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Fair Winds and Squalls: The Health Impact of Family Legacies Across the Lifespan

Posted By Alexandra E. Schmidt, D. Scott Sibley, & Caroline Dorman , Tuesday, November 29, 2016


As we prepared to present this topic at CFHA 2016, our team quickly realized that the therapists in the group used the term "family legacy” while our physician colleagues used the term "family culture” to describe how families impact health. We began to wonder, are they the same concept? Related? Totally different? How could we apply both concepts in our clinical work to connect better with patients, improve quality of life and daily functioning, and work towards better health outcomes?


As Ernest Burgess wrote over eighty years ago, "Whatever its biological inheritance from its parents and other ancestors, the child receives also from them a heritage of attitudes, sentiments, and ideals which may be termed the family tradition, or the family culture.” Family culture encompasses values about what’s important, what behaviors are acceptable, and what our relationships should be like. We believe family culture extends beyond parents and children to extended family interactions and families of choice, those not related by blood.


Patients’ decisions about how to care for themselves and how to engage with the healthcare system are infused with multigenerational cultural traditions. Family health culture provides the foundation for beliefs about the role of the patient and the role of the physician, value and meaning assigned to caregiving, causes of illness, and confidence to engage in health maintenance and improvement behaviors. Culture also shapes routine habits and behaviors related to eating, exercising, managing stress, and taking medications.


Beneficial or detrimental, we don’t get to choose our family health culture since it’s a composite of many family members’ beliefs and actions. We can’t change the foods placed on our childhood dinner table, the ratio of our parents’ active versus sedentary time, or how our families and communities have navigated difficult decisions about how and where to care for sick loved ones. As we acknowledge the role of family health culture, where do we honor the impact of individuals’ personal choice on health behaviors and beliefs?


Family legacies, on the other hand, emphasize how individuals take the past and craft it into current actions and use it to influence the future. As Boszormenyi-Nagy and Krasner wrote, "It is the task of the present generation to sort out that which is beneficial and translate it into terms of benefits for future generations.”


In essence, we funnel down the parts of our familial culture (beliefs, values, attitudes) that we wish to pass down to future generations to create a family legacy – in this case, our story about illness and wellness. Rather than passively receiving the habits and beliefs handed down to us, we have the ability to craft our legacy into a story we want others to remember. In addition, we can choose to emphasize health-related habits and beliefs that offer us the most options for a fulfilling life.


As healthcare professionals, what is our role in helping patients develop a healthier legacy? We recommend starting with one simple question: "If you were to change one aspect of how your family approached (or approaches) health, what would it be? How can I partner with you to work towards that goal?” Some patients might need to be prompted with areas for consideration, such as balancing work and self-care time, diet and nutrition, exercise, or communicating with healthcare providers.


The question could also be rephrased as: "What is one thing you learned from your family about how to take care of your health that has worked well for you? How has this been beneficial for you?” We also think it wise to begin asking these questions early with children, rather than wait until they are adults to reflect on healthy habits: "What is something you think your family does a good job of to be healthy and set up good habits? How can you keep up that habit?”


If we want healthier patients who use our valuable healthcare resources responsibly, we don’t have the luxury of ignoring familial cultural beliefs that influence their decision making and goals of care. We must take the time to inquire about patients’ beliefs and habits and how those are influenced by their family culture, even when we feel pressured with packed schedules and growing lists of clinical quality measures.


We must lead the conversation with patients in discussing how to harness the best parts of that family culture to craft a strengths-based legacy that bolsters personal purpose and growth, even in the context of disease, pain, and hardship. Although not the only way, we believe this approach provides a powerful starting point for helping patients and families enjoy as many days with fair winds as possible and have the stamina to endure stormy seas.



Burgess, E. W. (1931). Family tradition and personality. In K. Young (Ed.), Social Attitudes (pp. 188-207). New York, NY: Henry Holt.

Boszormenyi-Nagy, I., & Krasner, B. R. (1986). Between give and take: A clinical guide to contextual therapy. New York, NY: Brunner/Mazel.


Alex Schmidt, PhD, LMFT-A is an avid advocate of family-centered healthcare. She received her PhD in Marriage and Family Therapy from Texas Tech University and completed a Medical Family Therapy fellowship at St. Mary’s Family Medicine Residency in Grand Junction, CO. She now works as an Integrated Behavioral Health Advisor for Rocky Mountain Health Plans, where she partners with primary care practices in strategic scheming and dreaming to sustain integrated behavioral health practices and puts her graduate school research skills to good use to track down relevant, practical resources for providers. 

D. Scott Sibley, PhD, LMFT, CFLE enjoys teaching and researches commitment in couple relationships. He received his PhD in Marriage and Family Therapy from Kansas State University. He completed an internship at the University of Nebraska Medical Center in the Department of Family Medicine. He is currently an assistant professor in Human Development and Family Sciences at Northern Illinois University. 

Caroline Dorman, MD attended medical school at Oregon Health Sciences University after receiving an undergraduate degree in Psychology. She completed her residency at St. Mary’s Family Medicine Residency in Grand Junction, CO. Post-residency, she modeled herself after Dr. Quinn Medicine Woman and practiced in the isolated town of Craig, CO, where she did a little bit everything including CBT and making house calls on horseback. She returned to St. Mary’s to teach and mentor family medicine residents, where she has been inspiring young physicians for ten years. Next year, she’ll enter a new phase of her career providing hospice care.  

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