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2195 words (9 pages) Essay in Family

18/05/20 Family Reference this

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The purpose of this paper is to explore the Double ABCX Model of family stress as a viable framework from which to study the work of the National Alliance on Mental Illness (NAMI), and specifically my internship with NAMI-Eastside’s programs, namely the Family-to-Family program. The Double ABCX Model explains the phenomena that families experience when an adult family member lives with mental illness are part of a crisis formula, and how certain factors can predict and explain the trajectory of crisis recovery.  When resources such as the Family-to-Family program are added to the coping strategies of such family members, their levels of self-perception of strength and  optimism increases (Bademli & Duman, 2014). This paper examines the mechanisms involved in the efficacy of the Family-to-Family support group through the lens of the Double ABCX Model,  and my personal experiences as an intern where I witnessed the positive impact this organization has on the local community.

Keywords:  Double ABCX Model, mental illness, NAMI, Family-to-Family, internship

Caring for children with serious mental illnesses does not end for their families when they grow into adulthood. The isolation and lack of psychosocial support commonly experienced by the caregiving family members of patients with serious mental illnesses can lead to depression and anxiety which can, in turn, negatively affect the prognoses of the patients (Bademli & Duman, 2014). Family education and support programs such as NAMI’s Family-to-Family program are designed to target this specific population of caregivers; to provide information, resources, and community support in order to help caregivers increase their knowledge of mental health while maintaining their own well-being. During my internship with NAMI-Eastside in Redmond, Washington, I helped facilitate their 12-week Family-to-Family program which met every Saturday from February 02, 2019 to April 27, 2019. During those sessions, and during the other activities I carried out for NAMI during my internship, I recognized events and stressors that fit into the Double ABCX Model of family stress. Using this type of family stress theory as a guide, I was able to gain insight regarding NAMI’s role in the community and my role as an intern interested in having a positive impact on those affected by mental illness.

The Double ABCX Model

The Double ABCX Model was developed by Hamilton McCubbin and Joan Patterson as a modification of the ABCX Model created by Reuben Hill in 1958 (Lavee, McCubbin, & Patterson, 1985). The original ABCX Model posits that an event or stressor (A) interacts with a family’s resources for crisis-management (B) and the family’s perception of the event/stressor (C), to produce the actual crisis (X). In the Double ABCX Model (see Figure 1), McCubbin and Patterson added post-crisis variables (aA Pileup of Demands, bB Adaptive Resources, cC Perception, and xX Family Adaptation – either Bonadaptation or Maladaptation) to explain the mechanisms that lead to a family’s recovery from crisis over time. Within the context of my internship, I observed family member caregivers who had experienced Precrisis (e.g., a crisis-precipitating event such as an adult child diagnosed with a serious mental illness), Crisis (i.e., the family’s inability to retain stability), and Pileup, when the hardship of the stressor compounds over time while caregivers are dealing with the effects of chronic serious mental illness in their loved ones.  The outcomes of the Family-to-Family program, an example of factor bB Adaptive Resources, impacted the caregivers’ outlook (variable cC Perception). By the end of the program, many of those family caregivers felt they benefitted from the information and support given. Their positive coping mechanisms could lead them to a Bonadaptation outcome in the xX Family Adaptation variable, if they could continue to use those skills and mindsets at home.


NAMI’s Family-to-Family program is a peer-led educational support program for families or friends of adults living with specific mental health disorders: depressive disorders, bipolar disorder, schizophrenia spectrum disorders, borderline personality disorder, anxiety disorders, obsessive-compulsive disorders, Trauma-and stressor-related disorders, and addictive disorders . The trained instructors provide up-to-date information about major mental health disorders, including DSM-5-defined symptoms, evidence-based treatments, and local resources for support and services. During our Saturday sessions, this information was shared and discussed, important skills in the areas of communication and crisis problem-solving were taught, and families’ concerns were handled with empathy and compassion. The structured curriculum covered specific subjects each week (e.g., Week 2: Understanding Schizophrenia and Mood Episodes [depression and mania]). Much of the information they covered each week contained material I had already learned at Eastern Washington University, but I acquired an incredible amount of knowledge regarding the objective life burdens of these primary caretakers.  They face enormous challenges. For instance, one set of parents with an adult son living with schizophrenia struggled with the legal barriers impeding them from trying to seek treatment for their son. Other parents felt helpless as their sons or daughters made multiple attempts to commit suicide. HIPAA laws seemed to a be a common obstacle for these parents, as many of their sons and daughters were non-compliant in their treatment programs and HIPAA prevents healthcare personnel from discussing the cases with the parents of adult children unless explicit documents are on file regarding authorization to disclose medical information, signed by the patients. Despite the patients’ resistance to treatment, the parents feel compelled to endure in their roles as caregivers; they’re reluctant to abandon their children. Although each story shared was unique and some of their children had disorders in common, the strongest theme that seemed to emerge was that these parents were committed to a lifetime of painful ups and downs with no “happy ending” in sight. I noticed that as the weeks passed and the participants grew more comfortable sharing their situations with the others, there was an overall feeling of relief in the knowledge that they all shared similar feelings of grief, anger, entrapment, and guilt that accompany caring for someone with a chronic illness. Because the classes are a strictly confidential environment, it was safe for them to express these taboo feelings – feelings that sometimes bubbled up despite their love and devotion to their children – with the only other people in the world who could truly understand.

