Family assessment

FAMILY ASSESSMENT
Gayatri Ist M.Phil PSW
NIMHANS

Family history
• Socio demographic details of the family
Type of the family
Family size
Consanguinity

Family constellation
1. Father
2. Mother
3. Siblings
4. Spouse
5. Children
Age
Educational status
Occupation
Marital status
Income
Heath status
Any other significant family history

Genogram
• A genogram is a graphic representation of a family tree
that displays detailed data on relationships among
individuals.
• It goes beyond a traditional family tree by allowing the
user to analyze hereditary patterns and psychological
factors that punctuate relationships.
• Genograms allow a therapist and his patient to quickly
identify and understand various patterns in the patient's
family history which may have had an influence on the
patient's current state of mind.

cont…
• The genogram maps out relationships and traits that may
otherwise be missed on a pedigree chart.
• Genograms were first developed and popularized in
clinical settings by Monica McGoldrick and Randy Gerson
through the publication of a book in 1985.
• Genograms are now used by various groups of people in
a variety of fields such as medicine, psychology, social
work, genealogy, genetic research, and education.

Genogram format
A. Symbols: to describe basic family membership and
structure
B. Family interactions: least precise information on the
genogram but key indicator of relation ship patterns
C. Medical history: only major or chronic illness and
problems.
D. Other family information

Standard Symbols for Genogram
54 50
Death Date – to the right of the symbol
’1996 -
Male Female
- 2009
Birth Date – to the left of the symbol

Marriage Living Together
m. 1970
LT : 1970

Marital Separation
m. 1970 s.1980
Divorce
m. 1970 s.1980 d.1985

Getting Back together after divorce
d 1970 remarr.1980
Lesbian Couple
Gay Couple

Children in Birth Order from Left to Right
Biological
Child
Foster
Child
Adopted
Child
Still Birth Miscarriage Abortion

Identical Twins PregnancyTwins

Symbols Denoting Interactional Patterns
Between People
Close
Enmeshed

Family interaction patterns
Husband and wife as marital partners
Father and mother as parents
Parent and children
Siblings
Significant others

Boundaries
• the function of boundary is to protect the
differentiation of the system and to allow
for the emergence of a structure.
• Boundaries are the rules defining who
participates in the system and how i.e., the
degree of access outsiders have to the
system.

I. Clear / open – it is well defined enough to allow
subsystem members to carry out their functions without
undue interference but still allow contact between
members of the subsystem and others.
II. Diffuse – where distance decreases and boundaries are
blurred. The extreme sensitivity of its individual
members to each other and to their primary subsystem.
III. Closed/rigid which prevent the individual the
individual members from having predictable /
meaningful contact with each other.

Sub-system
It is one element of the total system. It
comprises a single person or several persons
joined together by common membership
criteria e.g. age, sex or shared purpose.
parent sub system
sibling sub system
parent child sub system
grand parent and grand child sub system

Alignment
Consists of coalitions and alliances
1.Coalition: when alignments stand in
opposition to another part of the system.
2.Alliance: The joining together of two or more
members. It popularly designates a positive
affinity between two units of a system.
Triangulation (cross-generational alliance)
Detouring (attacking and supportive)
Scapegoating (blaming)

Family development stage
The family life cycle (Duvall, 1977)
1. Married couples without children.
2. Child bearing families – oldest child from birth
to 30 months.
3. Families with pre school children – oldest child
21/2 to 6 years.
4. Families with school children – oldest child – 6
to 13 years.

5. Families with teenagers – oldest child
13 to 20 years.
6. Families launching young adults – from
first child’s to last child’s leaving house.
7. Middle aged parents – empty nest to
retirement.
8. Aging family members – retirement to
death of both spouses.

