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STRENGTHENING FAMILY COPING RESOURCES

Strengthening Family Coping Resources (SFCR) uses a skill-building, family framework to teach constructive
resources to families who have a high exposure to stress and trauma. As an intervention for high-risk families,
SFCR can cause a reduction in symptoms of traumatic distress and behavior problems and help families
demonstrate higher functioning. The SFCR manual is based on a systemic, family approach and uses
empirically supported trauma treatment that focuses on family ritual, storytelling, and narration, which
improves communication and understanding among family members. The manual is organized into three
accessible parts:

• Part I details the theoretical and empirical foundations of SFCR.

• Part II focuses on implementation and the clinical guidelines for conducting SFCR.
• Part III contains session guidelines focused on the multi-family group versions of SFCR.

Each session included in the intervention is structured according to specific guidelines, and instructions
provide examples of what facilitators might say to a group.

Formed through the input of psychiatrists, psychologists, social workers, and anthropologists, Strengthening
Family Coping Resources will help you reduce the symptoms of traumatic stress disorders and increase
coping resources in children, adult caregivers, and the family system. It also provides a novel approach to
addressing co-occurring traumatic reactions in multiple family members by including developmentally
appropriate skill-building activities that are reinforced with family practice. For anyone working with
families in a therapeutic capacity, this manual is a must-have resource.

Laurel Kiser, PhD, MBA, is a psychologist and an associate professor in the Department of Psychiatry at the
University of Maryland School of Medicine. Her research focuses on the protective role of rituals and routines
within families, schools, and neighborhoods, and the development of interventions to strengthen these to
reduce the effects of trauma. Dr. Kiser was awarded an NIMH-mentored career development grant in
support of this work and has also received funding from SAMHSA for dissemination and evaluation. Her
articles appear frequently in the professional literature and she is a regular presenter and invited lecturer
at national conferences.
This page intentionally left blank
STRENGTHENING
FAMILY COPING
RESOURCES
Intervention for Families Impacted by Trauma
LAUREL KISER
First published 2015
by Routledge
711 Third Avenue, New York NY 10017

and by Routledge
27 Church Road, Hove, East Sussex BN3 2FA

Routledge is an imprint of the Taylor & Francis Group, an informa business

© 2015 Laurel Kiser

The right of Laurel Kiser to be identified as author of this work has been asserted by her
in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988.

All rights reserved. No part of this book may be reprinted or reproduced or utilized in
any form or by any electronic, mechanical, or other means, now known or hereafter
invented, including photocopying and recording, or in any information storage or
retrieval system, without permission in writing from the publishers.

Trademark notice: Product or corporate names may be trademarks or registered

trademarks, and are used only for identification and explanation without intent
to infringe.

Library of Congress Cataloging-in-Publication Data

A catalog record for this book has been requested

ISBN: 978-1-138-83011-0 (hbk)

ISBN: 978-0-415-72953-6 (pbk)
ISBN: 978-1-315-83282-1 (ebk)

