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FAMILY SYSTEM ASSESSMENT AND HEALTH PROMOTION PLAN

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Introduction

George (60) and Linda (55) H. are considered as a modern middle class family with

two daughters – Emma (22) and Jane (26). The family was interviewed and examined by the

clinician Amber Lee, M.D. The family originates from Germany, and they lived in diaspora

area in the USA for around 23 years. Thus, they describe themselves as bicultural and

English speaking. George (60) was born in Germany and is retired. He suffers from

Alzheimer’s disease and has his health state worsening. Linda (55) is working as a teacher of

German language in local school. She suffered from heart attack at the age of 48 when her

husband was diagnosed with Alzheimer’s disease. She undergoes regular cardio examination.

George and Linda are married for 34 years. Emma (22) is studying at the university, and has

no problems with the health. She does not live with the parents already. Jane (26) has

graduated from the university and received the bachelor degree in engineering. She rather

often suffers from depression because of parents’ health and because she cannot find job. She

lives in the same house as her parents.

Three generational genogram of the family

Thus, it is worth paying attention to pedigree of the family, since it is considered to be

as some comprehension of the generation. Moreover, using this system it is possible to

conduct genetic investigations in order to find out which illnesses were inherited and which

were earned during the life span.

According to Galindo (2006), in order to find these details out, it is worth forming of

the genogram, which is the graphical representation of the family. Graphical scheme may be

ascendant (from ancestors to descendants) or vice versa descending (from descendants to

ancestors).

For the H. family it was decided to form the ascending genogram for three generations.

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FAMILY SYSTEM ASSESSMENT AND HEALTH PROMOTION PLAN 2 Therefore, it is worth mentioning that genogram is

Therefore, it is worth mentioning that genogram is recognized as one of the methods of

the family psychotherapy, which uses graphical representation of the information about the

family itself. Referring to McGoldrick (2008), this method was offered by Murray Bowen in

1978 and it still serves for conducting of analysis of the family history from the point of

system theory. The basis for this method is recognized in assumption that families copy and

reproduce themselves. This concept provides explanation for coincidence of the life situations

that are repeated in several generations. It also explains main patterns of relationships with

other people and patterns of emotional reactions towards different situations, and describes

family myths and rules.

According to Thomlison (2009), genogram is recognized as effective diagnostic,

analytic and therapeutic means, since it might help specialist find solutions to a range of

problematic cases, as investigation of the problem and its reasons for appearance, formulation

of hypothesis concerning existent problems, planning of the therapy and its outcomes.

Method of genogram is indispensable for description of multiple relationships in complex

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systems, such as family or generation. It is also successfully implemented in the work with

individual clients, pairs and families. Hence, it is possible to investigate family diseases and

find out certain tendencies of particular family members towards different pathologies. In this

case scheme provides diagnosed diseases and malfunctions of the family members. Such

information might be vitally needed in certain cases.

For example, in the H. family genogram there is vivid presence of systematic

pathologies concerning Alzheimer’s disease in the male representatives from the father’s

side, which may signify the tendency of male representatives to suffer from this illness. There

is also evidence that female representatives are more likely to suffer from cardiovascular

disease.

Moreover,

the

index

person,

who

is

Linda

(55),

is

also

observed

in

this

interdependence, since from her antecedents there is a clear line of cardiovascular diseases

probability which is accompanied with the cancer possibility for females. Taking into account

these details, it is possible to assume the probable health tendencies for the next generations.

This

issue

would

also

make

family

members

prepared

for

this

acknowledged about the ways of treatment.

probability

and

be

Usefulness of such gathering of information is vivid. Taking all the different details

about the family members and placing them into one scheme is the first step of analysis,

which can reveal critical issues and provide possible methods for their solution and

elimination for the future generations.

