RESEARCH ASSIGNMENT III

Narratives of Low-Income Mothers in Addiction Recovery Centers:

Motherhood and the Treatment Experience

Catherine Hiersteiner

ABSTRACT. This study examines the narratives shared by low-in- come women in addiction recovery centers about the meaning they attach to being a parent in recovery and how they view current pro- gram models that include children in daily treatment. Their stories reflect the centrality of the mothering role to women in recovery and offer insights that can guide treatment and program planning with fami- lies. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address: <[email protected]> Website: <http://www.HaworthPress.com> © 2004 by The Haworth Press, Inc. All rights reserved.]

KEYWORDS. Low-income women, substance abuse treatment, moth- erhood, parent identity, narrative, qualitative research

INTRODUCTION

This study examines what low-income mothers in substance abuse treatment centers say about their experience in recovery, with a focus on

Catherine Hiersteiner, MSW, LSCSW, is Adjunct Instructor in the School of Social Work, University of Missouri-Kansas City, and a doctoral candidate at the University of Kansas, School of Social Welfare. She maintains a private practice with children, youth, and families.

Journal of Social Work Practice in the Addictions, Vol. 4(2) 2004 http://www.haworthpress.com/web/JSWPA

© 2004 by The Haworth Press, Inc. All rights reserved. Digital Object Identifier: 10.1300/J160v04n02_05 51

the support they receive as parents to their children. The purpose of this inquiry is to sensitize practitioners and administrators to the critical role that motherhood plays in the identities of women in the process of re- covery and to reinforce treatment practices that build on the centrality of motherhood in the women’s identities and day-to-day lives (Azar, 1996; Hardesty & Black, 1999). Using in-depth interviews and methods of narrative inquiry and analysis, the study focuses on the women’s per- sonal “storied lives on storied landscapes” (Clandinin & Connelly, 2000, p. 8). By telling their stories, the women allow us into their worlds as they share their insights about themselves, their children, their family members, and other women in the recovery process.

As a result of partnership efforts among federal, state, and private agencies, networks of residential centers for recovering drug and alco- hol-dependent women have been established in the last decade. Just as the population of chemically-dependent women with children is hetero- geneous and diverse, programs designed to meet their needs differ in size, treatment approach, and setting. They range from short-term, detox inpatient units in hospitals for pregnant abusers (Malow et al., 1994) to long-term outpatient community support programs (Greif & Drechsler, 1993; Rogoff-Plasse, 1995) to small, community-based resi- dential treatment centers with length-of-stay ranging from 30-60 days designed for 12 to 20 women to remain in residence with their children (Brown, Sanchez, Zweben, & Aly, 1996; Plasse, 2000; Schumacher, Siegal, Socol, Harkless, & Freeman, 1996; Szuster, Rich, Chung, & Bisconer, 1996). Most centers provide follow-up day treatment, coun- seling, and support groups, although some refer women to community programs for addiction recovery and case management. While some women are self-referred to programs, most are court-referred as a result of poor parental functioning due to drug or alcohol abuse. A critical component of treatment for many of these women is the provision of parenting classes, parent-support groups, family counseling, and thera- peutic groups for children (Carten, 1996; Moore & Finkelstein, 2001; Plasse, 2000; Sun, 2000).

Recent studies suggest that parenting skill development and support is a critical treatment component for mothers in recovery and that re- building parenting skills and relationships with children and other fam- ily members can be an important component of relapse prevention (Carten, 1996; Moore & Finkelstein, 2001; Plaase, 2000; Stevens & Patton, 1998). Findings from researchers who have listened closely to mothers with substance abuse issues confirm that motherhood plays a central, defining role in the lives of many of these women (Azar, 1996;

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Hardesty & Black, 1999), challenging public images of them as uncar- ing and unconcerned about their children. For many women struggling with addictions, the role of motherhood provides a stable identity and an anchoring set of activities amidst the chaos of poverty, abuse, and marginalization and during the recovery process as well (Hardesty & Black, 1999).

APPROACH OF STUDY

This qualitative study was exploratory and descriptive in nature and guided by social work ethics and feminist values (National Association of Social Workers, 1996; Reinharz, 1992). Six mothers in two addiction recovery centers, one urban and one rural in the Midwest, each partici- pated in an hour-long on-site interview with the researcher and a second telephone interview a few weeks later. Participants were recruited in the parent support groups at each center by a staff member who described the study and asked for volunteers.