Typeset in Utopia
by Florence Production Ltd, Stoodleigh, Devon, UK
CONTENTS

Acknowledgments viii Vulnerability to Distress 16

What is in the SFCR Manual? ix Variability in Response 17
Lapses or Declines in the Family’s
PART I: THEORETICAL AND EMPIRICAL Ability to Serve its Basic Functions 18
FOUNDATIONS 1 Conclusion 19
Notes 19
Chapter 1: Introduction to SFCR 3 References 19
Overview 3
SFCR Intervention Development 3 Chapter 3: Theoretical Foundation for
SFCR Versions 4 Family Constructive Coping 25
Multi-Family Groups 4 Family Rituals and Routines as
SFCR-Family Trauma Therapy Coping Resources 25
(SFCR-FTT) 5 Defining Ritual and Routine 25
SFCR-Peer-to-Peer (SFCR-PP) 5 Why Families Practice Rituals and
Routines 26
Chapter 2: Conceptual Foundation for Links to Family Health and
Family Trauma: Families Exposed to Well-Being 26
Accumulated Traumatic Conditions 6 The Effect of Traumatic Contexts
Definition 6 on Family Ritual and Routine 27
Exposure to Accumulated Traumatic From Theory to Practice 27
Circumstances 7 Family Systems, Coping and Resilience
From Context to Response: Family Theories 30
Adaptation 8 Systems and Relational Theories 30
Complex Adaptations to Accumulated Family Stress and Resource Theories 32
Traumatic Circumstances in Families 9 Family Resiliency 34
Disturbances in the Family Unit 9 Protective Family Coping Resources 34
Anxious Anticipatory Coping Style 9 Notes 37
Systemic Dysregulations 11 References 37
Disturbed Relations and Supports 12
Altered Family Schemas 13 Chapter 4: Storytelling and Narrative
Implications for Working with in SFCR 43
Families in SFCR 13 Background for Family Storytelling
Reciprocal Distress Reactions 14 and Narrative 43
Individual Distress Reactions to Functions and Benefits of Family
Accumulated Traumatic Storytelling 43
Circumstances 16 Family Storytelling Skills 44

v
CONTENTS

Emerging Capacities and Family Chapter 6: Clinical Considerations and

Storytelling 47 Strategies 79
Understanding the Impact of Trauma Foundations in Core Elements of
on Family Stories 48 Trauma Treatment: Reducing
Narrative: A Therapeutic Approach 49 Symptoms of Chronic Exposure 79
Facilitating Storytelling and Narrative Conducting a Phased Intervention 80
in SFCR 51 Foundations in Family Treatment:
Overview of Storytelling in SFCR 52 Strengthening the Family’s Protective
Planning for Family Narrative Work 52 Function 80
Designing a Safe Narrative Developmental Issues to Consider 82
Experience 53 Age-Specific Breakout Groups 82
Conducting Narrative Sessions in Honoring the Rule that Caregivers are
SFCR 55 in Charge of Their Families 83
Notes 58 Family Approach to Emotional and
References 58 Behavioral Regulation Coaching 83
Multi-Family Groups (MFGs) 85
PART II: THE PRACTICE OF SFCR 63 Background of MFGs 85
Considering Elements of Group
Chapter 5: Implementing SFCR 65 Therapy 85
Exploration Phase or Pre-Implementation Considering Elements of Family
Planning 65 Therapy 87
Is SFCR Right for Us? 65 Facilitator Competencies and
Families Appropriate for SFCR 66 Responsibilities 87
Staffing SFCR 66 Clinical Competencies 88
Covering the Cost of SFCR 68 Consumers as Facilitators 89
Installation or Preparation Phase 68 Facilitators’ Role in Supporting
Training 68 Family Treatment 90
Team Building 69 SFCR and Diversity 90
The Logistics of Conducting SFCR 69 Adapting SFCR for Latino Families 91
Initial Implementation 71 Adapting SFCR for Individual
Consultation 71 Family Treatment 92
Team Meetings 71 Adapting SFCR for Peer-to-Peer
Monitoring Competence and Recovery Groups 92
Adherence to SFCR 72 Guidelines for SFCR Practice 93
Weekly Preparation for SFCR Sessions 72 Confidentiality 93
Recruiting, Selecting, and Engaging Managing Crises 93
Families 72 Session Routines 94
Full Implementation 76 Clinical Strategies in SFCR 94
Sustainability of SFCR 77 Building Family Routines 94
References 78 Problem-Solving 95

