A Family Resilience Framework: Innovative Practice Applications Author(s): Froma Walsh Reviewed work(s): Source: Family Relations, Vol.

51, No. 2 (Apr., 2002), pp. 130-137 Published by: National Council on Family Relations Stable URL: http://www.jstor.org/stable/3700198 . Accessed: 26/01/2012 05:36
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A Family Resilience Framework:Innovative Practice Applications

Froma Walsh*
An overviewof a research-informed and family resilienceframework,developedas a conceptualmap to guide clinical intervention preventioneffortswith vulnerable in families is presented.Buildingon studies of individualandfamily resilienceand developments strength-based approachesto family therapy,this practice approachis distinguished its focus on strengthening by familyfunctioning in the contextof adversity.Key processes thatfoster resilienceare outlined,as are several innovative family systems trainingand service applications. 2 decades, the Over the pastattention from field of family refocused therapy has

family deficits to family strengths(Nichols & Schwartz, 2000). This shift rebalances the longstandingoveremphasison pathology and assumptions of family causality in the field of mental health heavily influenced by the medical model and psychoanalysis. The therapeutic relationshiphas become more collaborativeand empowering of client potential,recognizing thatsuccessful interventions depend more on tapping into family resources than on therapist techniques.Assessment and interventionare redirectedfrom how problems were caused to how they can be resolved, identifying and amplifying existing and potential competencies. Therapists and clients work together to find new possibilities in a problemsaturated situationand overcome impasses to change and growth. This positive, future-oriented stance focuses on bringing out the best to enhance functioning and well-being. A family resilience approachbuilds on these developments to strengthenfamily capacities to masteradversity(Walsh, 1996, 1998b). A basic premise guiding this approachis that stressful crises and persistentchallenges influence the whole family, and in turn,key family processes mediatethe recovery and resilience of vulnerablemembers as well as the family unit. Interventions aim to build family strengthsas problemsare addressed,thereby reducing risk and vulnerability. As the family becomes more resourceful, its ability to meet future challenges is enhanced. Thus, each intervention is also a preventive measure. Here an overview of a research-informed family resilience frameworkis presented and discussed to guide intervention and prevention efforts.

The Concept of Family Resilience: Crisis and Challenge

Resilience-the ability to withstand and rebound from adversity-has become an importantconcept in mental health theory and researchover the past 2 decades. It involves a dynamic process encompassing positive adaptationwithin the context of significant adversity (Luthar,Cicchetti, & Becker, 2000). Researchershave found increasingevidence that the same adversity can result in different outcomes. For example, although many lives are shatteredby childhoodtrauma,othersemerge from similar high-risk conditions able to live and love well, evident in
*School of Social Service Administration and Department of Psychiatry, University of Chicago, 969 E. 60h Street, Chicago, IL 60637 (fwalsh@uchicago.edu). Key Words: family resilience, family theory, loss, recovery3, trauma.

(Family Relations, 2002, 51, 130-137)

the finding that most abused children do not become abusive parents (Kaufman& Ziegler, 1987). To account for these differences, early studies focused on personal traits associated with resilience, or hardiness,reflecting the dominantculturalethos of the rugged individual.Resilience was viewed as inborn or acquired on one's own, as in the "invulnerablechild" thought to be impervious to stress because of inner fortitudeor characterarmor(Anthony & Cohler, 1987). As researchextended beyond situationsof parentalmental illness or maltreatment multiple adverseconditions (e.g., socioeconomic to disadvantages,urban poverty, community violence, chronic illness, and catastrophiclife events), resilience came to be viewed in terms of an interplay of risk and protective processes over time, involving individual,family, and largersocioculturalinfluences (Garmezy, 1991; Masten, Best, & Garmezy, 1990; Rutter, 1987; Werner,1993). Notably, emerging studies of resilient individualsremarked on the crucial influence of significant relationshipswith caring adults and mentors, such as coaches or teachers, who supported the efforts of at-risk children, believed in their potential, and encouragedthem to make the most of their lives (for a review, see Walsh, 1996). However, the prevailing narrowfocus on parental pathology blinded many to the resources that could be found and strengthened in family relational networks, even where a parentis seriously impaired.Attentionfocused on building extrafamilialresources, often dismissing the family as hopelessly dysfunctional. A family resilience perspectivefundamentally altersthatdeficit-based lens from viewing troubled families as damaged and beyond repairto seeing them as challenged by life's adversities. Rather than rescuing so-called "survivors" from dysfunctional families, this approachengages distressed families with respect and compassion for their struggles, affirms their reparativepotential, and seeks to bring out their best. Efforts to foster family resilience aim both to avoid or reducepathology and dysfunction and to enhance functioning and well-being (Lutharet al., 2000). Such efforts have the potential to benefit all family members as they fortify relationalbonds. A family resilience frameworkcan serve as a valuable conceptual map to guide preventionand interventionefforts to support and strengthenvulnerable families in crisis. Family resilience involves more than managing stressful conditions, shouldering a burden, or surviving an ordeal. This approachrecognizes the potentialfor personaland relationaltransformation and growth that can be forged out of adversity.By encouragingkey processes for resilience, families can emerge strongerand more resourcefulthroughtheir sharedefforts. A crisis can be a wakeup call, heightening attentionto what matters.It can become an opportunityfor reappraisalof priorities, stimulatingnew or reFamily Relations

