Family Dynamics

Tim FOME
Fakultas Kedokteran Universitas Andalas

With Courtesy to
Leilanie A. Nicodemus, MD, MsCM-FM
1/9
 Outline of the Presentation
To discuss concept of family dynamics
konsep
To discuss methods of assessing family
dynamics metode u menilai
To discuss application of family dynamics
assessment in patient care aplikasi dlm
perawatan px
 What is Family Dynamics?? definisi
Inter-relationships between and among
individual family members hub antara...
Term used when describing the forces which
work within a family to produce or result in
certain behaviours pola relasi dlm kelg shg
memunculkan perilaku/sikap ttt.
This also refers to the way in which a particular
family lives and relates with one another
cara sbh kelg hidup dn berelasi
 Family Systems Theory
Useful paradigm to understand behaviour
of families. perilaku kelg

Family composed of parts which are

connected that a change in one part results in
changes in all other parts (parts = family
members)
 Components of Assessment of
Family Dynamics
1. Structure (Roles, Rules, Transactional,
Patterns, Coalitions)
2. Flexibility
3. Resonance
4. Ecological Context
5. Developmental Stage
 1. Structure
Behavioural patterns repeated over time

The behavioural skeleton around which

family life is built.
Deviation from these structures causes
members of the family to undertake corrective
measures.
 Structure
Components of Structure:

Roles
Rules
Coalitions
Transactional Patterns
 Structure: Roles
It is the function that is assigned to a
family member, and that function
maintains the stability and ensuring the
survival of the family system

Method of Assessment:
Who does what and when???
 Structure: Roles: Who does What
and When?
When someone gets sick in your family, who
does he go to first?
Who assists that person?
Who does he go to when he doesnt know what
to do?
Who decides when admission is necessary?
Who will pay for this admission?
Who will stay with the patient?
 Structure: Rules
Rules of behaviour are commonly agreed
upon ways of dealing with each other.
Overt Vs. Covert rules
Overt rules: Rules clearly and verbally stated
Covert rules: not stated but everyone conform
to them
Boundaries between subsystems
Special rules that govern the interaction
between subsystem in the family
 Structure: Transactional Patterns
The particular patterns of interaction between
family members.
The family dance
For example, a mother tells her child to pick up
his socks and he obeys. This interaction defines
who she is in relation to him and who he is in
relation to her. Repeated interactions constitute
a transactional pattern
The same sequence questions ROLES can
be used to determine this patterns
 Structure: Coalitions
The alliances between members of a
subsystem versus the other members.
Who agrees with whom?
Who in your family disagree with each other
the most?
When they disagree, who agrees with A.?
..and who agrees with B..?
 2. Flexibility
The degree to which a family can adapt to changes in its
internal or external environment
Assessment tool: Lifeline
Lifeline:
List of significant events in the family
Sometimes placed side-by-side with illness history
Focus for processing for information of flexibility
Based on family life cycle theory
Every stage has second order changes involving changes in
ROLE and necessitating changes in BOUNDARIES
There are NORMATIVE CHANGES. How flexible is the family
in handling them?
How well is the family handling the NON-NORMATIVE
CHANGES? Financial hardship, war, flood, fire, accident, etc.
 Flexibility: Example: The family
in later life
Making room in the system for the wisdom
and experience for the elderly; supporting
the older generation without over
functioning them
Dealing with loss of spouse, siblings, and
other peers; preparation for own death; life
review and integration
 Sample of Life line
date Psychological Medical Event
Event
1997 Retirement of husband; Depression diagnosed
favourite daughter got in husband
married and leaves.
1998 Diagnosis of lung
cancer in husband

1999 Death of husband

2000 Breast cancer

diagnosed
 3. Resonance
The degree of emotional reactivity between
members
Ranging from Enmeshed to Disengaged
Sequence Questions:
When A does/says this, what happens to B?
What does B do/say as a result?
When B does/says this, what happens to C?
and so on..
Does this happen all the time??
Who is closest to A? Who is next closest?
Who is farthest from A? Who is the next farthest?
Who was most upset about As illness? Who was next
most upset?
Who was least upset about As illness? Who was next
least upset?
 4. Ecological Context
Obstacles and resources
Socio-Cultural
Religious
Economic
Environmental
Medical

SCREEM
 5. Developmental Stage
Genogram
Life Cycle Stage
Typology of illness
Onset; acute Vs. chronic
Course; progressive vs constant vs relapsing
Outcome; immediately fatal vs eventually fatal
 Family Dynamic Assessment
1. Structure (Roles, Rules, Transactional,
Patterns, Coalitions)
2. Flexibility
3. Resonance
4. Ecological Context
5. Developmental Stage
 What the doctor can do?
Cognitive; provide information (making the
family aware of their dynamics) info u
kelg memahami ttg dinamika kelg
Affective; Counsel/emotional support
dukungan emosional
Psychomotor; Identify coping mechanisms
(maximize the use of these mechanisms to
achieve equilibrium) capai
keseimbangan