vi
 CONTENTS

Regulation Skills 95 Module I: Rituals and Routines 118

Safety 96 Pre-Session: Evaluating Trauma and
Building Strong Supports 97 Family Functioning 119
Timelines 99 Session 1: Telling Family Stories 122
Humor and Laughter 99 Session 2: Ritual Family Tree 133
Family Storytelling and Narrative 100 Session 3: Family Diary 142
Homework 100
Notes 100 Module II: Protective Coping Resources 152
References 100 Session 4: Feeling Safe I 153
Session 5: Feeling Safe II 163
Chapter 7: Measuring Change in Trauma Session 6: People Resources 172
Symptoms and Constructive Coping 104 Session 7: Life Choices 182
Measuring Pre-Post Change 104 Session 8: Spirituality and Values 192
Assessment Strategies 104 Session 9: Things Get in the Way 201
Measurement Protocol 104 Session HR10: Celebration! 212
Assessing Family Engagement
and Participation 106 Module III: Trauma Resolution and
Qualitative Measures 106 Consolidation 221
Evidence Base for SFCR 107 Session 10: Telling About What
Study 1: Open Trials 107 Happened 222
Study 2: Implementation Research 108 Session 11: When Bad Things Happen I 233
SFCR Research Agenda 109 Session 12: When Bad Things Happen II 242
References 110 Session 13: Marking the Trauma 251
Session 14: Good Things Happen Too! 260
PART III: SESSION GUIDELINES 113 Session 15: Celebration! 270
Post-Session: Re-Evaluating Trauma
Using the MFG Session Guidelines and and Family Functioning 277
Supporting Materials 115
Index 279

vii
ACKNOWLEDGMENTS

Strengthening Family Coping Resources would not adapting them for SFCR, and trying them out with
have been imaginable without the contributions of lots of families. The list is a long one and includes
many. The rituals and routines passed down in my (but is not limited to) Barry Nurcombe, Maureen
family for many generations and practiced faithfully Black, Jerry Heston, Marilyn Paavola, Ewa Ostoja,
and joyfully by my husband, David, and my sons, Kay Connors, Vickie Beck, Barbara Baumgardner,
Peter and AJ, convinced me of the value of this Joyce Dorado, and Sharon Stephan.
approach. I would also like to acknowledge support from
I am especially grateful to Dr. Linda Bennett, the National Institute of Mental Health, the Sub-
my friend and mentor, who introduced me to the stance Abuse & Mental Health Services Adminis-
study of family ritual and routines and who worked tration, and the Zanvyl and Isabel Krieger Fund.
collaboratively to translate theory into clinical Finally, to each of the families who has partici-
practice. pated in Strengthening Family Coping Resources,
I would also like to acknowledge the contribu- I express my appreciation.
tions of colleagues who supported development Cover art, SFCR logo, and session guideline
and evaluation of SFCR through offering many design created by Communication Associates.
wonderful suggestions for materials and activities,

viii
WHAT IS IN THE SFCR MANUAL?

The SFCR manual provides both a theoretical Part II contains implementation and clinical
orientation to the intervention and detailed guidelines for conducting SFCR.
instructions for implementing it. The manual is Chapter 5 presents a multi-phased implemen-
presented in three parts. tation process from exploration through sustain-
Part I details the theoretical and empirical ability. Each phase is described with detailed
foundations of SFCR. information regarding best practices for SFCR
Chapter 1 provides a brief overview of the implementation.
intervention, its development, and the multiple Chapter 6 describes the clinical considerations
versions available. and guidelines necessary for conducting SFCR. It
Chapters 2 and 3 provide theoretical background includes background information and instructions
related to the two primary goals of SFCR: reducing for the more unique clinical strategies and practice
the symptoms of traumatic stress disorders and elements that comprise the model.
increasing coping resources in children, adult Chapter 7 outlines the assessment processes
caregivers, and in the family system. integrated within the structure of SFCR, presents
Chapter 2 presents a conceptual model for results of evaluation efforts to date, and reviews a
understanding how families adapt to living in research agenda for the future.
traumatic contexts under chronic conditions of high Part III includes the session guidelines specific-
stress. ally focused on the multi-family group versions of
Chapter 3 offers a unique perspective on family SFCR.
coping skills derived from multiple theories and Supporting materials, including all of the hand-
models but with an emphasis on family ritual and outs, discussion guides, homework, and posters
routine theory. This chapter provides insight into needed for each session (along with recommen-
the methods used in SFCR for translating theories dations for preparing them), are available on the
of family coping to systemic trauma treatment SFCR website (sfcr.umaryland.edu).
strategies.
Chapter 4 provides a theoretical orientation to
family storytelling and narration, as well as detailing
with the use of these practice elements in SFCR.

