Clear boundaries- are well understood by all
Chapter 35 members of the family and give family members a
sense of “I-ness” and also “we-ness” they help
Behavioral family therapy- consist of:
define the roles of members within the family and
-psychodynamic therapy- problems arise allow members to function without unnecessary
from: developmental arrest, current interference from other members. However, they
interactions, projections and current are not so rigid as to restrict contact among family
stressers. Improvement through insight into members. Ex) a mother tells her 14 year old
problematic relationships originating in the daughter, “you don’t need to worry whether your
past little brother eats his breakfast. Your father and I
-family-of-origin therapy- family viewed as will handle that.” This boundary may be redefined
an emotional relationship system: goal is to as “I want you to make sure your little brother gets
foster differentiation and decrease emotional his homework done while your father and I are at
reactivity, concept of triangulation, and the movies.”
emphasis on the family origin Differentiation – refers to the ability of the
-experimental-existential therapy- goal of individual to establish a unique identity while
therapy is to encourage the growth of remaining emotionally connected to the family of
family: symptoms express family pain, origin. The lower of level of differentitation in a
family is responsible for its own solutions, family, the higher the tension is and the more
therapist uses nurturing and identifies important the role of triangling is to lowering of
dysfunctional communication patterns tension and the preservation of emotionally
-Structural therapy: focus is on stability. As the family becomes stressed, for
organizational patterns, boundaries, systems whatever reasons, the anxiety in the system is
and use of scapegoating: restructures triggered, and the triangles become more active.
dysfunctional triangles, clarifies boundaries, Diffuse or enmeshed boundaries- refers to a
looks at enmeshment and disengagement blending together of the roles, thoughts, and
(excessive distance) issues feelings of the individual family members so that
-strategic therapy- goal is to change clear distinctions fail to emerge. The members of a
repetitive and maladaptive interaction family that operates with difuse or enmeshed
patterns: identifies inequality of power life, boundaries are more prone to psychological or
life cycle perspectives, and use of double- psychosomatic symptoms. A common phenomenon
blind messages, uses paradox, prescribes within families with diffuse boundaries is that
rituals individuals expect other members of the family to
-cognitive-behavioral therapy- based on know what they are thinking (“why did you take
learning theory; focuses on changing that? You know I wanted that!”) and believe they
cognition and behavior; problem solving and know what the other family members are thinking
solutions focus on present situations, skills (“I know exactly why you did that”)
training is emphasized Double bind- a situation in which a positive
Boundaries- maintain a distinction between command (often verbal) is followed by a negative
individuals in the family. Boundaries may be clear, command (often nonverbal) which leaves the
diffuse, rigid, or inconsistent. Most families are recipient confused, trapped, and immobilized
combinations of these boundary types. because there is no appropriate way to act. A double
Central concepts of family, Box 35-2, p. 755 blind is a “no-win” situation in which you are
“darned if you do, darned if you don’t”
Page 1 of 9
, Family life cycle- the family’s developmental generation to generation through persisting
process over time; refers to the familys past course, interactive emotional patterns. A major concept is
it presents rasks, and its future course. thjat of triangling. By creating a genogram the
Family systems theory – aims to decrease nurses are able to map the family structure and
emotional reactivity and encourage differentiation record family information. Functional information
among individual family members Ex) increase regarding medical, emotional, behavioral status is
each members self esteem. The parents or adults in also recorded.
the system be encouraged to consider emotional Identified patient- is the individual in the family
patterns learned in their family of origin and attempt whom everyone regards as “the problem a
to utilize extended family resources to reengage in descriptive term for this person is also the “family
more mature patterns of interaction. Children who symptom bearer” this family member is generally
are identified as the “problem” receive counseling the focus of most of the family system’s anxiety.