A model of multidimensional inquiry, which invited stories from the mothers about their own inward landscapes and contextual environ- ments, guided this study (Clandinin & Connelly, 2000; Riessman, 1993). The interviews were semi-structured with a number of open-ended questions that invited narrative responses. The primary top- ical questions, supplemented by follow-up questions, included:

• What is your personal story about being a mother with young chil- dren in substance abuse recovery treatment?

• How would you describe the center’s approach to helping mothers with parenting? What has your experience been with this ap- proach?

• About having your children here with you? • What are some of your successes and accomplishments right now

as a parent in recovery? Some of your struggles and concerns?

Lieblich, Tuval-Mashiach, and Zilber (1998) have proposed a classi- fication system in which to locate a study’s strategy for understanding transcribed interviews using one of four methods: categorical-content, holistic-content, holistic-form, and categorical-form. “None of the ap- proaches . . . is as productive alone as in combination with the other ways of reading a life story” (Lieblich et al., 1998, p. 111). This study combined strategies from the categorical-content and the holistic-form

Catherine Hiersteiner 53

approaches, resulting in a layered style of analyzing and interpreting the women’s narratives. The categorical-content approach builds upon Strauss and Corbin’s model of content analysis, which attends to separate parts of the story within and between participant narratives (Strauss & Corbin, 1990). In the holistic-form approach, the researcher examines a participant narrative or group of narratives for a pattern or focus of the entire story. In this study, the researcher analyzed the texts in order to understand the meaning of motherhood to the women in the context of personal identity and the recovery experience.

All interviews were confidential and tape-recorded, with the partici- pants’ permission. Typed transcripts were returned to each woman for her review and feedback. Each participant received a $20 gift certificate to a local supermart. Transcript material was analyzed, aided by a soft- ware program called winMax 98 (Kuckartz, 1998). When the inter- views were completed, the researcher performed a content analysis in order to identify themes in the interviews and to pull out passages stated in the participant’s own words that highlighted an issue in a forceful or unique way. Narratives were then examined to understand how mother- hood was expressed in the structure of the women’s stories.

THE INTERVIEW PARTICIPANTS

The six women ranged in age from 20 to 34, and had from 2 to 6 chil- dren. All were single mothers and participated in the Temporary Assis- tance to Needy Families (TANF) program. All were court-mandated program participants. The three mothers from the rural center were white; one mother was white and two mothers were African-American from the urban recovery center. Two mothers were currently in resi- dence, one with a newborn, while the other four had completed the resi- dential treatment program and were continuing as outpatients, attending the centers four or five full days weekly. Two mothers had older chil- dren in foster care and were working towards reunification. Three of the mothers were repeat participants who returned after relapse, and three had participated continually in the program from their initial referral. All but one of the mothers were in recovery from narcotics abuse. Two of the mothers had been hotlined for giving birth to infants with positive toxicology screens. None of the women had been court-ordered due to physical child abuse but rather due to child neglect.

Both centers addressed parenting issues with mothers in individual counseling sessions and in group treatment. Both centers also invited a

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parenting specialist in weekly to conduct issue-oriented groups on child development, discipline, and child health and safety. Parenting was also addressed by counselors in a supportive way during spontaneous inter- actions among the women and children, for example, at mealtimes and during recreational time.

HOW THE WOMEN DESCRIBED THEIR EXPERIENCE AS RECOVERING PARENTS IN TREATMENT

All of the women were candid, cooperative informants and described the parenting aspects of the recovery programs as helpful, useful, and vital to their process of attaining and maintaining clean and so- ber lifestyles. Most, but not all, expressed initial relief at referral into the programs, sometimes following a period of ambivalence. They demon- strated good understanding of the parenting skills reinforced at the cen- ters and worried about surviving without the support of Center programs and staff. Below are portions of their narratives, in their own words, with the pseudonyms chosen by the mothers themselves. Their words invite us into their lifeworlds and serve to deepen our under- standing of their experience as parents in recovery (Van Manen, 1990).