ix
This page intentionally left blank
PART I

THEORETICAL AND EMPIRICAL FOUNDATIONS

This page intentionally left blank
CHAPTER 1
INTRODUCTION TO SFCR

OVERVIEW In taking a systemic, family approach to addres-

sing the effects of high stress and trauma, SFCR
Strengthening Family Coping Resources (SFCR) is
provides a fundamentally different intervention
a manualized, skills-based, family-focused, and
option. The majority of current empirically sup-
trauma-specific treatment. This empirically sup-
ported models of trauma prevention/treatment is
ported, clinic- and community-based interven-
focused either on individuals or dyads, and largely
tion was developed using a participatory research
neglects the critical issue of how the family does or
methodology to assure acceptability and tolerability
does not contribute to healing. The model of family
with populations living in traumatic contexts. Since
most families living in traumatic contexts contend treatment used in SFCR, which includes develop-

with multiple traumas, as well as ongoing stressors mentally appropriate skill-building activities that

and threats, SFCR is designed to meet two primary are reinforced with family practice, provides a novel

goals: (1) to decrease the impact of chronic trauma approach to addressing co-occurring traumatic

on families and identified family members; and (2) reactions in multiple family members.

to increase the protective function of the family by SFCR is being widely implemented by clinic-

improving constructive coping. and community-based providers who are excited

As an intervention for families experiencing about a model that can address the needs of
traumatic stress, SFCR provides accepted, empiri- multi-problem families whose lives are permeated
cally supported trauma treatment within a family with stress and trauma. Practice-based evidence
format. The model includes work on family story- demonstrates that SFCR is feasible, tolerable, and
telling, which builds to a family trauma narrative, effective. Children experience significant reductions
providing families with an opportunity to improve in symptoms of PTSD and in behavior problems. In
communication about, and understanding of, the addition, families gain skills in coping and stress
traumas they have experienced. reduction, and demonstrate healthier functioning,
In SFCR, trauma treatment strategies are coupled which increases their capacity to serve as a source
with skill building to increase coping resources in of support and protection.
children, adult caregivers, and in the family system
to support family protection and resilience. SFCR
SFCR INTERVENTION DEVELOPMENT
includes therapeutic strategies, based on family
ritual and routine theory, to address the unpredict- A multidisciplinary team of psychiatrists, psycholo-
able and often uncontrollable nature of ongoing gists, social workers, and anthropologists provided
stress and threats of exposure faced by families. input into the formation of SFCR. Development
These strategies help families boost their sense of of this family skill-building program was also
safety, function with stability, regulate their stress greatly influenced by other successful prevention
reactions, emotions, and behaviors, and make use intervention programs.
of support resources.

