Authors: Yeager, Barbara



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Title:

MFT student training in medical family therapy: A collaborative hospital project with radiation oncology.

Authors:

Yeager, Barbara, Norwalk Hosp, Whittingham Cancer Ctr, Norwalk, CT, US
Auyang, Michael
Brown, Dolores L.
Dickinson, Patricia
Goldstein, Jayne A.
Jaffe, Nina
McKay, Lynda
Roche, Pamela
Workman, Gwen

Source:



Families, Systems, & Health, Vol 17(4), Win, 1999. pp. 427-436

Publisher:

US: Families, Systems & Health, Inc.

Other Journal Titles:

Family Systems Medicine

Other Publishers:

US: Brunner/Mazel Publishers, Inc.
US: Educational Publishing Foundation
US: Family Process, Inc.
US: Family Systems Medicine, Inc.

ISSN:


1091-7527 (Print)
1939-0602 (Electronic)

Language:

English

Keywords:



student training in medical family therapy using collaborative hospital project with radiation oncology, family therapy students charged with staffing cancer center waiting room

Abstract:

Asserts that a community hospital can provide a Level 1 training environment for family therapy students interested in medical family therapy. This article describes a 2-yr pilot program that was organized for local universities by a medical family therapist supervisor. Ss were 8 family therapy students who were charged with staffing a cancer center's radiation therapy waiting room. Goals for the students focused on awareness and collaboration, in the hope that they would begin to understand the dynamics and complexity of the impact of illness on families with good coping skills and families with less effective coping skills. Most importantly, it was hoped that the students would understand that the range of behavior that they had been taught to recognize as needing intervention in other clinical settings is different in a medical setting. Four case study excerpts are included to demonstrate that the students tended to struggle with feelings about illness and death, and that they were eager to jump in and solve problems. It is concluded that the students played an important role in helping to establish a sense of comfort and safety in the waiting room and that they contributed to an overall sense of security that made living in the present more of a possibility. (PsycINFO Database Record (c) 2009 APA, all rights reserved)

Subjects:

*Cooperation; *Family Therapy; *Hospital Programs; *Medical Education; *Radiation Therapy; Medical Students; Neoplasms; Oncology

Classification:

Professional Education & Training (3410)

Population:

Human (10)
Male (30)
Female (40)

Location:

US

Age Group:



Adulthood (18 yrs & older) (300)

Methodology:

Empirical Study

Format Availablability:

Electronic; Print

Format Covered:

Print

Publication Type:



Journal; Peer Reviewed Journal

Document Type:

Journal Article

Release Date:

20000401

Correction Date:

20090223

Copyright:

Kluwer Academic/Human Sciences Press. 1999.

Digital Object Identifier:

10.1037/h0089894

PsycINFO AN:

2000-13483-004

Accession Number:

fsh-17-4-427

Number of Citations in Source:

12

Persistent link to this record (Permalink):


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Database:

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MFT Student Training in Medical Family Therapy: : A Collaborative Hospital Project with Radiation Oncology

Contents

  1. A TWO-YEAR PILOT PROJECT BEGINS

  2. GOALS FOR OUR HOSPITAL AND FOR OUR STUDENTS

  3. Learning What is “Normal” in a Medical Family Crisis

  4. Supervisor’s Notes

  5. Supervisor’s Notes

  6. Supervisor’s Notes

  7. Supervisor’s Notes

  8. AS WE LOOK BACK FIVE YEARS LATER…

  9. Student Feedback

  10. REFLECTIONS

  11. Footnotes

  12. REFERENCES

By: Barbara Yeager
Medical Family Therapist, Whittingham Cancer Center, Norwalk Hospital, Norwalk, Connecticut; Adjunct Professor, Department of Marriage and Family Therapy, Southern Connecticut State University AAMFT Approved Supervisor. Certified Diplomate, American Psychother-apy Association; American Cancer Society 1998 Lane W. Adams Award for Compassionate Service to Cancer Patients and their Families
Michael Auyang
Southern Connecticut State University and Fairfield University who participated in the Two Year Pilot Project at Norwalk Hospital
Dolores L. Brown
Southern Connecticut State University and Fairfield University who participated in the Two Year Pilot Project at Norwalk Hospital
Patricia Dickinson
Southern Connecticut State University and Fairfield University who participated in the Two Year Pilot Project at Norwalk Hospital
Jayne A. Goldstein
Southern Connecticut State University and Fairfield University who participated in the Two Year Pilot Project at Norwalk Hospital
Nina Jaffe
Southern Connecticut State University and Fairfield University who participated in the Two Year Pilot Project at Norwalk Hospital
Lynda McKay
Southern Connecticut State University and Fairfield University who participated in the Two Year Pilot Project at Norwalk Hospital
Pamela Roche
Southern Connecticut State University and Fairfield University who participated in the Two Year Pilot Project at Norwalk Hospital
Gwen Workman
Southern Connecticut State University and Fairfield University who participated in the Two Year Pilot Project at Norwalk Hospital

