Family and systemic therapy after injury or trauma

Serious and catastrophic injuries have an enormous impact, physically, mentally and financially. Whilst the first-hand impact affects the individual, their immediate and wider family also face a great deal of change in their lives. It has been fairly standard for researchers and clinicians to focus on the individual, but understanding is shifting and increasingly families are being included in post-trauma therapy.

Some immediate effects of trauma include loss of financial stability – if the main salary earner suffers the injury – and breakdown of relationships because the family unit can’t cope with the monumental change to their situation. But beyond these we need to consider how relationships are affected between partners, and with children, and how the injured party deals with their altered position in the family unit.

The 2013 study by C.R. Figley and L. J. Kiser, Helping Traumatized Families, considers the family unit as a whole who work together, systemically, and therefore are open to ‘systemic dysfunction’ as a whole, should one of them suffer a traumatic injury. The effectiveness of their response to the trauma depends on how the family interacted before the injury, how each of them viewed their roles, and the resources then made available to them post-trauma. Whilst not all will succeed in adapting effectively, those that do tend to be the families who continue to meet all member’s needs, and not shifting all their focus on to the injured party.

Regardless of changes to a family dynamic through trauma, all individuals retain the need for affection, security and growth. If these are overlooked, the family is more likely to adapt poorly, resulting in the family unit breaking down. But if they are met, the family’s adaptation and future is likely to be stronger and more beneficial to each person.

So what are the most effective ways to deliver systemic therapy?

Without a doubt, treating the whole family instead of the specifically affected person is the most important factor. Treating the injured person in isolation does, of course, have an effect, but without understanding their role in the family dynamic, it can have a limited impact.

M. Bowen in Family Therapy in Clinical Practice (1978), outlines key points related to systemic therapy:
• Stress affects the family as well as the diagnosed individual.
• Chronic anxiety and its role in family dysfunction can broaden the understanding of chronic stress and its effects on the individual and the family unit.
• Working clinically with the family can help reduce symptoms in the individual and in the family.
• Systems thinking becomes an important tool for the clinician.

Systemic therapy is widely available to any group that is suffering from dysfunction. By extending this to include families who are dealing with trauma or injury, and understanding how their relationships interrelated pre-trauma, could allow so many more families to survive the long-term after effects of trauma.

Read more about the family systems approach to treating families of persons with brain injury and also: Trauma and the Family: A Systems‐oriented Approach