3
INTRODUCTION TO SFCR

The intervention development process com- Multi-Family Groups

prised specification of content and treatment
SFCR has primarily been delivered using an MFG
procedures in the form of a manual, creation
format. Each SFCR MFG session is family-focused
of training materials, clinician competence and
with everyone in the family encouraged to attend.
adherence measures, and determination of meas-
In treating multiple families simultaneously, SFCR
ures of change within an interactive process to
is an intervention with the reach necessary for
assure cultural sensitivity and family engagement.
addressing the public health needs of vulnerable
Using a context-specific, interactive interven-
families.
tion development model, a stakeholder group of
There are three versions of SFCR that use the
population experts (community residents, opinion
MFG format. These include the trauma treatment
leaders, and community-based clinicians) provided
MFG, the high-risk MFG, and the workshop MFG.
input and feedback at all stages of the process.
The session guidelines in Part III of the manual
Stakeholder input was gathered around the fol-
provide instructions for implementing the trauma
lowing four issues: content and structure of the
treatment and the high-risk MFGs.
intervention, engaging families, measuring out- Each MFG version is described briefly:
comes, and assessing family participation. Specific The trauma treatment MFG is a 15-session
activities, materials, and methods created for SFCR closed-enrollment intervention. This version of
were reviewed for sensitivity, readability, support SFCR targets families impacted by traumas and
of different family forms, and consistency with an ongoing threats as evidenced by one or more family
approach that values the strengths within each members with symptoms of traumatic stress
family. Academic experts in family work and trauma disorders. Families are recruited for enrollment,
also reviewed the manual and materials. assessed for appropriateness, and asked to partici-
Initial versions of SFCR were implemented in a pate in weekly two-hour sessions. The trauma
variety of settings using a multiple-baseline design treatment MFG is conducted by a facilitator team
to gather information on the manualized treatment primarily made up of professionals with clinical
and on the dynamics involved in the multi-family training and expertise.
group (MFG) format. The outcomes of interest were The trauma treatment MFG focuses on symptom
the process measures indicating participation in reduction and on improving family coping
the groups, cultural sensitivity and acceptability, resources to increase protection and support
clinician competence, and intervention integrity. recovery, resilience, and thriving. It is a phased
The multiple-baseline design allowed for cycles of intervention; concepts and skills introduced and
feedback, revision, and retesting. practiced in early sessions are mastered and
scaffolded in later sessions.
The 15-week trauma treatment MFG is divided
SFCR VERSIONS
into three modules. Module I introduces the
SFCR can be implemented using a variety of families to the concept of family ritual, routine,
formats. The different formats allow the content and storytelling. Module II focuses on building
of SFCR to be delivered in multiple settings using constructive family coping resources for dealing
a variety of staffing patterns. with stress. Sessions in Module III engage families
in narrative work either to build narrative skills or

4
 INTRODUCTION TO SFCR

to talk explicitly about their trauma experiences. If SFCR-FTT is delivered in weekly one-hour
a family is ready, their narrative work deals with sessions. It uses the phased approach of the trauma
specific traumatic events, helps them reconnect, treatment MFG and is comprised of three similar
reach shared meaning about their experiences, and modules. The order and number of the sessions
move beyond their traumas. (especially those focused on coping skill develop-
The high-risk MFG is a 10-session intervention ment in Module II) can be customized to a certain
with closed enrollment. The high-risk version is degree to best reflect the needs of each family.
most appropriate for families likely to experience SFCR-FTT requires a clinically trained professional
trauma or families who have been exposed and are to work with each family.
vulnerable to traumatic stress disorders. The high-
risk MFG is also conducted by facilitator teams but
SFCR-Peer-to-Peer (SFCR-PP)
does not require as many clinically trained team
members. SFCR materials and strategies have also been
This version of SFCR is divided into two adapted for use as a peer-to-peer group model.
modules covering all of the coping components of SFCR-PP involves one-hour weekly groups led by a
the trauma treatment MFG. The high-risk version peer facilitator. SFCR-PP groups are conducted
includes sessions 1–9 and a final celebration using an open-enrollment model in which indivi-
session (a combination of sessions 14 and 15 of the duals can drop in for any number of sessions.
trauma treatment MFG). The primary difference SFCR-PP groups are typically conducted by trained
between the trauma treatment and the high-risk and experienced peer mentors.
MFGs is that the high-risk version does not include Along with their peer group leaders, partici-
the five-session module in which families engage pants focus on reconstructing intergenerational
in narrative. relationships whenever possible, “letting go” when
The third MFG version is a workshop model. The reconciliation is not possible (or perhaps not
workshop MFG is an open-enrollment group in desirable, as with family perpetrators of violence),
which families can drop in for any number of interrupting the cross-generational transmission of
sessions. The workshop MFG covers essentially the trauma, violence, and substance abuse, and leaving
same content as the high-risk version with some a legacy of guidance based on their own experiences
adaptations made for the different format. For and learning. The groups support individuals in
example, instead of asking families to complete recovery to make connections between trauma,
homework between sessions, they are given tips for violence, substance abuse, and parenting practices.
practicing at home what was learned during each The desired outcomes for participants who
session. attend these groups are twofold: (1) enhancing/
strengthening an individual’s own recovery; and
(2) better positioning individuals in recovery to
SFCR-Family Trauma Therapy (SFCR-FTT)
help family members with whom he or she has
SFCR-FTT, a version of SFCR for individual families, meaningful relationships avoid substance abuse,
provides trauma treatment using a family-driven violence, and victimization.
approach. It includes many of the same therapeutic Refer to Chapter 6 for additional information on
strategies used in the MFG models. the SFCR-FTT and SFCR-PP versions.