Acknowledgement: The authors wish to thank all those at Norwalk Hospital, Southern Connecticut State University, and Fairfield University who worked so hard to make this project possible, especially to editors Elizabeth W. Gordon and Molly M. Schilling. Our special thanks to Norwalk Hospital’s Pradip Patháre, M.D., Medical Director of the Whittingham Cancer Center, and Chief of Radiation Oncology, who helped to integrate this Internship Program into our ongoing Cancer Center services.

How does medical family therapy differ from family therapy, and does a hospital experience while in training help a student to make that distinction?

My work in the field of family therapy began in the early 1980s after studying Minuchin’s classic theories in structural systemic models (Minuchin, 1974) at Southern Connecticut State University. However, my strong interest in working with families began in a hospital ten years earlier.

I started working as a volunteer in a California hospital, eventually becoming an employee, in what was then referred to as the Human Support Department. I became keenly interested in the dynamic effect of trauma on family, not yet referred to as a “family system”. Again and again, as I worked with patients and their loved ones, I noticed the riveting and sometimes paralyzing effect that chronic illness and death had on a family’s perception of itself and its members, virtually disarming them. From this vantage point, and because I tended to think strategically, I developed an inclination to look for ways to help the family adjust to unexpected and devastating change.

When I moved to Connecticut in 1980,1 was fortunate to be hired by Paul Schulman, M.D., in the Norwalk Hospital Cancer Center, now the Whittingham Center. Dr. Schulman was visionary in his belief that cancer is, in his words, a family disease. He organized what was, in effect, a collaborative oncology team at a time when medical family therapy and systemic approaches were in their earliest stages. We came from various back-grounds, but we learned the medical culture by working in it.

By the early 1990s, as the field of medical family therapy was developing, I began to receive many requests from interested students for internships in the Cancer Center. Our oncology team and radiation staff met weekly to identify the medical, nursing, nutritional, and psychosocial concerns of our patients. We had become aware that patients were uncomfortable in the Center’s radiation treatment waiting room because it was not staffed, and felt “empty”.

We agreed to explore the possibility of using family therapy students interested in medical family therapy to staff the waiting room from 8:00 AM—5:00 PM on weekdays in what we designed to be a two-year pilot program. We developed clearly defined parameters for the project, which were jointly approved by the hospital’s Departments of Medicine, Radiation, and Volunteers, and the Family Therapy Departments of two local universities. In the Fall of 1994, we were ready to select students, train them, and begin our two-year program.

A TWO-YEAR PILOT PROJECT BEGINS

Eight eager students were selected to begin our program. Their initiation to the hospital was structured through the Volunteer Department. They were introduced first to the usual volunteer protocol for the hospital, and then were each assigned a four-hour shift, to occur at the same time, on the same day each week. They understood that this was a Level 1 1 Internship opportunity, and, although they would be carefully trained and supervised, they would not be receiving any accredited hours 2 toward their Master’s degree.

The students were then given a thorough introduction into radiation medicine by the radiation physicians and technologists. A tour of the facilities and a careful explanation of the equipment was followed by reading assignments designed to acquaint them with radiation therapy and the effects of treatment. The students were also asked to read Medical Family Therapy (McDaniel, Hepworth and Doherty, 1992) and Ethnicity and Family Therapy (McGoldrick, Pearce, and Giordano, 1982). In addition to these books, they read voraciously from our Cancer Center reading room, determined to understand medical terms and regimens related to Cancer diagnosis and treatment.

Finally, each student spent two weeks in on-the-job training with me in the waiting room.

Students were expected to keep notes about each patient and family in a special notebook that was kept locked in my office. Because most patients came for treatment five days a week for six to eight weeks, it became important for the students to compare notes and share observations and changes.