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newed investment in meaningful relationshipsand life pursuits. In fact, families reportthat throughweatheringa crisis together their relationships were enriched and more loving than they might have been otherwise (Stinnett & DeFrain, 1985). In other words, members may discover untappedresources and abilities they had not recognized. Ecological and Developmental Perspectives: Coping, Adaptation, and Resilience Family

A family resilience approachto clinical practiceis grounded in family systems theory (Walsh, 1996), combining ecological and developmental perspectives to view the family as an open system that functions in relationto its broadersocioculturalcontext and evolves over the multigenerational cycle (Carter& life McGoldrick, 1998; Falicov, 1995). This approachis guided by a bio-psycho-social systems orientation,viewing problems and their solutions in light of multiple recursiveinfluences involving individuals, families, and larger social systems. Using a stressdiathesis model, problems are seen as resulting from an interaction of individual and family vulnerability to the effect of stressful life experiences and social contexts. Symptoms may be primarilybiologically based, as in serious illness, or largely influenced by socioculturalvariables, such as barriersof discrimination. Family distress may result from unsuccessful attempts to cope with an overwhelming situation.Symptomsmay be generated by a crisis event, such as traumaticloss. A pile-up of internal and external stressor events can overwhelm the family and heighten the risk for subsequent problems (Boss, 2001; McCubbin & Patterson, 1983). A multisystemic assessment may lead to a variety of interventions or a combinationof individual,couple, family, and multifamily groupmodalities dependingon the relevance of different system levels to problem resolution. Putting an ecological view into practice, interventionsmay involve communityagencies, or workplace, school, health care, and other larger systems. A developmentalperspective also is crucial. A family resilience approachattendsto adaptational processes over time, from ongoing interactionsto family life cycle passage and multigenerationalinfluences. Life crises and persistentstresses can derail the functioning of a family system, with ripple effects to all members and their relationships. In turn, family processes in dealing with adversity are crucial for coping and adaptation (McCubbin,McCubbin,McCubbin,& Futrell, 1998; McCubbin, McCubbin, Thompson, & Fromer, 1998); one family may be disabled, whereas another family rallies in response to similar life challenges. How a family confronts and manages a threatening or disruptive experience, buffers stress, effectively reorganizes, and reinvests in life pursuits will influence adaptation for all members and their relationships. Family functioning is assessed in context of the multigenerational system as it moves forward over time, coping with significant events and transitions, including both predictable, normative stresses (e.g., birth of the first child) and unpredictable, disruptiveevents (e.g., the untimely death of a young parent). To assess symptoms in temporalcontext, as well as family and social contexts, a family time line and a genogram (McGoldrick,Gerson, & Shellenberger,1999) are essential tools, enabling clinicians to schematize relationship information, track system patterns,and guide interventionplanning. Frequentlysymptoms of dysfunction coincide with stressful transitionsor nodal events that pose new challenges and require 2002, Vol. 51, No. 2

boundary shifts and role redefinition (Walsh, 1983). Therefore, it is crucial to note the concurrencein timing of symptoms with recent or impendingevents that have disruptedor threatenedthe family. For instance, a son's drop in school grades may be precipitatedby his father'srecentjob loss, even thoughfamily members may not note the connection. Also, it is importantto attend to the wider kin network beyond the immediate household, as well as the context of multiple losses. For example, a young women's serious depression may follow the death of her godmother, who was her mainstay while growing up in a chaotic household. In the case of maritaltensions that escalate into violence, the context may be one where the couple has experienced multiplelosses: the failing of their small business and subsequent loss of friends and community with relocation. In such cases, too often treatmentfocuses narrowly on a destructive cycle of interaction without attending to its context. Thus, in assessing the impact of stress events, it is essential to explore how family membershandledthe situation:their proactivestance, immediate response, and long-term "survival" strategies.Some approaches may be functional in the short term but rigidify and become dysfunctionalover time. The convergence of developmental and multigenerational strainsheightens the risk for dysfunction. Distress increases exponentially when currentstressorsreactivatepainful issues from the past (Carter& McGoldrick, 1998). Unresolved conflicts and losses may surface when similar challenges are confronted. patternsare noted (e.g., a daughterbecoming Transgenerational sexually active at age 15, the same age her mother had become pregnant with her). Such issues from the past influence future expectations and catastrophicfears. Clinical experience demonstratesthat many families function well until they reach a point in the life cycle that had been traumatica generationearlier.For example, a woman whose father died suddenly at age 50 may have catastrophicfears of losing her husband(as her motherdid) when he reaches the same age. Other families may lose their perspective of time when a problem arises, as membersbecome overwhelmed by an immediate crisis or catastrophicfear. They may conflate immediate situationswith past events, become fixated on the past, or disengage emotionally from painful memories and contacts. Clinicians using a resilience-based approach make covert linkages overt throughrespectfulcuriosity.They help clients heal and learn from a past that cannot be changed to differentiatethe present, and they also help clients seize opportunitiesto handle currentand futuresituationsmore effectively. Whereasclinicians typically use genogramsto focus on problematicfamily-of-origin patterns,the approachadvocated here also searches for positive examples of dealing with past adversitiesand encouragesclients to seek out models and mentors in their kin network to support their best efforts. Advantages of a Family Resilience Framework Assessment of "healthy" family functioningis fraughtwith dilemmas. Recent postmodern perspectives have heightened awarenessthat views of family normality,pathology, and health are socially constructed(Walsh, 1999). Clinicians (and researchers) bring their own assumptions into every evaluation and intervention, which are embedded in culturalnorms, professional orientations,and personal experience. Moreover, the concept of the "normal" family has undergone redefinitionwith the social and economic transformations of recent decades. Although changing gender roles and a mul131

