M.A. / According to Edmonds and Wilcocks (1995:1-2), South Africa is in the grip of a major drug boom. If this is not taken seriously, South Africa could lose as much as 30% of its future generation in terms of health, happiness, functioning and even life. Drug abuse is an important factor that can affect the quality of life of not only the drug abuser, but also all those connected with them (Edmonds and Wilcocks, 1995:1-2). Substance abuse is a problem that influences the family system. Models such as Bell and Khantzian (1991) and Cooks' (1988) description of the Minnesota model define substance abuse as a disease. This model also known as the medical model, can be attributed to the work of Jellinek (1960). It focuses on individual biological factors with little consideration for familial, social or psychological variables. On the other hand, a family systems perspective indicates that the family system enables the substance abuser towards abusive patterns of behaviour. The family plays an important role in the process of dependency as well as in the rehabilitation process. These models are brought together in the study, as this combination is valuable in understanding the complexity of substance abuse and its effects on the family system. The aim of the study is to explore the families understanding of substance abuse and their role in the treatment process. A qualitative methodology is used to understand the life events, experiences and beliefs of family members, from their point of view. The focus of the research is on family members who have attended the family program at Stepping Stones Rehabilitation Center. Exploring the understanding they have of substance abuse and their role in the treatment process, from their frame of reference. The theoretical basis for the study is formulated within the medical model and a systems perspective. A nonprobability, purposive sample is utilized to seek information rich cases. Eleven respondents are interviewed. Different members within the family system are selected to illuminate the question under investigation. An interview schedule formulated from literature, is utilized to create consistency in the face-to-face interviews. The in depth interviews facilitate exploration. Data is gathered by means of a literature review, field notes and audiotapes transcribed by the researcher. Analysis of the data is done manually according to a schedule. The schedule I developed according to coding categories that are identified when working with raw data. The information from the data gathered is analysed and used to identify themes, which are offered as results. An extensive literature control is conducted, in order to further the validity of the research. From the study, methodological and theoretical conclusions can be made. Methodological conclusions indicate the effectiveness of using a qualitative methodology and face-to-face interviews in exploring the question under study. The theoretical conclusions indicate families understanding of substance abuse and their role in the treatment process. Recommendations in terms of intervention with families affected by substance abuse and future research, are drawn from the research process and context of the study ensure the link between results and conclusions and aims and objectives. The research indicates that families have an intellectual understanding of the disease concept of substance abuse. Their searching for alternative solutions and use of defence mechanisms, indicate that this concept has not been internalized. Respondents acknowledged the long term nature of recovery that is facilitated by the use of support groups.

This thesis follows a paper based format where papers 1 and 2 are stand-alone papers prepared for submission to the Journal of Pediatric Psychology. The relevant submission guidelines are included in the Appendix. Paper One: The purpose of this systematic review was to assess the effects of family-centred interventions for children and adolescents with Type 1 diabetes and review the bias associated with included studies. The review summarises the outcome measures which consisted of HbA1cs, hospital admissions for diabetic ketoacidosis (DKA), adherence, and family relationships including diabetes-related conflict. Research studies that were randomized controlled trials were selected to maximise the quality of information reviewed. Electronic searches of the OVID database using MEDLINE, PsycINFO, EMBASE, and CENTRAL were searched from their start dates until May 2012. Nine studies were located and assessed with the Cochrane risk of bias tool. Two studies were excluded from further analysis due to serious concerns about bias of their results. The remaining 7 had their findings summarised in a narrative statement, which indicated that family-centred interventions significantly improved HbA1cs, reduced DKA admission rates, improved adherence, and enhanced family relationships including reduced conflict. Family-centred interventions appear to be effective in enhancing health and psychological outcomes. The interventions however, were mainly in clinical settings and delivered by trained professionals. Given the importance of the family relationships in diabetes control, a need exists for interventions to have a more flexible setting and method of delivery, remain viable and demonstrate sustainability. Paper two: Clinic based interventions in type 1 diabetes have shown improvements in family relationships and metabolic control, but have limited reach. Therefore, a self-directed intervention was evaluated. Recruitment occurred through national advertising with diabetes charities, and the randomized controlled trial was conducted via online data collection. Parents of adolescents (aged 11-17) with diabetes were randomized to usual care (n = 37) or intervention (n = 42) using computerised block randomization, with researchers blinded to block size. The 10 week intervention involved the Self-directed Teen Triple P (Positive Parenting Program) workbook (10x1hour modules) and Chronic Illness tip sheet. Primary outcomes of diabetes-related family conflict and parenting stress were assessed pre and post-intervention. Intention-to-treat analysis was undertaken (n = 79), due to increased attrition from the intervention group. Intervention significantly improved diabetes related conflict, but not parental stress, compared to usual care. Followup analyses will assess maintenance effects and impact on metabolic control. Paper three: This paper was a Critical Evaluation, the purpose of which was to consider the findings from both papers, highlight additional and unexpected outcomes, place the research in the wider context, explore limitations of the thesis, and to discuss implications for future work.

