Family types

It is always easier to work with families when you have some idea of the family type they represent. Knowing the type gives the therapist a description of what the family life may be like and what problems they may have. Of course when you meet them you start testing the initial hypothesis. So here it goes, Minuchin's classification of family types:

1. Pas de deux families - these families consist of two people. Very often it is the mother and child. They spend a lot of time together and rely on each other. The child may spend quite a lot of time interacting with adults and perhaps less with peers. Mother may be good at reading the child's moods and satisfying his/her needs. There is a threat of over-reading the child which may lead to mutual dependence and mutual resentment at the same time.

Pas de deux family is also an older couple whose children have left home. They sometimes suffer from the empty nest syndrome. Yet another example of this family type is a parent living with an adult single child who have lived together all the child's life. They may be overinvolved and they may keep each other closed off from other relationships.

2. Three generation families - adults with their parents and children live together under the same roof. The organization of support and cooperation in family tasks is important here. Who does what and who is not permitted to do certain things should be clear. Often the grandmother wants to parent the child and the therapist's job is to bring the real mother a bit closer to parenting. It may also be that the adults are so involved in feuds with their parents that the children don't get much attention at all.

3. Shoe families - with many children in the household, older ones are often expected to help out with younger ones. In some sense they are treated like adults and given responsibilities but at other times they are treated as they are - like kids. This may result in the older child not being "one of us" among younger children nor the parents. However it may work well as long as the chores are clearly defined and age appropriate.

4. Accordion families - in some families one member is away for some time regularly. Quite often the husband is in the army and on missions or a truck driver or works on a boat. When one spouse leaves, the other one has to handle things at home and rear the kids. When the one away returns, rules change until the departure time comes again. This situation if often stressful for all because constant adjustments have to be made depending on how many people there in the family at one point or another. Sometimes the spouse at home becomes the bad parent and the one away the good one. However sometimes the one away becomes peripheral parent and excluded from the family. Therapy is often needed when the mission ends or the truck driver retires. Then the family needs to be reorganized and a new family is formed.

5. Fluctuating families - Some families are always on the move either because of someone's job or because of a restless nature of one. This type of family is also the family where a single parent has serial love affairs and boyfriends or girlfriends vary a lot over time. This may raise a question who are the members of the family. When families move, all members have to find new social networks and quite often this is not achieved without at least some stress. If the family becomes the only context of support, forming and maintaining relationships with others outside the family may be difficult.

6. Foster families - these are families with a temporary family member, usually a foster child. Foster parents are often told not to get attached but the bonds still form and child is incorporated into the family. The fact that it's temporary can be stressful.

7. Stepparent families - When the stepparent enters the family, he/she may not commit fully, the child may increase demands on the natural parent or the original unit may keep him/her peripheral. Gradual shift is needed and it is not expected for the family to function without problems at first.

8. Families with a ghost - some families may very strongly be "haunted by the ghost" of the loved one who left or passed away. They try to live as if the one who is gone, is still there and behave as that person would have liked or told them to. Taking over the functions of that person is seen as act of disloyalty. In this case, the mourning has not yet been completed.

9. Out-of-control families - one of the most common type in this category is the family with the preschool "monster" who does not obey any rules. Very often the parents do not agree on parenting issues and often it is said that the only way that a small child can be taller than the parent is by sitting on the other parent's sholders. This does not necessarily mean that one parent is contradicting another; silence is often interpreted by the child as alliance.
Similar family type occurs with teenagers when often the reason behind this is the inability of parents to move from concern to respect regarding their children. It is normal for children to want to become more independent and the key is to determine together with parents how much independence is ok. Delinquent children have learned from their parents that control is dependent on their presence so there are certain rules in one context but they dont apply in another context. The parent often makes a controlling demand, the child does not obey, the parent then makes another demand and so on. There is mutual yet unspoken agreement that after certain number of demands, the child responds. People in this family do not expect to be heard and relationship messages are more important than the content.

10. Psychosomatic families - psychosomatic complaints appear when nurturing is overly important in the family and the family seems to function best when someone is sick. In this family the members are overinvolved and overprotective and strive for maintaining peace and harmony by avoiding conflicts and confrontation at any cost. They are nice and cooperative people but it's is hard to get them to talk about problems in their family.

Laste haigused

See on nüüd üks tricky teema. Nimelt võivad paljud alloleva jutu peale öelda kohe, et autor on täitsa segi või et ma ei saa üldse aru, millest ta räägib. Neile ütlen nii palju, et kõike ei pea kohe omaks võtma, aga avatud olles me areneme ja tavaliselt tuleb see meile kasuks. Ehee, päris tugev disclaimer sai. :)

Laste haigused on reeglina seotud vanemate omavaheliste suhetega. Nii lihtne või keeruline see ongi. Ma ei ole selles parteis, et kui laps külmetab, siis tuleb nohu ja vahest ka köha. See ei tähenda, et peaksime pakasega oma tibud poolpaljalt välja mängima saatma, aga miks on nii, et kui väljas lustib külmaga palju lapsi, siis on neid, kes jäävad pärast haigeks ja neid kes ei jää. Milles on vahe? Immuunsüsteemis? Ok miks mitte, aga millest selle tugevus oleneb? Geenidest? Kindlasti osaliselt. Aga minu arvates mängib siin olulist rolli ka emotsionaalne seisund, mida omakorda mõjutab läbisaamine oma kõige lähedasematega.

