A child's environment
"A family is to a child as water is to a fish."
The 'nurturing system' that is the family is the most basic, most central context for a child's well-being and development. The emotional, caring surrounding that a family provides for a child is probably the single most important factor in that child's life. Nurturing systems, whether we call them families or not, come in all shapes and sizes and have a wonderful flexible variety as to the way they can work towards the common goal of the welfare of children. This idea is certainly not a new one; in many respects it has become a taken-for-granted assumption. Yet families who bring their child to a mental health professional often approach that event with a mixture of feelings. Will they feel welcomed, helped, criticized, even blamed? The psychiatric evaluation process should ideally be a family-friendly one. Since families are the most important context for the child, they should be welcomed and actively involved in the evaluation process as collaborators in a joint endeavor to create the best treatment approach for their child.
What is a family assessment?
The family stands at the interface of nature and nurture. The relationship between the biological givens of the child and the environmental influences of the family (including the biological givens of the various members) come together in a system of complex, mutual influence. Just as the 'nurture' of the family shapes the development of the child, the nature of the child shapes the expressions of nurture of the family. It is a reciprocal process of 'co-evolution," one that optimally creates a 'good-enough' fit for all members of the family.
As the meeting place of nature and nurture, the family should be a central part of the evaluation process when a child is brought for a psychiatric evaluation. Having said this, it is vitally important to emphasize that mental health professionals are not interested in blaming a family for a child's psychological, emotional, or behavior difficulties. Families need support, not blame, affirmation for their efforts and what they are doing right, not criticism or judgment.
A family assessment should proceed in the spirit of joint inquiry and collaboration. Families are experts on their own children. Professionals have expertise in diagnosis, assessment, and various forms of treatment. Family members should have their ideas and perspectives elicited and respected. Each family member, even small children, have unique perspectives that can be usefully included in developing a constructive plan of action. Therefore, as many family members and relevant others as possible (including ancillary members, extended family, even professionals who play key roles in managing or affecting the child and his/her problem) should participate.
A family assessment looks closely at the nurturing 'ecology' of the child and family, integrating family systems theory with newly emerging understandings about human behavior from such domains as neuroscience, biological psychiatry, trauma research, genetics, and infant developmental research. Each of these domains of knowledge defines an aspect of human development and experience that exists in a mutually shaping relationship with all other aspects. Like the Sufi story of the eight blind men who each understand only their piece of the elephant without the benefit of seeing the whole elephant, each of a child's domains offers a partial description of what it is to become a person. A family assessment, using the framework of systems theory, creates a 'ninth observer' who can see the entire elephant and how all the parts fit into a whole.
Families seeking help often present with what is called a 'problem-saturated' version of who they are. Families, too, can fall prey to the limitations of the blind men and the elephant, seeing only one aspect of their lives because this aspect has become so prominent and dominant. Their lives have been so consumed by the demands of dealing with a child's problem that the stories that shape their identity begin to consolidate around the problem and their struggle to cope. A family assessment should help family members adjust their perspective and see that although the problem is a big part of their lives, it is not the whole of their lives.
Reprinted with the permission of the NYU Child Study Center. © NYU Child Study Center.
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