EVA IRENE YU-MAGLONZO, MD
FAMILY AS A SYSTEM
SYSTEM
– ENTITY COMPOSED OF DISCRETE PARTS
WHICH ARE CONNECED IN SUCH A WAY
THAT A CHANGE IN ONE PART R...
CHARACTERISTICS OF
FAMILY SYSTEMS
 CIRCULARITY-

CASCADING SERIES OF
CHANGES IN THE FAMILY

 EQUILIBRIUM-

ORDERLINESS I...
FAMILY STRUCTURE


HIERARCHY – HOW POWER OR AUTHORITY IS
DISTRIBUTED IN THE FAMILY



ROLE SELECTION – UNCOSCIOUS
ASSIGN...
RULES
 AGREED

WAYS OF DEALING WITH EACH
OTHER, DEALING WITH SITUATIONS AND
THE EXTERNAL ENVIRONMENT
A. OVERT RULES – CLE...
BOUNDARIES


CLEAR- OPEN AND CAN TALK ABOUT
BOUNDARIES AND CHANGE THEM AS
CIRCUMSTANCES DICTATE



RIGID – NOT OPEN TO N...
FAMILY PROCESSES


FAMILY PATTERNS – ORDERED
SEQUENCE OF INTERACTION THAT
TYPIFY HOW FAMILIES FUNCTION



FAMILY DYNAMIC...
MINUCHIN’S FAMILY
DYNAMICS


ENMESHMENT- BOUNDARIES ARE DIFFUSE;
OVERLY REACTIVE TO THE STRESS OF
ANOTHER

EX. A MOTHER W...
MINUCHIN’S FAMILY
DYNAMICS
 DISENGAGEMENT-

RIGID BOUNDARIES;
EXCLUDING ONE MEMBERS INVOLVEMENT

EX. A HUSBAND WHO IS NOT...
MINUCHIN’S FAMILY
DYNAMICS
 TRIANGULATION-

THIRD PERSON IS DRAWN
IN A TWO-PAIR SYSTEM

EX. A COUPLE WHO HAS MARITAL PROB...
MINUCHIN’S FAMILY
DYNAMICS
 COALITION

– INFORMAL GROUPINGS WITHIN
THE FAMILY WHERE ONE USUALLY SIDE
WITH ANOTHER REGARDL...
CLINICAL RED FLAGS SUGGESTING
FAMILY DYSFUNCTION
1.
2.

3.

ATYPICAL MIGRAINE HEADACHE OF
LONG STANDING DURATION
PERSONS W...
CLINICAL RED FLAGS SUGGESTING
FAMILY DYSFUNCTION
4. PATIENTS WITH CHRONIC FATIGUE
5. PEDIATRIC COMPLAINT FOR WHICH PARENT
...
QUESTIONS TO ASSESS
FAMILY DYSFUNCTION


WHAT ARE THE SOURCES OF STRESS IN THE
FAMILY?



HOW ADAPTIVE OR HOW RIGID IS T...
CASE







INDEX PATIENT – MARICAR, 47 Y/O
DIAGNOSIS – BREAST CANCER STAGE 4
PRESENT CONDITION: SEPTIC ON
PIPERACILLI...
CASE


FAMILY PROFILE:
A. MARICAR – HOUSEWIFE, FINISHED SECOND YEAR
COLLEGE BUT DROPPED OUT DUE TO FINANCIAL
CONSTRAINTS
...
PSYCHOSOCIAL HISTORY







FATHER VISITS ONLY THE MOTHER EVERY TWO
WEEKS; SOMETIMES GIVE SOME MONEY AND
LEAVES
MARGA ...
FAMILY PSYCHODYNAMICS





MARICAR AND MARGA – DOMINANT TYPE
MANUEL – WOULD NOT ARGUE WITH MARICAR
AND MARGA WHEN CONF...
CASE ASSESSMENT
 DIVIDE

INTO 4 GROUPS
 DRAW THE FAMILY MAP
 IDENTIFY THE RULES, ROLES IN THE
FAMILY
 ASSESS DEGREE OF...
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Family psychodynamics (2)

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Family psychodynamics (2)

