Family Medicine and Community Health 1st year
2024
FAMILY PSYCHODYNAMICS
DR. PERET-CLARION
FAMILY PSYCHODYNAMICS
Motivation that directs all individuals involved
and the adaptive processes and mechanisms
they utilize to fulfil the requirement needed
for their proper functioning at the biological,
familial and social level of life
Basically, it is how the family functions as a
whole
INFLUENCE FAMILY DYNAMICS
➢ Nature of family dynamics
➢ Having a particularly soft or strict
parent
➢ Number of children in the family
➢ Personalities of different family
members
➢ An absent parent
➢ Levels and types of influence from
extended family
➢ Events which have affected family
members
➢ Family values, culture and ethnicity
➢ Dynamics of previous generation
➢ Broader system: social, economic,
political
FUNCTIONAL FAMILY RELATIONSHIP
FAMILY PERSONALITY
➢ Functional style of the family
➢ Rach person provides emotional
needs on each family members
➢ Internal processes that provide a
family a unique personality
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➢ Each family has its own attitude and
beliefs, regarding health definition of
health and how should one react to it
FAMILY ROLES
➢ Recurrent patterns of behavior by
which individuals fulfil family
functions and needs
➢ Individual members of the family
occupy certain roles such as child,
sibling, grand child
➢ A person’s role is always changing or
expanding, depending upon his age or
family stage
➢ Types of roles:
o Instrumental roles
-concerned with the provision
of physical resources, decision
making, and family
management
o Affective roles
-provide emotional support
and encouragement to family
members
ROLE ALLOCATION
➢ Assignment of responsibilities within a
family that enables the family to
function properly
➢ Making decision on who will be
responsible for completing a certain
task or fulfilling a particular
responsibility
FAMILY ACCOUNTABILITY
➢ Refer to a family member sense of
responsibility for completing the tasks
of an assigned role
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 Family Medicine and Community Health 1st year
FAMILY PSYCHODYNAMICS
DR. PERET-CLARION
5 ESSENTIAL ROLES FOR EFFECTIVE FAMILY
FUNCTIONING
1. Provision for resources
o Money, food, clothing, shelter
2. Nurturance and support
o Providing comfort, warmth
and reassurance for family
members
3. Providing comfort warmth and
reassurance for family members
o Physical, emotional,
educational and social
development of children and
adult
4. Maintenance and management of
the family system
o Leadership, decision-making,
handling family finances,
maintaining appropriate roles
with respect to extended
family, friends, and neighbors
5. Sexual Gratification
o Meeting sexual needs in a
manner that is satisfying to
both partners
INTERPERSONAL DYNAMICS
➢ No single interpersonal relationship in
a family exists in isolation from other
relationships within the family
➢ The more individual within the family
system, the more complex will be the
interactional pattern, and the greater
opportunity for conflict
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8 CONCEPTS RELATIONS TO THE IMPACT OF
FAMILY SIZE IN ROLES AND RELATIONSHIP
➢ Parental practices will be restrictive
➢ Parents will be authoritative
➢ Corporal punishment will be used
➢ One parent is dominant
➢ The father is the dominant parent
➢ Stress will characterize the role
playing of parents
Conversely, it is less likely that:
➢ Children will exhibit a positive affect
towards their parents
➢ Spouses will show positive affect
toward each other
IMPACT OF FAMILY SIZE ON ROLES AND
RELATIONSHIP
THUS, it appears that the larger the family,
the less likely it is that affection will be
shown and perceived among family
members.
FAMILY PATTERNS
➢ Some families have a distinct style
and pattern of interaction which
remain constant
➢ Some of the pattern or style that can
be observed are:
o Who talks after whom within
the family
o Style of interacting and
managing stress
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FAMILY PSYCHODYNAMICS Semester
2
DR. PERET-CLARION

o Method of coping with

STRESSFUL FACTORS THAT WEAKEN FAMILY
problems
STABILITY

➢ Alcoholism
➢ Drug abuse
FAMILY SUBSYSTEM
➢ Financial difficulty
➢ Serious illness
➢ Formed wherein 2 or more family ➢ Mental problem
members exclude the rest of the ➢ Marital discord
family ➢ Frequent absence of father
➢ Most subgroup consists of 2
A secure and supportive family gives comfort
individuals who pair up to form an
and strength to its members in times of stress
entity called DYAD
➢ Purposes: maintaining discipline
➢ Alliance could be temporary or
permanent EQUILIBRIUM

PERMANENT ALLIANCE
➢ The capacity to maintain effective
➢ Created for the purpose of defending
functioning under constantly changing
against others
condition
➢ Seriously disrupt a family’s functional
➢ A state of family homeostasis in which
adaptive capacity
member interaction results in
➢ Disruptive and distorts the normal
emotional and physical nurturing,
balance of family relationship
thus promoting growth of family
members and the family unit

FAMILY HOMEOSTASIS
FAMILY STABILITY
➢ Ability to maintain constant state in
the midst of a continuous interplay of
➢ Family remains the central refuge
internal and external forces
where all its members feel secure and
relaxed DISTURBED BY:
➢ Serves as a source of security in the
>Sudden socio-cultural change
midst of a fast-moving, stressful, and
chaotic world -Immigration from one culture to
➢ An essential feature of raising children another
to become secure individuals
➢ Family is the first level of support for -Unexpected alteration in
individual family members in the position on the social ladder
attempt to cope with the stresses of >Role change
daily living

