Family Medicine JC126: The "Family" In Family Medicine

Question 1

***5 tools for Family Assessment and Interventions

Answer 1

1. Family Life-cycle Theory
2. Genogram
   - Family organisation
   - Biomedical information
   - Inheritance, risk factors
   - Life events, family stories
   - Family relationships
3. Family APGAR Questionnaire
4. Satir’s model of communication stances and sculpting
5. The theory of Family Structure

Question 2

Family Medicine

Answer 2

Challenges:

• Ageing population
• Chronic illnesses
• Mental illnesses

Question 3

Marriage and Family therapy

Answer 3

• Evidence-based branch of psychotherapy that assess and treat various mental disorders and health conditions in ***family relationship perspective
• Diagnose + treat mental and emotional disorders within the context of **marriage, **couples, ***family systems
• ***Brief, Specific, Solution-focused, Attainable therapeutic goals
• 50% 1 to 1, 25% couple, 25% family

Management:

• Mental, Interpersonal, Physical problems
• Resolve family conflicts and crisis
• Help family adjust to changes and problems
• Nurture family relationships and personal growth
• Advise on work-family-self balance, adjustment to family life-cycle, couple-hood vs parenthood, importance of good marital relationship, family structure, communication

Question 4

Individual vs Systems perspective

Answer 4

Individual perspective:

• You own your Cognition, Emotions, Behaviour
• Problem belongs to one person

Systems perspective:
- People are products of their ***Interpersonal context
- People are modified and become what other people expect us to be
- Illness —> Individual —> Family —> Community / Other systems
- Individuals cannot be understood in isolation from one another —> all inter-connected + influencing each other
—> Behaviourally, Emotionally, Cognitively (expectations, assumptions, values)
- Family members can affect therapeutic influence if family is helped to resolve their problems
- Change in one member of family will affect whole family system

Question 5

Family-oriented approach

Answer 5

All clinicians:

• Patient-centreness
• Empathy
• Communication skills
• Doctor-patient relationship

Family doctor:

• Point of first contact
• Comprehensive, continuing, collaborative care
• Caring for ***other family members as well
• Think + manage using ***Systems perspective
• **Family as the unit of treatment:
• History taking
• Facilitate help-seeking, compliance, follow up
• Active involvement in treatment: taking medications, lifestyle modification, practical + emotional support
• Attending to needs + problems of whole family (ticket of entry for other members)
• Handle ***multiple problems (curative + preventive) simultaneously
• Improve family relationships
• Other social supports and resources

Question 6

Family Life-cycle stages

Answer 6

• **6 Stages:
  1. Leaving home (i.e. single young adult)
  2. Marriage (i.e. new couple)
  3. Families with young children
  4. Families with adolescents
  5. Families launching children and moving on (empty-nest)
  6. Families in later life
• Only applicable to ***contemporary 2-parent families
• ***Adaptation necessary for each change with new skills to be learned and change is followed by period of relative stability
• There are ***challenges at different time e.g. illness, death, financial, change in family
• Failure to readjust at transitions / stuck in transition —> Problems
• Couple as leader in the adaptation process
  —> Provide **anticipatory advices
  —> **Normalise difficulties
  —> **Validate efforts
  —> **Practical support

Question 7

Family structure

Answer 7

The way a family is organised into subsystems whose interactions are regulated by interpersonal boundaries

Question 8

Other family structures

Answer 8

1. Staying single
2. Unmarried couples
3. Childfree couples
4. Divorcing families
5. Single-parent families
6. Blended couples and families
7. Couples and families with divorce issues
8. Multiple relationships, EMA
9. Interracial marriages

Question 9

Comprehensive assessment of patients

Answer 9

1. Symptoms
2. Mental health
   - sleep, mood, difficulties, stressors
   - chair metaphor (4 cornerstones of life)
   —> **Study / Work / Finance (工作)
   —> **Family (家庭)
   —> **Self: interests, dreams, meanings, joy (自己)
   —> **Intimacy / Friendships (朋友)
3. Family-oriented approach

Question 10

Framework for Family-oriented approach

Answer 10

Initial assessment of presenting problems —>
4 Steps:
1. Seeing people in family context
2. Exploring family information
3. Assessing family relationships
4. Working with the family as a unit

• Conceptualise using Systems perspective
• Probing with reference to her Family life-cycle stage + use Genogram

1. Know person’s ***different roles in family
2. Balance between work and family
3. Listen to narrative of family life, family organisation
4. Relationship with partner
5. Other family relationships, family structure, communications patterns
6. Adjustments of roles: Self vs Husband-wife vs Mother-son vs as a daughter
7. Draft genogram

