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 RESULTS
IN CHANGES IN ALL OTHER PARTS
- PARTS ARE THE FAMILY MEMBERS; MAY
OR MAY NOT BE RELATED BY BLOOD
AFFINITY

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

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

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

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

FAMILY PROCESSES

FAMILY PATTERNS ORDERED

SEQUENCE OF INTERACTION THAT
TYPIFY HOW FAMILIES FUNCTION

FAMILY DYNAMICS DISENGAGEMENT,

TRIANGULATION, ENMESHMENT,
COALITION

MINUCHINS 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

MINUCHINS FAMILY
DYNAMICS
DISENGAGEMENT-

RIGID BOUNDARIES;
EXCLUDING ONE MEMBERS INVOLVEMENT

EX. A HUSBAND WHO IS NOT CONCERNED

WITH THE PRENATAL FOLLOW-UP OF HIS
WIFE

MINUCHINS 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

MINUCHINS 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

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

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

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 FAMILYS REPEATING

INTERACTION PATTERNS RELATED TO THE
PROBLEM?

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

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

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 CANT TAKE IT SEEING HIS
WIFE SUFFERS THAT IS WHY HE PREFERS TO
JUST LOOK FOR MONEY TO PAY THE HOSPITAL
RATHER THAN STAYING THERE

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.

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