Family Dynamics

DR . CUT NYAK DIAN

What is Family Dynamics??
• Inter-relationships between and among individual family members
• This also refers to the way in which a particular family lives and
relates with one another
Family Systems Theory
• Useful paradigm to understand behaviour of families.

• 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

• 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 doesn’t 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 Event Medical Event

1997 Retirement of husband; favourite Depression diagnosed in husband

daughter got 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 A’s illness? Who was next most upset?
• Who was least upset about A’s 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
What the doctor can do?
• Cognitive; provide information (making the family aware of their
dynamics)
• Affective; Counsel/emotional support
• Psychomotor; Identify coping mechanisms (maximize the use of these
mechanisms to achieve equilibrium)
•Thank”s you