The Turku Model. Psychosocial support to cancer patients and their families. Parenthood and parenting.

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The Turku Model. Psychosocial support to cancer
patients and their families. Parenthood and
parenting.

• How to work with cancer parents and their
  children experiences from the Turku model.
• Århus, January 26th, 2006

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Main guidelines (1)

• Family approach vs. individual approach
• Child centred
• Integrative a set of different theories is
  needed
• Eclectic Theories and Techniques are carefully
  chosen according to the specific needs of the
  patient and his family

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Main guidelines (2)

• Medical World
• Adult patient and adult spouse
• Child and siblings
• Developmental aspect of individuals and of the
  family as a system

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• Family system
• - individual level
• previous knowledge
• - level of trust
• - trans-generational history

Medical system -the oncologist as a person -the
illness, onset and outcome -the context -culture
in the organisation
Broader context society, values norms, culture
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Medical World

• The features of the disease
• - onset acute vs. chronic
• - course progressive, constant, relapsing,
  episodic
• - level of uncertainty and handicap
• Knowledge about psychopathology
• Knowledge about medication
• Knowledge about the culture of the medical system

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grand father
grand mother
grand father
grand mother
parental couple Couple relationship
father
mother
siblings
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Adult/Parent

• The ill adult patient is also a parent
• Working with the desire to bee a good parent
• Parenthood/parenting
• Reflective functioning ( P. Fonagy)

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Child/sibling

• Age and stage of development
• Own personal temperament
• Genetic capital
• Meaning that children give to what happens to
  them reflective functioning in children
• Only child vs. child and siblings

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Developmental aspects

• Developmental aspects of family members and of
  the family as a system
• Multigenerational patterns
• Belief systems
• Culture
• Communication in the system between family member
  and with outsiders

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Key Concepts

• The key concepts for the integration of all this
  aspects are parenthood and parenting
• - it is a need to make a distinction between
  parenthood and parenting
• - this distinction is relevant for classifying
  perceptions, structuring observations and
  planning interventions in clinical work

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couple relationship
Father
Mother
parenting
parenthood
relationship
relationship
Shadow of illness
Child
individual in-put
interaction in-put
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Determinants for parenthood (1)

• Refers to the inner world of the parent/psychic
  change in the mind of the individual, who becomes
  a parent (cf. D.Stern)
• Transition to parenthood
• Representation of self as a parent
• Representation of the child
• Quality of attachment

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Determinants for parenthood(2)

• Previous knowledge non-verbal, non-semantic,
  experiences of being hold/care
• Individual features/personality
• Impact of illness on parenthood
• Parenthood has to be seen as a process rather
  than as a state (child makes us parent/ adoption/
  maternal instinct)

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Determinants for parenting

• Refers to the external world behaviour/ what can
  be seen
• The working parental couple
• Socio-economical factors
• Communication
• Question does parenting reflect parenthood?
  Relationship between parenthood and parenting?
  Quality of reflective functioning and resilience

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Context in which parenthood and parenting are
realized

• Culture
• Values and norms in society
• Social support and available resources
• Resilience
• Helping systems

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Working with cancer ill parents and their
children (1)

• Attitude
• Shift from disease centred approach to
  parenthood/parenting approach. The patient is a
  mother or a father.
• Shift from the individual level to the family
  level
• When you are on the family level chose the point
  of view of the child and ask, if I would be the
  child of this person, what would I like to happen
  to him/her, which would be good for me?

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Working with cancer ill parents and their
children (2)

• Techniques
• Join the child the patient has once been, a long
  time ago
• Stretch your imagination in order to catch the
  childs experiences
• Familiarize yourself carefully with the files of
  the patient
• Ask always and first what the patient wants to do
  for his/her child

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The work in Turku

• 1.5.02-30.04.04 2063 new patients 678 patients
  were under 54 years. 134 patients were found to
  have children.
• Started the 1st of May 2002 until April 30th 2004
  
• 134 patients were personally contacted. 14
  patients refused. 85 patients participated in the
  research (70).
• 45 families were seen in counselling, 24 families
  in the standard counselling and 17 families in
  the need-specific counselling
• 4 families were seen in need-specific
  counselling, but are not belonging to the
  research sample.

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The Turku Model of Psychosocial Support for
cancer patient

• Joining the family and establish a strong
  therapeutic alliance
• Providing time and space separately for children
  and parent to elaborate on cancer
• Providing time and space for sub-systems
  (couple/siblings) to elaborate on cancer
• Validation of childrens feeling and thought
• Helping parents to see their childrens emotions
  and needs
• Decreasing feelings of guild and facilitate
  communication
• Emphasizing the uniqueness of each family
  experience, enhance hope
• Accompany the family members on their journey
  through loss and grief

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How does it work?

• First session for the parental couple or the
  whole family
• Second session for the whole family
• Third session a) siblings together b)
  parents/single parent
• Fourth session individual session for the
  children
• Fifth session whole family
• ½ year later follow-up session

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Bibliography

• Rolland, J.S. (1984) Toward a psychosocial
  typology of chronic and life-threatening illness.
  Family Systems Medicine, 2 245-263
• Rolland, J.S. (1987a) Chronic Illness and the
  life cycle a conceptual framework. Family
  Process, 26 203-221
• Rolland, J.S.(1987b) Family illness paradigms
  evolution and significance. Family Systems
  Medicine, 5 467-486
• Rolland, J.S.(1990) Anticipatory loss a family
  systems developmental framework. Family Process,
  29229-244
• Rolland, J.S.(1994) In sickness and in health
  the impact of illness on couples relationship.
  Journal of Marital and family Therapy, 20327-349
• Rolland, J.S.(1999) Parental illness and
  disability a family systems framework. Journal
  of Family Therapy, Vol. 21(3), pp.242-266.

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