The Byers Family
Meet the Family. The Byers family lives in Hawkins, Indiana (Duffer & Duffer, 2016). They are a postdivorce family with adolescent children
where Joyce acts as the single caregiver and primary financial supporter of her children (Kaakinen, Coehlo, Steele, Tabacco, & Hanson, 2015). The two boys are attempting to establish their identities and take on larger roles (Kaakinen et al., 2015). They underwent an incredibly stressful event last year when Will, the youngest, disappeared for two weeks (Duffer & Duffer, 2016). Will later turned up alive and uninjured but he is unable or unwilling to reveal details surrounding his disappearance (Duffer & Duffer, 2016). Will only speaks generally of being in a terrible place where he was alone, and constantly afraid (Duffer & Duffer, 2017). A year out, the family is trying to resume normalcy as Will grapples with the trauma of his experience (Duffer & Duffer, 2017).
Jonathan Byers is seventeen years old, is very protective of Will, and distrusts his father and mother’s new boyfriend Bob Newby (Duffer & Duffer, 2017). Since his parent’s divorce, he has tried to take on a larger role in the family as a caretaker and breadwinner (Duffer & Duffer, 2016; Kaakinen et al., 2015).
Joyce Byers works full-time at Will Byers is thirteen the local general store while years old and is trying to raising Will and Jonathan (Duffer establish his identity and & Duffer, 2016). She has independence while recently started a relationship grappling with the trauma with Bob Newby with whom she he experienced and his went to high school (Duffer & mother’s protective Duffer, 2017). Since Will’s behavior (Duffer & Duffer, disappearance, she has become 2016; Kaakinen et al., much more protective of her 2015). children (Duffer & Duffer, 2017).
Bob Newby manages the Radio Shack in Hawkins and feels a strong connection with Will (Duffer & Duffer, 2017). He sees much of himself in Will and, while he does not know the details of what happened to him, is determined to help him through his trauma (Duffer & Duffer, 2017).
Lonnie Byers is Joyce’s ex-husband and the father of Will and Jonathan (Duffer & Duffer, 2016). He briefly reconnected with the family when Will disappeared but has since not been in contact with the family (Duffer & Duffer, 2016).
Will Byers: Will Byers is thirteen years-old making him a young adolescent (Perry et al., 2014). He
is in the identity versus role confusion developmental stage where he attempts to establish his own identity separate from his family (Perry et al., 2014). He is an “A” student at Hawkins Middle School and a part of the Audio/Visual Club with three close friends (Duffer & Duffer, 2016). His friends and he are close and spend most of their free time together enjoying fantasy books, movies, and role play games (Duffer & Duffer, 2016). These interests have made Will and his friends the target of bullies at his school (Duffer & Duffer, 2016). Will confides that the bullying, while subsiding immediately following his return, has reemerged and that the mysterious circumstances surrounding his disappearance has been used by bullies to target him in recent months (Duffer & Duffer, 2016).
Will gets along well with his mother who engages with his interests and tries to reassure him of his safety (Duffer & Duffer, 2016). Joyce generally employs an authoritative parenting style with high expectations while allowing her children to grow into their emerging individual identities (Kaakinen et al., 2015). Sinse Will’s return she has become more protective but still allows Will and Jonathan to spend time with friends outside the house only with more limits and rules (Duffer & Duffer, 2017). Lonnie is an absentee parent so there is no conflict in parenting styles (Duffer & Duffer, 2016; Kaakinen et al., 2015). Bob Newby, Joyce’s new boyfriend, has taken an active interest in helping Will deal with bullies and his fears which has created a conflict between him and Jonathan (Duffer & Duffer, 2017). Jonathan and Will are extremely close with Jonathan acting as a protector, caregiver and provider since their parents’ divorce (Duffer & Duffer, 2016; Kaakinen et al., 2015). Jonathan feels a strong sense of guilt about not being home the night of Will’s disappearance because he picked up an extra shift at work (Duffer & Duffer, 2016). When Will went missing, Jonathan took over the responsibilities of running the house and organizing searches as Joyce struggled to cope (Duffer & Duffer, 2016; Kaakinen et al., 2015). Will Byers suffers from chronic post-traumatic stress disorder (PTSD) resulting from his mysterious disappearance last year (Duffer & Duffer, 2017; Perry, et al., 2014). He occasionally lapses into a catatonic state and re-experiences his trauma referring to it cryptically as “the upside down” (Duffer & Duffer, 2017; Perry et al., 2014), Will cannot articulate what happened to him but feels drawn to “the upside down” at the same time that it terrifies him (Duffer & Duffer, 2017; Perry et al., 2014). He experiences increased anxiety when out in public, even having a panic attack on Halloween when some older kids teased him (Duffer & Duffer, 2017; Perry et al., 2014).
