FAMILY LIFE CYCLE

NATIVIDAD M. BERLIN, M.D.

 
 THE FAMILY LIFE CYCLE:
 

• Represents composite of the individual

developmental changes of family members
• Shows the evolution of the marital
relationship
• Presents cyclic development of the evolving
family unit
BIOPSYCHOSOCIAL DIMENSION OF ILLNESS

• SICKNESS-SUFFERING,DISRUPTION OF PX/ FAMILY

• DISRUPTIVE OF FAMILY LIFE,HAZARDOUS TO
HEALTH OF MEMBERS
• ROLE REVERSAL,INCOME LOSS,DISRUPT
ACTIVITIES,DANGER OF transmission
• DS-EMBEDED in matrix of difficult family problems
—poverty , unemployment, other sickness ,
chronic f dispute, inadequate f condition
BIOPSYCHOSOCIAL DIMENSION OF ILLNESS

Illness vs disease
d-biologic and psychophysiologic disorder
i-px experience +dislocation px+family

d-pe+lab test
I-meaning to px+family; px understanding of ds

d-md dx+ manages

i- px experiences
FAMILY INFLUENCE ON HEALTH AND IMPACT
OF ILLNESS
• 1. GENETIC INFLUENCE
• 2.FAMILY IS CRUCIAL IN CHILD DEVELOPMENT
• 3.INFECTIOUS DSES SPREAD IN THE FAMILY
• 4.FAMILY FACTORS AFFECT M/M IN ADULTS
• 5.FAMILY IS IMPORTANT IN RECOVERY FROM
ILLNESS
FAMILY INFLUENCE ON HEALTH AND IMPACT
OF ILLNESS
• 1. GENETIC INFLUENCE
• 2.FAMILY IS CRUCIAL IN CHILD DEVELOPMENT
• 3.INFECTIOUS DSES SPREAD IN THE FAMILY
• 4.FAMILY FACTORS AFFECT M/M IN ADULTS
• 5.FAMILY IS IMPORTANT IN RECOVERY FROM
ILLNESS
FAMILY INFLUENCE ON HEALTH AND IMPACT
OF ILLNESS
• 1. GENETIC INFLUENCE
• 2.FAMILY IS CRUCIAL IN CHILD DEVELOPMENT
– Maternal care
– Physical trauma
– Behavioral disorder
FAMILY INFLUENCE ON HEALTH AND IMPACT
OF ILLNESS
• 3.INFECTIOUS DSES SPREAD IN THE FAMILY
• 4.FAMILY FACTORS AFFECT M/M IN ADULTS
– Mortality single,separted
– bereavement

• 5.FAMILY IS IMPORTANT IN RECOVERY FROM

ILLNESS
STAGES OF FAMILY ILLNESS TRAJECTORY

• I ONSET OF ILLNESS
• II REACTION TO DX
• III MAJOR THERAPEUTIC EFFORTS
• IV EARLY ADJUSTMENT TO OUTCOME
• V ADJUSTMENT TO PERMANENCE OF
OUTCOME
STAGES OF FAMILY ILLNESS TRAJECTORY
• I ONSET OF ILLNESS
– Prior to contact to health provider
– Nature of onset
– Md should 1.explore ROUTINELY explanatory model and fear
2.explore px conflict 3.pre dx of px and fx
• II REACTION TO DX
– Ds+tx
– Md
• 1.support
• 2.interpret findings
• 3.advise +encouragement
• 4.clarify procedures , encouragement
 WHY DO WE STUDY THE FAMILY LIFE CYCLE?
 

• It provides a predictable, chronologically oriented

sequence of events in family life with which family
physicians and other health professionals are
already familiar
• It involves a sequence of stressful changes that
requires compensating or reciprocal readjustments
by the family if it is to maintain viability
• Events of Family Life Cycle can be related to clinical
events and to health maintenance of the family
STAGES OF FAMILY ILLNESS TRAJECTORY
• III MAJOR THERAPEUTIC EFFORTS
– Issues in choosing tx plan
• 1. psycho state of px +fx
• 2.assumption of responsibility of care very early in the tx plan
• 3.economy of tx plan
• 4.lifestyle and char of a family
• 5.effects of hospitalization ,and other tx intervention
Md should
1.open to fx and provide info
2.consider all factors in plan tx
3.work in harmony w/px &fx
4.Coordinate all aspects of tx
5.anticipate patho response
STAGES OF FAMILY ILLNESS TRAJECTORY

• IV EARLY ADJUSTMENT TO OUTCOME

– Recovery
– Md should
• 1.deal w/ immediate effects of trauma
• 2.alleviate anxiety
• 3.give psycho support-understanding , reassurance
• 4.explore level of understanding px + fx
 WHY DO WE STUDY THE FAMILY LIFE CYCLE?
 

