Abstract:
Researchers and health professionals involved with the management of childhood asthma have long recognised the importance of the family. The family's support and understanding of the medical management is central to adequate control of attacks. When control breaks down despite increasing medical regimens, in those children most at risk from troublesome asthma, health professionals ask questions about the family dynamics which might be impeding control. At such times, family therapy is the intervention of choice. In this thesis I identify the interactive biopsychosocial features which might affect asthma control. I describe the difficulties that research on childhood asthma centred in objectivism has had in maintaining a stance free of the values of the researchers. I discuss the problems with the key family therapy models used to describe the family dynamics of troublesome asthma in children, and argue for a family therapy model centred in poststructuralist understandings of the significance of language. Following a discussion of the methodological problems with family therapy research, I explore the potential for a narrative therapy intervention. I provide a quantitative evaluation of this approach using a single case design arguing that quantitative research may be consistent with poststructuralism as long as the researcher identifies the intentions and the limitations of the research. In three further chapters the transcripts from family interviews become the source point for a qualitative critical analysis of the power relations the family encounters with the health system. I challenge a focus on the family which effectively excludes the context of the health system. Discourse analysis of the language used in the family interviews serves to expose the discourses and positionings of family members which constrained change.