Life as a ‘Using’ Parent

Prior to treatment the mothers described feeling oblivious to the needs of their children, cushioned from life stresses in an intoxicated fog. They rarely included other adults in the picture they described. Loneliness and isolation pervade the home, despite one’s sense that there are concerned or enabling family members or “friends” in the wings.

I used with all six children. It’s a really sad process because, when one was born, it was like, ‘Well, that’s over with.’ And I did not ex- pect another one, but as they came, I was using so much that I didn’t have time to have safe sex. I wouldn’t have an abortion because that was against my religion. And I got to thinking about the little money from welfare. ‘Oh, I’m gonna get a little more money. Here’s an- other child.’ But when I got to the last three, I did not want no part of it. I got to using, and hoped that it would go away . . . and it never did. (Cheryl)

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Before I was in recovery, my father was using, and I was using with him. It was horribly bad, because he was going to report me to SRS (Child Protective Services). (Maxine)

Before I came into recovery, I didn’t watch my kids. I would look right at them and not know what they were doing. It was because I wasn’t paying attention to them . . . I wasn’t being a mother. (Pam)

Pretty much I did not have time for my kids. ‘Go play,’ or ‘Come and get these kids, you all . . .’ or ‘You can all sit here,’ to the three little ones because I figured they didn’t know (what the drug para- phernalia meant). But they soaked in a lot. The three little ones, they’ve been through this with me twice. (Brenda)

While not all women who abuse substances are neglectful parents all of the time, these mothers in treatment observed that their interest in parenting and attention to their children was diverted by their involve- ment with drugs. They reported these experiences with a sense of guilt, implying an abandonment of a role in their families and communities that held importance for them. Treatment approaches should address this personal conflict between mothering identity and drug use as part of the process of substance abuse recovery and relapse prevention.

Coming into the Programs

The mothers voiced a range of opinions about their entry into recov- ery, expressing feelings of reluctance, resignation, resistance, fear, and relief. They described adjustment reactions among their children, mostly expressed as angry acting out or anxiety about separation from their mothers in a new place with new people.

Relieved on my first day was what I felt because I had someone working with me and I knew that there was an out and it wasn’t all dark anymore. But the first time when I came into recovery my son was so angry because I was parenting him for the first time. (San- dra)

When my kids came up here, they were a little shy. My son wouldn’t play with other kids because they wasn’t his cousins. He would wet the bed a lot at night because it wasn’t his room, or it wasn’t a place on the floor. The bathroom was maybe too much for him be-

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cause it had its own door and nobody was coming up to him and saying, “Hurry up! Get out! I gotta use it!” (Maxine)

The mothers’ words suggest a sensitivity to their children’s worries about coping in a new environment. Noticing and attending to the feel- ings and needs of others is a core mothering skill, a cornerstone of iden- tity in many women often practiced in the absence of emotional support from other adults for the mother herself. Reinforcing this skill of sensitiv- ity to others and helping a woman make the connection between getting her own needs met in order to be an effective parent are important compo- nents of the recovery process. Practitioners can help women understand how self-awareness and self-care are skills that can complement caring for others. One mother’s words illustrate her insight that separation and autonomy were significant issues for both her children and for herself:

I’m proud that I came here. I’m glad that I came here. The treat- ment has helped me a whole lot. The program has helped me set boundaries. I’m codependent. I mean I used to be codependent. But to tell you the truth, on my first day I was terrified because I had never been around very many people at one time. And I had never left my children. They stayed right with me. That was really hard for them and me (when I’d go off to groups and the children would go to day care). (Cheryl)

Not all women were completely compliant with the program. The women’s stories reflected their own experience as well as their observa- tions about other women in the program.

