MHS 4434 FINAL EXAM
Online Study Guide
1. Define “Role” in the context of family dynamics
a. Patterns of interaction become ingrained habits that make change difficult.
2. Be able to list and describe a Role and why a family member might take on that
role, either naturally or unexpectedly
a. Peace-keeper – prevent arguments or emotional tension, sensitive to
conflict
b. Scapegoat – Family unconsciously projects stress or conflict, helps avoid
addressing systemic issues
c. Second Mother – Parental absence, family stress, cultural expectations
d. Man of the house – Absence of a father, financial or protective
responsibilities fall to them
3. Understand the four areas of family dysfunction
a. 1) Marital Conflict, 2) Dysfunction in one spouse, 3) Impairment of one or
more children, and 4) Emotional distance.
4. What did the documentary Unnatural Causes deem as the best predictor of
health?
a. Why? Socioeconomic status basically your position in the social hierarchy
(income, education, occupation, and social power).
i. Health isn’t just about medical care or individual choices, its
strongly shaped by the conditions people live by (Chronic stress,
access to resources, control and power, environmental exposure,
and cumulative effects)
5. Know the three domains of the biopsychosocial model of health and be able to
provide examples for each domain
a. Biological, genetics, infections, hormone levels, physical injuries
b. Psychological: Stress, anxiety, depression, mood disorders, coping skills,
beliefs about health
c. Social: Socioeconomic status, family support, culture and community
norms, access to healthcare food and safe housing, work conditions
6. Why is the biopsychosocial model of health a powerful approach?
a. shows that health is shaped by the interaction of body, mind, and
environment, leading to better understanding, better care, and better
outcomes.
7. What should be present for a family to be considered “flexible”?
a. Adaptability in roles: Family members can shift responsibilities when
needed
b. Open communication: People can express thoughts and feelings honestly,
and others are willing to listen and adjust.
c. Willingness to change routines: The family isn’t rigid—they can modify
schedules, rules, or expectations when circumstances change.
d. Problem solving ability: They work together to handle challenges rather
than avoiding them or falling into conflict.
e. Balance between structure and freedom: There are still guidelines and
boundaries, but they’re not so strict that they prevent adjustment.
8. Know the basis of Bowen’s family systems theory along with the eight concepts:
family as an emotional unit where each person is interconnected. Instead of
looking at individuals in isolation, Bowen argued that patterns of interaction,
relationships, and emotional processes within the family shape behavior and
health.
a. Emotional Fusion and Differentiation of self - Ability to separate your own
thoughts and feelings from others.
b. Triangles - When tension between two people gets pulled into a third
person to reduce stress.
c. Nuclear Family and Emotional System - Patterns of emotional functioning
within the immediate family.
d. Family Projection Process - Parents project their own anxiety onto a child.
e. Emotional Cut off - When people distance themselves (physically or
emotionally) to manage unresolved family issues.
f. Multi-generational transmission process - Patterns (like anxiety, coping, or
relationship styles) are passed down through generations.
g. Societal Emotional process - The same emotional processes seen in
families also occur in society.
h. Sibling Position - Birth order influences personality and roles in the family.
9. What is a health disparity - A health disparity is an unfair gap in health status or
access to care that is driven by social and economic inequality.
10. What are types of “boundaries”? Be able to recognize or provide examples
a. Rigid: Very strict and closed off
b. Diffuse: Too loose and overly enmeshed
c. Clear: Balanced and flexible
11. Understand the levels/elements of cohesion/family systems theory (bullseye)
a. Chaotic - Lack of Leadership Dramatic Role Shifts Flexible - Shared
Leadership Democratic Discipline Role Sharing Structured - Shared
Leadership Sometimes Somewhat Democratic Discipline Role’s Stable
Rigid - Authoritarian Leadership Strict Discipline Roles Seldom Change
b.
12. What is a food desert? A food desert is an area where people have limited or no
easy access to affordable, healthy food, especially fresh fruits and vegetables.
