Date of Award


Document Type


Degree Name

PHD - Doctor of Philosophy


Counseling & Psychology

First Advisor

Sue L. Motulsky, Ed.D..

Second Advisor

Donna Marie San Antonio, Ed.D.

Third Advisor

Stephen Sternbach, M.D.


Treatment of serious mental illness (SMI) has shifted over the last 60 years from an institutional model to a community-based approach (Chan, 2011; Di Lorenzo et al., 2021; Jain & Singh, 2014). Families have become an integral part of the caregiving network, bringing into focus the relationships between caregivers and individuals with SMI. Although literature has emphasized the key role family members play in supporting individuals diagnosed with SMI, there is a dearth of in-depth qualitative research on how primary caregivers traverse these relationships (Biegel et al., 2013; Chang & Chen, 2021; Young et al., 2019). This research addressed that gap by seeking to gain deeper insight into the lived experience of caregivers by exploring how family caregivers navigate the complex relationships with family members diagnosed with SMI. Ten family caregivers of individuals with SMI participated in semi-structured interviews, which were then analyzed using the Listening Guide (Gilligan, 2015; Gilligan et al., 2003), a feminist voice-centered relational method. Findings revealed both a circular, dynamic process of interactions—through connections, disconnections, and reconnections—and a shift in how they navigate these fragile caregiving relationships over time. Participants’ stories encompassing trauma and disenfranchised grief (Doka, 2002) were often associated with long-standing cultural oppressive systems. Stigma within ecological systems (Bronfenbrenner, 1994) contextualized the impacts on the complex interpersonal relational dynamics. Education, participation in peer support groups, and guidance from mental health clinicians assisted caregivers in their attempts toward reconnection. Caregiver acceptance of the individuals with SMI in their care, empathy, and insight on relational balances and imbalances of power influenced shifts in caregiver approaches to their relationships.

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.



Number of Pages