Family Systems

Ryan Jeanne V. Ceralvo MD, DFM,

FPAFP

 Life is interrelated. We are caught in an

inescapable network of mutuality; tied in
the single garment of destiny. Whatever
affects one directly, affects all indirectly.

Martin Luther King, Jr.

Systems
Organized unit made up of
interdependent parts
Whole unit is greater than the sum of its
parts
Change in any part affects all other
parts

 The Family is a System

 A family system is a social

and/or biological construction
made up of a set of people
related by blood or intention.

Elements in System
Members interact in reciprocal
relationships, responding to one
another in the context of roles.
Interaction the interplay between
members
Reciprocity both parties influence
each other as they interact with each
other
Roles a character or function one plays

Elements of the Family System

Structures
Rules
Overt
Covert

Boundaries

Wholeness
To understand the family, it is
necessary to look at it in its entirety
not just at one or some parts.

 Family is system in which each member

has a significant influence on all other
members

Systems Theory and Families

Families may struggle to find a healthy

balance between two extremes:
Enmeshment = over involvement
in each others lives
Disengagement = too much
detachment from one another

Core Concepts
Centripetal and Centrifugal.
Cybernetics.
Family
Dyad.
Marital dyad.
Nuclear family.

 Holon
Family boundaries
Family homeostasis
Family projection process
Family system

 Family therapist
Family therapy
Feedback loop
Triangulation

Goldenberg and Goldenberg (2008)

included some other fundamental
concepts:
Family rules. Prescribed rules for
the boundaries of permissible
behavior. The rules may not be
verbalized but are understood by all
family members; the rules regulate
and help stabilize the family system.

 Family narratives and assumptions. Beliefs

about the world shared by the family members.
Some see the world as a friendly, orderly,
predictable place in which they can function
competently. Others see the world as
threatening, unstable, and unpredictable,
therefore, as dangerous.
The family story links certain experiences into
a sequence that justifies how and why they live
as they do.

 Pseudomutuality and
pseudohostility. The faade of
togetherness that masks underlying
conflict and the collusion of
quarreling that is a superficial tactic
for avoiding deeper issues.

 Mystification. An effort to obscure

the real nature of family conflict by
distorting experiences; contradicts
one persons perceptions and, after
repeated experiences, leads the
person to question reality.

 Scapegoating. Redirecting conflict

by holding one person responsible for
whatever goes wrong

Characteristics of the Family System

Circularity
Equilibrium
Homeostasis

Boundaries
The "lines of demarcation" that
indicate who is in and who is out
of a system.
Boundaries can be physical or
symbolic (or both)
Permeability
Ability to enter and exit the system
Degree to which the system is open

Boundary Ambiguity

Uncertainty about who is in and who is out of the

system
Very common at times of transition

Hierarchies - power
One Up/ One Down - Superior/
Inferior
Captain first mate
Captain makes decisions and first mate carries
them out

Egalitarian
Both partners maintain or attempt to maintain an
equal relationship
Difficult to maintain, if focus is on total equality,
in every way

Important concept in understanding how

systems work: Change vs. Stability

Family systems are stable in

their chaos and orderly in their
disorder . . .
Families are predictable in
general, unpredictable in detail.
What does this mean?

Homeostasis
The tendency of a system to return
to a state of equilibrium
This is counteracted by the need for
change in a living system (or the
natural state of change in living
system)

Entropy vs Negentropy
Entropy --

The natural tendency of systems to

dissipate.

Negentropy --

Requires change (addition of energy to

system) to occur in order for the system
to continue to exist

Epigenesis
Whatever we do early in our
lives and our relationships has a
significant impact on what
happens later in our lives.
This is why your early
experiences in your family have
such an impact on you and why
its difficult to change longstanding patterns.
Can you think of an example?

Equifinality and Equipotentiality

Equifinality -- Many beginnings can
lead to the same outcome.
Equipotentiality -- the same
beginnings can result in different
outcomes.

Subsystems
Smaller units in the larger
system which share the
characteristics of the larger
system
Because of subsystems, you
have multiple identities in the
system
Examples?

Alliances
Weaker elements in a system join
with stronger (or combine with other
weak ones) to counter a stronger
element.
An example the Grand alliance

In small groups, define and provide

examples of:
Reductionism
System elements
Interaction
Reciprocity
Roles
Wholeness
Boundaries
Permeability
Ambiguity

Hierarchies
Homeostasis
Entropy vs.
negentropy
Epigenesis
Equifinality
equipotentiality
Subsystems
Alliances

Other Theories in the Text

Rational Choice/ Social

Exchange Theory
Self interest theories
People maximize self interest by making
rational choices that maximize profit
and minimize loss in interactions

Equality in relationships
When partners are more equal, more
likely the relationship will be stronger
and that goals of the relationship will be
achieved.

Change Theories / Family Life Course

Change assumption
Everything in families changes

The community nature of family life

Family development is affected by the connections
in the family

Off-time transitions
Off-time changes are more difficult than on-time
ones

Epigenesis principle
What we do earlier in life has significant impact in
our lives later on

Conflict Theory
Inequity principle
Inequality in resource distribution creates
conflict.
Resources are almost never equally distributed.

Struggle and synthesis principle

Families struggle with distribution of resources.
Families that are best able to distribute
resources are best able to achieve synthesis
(i.e., combine elements into a coherent whole)

Symbolic Interaction Theory

Perception as reality
That which is perceived as real is real in
its effects.

Role strain
This occurs when filling one role causes
conflict with another role.

Thinking about how we define family

Facilitated Article Discussion

In small group, you will be discussing

reading #32, which addresses a
different way of conceptualizing family.
Note: Your discussion leader will
demonstrate how to facilitate
discussion by distributing a sample
summary of the article and will use a
set of guide questions he or she has
put together for discussion.

Small group: Final Thoughts and

Conclusions
In your small group, identify at least
one thing from family theories that
surprised you or confirmed
something you already knew about
how families operate. Identify one
concept that you believe you can
apply to your own family life.

Elements of the Family System

Roles
Coalitions
Power structures

Roles

Breadwinner
Caregiver
Symptom carrier
Family Doctor
Medical Specialist

Coalitions
Alliance between members
Informal groupings within the family
of people who usually side with each
other

Power Structures
Decision-makers
Usually parental generation

 What does all this mean for us as

family physicians?

Family Mapping
Application of family systems
concepts
Characteristics: members
Structure: boundaries, alliances,
coalitions
Process: enmeshment,
disengagement
Across time: intergenerational
coalition

Circular Questions
Series questions
Explores repetitive behavior
Who-does-what-and-when
questions
Explores different roles

 Closer-farther questions
Explores emotional closeness and
distance
Who agrees with whom questions
Elicits information about coalitions