13. What are good communication skills: Active listening, clarity and simplicity,
nonverbal communication, empathy, open-ended questioning, respect and
professionalism, feedback and clarification
14. What are three pathways that family relationships can influence health?
a. Behavioral pathway Families influence health behaviors (diet, exercise,
smoking, drinking, healthcare use).
b. Psychological (stress) pathway Family relationships affect stress, coping, and
emotional well-being, which then impact health (especially via chronic stress).
c. Social / relational support pathway Family provides support, care,
structure, and norms
15. Medical model of illness
a. views illness as a biological malfunction that should be diagnosed
and treated by medical intervention, rather than considering broader
social or psychological influences.
16. Know the parenting styles and resulting child behaviors
a. Authoritative: high warmth, high control - Sets clear rules and expectations
Explains reasoning behind rules (High self-esteem, Independent but
responsible, Good emotional regulation, Strong social skills)
b. Authoritarian: Low warmth, high control – strict rules emphasis on
obedience and punishment (Obedient but lacks independence, Higher
anxiety or low self esteem, may become socially withdrawn or overly
dependent)
c. Permissive: High warmth, low control Nurturing indulgent Inconsistent
boundaries Avoids discipline (Impulsivity and poor self control, difficulty
following rules, may struggle academically, low responsibility)
d. Neglectful: Low warmth, low control Little emotional involvement few rules
or guidance (low self-esteem, difficulty forming relationships, poor
academic and social outcomes, higher risk of behavioral problems)
17. Brody article “That Loving Feeling Takes a Lot of Work” – two broad domains that
strengthen relationships
a. Emotional support: This refers to the feelings, care, and emotional
connection between partners or family members.
b. Practical support: This refers to the actions and everyday behaviors that
maintain and strengthen the relationship.
18. Understand the basic functions of Family Therapy
a. Improve communication Helps family members express thoughts and
feelings more clearly
b. Change interaction patterns Identifies unhealthy family dynamics (e.g.,
constant conflict, avoidance, triangles) Helps shift patterns into more supportive
and functional ones
c. Strengthen relationships and support Builds trust, empathy, and emotional
connection Encourages healthier boundaries and role
d. Solve problems together Teaches families to work as a team Helps them
develop coping strategies for stress, illness, or life transition
e. Promote individual and family well-being Supports both individual
mental health and overall family functioning Reduces stress, conflict, and
emotional distress within the family system
19. Understand trauma-informed care, why it is used, and what perspectives one
should recognize when considering the use of trauma-informed care
a. Trauma-informed care is used to improve safety, trust, and outcomes
by recognizing how past trauma shapes health and behavior, and by
ensuring care is delivered in a way that is respectful, empowering, and
sensitive to lived experiences.
b. Trauma affects behavior, lived experiences matter, power dynamics exist
in healthcare, social and structural factors contribute to trauma, retraumatization is possible
20. Understand the two types of responses to stress and be able to provide
examples of each
a. Acute stress (fight or flight): This is a short-term, immediate reaction to
a perceived threat or challenge. It prepares the body to either confront or
escape the stressor. (Jumping out of the way of a speeding care, feeling
nervous before giving a presentation, etc)
b. Chronic stress This is a long-term, ongoing activation of the stress
response system when stressors persist over time. (Ongoing financial
problems, living in a high-conflict or unsafe home environment, long-term
caregiving for a sick family member)
21. Know the Circumplex Model (bullseye)
a. Cohesion (emotional closeness)
i. Disengaged (low cohesion): emotionally distant, little connection
ii. Separated: somewhat independent but still connected
iii. Connected: balanced closeness and independence (healthy
range)
iv. Enmeshed (very high cohesion): overly involved, little
independence
b. Flexibility (adaptability)
i. Rigid (low flexibility): strict rules, little change
ii. Structured: some stability with some flexibility (healthy range)
iii. Flexible: shared leadership, adaptable roles (healthy range)
iv. Chaotic (very high flexibility): unclear roles, unpredictable structure
c. Communication (supporting factor)
i. Active listening
ii. Clear expression of feelings
iii. Respectful problem-solving
iv. Emotional openness
22. Be able to read a vignette and determine a) where the family dynamics land on
the circumplex model or b) describe the three biopsychosocial domains and
apply the domains to a vignette character
a. ___
b. What is happening physically?, What is happening emotionally or
mentally?, What is happening in their environment/relationships?