have broadenedthe spectrumof tiplicity of family arrangements families (Coontz, 1997), the persistentmyth that one family form is essential for healthy child development (i.e., the idealized 1950s intact nuclearfamily, headed by a breadwinner fatherand supportedby a homemakermother)continuesto stigmatizeother family forms and make them appear abnormal.In fact, family diversity is common throughout history and across cultures (Coontz), and a growing body of researchreveals thatwell-functioning families and healthy children are found in a variety of formal and informal kinship arrangements (Walsh, 1999). What mattersmost are family processes, involving the quality of caring, committed relationships. Research on healthy family functioning over the past 2 decades has provided empirical groundingfor assessment to identify key processes that can be fostered in interventionwith distressed families (Walsh, 1993). However, most empirical measures have been standardized White, middle-class,intactfamon ilies who are not under stress. Too often, family distress and differences from the norm are readily assumed by clinicians to be pathological (Walsh, 1993). Furthermore,family typologies tend to be static and acontextual, not attending to a family's emerging challenges over time and in social context. Clinicians' use of a family resilience frameworkoffers several advantages.By definition, the frameworkfocuses attention on family strengthsunder stress ratherthan on pathology. Second, it assumes that no single model fits all families or their situations. Thus, functioning is assessed in context, relative to each family's values, structure,resources, and life challenges. Third, processes for optimal functioning and the well-being of members are seen to vary over time, as challenges unfold and families evolve across the life cycle. Although no single model of family health fits all, a family-resilience-basedapproachto practice stems from a strong conviction that families have the potential to recover and grow from adversity. A family resilience frameworkwas developed (Walsh, 1996, 1998b) to guide clinical practice. This frameworkis informed by research in the social sciences and clinical practice seeking to understandcrucial variables contributingto individual resilience and well-functioningfamilies (Walsh 1996, 1998b). Essenit tially a metaframework, can be used with a variety of models of intervention.It offers a conceptual map to identify and target key family processes that reduce the risk of dysfunction,buffer stress, and encouragehealing and growthfrom crisis. The framework draws togetherfindingsfrom numerousstudies, identifying and synthesizing key processes within three domains of family functioning: family belief systems, organization patterns, and communication processes (Walsh, 1998b). Table 1 outlines the key processes. Although it is beyond the scope of this article to describe these processes in detail, a few examples follow. Examples: Family belief systems. Family resilience is fostered by sharedbeliefs thathelp membersmake meaningof crisis situations; facilitate a positive, hopeful outlook; and provide transcendentor spiritual values and purpose. Families can be helped to gain a sense of coherence (Antonovsky & Sourani, 1988) by recasting a crisis as a sharedchallenge that is comprehensible, manageable, and meaningful to tackle. Normalizing and contextualizingmembers' distress as naturalor understandable in their crisis situationcan soften their reactionsand reduce blame, shame, and guilt. Drawing out and affirming family strengthsin the midst of difficulties helps to counter a sense of helplessness, failure, and despair as it reinforces pride, confidence, and a "can-do" spirit. The encouragement of family 132

Table 1 Key Processes in Family Resilience Belief Systems 1. Making meaning of adversity * Affiliative value: resilience as relationallybased * Family life cycle orientation: normalize,contextualizeadversityand distress * Sense of coherence:crisis as meaningful,comprehensible,manageablechallenge * Appraisalof crisis, distress, and recovery: Facilitative vs. constrainingbeliefs 2. Positive outlook * Hope, optimistic view; confidence in overcoming odds * Courage and encouragement;focus on strengthsand potential * Active initiative and perseverance(can-do spirit) * Master the possible; accept what cannot be changed 3. Transcendenceand spirituality * Larger values, purpose;future goals and dreams * Spirituality:faith, communion, rituals * Inspiration: envision new possibilities; creativity * Transformation: learning and growth from adversity OrganizationalPatterns 4. Flexibility * Capacity to change: rebound,reorganize,adapt to fit challenges over time * Counterbalanced stability:continuity, dependabilitythroughdisruption by 5. Connectedness * Mutual support,collaboration,and commitment * Respect individualneeds, differences, and boundaries * Strong leadership: nurture,protect, guide children and vulnerable family members o Variedfamily forms: cooperative parenting/caregiving teams o Couple/co-parental relationship:equal partners * Seek reconnection,reconciliationof troubledrelationships 6. Social and economic resources * Mobilize extended kin and social support;models and mentors * Build community networks * Build financial security;balance work-family strains CommunicationProcesses 7. Clarity * Clear,consistent messages (word and actions) * Clarify ambiguous information:truthseeking and truth speaking 8. Open emotional sharing * Share range of feelings (joy and pain; hopes and fears) * Mutual empathy;tolerance for differences * Responsibilityfor own feelings, behavior;avoid blaming * Pleasurableinteractions;humor 9. Collaborativeproblem solving * Creativebrainstorming; resourcefulness * Shared decision making and conflict resolution: negotiation, fairness, reciprocity * Focus on goals; take concrete steps; build on success; learn from failure * Proactive stance: Prevent problems; avert crises; prepare for future challenges