• It provides a predictable, chronologically oriented

sequence of events in family life with which family
physicians and other health professionals are
already familiar
• It involves a sequence of stressful changes that
requires compensating or reciprocal readjustments
by the family if it is to maintain viability
• Events of Family Life Cycle can be related to clinical
events and to health maintenance of the family
  TWO LEVELS OF ORDERS OF MAGNITUDE
OF CHANGE
• 1. FIRST ORDER CHANGES
• INVOLVE INCREMENTS OF MASTERY AND ADAPTATION
• A “NEED TO DO” something new
• Do not involve change in the main structure of the family
• Do not involve a change in an individual’s identity and self-image
• Additions to existing state of the individual’s self and family
• Tasks that must be accomplished by the family and family members working within a stage of the Family Life
Cycle e.g. A change that is present when a family moves to a new residence.

• 2. SECOND ORDER CHANGES

• INVOLVES TRANSFORMATION OF AN INDIVIDUAL’S STATUS AND MEANING
• A “NEED TO BE” something new
• Change in the very basic attributes of the family system
• Change in the role and identity of family members
• Occur between stages of the Family Life Cycle
• One characteristic intergenerational connectedness E.g. A change that is present when a family moves into
the stage of the birth of the first child. Husband becomes the father and wife becomes the mother of a
dependent sibling.
STAGES OF THE FAMILY LIFE CYCLE

Unattached Young Adult

The Newly Married Couple
The Family with Young Children
The Family with Adolescents
Family in Later Years
 
Unattached Young Adult 
“Between Families” It is the start of the family life cycle
wherein the unattached young adult has come to terms
with the family of origin. At this stage the young adult
formulate personal goals and develop as individual
including forming a new family.

The Newly Married Couple

“The Joining of Families through Marriage” is very true
in the Philippines, thus Filipino families are bilaterally
extended. This is the transition stage of the couple
from their lives as an individual to life as couple.
 
3. The Family with Young Children
This stage starts with pregnancy for the first child to emergence of adolescents. The coming of children
defines a new family status, as the wife becomes the mother, the husband the father. During this stage
also, the child starts going to school, which is his first significant contact with people outside of the
family. Conflict with practices in the home and school regulations may occur during this stage.
 

4. The Family with Adolescents

 
A family with adolescents has generally reached a stage when the parents are approaching a middle life
stage and the grandparents are in the later stage. Hence it is not only teenagers but also their parents
who are undergoing crisis (i.e. identity) at this stage.
 

5. Family in Later Years

 
This begins with departure of last child and continues through retirement of one or both of the couple
and ends when both are dead.
 
 
 Family
Life Cycle Stage -
Between Families / Unattached young adult
Emotional Process of Transition: Key Principle
Accepting parent offspring separation
 
Second Order Changes in Family Status: Required to Proceed Developmentally
1. Differentiation of the self in relation to the family of origin
2. Development of intimate peer relationship
3. Establishment of self in work
 
First Order Changes or Tasks Involved
1. External social contact outside of home includes dating, clubs and recreation
2. Job employment
3. Living accommodation
 
Problems Encountered at Each Stage of the Cycle
Medical:
Episodic problems
Sexually transmitted
Unwanted pregnancy
Pre-employment check up
 
Emotional
Psychosomatic problems secondary to new job, role and peer group
Depression secondary to adjustment to life away from home, difficulty in finding employment, suitable life partner, parental expectation.
 