  1. 1. EVA IRENE YU-MAGLONZO, MD
  2. 2. FAMILY AS A SYSTEM SYSTEM – ENTITY COMPOSED OF DISCRETE PARTS WHICH ARE CONNECED IN SUCH A WAY THAT A CHANGE IN ONE PART RESULTS IN CHANGES IN ALL OTHER PARTS - PARTS ARE THE FAMILY MEMBERS; MAY OR MAY NOT BE RELATED BY BLOOD AFFINITY
  3. 3. CHARACTERISTICS OF FAMILY SYSTEMS  CIRCULARITY- CASCADING SERIES OF CHANGES IN THE FAMILY  EQUILIBRIUM- ORDERLINESS IN THE BEHAVIOR OF FAMILY SYSTEMS  HOMEOSTASIS- TENDENCY OF SYSTEMS TO RESIST CHANGE AND GO BACK TO ITS PREVIOUS LEVEL OF FUNCTIONING
  4. 4. FAMILY STRUCTURE  HIERARCHY – HOW POWER OR AUTHORITY IS DISTRIBUTED IN THE FAMILY  ROLE SELECTION – UNCOSCIOUS ASSIGNMENT OF ROLES IN THE FAMILY  ALLIANCE- POSITIVE RELATIONSHIP BETWEEN ANY 2 MEMBERS OF A SYSTEM  BOUNDARIES – RULES DEFINING WHO PARTICIPATES IN THE SUBSYSTEM
  5. 5. RULES  AGREED WAYS OF DEALING WITH EACH OTHER, DEALING WITH SITUATIONS AND THE EXTERNAL ENVIRONMENT A. OVERT RULES – CLEARLY AND VERBALLY STATED B. COVERT RULES – NOT STATED BUT WHICH EVERYONE AGREES TO CONFORM TO ANYWAY
  6. 6. BOUNDARIES  CLEAR- OPEN AND CAN TALK ABOUT BOUNDARIES AND CHANGE THEM AS CIRCUMSTANCES DICTATE  RIGID – NOT OPEN TO NEGOTIATION IN SPITE OF THE FACT THAT CIRCUMSTANCES RENDER THE OLD BOUNDARIES NO LONGER APPROPRIATE.  DIFFUSE – LACK OF CLARITY AND BY INTRUSION BY ONE SUBSYSTEM INTO ANOTHER; INTRUSIONS ARE ACCEPTED AND SOMETIMES POSITIVELY REGARDED
  7. 7. FAMILY PROCESSES  FAMILY PATTERNS – ORDERED SEQUENCE OF INTERACTION THAT TYPIFY HOW FAMILIES FUNCTION  FAMILY DYNAMICS – DISENGAGEMENT, TRIANGULATION, ENMESHMENT, COALITION
  8. 8. MINUCHIN’S FAMILY DYNAMICS  ENMESHMENT- BOUNDARIES ARE DIFFUSE; OVERLY REACTIVE TO THE STRESS OF ANOTHER EX. A MOTHER WHO INSISTS THAT SHE ACCOMPANIES HIS COLLEGE STUDENT SON DURING THE PHYSICAL EXAMINATION IN SCHOOL
  9. 9. MINUCHIN’S FAMILY DYNAMICS  DISENGAGEMENT- RIGID BOUNDARIES; EXCLUDING ONE MEMBERS INVOLVEMENT EX. A HUSBAND WHO IS NOT CONCERNED WITH THE PRENATAL FOLLOW-UP OF HIS WIFE
  10. 10. MINUCHIN’S FAMILY DYNAMICS  TRIANGULATION- THIRD PERSON IS DRAWN IN A TWO-PAIR SYSTEM EX. A COUPLE WHO HAS MARITAL PROBLEMS ARGUES REGARDING MANAGEMENT OF BRONCHIAL ASTHMA OF THEIR SON RATHER THAN THEIR PERSONAL CONCERNS
  11. 11. MINUCHIN’S FAMILY DYNAMICS  COALITION – INFORMAL GROUPINGS WITHIN THE FAMILY WHERE ONE USUALLY SIDE WITH ANOTHER REGARDLESS OF ISSUE INVOLVED EX. A DAUGHTER SIDES WITH HER MOTHER ALWAYS REGARDING PROBLEMS WITH THEIR FATHER
