Families Therapies inside and outside the walls

October 2000-January 2002

Jean Bédard

Contribution of the 23 November 2000 conference: “Families therapies. Inside and outside the walls” organized by ERIE in the Paul Guiraud Hospital of Villejuif (France).

Abstract

Under the actual economical situation, poor people are constantly getting more numerous. With time, in addition of exclusion and humiliation, poverty will lead to a collapse in the self esteem. An internal dynamic along with the economical and social dynamic is transforming the poverty into a social distress. Only a multi dimensional strategy of social, community and family developments could reverse the processes. In his book, “Famille en détresse sociale” (tome 1 et 2), published at Anne Sigier in 1998, Jean Bédard is developing this strategy. In his lecture, he is insisting on the essential elements that are necessary for an efficient intervention with social distressed families. He is covering the evaluation, orientation and intervention phases. But more than that, it is the attitude that one have towards the poor people who can guarantee the success of the intervention.

Keywords :

Poverty, social distress, family, children, families intervention.

In Quebec...

In Quebec, several researches have shown the inefficiency of the services system faced to the social distress of the families. Confronted to this failure, the Association of Youth Centers of Quebec (witch regroups mostly the Youth Protection and the delinquency services) with the help of the Health Ministry and the social services financed and led a research whose the purpose was to propose a more efficient strategy.
I had the responsibility of this research. To help me, I had the assistance of :

• Dr Yvon Gauthier, Professor of psychiatry at the Montreal University and working at the Saint Justine Hospital.
• Mr Richard Cloutier, Scientific director of the University Institute on the youths in difficulties in Quebec.
• Micheline Mayer of the University Institute of the Youth Centers of Montreal.
• And some people of the intervention field, from directions of quality but also from the practical fields.

This made possible the creation of a kind of “user notice” to intervene in the field of social distress. Today, I will talk very briefly about two questions :

• What's the social distress ?
• How to intervene with some chance of success ?

What's the social distress ?

We define as social distress the chronic and global poverty that, by constantly humiliating, isolating and betraying on the human dignity, leads to a form of despair bringing people to contribute, despite themselves, to the vicious cycle of exclusion.
Social distress exists when poverty is:

• Economical (low income)
• Cultural (poor social abilities and education)
• Social (bring back actively people to their solitude, to their clan, to their ghetto)

With time, this leads to a collapse in the self-esteem. Time is an important factor because it products a kind of psychosocial phases's transitions. We can talk of phase transition when, for example, water becomes vapor. This is not a change in the essence of the being but it's a change in the state of being. The reversibility of the process is particularly difficult and costs a lot. That's why it's better to prevent than to heal.

If you take a person at random and you put him in a constant state of global poverty, it would take between 6 months and 2 years to make him doubt about his deep value.

Simone Weil (the famous philosopher) wanted to experience in her being the social distress and she did it. She said “In the pain field, the social distress (that she calls unhappiness) is something apart, specific. Why? Because it takes away the soul and marks it, till the deep, of a sign as visible as the one of the red iron on the pariah.
The one who has this mark on the expression of his face, in his language, in his behavior, his clothes, feels it as a shame. Most of the people will turn away their regards.”

The humiliation is violence over all the corporal being, it not only uproots the person of his community but also of himself by the shame it creates.

A situation of social distress results of the interaction between 2 dynamics:

• A cultural, social and economical dynamic that pushes to exclude from generation to generation families with difficulties of adaptation to their institutions and organizations.
• A family internal dynamic that makes difficult such an adaptation. This internal dynamic results of 2 elements:
  • A low family capital from the cultural, social an economical point of view.
  • A wound in the childhood that weaks the personal and social identity.

Imagine that family is a cell whose surviving depends on its exchanges (oxygen and nutrition) with the environment. This exchanges are done by openings: work, consummation, involvement in the decisions, friendship, symbols of social reconnaissance (clothes, jewelry, cars, bags, keys,...).

