Professional Documents
Culture Documents
INTRODUCTION:-
“Family faces are magic mirrors. Looking at people who belong to us, we see the past, present and
future.”
Gail Lumet Buckley
Family is the first social unit for developing the qualities of an individual. A true family grows and
moves through life together. The word "family" implies warmth, a place where the core feelings of the members
are nurtured. Family values represent the core values and guidelines that parents and family members hold in
high regard for the well-being of the family. Family provides necessary security and support, and acts as a buffer
against external problems. A family made up of secure people generates a magnetic power that can get things
done. They are the hope for real security in a stressful world.
THEORIES OF FAMILY DYNAMICS:
A variety of theoretical frameworks provides the nurse with a holistic overview of health promotion for
the individual and families across the life span. Major theoretical frameworks that nurses use in promoting the
health of the individual are need theories , developmental stage theories , and system theories. Major theoretical
frameworks that nurses use in promoting the health of the family are developmental stage theories , and general
system theories, Bowen’s family theory and structural – functional theories.
Family Development Task( Theory of Family):-
Family development refers to the process of progressive structural diffentiation and transformation over
time. A family development is defined as a “growth responsibility that arises at a certain stage in the life of a
family, the successful achievement of which leads to present satisfaction . approval and success with later”.
Failure in completing the task can lead to family unhappiness , societal disapproval and difficulty with latter
development.
The healthy family performs all roles appropriately according to family member’s age , competencies
and needs during family life cycle. Family life cycle dimensions provide the basis for the study of families
over time, emphasis family members and families developmental task at every stage of development ,identities,
family, stresses on critical developmental periods and recognizes the need for services and programme for
families through out the life cycles.
1. Beginning family/ married couple
• Establishing mutually satisfying marriage
• Relating with kin network
• Family planning
2. Early child – bearing family
• Integrating new baby in to the family
• Reconciling conflicting developmental task and needs of individual family members
• Maintaining satisfying marital relationship
• Expanding relationship with extended family
3. Family with preschool children
• Nurturing and socializing children
• Integrating new member (newborn) into the family while still meeting needs of older children
• Maintaining healthy relationship with marital partner , children , extended family and community
members
4. Family with school age child
• Socializing children
• Promoting school achieving
• Maintaining satisfactory marital relationship
• Meeting health needs of the family members
5. Family with teenagers
• Balancing teenage freedom and responsibilities
• Maintaining open parent child communication
• Focusing more attention on the marital relationship
• Building a foundation for future family stages
6. Launching family
• Releasing children as young adults
• Continuing to renew and readjust in the marital relationship
• Assisting aging and ill parents of the husband and wife
Research evidence
1. Shigeto, Aya., Mangelsdorf, Sarah., Brown, Geoffrey., Schoppe-Sullivan, Sarah. and Szewczyk
Sokolowski, Margaret. "Parental and child influences on family interaction patterns"(2006) Paper
presented at the annual meeting of the XVth Biennial International Conference on Infant Studies, Westin
Miyako, Kyoto, Japan, Jun 19
Background and Aims: Family systems theory suggests that the family operates as a whole and that
family members and relationships influence one another in a continuous, reciprocal fashion (e.g., Cox & Paley,
1997; Minuchin, 1988). Due to lack of research examining beyond individuals and dyads of the family, the goal
of the current investigation was to explore how parental and marital characteristics prebirth as well as child
characteristics were related to 13-months family interaction patterns.
Methods: 55 expectant parents completed questionnaires about depression (BDI; Beck et al., 1961), traditional
beliefs about paternal roles (a modified version of the Role of the Father Questionnaire; Palkovitz, 1984), and
marital adjustment (DAS; Spanier, 1976). Child temperament (ICQ; Bates et al., 1979) and marital adjustment
were assessed at 3.5 months postpartum, and family interaction was videotaped in the laboratory at 13 months.
Based on the scales used to code family interaction (Lindahl & Malik, 2000; Paley, Cox, & Kanoy, 2000), we
used two family interaction variables, sensitive engagement and family intrusiveness.
