Child and Adolescent Psychiatry

346 Chapter 41

individual well-being. The proposal is that there aredevelopmental tasks

that require mastery at each stage. Failure to come to terms with these

changes and to make the necessary adjustments may then lead to strain

or dysfunction in the family system and problems or symptoms in one

or all family members. Successful negotiation of the transitions may re-

quirefirst order changes(defined as within the system but not affecting its

structure) orsecond order changes(which require a fundamental alteration

in the system’s structure and function). Some of the life-cycle stages

are shown in Box 41.1, though individual, socio-economic and cultural

variations need to be considered, as do the impact of dislocations such

as divorce, unemployment, severe illness, etc.

Box 41.1Life-cycle stages

Stage Tasks

1 Leaving home (a) Develop own identity independent of family of origin

(b) Form close peer relationships

(c)Gain work and financial independence

2 Cohabitation (a) Form marital system

(b) Realign relationships with extended family, and friends

3 Family with young

children

(a) Adjust marital system to make space for children

(b) Join in child rearing, financial, and household tasks

(c)Realign with extended family to incorporate parenting

and grandparenting roles

4 Family with

adolescents

(a) Adjust relationships so adolescent can move in and out

of system

(b) Refocus on midlife marital and career issues

(c)Start joint caring for older generation

5 Children leaving

home

(a) Renegotiate marital system as a dyad

(b) Develop adult-to-adult relations with grown children

(c)Accept in-laws and grandchildren into system

(d) Cope with disability and death of parents

6 Late life (a) Adjust couple functioning in face of physiological,

financial and work-role decline

(b) Dealing with loss of spouse, siblings and friends

(c)Accepting assistance from children/outside agencies

Some working practices common to most types
of family therapy
Seeing as many family members as possible.Thisusedtobeverystrongly
recommended in order to assess the communication patterns and inter-
relationships going on. The concern was that failure to see all members