5
CHAPTER 2
CONCEPTUAL FOUNDATION FOR FAMILY TRAUMA
FAMILIES EXPOSED TO ACCUMULATED TRAUMATIC CONDITIONS1

As a field, we are just beginning to understand levels of stress and multiple traumas related to living
complex adaptations to trauma in families and to in a traumatic context, this chapter provides an in-
grapple with how best to provide treatment. We depth look at the complex adaptations that families
have been much more successful at understanding often make to survive so that SFCR facilitators can:
and treating individual psychopathology. As our
understanding of complex trauma and develop- 1. increase awareness of the contextual conditions
mental trauma disorder has improved, empirically or accumulated traumatic circumstances that
derived treatments have been developed target- influence families;
ing the most distressing and debilitating symp- 2. be familiar with adaptation processes that
toms. The well-developed complex trauma con- families use and appreciate the complex
struct is now the foundation for such treatments systemic maladaptations that result from living
as Attachment, Regulation, Competency (ARC; in a traumatic context;
Kinniburgh, Blaustein, Spinazzola, & van der Kolk, 3. recognize the clinical characteristics of such
2005), Structured Psychotherapy for Adolescents families and be able to adequately observe their
Responding to Chronic Stress (SPARCS; DeRosa concerns and strengths as they interact and
et al., 2006), and Trauma Affect Regulation: react to the activities offered in SFCR; and
Guidelines for Education and Therapy for Adoles- 4. use this understanding to assist families in
cents and Pre-Adolescents (TARGET-A; Ford & building new coping skills and resources.
Russo, 2006). All include a set of essential strategies
or core components necessary for intervention with
DEFINITION
complex trauma.
In a similar fashion, describing the hallmark The family is one example of a “trauma membrane,”
characteristics of complex adaptations to trauma the protective environment surrounding a trauma
in families has implications for organizing our survivor (Martz & Lindy, 2010; Nelson Goff &
clinical conceptualization of families who present Schwerdtfeger, 2004). Under the best of circum-
for treatment. It provides a framework for looking stances, the family provides extra support,
at systemic adaptations in a way that is manage- structure, and coping resources for a family
able and meaningful. As our understanding of member who is traumatized, and, with such
how families adapt to chronic stress and trauma support, a healthy reaction and positive adjustment
becomes more sophisticated, we can develop are more likely. However, under conditions of
empirically derived treatments targeting the most chronic, multiple, or ongoing trauma exposures,
pervasive family symptoms. the family may lose the ability to serve its protective
Because SFCR was developed specifically for function. Repeated exposures are often associated
families who have experienced chronically high with severe and persistent reactions in multiple

