JC126 (Family medicine) – The Family in Family Medicine

Question 1

5 tools for family assessment and intervention/ 5 ways to understand family

Answer 1

1. Family life-cycle theory
2. Genogram
3. Family APGAR questionnaire
4. Satir’s model of communication stances and sculpting
5. Theory of family structure

Question 2

Define family therapy

Answer 2

evidence-based branch of psychotherapy that assess and treat various mental disorders and health conditions in family relationship perspective

Question 3

Family APGAR questions

Answer 3

5 questions: adaptation, partnership, growth, affection, resolve
1. I can turn to my family for help when something is troubling me.

2. my family talks over things with me and shares problems with me.
3. my family accepts and supports my wishes to take on new activities or directions.
4. my family expresses affection and responds to my emotions, such as anger, sorrow, and love.
5. my family and I share time together.

Question 4

Scoring system using Family APGAR questions

Answer 4

Each question: “almost always” (2 points), “some of the time” (1 point), or “hardly ever” (0).

 7-10: highly functional family
 4-6: moderately dysfunctional family
 0-3: severely dysfunctional family

Question 5

Name method of mapping family relationship and medical history

Types of family relationships
Information included in map

Answer 5

Genogram:
- Maps personal relationships & medical history of a family ≥3 generations

Family relationship:

1. Mutually kind and helpful
2. Mutually hostile
3. Unequal, one-way, controlling
4. Distant (conflictual, neglect), cut-off
5. Enmeshed (conflictual, protective, abusive)

Additional information:
medical information, births, losses, relationship, communication patterns, roles, occupations, problems facing and supports (significant family events and stories)

Question 6

6 family life-cycle stages

Answer 6

Leaving home (single young adult)

Marriage – the new couple

Families with young children

Families with adolescents

Families launching children and moving on (empty-nest)

Families in later life (e.g. having disease)

Question 7

Life transitions in the first phase of family life cycle - Leaving home as single young adult

Answer 7

Theme of transition:
Accepting self-responsibility – financial & emotional

Adjustments and tasks:
 Differentiation of self
 Develop new relationships/ establish new intimacy
 Establishment of self-work and financial independence

Question 8

Life transitions in the second phase of family life cycle - Marriage as new couple

Answer 8

Theme of transition
 Commitment to each other and the new systems

Adjustments and tasks
 Forming marital system
 Including spouse into extended families and friends
 In-law relationship
 Household arrangement
 Career, financial adjustment
 Having children?

Question 9

Life transitions in the third phase of family life cycle - Families with young children

Answer 9

Theme of transition: 
 Developing parent roles
 Accepting new members into the system
 Accepting children’s personality
 Introducing children

Adjustments: 
 Accommodating children
 Parenting
 Work vs. family
 Financial planning
 Adjusting to school life, social life of children
 Realignment of extended family relationship with grandparenting roles
 Having more children?

Question 10

Life transitions in the second phase of family life cycle - Marriage as new couple

Answer 10

Theme of transition:
Increasing flexibility of family boundaries to permit children’s independence and grandparents’ frailties

Adjustments:
 Coping with changing needs of adolescents
 Permitting adolescents into and out of system; let go
 Midlife adjustment: career, financial, health, marriage
 Shifting care for older generation

Question 11

Life transitions in the fifth phase of family life cycle - Families
launching children and moving on (empty-nest)

Answer 11

Transition:
 In and out of the system
 “Empty-nest”, facing each other again

Adjustments:
 Developing adult-adult relationship with children
 Renegotiation of marriage
 Adjustment to physical decline, health issues, retirement planning, household
 In-laws, grandchildren, disabilities and death adjustment

Question 12

Life transitions in the sixth phase of family life cycle - Families in later life (e.g. having disease)

Answer 12

Theme of transition:
 Accepting old age and shifting generational roles
 Accepting losses

Adjustments and tasks:
 Adjustment to loss of health and functioning, retirement, household, new familial and social roles (grand-parenting)
 Supporting older generation
 Dealing with loss of spouse, siblings and friends

Question 13

Explain the system perspective of illness

Answer 13

problems (illness(s) / health issues) and people are products of their interpersonal context:

Individuals cannot be understood in isolation from one another, are all inter- related, and influencing each other

