Family Dynamics

Conceptual Frameworks for Studying Family

(Developmental and Systems Framework)
Conceptual Framework: is a model to organize and interpret data or
research and to develop an effective plan of action
Uses
1. Help the physician assess family structure and functions in an
organized and logical fashion
2. Provide parameters to consider when collecting data about
patient situation
3. Facilitates the synthesis of data so that family strengths and
needs can be identified
4. Help to explain family dynamics, which in turn, assists the
practitioner in developing appropriate intervention strategies
Without a conceptual framework:

It is difficult to group data

It is difficult to identify the relationship between the multiple

variables that make up a family

A. Developmental Framework

Based on the predictability of family life experience, which has

been observed to follow a universal sequence across the
family;s life cycle

2 Main Concepts in the developmental framework

1. Family life cycle

Represents composite of the individual developmental

changes of family members

1 | Fa m i l y D y n a m i c s

Begins with the formation of the family and ends with the
disoolution of the family through death, separation, divorce or
physical relocation of its members.
Importance
o Provides a predictable, chronologically oriented
sequence of events in family life
o Involves a sequence of stressful changes that requires
compensating or readjustments by the family if its to
maintain viability
o The vents of the family life cycle can be related to
health maintenance of the family
Clinical Relevance
o Serves as a valuable and reliable method for
predicting or anticipating a famils need for assistance
or anticipatory guidance

Anticipatory guidance: an attempt to prevent

a problem before it is possible to detect its
presence

In contrast, Screening and early detection,

depends on the existence of evidence of the
illness

2. Family Development Tasks (Refer to Stages of Family Cycle

Table)

Defined tasks are defined responsibilities connected with each

particular stage of family life

Each must be accomplished before a family can move to the

next cycle

STAGES OF THE FAMILY LIFE C YCLE

Stage

Between Families:
Unattached Young Adult
(Adolescent-21y/o)
Adult comes to terms with the
family of origin
Personal goals are formulated
Joining of families through
marriage: The newly
married couple
Filipino families are bilaterally
extended
The transition stage of the
couple from their life as an
individual to a couple
The family with young
Children

Early Child bearing

families

Families with
preschool children

Families with school

children
Starts: pregnancy with the 1st
child to the childs adolescence
Defines a new family status
(wife-mother, husband-father)
Child starts going to school(1st
significant contact with people
outside of the family)
Conflict in home and school
regulations may occur during
this stage.
Both parents and adolescents
undergo identity crisis (parents
middle life crisis; grandparents
later life crisis)

2 | Fa m i l y D y n a m i c s

Emotional
process of
transition:
Key Principles
Accepting
parent-off
spring
separation

Stage-Related Family tasks

Stage related Health concerns

Differentiation of self in relation to

family
Find yourself
Physically psychologically and
emotionally matured
Development of intimate peer
relationship
Establishment of self in work
Formation of marital system
Realignment of relationship with
extended family to include spouse

Adequate nutrition and exercise in light of

single lifestyle
Drug and OH abuse
Management of sexual expression and
functioning including birth control, abortion
and STDs
Management of work related and
interpersonal stress
Management of stress related to marital role
adjustment
Issues of reproductive health and infertility
Planning

Accepting new
generation of
members into
the system

Adjusting marital system to make

space for a child or children
Taking on parenting roles (Main task,
very critical)
Realignment of relationships with
extended family to include parenting
and grand parenting roles

Well baby and child care including

immunizations
Postpartum depression
Management of acute and chronic child
health problems
Environmental safety
Understanding of childrens needs and
abilities based on developmental levels
Management of role strain associated with
expansion of family system

Increasing
flexibility of
family
boundaries to

Shifting of parent child relationship

to permit adolescents to move in
and out of the system
Refocus on midlife, marital and

Intensified interest on marital pair in health

promotion and management of risk factors
Management of tensions arising from
adolescents increasing pressure toward

Commitment to
new system

Launching children and

moving on
Begins: 1st child leaves home
Ends: last child leaves home
If a child decides for himself
though he is stating in his
parents house, consider the
family as LAUNCHED.
The family in later life

Families of middle
years

Families in
retirement an old age
Begins: departure of the last
child
Ends: Death of both mother and
father
Elderly is usually the least
priorty of the family
All children leave the house
family is now a nuclear dyad

