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Family Theory for FNPs
I. Part1 Objectives
a. Discuss the principles of family systems
b. Identify the patient with in a family system
c. Analyze the dynamics of the family system
d. Discuss how families change
II. Systems Theory
a. No problem exists in isolation
b. All problems have a context
c. All problems are at least partly a reflection of their environment
d. Need to look for other problems that account for first problem
e. All problems have other problems as causes
III. Family System
a. New entity created when child is born
b. Changes in family interactive patterns
c. How has the family reorganized after the birth?
d. How did the roles change in each family member?
e. What else changed outside the family ?
f. Describe the sequence of interactions so that appropriate interventions can result in a possible change.
g. Goals to provide new ways of responding that are constructive to the relationship
h. Family is the primary system to which a person belongs
i. Families have their own structure, rules, histories of how it handles problems & crises
j. Family theory focus is on patterns and interact ions, on interpersonal process, not the individual
k. No-one in a family acts completely independently of all others in the household.
l. All members of a family have responsibilities, even those that are not clearly defined, toward all others involved.
m. What a family does is a systems process.
n. Provides a paradigm from which to view multiple causes and contexts of behavior.
o. Parts interact in predict able organized manner
p. Never function in isolation
q. Family system organized into a group forming a whole that transcends the sum of its parts
r. Relationship between family members is complex
s. Factions, coalitions, alliances, tensions exist.
IV. Family Systems-the Family is Your Patient
a. Systems strive towards homeostasis (stability)
b. Homeostasis may prevent long lasting change
c. Change in one part of system affects the other parts
d. Family is the primary system to which a person belongs
e. Subsystems--marital/parental/sibling/individual
f. Families have their own structure, rules, histories of how it handles problems & crises
g. Symptoms in family represent stress in system
h. A systems approach builds on strengths of the family
V. Family Structure
a. Who is in the family? Ask! (structure)
i. Have child draw picture of who is in the family
ii. It might change as people move in and out
iii. Boundaries of family system may be open or closed on continuum
iv. Open family system: information/people can move in and out freely
v. Closed family system: closed to new ideas, family think s for itself , hard to gain entrance into this family ,
hard to leave, hard to move away
VI. Transgenerational Transmission
a. Patterns tend to repeat over several generation
b. Genogram is 3 generation of a family
c. If get help to change the patterns... for this and the following generations...
d. “Can’t change the past.. Can change the future
e. (a good way to motivate families to change)
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VII. Generational Boundaries
a. Goal: clear boundaries between parental subsystem (whoever serving in this role), marital subsystem (single or
couple), and sibling subsystem (the kids )
b. Enmeshed boundaries: parents speak for child; no sense of separation between family members a big WE, no I in
this family; overrespond to stress
c. If marital and sibling subsystems don’t have good boundaries then risk for abuse, child become confidante of
parent
d. Rigid boundaries: no one responds to crisis;
VIII. Triangles versus Dyads
a. Triangles created as soon as child is born –
b. May turn to child to meet emotional needs when marital problems ( triangle)
c. Role reversal-Parental child role (common)
d. Goal: detriangulate: Build healthy 2 person relationships in families (called dyads)
e. If don’t respond the triangle can’t continue
f. Say “I know you and x can work this out”. Don’t rescue, don’t’ fix.
g. Advise: “Don’t bring up other people who aren’t there”
IX. Identified Patient
a. Usually the one seeking help(IP)
b. Often the adolescent in the family brought to attention of law, school, etc
c. Focus in syst ems is what is going on in system
d. Not focused on the individual only
e. May call for therapy for parents to strengthen their power/their relationship
X. Family Strengths
a. Objectives
b. Discuss “healthy family”
c. Assess strengths of family
d. Discuss framework s for assessing a family
XI. Healthy Family (Otto 1962, 63)
a. Nurturing
b. Support
c. Parental discipline
d. Encouragement of growth and maturation of all family members
e. Spiritual well being.