6
 CONCEPTUAL FOUNDATION FOR FAMILY TRAUMA

family members and can also lead to systemic event or events. Finally, families living with accu-
distress. mulated traumatic circumstances deal with con-
Efforts to define complex adaptations to trauma tinuing unpredictable and uncontrollable threats.
in families began in 2009 during an expert panel Accumulated traumatic circumstances are
meeting conducted by the Family Informed related to five classes of family stressors, ranging
Trauma Treatment (FITT) Center, a National Child from normative stressors to cataclysmic events or
Traumatic Network (NCTSN) Category II Center. traumas (Baum & Davidson, 1986).
The experts who took part in this meeting agreed on Normative stressors include all of the burdens
the following: associated with accomplishing the tasks of daily
family life. We know that certain periods of the
Too many families are exposed to accumulated family life cycle (e.g., families with infants or
traumatic circumstances. Complex adaptations toddlers) are associated with higher levels of
to trauma in families are defined by the intensity, normative stress. Normative stressors can feel
duration, chronicity, or toxicity of the accumu- overwhelming when families are also dealing with
lated trauma, and by the nature of the family’s exposure to other stressors and traumas.
response. Those families whose strengths are Families also experience stress related to
overwhelmed by their accumulated traumatic predictable individual and family developmental
stressors exhibit distress and disrupted family transitions. With marriage comes the negotiation
functioning. of new roles. When a child learns how to drive,
new rules and routines are established. Although
expected, these transitions create stress and require
EXPOSURE TO ACCUMULATED
the family to adapt to the altered conditions
TRAUMATIC CIRCUMSTANCES
(McGoldrick, Carter, & Garcia-Preto, 2011).
Family adaptation to trauma is related to the On top of normative and predictable transitions,
specifics of the family’s context, making it essential many families experience stress related to unpredict-
to understand their experiences and circumstances. able transitions. Divorce, separation, or removal of
Complex adaptations to trauma are more likely to a child from the family would be examples of such
occur when families are dealing with accumulated transitions. Unpredictability creates more stress
traumatic circumstances. and typically requires more of the family’s coping
Accumulated traumatic circumstances occur resources for successful adaptation.
when a family’s context contains high stress, trau- Families also experience a variety of contextual
matic exposures, associated secondary stressors, stressors or hassles related to conditions in the
and continued threats. Unfortunately, for too many community or society. Some family contexts are
families these experiences of adversity and trauma associated with multiple and chronic stressors.
are interdependent. Living with harsh circum- Consider families living in urban poverty. Often,
stances increases overall stress levels and the risk these families encounter limited community
of exposure to trauma. Once exposed to trauma, the resources, including crowded, substandard housing
risk of additional exposures grows. Exposure to and disadvantaged schools, limited employment
trauma may also lead to a series of secondary or opportunities, hassles related to obtaining services
cascading stressors associated with the original from overwhelmed service systems, and stigma

7
CONCEPTUAL FOUNDATION FOR FAMILY TRAUMA

related to their underclass status in society. Military FROM CONTEXT TO RESPONSE:

deployment during wartime is another example of FAMILY ADAPTATION
a potentially stressful context for families (Park,
Experiencing a stressor, by definition, requires
2011). Military families often experience finan-
a response (Selye, 1982). The magnitude of the
cial instability and inadequate supports caused
response is dependent upon the intensity, duration,
by extended separations and multiple deploy-
chronicity, or toxicity of the stressor. Over time,
ments. Once reunited, changes caused by their
families who live with accumulated traumatic
service member’s wartime experience may create
circumstances have to make significant adaptations
additional stress. In addition, uncertainty about
to survive.
redeployment may raise further concerns for the
How do families adapt to accumulated traumatic
family.
circumstances? Many theories use a stage model to
Finally, overwhelming stressors, often referred to
describe family adaptation to stress (Chaney &
as traumas or cataclysmic events, also impact
Peterson, 1989; McCubbin & McCubbin, 1993).
families. As with individual responses to trauma, a
These theories suggest that adaptation involves
family’s response is in large part predicated by the
acute, transition, and long-term stages with distinct
nature of their traumatic exposure and with their
reactions characteristic of each stage.
experience of associated secondary stressors. One
The family enters the acute stage immediately
variable of importance to a family’s response is the
following the trauma. As families make adjustments
number of traumas experienced. Unfortunately for
families exposed to accumulated traumatic circum- to deal with the demands of catastrophe, they move

stances, they often encounter multiple traumas over into the transition phase. This stage is distinguished

many years and across several generations. by instability and may result in development of

Following cataclysmic events, families frequently trauma-related distress. Symptoms of distress

have to contend with any number of related hassles and diminished functioning may be present in