I was referred by a probation officer because I had quite a case for selling narcotics. I came as an inpatient. I was pregnant. I stayed and worked the program for 90 days. I used three times in the pro- gram, truly because I didn’t want the program. I felt violated and dragged into the program. But it was because I was using. I wasn’t aware of my sickness. (Sandra)

I saw a mother leave here in mid-morning, a dark morning, leave her children here. When we woke up for breakfast, the children were in the room by themselves, crying. (Veronica)

It was New Year’s Eve and we all came back here to have a get-to- gether to watch TV for the clock-down. One lady goes into her

Catherine Hiersteiner 57

room and counts her own self down. She used. She brung drugs in with the paraphernalia. Everyone could smell it. She had just two days before she went to court to get her children. That was very devastating. That touched a part of my life. (Cheryl)

The mothers demonstrate, in their description of women who relapsed while in treatment, a strong reaction to the abandonment of children by a parent whose craving for narcotics overwhelms her responsibility to her children. Helping women develop skills for identifying triggers that occur in the context of the stress of parenting children is a first step to- wards confronting addiction as a coping mechanism. Exploring a woman’s thoughts and feelings about this fundamental conflict between relationships with one’s children versus one’s relationship to sub- stances is critical to relapse prevention. Understanding how relapse threatens a woman’s core sense of self as an effective mother and can evoke feelings of guilt and shame deepens the treatment process.

Mother Pride

The women spoke with pride about their increased abilities to play with their children, to use appropriate discipline methods, and to ver- bally encourage their children.

For me when I first started, everything just seemed to be piling up. And now I can actually spend time with the children, play games, go to the park, instead of just sitting there all day saying, ‘No, no, no, no.’ (Pam)

I’m not totally against spanking, because sometimes I do, but I’m totally against spanking when I’m angry. Because when I’m an- gry, I can get violent. So I have to let my children go into the bed- room and I put earplugs in so that I don’t hear a peep because it irritates me. Then I calm down and I can handle things. (Veronica)

One of the mothers also described an increased sense of closeness with her children complemented by clearer parent-child boundaries. Her own growth in the recovery process and her increased trust of self and others is reflected in her wishes for her children:

I’ve learned to be more nurturing. To recognize the little things they do. . . . My goal is by getting myself better than my children

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will start opening up to me more and trusting me more so when they do have some problem they feel they can come to me. I was afraid to come to my parents when I was a kid. (Cheryl)

Her pride in herself as a mother who can love, listen to, and protect her children has been renewed, her identity as a caring parent restored. Because mothering children is a core organizing role for these women, treatment that addresses bonding, communication, and relationships with their children is critical to their feelings of success as a parent and a cornerstone of recovery.

The Meaning of Participating in the Recovery Programs

All of the mothers indicated in a variety of ways that they were at- tached to the program, felt supported by the staff, and that the treat- ment experience has been significant in their lives.

As of today, I am a recovering parent. I feel proud, thankful. I feel appreciated. Trustworthy. And I’ve gained the trust of my chil- dren. And I feel more confident in myself. (Veronica)

The staff treats me like I am somebody. People here are always willing to lend a helping hand when you have problems. They’re very caring people. (Sandra)

Without this program, my children would be gone. They would be in foster care and I’d probably lose custody of them. So I wouldn’t have anything. I’m not even sure I’d be alive, to be completely honest, at the rate I was going. Its been life-giving. (Maxine)

In response to questions about the importance she attributes to the parenting programs at the centers, each woman naturally shifts to the relationships she has formed there. The women’s positive experiences in treatment appear to result in large part from the support, respect, ac- ceptance, and encouragement they feel. Their conversations suggest that supportive interaction with staff is a key element in their growth and increased sense of self-worth and self-confidence. An affiliative environment in a recovery center sets the stage for facing tough issues with addictions and for re-engaging with the role of a loving, effective, and protective mother.

Catherine Hiersteiner 59

Having or Not Having Children in Residence

Policy makers have maintained that including children in residence with their mothers in recovery removes barriers to treatment by provid- ing childcare and avoiding the trauma of foster care placement. This de- velopment has been seen as gender-sensitive and in the best interest of the woman and her family. The women had a variety of responses to questions about having their children with them and living in close quarters with a number of other families.

