JC126 (Family medicine) – The Family in Family Medicine Flashcards
5 tools for family assessment and intervention/ 5 ways to understand family
- Family life-cycle theory
- Genogram
- Family APGAR questionnaire
- Satir’s model of communication stances and sculpting
- Theory of family structure
Define family therapy
evidence-based branch of psychotherapy that assess and treat various mental disorders and health conditions in family relationship perspective
Family APGAR questions
5 questions: adaptation, partnership, growth, affection, resolve
1. I can turn to my family for help when something is troubling me.
- my family talks over things with me and shares problems with me.
- my family accepts and supports my wishes to take on new activities or directions.
- my family expresses affection and responds to my emotions, such as anger, sorrow, and love.
- my family and I share time together.
Scoring system using Family APGAR questions
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
Name method of mapping family relationship and medical history
Types of family relationships
Information included in map
Genogram:
- Maps personal relationships & medical history of a family ≥3 generations
Family relationship:
- Mutually kind and helpful
- Mutually hostile
- Unequal, one-way, controlling
- Distant (conflictual, neglect), cut-off
- Enmeshed (conflictual, protective, abusive)
Additional information:
medical information, births, losses, relationship, communication patterns, roles, occupations, problems facing and supports (significant family events and stories)
6 family life-cycle stages
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)
Life transitions in the first phase of family life cycle - Leaving home as single young adult
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
Life transitions in the second phase of family life cycle - Marriage as new couple
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?
Life transitions in the third phase of family life cycle - Families with young children
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?
Life transitions in the second phase of family life cycle - Marriage as new couple
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
Life transitions in the fifth phase of family life cycle - Families
launching children and moving on (empty-nest)
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
Life transitions in the sixth phase of family life cycle - Families in later life (e.g. having disease)
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
Explain the system perspective of illness
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
Explain complementarity of relationships
3 advice for couples in disagreement
Ratio of happy and unhappy interactions in happy couples
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)
Importance of understanding the family life cycle?
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
3 ways to define a family’s structure
- 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
- Boundaries: Invisible interpersonal boundaries define functional subgroups” (subsystems)
Describe the spectrum of personal boundary ambiguity
Red flags signs of a psychosomatic family
- Conflict avoidance / poor conflict resolution
- Overprotection
- Rigidity
- Enmeshment
- Triangulation of child patients
Describe triangulation in interpersonal conflict
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:
- A child and his/her parents;
- A parent, a child, and a grandparent
- Husband, wife, and an in-law
Describe the process of triangulating a child into parental conflicts
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)
Describe Satir’s model in coping stances and sculpting
4 “survival stances” to demonstrate how people cope with
problems:
1. Placating (placator): apologetic, tentative, and self-effacing
- Blaming (blamer): finds fault, calls name, and is ripe with criticism.
- Being super-reasonable (computer): intellectualizes and shows little affect.
- Being irrelevant (distractor): brings up irrelevancies to take the focus away from the issue.
- (Leveler: engages in honest, direct, clear communication)
Importance of coping stances and sculpting in interpersonal conflicts
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.
Common beliefs and principles of the Satir’s growth model:
Positive and negative communication methods
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.
Disease presentations that may indicate family problems
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