Lapse jaoks on kõige tähtsam turvaline ümbrus, mis oletame et talle harjumuspäraselt koosneb emast ja isast. Oletame, et ema ja isa tülitsevad pidevalt. Mida laps tahab? Laps tahab, et vanemad teeks koostööd ja saaksid hästi läbi. Kui laps haigeks jääb, siis mis tihti juhtub? Ema ja isa unustavad oma kraaklemise ja on koos mures lapse enesetunde pärast. Laps sai mis soovis ja saab terveks. Tülid taastuvad ja jälle tuleb haigus. Kõige drastilisem näide on küll välismaalt, aga siiski: kerge diabeediga poisi vanemad lahutasid ja pärast seda nad enam omavahel ei suhelnud. Poiss pettis haiglatest ja apteekidest insuliini välja ja viis ennast sellega koomasse, sest siis tulid ema-isa koos teda haiglavoodi äärde vaatama ja koos muretsesid tema pärast. See on ekstreemne näide, aga ilmestab seda, et alati tasub endalt küsida, millist eesmärki suhete mõttes konkreetne sümptom teenib.

Väidetavalt kuni kolmeaastased lapsed jäävad haigeks paljalt oma ema stressi, viha ja kurvameelsuse tõttu eriti kui see on seotud lapse isaga. Kahju on, et kui vanemad on sõjajalal, siis tihti tuuakse lapse haigust esile süüdistusena teise poole vastu, et näed nüüd, see et sa minuga nii ja naa käitud, sellepärast jäi meie laps haigeks. Selles on osaliselt tõtt, aga nii palju, et laps reageerib tugevalt eelkõige oma peamise kasvataja emotsioonide kõikumisele ning tavaliselt on selleks ema. Loomulikult on suured ja jätkuvad tülid või pikk külmasõda üldiselt lapsele kurnavad olenemata sellest kes alustas.

Tihti on lasteaeda minek see eluetapp, kus laps on palju haige. Lasteaias on ju sadu viiruseid, loomulikult korjab lapse need sealt üles ja põeb läbi, et edaspidi orgamism nende vastu immuunne oleks. Jah...aga. Tihti on need haigused seotud ka sellega, et ema ei ole valmis lapsest eralduma. Ta on üheksa kuud teda kandnud, imetanud, päevad ja ööd taga koos olnud, pidanud igal hetkel tema vajadusi ära aimama ja rahuldama ja nüüd äkki läheb laps lasteaeda. Hirmunult tuntakse kuidas osa elu mõttest siis kaob. Lapsel on nüüd uued inimesed ümberringi, lisaks vanematele on nüüd ka kasvatajad arvamusliidrid, kelle jututarkusi ka vanematele eeskujuks tuuakse, tekivad sõbrad kellega on tore koos olla jne. Lapse maailm ei ole enam ainult ema (ja isa). Isad tavaliselt võtavad asja kergemini, kuna nemad on niikuinii tavaliselt jätkanud tööl käimist ja taluvad seetõttu lapsest igapäevast lahusolekut paremini. Naine on aga harjunud ema ja kellegi maailma naba olema. Kui suhted mehega on keskpärased, on eriti convenient end rohkem lapsega siduda ja nii ennast selle kaudu mehest distantseerida.

Laps näeb, et ema on stressis ja tahab olla hea laps. Mida teeb hea laps? Jääb haigeks, et lasteaeda minna ei saaks ning ema saaks temaga koju jääda ja harjumuspärasust lähedust tunda. Kusjuures tavaliselt ei ole see teadlik tegevus. Teadlik võib olla pigem see, et ema on just tööle tagasi läinud ja nüüd on frustreerunud, et tõbise lapse pärast töölt puuduma peab.
Võib ka nii olla, et kui laps ei taha kuskile minna, miks mitte lasteaeda, sest näiteks teda kiusatakse seal, siis võib ta sellest pääsemiseks endale mingi sümptomi nt kerge palaviku "hankida". Asi võib ka konkreetse sündmusega seotud olla. Oletame, et laps kardab esineda aga talle on antud ülesandeks isade päeva aktusel laulda üks laul. Ta kardab nii, et hommikul on tal 39 palavik, mis kaob õhtuks jäljetult. Selliseid välk-haigusi on kindlasti ka teie lapsepõlves ette tulnud.

Ma ei püüa tavapäraseid käsitlusi haigustest ümber lükata, aga siiski võiks endalt lapse peavalu, kõhuvalu jms puhul küsida, kas selle taga võib olla midagi muud kui bakter või viirus. Loomulikult ei käi jutt ainult laste kohta, aga nemad on peres tavaliselt kõige tundlikumad ja kui midagi peresuhetes viltu on, siis nendel väljendub suhete düsfunktsionaalsus tihti haigusliku sümptomina.

Kuidas laste haigusi vältida? See on päris raske. Alustala on kindlasti tugev ja hooliv paarisuhe ja endaga kooskõlas elamine. Enda mõistmine, hirmude teadvustamine, nende kognitiivne muutmine, mis väljendub käitumise muutumises aitavad kõik kaasa, et haigusi oleks vähem või et need oleks lühiajalised ja kergekujulised. Rasked ja kroonilised haigused tulevad alles siis, kui mingeid asju, mis on halvasti, on pikka aega ignoreeritud. Olgem julged tunnistamaks seda, mis vajab parandamist ja olgem järjekindlad muutumises.

Soovin kõigile head uut aastat ja terveid lapsi!