A Family Systems Approach to Working with Post War Families

During war, not only are the political, geographical and social structures broken down, the family structure is also severely disturbed. There may be losses due to family separation, death, destruction of homes, emigrations, and changes of lifestyles and careers. All these factors affect not only the physical structure but also the psychological and cultural structures of the family. Many families become displaced and live in exile from their homelands as refugees. Those that stay within a war torn country face ambiguity and fear. In such highly stressful conditions, families have to adapt and cope with the various kinds of trauma they encounter. What are the protecting factors that buffer the adversity and how can a family therapist draw out these strengths from the family to promote healthy adjustment? What are the challenges the war traumatized families face, and how can the family therapist address these challenges in therapy sessions? These are the questions that will be dealt with in this paper.

Role of family therapist with families experiencing war trauma
According to B. S. Nelson (2003), the difficulties faced by families who have experienced war trauma are changes in structure, roles and functions of the family members. Thus the disruption caused by war does not affect only social structures, but also family structure. M. Ajdukovic (1996) describes the various stressors post war families experience, which include displacement, financial difficulties, break down of social network, isolation, marginalization and minority status, adaptation to host cultures, uncertainty, psychological trauma, losses, and coping with developmental and family life cycle issues in the context of the above mentioned stressors. Moreover, families have to learn new ways to handle changes in family obligations and roles, communication, connections to ethnic community and nation state, and transgenerational transmission of values (S. Weine, N. Muzurovic, Y. Kulauzovic, S. Besic, A. Lezic, A. Mujagic, J. Muzurovic, D. Sphahovic, S. Feetham, N. Ware, K. Knafl, & I. Pavkovic, 2004).

Although clinical psychological disorders, such as Post Traumatic Stress Disorder, do result from war trauma, other psychosocial effects also emerge (Nelson, 2003). Such effects can range from physical needs such as shelter and medical attention, to relational issues such as domestic violence and child abuse. Nelson (2003) and Weine et. al. (2004) advocates for a family systems approach to helping families deal with psychosocial effects of war trauma, in addition to the clinical treatment of psychological disorders. Reconstructing the broken structures will take rebuilding one relationship [italics added] at a time (Nelson, 2003). This is where the family therapist can play a very important role in the reconciliation of the families.

Addressing challenges faced by post war families
The challenges faced by post war families can be categorized as follows: physical needs such as shelter, medical and financial, changes in structures within the families, which include developmental and family life cycle changes, changes between families and their social contexts, which includes acculturation, and incapacity of parents to provide appropriate care to children due to absences or experiencing clinical symptoms on individual levels.

Physical needs. With regard to physical needs, advocacy and case management on behalf of the families will link the families with community resources that could assist them with fulfilling any unmet physical needs. The family therapist can empower the families in identifying and asserting their needs, and to actively engage in meeting these needs. Psychoeducation can be helpful in informing the families about the various resources available to them. Skill building will teach the families methods to obtain these resources on their own. Most organizations and agencies in the post war countries focus on meeting these physical needs, so much help is provided for families in this aspect (Nelson, 2003).

Changes in structures within family. Family structures change when there are separations, deaths and alterations of role assignments for its members as a result of war. When a family experiences physical loss of its members, the family roles have to adjust to the absences of those members. In addition, the nature of crises may pressure the family to restructure their roles so as to accommodate for the circumstances. For example, the family may still be fully intact in term of its number of members, but they will still experience changes in role when the father may not be able to find a job as easily as the mother does in a new country where they seek asylum.

When families cannot accommodate for structural changes, the therapist can help the families readjust to them and find new meaning in the roles that they now have. Structural family therapy is appropriate to implement restoration of the new hierarchy. According to S. M. Heitler (1990), hierarchy and division of labor are two factors in family structures. In post war families, the authority and responsibilities, which are part of hierarchy, are changed. The subsystems could be restored despite the changes in roles and obligations, so that hierarchy of the family can be maintained. J. Corcoran (2003) states how structural family therapy focuses on creating well-functioning hierarchy patterns where the subsystems have clear boundaries. In addition, the family members will have to learn new ways to communicate to each other in these new roles. Enactments, a technique of structural family therapy, in which the family has to play out the communication patterns, can reinforce the family to utilize new transactional patterns (Corcoran, 2003).