o help the Byers family achieve their maximal level of functioning and wellbeing, the strengths, weaknesses, and practices of
each member and the family as a whole need to be examined (Kaakinen et al., 2015). Will Byers faces a serious mental health problem and this effects everyone in his family. An assessment of the family will help provide an inventory of their assets and challenges, their practices and beliefs, and interactions with each other and those outside the family (Kaakinen et al., 2015). By taking this kind of comprehensive view of family health and the family system, opportunities for health interventions can be identified and employed aimed at making a more resilient and adaptable family (Kaakinen et al., 2015).
Routines and Rituals
The family has little in the way of routines and rituals (Duffer & Duffer, 2017). Because Joyce and Jonathan work, there is no consistent schedule around which to build habits like family dinners and even simple bedtime routines (Duffer & Duffer, 2017). This has lead to a low level of stability, making it difficult for the family to coordinate needs all together (Duffer & Duffer, 2017; Kaakinen et al., 2015). The family identifies as non practicing Christians so there are no routine rituals. However, holidays like Christmas and even Halloween are significant events as these are some of the few days where the entire family can get together (Duffer & Duffer, 2017).
Communication is essential for family health as it is the means by which needs become mutually understood and adaptation to stress can be negotiated and coordinated (Kaakinen et al., 2015). The Byers family is very direct and open with one another sharing not only thoughts and feelings but the reasons behind their actions (Duffer & Duffer, 2017). Joyce employs and authoritative parenting style where rules are created with mutuality in mind and the rationals are explained and left open to conversation (Duffer & Duffer, 2017; Kaakinen et al., 2015). She engages with her childrenâ€™s interests and uses this as a vehicle for facilitating open, honest dialogue (Duffer & Duffer, 2017). Since Will returned, he has had trouble communicating with his family and has withdrawn some- he feels he cannot adequately express his feelings and is reluctant to talk about what happened to him or his experience in â€œthe upside down.â€?
Strengths and challenges: The Family System Stressor Strength Inventory is a useful assessment tool for understanding the
challenges a family faces and and the assets they have to meet those challenges (Kaakinen et al., 2015). This tool allows each family member to report their perception of the family’s general stressors, specific stressors, and general strengths (Kaakinen et al., 2015).
Joyce: Will’s illness is Joyce’s primary general stressor and she feels that she is failing him because she does not know how to take care of him (Duffer & Duffer, 2017). Additionally, she is worried about providing for her children and spending adequate time with the whole family together (Duffer & Duffer, 2017). Jonathan: Jonathan is principally concerned with Will’s condition but has the additional stressor of assuming a caregiver role. He feels like his mom cannot bear the burdens of Will’s needs and his own (Duffer & Duffer, 2017). Will: PTSD prevents Will from engaging in his normal behaviors and leaves him with anxiety and the urge to avoid any potential trigger (Perry et al., 2014). He tries to resume his life but is unable to sustain his normal behaviors and feels he is losing his peer group (Duffer & Duffer, 2017). Bob: Though Bob is on the periphery of the family, he has taken a keen interest in Will’s wellbeing (Duffer & Duffer, 2017). However, he worries that his involvement will alienate Jonathan and is unsure about his role in the family (Duffer & Duffer, 2017).
Joyce: Joyce feels connected to her kids and feels that they are comfortable being honest and talking with her (Duffer & Duffer, 2016). She also mentions that Jonathan has risen to the challenges of the family and that Bob has been a positive influence and has allowed her to relax (Duffer & Duffer, 2016). Jonathan: Jonathan sees the close connection between everyone in the family as the most important family asset (Duffer & Duffer, 2017). Will: Will feels that the devotion that Jonathan and Joyce have shown to him and each other is the family’s greatest strength (Duffer & Duffer, 2017). Bob: Bob thinks that the honesty between Joyce and her kids is the family’s greatest asset (Duffer & Duffer, 2017). He also sees Jonathan’s commitment to the family and his ability to adapt to the needs of Will and Joyce as integral to maintaining stability thus far (Duffer & Duffer, 2017).