(e.g., relocation following a hurricane or flood, legal individual family members, family subsystems,
proceedings following a rape or murder, separa- and the family unit, and may last for some time.
tions following intra-familial abuse). Secondary or After this period of adjustment, the family again
cascading stressors associated with the original establishes stable patterns of interaction. This is
event or events compound and extend the impact characteristic of the third phase or longer-term
and require ongoing coping efforts. adaptation. The family may still experience
Most families who live with accumulated symptoms of distress when faced with additional
traumatic circumstances are not dealing with post- stressors or re-exposure to trauma (Peebles-Kleiger
traumatic reactions, but are faced with real and & Kleiger, 1994).
current dangers. “Episodes of actual danger are not The typical stage model addresses family coping
the entire stressor. The chronic stressor at issue with discrete stressors. Adaptation to high stress,
is the constant presence of the possibility of multiple traumas, and ongoing threats requires
vulnerability to dangerous forces that cannot be more complicated models:
controlled or avoided” (Wheaton, 1997, p. 57).
Uncertainty about recurrence or continued threats Families, who are dealing with multiple events
of re-exposure increases the risk of maladaptations. or situations involving on-going trauma, cycle

8
 CONCEPTUAL FOUNDATION FOR FAMILY TRAUMA

through these stages multiple times and may commonly comprised of an anxious anticipatory
be at different stages simultaneously related coping style, systemic dysregulations, disturbed
to separate exposures. The nature of chronic relations and supports, and altered schemas; (2)
stressors, “typically open-ended, using up re- reciprocal distress reactions that disrupt family
sources in coping, but not promising resolution” subsystem processes; and (3) increased rates of
(Repetti & Wood, 1997, p. 53) obscures the traumatic stress disorders among multiple family
adaptation process. members that are likely dyssynchronous. The
(Kiser & Black, 2005, p. 740) resultant lapses or declines in the family’s ability to
carry out their core functions often bring them into
Healthy adaption processes themselves may be treatment. Figure 2.1 offers a schematic of the
vulnerable to overuse. First, family adaptation to hallmark characteristics.
ongoing stressors and traumas frequently involves
adoption of coping and problem-solving strategies DISTURBANCES IN THE FAMILY UNIT
that work in the short-run but may create mal-
adaptations long-term. Second, constant efforts to Anxious Anticipatory Coping Style
adapt require significant resources. This depletes Anticipation or expectation of disturbing events
coping resources for many families, increasing their creates a complex and dynamic condition charac-
vulnerability to new threats. Third, the constant terized by alterations in individual and family unit
need for adaptation makes families less efficient at functioning. When trauma is unpredictable or
responding and less flexible in choosing coping followed by uncertainty about recurrence, families
strategies that match stressor demands. must cope with feelings of fearfulness, suspicious-
ness, and an ongoing sense of threat. In response,
they demonstrate heightened alert, anger and
COMPLEX ADAPTATIONS TO ACCUMULATED
conflict, and silence.
TRAUMATIC CIRCUMSTANCES IN FAMILIES
Circumstances that create persistent feelings
Although most families are able to adapt success- of not being safe and being unable to control
fully to enormous challenges and tremendous situations challenge family-level coping. The
hardships, many are overwhelmed. Accumulated chronic nature of anticipatory stress with ongoing
traumatic circumstances heighten vulnerability to attempts to cope with uncertainty may contribute
traumatic distress for both individuals and families. to the development of dysfunctional coping
Families exposed to prolonged, repeated mechanisms commonly associated with exposure
trauma often become “trauma-organized systems” to ongoing severe stressors. Adoption of these
(Bentovim, 1992). Such families can best be served anxiety-reducing coping strategies may be healthy
by recognizing and appreciating consistencies in in the short-term but have longer-term negative
their clinical presentations. consequences for family functioning (Dempsey,
Considering multiple frameworks for under- 2002). “These efforts [at coping with anticipatory
2
standing complexly traumatized systems, families anxiety] result in the development of new or more
exposed to accumulated traumatic circumstances intense patterns of interaction within the family
often present with multilayered adaptations system. These patterns may temporarily reduce
characterized by: (1) a family unit response anxiety, but will likely make the family more

9
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