This research is an attempt to investigate to what degree society, as represented by a selected group of married women, is accepting the role of the working wife and mother, and to what degree the traditional definition still prevails in the minds of two generations of women.

The formation of a sense of personal identity is a major task of adolescence. An adolescent's experimentation with roles is carried out in social interactions, the family being one important context for development. Research evidence suggests that the family's ability to tolerate individuality and maintain connectedness has implications for the process of identity formation. The purpose of this study was to identify family relations factors that facilitate or inhibit patterns of identity development during middle adolescence (high school years). Self-report and observational data were obtained from 49 families with middle adolescents to tap behaviors conceptualized as enabling or constraining individuality and connectedness. Mothers, fathers, and adolescents females, 20 males) completed two questionnaires assessing their perceptions of child-rearing behaviors within the parent-adolescent dyad : the Parent-Adolescent Relationship Questionnaire (PARQ) and Ellis, Thomas, and Rollins subscales. Perceptions of f amily system functioning were measured by FACES II. All three family members participated in a family interaction task, and observed social interaction behaviors were coded by nonfamily members . Adolescents completed an ego identity questionnaire (EOM-EIS) in the first and third years of the study. Based upon changes in identity status, adolescents were categorized as progressive, stable, or regressive. Family relations factors were then compared for each of these three groups . Results identify several child-rearing perceptions and social interaction variables as factors associated with progressive or regressive identity development. Fathers' perceptions of moderate levels of affection in the fatheradolescent relationship appear to facilitate identity development, while high levels of companionship and support are inhibiting factors. Adolescents' perceptions of a moderate level of withdrawal in the father-adolescent relationship are another facilitative factor. Lower proportions of fathers' and adolescents' enabling individuality behaviors appear to inhibit development, as do high proportions of enabling connectedness behaviors by both parents. The results from both perceptual and behavioral data support the notion that to facilitate identity exploration during middle adolescence, there needs to be a balance of expression of individuality and moderate connectedness in the family environment.

Since the beginning of the Global War on Terror, almost three million children, spouses, and adult dependents have been directly affected by the deployment experiences of more than two million service members. This study examined the applicability of the Contextual Model of Family Stress (Boss, 2002) to a reintegrating military family sample (N = 228) by assessing the effects of external, military-related contextual factors (i.e., rank, component, combat exposure, length of time home post-deployment, and cumulative length of deployments) and internal contextual factors of boundary ambiguity and family and deployment-related ambivalence on family functioning. Quantitative data were taken from a national survey of service members from multiple branches of the United States military. A hierarchical regression analysis revealed that, as a whole, the addition of the military-related contextual factors, boundary ambiguity, and the ambivalence variables made a significant contribution to the prediction of family functioning, controlling for all previously entered variables. Service members from lower ranks and those who had been home for longer periods of time reported poorer family functioning. Higher degrees of boundary ambiguity and family ambivalence were also associated with poorer family functioning. The results from this study extend existing theoretical applications of the Contextual Model (Boss, 2002) to military families through the incorporation of boundary ambiguity and ambivalence. Findings will also inform interventions aimed at promoting family resilience in the military population during the post-deployment period. / Ph. D.