It’s harder when you’ve got your kids with you because they want attention or need milk or something. But I’d rather have my chil- dren with me in treatment because I know they’re safe and no- body’s gonna hurt them. For me, I didn’t have any place for them to go so I was grateful for this program that I could have them here with me. (Pam)

It was real hard having my kids with me. Because I was the only one with small children and it was real hard to learn how to parent because of all the other women wanting to tell me what to do. Ev- ery morning we would have group and every morning I would be told what kind of behavior problems my kids were having. (Ve- ronica)

It was real hard for me, too, but the parent specialist would come over and help me. ‘That is their stuff and this is what we’re work- ing on. . . .’ Having them not there would have been really hard be- cause I don’t let my children get very far away from me. So I don’t think I would have been able to handle not having them there. (Brenda)

When new mothers and kids come in, I see myself in them like I was before I got the knowledge that I have today. Stress kicks in quick. What they don’t know yet is that this is a very structured en- vironment. Sometimes I have to say to myself, ‘Whoa, that’s not your job to do, trying to tell them about the program. They have boundaries, too.’ You can’t fix and help everybody. (Maxine)

The children-in-residence policy may deserve further study in order to move it from the realm of ideal belief to a practical, effective, well-tested solution. The variety of concerns expressed about the living

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arrangements at the centers may prompt a closer look at the assumptions that may have guided early program and policy implementation. While isolation is reduced and separation fears are quelled, boundary stresses complicate treatment.

What began as a policy to better meet the needs of women and their children may inadvertently serve oppressive ends because it also as- sumes that all mothers should take care of their children all the time and at all costs. Possibly lurking behind the curtain of benevolence is the agenda to save money by avoiding a costly foster care placement. Ade- quate facilities and differential case planning may, in the end, serve in- dividual needs more effectively. One mother reluctantly but forcefully emphasized that her program needed some improvements.

I’ve got four kids. I’ve only got one set of eyes and ears. After din- ner here they say to keep your children with you. But if they would give them something to do. Some toys or something for them to play with. A little area just for them. In the evening instead of ‘bonding time,’ I’d say let them have a room for themselves to play in. And you play with them. They need something to do in- stead of just staying in our bedroom. And that room is not big enough to keep them in there. The kids want to go out of the room and move around. (Brenda)

The challenge of planning programs and space needs around mothers and children in residence is ongoing. All mothers and children need bal- anced opportunities for closeness and for separation. Low-income, sin- gle mothers rarely get child care relief, often neglecting their own needs for rest and recuperation. Centers which expect mothers to participate in a full day of treatment followed by a full evening of taking care of chil- dren may want to talk further with women as experts on their own situa- tions and to re-examine levels of funding necessary to support quality programs. One of the mothers observed:

I want to tell you something. This is a good program. Because I hear some of the other ladies talking about (an outpatient recovery program nearby). It’s outpatient all the way, so your mind’s not into it. You can’t get a good grip on life . . . you’ll use again. But you need a playroom up here (for children). That would keep your program real competitive. And I’d sure tell the people to come. . . . (Brenda)

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IMPLICATIONS FOR PRACTICE

Mothers who collaborated in the authoring of this study were thoughtful in their reflections about their experiences in the parent sup- port programs and provided details that should enrich treatment provid- ers’ response to them and their children at the policy and program level. Their accounts about parenting skills learned; their observations about themselves, their children and the other members of the center commu- nity; and their willingness to share their stories are evidence of program concepts that are working overall. Adequate staffing and facilities are critical to the women’s successful participation in recovery programs.

Restoration and maintenance of oneself as a loving, protective, and effective mother was a fundamental, organizing theme in the women’s stories and, therefore, has important implications for practice. Treat- ment programs for women in residence with their children need to present ongoing opportunities for each woman to describe, own, and practice the kind of mother she wants to be. Even in the case of a woman who has or will face losing custody of a child due to past neglect or abuse, treatment conversations should open space for her to give voice to the meaning of motherhood to her–past, present, and future. These conversations about motherhood with recovering women must also honor meaning across diverse cultures and in the context of com- munity (Hardesty & Black, 1999; Ohye, 2001).

Naming and reclaiming motherhood is a cornerstone of the recovery process, according to the women in this study. Narrative theory pro- vides a guiding paradigm for not only listening to women’s life stories but also for helping them live new stories every day that can guide and nourish their recovery (Friedman & Combs, 1996; White & Epston, 1990). As women with children re-story themselves in recovery from substance abuse, treatment should provide a variety of venues for each woman to understand, express, and, in some cases, re-engage with the importance of motherhood to her, to her children, to her family, and to her community. Residential treatment centers offer a sheltered, inten- sive environment with sufficient social support to address deep parenting issues and themes. When women leave the centers and are ready for less structure and supervision, ensuring that they continue to have audiences to participate in and help them sustain their newly authored or revived parenting narratives is a responsibility that commu- nities must embrace so that these stories can continue into the future and in future generations.