and behavior therapy but are not the focus of the She or he may serve to divert the attention from
therapy. Instead, the couple or parent is encouraged other more serious debilitating problems within the
to consider system factors that may contribute to the family, such as a crumpling marriage, substance
child’s emotional and/or behavioral problems abuse, or infidelity. Furthermore, the symptoms of
Family triangle – when tension in a family is low, the identified patient may serve as a stabilizing
the dyad or two-person system may interact mechanism to bring about customary behavior is a
comfortably, although some tension lies in the distressed family. The identified patient may even
struggle between closeness and independence. be aware at some level of the role he serves in order
When the tension in a close twosome builds, a third to “save” the family. For example: adult children
person (child, friend, parent) may be brought in to may sacrifice their autonomy by staying home to
help lower the tension. The family triangle becomes hold the parents together. When a family comes in
the basic building block of interpersonal for treatment the presenting problem which is
relationships. All triangles contain a close side, a usually related to one member of the family must be
distant side, and a side in which conflict or tension addressed before underlying systemic problem is
exists between two people. dealt with. The family member who is the identified
patient may or may not be the one who initially
Flexibility – allows for changes inherent to normal
seeks help form inpatient or outpatient services.
growth and development.
When working with families it is important to
Genogram – a format for efficiently providing a consider not only the family as a system in a
clinical summary of information and relationships particular stage of life-cycle development but also
across at least three generations of a family. It is a the individual developmental stage of each member.
valuable assessment tool that provides a graphic
display of complex patterns and serves as a source
of hypotheses as to how the presenting problem Multigenerational issues- the influence of family
connects to the family context and the evolution of is not restricted to the members of a household.
family. Bowen proposed that the family is Family is composed of the entire emotional system
organized according to generation, age, sex, roles, of at least three and sometimes four generations.
functions, and interests, and suggested that where Through this system various patterns ( involving
each individual fits into the family structure geographical distance between members, suicide,
influences the family functioning, relational divorce, addiction, affairs, grief, triangles, and loss)
patterns, and type of family formed in the next are passed down through generations. Ex) in a
generations. He further contended that sex and birth family with adolescents in which the grandmother is
order shape sibling relationships and characteristics. terminally ill, if a pattern of addiction is already
Also some issues tend to be played out from established in the family, the impending loss of an
Page 2 of 9
Chapter 35 members of the family and give family members a
sense of “I-ness” and also “we-ness” they help
Behavioral family therapy- consist of:
define the roles of members within the family and
-psychodynamic therapy- problems arise allow members to function without unnecessary
from: developmental arrest, current interference from other members. However, they
interactions, projections and current are not so rigid as to restrict contact among family
stressers. Improvement through insight into members. Ex) a mother tells her 14 year old
problematic relationships originating in the daughter, “you don’t need to worry whether your
past little brother eats his breakfast. Your father and I
-family-of-origin therapy- family viewed as will handle that.” This boundary may be redefined
an emotional relationship system: goal is to as “I want you to make sure your little brother gets
foster differentiation and decrease emotional his homework done while your father and I are at
reactivity, concept of triangulation, and the movies.”
emphasis on the family origin Differentiation – refers to the ability of the
-experimental-existential therapy- goal of individual to establish a unique identity while
therapy is to encourage the growth of remaining emotionally connected to the family of
family: symptoms express family pain, origin. The lower of level of differentitation in a
family is responsible for its own solutions, family, the higher the tension is and the more
therapist uses nurturing and identifies important the role of triangling is to lowering of
dysfunctional communication patterns tension and the preservation of emotionally
-Structural therapy: focus is on stability. As the family becomes stressed, for
organizational patterns, boundaries, systems whatever reasons, the anxiety in the system is
and use of scapegoating: restructures triggered, and the triangles become more active.