Weine et. al. (2004) discusses how communication and relationships among family members are important in rebuilding the family after adverse war trauma. Reconciliation of family roles and obligations are also essential to the rebuilding of the family. Weine et. al. (2004) describes a Family Consequences of Refugee Trauma Model (FAMCORT), in which the three above-mentioned factors play a role in transitioning family members to healthy responses. The model draws on the assessment of adverse changes in the various realms of family life displaced by war to explore strategies for rebuilding of lives for these families. Such a model is strength based and focuses on the family as a unit for treatment.

The model addresses the challenges of displaced families’ realms of family life by reconstructing the relevance of each challenge in a new context, i.e. changing the nature of the structure of these challenges. For instance, by utilizing the support of grandparent parenting, the challenges of patriarchy are addressed. Another example is by planning a reunification for families that are dispersed in the Diaspora, the family relationships can be maintained (Weine et. al., 2004). In such ways, the model also uses structural family therapy techniques.

It is important to consider individual developmental and family life cycles when dealing with issues related to changes in family structures. Most, if not all, of these changes that result from war occur in the context of the family members’ life span development as individuals, as well as across the different stages of family life cycle. For example, a mother has to cope with being a caregiver while experiencing a family life cycle stage of becoming a single mother if the father is separated from the family as a result of war. This new status could bring up issues of intimacy and identity for her that she would have to re-experience in her individual development. However, her current role as a caregiver prescribes her to be in the generative phase according to Erik Erikson’s theory of development. Her children will be experiencing a whole other aspect of life development, similar to her own struggles with intimacy and identity, and this could impound on her own developmental cycle. Therefore, maintaining clear boundaries of the hierarchy and subsystems in the family is crucial to keeping intact the structure of the family and the parent’s role as a caregiver and authority figure (Heitler, 1990).

Changes in structures between families and their social contexts. It is inevitable that the social and political contextual structures change as a result of war—whether they are in the post war country or in the new countries that the family seeks asylum in. To adjust for these changes, the family has to reconstruct the new realities of their changed worlds. A. Ben-David & Y. Lavee (1996) states that in times of stress, the family members have to redefine the worldviews of its members in relation to the environment and accommodate for adjustments in their relationships so that they could cope as a unit, as well as in their support system, social embeddedness, extended family, and the community. Ben-David & Lavee (1996) emphasizes how the consensus building of the construction of the family’s realities is crucial in managing the future of their new lives. Hence, the cognitive structures of the family in perceiving their worlds have to adapt.

Family therapists can guide the reconstructing of the worldviews of the family members so that agreement can be established and family cohesiveness can occur. When there is family cohesiveness, the family can respond effectively as a unit to the environmental stressors. Since shared reality is undermined by ambiguity, and war trauma can bring forth much uncertainty (Ben-David & Lavee, 1996), the therapist’s work should also focus on supporting the family in providing containment and security within the sessions to alleviate fears about uncertainty.

Not only do cognitive structures change, but the nature of involvement of the families in their communities change too. R. J. Laufer & M. S. Gallops (1985) mentions that war veterans experience social separation, career disorientation, and personal or psychological trauma that hinder the development of domestic lives. Although Laufer & Gallops (1985) describes Vietnam war veterans in their article, the same could be generalized to other family members who have experience some form of war violence. Due to their trauma, the family feels isolated and their family life cycle is disrupted, which alienates them from other families in the communities.

In addition, a significant realm of family life—the family connections with ethnic community and nation—is affected as a result of refugee trauma. The family might be concerned about their culture and ways of life being lost through assimilation to the new environment (Weine et. al., 2004). Weine et. al. (2004) provides a few strategies in the FAMCORT model to help family keep their culture and ethnic identities through actively participating in their cultural languages, rituals and passing on of history. Narrative family therapy can be especially helpful in this arena. The stories and meanings can be kept alive through the narration of the family’s experiences prior to, during, and post war periods.

Incapacity of parents to provide appropriate care for their children. The most obvious incapacity of parents to provide care is their absences. When one or more parents are separated or lost as a result of war, the children will need other parental figures to replace their biological parents. Attachment theory greatly emphasizes the importance of healthy attachment of child with the parents for the development of the child’s personality (J. Bowlby, 1988). When the child finds that the parent is not available or able to respond, separation anxiety might result. In war torn families where one or more parent is not around, the availability and response are not there for the child’s healthy attachment. Thus insecure attachment and separation anxiety could be present in the child.