The National Alliance on Mental Illness. NAMI is a grassroots, non-profit organization which advocates for mental health awareness to improve the lives of people living with mental illness. The NAMI-Eastside office serves the East and North King County communities by operating peer and family support groups, conducting Washington state training for group facilitators, battling mental health stigma by providing mental health education presentations in schools, guiding those living with mental illnesses with the evidence-based W.R.A.P. program, and advocating for improved mental healthcare delivery by lobbying for government policy change. They do all of this with just three paid employees and the power of volunteers.  The broad scope of services NAMI offers is made possible by individuals who prove that many hands make light work. The Family-to-Family program session I helped with took place on Saturdays from 9am -12pm. I arrived by 8am each Saturday, bringing travel containers of coffee for the group, and arranged the conference room with the materials needed for the 18 participants and  2 teachers. There were large signs, banners, and street signage to set up, as well as a display of multiple NAMI flyers, along with class materials needed for each individual. Two of the sessions took place at an off-site location and I transported the materials and helped to setup, breakdown, and return the site to its original condition. I assisted with small group sessions for skills training and discussions, but mostly observed and took notes during class time. The group facilitators maintained a Google Classroom online for the participants to access supplemental materials and to make inquiries, and I assisted the facilitators by researching and providing information for the site.

As NAMI-Eastside manages multiple programs and events, they naturally have the need for assistance in a variety of areas. Although my internship called for only a four-hour volunteer time-commitment, I found myself dropping in during the week to lend a hand when needed; the longer I worked there, the more I could see that the community need for mental health support far outweighed the manpower available to provide it. Using feedback from participants in certain NAMI programs whose loved ones had encounters with law enforcement, I helped compile a document that was used to provide feedback for the King County Crisis Intervention Training classes for first responders. One week I manned the NAMI table at the King County Community Court and Resource Center in the Redmond public library. In the company of over 25 social service agencies, I witnessed individuals being expedited through Maslow’s hierarchy of needs as they made the rounds of services offered and were able to secure food, housing, health insurance, access to job training and higher education, and mental health support. Again, I was shown that the community support provided by NAMI is a vital resource for families experiencing crisis, whether that crisis is serious mental illness, homelessness, or lost income from unemployment or incarceration.  On June1st and 8th I will operate the NAMI-Eastside booth at the Issaquah Farmer’s Market. Tabling events like these increase mental health awareness and reduce mental health stigma. Studies have shown that the perception of stigma towards individuals who live with mental illness can negatively impact mental health help-seeking behaviors (Clement et al., 2015). NAMI operates under the knowledge that maintaining a ubiquitous public presence normalizes mental health as a topic that can be discussed in open conversation.


Although I was only able to help with a small selection of activities in the community, I became aware of the broad array of  essential services that NAMI-Eastside manages to provide with limited resources. When I later studied the Double ABCX Model, it dawned on me that the bB Adaptive Resources variable, involved in mitigating Pileup in the Postcrisis period, needed to do more than merely exist in order for a family to recover from crisis. To achieve Bonadaptation, the positive family adaptation option for variable xX, there must be great power in the bB Adaptive Resources variable. I witnessed the Family-to-Family program change the lives of the families who attended the February – April 2019 session.  Bearing the weight and responsibility of  caring for a loved one with serious mental illness is a task that may carry on for years, if not a lifetime.  These families may have struggled with their crises by forming, or continuing to practice, maladaptive coping mechanisms, to the detriment of their loved ones. Instead, they reached out for help, came together to learn new information and new ways to cope, and in the process found support and compassion. Their shared burdens were lightened by their new knowledge and the comfort of a tribe mentality, where they know they are not alone in their struggles. Most of the participants went on to form a family support group among themselves, which is underwritten by NAMI but will be self-sustaining through the efforts of the members.  My internship with NAMI-Eastside had a profound impact on my view of community mental health. It showed me that the reality of the need for increased mental health support is much more urgent than I had previously thought. The energy level and amount of dedication in the three salaried employees I worked with far exceeded those of any employees I have met in other industries. I was left inspired by their passion for mental health advocacy. I am grateful for the real-world experiences that this internship allowed me because not only did I have an opportunity to witness mental health support in action, but I was also able to confirm that my choice to work in the field of psychology would bring great satisfaction through relieving others of psychological pain.


  • Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., . . . Thornicroft, G. (2015). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine, 45(1), 11-27. doi:10.1017/S0033291714000129
  • LaBademli, K., & Duman, Z. Ç. (2014). Effects of a Family-to-Family support program on the mental health and coping strategies of caregivers of adults with mental illness: A randomized controlled study. Archives of Psychiatric Nursing, 28(6), 392-398. doi:10.1016/j.apnu.2014.08.011
  • Lavee, Y., McCubbin, H. I., & Patterson, J. M. (1985). The Double ABCX Model of family stress and adaptation: An empirical test by analysis of structural equations with latent variables. Journal of Marriage & Family, 47(4), 811. doi:10.2307/352326





The Double ABCX Model of Family Stress and Adaptation (Lavee et al., 1985)

Figure 1. Double ABCX Model (Lavee et al., 1985)

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