dysfunctional triangles, clarifies boundaries, Diffuse or enmeshed boundaries- refers to a
looks at enmeshment and disengagement blending together of the roles, thoughts, and
(excessive distance) issues feelings of the individual family members so that
-strategic therapy- goal is to change clear distinctions fail to emerge. The members of a
repetitive and maladaptive interaction family that operates with difuse or enmeshed
patterns: identifies inequality of power life, boundaries are more prone to psychological or
life cycle perspectives, and use of double- psychosomatic symptoms. A common phenomenon
blind messages, uses paradox, prescribes within families with diffuse boundaries is that
rituals individuals expect other members of the family to
-cognitive-behavioral therapy- based on know what they are thinking (“why did you take
learning theory; focuses on changing that? You know I wanted that!”) and believe they
cognition and behavior; problem solving and know what the other family members are thinking
solutions focus on present situations, skills (“I know exactly why you did that”)
training is emphasized Double bind- a situation in which a positive
Boundaries- maintain a distinction between command (often verbal) is followed by a negative
individuals in the family. Boundaries may be clear, command (often nonverbal) which leaves the
diffuse, rigid, or inconsistent. Most families are recipient confused, trapped, and immobilized
combinations of these boundary types. because there is no appropriate way to act. A double
Central concepts of family, Box 35-2, p. 755 blind is a “no-win” situation in which you are
“darned if you do, darned if you don’t”
Page 1 of 9
, Family life cycle- the family’s developmental generation to generation through persisting
process over time; refers to the familys past course, interactive emotional patterns. A major concept is
it presents rasks, and its future course. thjat of triangling. By creating a genogram the
Family systems theory – aims to decrease nurses are able to map the family structure and
emotional reactivity and encourage differentiation record family information. Functional information
among individual family members Ex) increase regarding medical, emotional, behavioral status is
each members self esteem. The parents or adults in also recorded.
the system be encouraged to consider emotional Identified patient- is the individual in the family
patterns learned in their family of origin and attempt whom everyone regards as “the problem a
to utilize extended family resources to reengage in descriptive term for this person is also the “family
more mature patterns of interaction. Children who symptom bearer” this family member is generally
are identified as the “problem” receive counseling the focus of most of the family system’s anxiety.
and behavior therapy but are not the focus of the She or he may serve to divert the attention from
therapy. Instead, the couple or parent is encouraged other more serious debilitating problems within the
to consider system factors that may contribute to the family, such as a crumpling marriage, substance
child’s emotional and/or behavioral problems abuse, or infidelity. Furthermore, the symptoms of
Family triangle – when tension in a family is low, the identified patient may serve as a stabilizing
the dyad or two-person system may interact mechanism to bring about customary behavior is a
comfortably, although some tension lies in the distressed family. The identified patient may even
struggle between closeness and independence. be aware at some level of the role he serves in order
When the tension in a close twosome builds, a third to “save” the family. For example: adult children
person (child, friend, parent) may be brought in to may sacrifice their autonomy by staying home to
help lower the tension. The family triangle becomes hold the parents together. When a family comes in
the basic building block of interpersonal for treatment the presenting problem which is
relationships. All triangles contain a close side, a usually related to one member of the family must be
distant side, and a side in which conflict or tension addressed before underlying systemic problem is
exists between two people. dealt with. The family member who is the identified
patient may or may not be the one who initially
Flexibility – allows for changes inherent to normal
seeks help form inpatient or outpatient services.
growth and development.
When working with families it is important to
Genogram – a format for efficiently providing a consider not only the family as a system in a
clinical summary of information and relationships particular stage of life-cycle development but also
across at least three generations of a family. It is a the individual developmental stage of each member.
valuable assessment tool that provides a graphic
display of complex patterns and serves as a source
of hypotheses as to how the presenting problem Multigenerational issues- the influence of family
connects to the family context and the evolution of is not restricted to the members of a household.
family. Bowen proposed that the family is Family is composed of the entire emotional system
organized according to generation, age, sex, roles, of at least three and sometimes four generations.
functions, and interests, and suggested that where Through this system various patterns ( involving
each individual fits into the family structure geographical distance between members, suicide,
influences the family functioning, relational divorce, addiction, affairs, grief, triangles, and loss)
patterns, and type of family formed in the next are passed down through generations. Ex) in a
generations. He further contended that sex and birth family with adolescents in which the grandmother is
order shape sibling relationships and characteristics. terminally ill, if a pattern of addiction is already
Also some issues tend to be played out from established in the family, the impending loss of an
Page 2 of 9