General Family System Stressors

Family Member/Age

General Stressor Score

General Stressors/Analysis

 

George/60 years old

2,21

1 – Health state/Illness (Alzheimer’s

disease);

 

2 – Financial status/Unemployment;

3

Marital

status/Serious

spousal

FAMILY SYSTEM ASSESSMENT AND HEALTH PROMOTION PLAN

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arguments

 

Linda/55 years old

3,76

1

- Health state/Illness (heart attack,

depression, anxiety) and concerns with

husband’s and daughter’s health;

 

2

- Financial status/Low income;

3

-

Marital

status/Serious

spousal

arguments;

 

4

Family

state/Misunderstandings

with children

 

Emma/22 years old

1,98

1

- Health state/Illness (concerns with

father’s, mother’s, and sister’s health);

2 – Tiredness at university;

 

3 – Financial status

 

Jane/26 years old

2,12

1 - Health state/Illness (concerns with

father’s and mother’s health);

 

3

– Financial status/Unemployment;

4- Social status/Depression

Amber Lee/clinician

2,01

 

Taking into account these details,

the

index

person

with

the

highest

influence of the stressor is Linda (55),

since

she

has

the

highest

stressor’s

score

and

minds

more

points

of

stressors.

Thus,

the

core

general

stressors’

issues

deal

with

the

following:

 

FAMILY SYSTEM ASSESSMENT AND HEALTH PROMOTION PLAN

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1-

Health state;

 

2-

Financial status;

 

3- Family state (spousal relations

 

and relationship with children).

Therefore,

each

family

member

is

influenced by the health state of the

father and more or less by the health

state of other three family members.

According

to

the

stressors’

scores,

established for Linda, she suffers more

than others in the family as far as she

keeps in mind all three elements of

health state problems relating not only

to

father’s/husband’s

health

state

(Alzheimer’s disease), but also Jane’s

health state (depression), Emma’s state

(tiredness),

and

her

own

(cardiovascular

system

problems).

Moreover, she is the only member of

the family who earns money for living;

therefore, she is also recognized as the

one put under stress circumstances by

working

for

the

whole

family.

Additionally, stress level is also vivid

in

terms

of family status

problems,

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since there were found evident serious

cases

of

misunderstanding

with

the

spouse as well as with children.

Specific Family System Stressors

Family Member/Age

Specific Stressor Score

 

Comments/Analysis

 

George/60 years old

3,5

His

health

state/George’s

suffering

from

Alzheimer’s

disease

with

permanent

worsening

of

his

health

state has large impact on the family in

psychological way

 

Linda/55 years old

4,6

Health

state

of

husband/Worsening

condition of husband’s health impacts

psychological state and physiological

one,

leading

to

need

to

regular

examinations

of

cardiovascular

system, associated with probability of

repeating

heart

attack

because

of

stress;

 

Health state of daughter/Depression of

daughter leads to psychological state

and physiological health problems and

need

for

regular

examinations

of

cardiovascular system

 

Emma/22 years old

2,1

Health

state

of

father/Worsening

condition of father’s health impacts

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physiological

state

and

leads

to

depressions

 

Jane/26 years old

2,6

Health

state

of

father/Worsening

condition of father’s health impacts

physiological

state

and

leads

to

depressions

 

Amber Lee/clinician

4,2

By

conducting

examinations

and

interviews with each family member,

it

was found out that due to health

state of father (Alzheimer’s disease)

and

being

acknowledged

of

its

outcome (death in 80-92%), daughters

do not

want

to

stay at

home, feel

depressed

and

angry.

They tend to

express themselves in rather nervous

and unsuitable way. Moreover, Linda

and George also tend to communicate

less

due

to

worsening

of

George’s

health

state

and

inability

to

talk

normally, as well as due to Linda’s

feeling depressed and trying to calm

down

because

 

of

need

to

control

cardiovascular disease, as far as she is

the only family member who earns

money

for

the

family

living.

The

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clinician

explained

that

there

is

a

crucial need for communication and

understanding

which

would

lead

to

mutual

support

and

solution

of

depression.

Moreover,

in

case

of

depression disappearance, the problem

with cardiovascular disease of Linda

might

become

less

dangerous

and

would

not

necessitate

regular

examinations.

