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Expressive functioning is related to communication such as emotional, verbal, and nonverbal communication, problem solving and roles within the family. Beliefs within the family are also a part of expressive functioning.
For the purpose of the Calgary Family Assessment Model, a family is defined as who they say they are. It is very important that the clinician performing the assessment not assign their own beliefs upon what he or she believes a family is, and take into account what the patient feels about family as to the patient is may mean not only the people who actually live within the household but can also address past, present and future emotional attachments.
Calgary Family Intervention Model:
The immediate family is composed of Mr. Herbert Schelley (the patient), Mrs. Annette Schelley (his wife), and their son Thomas Schelley. The extended family consists of the Schelley's two married daughters, their husbands and their children (the patient's grandchildren). Mr. Schelley describes his family as close and loving, and states that the extended family of often over to the house for dinner and visited him regularly in the hospital. Mr. Schelley and Thomas admit to some tensions between them in the past six months surrounding Thomas's lack of employment and the fact that he continues to live in the family home. Mr. Schelley and Thomas still describe their relationship as close, and Thomas appears to demonstrate the appropriate amount of concern for his father's medical condition. Mrs. Schelley and Thomas endorse that Mr. Schelley's illness and recent hospitalization has caused a great deal of anxiety and concern in the immediate and extended family. Mrs. Schelley reports feeling somewhat overwhelmed at the thought of providing nutritious and appropriate meals for Mr. Schelley, who describes himself as "a meat and potatoes man, I am fond of my sweets." Mrs. Schelley admits that she does not really know what she should cook for her husband, and has little or no knowledge about portion control. Mrs. Schelley reports that she knows that many of the things she buys or prepares for her husband are not good for his health, but does not feel like she has the right to tell him what to eat or how to manage his diseases.
The gender expectations in the Schelley household are "typical," in that Mr. Schelley was always the monetary provider and Mrs. Schelley was a stay-at-home wife and mother. Both Mr. Schelley and Mrs. Schelley admit they have been somewhat at a loss for activities since Mr. Schelley's retirement. They have few friends outside the home and belong to no social clubs or religious organizations. It is noteworthy that Mr. Schelley has gained 50 lbs since his retirement five years ago.
Mr. Schelley is the oldest member of the family at 66. Mrs. Schelley is 64, Thomas is 38 and the twin daughters are 35. There are several subsystems within the family. Mr. And Mrs. Schelley, the daughters and their husbands consist of husband and wife subsystems, while the Schelleys and Thomas consist of another subsystem. While the twin daughters are also involved in their parents' life, they are not so intimately involved in the day-to-day happenings within this household. A parent and child subsystem exists between Thomas and Mr. Schelley. This subsystem is the source of some significant disagreements within the household. Mr. Schelley does not approve of the fact that Thomas has left his wife and is not currently working. Mr. Schelley also feels that Thomas drinks too much alcohol. Thomas admits to the use of approximately one six pack of beer per day. Mrs. Schelley admits that she tries to stay out of their arguments. They all deny any family violence, and report that the disagreements usually end with Thomas leaving the house for several hours. Mr. Schelley and Thomas both report they usually only have these disagreements once or twice per month, but admit there is rarely any closure and that they seem to fight over and over about the same things. The reporting of these arguments does not appear to cause Mr. Schelley or Thomas any siginificant distress, but Mrs. Schelley does admit that their disagreements are often very upsetting to her. It is noteworthy that when this came up in conversation, both Mr. Schelley and Thomas seemed both genuinely surprised and concerned at Mrs. Schelley's report of distress.
The husband and wife subsystem and the subsystem the Schelley's appear to share with their adult daughters and the daughter's families appear to have clear boundaries, although with permeable borders which allow flexibility. The boundary that Mr. Schelley shares with Thomas appears to be more dynamic in nature, in that Thomas is attempting to define himself as a grown man in relationship to his father, the dichotomy being that he is trying to do so while living under his father's roof with no visible means of support. Mrs. Schelley's boundaries with the subsystem that consists of Thomas and his father appears to be the most rigid within this family as she feels that she cannot express her concerns over their arguments nor express her distress at the fights they have once or twice per month.
As the Schelley's older daughters were not present for this interview, it is difficult to assess exactly how the extended family is impacted by, or impacts this system. As far as larger systems impact can be seen, this family appears to have little to no contact with larger groups which may exert influence on the family. No one in the immediate family is currently involved in any social or church groups, no one works and they have very few friends. Mr. Schelley's recent hospital stay and referral for Home Health are probably the most meaningful outside connection that this family has made since Mr. Schelley's retirement, and even so Mr. Schelley is not yet fully engaged in using Home Health to improve his current medical condition.
The lifecycle of this family is somewhat dynamic and caught in a place between children leaving home and retirement. The presence of the mild degree of dysfunction between Thomas and his father shows that there is an element a maladaption to this stage. This maladaptive pattern also appears present in the relative social isolation that has existed for Mr. And Mrs. Schelley since Mr. Schelley's retirement.
Regarding instrumental functioning, Mrs. Schelley provides most of the housework, cooking and shopping as well as meal planning. Mr. Schelley continues to do the bill paying and Thomas does some yard work and odd jobs around the house, as his parents' request. Mr. Schelley is still able to perform all his own self-care activities such as feeding and toileting. Before Mr. Schelley was hospitalized, Thomas did assist in daily dressing changes on the wound on Mr. Schelley's lower leg.
Expressive functioning in this family is difficult to assess. As noted before, the men of the household were very surprised to hear that their arguments caused Mrs. Schelley a significant amount of distress. It must also be noted though, that she is a somewhat reticent woman and is probably not forthcoming in her feelings or thoughts. There appears to be no subtext in their discussions. They appear to be able to speak to each other and communicate when they want to. It just appears that in many cases they do not chose to. Emotionally, the family appears to be reserved and uncomfortable with questions about feelings. It does appear that Mrs. Schelley is the most likely one to hold in her feelings. Neither Mr. Schelley nor Thomas were able to identify to me a way they could say if Mrs. Schelley were happy or sad, and seemed moderately uncomfortable with the question. Both Mr. Schelley and Thomas did express what appeared to appropriate concern surrounding the mother's distress at their fights, but were unable to verbalize to me how they could avoid these upsets in the future. Verbal communication within this household seems clear but somewhat lacking in content. When questioned about non-verbal cues, none of the family was able to describe to me any cues another family member might make to identify distress. Problem solving skills in this family mostly consist of avoidance of the issue.
Problem List and Discussion:
Relative lack of knowledge surrounding disease states and lifestyle modifications related to diabetes.
Discussion: Mr. Schelley admits to having a glucometer but states that he does not use it regularly. Education was given to the family on the need for Mr. Schelley to monitor his blood sugars at least once daily and ideally in the morning before breakfast, two hours after lunch and at bedtime. Goal ranged of 126 a.m. fasting, <180 post prandial and <200 at h.s. were set. Thomas appears interested in becoming more involved in this aspect of Mr. Schelley's care and he and Mr. Schelley agree that Thomas will take charge of the testing. Mrs. Schelley was provided…[continue]
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