As their supervisor, I met weekly with each student to discuss his/her observations and interactions with patients and families. We scheduled a group meeting every other month for a Sunday afternoon where they could be more reflective. We discussed their thoughts about the program and its challenges, the effects of chronic illness on the family, and the need for a collaborative effort in the medical community (Seaburn, Lorenz, Gunn, Gawinski, Mauksch, 1996; Muchnick, Davis, Getzinger, Rosenberg, & Weiss, 1993; Engel, 1996).



GOALS FOR OUR HOSPITAL AND FOR OUR STUDENTS

Our goal for our Cancer Center and for our patients was to provide an increased sense of care and support (Engel, 1996) as they faced the tedium and frustration of daily treatment, often for six or eight weeks.

Our goals for the students focused on awareness and collaboration. We hoped they would see the importance and usefulness of techniques in working toward agency and communion (McDaniel, et al., 1992; Seaburn, et al., 1996). We hoped they would begin to understand the dynamics and complexity of the impact of illness on families with good coping skills and families with less effective coping skills. But most importantly, we wanted the students to understand that the range of behavior that they had been taught to recognize as needing intervention in other clinical settings is different in a medical setting.

Learning What is “Normal” in a Medical Family Crisis

Medical family therapy exists in a world of its own, well beyond the domain of traditional family therapy. When patients and their families enter into a medical treatment environment, they enter into a new and unfamiliar culture (McDaniel, Hepworth, Doherty, 1992). The range of behavior that can be considered “normal” is much broader than the range that most students have become accustomed to through other clinical placements (Walsh, 1982). This variation of “normal” is difficult for students to grasp, and tends to frustrate their helpful inclinations. It has become apparent to us through this project that living in “that delicate and complex terrain” (McDaniel, Hepworth, Doherty, 1992) with the patients—experiencing the medical culture— helps students to understand it better.

When patients and their families come to the Cancer Center for the first day of radiation treatment, we often find that their anxiety level is high. Radiation treatment represents a whole new world for them, and a whole new language. When our students begin their internship in the hospital, they tend to experience anxiety as well. We refer to this as a “parallel” process. The student is scheduled to spend four hours in the waiting room, and will make contact with as many as 30 families; the radiation machines are scheduled to treat two or three patients every 15 minutes. At first, the students are faced with anxieties relating to the medical environment: will the patients look and act sick; will they feel like talking; will they want to talk to me; will I remember the details for each family; can I really help? Under these high-pressure circumstances the students are forced to become skilled observers, which eventually enables them to discern the natural adjustment process that patients and families must make to their illness and treatment.

The challenge for the family therapy student, who has been trained to spot resistance and make intervention, is first to overcome anxiety about illness and issues of life and death, and then to learn to tame their natural inclination to interfere with the patient’s adjustment process. Here in the hospital the student is exposed most effectively to the natural rhythms of a medical family crisis.

The student notebooks become a very important part of the Internship process. After each four hour shift, the student will spend approximately one hour making entries for each family describing their mood and the developments in treatment. When the entries are finished, the student will spend time with me discussing the families’ progress and reviewing the student’s perceptions.

The students are encouraged to look at each others’ notebooks before their shift begins; this is how they keep up with developments for each patient, and begin to see behavior patterns. For example, they notice a consistent “lift” on Friday and a “dip” on Tuesday. Patients are often lighter in mood on Friday, focused on a “free” weekend. The mood is usually heavier in the early part of a week, when patients are more aware of the relentless demands of treatment and how it interferes with their lives and their plans. The students notice differences in the first day of treatment and the last day: cookies and cakes are likely to arrive on the last day.

The students eventually become attuned to patterns of unfolding coping skills in the patients. “Withdrawal”, for example, is a normal early response in illness, whereas, in a clinical environment, this behavior might be seen as sullenness or non-compliance. They begin to recognize families with high anxiety, and then they see how we work to offer some relief.

Because the students become part of a collaborative environment in the Cancer Center, they see how we all keep an eye on patients and families. They might hear, for example, the radiation therapist noticing that a particular family looks well-grounded, has good coping skills—“look at what happened the first week and it’s only the third week.” That awareness among team members can be affirming for the family and the student. Likewise, there may be another family where rigid family patterns are consistently working against family members, making the situation more difficult in a critical time; again, they see how we try to intervene.

Our bi-monthly group meeting is a time when all eight students come together and share their experiences. This opportunity facilitates a dynamic discussion about their perceptions. They see that some families are easy to be with and some are very difficult. These meetings tend to develop the student’s insight and self-confidence.