Social
Peer group pressure or acquiring vices such as alcoholism
Fiancee pressure for marriage and premarital sex
II. Family Life Cycle Stage - Newly Married Couple
Emotional Process of Transition: Key Principle
Commitment to the new system
 
Second Order Changes in Family Status: Required to Proceed Developmentally
1. Formation of marital system
2. Realignment of relationship with extended families and friends to include
spouse
 
First Order Changes or Tasks Involved
1. Establishing a home base in a place to call their own
2. Establishing a mutually satisfying system for getting and spending money
3. Establishing mutually acceptable patterns of who does what and who is
accountable to whom
4. Establishing a continuity of mutually satisfying sexual relationship
5. Establishing system of intellectual and emotional communication
6. Establishing a workable relationship with relatives
7. Establishing was of interacting with friends and associates in the community
8. Facing the possibility of children and planning for their coming
 
• II. Family Life Cycle Stage - Newly Married Couple
Problems Encountered at Each Stage of the Cycle
Medical:
Episodic problems
Early pregnancy
STD
Job-related physical examination
Gynecologic problem
infertility
 
Emotional & Social
Depression due to forced early marriage and unwanted pregnancy
Jealousy to job, friends and previous fiancee
Emotional problems relating to new role as a spouse (communication, personalities
and character differences in habits and background)
Problems relating to in-laws friends and peers and money
Demands of new role
Problems of adjustment to office and work
II. Family Life Cycle Stage - Family with Young Children
 
Second Order Changes in Family Status: Required to Proceed Developmentally
1. Accepting marital system to make space for children
2. Taking on parenting role
3. Realignment of relationship with extended family to include parenting and
grandparenting roles
 
First Order Changes or Tasks Involved
1. Supplying adequate space, facilities and equipment for the expanding family
2. Meeting predictable and unexpected costs of family life with small children
3. Sharing responsibilities within the extended family and between members of
the growing family
4. Maintaining mutually satisfactory sexual relationship and planning for the
future children
5. Creating and maintaining effective communication system in the family
6. Cultivating the full potentials of relationship with relatives within the extended
family
7. Tapping resources serving needs and enjoying contracts outside
• III. Family Life Cycle Stage - Family with Young Children
• Problems Encountered at Each Stage of the Cycle
•  
• PARENTS
• Medical:
• 1. Episodic medical problems
• 2. OB-Gyne problems
• 3. family planning
• 4. annual PE in the job
• 5. STD
•  
• Emotional & Social
• 1. Peer pressure on alcoholism and other vices including drug abuse and extra
• marital affairs
• 2. Sexual inadequacies
• 3. Spouse abuse
• 4. Job-related problems
• 5. Problems on child rearing
• 6. Communication problems
• 7. In-laws problems
• 8. Taking care of the sick and old parents or in-laws
• 9. Financial difficulties

• :
• III. Family Life Cycle Stage - Family with Young Children
• Problems Encountered at Each Stage of the Cycle
• GRANDPARENTS
• MEDICAL
• 1. Episodic medical problems
• 2. Degenerative diseases
• 3. Chronic debilitating diseases
•  
• Emotional & Social
• 1. Psychosomatic problems related to illness and loneliness, financial
• difficulties
•  
• CHILDREN
• Medical:
• 1. Episodic medical problems
• 2. Accidents
• 3. GOBI
• 4. Mental retardation
• 5. Poisoning
•  
• Emotional & Social
• 1. Learning deficiencies
• 2. Child abuse and neglect
• IV. Family Life Cycle Stage - Family with Adolescent
  Increasing flexibility of boundaries to include children independence

• Second Order Changes in Family Status: Required to Proceed Developmentally

• 1. Shifting of parent-child relationships to permit the adolescent to move in
• and out of the system
• 2. Refocus on mid-life, marital and career issues.
• 3. Beginning shift towards concern for the older generation

First Order Changes or Tasks Involved

• 1. Providing facilities for widely different needs.
• 2. Working out money matters in the family with teenagers.
• 3. Sharing the tasks of responsibilities family living.
• 4. Putting the marriage relationship into focus.
• 5. Keeping the communication system open.
• 6. Maintaining contacts with the extended family.
• 7. Growing into the world as a family and as a person.
• 8. Reworking and maintaining philosophy of life.
•  
• IV. Family Life Cycle Stage - Family with Adolescent
Increasing flexibility of boundaries to include children independence
• Problems Encountered at Each Stage of the Cycle
•  
• ADOLESCENT
• Medical:
• 1. Drug and other substance, abuse disorders
• 2. STD
• 3. Acne, bad odor
• 4. Gynecologic problems
• 5. Menstrual problems
• 6. Allergies and other skin diseases
• 7. Circumcision

• Emotional & Social

• 1. Sexual experimentation leading to teenage prenancy
• 2. Homosexuality
• 3. Conflict with parents
• 4. Juvenile delinquency
• 5. Depression secondary to peer pressure, identity crisis and secondary sex
• characteristics
• 6. Child prostitution
• 7. Suicidal tendencies
• IV. Family Life Cycle Stage - Family with Adolescent
Increasing flexibility of boundaries to include children independence
• Problems Encountered at Each Stage of the Cycle