Nurse analysis: Will’s illness is taxing on the family’s resources and well being. Their lack of access to proper care stands in the way of making any progress and finding coping tools to allow proper familial and individual development. Additionally, the family’s lack of time together as a unit is an obstacle to proper functioning and adaptation (Kaakinen et al., 2015). The family is closely connected, exhibiting many of the traits that make families adaptable, resilient, and nurturing (Kaakinen et al., 2015). Joyce is encouraging of her children’s pursuits and is providing a nurturing environment in which they can establish their own identities (Duffer & Duffer). Jonathan and Bob have taken some of the burdens of care, running the house, and providing for the family in response to Will’s illness (Duffer & Duffer, 2017; Kaakinen et al., 2015).
Family Systems Theory: The Byers family’s needs can best be understood using
the Family Systems Theory (Kaakinen et al., 2015). This theory examines the family as a whole unit and assumes that family behaviors, whether adaptive or maladaptive, are aimed at obtaining or maintaining stability (Kaakinen et al., 2015). The theory posits that all parts of a family structure are interconnected and that changes to any one part will affect the rest (Kaakinen et al., 2015). Changes and stresses threaten stability so alterations to any one part of the family system necesitate structural or behavioral changes in all other parts of the system (Kaakinen et al., 2015). This theory is best understood in four parts:
Kaakinen et al., 2015, p. 77).
All parts of the system are interconnected: A change to one family member affects all others to varying degrees (Kaakinen et al., 2015). Adaptation to a
stressor or alteration to one family member’s role may require role changes on the part of one or several other members of the family to maintain the stability of the entire structure (Kaakinen et al., 2015). Will’s PTSD prevents him from going to school normally and requires more care and attention than a healthy thirteen year-old would require. This puts additional strain on Jonathan and Joyce and to a lesser extent Bob to provide care and help him develop coping skills (Kaakinen et al., 2015). This requirement adds difficulties to already overburdened members of the family who have faced financial strain for years (Duffer & Duffer, 2017). Under this strain, Joyce and Jonathan’s relationship has suffered and is further compounded by the addition of Bob to the family system (Duffer & Duffer, 2017). Additionally, it is important to understand that Will’s care is limited by the financial realities of his family- they lack the resources and knowledge to find appropriate psychological services for him (Duffer & Duffer, 2017).
The whole system is greater than the sum of its parts: Each member of a family system contributes to the maintenance of the larger entity of the family
(Kaakinen et al., 2015). The family is not simply a collection of individuals, it has its own health and wellbeing that is affected by family members and external events (Kaakinen et al., 2015). As Will suffers from his illness, the entire family suffers (Duffer & Duffer, 2017; Kaakinen et al., 2015).. The Byers family as a single unit is put under strain to try and adapt to this threat to collective stability (Duffer & Duffer, 2017; Kaakinen et al., 2015).
Family Systems Theory continued. Boundaries exist between the system and the environment: Familial stability requires that there be some distinction between the family and other
people, groups, and institutions and that interactions between the family and other entities be regulated (Kaakinen et al., 2015). The boundaries between the inside and outside can be occlusive, permeable, or variable (Kaakinen et al., 2015). Outsiders can serve to promote stability or can act as agents of instability (Kaakinen et al., 2015). Bob, Joyces new boyfriend, is both a stabilizing and destabilizing force who exists within the family but not on the same level as Joyce, Will, and Jonathan (Duffer & Duffer, 2017). He is helpful with Will and supportive of Joyce but his presence alienates Jonathan (Duffer & Duffer, 2017). Will’s friends provide needed emotional support and a safe space for him to interact with the outside world (Duffer & Duffer, 2017). Since Wills disappearance, Joyce has attempted to strengthen the barriers between the family and the rest of the community in order to ward off potential threats (Duffer & Duffer, 2017).