Key Results and Conclusion: Fathers’ traditional beliefs about paternal roles were associated with less sensitive
engagement, r = -.28, p < .05, and greater family intrusiveness, r = .35, p < .05. Difficult temperament was
negatively associated with family intrusiveness, r = -.36, p < .05. Regression analyses indicated that when the
child was temperamentally easy, families with more depressed fathers prebirth showed more intrusive behaviors
than families with less depressed fathers (beta = -.24, p < .05). When the child was easy, parents who viewed
being a disciplinarian and a breadwinner as important roles for the father were more intrusive (for mothers, beta
= -.28, p < .05; for fathers, beta = -.28, p < .05). Families whose marital adjustment decreased over the transition
to parenthood were more detached when the child was easy (the effects were most specific to one of components
of sensitive engagement, family detachment), whereas families whose marital adjustment did not change or
increased were more detached when the child was difficult (beta = -1.09, p < .05). Taken together, these results
suggest that prebirth and postbirth parental and child characteristics play important roles in shaping family
interaction patterns.
2. Brook JS, Brook DW, Gordon AS, Whiteman M, Cohen P. The psychosocial etiology of adolescent drug
use: a family interactional approach.Genet Soc Gen Psychol Monogr. 1990 May;116(2):111-267.
The purpose of this monograph was to propose a framework, family interactional theory, for explaining the
psychosocial aspects of adolescent drug use. Three themes are stressed: (a) the extension of developmental
perspectives on drug use, (b) the elucidation of family (especially parental) influences leading to drug use, and
(c) the exploration of factors that increase or mitigate adolescents' vulnerability to drug use. We present a
developmental model with two components; the first deals with adolescent pathways to drug use, and the second
incorporates childhood factors. The model was tested in two studies: one cross-sectional study of 649 college
students and their fathers, and one longitudinal study of 429 children and their mothers. The subjects were given
self-administered questionnaires containing scales measuring the personality, family, and peer variables outlined
in the model. The results of each study supported the hypothesized model, with some differences between
parental influences. We also found that individual protective factors (e.g., adolescent conventionality, parent-
child attachment) could offset risk factors (e.g., peer drug use) and enhance other protective factors, resulting in
less adolescent marijuana use.
General Systems Theory:-
Provides social workers with a conceptual framework that shifts attention from a cause/effect
relationship of paired behaviors, to a broader environmental etiology of behavior
Observes the following:
o A person is only a piece of their entire life situation
o Dynamic interactions between person, systems and environments
o Functionality as an individual and a system
It is not enough for the social worker to simply assess the client and then the environment, but the
dynamic processes must be integrated into a biopsychosocial hypothesis that reflects the presenting
behavior within the context of ecological systems
One of the Best Ways to view General Systems Theory is in the context of family life: a subsystem of the larger
community system
The whole is greater than the sum of its parts
Changing one part of the system, results in changes to other parts of the system
Families become organized and developed over time. Families are always changing and, over the life
span, family members assume different roles
Families are generally open systems in that they receive information and exchange it with each other
with people outside the family. Families vary in their degree of openness and closedness, which can vary
over time according to circumstance
Individual dysfunction is often reflective of an active emotional system. A symptom in one family
member is often a way of deflecting tension way from another part of the system and hence represents a
relationship problem (I.E. the identified patient)
Four key Domains of Environmental Interactions
Situation: The part of the environment that is accessible to an individual’s perception at any given
moment of time
Micro: The part of the physical and social environment that the individual has direct contact with and can
interact with in daily life
Mezzo: The part of the environment that in some way or other influences and determines the character
and functioning of the micro environment
Macro: Common to most members of groups living in it and involves physical, social, cultural,
economic, and political structures of the larger society
Rules & Roles in General Systems Theory
o Rules can be conscious and unconscious
Often times the unconscious rules have more impact on social exchange
Boundaries: Both physical and unconscious
o Roles: Adopted within the family systems in order to maintain equilibrium
Role Contiguity: Whether Peter’s expectations of Peter’s behavior is the same as Susan’s
expectations of Peter’s Behavior
Role Competency:Does one have the skill or knowledge to meet prescribed role
expectations and does the person understand their role
Role Conflict: Demands of two roles conflict with each other…example: being a mother
and a full-time student
Structural Family Theory (Minuchin):-
Basic Goal: By changing the structure of the family, both the behavior and intrapsychic processes of the
family will be changed.