The following case studies 3 are excerpts from four student notebooks. They demonstrate that students tend to struggle with feelings about illness and death, and that they are eager to jump in and “solve problems” (McDaniel, Hepworth, Doherty, 1992). These case studies also show that students develop good observation skills and learn to better understand and use the network of community services available in a hospital environment.

Case Study

by Michael Auyang, Southern Connecticut State University

PAUL

Notebook Entries:



Wednesday, October 3 3

Paul is a patient in his late forties, with recurring prostate cancer. He comes in regularly for radiation treatment. There is uncertainty and fear—sometimes anger—in the waiting room. My contact time with patients is only as long as they will allow— usually an average of 15 minutes before the patient goes in for treatment.

At first, Paul seemed friendly; he was engaging, and asked many questions about me. The oldest of four siblings, he was accustomed to being responsible; he was definitely the caretaker of his family. He seemed proud of his work where he controlled solutions to problems. Now, he had a personal problem, and no apparent solution. As he began to trust me, he described a strong family history of prostate cancer. As he told me more about his disease, I could only imagine his frustration, his fear, and his anxiety with this overwhelming personal experience.

Wednesday, November 20

I have observed Paul over the last seven weeks and his anxiety level is significantly greater. He has developed stomach pain, and has been assured by the radiation oncologist that the pain is unrelated to the treatment. The pain has continued, but he is not scheduled to see other physicians until the conclusion of his treatment. We talked at length about allowing his family to be part of his support.



Wednesday, November 27

Paul is now back in the hospital with metastatic disease to his stomach and colon, and his prognosis is not encouraging. This new development is a harsh reminder of the limitations of humanity and the reality of mortality.

Supervisor’s Notes

Michael’s ongoing support and encouragement allowed the family to be receptive to psychosocial support when Paul’s illness became end-stage. Michael’s struggle in supervision was in discovering and accepting the family’s process. Being patient with the family’s experience was central to our focus in supervision.



Case Study

by Jayne Goldstein, Southern Connecticut State University

MICHAEL

Notebook Entries:



Thursday, October 4

Michael is a 55 year-old white male with a history of gastric ulcer; he is diagnosed with Stage IV squamous cell carcinoma of the left base of the tongue. His overall prognosis is guarded. Michael appears friendly and talkative. His spirits appeared to be good, and his attitude is “one day at a time”.



Thursday, October 11

Michael chose not to speak openly about his disease or his concerns and fears. He is complaining of pain around his ear and jaw. He has already lost 25 pounds. He has begun seven weeks of radiation treatments. All his remaining teeth were removed prior to the radiation. The treatments seem to increase his eating difficulties and intensify throat soreness. Michael maintains a strong spirit and a sense of humor. The family animates conversation with humor. Joking is a major part of their conversation, even around a subject as sobering as death. Michael’s wife said they were always this way—they joked about everything. I could see her need to remain in control of herself by her steady stream of conversation.



Thursday, April 2 (six months later)

Michael has been admitted to the hospital for chemotherapy treatments. My visits take place on the hospital floor. After two days of chemotherapy, he developed diverticulitis. Pain and dizziness confine him to bed. He appears discouraged, saying he sleeps a lot, hoping to wake up and find himself at home.

The family unit consists of father, mother, daughter, and son. The daughter is a nurse in a local hospital; she is very quiet and seemed uncomfortable when I mentioned that I thought her mother was having a hard time with her father’s illness. She didn’t want to talk about it.

I learned that Michael drinks three to four cases of beer per week and has smoked three to four packs of cigarettes per day for 31 years. I also learned that their son is estranged from the family. Family problems are kept quiet, with no showing of emotions or feelings. It seems that what is not being said is as important as what is being said. I find this frustrating. I want to “make something happen”; I want to “do” therapy.



Thursday, April 16

Michael is still hospitalized, anticipating discharge after the current round of chemotherapy. Unfortunately, the cancer has progressed to both lungs and Mr. P. has developed pneumonia. Chemotherapy has been stopped.

Supervisor’s Notes

In supervision, Jayne learned to see the complexity of various family systems and to better understand their characteristics. She worked diligently in supervision “not to make an issue where the family found none.”



