Family systems therapy seeks to alter the structure or processes of a family for the purposes of reducing distress in one or more persons and improving the ability of the family to meet members’ needs. Building from a general systems paradigm, family systems therapy recognizes that family structures shift over time as they respond to members’ developmental processes and broader system demands. As members enter and exit or change capacity, and as external stressors arise, the family typically uses adaptive processes to demonstrate resilience. Family systems therapy is useful when the family struggles to adapt, or the adaptation strategy further stresses the family. Multiple models of family systems therapies offer variations in intervention approaches but have common tenets. Major models include Ackerman’s early psychodynamics model, transgenerational models of family therapy, structural family therapy, strategic family therapy, and communications approaches to family therapy. Models vary in their recommended roles for the therapist, strategies for therapist and family, and the salience of immediate versus longer-term goals. Family systems therapies conceptualize family interactions as complex, reciprocal, open, self-organizing, adaptive, social constructionist, and meaning-making. Family systems therapy also can be used with systems larger than families, such as schools or organizations, or to understand cultural phenomena. The field of marriage and family therapy has defined competencies for practice, training requirements, and licensure standards and established national and international professional organizations.
Sara Honn Qualls and Lacey Edwards
Caring for an older adult who needs help or supervision is in many cases associated with mental and physical health issues, especially if the care recipient has dementia, although positive consequences associated with caregiving have also been reported. Several theoretical models have shown the relevance of psychological variables for understanding variations in the stress process associated with caregiving and how interventions may benefit from psychological techniques and procedures. Since the 1990s it has been witnessed an increment in the number of studies aimed at analyzing caregiver health and developing and testing interventions for decreasing caregiver distress. Several examples of interventions for helping caregivers are considered empirically supported, including interventions for ethnically and culturally diverse caregivers, with psychotherapeutic and psychoeducational interventions showing strong effect sizes. However, efforts are still needed to maintain the results of the interventions in the long term and to make the interventions accessible (e.g., through technological resources) to a large number of caregivers who, because of time-pressure issues associated with caregiving or a lack of support, are not benefiting from them. Making these interventions available in routine healthcare settings would help a large population in need that presents with high levels of psychological suffering.
Cornelia Wrzus and Jenny Wagner
Over the entire life span, social relationships are essential ingredients of human life. Social relationships describe regular interactions with other people over a certain period and generally include a mental representation of the relationship and the relationship partner. Social relationships cover diverse types, such as those with family members, romantic partners, friends, colleagues, as well as with other unrelated people. In general, most of these relationships change in number, contact frequency, and relationship quality during adulthood and old age. For example, both the number of and contact with friends and other unrelated people generally decrease with advancing age, whereas the number of and contact with family members remain rather stable. Relatively little is known about longitudinal changes in the quality of relationships, apart from romantic relationships, because few longitudinal studies have tracked specific relationships. Some explanatory factors, which are discussed in the literature, are (a) motivational changes, (b) reduced time due to work and family demands during adulthood, and (c) resource constraints in older age. Future work on social relationships would benefit from increasingly applying dyadic and network approaches to include the perspective of relationship partners as well as from examining online and offline contact in social relationships, which has already proved important among younger adults.
Allison R. Heid and Steven H. Zarit
Individuals are living longer than they ever have before with average life expectancy at birth estimated at 79 years of age in the United States. A greater proportion of individuals are living to advanced ages of 85 or more and the ratio of individuals 65 and over to individuals of younger age groups is shrinking. Disparities in life expectancy across genders and races are pronounced. Financial challenges of sustaining the older population are substantial in most developed and many developing countries. In the United States in particular, employer-based pension programs are diminishing. Furthermore, Social Security will begin taking in less money than it pays out as early as 2023, and the debate over its future in part entails discussions of equitable distribution of resources for the young in need and the old. Living longer is associated with a greater number of chronic health conditions—over two-thirds of Medicare beneficiaries in the United States have two or more chronic health conditions that require complex self-management regimes partnered with informal and formal care services from family caregivers and institutional long-term services and supports. Caregiver burden and stress is high as are quality care deficiencies in residential long-term care settings. The balance of honoring individuals’ autonomous wishes and providing person-centered care that also addresses the practicalities of safety is an ever-present quandary. Furthermore, complex decisions regarding end-of-life care and treatments plague the medical and social realms, as more money is spent at the end of life than at any other point and individuals’ wishes for less invasive treatment are often not accommodated. Yet, despite these challenges of later life, a large percentage of older individuals are giving financial support, time, and energy to younger generations, who are increasingly strained by economic hardship, the pressures on dual earner parents, and the problems faced by single parenthood. Older individuals’ engagement in society and the help they provide others runs counter to stereotypes that render them helpless and lonely. Overall, the ethical challenges faced by society due to the aging of the population are considerable. Difficult decisions that must be addressed include the sustainability of programs, resources, and social justice in care, as well as how to marshal the resources, talents, and wisdom that older people provide.
MacKenna L. Perry and Leslie B. Hammer
Study of the intersection of work with nonwork components of individuals’ lives has most often focused on roles within nuclear and extended families but is increasingly focused on nonwork domains beyond family, such as roles within friendships, communities, leisure activities, and the self. In line with the focus of most existing literature on the family-specific domain within nonwork lives, the nonwork domain will generally be referred to here as “family.” One popular conceptualization of linking mechanisms between work and family differentiates between work-family conflict or stress, which occurs when a work role and a nonwork role are not fully compatible and results in some type of physical or psychological strain. Alternatively, work-family enrichment occurs when participation in one role benefits life in the other role. Concepts similar to work-family enrichment include work-family positive spillover and work-family facilitation; all emphasize the ways in which one role can positively impact another role. Additionally, the popular concept of work-family balance highlights either a state of low conflict and high enrichment or the presence of effectiveness and satisfaction in both roles. Broadly speaking, the links between work and family are bi-directional, such that the work domain can influence the family domain, the family domain can influence the work domain, and both can occur simultaneously. Work-family conflict and enrichment have been tied to important employee outcomes, including work (e.g., absenteeism), family (e.g., family satisfaction), and domain-unspecific outcomes (e.g., physical and psychological health), as well as to organizational outcomes (e.g., market performance). Working conditions contributing to work-family conflict and enrichment are frequently characteristic of lower wage jobs, such as low levels of control over work, high work demands, low levels of supervisor support, shift work, and temporary work that can lead to unpredictable schedules, high degrees of job insecurity, and increased health and safety hazards. Researchers are presented with unique challenges as the workplace continues to change, with more dual-earner couples, an increasingly aging workforce, and surges of technology that facilitates flexible work arrangements (e.g., telecommuting). Nonetheless, researchers and organizations work to explore relationships between work and family roles, develop policies related to work and family (i.e., national, state or local, and organizational), and build evidence-based interventions to improve organizations’ abilities to meet employees’ needs.