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The Family Adaptation to Medical Stressors (FAMS) was developed as a measure of family process and adaptation to stress. Three tests of reliability and three tests of validity were performed, using data from interviews with ten families on two occasions and questionnaires completed by 214 respondents. The instrument was found to be both valid and reliable. Interrater reliability, test-retest reliability, internal consistency, and face validity ranged from .75 to .99. Each exceeded the criterion of .70. Six factors were identified using a classical factor analysis with orthogonal rotation. When these factors were scaled and correlated with respondents' scores on a measure of criterion validity, five of the six correlation coefficients were significant (p <.O1). It was concluded that the instrument measures multidimensional constructs which are associated with family adaptation to medical stressors.As the extrafamilial environment becomes increasingly complex, the family and its members experience more varied and frequent intra-and extrafamilial stressors. Thus, the study of family adaptation to stress has become increasingly important. In order to facilitate coping, we must first understand the processes which exacerbate and ameliorate stress within families. A first_step toward this understanding entails developing a means of measuring family experiences relevant to adaptation to stress.Three major reviews of the family theory and empirical literature in general and of the family stress literature in particular have been published in recent years (2,4,15). In addition, McCubbin and Patterson (16) have published a manuscript containing eight measures of family stress which synthesize previous measures of family stress and coping.Two conclusions may be drawn from this body of literature and from a review of studies of family stress and coping subsequent to it. First, while family stress continues to be conceptualized and measured in terms of Hill's (11,12) linear and nonrecursive model, the consensus among those who study the family is that the time has arrived to focus on the processes which create and /or perpetuate the outcomes heretofore

A model of family adaptation to chronic illness is described. The model predicts that, when family rules allow for expression of emotions and when family roles are flexible, the adaptation process will be effective. When family rules prohibit emotional expression or family roles are inflexible, adaptation will be ineffective. Ineffective adaptation is characterized by a pile-up of stressors that are related to the adaptation process and that increase the likelihood of negative mental health outcomes for the patient and family members. The implications of this model for prevention and treatment are described, and suggestions for testing the model discussed.When a family member becomes chronically ill, two questions about the family's adaptation process arise. The first asks whether the family's premorbid adaptation played a role in the etiology of the illness. The second question concerns the family's adaptation following the onset of the illness and the implications of that process for the mental health of the patient and his/her family. Characteristics of the family's premorbid adaptation inevitably reappear in the post-diagnosis adaptation (24). However, the preventive mental health implications of a family's adaptation to a chronic illness may be more easily addressed by focusing on the second question.The development of empirically-based preventive mental health interventions for families following diagnosis of a chronic illness may be viewed as a three-stage endeavor. First, a conceptualization of the family adaptation process following the diagnosis is necessary. The conceptual model must include testable hypotheses related to negative mental health outcomes for family members, as well as clear implications for preventive interventions by health care providers and mental health practitioners.The second stage in prevention research involves testing the hypotheses which

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An integrated systemic‐psychodynamic approach to the treatment of characterological disorders within conjoint marital therapy is suggested. Spouses' personality disorders may serve a homeostatic function within the marital relationship. Thus, any effort to effect change on either the marital or individual system level must address both the individual and relationship distress. Borderline personality disorder, an extreme characterological impairment, has been considered intractible, although object relations therapists have experienced success in treating such clients. The present paper draws from object relations and systemic therapies in developing a treatment approach to marriages which include at least one borderline spouse. A case example illustrates the conceptualizations and interventions which are proposed.