12.3c Principles and skills: Family reactions

Principle 3

Principle: Understanding family reactions

Families can experience many different types of reactions when their relative has sustained an injury, and when they openly display these reactions it can be difficult for staff.

Three common types of reactions are:

(i) Confused and fearful:

Earlier we viewed the DVD of Angela, and considered some of the key adjustment challenges she faced. Like many family members she was confused and fearful in the early stages of Steven’s time of rehabilitation, and wondered what the future held.

(ii) Distressed and/or crying:

Some family members will go through periods in which they will experience distress – distress may also be expressed through tears.

(iii) Anger:

Understanding some of the fears family members may be experiencing will mean we are less likely to personalise aggressive or angry responses.  

 

Responding to common scenarios

Read through each of the three case studies and answer: How would you manage the situation?

Confusion/fearfulness – You are working through a check-list of equipment needs with one of your clients and their wife. The wife suddenly erupts in tears stating that none of this makes sense. She claims that her husband will not need any of this equipment because he will be so much better by the time he is discharged. It becomes clear that she has become confused and fearful about discharge, feeling that she will not be ready.

Briefly describe how would you manage this situation?
Check your answers here
  • Listen to their concerns – what are they most worried about?
  • Provide reassurance
  • Normalise their feelings
  • Provide information – verbal or written – leave contact details
  • Check understanding of person with injury
  • Provide opportunities to ask questions
  • Establish clear limits on the information that different staff members can provide (medical, psychology, nursing, SW, physio, occupational therapy)
Sadness/depression – you have been providing a service to a client for a few months now and have noticed that over time, a close family member has become more and more depressed. You have noticed that he/she is withdrawn, often teary around you and when you talk with them, they are often at a loss with what to do. You genuinely feel sorry for this family member as you can relate to their situation.

Briefly describe how would you manage this situation?
Check your answers here
  • Consider whether you speak privately with the family member or in presence of the client
  • Acknowledge change and progress
  • Check if family member expectations are too high
  • Gently suggest SW or psychology services
  • Emphasise things that family can still do together
Anger – you are doing a home visit to do therapy with a client. A family member meets you at the door to let you in. You can see by their body language that they are angry (e.g. cold greeting, body is rigid/tense, responses to your questions about how the client has been travelling in the last few weeks is given in a brisk manner). The family member starts getting angry with you because they feel that the client has not been getting enough therapy, that they are single handedly managing their therapy and he/she has been ‘dumped’ by the service upon discharge home.

Briefly describe how would you manage this situation?
Check your answers here
  • Acknowledge what family member is upset about
  • Try and understand why they are upset
  • Discuss the situation
  • Don’t reason or argue
  • Try to listen – don’t get angry
  • Be calm
  • Explain staff member role and be clear
  • Let Social Worker know
  • Advise family member to contact manager if they wish to discuss situation further

Managing Family Reactions General Principles

Be open and non–defensive

Sometimes working with people in distress can come at the worst possible time. You are in the middle of a therapy session, you need to collect some information or you are simply asking someone how they are going. Because of this, it is often hard to manage people in distress.

  • Take a deep breath and put your own needs aside
  • Be mindful of your body language and frame of mind
  • Use S.O.L.E.R.

Listen and be empathic

  • Be genuine and listen to the feelings being expressed
  • Concentrate and focus attention
  • Don’t interrupt
  • Don’t assume or jump to conclusions
  • Put your own feelings, worries and emotions aside 
  • Put other needs aside for 10 minutes and allow the person to talk. Through telling their story, feelings will dissipate and become less intense
  • When they have calmed down, acknowledge their feelings
  • Discuss what sort of support they are getting or would like to have

Assess the situation

  • Assessing the situation when you encounter someone who is extremely distressed is the first step to managing and containing the situation

Pushing buttons

 

 

Family reactions: Carers (1 min 13 sec)

How do families react to carers coming into their home for the first time?

How do you respond?

Cheryl talks about her experience.

The video may take a few moments to load.

     
How would you have responded to Cheryl if you were one of the staff turning up on her doorstep?

Family reactions: Equipment (1 min 13 sec)

How do families react to changes being made to their homes? Railings? Bathrooms? Ramps?

How do you respond?

Cheryl talks about her experience.

The video may take a few moments to load.

     
How would you have responded to Cheryl if you were one of the staff suggesting changes to her house?

S.O.L.E.R.

When communicating with family members, keeping the following skills (S.O.L.E.R.) in mind will help.

Face the person Squarely: turning ones head / body away too far from patients during an interview can indicate diminished attention and interest. “Squarely is not a military term”…”… bodily orientation should convey the message that you are involved with the person” p76 (Egan 2007)

Open posture: crossed arms and legs are “closed” postures and can communicate lessened ability and involvement to some patients / families

Lean toward the person: in Western Culture a slight lean toward the other during conversation communicates availability to listen. Leaning back or away can convey the opposite message “I’m not entirely with you” or “I’m bored” p76 (Egan 2007)

Good Eye Contact: good eye contact does not mean staring. Two people “deep in conversation” will display considerable direct eye contact. Looking away too much, or failing to meet another’s eyes when conversing, can be quite disconcerting for most people. As with all attending skills, it is important for workers to take into account cultural sensitivities when it comes to eye contact.

Be Relatively Relaxed: when a worker approaches a person in a relaxed manner this can help the person relax. (Egan 2007)

Managing Family Reactions: Specific Strategies

Managing fear and confusion

Suggested approach:

  • Be reassuring
  • Make sure they are aware there is support they can receive to assist them.  This can include counselling and information so they can better understand what is happening and make sense of the disability. 
  • While offering this support it is important to work at the family’s pace and introduce new information when they are ready for it. 
  • Do not overwhelm them or overload them with expectations.    
  • Repeat information if people are finding it hard to take things in and write it down

Managing anger

Suggested approach:

  • Don’t judge or argue back
  • Tell yourself that the anger is not directed at you.
  • Stay calm
  • Avoid escalating the situation.
  • Listen to the concerns and write them down
  • Give a clear plan of what you will be doing with the information
  • Make sure feedback is given to the family member who has raised the concerns

Managing sadness/depression

Suggested approach:  

  • People often need to experience deep sadness in order to be able to move to integrating the loss into their lives.  
  • Simply being there and listening is enough
  • Don’t judge or give advice or try and make them ‘feel better’
  • Discuss what sort of support they are getting or would like to have
  • Accept feeling helpless and allow the person to talk if they want to
  • Acknowledge to yourself that this case is ‘close to home’ and seek appropriate support/supervision
 

Answer the following question
When dealing with a family member who is angry about the services ...
(tick FOUR responses)
Tell the person that being angry won't help their relative
Listen to any concerns and write them down
Try to calm the person by dealing with any criticisms openly and honesty
Tell the person that their behaviour is unacceptable
Tell yourself that the anger is not directed at you
Agree with the criticisms that the family member is making about the services they are receiving because this will help calm them down
Make sure feedback is given to the family member who has raised concerns.
 Try to point out in a calm voice where the family member is wrong