Even if the child has other substitute caregivers, this could still occur because the child’s initial primary caregiver was the parent. So the child has to overcome the previous distorted views of attachment anxiety resulting from the disruption of the initial caregiver before forming a new and healthy attachment to other significant people (Bowlby, 1988).

Family therapists can help the child adjust to the new caregiver and restore healthy attachment style. Bowlby (1988 ) suggests that the therapist can do this by providing a secure base for the child and encouraging the child to explore healthy relationships with current significant figures.

On the other hand, the parents might be around to provide care for the child. However, as a result of war trauma, they may not be able to carry out their duties sufficiently. Ajdukovic (1996) states how the disruption of the family life cycle and the coping of loss and trauma can disable the mother to remain patient with her child and to communicate with the child effectively. She suggests that psychoeducation as useful intervention, where the mother can learn coping resources and parenting skills to manage her child at time of crisis. Nelson (2003) also advocates for psychoeducation of parent training and vocational training to reduce the stressors and empower the caregivers.

Children can be vital to the resiliency of post war families. Therefore, it is imperative for the parent-child relationship to remain intact. Many post war families draw their hope and willingness to survive on the belief that their children will benefit from their struggles (Weine et. al., 2004). Such a strong faith is a strength of these families. However, a dependency on the children to fulfill this high expectation can also be a burden for them. Therefore, care must be taken to ensure that over burdening of the children do not occur in these families. The FAMCORT model suggests how flexibility and trust in the children’s choice in the roles they play can assist the families in this aspect. Family therapists can coach the families in open communication so that trust and flexibility can be built within the family transactional patterns (Weine et. al., 2004).

Conclusion
The paper started out with two questions: how can the family therapist address the adversities faced by the post war families, and how can the family’s strengths be used in therapy to rebuild their lives? In summary, the post war families face several challenges related to meeting physical needs, changes in structures within the families as well as in context of their new environments, and the barriers to appropriate parental care of children. The family’s hope in the future of their children, and the ability of the family to rebuild their lives by reconstructing the challenges of displacement are the strengths that the family therapist can focus on to remind the families about their own resources in a time of distress and ambiguity.

Structural family therapy, psychoeducation, and narrative therapy are techniques that the family therapist can use to help the families manage the challenges they experience. Since war inevitably result in changes in structures and introduction of new realities in the post war family’s world, structural family therapy can promote the growth of new structures and restore the old broken down ones. Moreover, psychoeducation empowers the family to become skillful and active participant in the new world. Narrative therapy validates the family’s experiences and maintains their cultural and ethnic identity during acculturation. In addition to the various therapeutic modules, it is important to approach the post war families within the context of attachment and developmental life cycle issues because these issues influence the individuals’ and family’s responses to the various adversities they face.

In conclusion, a competent family therapist utilizing the systems approach will consider all the various factors of the systems. The different aspects involved are beyond just the family systems or the socio-political systems. They also include the individual level of development as well as cultural and contextual levels that the family is currently placed in.

REFERENCES

Ajdukovic, M. (1996). Mother’s perception of their relationship with their children during displacement: A six month follow-up. Child Abuse Review, Vol. 5, 34-49.

Ben-David, A. & Y. Lavee. (1996). Between war and peace: Interaction patterns of couples under prolonged uncertainty. The American Journal of Family Therapy, Vol. 24, No. 4, 343-357.

Bowlby, J. (1988). A secure base: Parent-child attachment and healthy human development. U.S.A.: Basic Books, Inc.

Corcoran, J. (2003). Structural family therapy with adolescent conduct disorder, in Clinical applications of evidenced based family interventions. New York: Oxford Press, 155-177.

Heitler, S. M. (1990). Negotiation patterns and family structures, in From conflict to resolution: Skills and strategies for individual, couple, and family therapy. New York: W.W. Norton, 140-160.

Laufer, R. S. & M. S. Gallops. (1985). Life course effect of Vietnam combat and abusive violence: Marital patterns. Journal of Marriage and the Family, November, 836-853.

Nelson, B. (2003). Post-war trauma and reconciliation in Bosnia-Herzegovina: Observations, experiences, and implications for family therapy. The American Journal of Family Therapy, 31, 305-316.

Weine, S., N. Muzurovic, Y. Kulauzovic, S. Besic, A. Lezic, A. Mujagic, J. Muzurovic, D. Spahovic, S. Feetham, N. Ware, K. Knafl, I. Pavkovic. (2004). Family consequences of refugee trauma. Family Process, Vol. 43, No. 2, 147-160.