members bolsters efforts to take initiative and persevere in efforts to overcome barriers.As such, therapistsalso can help family membersfocus efforts on masteringthe possible and accept that which is beyond their control. Spiritualor religious resources, through faith practices such as mediation or prayer and religious or congregationalaffiliation,now have empiricalsupport for theirhealing power.Many find strengthand recovery through more soulful connection with natureor through artistic expression. Although spiritualresourceshave been largely neglected in clinical practice,they can be tappedas wellsprings for resilience (Walsh, 1999). In family organization, resilience can be fostered through flexible structure,shared leadership, mutual support, and teamwork in facing life challenges. Families in transitionare assisted in navigatingdisruptivechanges and structural as reorganization, with the loss of a parent or with postdivorce and stepfamily Clinicianscan help families counterbalance disreconfigurations. Family Relations

orienting changes with stability. Especially valuable are strategies that reassurechildren and other vulnerablefamily members by coaching behaviors that reflect strong leadership, security, continuity, and dependability. Communicationprocesses that clarify ambiguoussituations, encourage open emotional expression and empatheticresponse, and foster collaborativeproblemsolving are especially important in facilitating resilience. Therapeuticefforts are future directed, helping families "bounce forward"(Walsh, 1998b). Families become more resourcefulwhen interventionsshift from a crisis-reactive mode to a proactivestance, anticipatingand preparingfor the future.Most important, interventions help families in problemsaturatedsituationsto envision a better future and take concrete steps towardachieving their hopes and dreams(Walsh, 1998b).

Applications of Family Resilience Approaches

Family resilience-orientedintervention in clinical practice builds on the principlesand techniquescommon among strengthbased approachesare included. Additionally, a resilience orientation requiresthat clinicians attendmore centrallyto the linkage between presenting symptoms and family stressors,focusing on the family coping and adaptational pathwaysin dealing with and recovery from adversity.Interventionsare directedto reducevulnerability and master family challenges. Even when used with brief problem-solving models (Nichols & Schwartz, 2000), this approachalso attends to the suffering clients have endured.In this context, resilience does not mean bouncing back unscathed, but ratherit is reflected in clients who effectively work through and learn from adversity and who attempt to integrate the experience into their lives (Higgins, 1994). Clinicians can encourage family members to share their stories of adversity, often eliminating the silence or secrecy around painful or shameful events to build mutual supportand empathy.For example, a son, finding it difficult to care for his dying mother because of lingering anger at her alcohol abuse and neglect during his childhood, can be helped to see her in a more compassionatelight by as learning about her abandonment a child, coming to appreciate her struggles and courageous efforts alongside her limitations. Clinicians come to see all family members as "heroes on life journeys" who are challenged along the way. Not every family member may be as successful in overcoming adversities,but all are seen to have worth and dignity. Clinical experience suggests that use of this approachmore readily engages resistant families, who often are reluctant to come for mental health services out of beliefs (frequentlybased on prior experience) that they will be judged as disturbed or deficient and blamedfor theirchildren'sproblems(Walsh, 1995). Instead,family membersare viewed as intendingto do theirbest for one another,albeit in misguided ways, and strugglingas best they know how with an overwhelming set of challenges. Therapeutic efforts are directed at mastering family challenges throughcollaborativeefforts. Resilience-based family interventions can be adapted to a variety of formats including periodic family consultations or more intensive family therapy. Psychoeducationalmultifamily groups emphasize the importanceof social supportand practical information,offering concrete guidelines for crisis management, problem solving, and stress reductionas families navigate stressful periods and face future challenges. Therapistscan identify specific stresses the family confronts and then help membersto develop more effective coping strategies, gaining success in small incrementsand maintainingfamily morale. Brief, cost-ef2002, Vol. 51, No. 2

fective psychoeducationalmodules timed for critical phases of an illness or persistentlife challenge encouragefamilies to accept and digest manageable portions of a long-term coping process (Rolland, 1994). Offering a nonpathologizingapproachto stress, coping, and adaptation,the family resilience frameworkadvocated here can be applied with a wide range of problematicsituations.Families typically come for help when in crisis, but they often do not connect the presenting problem or one member's symptoms to stressful events and concerns that are relevant.For example, one inner-city mother sought help for her daughter's school problems. During the assessment it was learned that the eldest son in the family had recently been shot and killed in gang crossfire. The family cohesion had been shattered,each membergoing off separatelyto deal with the loss: The father isolated himself and drank;a brothersought revenge in the streets;the daughter was upset at school; and the mother, alone in her unbearable grief, focused on her daughter'sschool problems.Family therapy sessions focused on building mutual support for the family to deathtogether(Walsh, surmountthe tragedyof this unanticipated 1996). All clinical training and services at the Chicago Center for Family Health (CCFH) are groundedin a family resilience orientation to practice. The frameworkoutlined in Table 1 guides assessment and intervention planning to foster coping and adaptationin response to normativeand nonnormativechallenges across the family life cycle, rangingfrom early parentingto caregiving for the elderly. Valuable application of the family resilience frameworkis evident in the development of several innovative programsaddressing:(a) changing family forms and challenges (e.g., divorce and stepfamily reorganization,gay and lesbian couples and families), (b) job loss and workplacetransition, (c) serious mental and physical illnesses, (d) end-of-life challenges and loss, and (e) war-relatedtrauma recovery. A brief overview of these programsfollows.

