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Gray Families: An Interview with Sara Honn Qualls

Posted By Barry J. Jacobs, Thursday, December 13, 2012
Updated: Wednesday, December 12, 2012

In the evolution of healthcare, demographics will shape our destiny. On the horizon is the so-called "silver tsunami”—the increasing prevalence of aging Baby Boomers using more and more healthcare resources. But there’s a dearth of American healthcare professionals interested in geriatrics. And there are relatively few collaborative, team-based programs focused on the needs of aging adults.

Psychologist Sara Honn Qualls, Ph.D. has spent her career integrating the evidence-based insights of gerontology with both elegant and pragmatic formulations of family systems thinking. The Kraemer Family Professor of Aging Studies and the director of the Gerontology Center at the University of Colorado, Colorado Springs, she is one of the country’s leading clinicians, writers and educators about families in late-life. Her latest book, Caregiver Family Therapy (co-written by Ashley A. Williams) was recently published by APA Books. It should become a foundational text of not only medical family therapy academic programs but of all family-oriented healthcare training.

Sarah Honn Qualls   Caregiver Family Therapy

I had the privilege of working closely with Dr. Qualls for a year-and-a-half as members of the APA Presidential Task Force that produced the Caregiver Briefcase, a web-based resource on family caregiver research, practice and policy. It was good to hear her quick, incisive voice again as she talked with me about her new book.


BJ: What has led you to focus your career on aging families?

SHQ: My family-of-origin had exposed me to a lot of aging families. Then, while I was an undergraduate during the late-70s and early-80s, I did a workshop in gerontology for which we went out in the field. I was hooked. I just got it. I became interested in the psychology of aging families but there wasn’t much information out there. At the time, however, there was a rich family therapy literature that was mostly based on families with young children. It was fascinating for me to try to translate those early family therapy models into ideas about families of older adults in which there was a lot more ambiguity about what family roles could or should be. When I started working as a psychologist in the aging field, it was clear to me that family is the key social and service context for older adults. Families ought to be key members of the integrated healthcare team but are often considered outside the pale and are left outside team deliberations. 

BJ: Why write the book Caregiver Family Therapy?

SHQ: In the field of gerontology, family caregiving interventions have had a focus on the individual framed mostly in a stress and coping paradigm. But what struck me while talking to caregivers in our clinic is that most of them didn’t seem to think of themselves as individual caregivers dealing with stress so much as they saw themselves as part of families in late-life transition.  

We wrote the book because there was a need to integrate various caregiving interventions into a systemic framework that isn’t addressed in the stress and coping paradigm. How do we help family members walk through an illness trajectory while identifying the transition points that challenge the whole family’s organizational structure. How do we help family members make the transitions they need to make while supporting the development of all family members? All these types of changes require a systems frame to understand and intervene.

BJ: You focus in your book on "naming the problem.” What do you mean by that?

SHQ: Families come into treatment because something isn’t going right for them. Their name for the problem is often not what the healthcare system calls it. That’s a disconnect. For example, caregivers may call me to see their mother for depression when it’s clear to me that their mother also has cognitive changes, possibly dementia. As a professional, I have to gather all the assessment data and integrate it and make sense of it. And then I have to offer that understanding to the family in a way that will be useful to them so that it matches their value system and cultural context and positions them to respond to the practical health and well-being needs of their elder.

BJ: You also focus on what you call "role structuring.” How do you help family caregivers shift into new roles?

SHQ: We have to increase their awareness of the transitions that are required to deal with aging and illness, especially dementia. We then have to figure out the barriers that are keeping them from smoothly making those transitions. In our clinic, we use role plays or imagery exercises to help family members understand what would be a more effective strategy and to make real the risks they run if they insist on playing the same roles they’ve always played.

BJ: You engage family caregivers in problem-solving. What evidence do you have that that kind of cognitive process is effective?

SHQ: Insight is necessary but rarely sufficient, especially when it comes to changing fundamental aspects of our roles across generations. By engaging family members in problem-solving, we are more likely to elicit the real barriers to action or transition—e.g., guilt or fear of conflict with a sibling. The power of change is in helping family members see the problem in a new frame and exploring new resources.

BJ: How can family-oriented healthcare professionals improve their effectiveness with family caregivers?

SHQ: By asking family caregivers to collect clinical data about the patient for us—say, through using reporting scales-- healthcare professionals may become aware of problems that we didn’t even know about. This will lead us to ask ourselves different questions about how to help our aging patients and their devoted family members.

Barry J. Jacobs

Barry J. Jacobs, Psy.D. is the Director of Behavioral Sciences for the Crozer-Keystone Family Medicine Residency Program in Springfield, PA and is the author of The Emotional Survival Guide for Caregivers.

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