Conceptual Models

Multiple theoretical models and frameworks can serve as a basis for psychologists’ clinical services for caregivers. Although derived from practice concepts in varied settings, the models below all offer guidance for psychologists seeking to intervene effectively with caregivers.

Key concept:

A family’s functioning in the face of illness and disability is the outcome of the interaction of:

• The family’s developmental stage.
• The illness “typology”, which is the expected course or trajectory of change over time.
• The family system, including structural and functional characteristics.

For further reading

Rolland, J. S. (2005). Cancer and the family: An integrative model. Cancer, 104(S11), 2584-2595. doi: 10.1002/cncr.21489

Key concepts:

• Personal well-being is greatest when environmental demands match a person’s capabilities.

• Environments can be modified to support higher-level functioning and improvements in well-being.

For further reading

Lawton, M. P. (1999). Environmental design features and the well-being of older persons. In M. Duffy, Handbook of counseling and psychotherapy with older adults (pp. 350-363). New York: Wiley.

Stokes, J. E. (2019). Implications of perceived neighborhood quality, daily discrimination, and depression for social integration across mid- and later life: A case of person-environment fit? The Gerontologist, [Advance online publication]. doi: 10.1093/geront/gnz103

Wahl, H., Fange, A., Oswald, F., Gitlin, L., & Iwarsson, S. (2009). The home environment and disability-related outcomes in aging individuals: What is the empirical evidence?. The Gerontologist, 49(3), 355-367.

Key concepts:

• This model is an extension of structural family therapy’s approach to psychosomatic families.

• It posits that family relational patterns and the individual’s biobehavioral reactivity interact to affect the health of children with illness and disability.

For further reading

Priest, J. B., Roberson, P. N. E., & Woods, S. B. (2018). In our lives and under our skin: An investigation of specific psychobiological mediators linking family relationships and health using the biobehavioral family model. Family Process, 58(1), 79-99, doi: 10.1111/famp.12357

Key concepts:

• The goals of psychotherapy are to increase “agency” (taking active steps to improve one’s own well-being) and “communion” (sense of being supported)
• Mental Health therapists need to learn the skills of collaborating effectively with physical health providers.

For further reading

Hodgson, J, Lamson, A, Mendenhall, T, Crane, DR (eds) (2014). Medical Family Therapy: Advanced Applications. New York: Springer.

McDaniel, SH, Doherty, WJ & Hepworth, J (2014). Medical Family Therapy and Integrated Care--Second Edition. Washington, D.C.: APA Books

Key concepts:

• Caregiving is inherently stressful due to tasks and time demands, with secondary effects on other aspects of daily life.
• Coping strategies can buffer or exacerbate the negative effects of stress.

For further reading

Aneshensel, C. S., Pearlin, L. I., Mullan, J. T., Zarit, S. H., & Whitlatch, C. J. (1995). Profiles in caregiving: The unexpected career. San Diego, CA: Academic Press.

Folkman, S. (1997). Positive psychological states and coping with severe stress. Social Science & Medicine, 45(8), 1207-1221. doi:10.1016/S0277-9536(97)00040-3

Pearlin, L. I., Mullan, J. T., Semple, S. J., & Skaff, M. M. (1990). Caregiving and the stress process: An overview of concepts and their measures. The Gerontologist, 30, 583–594.

Key concepts:

• The majority of families with a child with cancer are competent, highly organized families.
• Assessing a family’s level of universal, selective or indicated risk can help determine an appropriate intervention strategy.

For further reading

Kazak, A. E., & Noll, R. B. (2015). The integration of psychology in pediatric oncology research and practice. American Psychologist, 70(2), 146-158, doi:10.1037/a0035695

Key concepts:

• Family caregivers' experience of illness can be conceptualized in a biopsychospiritual framework.
• The goals of psychotherapy are to foster “facilitative” beliefs to decrease caregivers' suffering due to illness and to discourage “constraining” beliefs which increase such suffering.

For further reading

Quinn, C., Jones, I. R., Martyr, A., Nelis, S. M., Morris, R. G., & Clare, L. (2019). Caregivers’ beliefs about dementia: Findings from the IDEAL study. Psychology & Health, 34(10), 1214-1230. doi: 10.1080/08870446.2019.1597098

Wright, L. M. & Bell, J. M. (2009). Beliefs and illness--model for healing. 4th Floor Press, Calgary, Alberta.

Key concepts:

• When caregiving stems from other-directed motivation (e.g., empathetic concern for a loved one), a neurobiological system produces a stress-buffering effect that protects the caregiver’s health.
• When caregiving is undertaken to seek reward or avoid guilt, caregivers do not experience a stress-buffering effect and negative health outcomes are more likely.
• Clinical implication: Assessing underlying motivations to provide care may indicate likelihood of positive and negative outcomes.

For further reading:

Brown, R. M., & Brown, S., L. (2014). Informal caregiving: A reappraisal of effects on caregivers. Social Issues and Policy Review, 8(1), 74-102.

Key concepts:

• Individuals follow culturally defined standards for behavior - roles; being a “caregiver” is a role.
• Competing demands hypothesis: Caregivers have limited resources (e.g., time, energy) to meet the demands of their multiple roles; competing role demands can lead to role strain, role overload, burden, and exhaustion.
• Role captivity: Unwanted participation in a role (e.g., caregiving), role captivity, can produce frustration and depression.
• Role reversal: Particularly common among caregivers of dependent parents, role reversal is the dramatic shift of dependency within the parent-child relationship and the loss of parental support.

For further reading:

Penning, M. J., & Wu, Z. (2016). Caregiving stress and mental health: Impact of caregiving relationship and gender. The Gerontologist, 56(6), 1102-1113. Doi: 10.1093/geront/gnv038

Key concepts:

• Self-determined individuals have a sense of choice and ownership over their actions (autonomy), gain mastery and confidence in carrying out tasks (competence), and feel a sense of belonging and attachment to others (relatedness).
• Autonomous motivation to provide care is intimately linked to caregiver well-being.
• More self-determined caregivers perceive lower caregiving burden and experience more positive outcomes of caregiving; less self-determined caregivers perceive higher burden and experience fewer positive outcomes of caregiving.

For further reading:

Dombestein, H., Norheim, A., & Lunde Husebø, A. M. (2019). Understanding informal caregivers’ motivation from the perspective of self-determination theory: An integrative review. Scandinavian Journal of Caring Sciences, [Advance online publication], doi: 10.1111/scs.12735

Schulz, R., Beach, S. R., Cook, T. B., Martire, L. M., Tomlinson, J. M., & Monin, J. K. (2012). Predictors and consequences of perceived lack of choice in becoming an informal caregiver. Aging & Mental Health, 16(6), 712-721. doi: 10.1080/13607863.2011.651439