Case Study

by Pamela Roche, Fairfield University

MARY

Notebook Entries:



Tuesday, October 5

Mary is 59 years-old and was diagnosed with metastatic breast cancer two years ago. When we met, she appeared worried and talked readily about the status of her disease. She had undergone numerous surgeries, including a bone marrow transplant and several courses of chemotherapy. She is also taking decadron. Mary is active, athletic, the proud mother of two grown sons, and for over thirty years the wife of a prominent attorney. While on vacation in Germany, her birthplace, she had experienced dizzy spells. When she returned home, her doctor ordered a CAT scan which revealed that the cancer had metastasized to her brain.



Tuesday, October 17

Mary is receiving brain radiation treatments. She reported no headaches or dizziness, though she did feel weaker. When she told me of an upcoming appointment with a leading New York University neurosurgeon, I noted both anxiety and hope in her demeanor. I offered the hospital services of support groups and individual and family counseling. She thanked me and told me that she was not a “talker”.



Tuesday, October 25 Mary asked me to join her in the hospital cafeteria. We talked for nearly an hour. She told me of her recent trip to Europe and described the successful careers of her two sons. We discussed the treatment plan for her cancer and she reported she felt she has had “no luck” so far.

Tuesday, November 12

I saw Mary on her way to a chemotherapy treatment. Her appearance has dramatically changed as a result of the aggressive chemotherapy. Her face is bloated and she is now wearing a wig. I asked about her recent visit to New York University, and she cried as she told me that her blood count is too low to operate on the tumor in her brain. Again, I offered the services available to her and her family, but she declined. I sensed that she didn’t want to burden others with her troubles.



Tuesday, November 27

Mary has been admitted to the hospital. Despite the radiation and chemotherapy, her cancer is spreading. She said she felt very weak, and appeared to be having trouble breathing. She cried and then told me of her daughter who had died at age twenty, and described the sadness she has carried ever since. We briefly talked about how difficult her life had been, and she then said she did not have the strength to talk about it any more.



Tuesday, December 6

Mary was sleeping when I entered her room. She was extremely weak and jaundiced; her liver and kidneys had begun to fail.

Her room felt cool and when she awoke I asked her if she would like her air conditioning vent covered. She said “yes” and I did so. That was the only time we communicated that day.

I sat by her bed while she slept and she occasionally awakened to look at me. There were no words of hope to offer her any longer. I was simply hoping that a familiar face would be comforting to her.



Final note

I never met Mary’s husband, and only met one of her two sons. She always came alone to her treatments. Mary expected to take care of herself and was inclined to reject help from the staff. I never met any of her family until she was near death, which tells me something about how this family functions. I do believe that Mary benefited from our interaction. I sensed that she felt supported by our relationship and buoyed from our visits.

Supervisor’s Notes

Mary had suffered deeply by the loss of her daughter, and now she was grieving her own loss of life—seemingly alone. Pam learned that “being” with Mary, without judgment, was the key to being allowed in to comfort her. Ultimately, she saw that Mary was able to rely on herself, and manage the disease with dignity.



Case Study by Gwen Workman, Fairfield University

JOHN and his son, TOM

Notebook Entries:

Monday, June 15

John is an 88 year-old white male. He is scheduled for six weeks of daily radiation therapy following a transverse loop colostomy in May. John is a quiet man of Polish descent. This is his second colon operation since being diagnosed with rectal cancer in 1993. Following the surgery, John was also diagnosed with gastric polyps, a hiatal hernia, and cirrhosis of the liver from long-term alcohol abuse.

Peggy is John’s daughter-in-law. She has taken on the role of caretaker and family spokesperson. Peggy indicated that John’s conversation with his doctor is minimal. Further, he avoids addressing emotional issues. I met with Peggy in the waiting room while John received radiation therapy. She avoided making eye contact, frequently fighting back tears. She is deeply concerned for John, but also for her husband, Tom, who five years ago had cancerous ulcer surgery and was presently re-experiencing stomach pain. They both fear this might herald a recurrence of cancer.

She also spoke with sorrow and regret over her inadequacy as a mother and her embattled life. Peggy said her husband was unable to cope with his father’s terminal illness. She admitted that she felt as if she were always riding a roller coaster of emotions. She voiced concern for the family’s financial welfare and a fear of her husband’s possible death.



Monday, June 22

I met with Peggy again in the waiting room. She expressed resentment toward John for his seeming lack of concern for his son’s medical problems and her own overwhelming stress. She complained of weight loss and insomnia. Her vision of herself as the family “rock” was crumbling as her coping strategies seemed to be failing. She believed that asking for help was a sign of weakness. She was afraid of losing control. Her dialogue was peppered with words like “swamped”, “over-burdened”, and “losing it”. I suggested that she make an appointment with the hospital’s medical family therapist.