Question 11

Genogram

Answer 11

• Comprehensive + Clear pictorial display of personal relationships + medical history of a family ***>=3 generations
• Use:
  1. Information collection
  2. Analysis
  3. Hypothesis formulation
  4. Management planning
  5. Record keeping
• ***Assess:
  1. Family organisation
  2. Biomedical information
  3. Inheritance
  4. Risk factors
  5. Life events
  6. Family stories
  7. Family relationships
• Construct genogram with the ***family —> feel more comfortable talking about certain relationships, losses, histories
  1. See themselves in new ways
  2. Identify new supports and strengths
  3. Recognise patterns that can be changed
• Understand the family of origin —> rules and beliefs from past generations can have great effects on family’s value system

Question 12

Family APGAR Questionnaire

Answer 12

5 questions:

1. I am satisfied that I can turn to my family for help when something is troubling me
2. I am satisfied with the way my family talks over things with me and share problems with me
3. I am satisfied that my family accepts and supports my wishes to take on new activities / directions
4. I am satisfied with the way my family expresses affection and responds to my emotions, such as anger, sorrow and love
5. I am satisfied with the way my family and I share time together

Scoring:

• 2: Always
• 1: Sometimes
• 0: Never

Overall score: Impression on ***Family functioning

• Active listening, Circular questioning, Empathy, Enactment, Feedback, Reframing, Sculpting (Blaming, Placating, Computing, Distracting)
• Trying not to blame one but to externalise the difficulties

Question 13

Complementarity

Answer 13

• Refers to Reciprocity in every relationship
• One’s behaviour is yoked to the other’s in any relationship
• Mutual training will take place and pattern repeats and perpetuates

Question 14

3 important elements in relationship

Answer 14

1. Do not insult others
2. Do not say things you won’t do
3. Love has to be expressed

Question 15

John Gottman’s Love Lab

Answer 15

5: 1 ratio

- 5 good things to counteract / compensate for 1 bad thing

Question 16

Satir’s model of communication stances and sculpting

Answer 16

Experiential intervention that helps family members to reflect and improve their communication styles and family relationships

4 stance model:

1. Blaming
2. Placating (和事佬)
3. Computing (appear cold or unfeeling, display no emotion)
4. Distracting (seek attention to compensate for their feelings of loneliness or inadequacy)

Question 17

Psychosomatic families

Answer 17

Families that may produce somatic symptomatology

Characteristics:

1. Enmeshment of subsystems (e.g. Mother-Child: become same hierarchy, parenting becomes ineffective, child will share mother’s emotions, child will be involved in parental relationship)
2. Conflict avoidance / Poor conflict resolution
3. Overprotection
4. Parental conflict was detoured via the triangulation of the child patients

Most commonly seen psychosomatic family structure: **Mother-child enmeshment / **Disengaged father

Question 18

Satir’s growth model

Answer 18

1. The problem is not the problem, Coping is the problem
2. We cannot change past events, only the effects they have on us.
3. Appreciating + accepting the past increases our ability to manage our present
4. Change is possible. Even if external change is limited, internal change is possible
5. We all have internal resources we need to cope successfully and to grow

Question 19

Scenarios indicated for Family-oriented approach

Answer 19

1. ***Mental health problems
2. ***Psychosomatic symptoms, MUPS (Medically Unexpected Physical Symptoms)
3. ***Adjustment to life stressors, illnesses and death
4. ***Children and adolescent problems
5. Elderly problems
6. ***Couple problems
7. ***Infertility, Sexual dysfunction, HIV, STD
8. Chronic illnesses: e.g. DM, Asthma, Eczema
9. Serious illnesses: e.g. Cancer, Stroke, Degenerative diseases
10. Routine obstetrical and well-child care, annual checkups
11. Health promotion and disease prevention including lifestyle modification
12. Concordance problems

Question 20

Difficult cases: Think about family

Answer 20

1. ***Somatic symptom disorder / MUPS
2. Tics
3. Hair loss / Trichotillomania
4. Secondary enuresis
5. Encopresis (Faecal incontinence)
6. Anorexia nervosa
7. Globus hystericus
8. Recurrent abdominal pain
9. ***School refusal
10. ***Internet addiction
11. ***ADHD-like condition
12. ***Autistic spectrum disorder, SEN
13. ***Depression, anxiety disorders
14. Temporal relationship with family events

Question 21

Circular questions

Answer 21

Designed to shift people from thinking about individuals and linear causality —> towards **reciprocity and **interdependence

• Bring people into constructive discussion on their differences and come up with a more effective way to relate + cope with each other
• Promote mutual understanding, empathy, new way of interacting