This theory is very concrete, based upon the here and now, and a very involved social worker
It Consists of Seven Basic Premises
o Focuses on Concrete Issues
o Located in the Present
o Mediated through Client’s Experience
o Based on Reorganizing the Structure of Family Relationships
o Built upon Client Strengths
o Aimed at Palpable Outcomes
o Active Involvement of the Social Worker
Focused on Concrete Issues:
o The social worker addresses the most urgent issue that has the families attention first
This is considered the most compelling concern.
Success breeds success
o The concrete issue can be anything as long as it is of the utmost concern to the family
o Look for motivations behind actions and tie these motivations into interventions as they will
increase the likelihood of success
o Spirituality, Existential Meanings, Key Relationships…whatever works….think practical
Located in the Present
The past is accessible through the present, as current behaviors are related to past
interpretations…there is no need for regressional work
The client issue contains the focal point of today’s concern, the dynamics currently generating the
distress, and traces the family history that explains the why and how of the problem’s birth.
Be remedying and changing the current structure, past memories, perceptions, and psychological
residue are alleviated.
Mediated through the client’s experience
The primary model of intervention is enactment of their issue in session…there is less focus on
the verbal recount of a situation as noted in traditional family therapy.
The structural family social worker seeks to understand the unique experience of each individual
within the context of the presenting concern and looks for areas of convergence and divergence in
experience.
Based upon Reorganizing the Structure of Relationships
The social worker pays close attention to the structure of the family in context of the presenting
concern
Boundaries: What defines who is in or out of a family relationship in the context of
the focal issue, as well as what their roles are in this interaction
Alignment: Who is with or against the other in the transactions generating the problem
Power: What the relative influence is of the participants in the interactions that
contributes to the presenting problem
Alignments, Coalitions, Disengaged Families, Enmeshed Families
Look for the etiology of problems
• Conflicting feelings and needs
• Weakly organized relationships
• Both
Encourage adaptive structures in family dynamics.
Built Upon Strengths
Identify current and underutilized family strengths/ resources to assist in alleviating the
presenting concern.
Integrate these strengths and resources within the family structure or relating
Look to draw the good out of the bad
Characterized by Active Social Work Involvement
Join the family interaction in a carefully planned, goal directed way
The social worker may purposefully draw attention to the area of conflict to increase the
emotional dynamics of the family system
The social worker may purposely block pathological interactions within the family systems and
force the family members to develop new methods of communication/interaction
Supports adaptive behaviors
Intensive use of “self” in the therapy process
Assignment of homework…practicing a specific skill to change family structure.
IMPACT OF ILLNESS ON THE CLIENT AND FAMILY:-
Impact of illness is not an isolated event. The client and the family deal with changes resulting from
illness and treatment. Each patient respond uniquely to illness and therefore nursing interventions must be
individualized. The client and family commonly experience behavioral and emotional changes as well as
changes in family life, roles , body images and self concept & family dynamics
Factors determining the impact of illness on the family:-
The nature of illness which ranges from minor to life threatening
The duration of illness , which ranges from short term to long term
The residual effects of illness, including none to permanent disability
The financial impact of the illness, which is influenced by factors such as insurance and ability of the ill
person to return to work
The effect of illness on future functioning
Behavioral and emotional changes:-
People react differently to illness or threat to illness. Individual behavioral and emotional reactions
depend on the nature of illness. Clients attitude towards it, the reaction of others to it & variables of the illness
behaviors.
Short term non life threatening illness evoke few behavioral changes in functioning of the client/ family.
A husband or father who have cold, for example may lack energy and patience to spend time with family
activities and may be irritable and may prefer not to interact with family. This is a behavioral change but the
change is subtle and does not lost long . some may even consider such a change as normal response to illness.
An individual’s emotional state, as well as attitude towards the loss of health and well being tends to vary .
STRAIN identified several psychological reactions that a person may experience after the diagnosis of illness.
