The Family Life Cycle

MEK VILLAFUERTE-SOLANA, MD SAN BEDA COLLEGE OF MEDICINE FCH 1 SEPT 8, 2009

Objectives for this Session
Learn the effect of families and their complex relationships to health Discuss the family life cycle and why we need to study it Determine the two levels of orders of magnitude of change Learn the stages of the family life cycle, the key principles and conflicts in each stages

Research on Families and Health
The family is the primary social context in which health care issues are addressed Most health beliefs and behaviors are developed and maintained within the family Family members provide most of the health care for patients

Research on Families and Health
Family support affects the outcome of most chronic medical illnesses Ex. 3x mortality rate for MI patients with few or no family support Emotional support is the most important and influential type of family support

Family’s Influence on Health
Genetic Influence Family crucial in child development Infectious disease spreads in the family Family factors affect morbidity and mortality in adults Family is important in recovery from illness

Families go through different stages for which specific developmental tasks must be accomplished. Families who are not able to accomplish these tasks may develop difficulties with subsequent family development.

FAMILY LIFE CYCLE
Provides chronologically oriented sequence of events in family life View of the stressful changes in the family Events in the FLC can be related to clinical events and to health maintenance in the family

FAMILY LIFE CYCLE
The individual life cycle takes place within the family life cycle, which is the primary context of human development Family stress is greatest at transition points from one stage to another of the family developmental process

The FAMILY as a SYSTEM moving through time:
Boundaries will shift Psychological distance among

members may change Roles within and between subsytems may be redefined
Norris

& Tindale 1994 Cicirelli, 1995

The Family is a System Moving Through Time
Families incorporate new

members only by birth, adoption, or marriage, and members can leave only by death Main value in families is in the relationship, which are irreplaceable

Flow of Anxiety in a Family
SYSTEM LEVELS
1. 2. 3. 4. 5. Social, cultural, political, economic Community, work, friends Extended family Nuclear family Individual

Vertical Stressors Family patterns, myths, legacies

Horizontal Stressors 1. DEVELOPMENTAL- Life cycle transitions 2. UNPREDICTABLE- Untimely death, chronic illness, accident

2 Levels of Orders of Magnitude Change
First Order Change - Involve adaptation - Do not involve change in the main structure of the family - Do not involve a change in an individual’s identity and family - A “NEED TO DO” something new -Tasks that must be accomplished by the family and its members working within a stage in the FLC

2 Levels of Orders of Magnitude Change Second Order Change - Involve transformation of an individual’s status or meaning - a “NEED TO BE” something new - Change in the role and identity of family members - Change in the very basic attributes of the family system - Occur between stages in the FLC

Stages of the Family Life Cycle Unattached Young Adult Newly Married Couple Family with Young Children Family with Adolescents Launching Family Family in Later Years

Leaving Home: The Unattached Young Adult
Start of the family life cycle Primary task: coming to terms with

their family of origin Issues on separation from parents/ family of origin Formulation of personal goals Need for self-differentiation Alcoholism, smoking, STD’s, unwanted pregnancies

Unattached Young Adult
Differentiation of self in

relation to family of origin Development of intimate peer relationships Establishment of self in respect to work and financial independence

Newly Married Couple
The joining of families Key principle: Commitment to the

new subsystem Formation of the marital system Realignment of relationships with extended families and friends to include the spouse Establishing home base Money matters Demands on new role

Newly Married Couple
Establishing a satisfying sexual

relationship Interaction with friends and associates in the community Facing the possibility of children and planning for their coming

Newly Married Couple
Marital

adjustment Family planning and fertility management

Family planning Pregnancy and

pre-natal care Labor and delivery Post partum care

The quality of a marriage has a particularly strong influence on over all health.

Family with Young Children
Pregnancy for the first child to

emergence of adolescents Stage when child starts to go to school Becoming parents Key principle: Accepting marital system to make space for children

Family with Young Children
Taking on parenting role Key principle: Realignment

of relationship with extended family to include parenting and grand parenting roles FLC phase that has the highest rate of divorce

Family with young children
Child care Parenting and

child rearing Discipline

SOLANA-VILLAFUERTE FAMILY
I
Graciano 82 Remedios 65 David 58 Tess 55

II
Manding Victoria Amy Nene George Julie Lydia Mien Michael Lester Chai 3 Imelda Elizabeth Grace Reggie 31 Hearty 28 Mandy 28 Jhay 22 Bhen 20

III 4

4

6

Heart disease Diabetes Asthma HPN Stroke P Provider C Caregiver

P
Justin 39 Junilyn 28 Thea 2 mos

P
Mek 33 Nanay Puring 58

Nov. 25, 2007

Family with Adolescents
Key principle: increasing

flexibility of boundaries to include children independence Identity crisis Re-focus on midlife, marital and career issues Beginning shift towards concern for the older generation

Family with Adolescents
Adolescent care Injury prevention STD Teen age Adolescence
 Identity  Autonomy  sexuality

pregnancy Drug use and abuse

Midlife Art of

negotiation

Launching Family
Begins when the first child leaves home Longest stage, most problematic of all

phases Key Principle: accepting a multitude of entries and exits into the family system Adjustment to new family members Dealing with illness or death of parents/grandparents Career stagnation vs financial liberation Extramarital affairs vs a restructured marital relationship

Launching Family
Physiologic

decline Diseases of middle age

Letting go Midlife crisis

Launching Children and Moving on
Development of adult to adult

relationships between parents and their grown children  re-alignment of relationships to include in-laws and grandchildren Dealing with disabilities and deaths of parents

SOLANA-VILLAFUERTE FAMILY
I
Graciano Remedios David 58 Tess 55

II
Manding Victoria Amy Nene George Julie Lydia Mien Michael Lester Chai 3 Justin 39 Junilyn Thea 2 mos Mek 33 Imelda Elizabeth Grace Reggie 31 Hearty 28 Mandy 28 Jhay 22 Bhen 20

III

4

4

6

Heart disease Diabetes Asthma HPN Stroke
28

Nanay Puring 58

Nov. 25, 2007

The Family in Later Life
Begins with departure of

last child and continues through retirement and death Old age and disease Financial/ retirement adjustments Death of spouse Empty nest syndrome Key process: accepting the shifting of generational goals

SOLANA-VILLAFUERTE FAMILY
I
Graciano 82 Remedios 65 David 58 Tess 55

II
Manding Victoria Amy Nene George Julie Lydia Mien Michael Lester Chai 3 Justin 39 Junilyn Thea 2 mos Mek 33 Imelda Elizabeth Grace Reggie 31 Hearty 28 Mandy 28 Jhay 22 Bhen 20

III

4

4

6

Heart disease Diabetes Asthma HPN Stroke
28

Nov. 25, 2007

The Changing Family Life Cycle
Due to lower birth rate Longer life span/ expectancy Changing role of women Increasing divorce and remarriage

rate

Role of Women in the FLC
Central to the functioning of the family Identities determined primarily by their

function as wife and mother Life cycle phases linked almost exclusively to child rearing activities A woman who choose a primary role as mother and homemaker will have to face an “empty nest” phase later on in life

Role of Women in the FLC
Women most prone to symptom

development at life cycle transitions The goals of career and family present severe dilemma Likely to be depressed at childbirth Seek help during the child-rearing years Responsible for older relatives Bear emotional responsibility for all family relationships

References: Isabelita Samanego, MD. Proceedings of the Orientation Course in Family Medicine. PAFP, Inc. Carter, B. and McGoldrick, M. The Changing Family Life Cycle, A Framework for Family Therapy, 2nd ed. 1989. p3-28.