Lesson #5: The Homeostasis Bug-a-Boo

I was a naive Ph.D. student when I first encountered the concept of family systems. Maybe it was an indicator of my immaturity regarding my own family dynamics that I firmly resisted learning about the concept. I much more liked the notion of dealing with people as individuals, talking to them about what they’d done in their past, dreaming about the future, and offering the wisdom I gleaned from books and stored in my head. I had a hunch that dealing with the reality of families and their systems would involve a lot of messy work. Dealing with ideas in my head and talking about them was so much cleaner!

Lo and behold, I learned that no matter how wise my advice seemed in the individual counseling hour, no matter how cool the ideas were that we discussed, whatever clients had acknowledged when talking with me got profoundly altered, if not completely dismissed, when they got back with their families. Grudgingly I came to realize that when an individual came into my office, ghosts walked in with them. I HAD to acknowledge how profoundly their family systems affected their interactions with me, both in the counseling hour and otherwise.

This dynamic plays with special strength when one proposes a support team to a patient. By definition, this proposes doing some engineering to the system as it exists, and if the system doesn’t have a custom of incorporating extra-familial forces, the persons may politely refuse to cooperate. You see, families want to maintain – here’s the word – homeostasis. They want things to stay the way they’re used to them because that reduces their level of anxiety.

Murray Bowen and Virginia Satir were the first to fully describe this dynamic and scores of therapists have added to this particular body of knowledge. Basically, “homeostasis” refers to a family’s desire for balance and control such that the family can maintain the customary way the family interacts in order to handle challenges and adjust to changes. When an illness occurs, anxiety increases and most families move as quickly as possible to restore their normality as it was before the illness, which will lower their anxiety. Families reflexively apply their customary means of problem solving on the new situation. For families that have maintained a more independent posture relative to extra-familial relationships, the offer of a chaplain to organize a support team introduces the idea of another change, and subsequently raises the family’s anxiety level.  The offer, which the chaplain meant as a kind invitation, instead feels more like a threat.  Even if the chaplain or care-giver can compile a list of objective data that indicate a need for a support team, those factors remain subject to the family’s customs.

Some families, as a component of their customs, include more permeable boundaries. In such cases, the offer of a support team results in an invitation to be one more part of their system, which already includes extra-familial relationships.

In all cases, whether or not a family accepts a support team depends upon the nature of that family’s sense of homeostasis. It will behove the chaplain to spend some time discerning the character of a particular family’s dynamics. When the chaplain has a non-judgmental understanding of a family’s unique style of relating – how they lower their anxiety – then he or she can fashion an approach toward offering the nurturance of a support team.

At this point, gaining the acceptance of a support team becomes more art than science. The chaplain or care giver needs to customize the manner in which they educate families as to the need. Some families see the need for a team straight away and immediately begin to adjust to the presence of an organized regimen of friends and family showing up. Others require more gently applied education so that they arrive at the conclusion that the presence of a support team only strengthens their system in a healthy manner. Again, the level of trust developed between the chaplain and the family plays a crucial role in how a family hears the chaplain (see Lesson #4).

In all cases, families that eventually accept support teams recognize the presence of the team as a sign of strength, wisdom, and health, not as a judgment on their customary manner of doing things, but a means to lower their anxiety.

Ultimately, each family differs to some degree from other families.  What feels right to one family won’t correspond exactly to what feels right with another.  There isn’t a template beyond being what Ed Friedman called “a non-anxious presence” who listens with as little pre-judgment as possible.  What I had a hunch about in graduate school some 30 years ago holds true: it’s a messy process.