Family systems theory

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Family systems theory

  1. 1. Family Systems Theory<br />Aileen B. Pascual, MD, DPAFP<br />
  2. 2. What is a SYSTEM?<br />An entity composed of discrete parts which are connected in such a way that a change in one part results in changes in all of the other parts<br />
  3. 3. The Family is a System<br />
  4. 4. Characteristics of the Family System<br />Circularity<br />Equilibrium<br />Homeostasis<br />
  5. 5. Elements of the Family System<br />Structures<br />Rules<br />Overt<br />Covert<br />Boundaries<br />
  6. 6. Structures<br />Behavioral patterns repeated over and over again<br />Behavioral skeleton around which the family is built<br />
  7. 7. Rules<br />Commonly agreed upon ways of dealing with each other, dealing with situations, and dealing with the external environment<br />Overt Rules<br />Covert Rules<br />
  8. 8. Boundaries<br />Special rules that govern the interactions between subsystems in the family<br />Clear<br />Rigid<br />Diffuse<br />
  9. 9. Elements of the Family System<br />Roles<br />Coalitions<br />Power Structures<br />
  10. 10. Roles<br />Breadwinner <br />Caregiver<br />Symptom carrier<br />“Family Doctor”<br />“Medical Specialist”<br />
  11. 11. Coalitions<br />Alliances between members<br />Informal groupings within the family of people who usually side with each other<br />
  12. 12. Power Structures<br />Decision-makers<br />Usually parental generation<br />
  13. 13. What does all of this mean for us as family physicians?<br />
  14. 14. Family Mapping<br />
  15. 15. Family Map<br />Application of Family Systems Concepts<br />Characteristics : members<br />Structure: boundaries, alliances, coalitions<br />Process: enmeshment, disengagement<br />Across time: intergenerational coalition<br />
  16. 16. Circular Questions <br />Series Questions <br />Explores repetitive behavior<br />“Who-does-what-and-when” Questions<br />Explores different roles<br />
  17. 17. Circular Questions <br />“Closer-farther” Questions<br />Explores emotional closeness and distance<br />“Who agrees with whom” Questions<br />Elicits information about coalitions <br />
  18. 18. Family Map Symbols<br />Functional relationship<br />Enmeshed or over-involved relationship<br />Dysfunctional relationship<br />
  19. 19. Family Map Symbols<br />Clear<br />Rigid<br />Diffused<br />
  20. 20. Family Map Symbols<br />Coalition or Alliance<br />Escape from the system<br />Triangulation<br />
  21. 21. Jun50<br />May 50<br />Chary 16<br />Ringo<br />18<br />
  22. 22. Tools in Family Assessment<br />
  23. 23. Family Assessment Tools<br />Function<br />APGAR<br />Family Map<br />Lifeline<br />SCREEM<br />Ecomap<br />Development<br />Family Life Cycle<br />Anatomy<br />Genogram<br />
  24. 24. Genogram<br />Inheritance patterns<br />Family illnesses<br />Family members<br />Family relationships<br />Significant dates <br />
  25. 25. CabentogFrias Family<br />January 21 2009<br />FRIAS<br />CABENTOG<br />Lourdes<br />68<br />Lito<br />65<br />?<br />?<br />Susan<br />30<br />Jun<br />45<br />Marites<br />47<br />Anna<br />49<br />?<br />Allan<br />50<br />Bong<br />44<br />Connie<br />42<br />Bel<br />39<br />Mon<br />47<br />Liza<br />46<br />2004<br />2004<br />Legend<br />?<br />5<br />Angelica<br />16<br />CVD<br />HPN<br />Hyperthyroidism<br />Asthma<br />
  26. 26. Family Life Cycle<br />
  27. 27. APGAR<br />A – adaptation<br />Capability to utilize and share resources<br />P – partnership<br />Solving problems by communicating<br />G – growth<br />Freedom to grow and change <br />A – affection<br />Intimacy and emotional interaction in the family<br />R – Resolve<br />Commitment by other members to the family<br />
  28. 28.
  29. 29. APGAR<br />Scoring:<br />Almost always – 2<br />Some of the time – 1<br />Hardly ever – 0<br />Total :<br />8-10 – highly functional<br />4-7 – moderately dysfunctional<br />0-3 – severely dysfunctional<br />
  30. 30. Family Lifeline<br />Family History<br />Significant events that may have effect on a patient’s health<br />
  31. 31.
  32. 32. Family Assessment Tools - Function<br />Draw a Family Test (DRAFT)<br />Draw a Circle Test<br />
  33. 33. Family Assessment Tools Community Resources<br />SCREEM<br />Family Ecomap<br />
  34. 34. SCREEM<br />Sources of help<br />Barriers to patient care<br />Relationships of health behavior, practices and utilization of health services<br />
  35. 35.
  36. 36. Ecomap<br />The ecomap is a “snapshot” of the patient within his/her family and social environment at a particular point in time<br />
  37. 37. Ecomap<br />Connects the environment outside of the family with the family members.<br />Where is energy being directed and what is the nature of that exchange?<br />What is the quality of that exchange?<br />
  38. 38. Ecomap – Quality of Exchange<br />The STRENGTH of the connection (Weak; tenuous/uncertain; Strong)<br />The IMPACT of the connection (none; draining resources or energy; providing resources or energy) <br />The QUALITY of the connection (Stressful; Not stressful) <br />
  39. 39. Commonly Used Symbols<br />Stressful, conflictual +++++++<br /> relationship<br />Tenuous and/or<br />uncertain relationship - - - - - - - <br />Positive relationship _________<br /> or resource <br />The direction of the <br /> giving & receiving <br /> exchange or a relationship <br />or resource <br />(also known as energy)<br />
  40. 40. Interpretation<br />Thicker (darker) lines mean stronger relationship<br />Curvy or red lines mean that the system is a stressful relationship<br /> Arrows pointing to the patient mean that the system primarily influences the patient.<br /> Arrows pointing to the system mean that the patient primarily influences the system<br /> Arrows pointing both direction depicts a two direction flow of influence<br />
  41. 41. Coffee<br />Group<br />Daycare<br />Church<br />Rotary <br />Sister<br />Clinic <br />Px<br />Parents <br />++++++++++++<br />Hospital<br />Brothers <br />Family<br />

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