The Power of Family: Understanding Family Structure, Affective Involvement, Control Styles, and Communication

2. Family By prof. SalwaTobar

3. The family is the most powerful force for:

4. Structure of family

5. The family structure may be = the nuclear family consists of a married couple and their children = extended family h as parents, their son and his wife and children. =The joint family M ay contain 3 or more generations within one household.

6. It is more important to know • “what kind of patient has the disease” than “what kind of disease the patient has”. • ” What kind of patient”, is determined critically by the earliest social environmentinvolved in shaping that person

7. Family plays a crucial role in

8. This is specially true for children’s behavioral disorders. • Even when child comes out of the family, its subsequent experiences are perceived, understood and emotionally reacted according to the foundations established within the family.

9. Classification of families according to • Affective Involvement • Control Styles • Communication

10. Affective Involvement • Optimally the family meets emotional needs of all members and provides: cohesion, security and sense of being valued. • that contribute to the development of: trust, self-esteem and independence. • The degree of affective involvement varies in the families, with some having more intense and involving family relationships. • The quality of involvement determines, whether the relationship is nurturing and supportive or destructive and self-serving).

11. Pathological Family types according to Affective Involvement • In the uninvolved family, both the degree and the quality of involvement are low. Such families encourage premature emotional separation, often resulting in pseudo independence that markedly impairs the capacity to tolerate true intimacy. • Some families still show a still higher intensity of affective involvement, but withdraw their acceptance as soon as any member fails to satisfy the others’ needs. Such parental narcissistic involvements are destructive in quality and usually excessive in degree.

12. enmeshment(symbiotic) relationships • Intense but destructive involvement . • It has pseudomutuality, undifferentiated family ego, and too richly cross jointed system. • They are destructive as they are incompatible with the development of autonomy . • usually involve tolerance, and reinforcement by other family members. • Those involved are overly sensitive and react with panic or rage to any attempt by the other partner at withdrawing.

13. Pathological Family types according to Affective Involvement

14. Control Styles • Family members influence each other to ensurethe accomplishment of the tasks andrequirements of daily life. • Eachfamily has its own prototypical control styles. • Generally control styles have been classified intofour types: • (i)rigid, • (ii) flexible, • (iii) laissez-faire • (iv) chaotic.

15. Rigid families are quite successful at maintenancecontrol, but their rigidity interferes withsuccessful adaptation and assumption of personalresponsibility. • A flexible control style combines moderatepredictability with high constructiveness. • In aflexible style, task accomplishment is relativelyeasy to achieve because its supportive andeducational toneencourages family membersto participate and to adopt the rules ofthe family.

16. In laissez-faire style, members do as theyplease so long as to avoid bothering others and as little responsibility is assumed or expected. Because of their constant disorganization, role integration is rarely achieved, task accomplishmentis haphasard and communication is frequently insufficient, unclear and indirect. • A chaotic style is extremely low, both inpredictability and constructiveness. Changesdepend more on the mood of the dominantmembers in the family than situational demands. Instability and inconsistency typify these familiesand the overall effect is destructive.

17. According to control style

18. The goal of communication amongst thefamily members is towards the achievement ofa mutual understanding, which is possible onlywhen: • the messages sent are clear, direct, andsufficient • and the receivers are psychologicallyavailable.

19. Communication can be clearor masked (vague), disguised or ambiguous. • Themore masked is the message, the more likelyit is to arouse confusion, anxiety and subsequentdistortion in the receiver. • In a disturbed family, the members interact with one another in ways that are exploitative or disturbing

20. Pathology and Communicationin Families • Family psychopathology generallyrevolves around two concepts, which are centralin understanding of psychopathology and usedin therapy: • the double-bind and the • family homeostasis.

21. The double-bind messages • in which an individual receives two or more conflicting messages, with one negating the other. This creates a situation in which a successful response to one message results in a failed response to the other ,so that the person will automatically be wrong regardless of response.  • are peculiar to families, in which one of the members is schizophrenic. • may also be foundin other families.

22. Homeostasis • The family (as the social system) is seen asmaintaining a cooperative balance or homeostasis.

23. Systems Theory • Systems theory is a general theory to explainthe interactions and relationships between theindividual components comprising a larger structure. • This theory provides a framework tounderstand the behavior of the individualsubsystems of the family such as the childrenor the parents, as well as their relationships tothe outside world. • This theory has gained popularityas it not only explains how families workand function, but also provides a method ofanalyzing faults and flaws in the daily activitiesof family life. For instance, poor delineation ofthe boundaries between the parental and childsubsystems can be responsible for problems ofcontrol and discipline with the children.

24. The four other concepts in the general system theory include • I- Wholeness • II- Equifinality • III- Feedback • IV Homeostasis

25. I- Wholeness: • It states that the system cannot be understoodby dissection and study of its individual parts,We study the system as a whole. • If one memberin the system changes, then all the members of that system will change because of that onemember’s behavior in terms of response to thatchange.