XII. All families have some strengths!
a. A healthy family : A family that supports the strength of each member of the family
b. Identify the strengths of the family you are working with
c. Give them feedback about their strengths
d. Plan care based on their strengths to cope with crisis or illness.
e. Strengths in one area may help overcome deficits in another area!!(Defrain and Stinett, 19 92)
XIII. Family strength (Gabler & Otto,1964)
a. Family as strength within itself
b. Strong marriage
c. Strength as parents
d. Parents helping children to develop.
e. (68 % of references fell into the above categories in systematic review)
XIV. Stinnert and DeFrain’s Qualities of Strong Families Study (1985)
a. Commitment--to each other’s happiness
b. Appreciation and affection
c. Positive communication- respectfully listening & discussing issues without attacking
d. Time-- spend quality time together
e. Spiritual wellness-- sense of greater good or power that brings meaning and purpose
f. Coping abilities-- View stress as opportunity , humor, keep things in perspective
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XV. McMaster Model of Family Functioning
a. Problem solving competence
b. Communication exchange & clarity
c. Established patterns of roles
d. Affective responses over a broad range of stimuli
e. Affective involvement in activities & achievements of other family members.
f. Behavioral control (standards of conduct)
XVI. Other ideas of healthy family
a. Decision making- democratic
b. Degree of involvement in environments
c. Achievement of goal
d. Innovative responses to change things & handle daily situations
e. Clear power structures
f. Expressed warmth & optimism
g. Awareness of behavior /needs of others
XVII. Tool to assess family strength
a. American Family Strengths Inventory (Defrain & Stinnert 200 8)
b. Asks families to put S for strength family has, G for area for growth and NA for not applicable
c. Make a plan and schedule activities to enhance strengths
d. Useful for FNP practice!
XVIII. Family Theory for FNPs Part4 Strategies for families in crisis
a. Objectives
b. Describe assessment strategies with families
c. Identify treatment techniques with families
XIX. Assessment techniques
a. Ask each person to describe his/her sense of the problem & its history
b. Identify nonverbal communication
c. Ask each other’s reaction to what one member said
d. Identify themes comm on in the relationship
XX. Assessing family using family theory
a. How open is the family to new information?
b. What keeps them from changing?
c. What are the family strengths?
d. What are the rules in this family?
e. Who has the power in the family ?
f. What would open up the system?
g. If someone changes what effect will it have on others?
h. What holds this family together?
XXI. Assess roles & roles
a. Are their “rigid roles”
b. Addict or one with the “power”
c. Enabler – makes family look good
d. Hero- takes on too much
e. Scapegoat- blamed f or problems
f. Lost Child- quiet, little involvement
g. Are their “rigid rules?”
i. “Don’t mess up”
ii. “Always be perfect”
iii. “Don’t think for yourself”
XXII. Treatment techniques in Family Therapy
a. Ask each to speak in “I” message
b. Ask that each expressed need be accompanied by a proposed solution
c. Assign homework or tasks that respond to the situation
d. Clarify —repeat and ask if this is what was intended
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XXIII. Family Life Cycle Theory
a. Horizontal stressors___________
i. Developmental ( Life Cycle Transitions)
ii. External stressor s (untimely death, chronic illness)
b. Vertical Stressors-- transgenerational
i. Family Patterns; Issues
ii. Myths; Attitudes; themes; labels
iii. Taboos; expectations; triangles
XXIV. Life Cycle Stages(Duvall& Others)
a. Dating/courtship; single
b. Early married
c. Married without children
d. Infant/toddler
e. School Age
f. Adolescent
g. Launching the family (young adult)
h. Middle Age
i. Older Adult
j. Reconstituted family (step/blended)
XXV. Life Cycle of family
a. Similar to life cycle of individual
b. Move through stages of development as family
c. Based on age of oldest child, when there are children
d. Each pers on in family moving through their own development also (e.g. Erickson)
e. Complete tasks of one stage before move to next stage
f. Crises -- resolution depends on earlier stages & other stressors
XXVI. Goal is to move through the next stage of family life cycle
a. Realignment of the relationship system to support development of family members
b. Will be dysfunctional if the e is enough stress on horizontal axis
c. If vertical is full of intense stress only need small amount of horizontal stress for disruption
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