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REFERENCES

Azar, S. (1996). Cognitive restructuring of professionals’ schema regarding women parenting in poverty. Women and Therapy, 18(3/4), 149-163.

Brown, V., Sanchez, S., Zweben, J., & Aly, T. (1996). Challenges in moving from a traditional therapeutic community to a women’s and children’s TC model. Journal of Psychoactive Drugs, 28(1), 39-46.

Carten, A. (1996). Mothers in recovery: Rebuilding families in the aftermath of addic- tion. Social Work, 41(2), 214-224.

Chase, D. (1995). Taking narrative seriously: Consequences for method and theory in interviews studies. In R. Josselson & Lieblich, A. (Eds.), Interpreting experience: The narrative study of lives, Vol. 3, (pp.1-25). Thousand Oaks, CA: SAGE Publica- tions.

Clandinin, D., & Connelly, F. (2000). Narrative inquiry: Experience and story in qual- itative research. San Francisco, CA: Jossey-Bass Publishers.

Friedman, J., & Combs, G. (1996). Narrative therapy: The social construction of pre- ferred realities. New York: W. W. Norton & Co.

Greif, G., & Drechsler, M. (1993). Common issues for parents in a methadone mainte- nance group. Journal of Substance Abuse Treatment, 10(4), 339-343.

Hardesty, M., & Black, T. (1999). Mothering through addiction: A survival strategy among Puerto Rican addicts. Qualitative Health Research, 9(5), 602-619.

Kuckartz, U. (1998) WinMax scientific text analysis for the social sciences user’s guide. Thousand Oaks, CA: SAGE Publications.

Lieblich, A., Tuval-Mashiach, R., & Zilber, T. (1998). Narrative research: Reading, analysis, and interpretation. Thousand Oaks, CA: SAGE Publications.

Malow, R., Ireland, S., Halpert, E., Szapcznik, J., McMahon, R., & Haber, L. (1994). A description of the maternal addiction program of the University of Miami/Jackson. Memorial Medical Center. Journal of Substance Abuse Treatment, 11(1), 55-66.

Moore, J., & Finkelstein, N. (2001). Parenting services for families affected by sub- stance abuse. Child Welfare, 80(2), 221-240.

National Association of Social Workers (1996). NASW Code of Ethics. Washington, DC: NASW Press.

Ohye, B. (2001). Love in two languages: Lessons on mothering in a culture of individu- ality. New York: Viking Press.

Plaase, B. (2000). Components of engagement: Women in psychoeducational parenting skills group in substance abuse treatment. Social Work with Groups, 22(4), 33-51.

Reinharz, S. (1992). Feminist models in social research. NY: Oxford University Press. Riessman, C. (1993). Narrative analysis. Newbury Park, NJ: SAGE Publications. Rogoff-Plasse, B. (1995). Parenting groups for recovering addicts in a day treatment

center. Social Work, 40(1), 65-74. Schumacher, J., Siegal, S., Socol, J., Harkless, S., & Freeman, K. (1996). Making eval-

uation work in a substance abuse treatment program for women and children: Olivia’s House. Journal of Psycho-active Drugs, 28(1), 73-83.

Stevens, S., & Patton, T. (1998). Residential treatment for drug addicted women and their children: Effective treatment strategies. Drugs & Society, 13(1/2), 235-249.

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Strauss, A., & Corbin, J. (1990). Basics of qualitative research. Newbury Park, Cali- fornia: SAGE Publications.

Sun, A. (2000). Helping substance-abusing mothers in the child welfare system: Turn- ing crisis into opportunity. Families in Society, 81(2), 142-151.

Van Manen, M. (1990). Researching lived experience: Human science for an ac- tion-sensitive pedagogy. New York: State University of New York.

White, M., & Epston, D. (1990). Narrative means to therapeutic ends. New York: W.W. Norton & Co.

RECEIVED: 07/15/02 REVISED: 05/20/03

ACCEPTED: 08/07/03

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