Changing Families in a Changing World: Navigating New Challenges

A resilience frameworkis especially timely in helping families with unprecedented challenges as they and the world around them change at an acceleratedpace (Walsh, 1998b). Family cultures and structureshave become increasinglydiverse and fluid. Over a lengthening family life cycle, children and their parents are likely to move in and out of varied and complex family challengconfigurations,each transitionposing new adaptational es (Walsh, 1998a). Thus, amid the social and economic upheavals of recent decades, families are dealing with many losses, disruptions,and uncertainties. As families move into unchartedterritory,many are creatively reworkingtheir family life in a variety of households and kinship arrangements(Stacey, 1990). Yet changing patternscan be stressful and can contributeto individual symptoms and relational stress. Myths of the ideal family can compoundthe sense of deficiency for families in transition,making their adaptations more difficult. Clinicians can assist members to grieve their actual and symbolic losses, such as the loss of the intact family with divorce, and help them find coherence in the midst of complexity and continuitiesin the midst of upheaval. Clinicians assess and addresscouple and family distress, as well as symptoms of individual members, in this larger context of social change. Too often, clients experience these stresses as 133

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their own personal deficits or a failed relationship.The numbers of dual-earnertwo-parent families and of single-parenthouseholds is growing, and they face dauntingchallenges in juggling workplace,household,parenting,and eldercaredemands(Hochschild, 1997). Women's efforts for equality and men's desires for more involvement in childrearingare difficult to put into practice, straining relationships and requiringhelp in renegotiation and rebalancingof traditionalgender-roleconstraints. Families undergoing divorce may need help, in particular, with myriad challenges over time and initially in the midst of the immediateupheavalof separation,to effective reorganization in single-parenthouseholds and coparenting issues. Most face further challenges associated with stepfamily integration. One CCFH program trains family mediation professionals to assist with the resolution of divorce, custody and visitation, and postdecree issues through mediation. Our experience is that many families are anxious and guilty because of the widely held but faulty assumptionsthat divorce and single-parenthouseholds inevitably damage all children. Such generalizations, based on flawed studies (e.g., Wallerstein& Blakeslee, 1989), fail to account for the multiple influences over time that can make a difference in children's adaptation, including the predivorce climate, postdivorce coparenting, and financial security strains (Walsh,Jacob, & Simon, 1995). Researchthat identifieskey factors distinguishingfamilies and childrenwho do well from those who fare poorly over time can inform prevention and intervention efforts for optimal postdivorce adaptation(e.g., Hetherington & Kelly, 2000). For instance, findings that childrendo better when their parentscontain couple conflict, help them preparefor the separation,reassure them that it is not their fault and that they will be cared for, buffer transitionaldislocations, and form a cooperative postdivorce parental alliance (e.g., Whiteside, 1998) can be applied to clinical efforts. Therapeuticand mediation approachescan facilitate amicable divorce processes and planning for ongoing care, contact, and support of children (Walshet al., 1995). Laterconsultationscan addresssuch emerging challenges as custody changes or parentalrelocation. Specifically, we might encouragea postdivorcefatherin developing parentingcompetencies and a more nurturingrelationshipwith his children than he had-or believed he was capable of-when he previously had relied on his wife for parentingin their intact family with traditionalgender roles. Furthermore,gay and lesbian couples and parents are expanding definitions of marriageand family to a broaderview of committedrelationships,yet these relationshipsface obstacles of stigma and discriminationthat can erode them. Our center is collaborating with two community-based agencies, Howard Brown Health Center and Horizons CommunityServices, to offer training to mental health professionals to better understand and respond to the pressing issues and needs of lesbian, gay, bisexual, and transgenderclients and their families. Application of a family resilience lens can normalizeand contextualizetheir struggles, affirm their desires for loving relationships, and applaud their courage and perseverancein forging new models of human connectednessdespite the barriersthey face.

