantaged (Lorion, 1978). These new labels, in contrast to the term multiproblem family, tend to describe the families’ emotional state.

The perspective of these definitions has since changed from mere description to include causality. Furthermore, since we know that different problems in multiproblem families impact on one another, we cannot suggest a linear cause-and-effect relationship, but rather a circular connection among the various problems. Based on the literature of the 1970s, one can pose the following questions: What is the meaning of failure in the roles of parents and children? What is the significance of multiproblem families’ dependence on social services, and why are they so resistant to help? The discussion on these issues will be treated more extensively in the following chapter.

Parental Role Failure and Marital Adjustment Failure

Polansky, Borgman, and DeSaix (1972), in their book Roots of Futility, speculate on what makes different people, or families, react in singular ways to their life experiences. Polansky asks, “Why is it that we meet a child on AFDC (Aid to Families with Dependent Children) who is skinny, barefoot, and unkempt, while half a mile away is another child, also on AFDC, but infinitely better cared for?” (p. 3). The question is highly relevant, and can be illustrated by the following two examples:

John Ash, 17 years old, is a dropout by necessity, not by choice. His girl is pregnant.… He has to get married and go to work, if he can get a job. The place John calls home is an undersized apartment.… On television a white child tempts them with toys they will never enjoy.… For John's brother, Calvin, age eleven, reading is a torturously slow affair. Nathaniel's only playground is the street. Calvin's older brother, John, has one ambition: to start a youth labor union.… He is afraid that his ideas and all his ambitions are going to fade, but he will keep on plugging. “You try to move a little faster,” he says, “so the world won't leave you behind with your head in your hands.” (Leinwand, 1968, pp. 54–56)

There were seven children in the family and her father earned $12 a week. They had a three-room, cold water flat and no lights.… Her parents fought constantly. Her father was ill-tempered and gave her mother a hard time. Her mother was a nice person but had to work too hard. The mother indulged in much outside sexual activity as well as probably being epileptic.… He (the father) tried to molest her several times.… She always had to work and give the wages to her father which he immediately drank up. (Geismar and La Sorte, 1964, pp. 141–142)

In the first example, we find a family struggling with severe economic problems and deprivation. However, there is ambition and, more important, hope for a better future. We see a family that, despite tremendous obstacles, attempts to challenge what appears to be its fate. In the second example, one can almost sense the despair. “We didn't have anything,” says one of the family members, and by that, she refers to “the economic situation but also to a complete absence of family cohesiveness” (Geismar and La Sorte, 1964, p. 141).

As we have seen, even if both parents are present, they fail in their parental roles. Both Mazer (1972) and Chilman (1973) emphasize that in multiproblem families, many couples marry when the wife is already pregnant, and since they have little family-planning knowledge, if any at all, they end up having many children, one after the other. They also typically marry very young as an escape from their own families. In many cases, in addition to the fact that they are neither prepared nor qualified to become parents, these couples do not really want to have children. It is no surprise, therefore, that they have difficulty functioning as parents, being, themselves, children who have children. Herein lies the essence of the vicious cycle, perpetuating itself from one generation to the next (Polansky, Borgman, DeSaix, 1970; Polansky, Borgman, and De-Saix, 1972). Minuchin and associates (1967), in their book Families of the Slums, point out the need for parents in any family to share in the responsibilities of parenthood in a complementary manner. Such sharing does not generally exist in multiproblem families, since both parents lack the skills of competent functioning. Parental responsibilities are often transferred to the older siblings or to all the children in the family. Sometimes, very young children are forced to take on responsibilities that are well beyond their capabilities (Marans and Lourie, 1967).

In many multiproblem families, at least one member of the family is constantly looking for work. Since many of the men have either criminal records or some kind of addiction (drug, alcohol, or gambling), it is often the women who find work, bringing about a role reversal that greatly affects the relationship between the parents (Pettigrew, 1964). The men sense their failure as fathers and in their role as head of the family. The mothers, on the other hand, are overworked and overloaded with responsibilities, making them unable to invest time or energy in their children, who, as a result, are deprived of much-needed emotional support (Polansky, DeSaix, and Sharlin, 1972; Polansky et al., 1981).

It is important to note that the reversal of traditional roles described here is not equally balanced. Although many women work outside the home, it is in addition to their housekeeping responsibilities, while the husbands do not contribute to child care or housekeeping chores. Unemployed, they remain idle, easily falling prey to alcoholism, drug abuse, or other criminal activity. Since the fathers in multiproblem families typically do not provide for their families, their role as “man of the house” is greatly impaired, and in an attempt to assert their masculinity, they may become violent toward their wives or their children.

Although it is clear that parents can hardly function under such conditions, research has largely neglected the study of these fathers, focusing mainly on the mothers. The mothers are often described as apathetic, hopeless, and in extreme despair. Polansky and colleagues (1972) call it “The apathy-futility syndrome” (p. 54), citing it as a possible cause of child neglect.

The characteristic effect of the apathy-futility syndrome is the deep sense of futility, accompanied by massive inhibition, giving rise to a far-reaching anesthesia or numbness. Behaviorally, there is a generalized slowing down and a straining towards immobility.… Impoverishment in relationships is accompanied by reticence, especially in speech. (Polansky, Borgman, and DeSaix, 1972, pp. 54–55)

Evidence of poor communication in multiproblem families is very common in the literature (Bernstein, 1960, 1961, 1962, 1964; Marans and Lourie, 1967; Minuchin et al., 1967; Minuchin and Montalvo, 1968). Communication, either between the spouses or between parents and children, is mostly of an informative nature and very concise. They only share very basic, unsophisticated information, hardly listening to one another and attempting to speak at the same time. The couples argue and quarrel a great deal, with potentially violent results (Minuchin et al., 1967).

Parents in multiproblem families not only fail in their parental roles and their family relationships but also in their relations with the immediate community as well. The multiple-problem family actually suffers from extensive ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Senior Editor’s Comments
• Foreword
• Preface
• Acknowledgments
• Part I: Introduction to the Problem
• Part II: From Theory to Practice—An Overview of the Model
• Part III: Assessment of Fed
• Part IV: Intervention Techniques
• Part V: The Research Project—Process and Evaluation
• Part VI: Future Perspectives
• Bibliography
• Index