Yes / Family relationships are important for wellbeing across the life course and are known to be important for people living with dementia, bringing benefits to self-esteem and identity, as well as providing support for people living at home. Recent research has explored the impact of dementia upon relationships. Much of this research is qualitative in nature and rarely included in systematic reviews, however, it has the potential to provide significant contributions to understanding the interplay between family relationships and dementia and to inform interventions. A systematic synthesis of qualitative research concerning the impact of dementia upon family relationships was undertaken, using thematic synthesis. Eleven articles were reviewed, which address the perspectives of people living with dementia and their spouse and/or adult children. The aims of this review are to illuminate what is currently known about the reciprocal influences between family relationships and dementia from the perspectives of the family (including the person with dementia); and to consider the implications of these findings for research and practice. Four super-ordinate themes were identified: A shared history, negotiating the impact of dementia upon the relationship, openness and awareness, and shifting sands. This synthesis contributes to an emerging field but also highlights gaps in current understanding of the impact of dementia upon relationships and in providing appropriate interventions. Implications for research and practice are considered.

Thesis (MSc)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: The primary aim of this study was to identify family resilience qualities that families use to adapt after a member has been diagnosed with schizophrenia. Family resilience refers to the family’s ability to adjust and adapt after a crisis. A secondary aim of this study was to determine whether there are significant differences between groups with regard to biographical variables (i.e. relationship to the ill member, home language, racial groups, family structure, and annual household income) and potential resilience variables. The primary theory utilised in this study was proposed by McCubbin and McCubbin (1996a), namely the Resiliency Model of Family Stress, Adjustment and Adaptation, and the secondary theory utilised is the Family Resilience Framework described by Walsh (2012). Qualitative and quantitative data were collected and analysed in order to answer the research question. Data were collected from 51 participants, who represented 42 families. Families were recruited from three support groups within the Western Cape, South Africa. Qualitative data were obtained through an open-ended question in which the participant was asked to indicate the strengths and resources used by the family to adapt after a member had been diagnosed with schizophrenia. Resilience qualities within the qualitative data were identified through a process of thematic theme analysis. Quantitative data were collected using seven self-report questionnaires, which collectively gave an indication of possible family resilience qualities within the family. Quantitative data were analysed using a mixed model repeated measures analysis of variance (ANOVA), Pearson’s product-moment correlations, and a bestsubset regression analysis. Ten statistically significant correlations were found between independent variables and family adaptation. Nine of these variables had a significant positive correlation with family adaptation, namely family income; the degree to which the family finds support in their community; special events and family time; the style of communication during crises; positive communication patterns during crises; family hardiness; the ability of the family to work together and their internal strengths; positive reframing and ability to learn; and the internal locus of control within families. Only one negative correlation with family adaptation was found, namely