A person progressively enters in the social distress by following more or less these steps:

1. Isolation and suffocation: when exchanges windows between the family cell and the community are closed, the family suffocates socially. The family is unable to treat the informations that are useful to the favorable adaptation. The family reacts with its social and familial capital, which is properly insufficient, and non-adapted.

2. Non adapted resistance: the family reaction will be interpreted in a wrong way by the environment. The environment comes to say to behave correctly, to assume the responsibilities, and particularly the parental ones. This situation has for consequence to amplify the stress. The family interprets negatively the message and reacts more aggressively or more passively. There is a double misunderstanding. The family becomes toxic for the environment and the environment toxic for the family.

3. Installation: a collapsing of the self-esteem occurs. The person seems to stop fighting. But she is internally betrayed. It follows different processes of self-mutilation as alcohol, drug, violence, and anti-social behavior.

4. Child Symbol: there is a lot of probabilities that the child represents the last symbol of success. This makes possible an ultimate try to regain the self-esteem.

5. Neglected Child: but how to give to the child what you don't have? A recent study of Tourigny, Mayer, Wright, Bouchard, Chamberland, Cloutier and Lavergne shows that over 10000 youth protection's signalmen's about 60 % of the families possesses the social distress's characteristics. For example, when the self-esteem collapses the parent has a huge difficulty to create normal links to his child. Therefor, the child has a lot of probabilities to be strongly neglected.

6. Adolescent in rupture: his chances of scholar success are lowered and by consequence his chances to get an employ. The problem happens from generation to generation. It becomes extremely difficult to get valuables results.

How intervene with chances of success?

Acting together in an unified way.
By the social development :

• Augment the ability of social and economical integration in the community.

By the community development:

• Unify the community around the families in difficulties.
• Offer help to families as soon as the problem shows announcing signs by an approach that valorize the self-esteem.

By the family intervention:

• Help the families in social distress by a multi-dimensional approach after an accurate evaluation.

We are talking of social development:

When the organization has 6 criterions:

• the work is less sequential, there is a low division of the work.
• the work appeals to personal relationships with clients.
• the development of social abilities is a priority.
• we aim a local market.
• we appeal to the solidarity of the community.
• the workmanship receives services in compensation of the low income.

We are talking of community actions:

When action is done with the community, by the community and for the community. The action has then 8 criterions:

• we appeal to the participation of the aimed clients.
• the action and the attitude are valorizing.
• we guarantee the collaboration of the entire services network.
• we are attentive to the interindividual and group peering.
• first of all, we are supplying concrete services responding to basics needs of people.
• we guarantee the cultural accessibility to the services.
• we encourage the receivers of services to become actors of services.
• we assess the results of actions with the actors.

The family intervention:

It's founded on the global and accurate assessment of the family in social distress's situation. The assessments is openly done and contains 7 dimensions:

• the family social integration.
• the dynamic of social organizations towards the family.
• the parental abilities of the family.
• the anterior utilization of services and the apparition process of the problem.
• the couple dynamic.
• the attachment link parent-child.
• the impact of the problem on the child.

The service plan that will result of this assessment would have the following results:

• supply concrete services to reduce the impact of poverty on families.
• improve the cultural, social and parental abilities.
• help the family in it's social integration.
• improve the parents abilities to fulfill their rule towards the children.
• heal the childhood's wounds.
• heal the psychological or social wounds of children and ameliorate the inappropriate behaviors.
• supply the temporary or durable deficiency of the parents.
• insure the security and development of children.

These goals must be selected and hierarchized according to the needs of the families and in priority children.
All this strategy depends on the attitude. The true compassion is the active ingredient. The compassion can only grow in a person convinced by the idea that women and men are united by a same humanity, deserving to participate to life. The compassion results also of the experience that every women and every men share a same vulnerability, fragility and uncertainty that can make us fall down if socially we don't share links of protection and solidarity.