Forming a Unified Framework
Points of Model Integration
Each of the above models nicely pertain and can be used to help families affected by illness. The Double ABCX Model (McCubbin & Patterson, 1983) provides a nice framework of how families cope when stressors/strains are presented. The framework also illustrates the degree to which the family implements resources and explores their perceptions to help them cope when faced with illness or disability. If they are not able to cope well, a crisis occurs. Then, when exposed to other stressors/strains, this crisis is “piled-up” with these additional challenges, and is then experienced by the family to a greater degree. How well the family deals with the pile-up leads to the degree of family functioning. This is measured on a continuum ranging from bonadaptation (good adaptation) to maladaptation (poor adaptation). As a general framework, the ABCX Model does not necessarily pertain to illness and disability, though these are often major stressors for families, and therefore apply to this model. On the other hand, Rolland’s Family Systems-Illness Model (1994) is specifically geared to families dealing with illness. In fact, his model specifically deals with the family structure and the timeline or phases of illness, whereas the ABCX Model does not necessarily detail phases of time associated with stressors and strains.
Points of Model Integration
In this section, concepts from Rolland’s model have been applied to the Double ABCX Model. In some ways it appears that Rolland’s model elaborates upon the Double ABCX Model and seems to give specific examples to the Double ABCX Model as it relates to illness and disability. First, the specific stressor/strain presented to the family is the actual type of illness or disability itself. For example, Rolland (1994) posited that the course of the illness presents certain challenges that another illness may not. Some diseases are more difficult and costly to deal with than others. Some diseases are progressive while others are episodic. Second, in his interface of chronic illness in the family, he discusses the resources (as presented in the Double ABCX Model) that a family can bring when faced with a chronic illness. So, to illustrate this point, in his model, family style (the degree to which a family communicates, is cohesive, and adaptable) can affect coping with the challenges of a specific type of illness or disability (as explained above). Third, he discussed how the family paradigm and meaning of the illness (stigma attached to it) come together. For example, how do family beliefs and values affect how the family perceives and deals with the illness? How does the family approach the illness? How does the patient’s peers and community view the illness?
One of the other things that Rolland’s model contributes to the ABCX Model is that of the inevitability of pile-up when families are faced with a chronic illness. The family is constantly readjusting and changing with the amount of internal and external stressors placed on them as a result of the illness and the costs associated with the illness. In this dynamic state, they then fluctuate somewhere on the continuum of adaptation between mal- (bad) and bonadaptation (good). As mentioned previously, with illness, each day presents differently than others. Some days the patient is found with little pain and/or distress associated with the illness. Other days find the patient and family reeling from the pain and distress associated with the medical condition, as well as from other stressors and strains. Therefore, it is possible for the family to be adjusting well to the stressors/strains presented to them (e.g., the demands of the illness, phase of the illness, costs associated with the illness) one day, and then to not be adjusting well the next day. With this in mind, a family’s functioning or type of adaptation is constantly in a state of flux and varies on the continuum somewhere between bonadaptation to maladaptation.