incendiary communication during times of crisis. The quantitative results were compared with the qualitative themes, and additional findings from the qualitative data were reported. An additional theme that emerged from the qualitative analyses was factors relating to the diagnosed family member, and a subtheme, namely passive appraisal of a crisis. Differences were also found between groups with regard to the measured variables. It is evident from the findings that the identified qualities and resources may be used in interventions to strengthen other families in which a member has been diagnosed with schizophrenia. / AFRIKAANSE OPSOMMING: Die primêre doel van hierdie studie was om gesinsveerkragtigheidskenmerke te identifiseer wat gesinne gebruik om aan te pas nadat ’n gesinslid met skisofrenie gediagnoseer is. Gesinsveerkragtigheid verwys na die gesin se vermoë om verstellings te maak en aan te pas ná ’n krisis. ’n Sekondêre doelstelling van hierdie studie was om vas te stel of daar beduidende verskille tussen groepe is ten opsigte van biografiese veranderlikes (verhouding met gediagnoseerder lid, huistaal, ras, gesinstruktuur, en jaarlikse huishoudelike inkomste) en potensiële veerkragtigheidsveranderlikes. Die primêre teorie onderliggend aan hierdie studie is dié van McCubbin en McCubbin (1996a), naamlik die “Resiliency Model of Family Stress, Adjustment and Adaptation”. Die sekondêre teorie wat gebruik is, is die “Family Resilience Framework” beskryf deur Walsh (2012). Kwalitatiewe en kwantitatiewe data is ingesamel en ontleed ten einde die navorsingsvraag te beantwoord. Data is vanaf 51 deelnemers wat 42 gesinne verteenwoordig het, ingesamel. Gesinne is verkry by drie ondersteuningsgroepe in die Wes-Kaap, Suid-Afrika. Kwalitatiewe data is met ’n oop-einde vraag ingesamel waarin die deelnemende gesinslid gevra is om in sy/haar eie woorde te beskryf watter hulpbronne/kwaliteite/eienskappe die gesin as ’n eenheid gebruik het om aan te pas nadat die lid met skisofrenie gediagnoseer is. Veerkragtigheidseienskappe in die kwalitatiewe data is deur ’n proses van tematiese tema-ontleding geïdentifiseer. Kwantitatiewe data is met behulp van sewe self-rapporteringsvraelyste ingesamel wat gesamentlik ’n aanduiding verskaf van moontlike gesinsveerkragtigheidseienskappe. Kwantitatiewe data is met behulp van gemengde-model herhaalde metings variansieontleding (ANOVA), Pearson produkmomentkorrelasies, en beste-substel regressieontledings ontleed. Tien statisties beduidende korrelasies is tussen onafhanklike veranderlikes en gesinsaanpasbaarheid gevind. Nege van hierdie veranderlikes het ’n positiewe korrelasie met gesinsaanpasbaarheid gehad, naamlik gesinsinkomste; die mate waartoe gesinne ondersteuning van hul gemeenskap kry; spesiale geleenthede en gesinstyd; die kommunikasiestyl tydens ’n krisis; positiewe kommunikasie-patrone tydens ’n krisis; gesinsgehardheid; die vermoë van die gesin om saam te werk en hulle interne sterktes; positiewe herformulering en die vermoë om te leer; en ’n interne lokus van kontrole binne die gesin. Slegs een negatiewe korrelasie met gesinsaanpasbaarheid is gevind, naamlik die gebruik van opruiende kommunikasie. Die kwanitatiewe resultate is met die kwalitatiewe temas vergelyk en bykomende bevindinge vanuit die kwalitatiewe data is gerapporteer. ’n Bykomende tema wat in die kwalitatiewe ontledings na vore gekom het, is kenmerke van die gediagnoseerde gesinslid, asook ’n subtema, naamlik passiewe aanvaarding van ’n krisis. Verskille tussen groepe is ook vir die gemete veranderlikes gevind. Dit volg uit die bevindinge dat die geïdentifiseerde kenmerke en hulpbronne in intervensies gebruik kan word om ander gesinne waarin ’n lid met skisofrenie gediagnoseer is, te versterk.

The increasing number of children who have reentered foster care is a pervasive problem today. The present study examined the recovery of substance-dependent parents and the length of time between reunification and a maltreatment recurrence event.