  12. 12. CLINICAL RED FLAGS SUGGESTING FAMILY DYSFUNCTION 1. 2. 3. ATYPICAL MIGRAINE HEADACHE OF LONG STANDING DURATION PERSONS WITH CHRONIC DEPRESSION UNMANGEABLE WITH LONG TERM THERAPY PATIENTS WITH “CHRONIC ANXIETY” WITH MANY CLINIC VISITS AND NO EIDENCE OF ORGANIC PROBLEM
  13. 13. CLINICAL RED FLAGS SUGGESTING FAMILY DYSFUNCTION 4. PATIENTS WITH CHRONIC FATIGUE 5. PEDIATRIC COMPLAINT FOR WHICH PARENT EDUCATION IS NOT EFFECTIVE A. POOR APPETITE IN FIRST YEAR OF LIFE B. ENURESIS C. FUSSINESS & POOR SLEEP PATTERNS D. HYPERACTIVITY IN THE CHILD 6. INSOMINIA
  14. 14. QUESTIONS TO ASSESS FAMILY DYSFUNCTION  WHAT ARE THE SOURCES OF STRESS IN THE FAMILY?  HOW ADAPTIVE OR HOW RIGID IS THE FAMILY?  HOW COHESIVE IS THE FAMILY?  WHAT ARE THE FAMILY’S REPEATING INTERACTION PATTERNS RELATED TO THE PROBLEM?
  15. 15. CASE     INDEX PATIENT – MARICAR, 47 Y/O DIAGNOSIS – BREAST CANCER STAGE 4 PRESENT CONDITION: SEPTIC ON PIPERACILLIN, DETERIORATING SENSORIUM AND MOANS ONLY WHEN A PAINFUL STIMULI IS APPLIED PATIENT HAS NIL CHANCE OF LIVING; POSSIBILITY OF BEING INTUBATED AND HOOKED TO RESPIRATOR
  16. 16. CASE  FAMILY PROFILE: A. MARICAR – HOUSEWIFE, FINISHED SECOND YEAR COLLEGE BUT DROPPED OUT DUE TO FINANCIAL CONSTRAINTS B. MANUEL – CONSTRUCTION WORKER; DID NOT FINISH HIGH SCHOOL C. MARGA – 24 Y/O DAUGHTER, FINISHED SECRETARIAL COURSE; UNEMPLOYED BECAUSE SHE HAS TO TAKE CARE OF HER MOTHER D. MARLO – 20 Y/O SON TAKING ACCOUNTING BUT FORCED TO STOP DUE TO FINANCIAL CONSTRAINTS; WORKS AS A WAITER
  17. 17. PSYCHOSOCIAL HISTORY     FATHER VISITS ONLY THE MOTHER EVERY TWO WEEKS; SOMETIMES GIVE SOME MONEY AND LEAVES MARGA IS THE CAREGIVER AND FURIOUS BECAUSE HER FATHER IS UNCARING AND IRRESPONSIBLE MARLO AGREES WITH HER SISTER MANUEL CLAIMS HE CAN’T TAKE IT SEEING HIS WIFE SUFFERS THAT IS WHY HE PREFERS TO JUST LOOK FOR MONEY TO PAY THE HOSPITAL RATHER THAN STAYING THERE
  18. 18. FAMILY PSYCHODYNAMICS     MARICAR AND MARGA – DOMINANT TYPE MANUEL – WOULD NOT ARGUE WITH MARICAR AND MARGA WHEN CONFRONTED MANUEL IS THE CLOSEST TO THE PATIENT AND NEXT IS MARGA MARICAR WOULD NOT LET MARGA HAVE A BOYFRIEND UNTIL SHE HAS FINISHED COLLEGE AND MARGA ABIDED.
  19. 19. CASE ASSESSMENT  DIVIDE INTO 4 GROUPS  DRAW THE FAMILY MAP  IDENTIFY THE RULES, ROLES IN THE FAMILY  ASSESS DEGREE OF FLEXIBILITY AND RESONANCE IN THE FAMILY SYSTEM  SUBMIT YOUR REPORT

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