1. Loss of control or one’s body that threatens self esteem and sense of body wholeness
2. Fear that illness and dependent others will cause significant others to withdraw love & general approval
of the person
3. Loss of independence and loss of control over body functions
4. Anxiety because of separation from loved ones and familiar environment due to hospitalization
5. Fear of loss of or injury to body parts
6. Guilt of fear of retaliation from family for having incurred the health problems in the first place
7. Fear of pain
8. Fear of strangers providing intimate care
The 5 stages of emotional reactions:-
1. Denile or disbelief: avoids discussion on illness. “there is nothing wrong with me” is the answer
2. Anger : client blames and complaints “I often directs anger towards god or others”
3. Bargaining :client or family members promises to live better life in exchange for promise of good health
4. Resolution :client or family members begin to express openly realizes that illness has created changes in
life
5. Acceptance : client recognizes reality of condition strives for independence.
Family behavior: according to BROOKS:-
BROOKS identified 3 types of family behaviors that sometimes emerges in the family limits of the ill
client.
1. A rejecting family:- makes no place for the client. The family members are capable of carryout the
family routines without any regard to the persons needs. Other members are united and exclude the ill
person. This can lead to divorce or institutional placement.
2. Scarifying family :- in which the client becomes the centre of all family members. They over emphasis
his needs and support . They become over protective and anxious and foster the dependent behaviors.
Family members may force their opinion without regard for clients interest ,personal plans resulting in
client regression , depression, filling of helplessness and anxiety.
3. Natural family :- it is the traditional family setup where they know what is the needs of the patient and
they attend the needs of the individual when ever they require.
Flexibility and good communication skills are necessary to overcome many physical, psychological and
social barriers. Good adjustment can be made after few weeks of diagnosis. The family participations result in
better ability to cope with disability and illness.
Impact of family life:-
Those people who closely associated with the ill person may feel relief and depressed. Not all the
members of the family work through the stages of grief at the same rate. One griever may be in a state of shock ,
where as the other may be depressed. As each person goes through an action mental stage, the family system as
a whole proceeds through intensive changes.
Serious of prolonged illness is a common source of stress , posing major problems of adjustments for
both client and family. Severe injury , diagnosis of chronic illness and resultant disabilities also can mean
catastrophe for the family as well as the individual family members .
A number of people have suggested that the roles available to members of families where abuse is a
factor can be summarized by looking at three primary roles: victim, abuser, hero/messiah and non-protective
person. None of these three roles is healthy. They are all best understood as part of the abusive system. One of
the more important things to observe about the abusive system is the relative ease with which people within the
system can change roles. Because each of these roles is part of the abusive system, they all are painful to
experience. And so people often try to switch roles, hoping that one of the other roles will be less painful. Here
are short descriptions of all available options–notice the obvious, they are all bad options:
• A Victim can become a Non-Protective Person. Example: someone who was sexually abused by a father
who finds themselves later in life unable to protect their children from their grandfather.
• A Victim can become an Abuser. Some people talk about this as an attempt to find a more powerful role.
“I’m tired of being the victim. I need to be more powerful than that. I can fight back.” Others think of this as
a kind of returning to the scene of the crime–returning to an abusive situation but in a more powerful role.
This is what Sandra Wilson is getting at in her book “Hurt People Hurt People.”
• A Victim can become a Hero/Messiah. Example: someone who prematurely seeks to turn their own painful
experiences into ministry to others. The focus on others can truncate the healing process. There’s nothing
wrong with helping others but if it is a way to avoid doing my own recovery work, then the results are not
pretty.
Bad Options for a Hero/Messiah
• A Hero/Messiah can become a victim. Example: I have worked myself to death rescuing victims and
sometimes they don’t even appreciate all my sacrificial giving. In fact some of them resent me. I’m starting
to feel like I’m the victim here.
• A Hero/Messiah can become a Non-Protective Person. I call this the ‘trajectory of the burnt out social
worker’. Example: “I’ve been giving too much for too long and I’m just not able to care anymore. I’m
resentful at people who have not appreciated my work. And I’ve learned my lesson . . . I’m not going to be
a hero anymore. I can’t fix this and I’m not going to pretend that I can. I’ll do what I’m required to do but
that’s it. I can’t protect everyone anyway. And a lot of them don’t even want to be protected.”
• A Hero/Messiah can become an Abuser. Think of a spouse of someone who was sexually abused as a
child. When it first becomes apparent that abuse is part of their spouse’s story, they commit themselves to
being the perfect spouse. “My spouse needs me now more than ever. I’m going to be really strong and really
helpful and really good.” But over time you get tired. Hurtful things are said. You are getting hurt. . . and
you need to defend yourself. The once strong, helpful, good person can eventually find themselves doing
things which the Victim says are hurtful. Even if they do no actual harm. . . they have made the move from
the hero/messiah role to the abuser role.