“Biologically, the character is experiencing fatigue and headaches.
Psychologically, they are under chronic stress and anxiety due to work
pressure. Socially, they lack family support and are facing financial
instability.”
23. Be sure to watch the TedTalk depicting a young researcher discussing her
research in the Positive Psychology module (Alia Crum Change your mindset)
a. Mindsets shape physical reality Crum explains that what we believe about
something (stress, food, exercise) can actually change how our body responds to it.
i. Example: People who think stress is harmful experience worse health
outcomes But people who view stress as helpful or energizing actually
perform better and have healthier physiological responses
b. The placebo effect proves mindset power She uses placebo research to show
that expectations alone can lead to real biological changes:
i. If people believe a treatment works, their bodies often respond as if it
actually did
c. Reframing stress is key Stress is not always bad—it depends on how you
interpret it:
i. “Stress is harmful” mindset → worse health and performance
ii. “Stress can help me rise to the challenge” mindset → better focus, energy,
and resilience
d. Real-world examples She gives studies showing:
i. Hotel workers improved health when they were told their daily work
counted as exercise (even though behavior didn’t change)
ii. People’s physiological responses to food changed depending on what they
believed they were eating
e. It’s not just your situation that matters—it’s how you interpret your situation.
Changing your mindset can actually change your body, stress response, and
performance.
24. What is Positive Psychology Positive psychology is a branch of psychology that
focuses on what helps people thrive, not just what causes mental illness or
problems.
25. What are the three factors one can use to minimize stress
a. Social support
b. Control/sense of control
c. Coping strategies
26. Which of the two responses to stress leads to more flexibility and creativity
a. Challenge response: (MORE flexibility and creativity) Happens when you
perceive a stressful situation as manageable or an opportunity to grow
b. Threat Response: Happens when a situation feels overwhelming or
beyond your control
27. Understand Family Therapy and clientele
a. Family therapy is a form of psychotherapy that treats the family as a
system, meaning problems are understood in the context of family
relationships rather than focusing on just one individual.
i. Nuclear families (parents and children)
ii. Extended families (grandparents, relatives)
iii. Couples or partners
iv. Blended families
v. Sometimes even individuals
28. Know the IRS of caregiving
a. Instrumental support - Practical, hands-on help with daily tasks.
b. Resource support - Providing access to material or informational
resources needed for care.
c. Social/emotional support - Providing emotional care and companionship.
29. Be familiar with at least one of your fellow student’s presentations for one of the
extra credit questions
a. This presentation explains the difficult relationship between homelessness
and substance use and shows how these two challenges combine to
damage a family's stability. The group suggested a plan that provides
three main types of support at the same time which are a safe place to
live, mental health counseling, and medical treatment for addiction. This
approach shows they understand that you cannot fix one of these
problems without also addressing the others. By using class concepts like
Family Systems Theory, the group showed how every member of a family
is connected and how health disparities create unfair gaps in care. The
visuals were clean and simple which helped keep the focus on the facts,
and the group took a deep look at the current system to point out exactly
where it is failing families today. One of the most interesting parts was the
question of whether housing and treatment should be offered together as
one package because this is a big debate in the real world and shows the
group was thinking critically. Since the presentation focused on the family
unit, do you think it is more effective to provide specialized services for the
children and parents separately, or should all treatments be conducted as
a joint family session to improve long-term stability?