Leadership patterns
1.      Power structure:
        Is it gender and/or authority specific
•        Acceptance
•        Nominal
•        Functional

Decision making process
Authoritarian: Firmness, Self assurance,
Domination of others
Democratic : Responsiveness, Participation,
Mutual interaction
Chaotic :
(Participants Implementation )

Role structure and functioning
The idea of role has been used to denote
prescription, description, evaluation and
action, it has referred to covert and overt
processes, to the behavior of the self and
others.
1. Multiplicity role : refers to different roles
being given to one family member.
2. Complementarily role : It exists when
the reciprocal role of role partner is carried
out automatically without difficulty and in
the expected way.

3. Role expectation : refers to a concept held about
a behavior likely to be exhibited by a person in a
given situation.
4. Role Performance: refers to how well a person
performs a role relative to the expectation for the
role.
5. Role Conflict : refers to a felt difficulty in
fulfilling role obligations. Any situation in which
the incumbent of focal position perceives that he
is confronted within compatible expectations.

6. Role Diffusion: refers to more than one
person being allotted the same role.
7.Role Ambiguity occurs when no place
has been made in the social system, no
formal recognition given that particular
status exists.
8.Role prescription refers to behavior
which is socially prescribed and defined
on a normative basis.

9. Role Explicit: role are those which are open
to observation, they are conscious and both
participants of the transacting system are
aware of them.
10. Role Implicit : roles are those roles which
the person is not aware of and are usually
unconscious.
11. Role accountability :It refers to the process
of holding members accountable for the
functions that have been allocated to them.

12. Role Acceptance: It refers to duly
acknowledging and accepting the role allocated.
13. Instrumental role : this role is final court of
appeals, final judge and execution of
punishment, discipline and control over the
children of the family.
14. Expressive role : refers to the role of the
mediator, conciliator of the family, the person
who smoothes over disputes, resolves hostilities
in the family.

• Direct/indirect, verbal/non-verbal
• Equality of participation, Clarity of communication, Noise
level
• Listening skills, speaking skills, self-disclosure, clarity,
continuity tracking, and respect and regard.
• Affective communication:
– Welfare feelings (love, joy)
– Emergency feelings (fear, anger
Communication

Channels of communication:“who speaks to
whom” among all family members.
Direct communication: the message is
spoken directly to the person for whom it
is intended.
Indirect communication: when the
messages are unclear which is received
differently.

• Ambiguous communication: the nature of the
communication is flexible and words and phases can
have different meanings in different context
• Paradoxical communication :A paradox is a special
kind of contradiction, where the incompatible
statements exist on different “logical levels.” That is,
one of the statements is part of the context of the
other statement. These are significantly more difficult
to decode and comment on. The two logical levels in
human communication are usually verbal and non-
verbal behavior, where the non-verbal behavior is the
context for the verbal.

Switchboard communication occurs
when communication is through third
parties with the avoidance of
confrontation and with the risk that the
message will be distorted enroot

Cohesion
• Commitment & Intimacy- family rituals, ‘we’
feeling, dependence-independence, activities
(social, emotional, personal).
• Cohesion often is expressed in terms of
commitment and the degree of intimacy in the
interpersonal dimension.
• Enmeshed –refers to families in which there is
extreme sensitivity among the individual members
to each other and to their primary subsystem.

• Emotional Bonding: Emotional separateness, limited
closeness, occasional family loyalty.
• Family involvement: Involvement acceptable, personal
distance preferred, some affective responsiveness.
• Marital relationship: Emotional separateness, some
closeness.
• Internal boundaries: More separateness than
togetherness.
• Parent child relationship: Clear generational
boundaries, some parent child closeness.

Adaptive Patterns
• Conflict Resolution
• Problem solving ability
• Coping strategies
Flexibility:
– rigid (very low)
– structured (low to moderate)
– flexible (moderate to high)
– chaotic (very high)

Social Support
• Primary (immediate family)
• Secondary (relatives, friends, neighbors)
• Tertiary (hospitals, agencies, religious)
– Availability
– Utilization

Other aspects
• Any legal issues (related to marriage,
property, etc.)
• Expectations from treatment (Patient’s and
family members’ expectations)

Family assessment

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