The circumplex model and head injury family types: A test of the balanced versus extreme hypotheses

The long-term physical, cognitive, and psychosocial deficits that result from head injury affect an individual's interpersonal, emotional, and vocational functioning (Kay & Lezak, 1990). Consequently, the needs for care and assistance of persons who sustain head injuries and the costs of meeting such needs are substantial. Given that the responsibility for the lifelong well-being of persons with head injuries rests primarily on the individual's family (DeJong, Batavia, & Williams, 1990), head injury affects not only the person who sustains the injury, but the individual's entire family system. Unfortunately, an extensive body of literature provides firm evidence that head injury hurts families socially, emotionally, and financially. Kozloff (1987) found that one of the most profound changes following a member's head injury was the social isolation of families. Jacobs (1988) reported that a recurring family worry was the chronic financial strain due to the person with the head injury not working and loss of income if a family member gives up work to supervise the person with the injury. Shock, disbelief, denial, and anger are common in relatives immediately following injury (Mathis, 1984). Problems with role functioning, marital relationships, and the physical health of individual family members become evident during the first year after injury (Livingston, 1990). As time goes by (i.e., from two to six years after injury), depression, poor communication, and drug and alcohol abuse are observed among family members. Finally, Thomsen (1984) concluded that family functioning is negatively affected by personality changes in the person with the injury and the day-to-day strain of meeting his or her needs for up to 15 years after injury. Given the fact that head injury undoubtedly exerts a large and lasting toll on families, rehabilitation professionals working with families of persons with head injuries can benefit from information useful for planning family assessment and intervention and the development of long-term family support services (Miller, 1993; Rosen & Reynolds, 1994). As recommended by Kosciulek (1995), a useful starting point for designing services for families of people with head injuries is to understand underlying patterns of family functioning, or family types. Family types, defined as a "set of basic attributes about the family system which characterizes and explains how a family system typically, appraises, operates, and/or behaves" (McCubbin & McCubbin, 1991, p. 6), can play a vital role in head injury family assessment, intervention, and research. They may provide clues to rehabilitation professionals about how to best help families following a member's injury. Olson's (1993) Circumplex Model of Marital and Family Systems, a resource for assessment-based treatment planning with families experiencing stress, provides a clinical and theoretical framework for studying head injury family types. Brief Overview of the Circumplex Model The Circumplex Model of Marital and Family Systems bridges family theory, research, and practice. The central dimensions of family behavior integrated in the model are Cohesion and Adaptability (Olson, 1993). Family Cohesion is defined as "the emotional bonding that family members have toward one another" (Olson, Russell, & Sprenkle, 1983, p. 70). As shown in Figure 1, within the Circumplex Model there are four levels of Cohesion ranging from extremely low (disengaged), to moderate (separated, connected), to extremely high (enmeshed). Family Adaptability is defined as "the ability of a marital or family system to change its power structure, role relationships, and relationship rules in response to situational and developmental stress" (Olson et al., 1983, p. 70). There are four levels of adaptability ranging from extremely low (rigid), to moderate (structured, flexible), to extremely high (chaotic). The Family Adaptability and Cohesion Evaluation Scale II (FACES II) (Olson, Bell, & Portner, 1990) is a family self-report instrument based on the Circumplex Model designed to assess family type. …