3 | Fa m i l y D y n a m i c s

include
childrens
independence
Adolescents and
Midlife crisis
Midlife:
climacteric
marital problem
Accepting a
multitude of
exists from and
entries into the
family system

Accepting the
shifting of
generational
roles

career issues
Parents: balance the need to control
and the need to be independent

individuation and autonomy

Heightened risk of adolescent substance
abuse, automobile accidents and other
accidents

Renegotiations of marital system as

a dyad
Development of adult to adult
relationships between grown
children and their parents
Realignment of relationships to
include in laws and grandchildren
Dealing with disabilities and death of
parents (grandparents)
Maintaining own or couple
functioning and interest in face of
physiological decline, exploration of
new familial and social role options
Support for a more central role for
the adult children
Making room in the system for the
wisdom and experienced of the
elderly, supporting the older
generation without over functioning
for them
Dealing with the loss of spouse,
sibling, other peers and preparation
for own death (related to depression)
Life review and integration

Management of stress arising from reshaping

of family
Dealing with young adult separation from
family
Management for impact of aging
grandparents, provisions of assistance and
care, coping with their death
Dealing with emerging chronic health problem
of marital pair
Promotion and maintenance of health
Deterioration of physical or mental health or
both, coping with loss of function, provision of
assistance and care
Management of stress generated by changing
role relationships within marital dyad and
among parents and children

B. Systems Framework theory

Definition: a system is composed of separate parts related in such a
way that a change in one part results in a change in all other parts.

Thus, the patterns of interaction among its members affect

each person

A family is composed of all emotionally significant people

bound together by enduring ties

FAMILY SYSTEMS CONCEPT

A. Family as a System

The whole is more than the sum of its parts

Family is each individual relates to all the other as well to the

system as a whole

Threat: any change to the balance

Healthy individuals can adapt to change

B. Family Stability

Interpersonal process by which the family strives to maintain

emotional balance as a system

If an influence upsets the balance in relationships systems

attempts to regain the status quo
o E.g. HOMEOSTASIS: if one family member relates
differently to another, then others will compensate in
their behavior to help the system go back to its
original way
C. Family Change
Interpersonal process by the family adapts, alters or becomes
different
The ability to adapt to change is the hallmark of healthy
family functioning
D. Relation Context of the Symptom
Individual symptom may have a function within the family
The presenting symptom is part of a large family and
psychosocial context that can influence and be influenced by
that symptom
E.g. secondary gain
o Fever not go to school OR sick
o Recurrent asthma

Stress

If in children: marital problem

4 | Fa m i l y D y n a m i c s

E. Circular Causality

Repeating sequence of actions that creates or sustains the

problem

Family share joint responsibilities for their problems

o Eg. Addiction

Addict: dependent

Family: co-dependent

Treat both to avoid relapse

FAMILY ASSESSMENT PROCESS

Help identify who the family is and how family members

interact to carry out their family functions

A. Structural Parameters

1. Hierarchy

How is power distributed with in the family?

Power: capacity to carry out, by whatever means, a

desired course of action despite the resistance of
others and without having to take into consideration
their needs

Authority: institutionalized power through respect,

fear, esteem or position
o E.g. used in decision making especially
getting the informed consent

Usually father (tradition) or whoever

has the money (modern)
2. Subsystem

Ways in which family differentiates and carries out its

function
o E.g. Parental subsystem (father and mother)
nurturance and socialization
o Marital subsystem (husband and wife)
mutual support
3. Boundaries

Defined limits of a family and its members

Rules defining who participates in the subsystem and

how they participate

Each individual have their own boundaries, helping

them achieved AUTONOMY
Healthy boundary is clear, flexible and open
Rigid boundary will cause emotional distance
o E.g. OFW/Caregiver fatigue disengaging

5 | Fa m i l y D y n a m i c s

4. Roles

Roles is a position in a family within a series of

reciprocal expectations

Examples:
o Scapegoat/Noble symptom bearer

Source of its problems

Accepts family blame

His symptoms reflects the dysfunction

of the family as a whole
o Parentified child

Child in the family, often the oldest

Performs the parental functions when

one or both have abdicated the role
5. Values

Mental and emotional sets which aid persons in

judging the relative worth or importance of things,
ideas or events

Becomes a proble if values diverge or are in conflict

6. Alliance

Positive relationship between any 2 members of a

system

Work together to achieve a common goal

7. Coalition

Relationship between 2 persons in which 2 collude

against a 3rd

Stay neutral toward a problem

B. Process Parameters

1.