ADOLESCENT

 
• PARENTS
• Medical:
• 1. Common medical problems
• 2. OB-GYNE problems
• 3. pre-menopausal symptoms
• 4. Alcoholism and other vices
•  
• Emotional & Social
• 1. Mid life crises
• 2. Male climacteric
• 3. Extra-marital affairs
• 4. Insecurities secondary to changing appearance
• V. Family Life Cycle Stage - Launching Family
•  
• Emotional Process of Transition: Key Principle
• Accepting a multitude of entries and exits into the family system.
•  
• Second Order Changes in Family Status: Required to Proceed Developmentally
• 1. Renegotiating of marital system as a dyad.
• 2. Development of adult to adult relationship between grown-up children and their
• parents.
• 3. Realignment of relationship to include in-laws and grandchildren.
• 4. Dealing with disabilities and death of parents and grandparents.
•  
• First Order Changes or Tasks Involved
• 1. Adjusting to the physiologic changes of middle life.
• 2. Discovering new satisfaction in relation with spouse.
• 3. Setting up a comfortable home for themselves that accommodates periodically
• other members of the family.
• 4. Helping their adolescent children to free themselves and become responsible
• and happy adults with families of their own.
• 5. Re-examining their living arrangement with their own parents.
• 6. Adjusting to the reality of their own work situation.
• 7. Assuring security for their later years.
• 8. Participating in community life.
• 9. Reaffirming the values of life that have real meaning especially dependent
• newly married children.
• V. Family Life Cycle Stage - Launching Family
•  
• Emotional Process of Transition: Key Principle
• Accepting a multitude of entries and exits into the family system
•  
• Problems Encountered at Each Stage of the Cycle
• PARENTS:
• Medical:
• 1. Episodic problems
• 2. OB-GYNE
• 3. Degenerative disease
•  
• Emotional & Social
• Depression due to
• a. career stagnation
• b. emptiness syndrome
• c. over-dependent married children
• d. early retirement financial problems
• e. extra-marital affairs
• f. taking care of the sick parent or in-law
• g. adjustment to the new member of the family through marriage
•
• V. Family Life Cycle Stage - Launching Family
•  
• Emotional Process of Transition: Key Principle
• Accepting a multitude of entries and exits into the family system
•  
• Problems Encountered at Each Stage of the Cycle
• PARENTS:

• CHILDREN:
• Medical:
• 1. Episodic problems
• 2. OB-GYNE
• 3. Medical problem of adolescence
•  
• Emotional & Social
• 1. Independence and dependence proper
• 2. Juvenile delinquency
• 3. Peer group pressure on vices
• 4. Problems of old relatives
• 5. Conflict with parents
• 6. Problems on adjustment to married life
•
• VI. Family Life Cycle Stage - The Family In Later Life
•  
• Emotional Process of Transition: Key Principle
• Accepting the shifting of generational goals
•  
• Second Order Changes in Family Status: Required to Proceed Developmentally
• 1. Maintaining own and or couple functioning and interest in the face of the
• physiologic decline, exploration of new familial and social options.
• 2. Support for more central role for middle generation.
• 3. Making room in the system for the wisdom and experience of the elderly
• generation without over-functioning them.
• 4. Dealing with loss of spouse, siblings and other peers and preparation for own
• death, life review and integration.
•  
• First Order Changes or Tasks Involved
• 1. Adjusting to the physiologic changes of later life.
• 2. Re-examining their living arrangements.
• 3. Participating in group activities.
• 4. Maintaining contact with younger generation.
• VI. Family Life Cycle Stage - The Family In Later Life
Emotional Process of Transition: Key Principle
• Accepting the shifting of generational goals

• Problems Encountered at Each Stage of the Cycle

• PARENTS & GRANPARENTS:
• Medical:
• 1. Degenerative diseases
• 2. Episodic medical problems
• 3. Gynecologic problems
• 4. Urologic problems
•  
• Emotional & Social
• 1. Depression due to death of spouse and sickness
• 2. Psychosomatic problems secondary to children leaving the home
• 3. Loneliness
• 4. Financial adjustment
•  
• CHILDREN:
• Medical:
• 1. Episodic medical problems
• 2. OB-GYNE problems
• 3. Menopausal problems.