26. II- Equifinality • The concept of equifinality implies that there aremany paths to the same destination. • it means that the particularpath a family takes as it evolves, its form is lesssignificant than the final form itself. • This isbecause there are more than a set of eventsleading to a certain end state and therefore, studying the events will not produce much usefulinformation as studying the end state.

27. III- Feedback • Feedback refers to how individual units in thesystem communicate with each other. • Feedbackis circular rather than linear. • In a systems theory, we understand the network in terms of a circularfeedback loop, i.e. a change in A may producea change in B and subsequently A again. • Eachperson’s behavior becomes a reinforcingfeedback for the behavior of the other.

28. IV Homeostasis • Feedback either reflects: • change (positive feedback) • or reinstates stability (negative feedback). • The tendency of a system to seek stability andequilibrium is referred to as homeostasis. • This concepthas been enormously helpful for family therapistsin understanding a family’s reluctance tochange.

29. Model of Individual Psychopathologyand Family Dysfunction • The fundamental principle of a systems theoryis that traditional problemsandother psychiatric disorders as schizophrenia, depression, drug abuse and anxiety are bestunderstood as manifestations of disturbances inthe family • The family member with “symptom” islittle more than a messenger or family scapegoat; his/her symptoms serve to cover up thegeneralized family disturbance.

30. In this sense, thesymptoms of the identified “patient” are viewedas serving a function for the family as a whole,despite the overt distress that may occur as aconsequence of these symptoms, e.g. adisruptive or delinquent child may consume aninordinate amount of attention from other familymembers, and thereby prevent parents fromattending to the emptiness and lack of intimacyin their own marital relationship. • As long as thechild continues to engage in delinquent acts; the parents are protected from having to focus ontheir marriage. • The functional value of the child’ssymptoms is usually beyond the awareness ofall family members.

31. We can consider thefollowing example: • Spouse A is driving and spouse B is in a hurryto get to their destination (also conveys thisbefore starting). • A accelerates and moves fastwith a jerk, B holds on to the glass and criticizesA, B protests more loudly, A shouts back andthe child C starts to cry. • At this point, theargument stops while B attends to C and A slowsdown.

32. This sequence exemplifies one form of arepetitive dysfunctional family process, where thechild behaves in such a way that attention iswithdrawn from the conflict between the spousesand refocussed onto the child.

33. Despite the expressedconcern with the patients’ symptoms on the partof all family members, the family is inherently motivated to maintain homeostasis and willthereby resist any effort on the part of thetherapist to modify the symptomatic behaviorof the identified patient. • This makes the task ofthe family therapist exceedingly difficult.

34. Family Therapy • If symptoms serve to stabilize the family andmaintain homeostasis, it follows that the individual cannot be expected to change unlessfundamental changes occur in the family system. • This notion that family members will resist the therapists change attempts, has led to thedevelopment of this strategic therapy calledfamily therapy. • The model also implies thatchanges in individuals will effectively come aboutonly when the structure of the family undergoesa change. • Therefore, whether the therapist istreating one client or the entire family, the targetof change is the family system.

35. Family Counselling • Family counselling is widely used in medicalpractice. • You come across a family with Down’s syndrome, and the family wants to have anotherchild. You have to provide genetic counsellingto this family. • Similarly, role of family counsellingin patients with AIDS, addictions, child psychiatricproblems, development delays, patientundergoing painful procedures, all require familycounselling.

36. Clinical Application • The importance of understanding family inrelation to medicine is best understood whenyou are working in community medicine andyou make family visits. • In all the hospitals, aconcept of family medicine is emerging and hasled to creation of separate departments of familymedicine. • The significance of the family in relationto health and illness lies in the fact that almostevery patient or potential patient, is a memberof a family and the interaction within the familyis a two way process. • The family may beconsidered from two points of view, one aspossible causative or modifying agent in thepatient’s illness, and on the other hand as more immediate social environment within which theillness occurs—including the reaction of the otherfamily members to it.

37. Family provides socialsupport, which has been considered veryimportant in the recovery of the patient. • Inpatients where there is no social support, thephysicians have to work out in providing socialsupport through non voluntary organizations. • Family pathology, or sickness of the family itselfmay lead to codependence; this means that inchronic illness, the spouse may also developsimilar symptoms. • In some cases, chronic illnesscan lead to family breakdown, separation ordivorce. This is especially true in patients havingaddictions or chronic mental illness. • Theseparation or divorce between parents, due tothe social changes prevalent in the present timeis also giving rise to psychological problems inchildren.

38. In patients with AIDS, the relevance of understanding family and providing counsellingcannot be simple. • The difficultiesextended to the family members in looking after the sick patient also often calls for familycounselling, to provide support and help to theentire family in the crisis situation.

39. Cultural factors • may also be important inimmigrant families, where conflict arises betweenthe first and the second generations owing to the influence of different values. • At times, socialmobility causes conflict in children related to thevalues.