Determines how
o Family structure evolves
o Decisions are made
o Family carries out its function to maintain stability and
growth within the unit
Enmeshment (over involvement)

Family members have

1. Few interpersonal boundaries
2. Limited individual autonomy
3. High degree of emotional reactivity

Occurs in DIFFUSED BOUNDARIES

1. E.g. marital pair has no privacy from their
children
2. Doctors get overinvolved, so boundaries must
be set

6 | Fa m i l y D y n a m i c s

2. Disengagement

Family members are emotionally distance and

unresponsive to each other

Occurs in RIGID BOUNDARIES

1. E.g. parent child subsystem excludes the
fathers involvement in parenting
2. Thus, offers the members little protection and
the children little guidance
3. E.g. Doctors make px visits his routine and
lacks compassion
3. Triangulation

Occurs when a 3rd person is drawn into a 2 person

system in order to diffuse anxiety over issues of
intimacy in the 2 person system

E.g. instead of aguing about their personal issues,

mother and father express their marital discontent by
arguing over parenting their son
4. Transaction Patterns

Are the chief assessment tool in family dynamic

Reflects the repeating sequence of family interactions

(who relate to whom, how and when)
2 forms:
1. Rules

Developed over time in explicit

contracts

Overt Rule
o Openly discussed
o Observable/everyone knows
o Healthy

Covert Rule
o E.g. Filipino family: Wag natin
isama ang mga bata sa
usapan
2. Ritual

Give regularity to life

E.g. Health care practices of the

family

Communication (direct or indirect) is an aspect of

family interaction pattern. 2 basic categories are:
1. Directness of the communication

Communication through intermediates

E.g. son tells his mother when he is

angry with his father, deal with the
problem straightforwardly

7 | Fa m i l y D y n a m i c s

2.

Congruence

Refers to whether the verbal and non

verbal channels of communication are
sending the same message

When members are mad with one

another, do they laugh with each
other or avoid contact.
Transaction patterns that maintain clear boundaries
across family subsystem is important to take note of,
as it reflects the family hierarchy.

6. Growth enhancement

Experiences within and outside the family make the familys

relationship grow

7. Family Unity

The Dysfunctional Family

4 Core Characteristics of Psychosomatic families

The Functional Family

1. Enmeshment

Attributes of a functional Family

2. Overprotectiveness

1. Flexibility of Rules/Role Relation

Flexibility/Adaptability in times of stress cause role changes

of family members
Rules and Role change in terms of stress

2. Personal Autonomy or Individualization

Recognize, respect and treat each other as individuals

Thus children are not seen as an extension of the
parents and are allowed age appropriate behavior
Individuation: ability to be ones own person results in a high
degree of intimacy
If with low individuation avoid true intimacy due to
the fear of losing his identity

3. A high degree of involvement within and without the

family

There is consensual decision making or clear allocation of

responsibility in different areas baed on open communication
and an ability to face and resolve conflict

5. A warm, caring and supportive environment

Ability to provide for the familys emotional, spiritual and

physical is the prime function of a family
Trust is an essential part of open expression and affection

8 | Fa m i l y D y n a m i c s

Members are overly reactive to stress on one member and

demonstrate a lack of individual autonomy
Members are not permitted to handle their own problems

3. Conflict avoidance

Open airing of disagreement is not permitted, although

covert conflict is rampant

4. Rigidity

Transactional patterns are repeated inflexibility and change

is resisted

Family Map (Refer to the Family Case)

Able to help itself and seek help outside the family when
needed
Family assume responsibility in community relationships

4. Open and honest communication

Family map: Graphic representation of the psychological

relationship of the family
Mr Ramos
Wife
Legend
Functional:
Dysfunctional:
Over involvement:
Bob
Maria
Triangulation:
Answer to Case:
o Who triangulated? Maria
o Family physician should

Recognize the problem

Intervene with the problem

If you cant intervene, refer!