Monday, June 30

Peggy and I spoke again in the waiting room. She talked of her grown children who don’t visit, although several live within 30 miles of her. She also feels unaccepted by Tom’s side of the family. The couple’s lifetime focus has been on basic survival, and their closed family style seems to leave few openings for support. I described the supportive services available to the family and suggested again to Peggy that she could make an appointment with the hospital’s medical family therapist.



Monday, July 10

John is completing radiation therapy, but Tom is about to be hospitalized. Peggy has asked to be introduced to the medical family therapist.



Monday, July 18

I met with Tom and Peggy on the hospital floor. Tom had been admitted for gall bladder surgery. They had visited with the medical family therapist who had arranged for medication to be prescribed for Peggy to relieve her anxiety. She said the medication helped her to manage better and that she was beginning to organize more community support for her family; she had contacted the local Hospice Organization.



Monday, July 23

I met with Peggy on the hospital floor. She seemed calmer. She spoke of feeling confident and at peace despite Tom’s terminal illness. She expressed deep gratitude to those who had helped from the hospital. As I left, Tom’s daughter, son-in-law, and grandson were arriving for a visit.

Supervisor’s Notes

This family was overwhelmed with multiple medical, financial, social, and family concerns. This is not unusual. In supervision, Gwen learned of the many hospital and community resources that are available to patients and families. She also saw how unpredictable cancer can be. In just six short weeks, the focus of the family shifted from father to son.



AS WE LOOK BACK FIVE YEARS LATER…

We had a number of goals in mind both for our students and for our hospital environment when we ventured into this pilot program, and we feel that success has been evident, so much so that we have now instituted a continuing Level 1 Internship program in the hospital, where second year students can apply and be accepted to work for one year in the Cancer Center.

In a practical sense, a Level 1 Internship in a hospital or medical setting offers a very important learning experience for the student in the following ways:

1. As future family therapy professionals (even if they do not go on to focus in medical family therapy), these students will inevitably be faced with patients who are experiencing a medical crisis; the hospital experience can familiarize them with the biological complexities and the psychosocial dimensions of illness and even death. The students have the opportunity to communicate with physicians and healthcare staff; they learn medical terminology and protocols. They witness patients and their families struggling with overwhelming circumstances and making transitions over time.

2. They have the opportunity to observe and understand “normal” behavior in a medical family crisis, and more particularly how that behavior is further defined by culture (Walsh, 1982). They begin to understand the strengths and weaknesses of family systems from various ethnic backgrounds as they face a non-normative stress like cancer.

3. They are likely to face their own fears and anxieties about illness and death, and develop a deeper personal perspective. As they search to find realistic coping mechanisms, our collaborative team organization and our use of systemic approaches support an open relationship for student and team members: they are free to ask, discover, and understand. The model of trust and openness that they experience with our team becomes the experiential model that they then attempt to recreate in the waiting room, and hopefully in their future.

Student Feedback

At the conclusion of the two-year pilot project, the eight students were asked to write an evaluation of the project and their personal learning experience. Following are excerpts from four of the student evaluations:

“As patients and families began expressing their fears, guilt, shame and anger about cancer invading their world, it touched my humanity and made me aware of the real people behind the diagnosis… As an African-American family therapist, I felt a mutual respect for our diversity and our sameness.”

Delores Brown, Southern Connecticut State University

“Cancer intimidated me; I felt sympathy for the patients and their families. Now I have grown to feel empathy.”



Lynda McKay, Southern Connecticut State University

“As a Chinese-American woman, I am very aware of ethnic differences among people. I have learned that different ethnicities come with different hierarchies, boundaries, patterns of communication and norms.”



Nina Jaffe, Southern Connecticut State University

“My greatest lessons have been learned from the dying patients and their families. This is a time to respect and embrace existing family structures, rather than seek to alter family patterns that are frozen in pain.” Patricia Dickinson,



Southern Connecticut State University

Over the past five years, both students and staff have continued to indicate that the project is important. The staff know that they will have the extra support of a compassionate person in the waiting room as they proceed with their technological services. The students come to realize that the intimacy they share with the cancer patients and the staff in the hospital is unlike any other experience in their learning environment.