Within the family system there are subsystems: The different relations like siblings, spouses, and parent and child relationships within the family system
can act as their own systems (Kaakinen et al., 2015). It is important to recognise the functions of these subsystems because they can better allow a nurse to target family interventions to utilize existing relationships and structures to achieve a goal or to strengthen a particular subsystem to add strength to the entire family unit (Kaakinen et al., 2015). In the Byers case, the incredibly close relationship between Jonathan and Will is an asset for coordinating care and providing emotional support (Duffer & Duffer, 2017; Kaakinen et al., 2015). However, it is also critical to recognise that the relationship between Joyce and Jonathan could use strengthening because Will’s needs have diverted energy from that relationship and Bob’s presence has served as a wedge between them (Duffer & Duffer, 2017; Kaakinen et al., 2015). Using this theory to examine the Byers family allows the nurse to examine how Will’s PTSD affects the other members of the family and how the other family members affect Will’s coping (Duffer & Duffer, 2017; Kaakinen et al., 2015). The Byers are a family with many problems but, so far, they have been able to meet the challenges (Duffer & Duffer, 2017). However, while the increased demands of Will’s illness have lead to positive adaptation, the strain on the family system appears unsustainable given enough time as evidenced by the growing distance between Jonathan and Joyce (Duffer & Duffer, 2017; Kaakinen et al., 2015). Additionally, Will is unable to receive the care he needs for his condition to improve leading to a vicious cycle of ever present strain that cannot be sustained. It is incumbent upon the family nurse to remove stressors, facilitate outside assistance when possible, and to help create a framework for rebalancing the family’s burdens according to needs and strengths of its members (Kaakinen et al., 2015).
Interventions aimed at assisting the Byers family should aim at improving the adaptive and care capacity of individuals and family, remove barriers to services, provide care to Will directly (Kaakinen et al., 2015). This will increase the family stability as burdens are lifted and rebalanced (Kaakinen et al., 2015). The Byers have a limited income and live in a small rural town in Indiana that lacks Will has a standing weekly appointment with a clinical psychologist appropriate psychological services (Duffer & Duffer, 2016). The Byersâ€™ would benefit from in a neighboring town. Arrangements have been made to allow care coordination that could locate appropriate mental health services in a nearby town Jonathan to leave school early each Friday to take his brother to his and coordinate appointment setting and help arrange transportation (Shepherd-Banigan et appointment. Will is developing coping strategies for dealing with al., 2018). Access to appropriate care is the first step in helping Will and thus reducing the his anxiety and has not seen â€œthe upside downâ€? since treatment care burden of the family. By acting as a coordinator and facilitating access, the additional began. logistical stress is reduced (Kaakinen et al., 2015). The family needs to establish routines for the time they spend together (Bocknek, 2017). Studies have shown that individuals in families with well established routines show greater resistance and adaptation to stressful events (Bocknek, 2017). While everyone in the family is close, it is rare for everyone to be together at once (Duffer & Duffer, 2017). At this stage, it is advisable that the family commit to having family dinners together on weeknights. This will provide structured time for the family to be together to communicate needs and coordinate care and the distribution of resources.
The family has shown tremendous commitment to nightly dinners and Bob Newby has been included twice a week. Jonathan was resistant at first but recognises the positive impact he has with Will. Joyce reflects that she does not think that the family has ever spent this much time together. She feels that these dinners have been valuable in allowing her to check-in with the family as a complete unit.
Will enjoys fantasy fiction and often draws himself as characters in stories and games (Duffer and Duffer, 2016). He would likely benefit from art therapy as a means of anxiety management and even to help him connect with his trauma that he appears to have a difficult time identifying (Schouten, De Niet, Knipscheer, Kleber, & Hutschemaekers, 2015). A systematic review of art therapy studies shows a reduction in trauma symptoms among those who engaged in art therapy (Schouten et al., 2015). By helping Will manage his trauma, the burden of care for the family is reduced resulting in greater overall family health and functioning (Kaakinen et al., 2015).
Will has started drawing for thirty minutes each day. Sometimes it is idle fantasy work but occasionally the artwork takes a darker tone. He reports that he enjoys the escapism and does not find these periods distressing. His mood and demeanor reflect a reduced anxiety level.
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Published on Mar 14, 2018