1. EVA IRENE YU-MAGLONZO, MD

2. 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

3. 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

4. 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

5. 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

6. 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

7. FAMILY PROCESSES

FAMILY PATTERNS – ORDERED
SEQUENCE OF INTERACTION THAT
TYPIFY HOW FAMILIES FUNCTION

FAMILY DYNAMICS – DISENGAGEMENT,
TRIANGULATION, ENMESHMENT,
COALITION

8. MINUCHIN’S 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

9. MINUCHIN’S FAMILY
DYNAMICS
 DISENGAGEMENT-
RIGID BOUNDARIES;
EXCLUDING ONE MEMBERS INVOLVEMENT
EX. A HUSBAND WHO IS NOT CONCERNED
WITH THE PRENATAL FOLLOW-UP OF HIS
WIFE

10. MINUCHIN’S 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

11. MINUCHIN’S 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

12. 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

13. 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

14. 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 FAMILY’S REPEATING
INTERACTION PATTERNS RELATED TO THE
PROBLEM?

15. 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

16. 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

17. 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 CAN’T TAKE IT SEEING HIS
WIFE SUFFERS THAT IS WHY HE PREFERS TO
JUST LOOK FOR MONEY TO PAY THE HOSPITAL
RATHER THAN STAYING THERE

18. 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.

19. 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