Transitional Stresses of Job Loss, Reemployment, and Welfare-to-Work

Another application of a family resilience-based program has been directed to the transitional adjustment of displaced workers when jobs are lost because of factory closings or com134

pany downsizing. CCFH resilience-based support groups and counseling services are provided in partnershipwith a community-based agency, OperationAble, that specializes in transitional services of job retrainingand placementof displaced workers. Agency staff sought our resilience approachbecause it became clear that the ability of workers to rebound from job loss involved many interwoventransitionalstresses that interferedwith their ability to gain, succeed at, and retainnew employment.The simultaneous losses of income and breadwinnerstatus, as well as uncertaintyaboutreemploymentsuccess, often fueled anxiety, depression,substanceabuse, and couple and family conflict. This pileup of stress over many months, in turn, reduced the ability of family members to supportthe efforts of the worker.In one case, with the closing and relocation of a large clothing manufacturing plant, more than 1,800 workers lost their jobs. Most were AfricanAmericanor Latinobreadwinners theirfamilies, for of whom were single parents with limited education or many skills for employment in the changing job market. Psychoeducational support groups and counseling addressed the personal and familial impact of losses and transitional stresses from a resilience perspective. This approach also addressed family strains and rallied family members as a resource to supportthe best efforts of the displaced worker.Group sessions focused on keys to resilience, such as identifying constrainingbeliefs (e.g., "No one will ever hire me, because of all my deficiencies-lack of skills, poor English, limited education"),to ultimatelyidentify and affirm strengths(e.g., pride in doing a job well, attentionto detail, and personal qualities of dependabilityand loyalty). The group offers support and encouragementto take initiative and persevere in job search efforts. When a group member fails to get a job or loses a position, s/he is supportedto view it as an experience from which to learn and to redouble efforts to overcome obstacles and seize other opportunities. Our experience indicates that the "can-do" spiritis contagious,turningthe cycle of hopelessness and despair into hope and determination sucto ceed. A similar resilience-based programhas been developed to address the adaptationalchallenges of single mothers in a Welfare-to-Workgovernmentprogram.Most of these mothersmust overcome vulnerabilitiesand multiple barriersto sustained employment, many involving their families and household. Too often these mothers are seen througha deficit lens as unmotivated and underfunctioningand too readily labeled as characterdisordered. In contrast, a resilience approachviews these mothers as underresourced and overwhelmed by multiple and persistent stressorsin all aspects of their lives. A family-centeredapproach accounts for child-care arrangementsthat must be managed around new employment demands. Counseling assists them in mastering particularchallenges associated with raising a child with special needs, caring for a disabled elder, stabilizing a chaotic household, or ending a troubledrelationshipthat heightens risks of substance abuse or violence. Potential kin and social supports,including religious or spiritualresources, are identified and accessed. The resilience-based orientation shifts mothers' outlooks from hopeless despair to affirmationof their strengths and potential. It encourages their active initiative, perseverance, and mastery of the possible in their efforts to make a better life for themselves and their children. Living Well With Serious Illness Serious physical or mental illness poses a myriad of challenges for families, requiringconsiderableresilience for coping Family Relations

and adaptation.A family resilience approachuses concepts and languagethathumanizethe illness experienceand accompanying challenges as it encouragesoptimal functioningand personaland relationalwell-being. Although particularfeatures of specific illnesses may differ, there are many commonalities related to psychosocial demands and the timing of an illness in the life of an individual and his or her family. The family-system-illness model developed by CCFH co-directorJohn Rolland (1994), provides a useful framework for resilience-oriented assessment and intervention with families dealing with chronic illness and disability. The model casts the illness in systemic terms according to its expectable pattern of psychosocial challenges over time. The unfolding of a chronic condition is viewed in a developmentalcontext, with the interweaving of illness, individual, and family life cycles. It offers families a psychosocial map to normalize and contextualize their experience. Our experience is that family members find this of particularvalue because they tend to feel abnormal and deficient in comparisonto "normal," "healthy" peers who are not dealing with an illness situation. Assessment and intervention are attunedto family challenges in relation to three dimensions: (a) the expectable demands of varied psychosocial types of illness (i.e., patterning of onset [acute vs. gradual], course [progressivevs. constantvs. relapsing], and outcome [fatal vs. shortenedlife expectancy or possible sudden death vs. no effect on longevity]); (b) the challenges accompanying varied illness phases (acute, chronic, and terminal) over time; and (c) key family system variables, such as beliefs and multigenerational legacies of past experience coping with illness and other adversity. This frameworkcan be used to guide periodic family consultations or "psychosocial checkups" to foster optimal coping and adaptationas salient issues and prioritiessurfaceand change over time. For instance, in the crisis phase of an illness, family tasks include creatinga meaning for the condition thatpreserves a sense of mastery, grieving the loss of the preillness family identity, undergoing short-termcrisis reorganization,and developing flexibility in the face of uncertaintyand possible threatened loss (Rolland, 1994). Gradually,families need help in coming to accept the persistence or permanence of the condition, learning to live with illness-related symptoms and treatments, forging an ongoing relationshipwith health care professionals, and navigating the often-frustrating maze of managed care. In the chronic phase, families must learn to pace themselves and to find respite to avoid burnout,manage relationshipskews (as in caregiving), and juggle competing needs and priorities of all family members (Rolland). They may need help in finding ways to preserve or redefine individual and shared goals within the constraintsof the illness, as well as ways to sustain intimacy in the face of threatenedloss. Facing Death and Loss Coming to terms with death and loss is the most painful challenge a family must confront,with ripple effects for all family members and their relationships (Walsh & McGoldrick, 1991). Although there is considerable diversity in individual, family, ethnic, and religious approachesto death and mourning, we can identify common family adaptational challenges that clinicians can help families to master (Walsh & McGoldrick). These include (a) sharing the experience of death, dying, and loss through acknowledgment of the reality, memorial rituals, and open communicationof the range of feelings and attempts 2002, Vol. 51, No. 2