Thesis (PhD)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: The aim of the current study was to investigate factors that help single-parent families cope with the news that a family member has been diagnosed with HIV. The theoretical model that underpinned the study is the Resiliency Model of Family Stress, Adjustment and Adaptation of McCubbin and McCubbin (1996). A salutogenic perspective offers a view of human suffering that moves away from pathology to focus on factors that support successful coping, hence the focus of the current study on resilience. A cross-sectional survey research design was used, incorporating a combination method inclusive of both a qualitative and quantitative component. A total of 109 families, represented by an adult and a child, answered a qualitative question about what they considered to have helped them cope, and completing a biographical questionnaire and five questionnaires based on the theoretical model. Analyses included the Grounded Theory Method, a qualitative analysis method of Strauss and Corbin (1994; 1998), Pearson correlations and ANOVAs (for a categorical independent variable – employment status) to compute the significance of correlations between a dependent variable and a number of independent variables, and regression analysis. The results of the qualitative investigation revealed that families considered internal strength (or hardiness), social supports, communication, a sense of hope, using denial (both positive and negative behaviours to get on with life despite the presence of hardship), changing or reframing thoughts about the stressor, and material support to have been helpful. The quantitative results supported the qualitative results and showed that family hardiness (working together, viewing stressors as challenges and having a belief in own coping abilities), the availability of social support, supportive communication, use of reframing, accepting help from others and spiritual support all contributed to families functioning well under adverse conditions. It was also shown that inflaming types of communication, such as fighting and doing nothing about a crisis situation, negatively influenced the family functioning. It was interesting to note that family size had a significant, positive correlation with the parents’ views of family functioning, and that the higher the children’s level of education, the lower they rated their family functioning to be. Recommendations for further studies include a focus on resilience in various family types, a focus on families successfully coping with HIV diagnoses in their families, and the development of intervention programmes, inclusive of Cognitive Behaviour Therapy and Acceptance and Commitment Therapy. / AFRIKAANSE OPSOMMING: Die doel van die huidige studie was om ondersoek in te stel na faktore wat enkelouer gesinne met ‘n MIV-gediagnoseerde gesinslid ondersteun het. Die studie is teoreties gebou op McCubbin en McCubbin (1996) se Resiliency Model of Family Stress, Adjustment and Adaptation. Salutogenese bied ‘n siening of waardering van die manier waarop mense terugslae hanteer wat weg beweeg van die tradisionele fokus op patologie om te fokus op faktore wat suksesvolle aanpassing ondersteun ten spyte van die teenwoordigheid van genoemde krisis. Hierdie benadering bepaal dus die fokus op veerkragtigheid of gesinsveerkragtigheid wat hierdie studie rig. ’n Deursnee- steekproefontwerp is vir die navorsing gebruik en het ‘n kwalitatiewe en kwantitatiewe komponent ingesluit. ‘n Totaal van 109 gesinne is bestudeer, elk deur een volwassene en een kind verteenwoordig. Die deelnemers het ‘n kwalitatiewe vraag beantwoord oor wat hulle as ondersteunend ten opsigte van hulle eie krisishantering beskou het, en het ook ‘n biografiese vraelys en vyf vraelyste wat verskillende aspekte van die teoretiese model gemeet het, voltooi. Die deelnemers se response is ontleed deur middel van Strauss en Corbin (1994; 1998) se Grounded Theory Method vir die kwalitatiewe komponent; Pearson se korrelasies en ANOVA’s (ten opsigte van ‘n katogoriese onafhanklike veranderlike – werkstatus) is gebruik om die korrelasies tussen die afhanklike en ‘n aantal onafhanklike veranderlikes te bereken en regressie-ontledings is gedoen. Die kwalitatiewe resultate het aangedui dat die volgende faktore deur die gesinne beskou is as ondersteunend van hulle vermoë om krisisse te hanteer: innerlike sterkte, sosiale ondersteuning, kommunikasie, ‘n gevoel van hoop, die gebruik van ontkenning (beide positiewe en negatiewe gedrag om met die lewe aan te gaan ten spyte van die swaarkry), verandering van of herbesinning oor die stressor, en materiële ondersteuning. Die kwantitatiewe bevindinge het die kwalitatiewe resultate ondersteun en getoon dat gesinsgehardheid (saamwerk, beskouing van stressors as uitdagings en ‘n vertroue in eie vermoëns), die beskikbaarheid van sosiale ondersteuning, ondersteunende kommunikasie, die gebruik van herbesinning, aanvaarding van hulp van ander en geestelike ondersteuning almal gehelp het om die gesin onder ongunstige toestande goed te laat funksioneer. Daar is ook gevind dat opruiende soorte kommunikasie, soos baklei en niks oor ‘n krisissituasie te doen nie, ‘n negatiewe invloed op gesinsfunksionering gehad het. Dit was interessant om te vind dat gesinsgrootte positief met die ouers se beskouing van gesinsfunksionering gekorreleer het, terwyl ‘n hoër vlak van opvoeding onder die kinders gekorreleer het met ‘n laer skatting van gesinsfunksionering. Aanbevelings vir verdere navorsing sluit in ‘n fokus op gesinsveerkragtigheid in verskillende gesinstipes, ‘n fokus op gesinne wat ‘n MIV-diagnose in die gesin suksesvol hanteer, en die ontwikkeling van ingrypingsprogramme gebaseer op die beginsels van Kognitiewe Gedragsterapie en Acceptance and Commitment Therapy.