• An Abuser can become a Non-protective Person. When an abuser starts to feel threatened, they may try
to find safety by distancing themselves from the whole situation. “This is not my problem. I can’t help you
with this. I can’t protect you from whatever you think is going on.” When neither the hero role nor the
victim role are available, this may become an attractive transition for someone who feels stuck in the abuser
role.
• An Abuser can become a Victim. The most common response of abusers when their abuse becomes
known is to argue that they are really the victim. People are accusing them falsely. People are hurting them
by thinking such evil things. When the abuser role becomes painful it feels safer to compete for the victim
role. If an abuser was abused earlier in life this sense of entitlement to the victim role can be particularly
strong.
• An Abuser can become a Hero/Messiah. The classic example of this is domestic violence. Immediately
after a violent episode the abuser will typically be full of remorse, will promise that it will never happen
again and will be determined to be the best husband ever. None of this represents a move towards health. It
is just a move from the abuser role to the hero/messiah role. It is a move within the system — not a step
outside of the system.
•A Non-Protective Person can become a Victim. Think here about a mother who was unable to protect her
children from being sexually abused by their grandfather even though she knew they were at risk. The
abusive system may seek to reassign this mother to the abuser role (see below) but this effort will be
resisted by the non-protective parent who may argue that they are really the one who has been betrayed.
They may insist that they are just as much a victim in this situation as the children. This may, of course,
have some truth to it. But the move from non-protective person to victim does not represent any progress.
Both roles are part of the abusive system.
• A Non-Protective Person can become a Hero/Messiah. Earlier I characterized the transition from Hero to
Non-protective Person as the ‘trajectory of the burnt out social worker.’ A transition in the opposite
direction is what can happen when a burnt out social worker (or pastor, or spouse or whatever) finds a way
to recharge their batteries. They take a break, find some more energy and get right back into the battle. The
experience of burn-out does not always lead to substantive change. We may just rest, recharge and plunge
as soon as possible back into the same role which lead us to burn-out in the first place.
• a Non-Protective Person can become an Abuser. A person in the non-protective role is always at risk of
being reassigned to the abuser role. “If you didn’t stop it, you are just as responsible. If you didn’t know,
you should have known.” Note that a person does not need to act abusively to be assigned to the abuser role.
These are roles — the system rarely feels an obligation to be fair when role assignments are made.
There are three main reasons for taking the time to focus on roles in abusive systems.
First, it is important to emphasize again that all of these roles are grace-less, hurt-full roles. None of them
provide people what they really need and long for — to love and be loved. But they are very powerful roles as
well. Once in an abusive system it will take significant effort to imagine other ways of being in the world.
Second, it is important to say the obvious: changing roles has very little to do with healing. Changing
roles is a classic rearranging the deck chairs on the Titanic kind of thing. Moving to a different role may seem to
provide some respite from the pain of our current role, but the respite is temporary at best. Any healing will
require finding a way to get ‘outside of the box’ of abusive systems. That presents an obvious problem: when
you are inside the box, the inside of the box is all you can see. It may be literally unimaginable that things could
be different. That is why recovery is not something we can do by ourselves. We just can’t see what we need to
see. We need other people to help us.
Finally, if you are a pastor or other person in a caring role, you will be invited to participate in systems of
this kind — typically the invitation will come as a recruitment for the vacant position of hero-messiah. If this
seems like a wonderful invitation to you — like an invitation that is a good match for your gifts and interests —
then you will be in significant danger of becoming part of the abusive system. And once part of the system you
will find it extremely difficult to be helpful. Even if you are aware of your limitations and conscious of the
dangers of becoming part of abusive systems, people inside the system will experience you as if you were part of
the system. And, if you are not really, really good at the hero-messiah role you may find that you are at risk of
being reassigned to a different role within the system. Finding a way to speak truth and offer hope in the context
of abusive systems without becoming enmeshed in the abusive dynamics is not easy. Possible. But never easy.
FAMILY COPING MECHANISMS:-
“Family coping mechanisms are the behaviors the family uses to deal with the stress or change.”
Coping mechanisms can be viewed as “an active method of problem solving developed to meet the life’s
challenges. The coping mechanism the individual and the family uses reflect their individual resourcefulness.”