to make meaning by family members;and (b) reorganizationof the family system and reinvestment in other relationships and life pursuits. Clinicians should be alert to a heightened risk of complications in circumstances such as ambiguous, sudden, or untimely loss; violent death or suicide; conflictualrelationships at the time of death; and social stigma, as in cases of AIDS (Walsh & McGoldrick). Early intervention is importantto prevent marital or family breakdown, precipitous replacement,or long-term dysfunction (Walsh & McGoldrick). Even when death is anticipatedand comes in the lateryears of life, medical advances pose anguishing dilemmas about the quality of life, suffering, and control over the dying process. We have found family consultations to be especially importantto clarify informationand options and to assist membersin voicing different feelings and resolving conflict on sensitive issues. A resilience-oriented practice approach facilitates, wherever possible, importantend-of-life conversations and collaborative decision making. It encourages family members to make the most of limited or uncertaintime together.By focusing on mastering the possible and accepting that an impending death is beyond control, family members are encouraged to take active part in enhancingthe quality of life to the greatestextent possible, with palliative care to minimize pain and suffering. A conjoint family life review (Walsh, 1998a) can be valuable as family members reflect together on significant milestones, hopes and dreams, the challenges faced, and their successes and disappointments, thereby gaining a largerperspective differentvantagepoints (Walsh, 1998a). Therapeuincorporating tic consultationscan assist estrangedfamily members in efforts to heal old wounds or seek reconciliationand forgiveness of past grievances. Even when physical healing is no longer possible, psychosocial and spiritualhealing can be deeply meaningfulfor all. When family members are encouraged to be fully present for one another,they commonly reportthat this most painful of times also has been the most precious in their relationship (Walsh, 1998b). Although clinicians observe that the death of a child poses a heightened risk for parental divorce (Walsh & McGoldrick, 1991), many couples reportthat their relationships grew strongerby pulling togetherto deal with their painful loss. In the aftermathof loss, survivors are helped by finding ways to transformthe living presence of a loved one into cherished memories, stories, and deeds that carry on the spirit of the deceased and of their relationship. Recovery From War-Related Trauma and Loss In 1998, CCFH was called on to develop resilience-based multifamily groups for Bosnian refugees in Chicago (home to 20,000 Bosnian refugees) and the following year for ethnic Albanians arrivingfrom Kosovo. As a result of the Serbian genocidal campaign of "ethnic cleansing," families in both regions experienced the devastatingbombing and destructionof homes and communities;they suffered and witnessed widespreadatrocities, including brutal torture,rape, murder,and the disappearance of loved ones. Our family resilience approachwas sought because traditionalmental health services were viewed in the refugee community as unhelpful and pathologizing, particularly in their deficit-based psychiatric diagnostic categories and narrow focus on treating "traumatizedindividuals." Often social services offered assistance to immigrants in adaptationto the United States but tended to be less attunedto refugees' experiences of traumaand losses and their deep need for connection to their community and culturalroots. 135

In contrast,our family resilience approachwas experienced as respectful, healing, and empowering. This program, called CAFES for Bosnian and TAFES for Kosovar families (Coffee/ Tea And Family Education,Support)used a 9-week multifamily group format. CAFES and TAFES Projects were funded by a National Institute of Mental Health research programto understand and address the mental health consequences of genocide and torturewith Stevan Weine, MD, as the principalinvestigator and codirectorof the Project on Genocide, Psychiatry,and Witnessing at the University of Illinois. The programworked well (Rolland & Weine, 1999) because it tapped into the strong family-centered values in their culture. It offered a compassionate setting to encourage families to share their stories of suffering and struggle while drawing out and affirming family resources (e.g., their courage, endurance, and faith; their strong kinship networks and deep concern for loved ones; and their determination to rise above their tragedies to forge a new life). Kosovar refugees faced the additional challenge of uncertainty about whether to remain in the United States or to returnto Kosovo, a hazardousand unstable war zone. To foster a spirit of collaboration and develop resources within their community,Bosnian and Kosovar paraprofessional facilitatorswere trainedto co-lead groups. The positive response to these projects led to the development of the Kosovar Family Professional EducationalCollabobetween mentalhealthprofessionrative, an ongoing partnership als in Kosovo, throughthe University of Pristina, and teams of American family therapists,throughthe auspices of the American Family TherapyAcademy, CCFH, and the University of Illinois. The project is co-led by Stevan Weine, John Rolland (MD, co-director,CCFH and clinical professor, Departmentof Psychiatry, University of Chicago), and Ferid Agani (MD, associate director of clinical services, University of Pristina and Mental Health Assistant to the WorldHealth Organization).The overall aim of this projectis to provide resilience-based,familyfocused education and trainingin Kosovo. The primarypurpose of the education and training is to enhance the capabilities of mental health professionals and paraprofessionals addressing in overwhelming service needs in their war-tornregion by strengthening family capacities for coping and recovery in the wake of traumaand loss. In describing the value of this approach,Rolland and Weine (2000) noted, The family, with its strengths,is centralto Kosovar life, but health and mental health services are generally not oriented to families. Although "family" is a professed part of the value system of internationalorganizations,most programs do not define, conceptualize, or operationalizea family approachto mental health services in any substantialor meaningful ways. Recognizing that the psychosocial needs of refugees, other traumasurvivors, and vulnerablepersons in societies in transition far exceed the individual and psychopathological focus that conventional trauma mental health approachesprovide, this project aims to begin a collaborative programof family focused education and training that is resilience-basedand emphasizes family strengths.(p. 35) Over an initial 12-monthperiod (April 2000 to April 2001), five teams of American family therapistsconducted weeklong training sessions in Pristina. Bringing varied approachesto family therapy (e.g., structuraland narrativemodels), they all emphasized a resilience-basedperspectiveto addressfamily challenges, encouraging Kosovar professionals to adapt the frameworkand 136