 

Additionally,

communication would also help father

feel more comfortable and needed in

the

family.

This

strategic

approach

should solve psychological instability

within

the

family

and

assist

in

improvement of the health state.

 

Scope of Family Health Problem

Referring to McGoldrick (2011), heart attack is observed as the reason for around

500 000 deaths in the USA each year, and this number constantly grows. Moreover, it is

already established that this disease is the core reason for the deaths among female

representatives, although many scientists still presume that the core reason is breast cancer.

However, due to statistical data, it is established that there are more deaths among females

from the heart attacks than from all the cancer types gather together. Besides, American

sociologists admit that 13% of women understand that cardiovascular diseases might be their

“killer #1”. According to Rigazio-DiGilio (2005), everything that causes influence on heart

FAMILY SYSTEM ASSESSMENT AND HEALTH PROMOTION PLAN

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and/or blood vessels, like emotional crisis, hypernutrition, increased physical activities might

become the releaser for development of cardiovascular diseases, including heart attack.

People with high risk of development of heart attack have corresponding family past medical

history of cardiovascular diseases, which is observed in their genograms. They are smokers,

drug addicts, have sedentary mode of life, might suffer from diabetes mellitus, arterial

hypertension, high cholesterol level in blood, and face loads of stress situations.

The main stressor is

Family and Clinician Perception

Linda’s need to

control her state of being regarding the

cardiovascular disease, since she faces different complicated situations regarding the need to

provide health assistance for her husband, need to earn money for the family, and need to

help daughters deal with depressions, associated with father’s Alzheimer’s disease. Thus,

common topics expressed by children are most often associated with father health state and

insufficient funds within the family. This factor also influences health state of Linda and

makes it worse. Taking into account this current situation, the spousal relationship between

George and Linda are also worsening since they do not support each other and behave on

their own. In order to solve this situation, children should understand what influence their

actions and words have on their mother and father. Moreover, one of the daughters should

take care of her ongoing depressive condition and find the job in order to help mother earn

money for the family.

Differences in Perceptions

The matter is that the clinician observes more problems than the family itself does.

Therefore, family should not only take into account the problem of financial status, but also

the need for mutual support and help in order to find solution to the problems with health and

provide assistance for father, since the conditions are worsening.

Overall Family Functioning

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In general, the H’s family is admitted to function worse since there are no mutual

understanding and cooperation. As the time passes, the family became rather separated from

each other due to different stressors they faced. The common themes they tend to express in

the interviews dealt with health state worsening and financial problems.

Overall Physical Health Status

Overall physical health state is rather stable, besides Linda’s one. George’s health state

due to Alzheimer’s disease is quite predictable and constantly worsens. Linda’s health state is

always changing due to a range of influencing stressors that she has: children depression,

husband’s health and financial issue. Children health state is normal, besides psychological

temporal depressions due to worsening of father’s health.

Overall Mental Health Status

There were no mental disorders found, except for slight depressions.

Wellness Inventory Results

Linda, as index person, showed rather low scores in physical actions (22%), correct

nutrition (20%), and emotional awareness (15%). Thus, it is recommended to make more

physical exercises, radically change nutrition budget, and use different meditation methods

for emotional calming down and relaxation.

Conclusion

In general, the assessment described the influence of stress factors on the family on the

whole, its relations inside and behavioral changes in society. The index person was Linda

(55), who suffered most due to her own instability of health associated with emotional

stressors from different angles within the family: husband and children.

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References

Galindo, I. & Boomer, E. (2006). A Family Genogram Workbook. Educational Consultants.

McGoldrick, M. (2008). Genograms: Assessment and Intervention. Norton Professional

Books.

McGoldrick, M. (2011). The Genogram Journey: Reconnecting With your Family. Norton

Professional Books.

Rigazio-DiGilio,

S.

A. (2005).

Community Genograms: Using

Individual

Family and

Cultural Narratives with Clients. Teachers’ College Press.

Thomlison, B. (2009). Family Assessment Handbook: An Introductory Practice Guide to

Family Assessment. Brooks Cole.