Thesis (MA)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: A child’s death represents a traumatic loss, which can be understood as a crisis impacting on the family as a functioning unit. The purpose of the current study was to investigate grief and resilience in families in which a child has died, while specifically focusing on the internal resistance resource of family hardiness. A cross-sectional research design was implemented concurrently with intensive interviews conducted according to the principles of grounded theory. In total, 35 bereaved parents from the Western Cape participated in the study as representatives of 23 families. The participants each completed three questionnaires, a biographical questionnaire, the Family Hardiness Index and the Family Attachment and Changeability Index 8. Pearson and Spearman correlational analyses indicated significant positive correlations between family hardiness scores (including scores on the subscales for commitment, challenge and control) and family adaptation (measured by use of the Family Attachment and Changeability Index 8). Significant associations were also found between certain biographical variables and family hardiness. Intensive interviews were, furthermore, conducted with participants representing 12 different families. The analysis of interviewtranscriptions resulted in the formulation of various thematic categories, such as grief-reactions, continuing bonds, external support, religion, as well as the core category of family hardiness. A grounded theory was thus developed concerning grief and resilience in families in which a child has died. The results of the study reveal the importance of qualitative methods to explore the unique experiences of bereaved parents and families with the purpose of constructing applied interventions on the family level. The family hardiness concept was also clarified and shown to be a possible resistance resource conducive to family adaptation following the loss of a child. / AFRIKAANSE OPSOMMING: Die dood van `n kind is `n traumatiese verlies, wat beskou kan word as `n krisis wat `n impak het op die gesin as `n funksionerende eenheid. Die doelwit van die huidige studie was om verdriet en veerkragtigheid in gesinne waarin `n kind oorlede is, te ondersoek, met `n spesifieke fokus op die interne weerstandsbron van gesinsgehardheid. `n Dwars-snit opname navorsingsontwerp is gebruik in oorleg met intensiewe onderhoude, wat volgens die beginsels van gegronde teorie gevoer is. In totaal is 35 ouers, woonagtig in die Wes-Kaap, betrek by die studie, wat opgetree het as verteenwoordigers van 23 gesinne. Die deelnemers het elk drie vraelyste voltooi, naamlik `n biografiese vraelys, die Gesinsgehardheid Indeks en die Gesinsgehegtheid en Veranderlikheid Indeks 8. Pearson en Spearman korrelasie-berekeninge het aangedui dat gesinsgehardheid-tellings (asook die tellings op die subskale vir toewyding, uitdaging en beheer) beduidend positief korreleer met gesinsaanpassing (gemeet met die Gesinsgehegtheid en Veranderlikheid Indeks 8). Beduidende verhoudings is ook gevind tussen sekere biografiese veranderlikes en gesinsgehardheid. Verder is intensiewe onderhoude gevoer met die verteenwoordigers van 12 gesinne. Die ontleding van onderhoud-transkripsies het gelei tot die formulering van verskeie tematiese kategorieë, naamlik verdriet-reaksies, die voortdurende verbintenis, eksterne ondersteuning en godsdiens, asook die kern-kategorie van gesinsgehardheid. `n Gegronde teorie is sodoende ontwikkel, wat betrekking het op verdriet en veerkragtigheid in gesinne waarin `n kind oorlede is. Die resultate van die studie wys op die belang van kwalitatiewe metodes om die uniekheid van bedroefde ouers en gesinne se ervarings te verken met die doel om gepaste intervensies op gesinsvlak te ontwikkel. Die konsep van gesinsgehardheid is ook verhelder en aangedui as `n moontlike weerstandsbron, wat bevorderlik is vir gesinne se aanpassing ná die verlies van `n kind.