develop their own practice models to best fit their culture and service needs. Readings found to be valuable were sustained through e-mail and collaborative writing. One piece written by a member of the writing group told of a family in which the mother had listened to the gunshots as her husband, two sons, and two grandsonswere murderedin the yardof theirfarmhouse. She and her surviving family members talked with team members in their home about what kept them strong. Survivingson: We are all believers. One of the strengthsin our family is from God .... Having something to believe has helped very much. Interviewer:What do you do to keep faith strong?
Son: I see my mother as the "spring of strength" ... to

see someone who has lost five family members-it gives us strengthjust to see her. We must think about the future and what we can accomplish.This is what keeps us strong.What will happen to him [pointing to his 5-year-old nephew] if I am not here? If he sees me strong, he will be strong. If I am weak, he will become weaker than me. Interviewer: What do you hope your nephew will learn about the family as he grows up? Son: The moment when he will be independentand helping othersin the family-for him, it will be like seeing his father and uncles alive again. (Becker, Sargent,& and grandfather Rolland, 2000, p. 29) In this family, the positive influence of belief systems was striking; particularlystrong was the power of religious faith and the inspiration of strong models and mentors. Other families saw their resilience as strengthenedby their cohesiveness and adaptive role flexibility: Everyone belongs to the family and to the family's homeland, alive or dead, here or abroad. Everyone matters and
everyone is counted and counted upon .... When cooking

or planting everyone moves together fluidly, in a complementary pattern,each person picking up what the previous adaptabilityto who fills in each of the absented roles. Although the grief about loss is immeasurable,the ability to fill in the roles ... [is] remarkable.(Becker et al., 2000, p. 29)

person left off. . . . A hidden treasure in the family is their

Unlike many other international trauma-trainingprojects in which foreign experts descend on a war zone to dispense knowledge and then leave, this programhas emphasized ongoing collaboration with respect for Kosovar professionals' knowledge about their own culture, values, and service needs. U.S. colleagues gained firsthandknowledge of the impact of the war through orientation sessions arrangedby the Kosovar professionals and visits with families in villages and towns throughout the war-tornregion. As a product of this collaboration,the Kosovar and American colleagues plan to develop a manual for resilience-based, family-centered training and intervention that can be adaptedto other settings worldwide.

Conclusion
Family research and clinical practice must be rebalanced from focus on how families fail to how families can succeed if the field is to move beyond the rhetoric of promoting family strengthsto facilitate key processes in interventionand prevenFamily Relations

tion efforts. Both quantitativeand qualitativeresearchcontributions are useful in informing such approachesand in systematia cally evaluatingtheir effectiveness. As Werner, leading pioneer in resilience research, has recently affirmed,resilience research offers a promising knowledge base for practice;the findings of resilience research have many potential applications; and the building of bridges between clinicians, researchers,and policy makers is of utmost importance(Werner& Johnson, 1999). The family resilience frameworkpresentedhere can be valuable in guiding clinical practice with families in crisis and those facing persistent adversity. This integrative strength-promoting orientationinvolves a crucial shift in emphasisfrom family damage to family challenge. This approachis founded in the conviction that individual and family adaptation, recovery, and growth can be achieved throughcollaborativeefforts. Interventions are targeted to foster family strengthsas presentingproblems are resolved. As a broad metaframework,a family resilience approachcan be integratedwith a variety of practicemodels and modalities and usefully applied with a wide range of populations and problem situations with respect for family and culturaldiversity. In additionto the projectsdescribedhere, CCFH faculty are involved in innovative resilience-based approaches to familyschool partnershipsfor the success and well-being of at-risk youth, as well as community-basedefforts to reduce the risk of adolescent violence. We hope that such programscan serve as models to inspire efforts elsewhere. Programsneed to be developed proactively to meet emerging global challenges, including increasingcaregiving and end-of-life dilemmas for families with the aging of societies. In every case, we must help families avert breakdownand seize opportunitiesfor recovery and growth out of crisis. With the tremendoussocial and economic upheavalsof recent decades and widespreadconcern about the survival of the family, useful conceptual models such as a family resilience frameworkare needed to guide efforts to strengthencouple and family relationships. In sum, resilience-orientedservices foster family empowerment as they bring forth shared hope, develop new and renewed competencies, and build mutualsupportand collaborative efforts among family members. From this perspective, it is not enough to solve a presentingproblem. By strengtheningfamily resilience, we build family resources to meet new challenges more effectively. In this way, every intervention is also a preventive measure.

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