(a) behaviorally,
(b) emotionally, and
(c) cognitively (expectations, assumptions, values)

Change in one member of the family will affect the whole family system

Question 14

Explain complementarity of relationships

3 advice for couples in disagreement

Ratio of happy and unhappy interactions in happy couples

Answer 14

Complementarity (yin-yang):
 = the reciprocity in every relationship (in any relationship, one’s behaviour is yoked to the other’s)

Advice:
 Don’t insult others (name calling)
 Don’t say things you won’t do
 Love has to be expressed (say out or act out)

Ratio:
5:1 ratio (stable, happy couples have a 5:1 ratio between positive interactions and negative interactions)

Question 15

Importance of understanding the family life cycle?

Answer 15

Adaptation is necessary for each change with new skills to be learned; change is followed by period of relative stability

Failure to readjust at transitions in the family life-cycle / stuck in transition causes problems

Recognize transition themes and offer help accordingly

Question 16

3 ways to define a family’s structure

Answer 16

1. Hierarchy: Position / status in terms of power dictating authority and decision making in a family

2. Subsystems: Carry out various tasks in a family
formed by:
1. Generations,
2. Gender,
3. Hierarchy,
4. Functions

3. Boundaries: Invisible interpersonal boundaries define functional subgroups” (subsystems)

Question 17

Describe the spectrum of personal boundary ambiguity

Answer 17

Question 18

Red flags signs of a psychosomatic family

Answer 18

1. Conflict avoidance / poor conflict resolution
2. Overprotection
3. Rigidity
4. Enmeshment
5. Triangulation of child patients

Question 19

Describe triangulation in interpersonal conflict

Answer 19

process of detouring 2 persons’ conflicts to the third person:

e.g. “triangle in” a third member as a way of stabilizing their relationship and freezing their conflicts

Common family triangles include:

1. A child and his/her parents;
2. A parent, a child, and a grandparent
3. Husband, wife, and an in-law

Question 20

Describe the process of triangulating a child into parental conflicts

Answer 20

Mother-child closeness and peripheral father figure in families with psychosomatic problems

Child disobeys the father as perceiving that the mother is shouldering him/her

Mother also cannot control the child as she is only seen to have same hierarchy as the child.

wife is likely to be dissatisfied in couple relationship, and as an unhappy mother, her unhappiness can be absorbed by the child through insecure attachment process

The child may then be triangulated into the parental relationship as
a way to maintain its balance and often becomes too involved with
the parental conflicts (parent watcher)

Question 21

Describe Satir’s model in coping stances and sculpting

Answer 21

4 “survival stances” to demonstrate how people cope with
problems:
1. Placating (placator): apologetic, tentative, and self-effacing

2. Blaming (blamer): finds fault, calls name, and is ripe with criticism.
3. Being super-reasonable (computer): intellectualizes and shows little affect.
4. Being irrelevant (distractor): brings up irrelevancies to take the focus away from the issue.
5. (Leveler: engages in honest, direct, clear communication)

Question 22

Importance of coping stances and sculpting in interpersonal conflicts

Answer 22

Coping stances developed through people’s lives from childhood from a state of low self-worth, low self-esteem and imbalance

People adopt survival stances to protect their self-worth against verbal and nonverbal, perceived and presumed threats.

Question 23

Common beliefs and principles of the Satir’s growth model:

Answer 23

Question 24

Positive and negative communication methods

Answer 24

 Positive “process”: nodding in acknowledgement, eye contact, leaning closer, reaching over to take someone’s hand, allowing someone to speak and to finish their point, using respectful language to disagree

 Negative “process”: defensive body posture, sarcasm, attacking tone or words, interrupting, raising voices, seductive behavior, manipulation through charm, etc.

Question 25

Disease presentations that may indicate family problems

Answer 25

 Somatic symptom disorder/MUPS
 Tics
 Hair loss/trichotillomania (hair-pulling disorder)
 Secondary enuresis
 Encopresis (soiling of underwear with stool by children who are past 4yo)
 Anorexia nervosa
 Globus hystericus
 Recurrent abdominal pain
 School refusal
 Internet addiction
 ADHD-like condition
 Autistic spectrum disorder, SEN (special educational needs)
 Depression, anxiety disorders