Family may use the same coping mechanism rather consistently overtime or may change their coping strategies
when new demands are made on the family. Coping is a basic function that helps the family meet the demands
imposed from both within and with out. The success of the family depends on how well it copes with the stresses
it experiences.
Family Coping
• An active process where the family utilizes existing family resources and develops new behaviors and
resources to strengthen the family unit and reduce the impact of stressful life events. (McCubbin, 1979).
• A family crisis results when current resource and adaptive strategies are not effective in handling the
stressors.
Family Adaptation
• “the process in which families engage in direct responses to the extensive demands of a stressor, and
realize that systemic changes are needed within the family unit, to restore functional stability and
improve family satisfaction and wellbeing” McCubbin & McCubbin (1993, p.57).
• Most widely used tool to assess life changes in families is Family Inventory of Life Events & Changes
(FILE).
• Families with higher scores have been found to have lower family functioning and poorer health
(McCubbin & Patterson, 1991).
(1) Relationship
(2) Cognitive
(3) Communication
(3) Spiritual
Internal Strategies
1.Relationship Strategies
Role Flexibility
2. Cognitive Strategies
Normalizing
• Family able to discuss a problem, seek logical solutions, & reach consensus on what to do
• Collaborative problem-solving approach
3. Communication Strategies
Use of Humor
• Humor & laughter invaluable in coping & can bolster immune system
• In addition to extended family & network of health care professionals, there are neighbors, employers,
classmates, teachers, & cultural or recreational groups as potential supports
• Many people don’t seek needed external supports for variety of reasons
3. Spiritual Strategies
• Can temporarily reduce stress, but do not solve the problem and have long-term deleterious effects.
Research evidence
Bossert E. Factors influencing the coping of hospitalized school-age children. Journal of Pediatric Nursing.
(1994). Oct;9(5):299-306.
Factors influencing the coping process in hospitalized children were examined by studying the effect of
health status (acutely or chronically ill), gender, and trait anxiety on the coping behaviors used in response to
intrusive hospital events and the perceived effectiveness of the overall coping process used during hospitalization.
The sample consisted of 82 children, age 8 through 11 years, hospitalized in an acute care pediatric unit in one of
six California hospitals. Data were obtained on the second or third day of admission, through interview, word
graphic rating scale, and State-Trait Anxiety Inventory for Children (STAIC). Significant results indicated that
acutely ill children are more likely to perceive their coping as effective than are chronically ill children, and
children with low trait anxiety are more likely to perceive their coping behaviors as effective than do those with
high anxiety.
• Problem focused coping refers to efforts to improve a situation by making changing or taking some
action.
• Emotion focused coping include thoughts and actions that relieve emotional distress. It will not
improve the situation but the person often feels better
Nurses working with the families realize the importance of assessing coping mechanisms as a way of
determining how families relate to stress. Also important are the resources available to the family.
Internal resources such as knowledge , skill, effective communication pattern, and a sense of
mutuality and the purpose with in the family , assist in problem solving process. In addition external support
system promote coping and adaptation. These external systems may be extended family, friends , religious
affiliation , health care professionals and social services.
The development of social support system is particularly valuable today because many Families , due to
stress , mobility or poverty, are isolated from resources that would help them to cope.
Another classification:
• Long term coping strategies can be constructive or realistic. For example , incertain condition talking
with other about the problem and trying to findout more about the condition are long term stratagies.
Other long term strategy include those that involve a change in the life style pattern such as eating
a balanced diet, exercising regularly etc…
• Short term coping strategies can reduce stress to tolerable limit temporarly but are in long run
ineffective way to deal with reality. They may even have a destructive or detrimental effect on the
person.
For example use of alcoholic beverages , or drugs , day dreaming and fantasizing, relying on the
belief that every thing will work out, and giving into others to avoid anger.
Adaptive helps the person to deal effectively with stressful events and minimizes distresses
associated with them.
Mal adaptive can result in unnecessary distress for the person and others associated with the
person or stressful event.
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Sokolowski, Margaret. "Parental and child influences on family interaction patterns"(2006) Paper
presented at the annual meeting of the XVth Biennial International Conference on Infant Studies, Westin
Miyako, Kyoto, Japan, Jun 19 ;112(6): 45-48
FAMILY DYNAMICS