Family

Dynamics
Ntokozo Nxele
Simiso Siwawa
Carol Maluleke
  It means different things to different people…

1. Unit of two or more persons united by marriage, blood, adoption

or consensual unit consulting a single household, interacting and
communicating (Desai, 1994)
2. A group of people related either by consanguinity or affinity (by
Definition of marriage or other relationship), (definition adopted by WHO)
3. Family is a kinship unit and that even when its members don’t
Family… share a common household, the unit may exist as a social reality
(UNESCO report)
Types of Family structures…
Characteristics of healthy family structure

1. Healthy communication: freedom of expression

2. Personal autonomy: equal power
3. Appreciation: praise and encouragement, promoting healthy self esteem
4. Support Networks
5. Family time
6. Spouse bonding
7. Growth: encouraging environment promotes growth of individual members
8. Spiritual and religious values
 The patient and family dynamics
 Health is multifactorial
 WHO describes health as a state of complete physical, mental and social well being and not merely the
absence of disease and infirmity
 Family can determine or impact your health
 Genetics
 Lifestyle
 Finances
 Health seeking Behaviours
 Ultimately family and environmental factors can affect health
 family living in harmony promotes good mental health and social stability
 Addressing these determinants of health forms part of Bio-psych-social approach
 PHC we see patients who present with physical symptoms that a primary emotional or
psychosocial basis, with no organic cause
 In order to understand the clinical presentations, we have to have an understanding of
underlying precipitants or external factors that may lead to presentation…
 Otherwise we end up treating the symptoms and not the cause
THE CLINICAL SETTING

EXPLORING ‘THE PRESENTING

COMPLAINTS’
DUVALL’S FAMILY DEVELOPMENT AND
LIFE CYCLE THEORY
 Developed in 1988
 Families follow a predictive pattern comprising of 8 stages of development
 Each stage of development poses a potential threat to the health of the family members
involved
LIMITATIONS OF DUVALL’S THEORY

 Designed for nuclear families

 Arrests in the life cycle
 The chronology of the sequence of events
HOW TO ASSESS FAMILY DYNAMICS
IN THE CONSULTATION ROOM
1. THE GENOGRAM
GENOGRAM CONT….

 A summary of the patient’s context

 Highlights patterns of illness in the family and psychosocial relations
 Therapeutic and preventative tool
 Time consuming
 Informant dependent
2. THE BATHE TECHNIQUE

 Elicits the social context of the patient’s visit

 Enhances rapport
3. APGAR SCORING SYSTEM
Family APGAR
Family APGAR: Introduced by Gabriel Smilkstein is a family function test designed to assess five areas of family
function.
A: Adaptation P: Partnership G: Growth A: Affection R: Resolve
Part 1: Part 2:

8-10 Highly functional

4-7 Moderately dysfunctional
0-3 Severely Dysfunctional
 Intervention…
Doherty and Baird: Five
Levels of Primary Care
Collaboration
Pitfalls

 Boundaries: if the general practitioner becomes too involved with the family the could end
up taking the role of “rescuer”
 Not all members of the family may be available for intervention
 Taking sides
 Confidentiality
Avoiding Pitfalls

 Enable autonomy
 Encourage teamwork
References

1. Sharma, R. 2013. The Family and Family Structure Classification Redefined for the
current times. J Family Med Prim Care pp:306-310.
2. Kim JH, Park YN, Park EW, Cheong YS, Choi EY. Effects of BATHE Interview Protocol
on Patient Satisfaction. Korean J Fam Med. 2012;33(6):366-371.
3. G. Pirooz Sholevar. Family development and life cycle; Psychiatry Journal/ Child
psychiatry 94(2): 1-8.