Year

2013

Degree Name

Doctor of Philosophy

Department

School of Psychology

Abstract

Having a loved one with a substance use and/or mental health disorder has a significant negative impact for family members or carers, and it often results in the loss of ideals and lifestyle. The aim of this thesis was to investigate family members’ or carers’ personal identities when they are recovering from the impacts of their loved one’s substance use and/or mental health disorder. A number of processes have arisen from previous investigations into family recovery. One of those processes is identity; however, research into the process of identity has been neglected.

Family members or carers often undergo a process of recovery which is similar to their loved one. This recovery journey is personal, dynamic and needs to focus on the family members’ strengths not only on their deficits or problems. ‘Personal and Relational Empowerment’ is a term that could be used to describe the recovery journeys of family members or carers, as they seldom see themselves as being in recovery. A ‘Personal and Relational Empowerment’ framework focuses on the intrapersonal and interpersonal relationships of family members. This framework concentrates on the family members’ needs and living their lives in line with their values. Identity is viewed as a fundamental component of ‘Personal and Relational Empowerment’. Personal identity involves the personal meanings that individuals assign to their identity; and can be viewed as the relationship people have with themselves. There is often a discrepancy between how people perceive themselves and how they would ideally like to be. This discrepancy produces feelings of frustration and disappointment; therefore, family members may be motivated to decrease these feelings by moving towards their ideal self (decreasing selfdiscrepancy).

Investigating personal identity may enable the identification of ways to help promote not only coping but also encourage growth and development of the family member towards a ‘preferred’ or ‘ideal’ self. Therefore, the internal processes of identity were investigated with the following research question: How do family members perceive themselves and others in regards to selected personal constructs? Personal identity may also affect or be affected by the other processes associated with recovery. Therefore, the relationship between identity, specifically self-discrepancy, and processes of recovery were investigated with the following research question: What is the relationship between identity (self-discrepancy) and other processes associated with recovery, such as, grief, coping, well-being and stigma? Support groups provide an opportunity for families to share their experiences and to receive help and guidance. What family members or carers experience in the support group may be used within the family to help improve family functioning. Personal identity may also provide an insight into the way that family members perceive their family and support group. Therefore, family, support group and identity were investigated with the following research question: What is the relationship between how the family members perceive their family and the support group? Interviews were conducted to identify themes that occurred from the time the family members’ loved ones had a substance use and/or mental health disorder and after 12 months. The following research question was investigated: What themes are identified in the interviews at the start and after 12 months?

To investigate the research questions a mixed methods design was used. The quantitative component involved the use of questionnaires and a repertory grid. There were seven questionnaires which focused on experiences of care giving, hope, wellbeing, grief, family, support group and recovery. The repertory grid technique was used to examine identity from both ideographic and nomothetic perspectives. The qualitative component involved semi-structured interviews. The participants were drawn from support groups and services for family members or carers impacted by their loved ones substance use and/or mental health disorders. The research included both cross-sectional and longitudinal data collection. The cross-sectional study involved 77 participants (17 males, 33 females; average age 58.67 years) from eight drug and alcohol carer support services throughout New South Wales and the Australian Capital Territory, Australia. The longitudinal study conducted over 12 months (Time 1 and Time 2) involved 44 participants (11 males and 33 females; average age 62.02 years) from the ‘Very Important Families’ support group provided by the Salvation Army, Wollongong, New South Wales. Nineteen of these participants (5 males and 14 females; average age 62.84 years) were involved in the interviews at Time 1 and Time 2.

Many of the findings in relation to the internal processes of identity are related to the family members’ different selves (i.e., ‘best self’, ‘ideal self’ and ‘past self’) and their loved one. Initially, family members perceived their ideal self and loved one as significantly different; however, after 12 months they perceived them as being similar to each other. Over time family members viewed their loved one more positively and differently from how they viewed themselves on their best day.

Over 12 months there were significant changes in the recovery processes that reflect an intrapersonal relationship (e.g., hope, well-being, personal sacrifice and burden). However, there were no significant changes in those recovery processes reflecting an interpersonal relationship (e.g., experiences of caregiving and worry and felt isolation). It was found that decreases in self-discrepancy predicted increases in the positive aspects of care giving (e.g., emotional well-being and social well-being).

Self-discrepancy moderated the relationship between social learning and how much family members identified with the support group. This finding suggests that the degree to which family members identify with the support group is influenced by the combination of both a movement towards their ideal self (i.e., a decrease in selfdiscrepancy) and how much family members are able to generalise their experiences between the support group and family (i.e., an increase in social learning).

In regards to the interviews, initially the family members’ focus was on the behaviour of their respective loved ones. After 12 months, the focus was mainly on the family members themselves with references to their loved one, other members of their family and the community. The themes occurring after 12 months, identified using Leximancer v 3.5, were more positive than those at baseline. Initially, there was a focus on the negative impacts that their loved one’s substance use and/or mental health disorder had on family members. This negative impact was not only in the past but was currently experienced by family members. After 12 months there was a more positive outlook which persisted regardless of whether their loved ones were in recovery or not. After 12 months, family members spoke about life being better than the past, happier in the present, and more optimistic about the future.

These findings have implications for services providing support for families, particularly in terms of family members refocussing their energies on their own lives. This may enable family members to clarify who they are and who they want to be, and use their own strengths to practice their preferred identities. That is, fulfilling the higher order needs, and moving towards self-actualisation as described in the ‘Personal and relational empowerment’ framework. The movement towards an ideal self has been shown to lead to increases in hope, well-being and the quality of their interpersonal relationships. This increase in the positive aspects of care giving may influence other interpersonal relationships such as those in the community, support group and family.

This research indicates that family members’ or carers’ personal identities are changed when they are impacted by, and recovering from, their loved one’s substance use and/or mental health disorder. Family members initially focus on their loved one and perceive them more negatively. Over time family members focus more on themselves, where they perceive themselves more positively and are optimistic about their future. This finding has impacts on the positive aspects of care giving, as well as the relationship between family members’ ability to generalise their experiences between the support group and family, and the degree to which they identify with the support group. Regardless of whether their loved one was in recovery or not, when family members refocus on themselves a number of positive outcomes are achieved.

FoR codes (2008)

1117 PUBLIC HEALTH AND HEALTH SERVICES, 1701 PSYCHOLOGY

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Unless otherwise indicated, the views expressed in this thesis are those of the author and do not necessarily represent the views of the University of Wollongong.