REFLECTIONS

Perhaps on a larger scale, we can look to our times and see that outpatient treatment of illness is becoming more common. People are living longer. Middle-aged couples are dealing with serious illness in their own lives as well as those of their aging parents, and, at the same time, raising young children. There is great stress in society, and it will be even more important for the mental health professionals of the future to have an accurate understanding of the sources of distress—to understand that different approaches are needed in order not to make an already complex situation more complicated.

A family faced suddenly with a life-threatening illness is often shaken to its foundations (McDaniel, Hepworth, Doherty, 1992). Reality is no longer what it was supposed to be. Family members struggle individually and collectively with confusion and loss of purpose. The task they face involves complex levels of reorganization, now that this terrible change has inflicted itself upon their lives. Victor Frankl, psychiatrist and philosopher, has given us evidence that under the worst of circumstances, people can refocus themselves around a renewed meaning and purpose in life (Frankl, 1959). Fritz Perls, the father of Gestalt theories (Perls, Hefferline, Goodman, 1951), takes us a step further by encouraging us to focus on the present: not to spend too much time thinking about the past and what was, and not to look too far into the future but to focus on what’s now. He suggests we look to find joy and contentment in the present.

Because our students become part of the collaborative environment in our Cancer Center, they play an important role in helping to establish a sense of comfort and safety in the waiting room; they contribute to an overall sense of security that makes living in the present more of a possibility.



Footnotes

1 As Holland describes in the Handbook of Psychology, there are three levels of psychosupportive care: level one is basic support as part of routine care, level two is support groups, clergy and social work intervention, level three is referral of serious issues, such as anxiety, depression, to the Medical Family Therapist or other health professional.

2 The hours spent by the student in our program will appear on their record, but these hours do not replace any of the required hours that the student needs to earn in order to graduate from an accredited institution. These “Level 1” service hours are conducted in an environment where supervision is not as intense, nor is the environment as private as it needs to be for accreditation. The students are not acting with as much responsibility, nor are they intervening in a way that necessitates close supervision. By an agreement with both Universities involved in this project, these “extra” hours earned will appear on the student’s record, thereby standing them well for further Medical Family Therapy training, if they choose to pursue it, or, it may be of benefit when the student eventually sits for a license in Marriage and Family Therapy.

3 Names and dates have been changed for reasons of privacy.

REFERENCES

Engel, George L. (1996) From Biomedical to Biopsychosocial: A Personal OdysseyFamilies, Systems & Health. Volume 14, Number 4:434–435

Frankl, Viktor E. (1959) Man’s Search For MeaningNew York: Washington Square Press

Kreutzer, Sander, Fernandez. (1997) Misperceptions, Mishaps and Pitfalls in Working with Families after Traumatic Brain Injury. Journal of Head Trauma Rehabilitation. December: 63–72

Massie and Hollands. (1990) Handbook of Psychooncology. New York

Minuchin, Salvador. (1974) Families and Family TherapyCambridge: Harvard University Press

Muchnick, S., Davis, B.L., Getzinger, A., Rosenberg, A., and Weiss, M. (1993) Collaboration Between Family Therapy and Healthcare: An Internship ExperienceFamily Systems Medicine. Fall: Volume II #3271–281

McDaniel, S.H., Hepworth, J., Doherty, W.J., (1992) Medical Family Therapy: A Biopsychosocial Approach to Families with Health Problems. New York: Harper Collins Publishers, Inc.1) Ibid., page ix–xxi2) Ibid., Chapter 1: Family Therapy and Medical Illness, page 1–113) Ibid., Chapter 8: The Challenge of Chronic Illness page, page 184–210

McGoldrick, M., Pearce, J.K., and Giordano, J. (1982) Ethnicity and Family TherapyNew York: The Guilford Press

Perls, F., Hefferline, R.F., and Goodman, P.. (1951) Gestalt TherapyNew York: Crown Publishers

Seaburn, D.B., Lorenz, A.D., Gunn, W.B.Jr., Gawinski, B.A., Mauksch, L.B. (1996) Models of CollaborationNew York: Harper Collins Publishers, Inc.1) Ibid., Chapter 3: Collaboration, page 36–60

Walsh, F., (1982) Normal Family ProcessesNew York: The Guilford Press1) Ibid., Chapter 16: Normal Families: An Ethnic Perspective



Zinker, J. (1977) Creative Process in Gestalt TherapyNew York: Random House


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