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FAMILY PSYCHODYNAMICS
DR. PERET-CLARION
CHARACTERISTICS OF FAMILIES BEST ABLE TO
WITHSTAND STRESS AND MAINTAIN
HOMEOSTASIS
➢ Approach problem in a unified
manner as a family
➢ Have a non-materialistic orientation
➢ Husband and wife frequently share
tasks
➢ Perceive the nature of the problem
accurately
➢ Have a democratic orientation with
SUCCESSFUL ADJUSTMENTS TO SERIOUS ILLNESS
diffusion of leadership regarding
problem solving tracks
STABLE FAMILIES
➢ Love
o Provides an atmosphere of
warmth, acceptance, and
support
➢ Discipline
o Provides guidelines for
acceptable activity as well as
the ability to save and
prepare for future needs
➢ Tolerance
o Allows for individual freedom
and development
➢ Adaptability
o Makes it possible to adjust
and respond to sudden or
relatively unexpected changes
➢ Free Communication
o Contributes to the
consistency of open and
honest realtionships among
members
COPING
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➢ Refers to adjustment by the family to
stressors within and outside the
family
Example: Changes resulting from the
illness of one of its members
CHARACTERISTICS OF FAMILY WHO MAKE
➢ Clear separation of generation
➢ Flexibility of family roles
➢ Effective and contrast communication
➢ Tolerance for individuality
THE HEALTHY/SUPPORTIVE FAMILY
➢ An attitude of service-looking out for
each other
➢ Secure relationship between parents
(or other guardian/authority figure)
➢ Parents teach and train- encourage
each family member to grow and
develop as an individual
➢ Attitude of honor- parents lead with
love, children will respect and obey
➢ Have shared experiences/activities on
a regular basis
➢ The foundation of a well-functioning
family is a balance of love and respect
base on a shared set of values/beliefs
➢ Rules, roles and relationships work
together to meet the goals/purpose
of the family
➢ A healthy family will more easily
weather the storms of life
o Family members accustomed
to helping each other, self-
sacrifice
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FAMILY PSYCHODYNAMICS
DR. PERET-CLARION
o Open to share feelings and
fears without being
threatened
o Easier time adjusting to new
roles
o More likely to plan ahead and
be prepare
COMPLIMENTARY NEED OS THE FAMILY
➢ Each person tends to select a spouse
most likely to provide gratification
and best satisfy his needs
➢ Harmony and stability within the
family system are maintained if the
spouses’ personalities, goals, and
expectations are complimentary
➢ Relationships needs to be flexible and
adjustable over time
➢ When complimentary function fails,
anxiety, conflict, and hostility result;
equilibrium is disrupted and
dysfunction occurs
DYSFUNCTIONAL FAMILY
> The essence of a dysfunctional family is
that the parents are unable to meet the
emotional needs of their children (Core
needs: Purpose, Love/Acceptance, Value)
>Emotional problems and difficulties as
adults can be the result of individuals being
raised in dysfunctional families
>A dysfunctional family is an unhealthy place
where family members adopt destructive
behaviors in order to cope with pain,
suffering, fear, and loneliness
>Sometimes family members experience
verbal, emotional, physical, and/or sexual
abuse
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>Maybe characterized b negative unwritten
rules: “Don’t Talk, Don’t Trust, Don’t Feel”
>Troubles will be magnified on times of
stress
>Family rules may be either too restrictive,
too loose, or not exist at all. Rules are
harmful, not helpful
>Family relationships are hurtful and bring
each other down. They may be too close
(enmeshed, co-dependent), too distant (cut-
off, aloof) or inappropriate (ie. Child who has
take responsibility due to depressed parent)
>Family Role no longer exist for the “greater
good”, but to help each individual family
member cope
>THE ENABLER
o Has distorted thinking and
believes that they are basically
responsible for the other person’s
dysfunction
ROLES THAT THE CHILDREN IN DYSFUNCTIONAL
FAMILIES DEVELOP
THE SCAPEGOAT
➢ Tends to blame others, makes strong
peer alliances, ad is often disciplined
by teachers or other adults for
breaking rules
THE HERO
➢ Always volunteering, very responsible
and manifests a drive, almost a
compulsion, to be on top
THE MASCOT
➢ Tends to be funny or distracting and
gets attention frequently. This
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FAMILY PSYCHODYNAMICS
DR. PERET-CLARION
student likes to hide, makes faces,
pull the chair from someone else,
otherwise act out
THE LOST CHILD
➢ Often gets lost in the shuffle. Adults
sometimes can’t remember the
student’s name because s/he is so
quiet and is seldom a behavior
problem
TYPES OF DYSFUNCTIONAL FAMILY
MARITAL CONFLICTS
➢ A result of disordered family dynamics
➢ Child feels caught in the middle and
forced to take sides with one parent
against the other
SCAPEGOATING
➢ Mans the assigning of blame to a
person or things for fault of others
➢ The object of scapegoating to draw
off tension that cannot be resolved in
the usual manner and assign it to
another
➢ Frequently occurs in a strict
authoritarian family
➢ Possible RESULTS in a child
o School phobias
o Behavior problems
o Poor school performance
DOLL’S HOUSE FAMILY
➢ One in which the wife is dependent
and infantile and in which the
husband’s self-esteem and fragile
maturity depend on keeping her that
way
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➢ The husband’s ego strength and
borderline maturity rely upon the
continuation of this relationship
SCHIZOPHRENIC FAMILY
➢ The spouses are not merely unhappy
but are openly hostile to one another,
often completing for loyalty of the
children
➢ The mother in a schizophrenic family
is typically describe as domineering
over protective and manipulative of
both father and child
➢ The father is usually weak, passive,
and elusive, having little interaction
with the child
➢ Parental coalition is absent
➢ Parents are in chronic conflict
➢ Family members rarely make
affirmative statement statements
DELIQUENCY
➢ Comes from disordered family
relationships
➢ Families of delinquent family
relationships
➢ Families of delinquent children lack a
warm, affectionate relationship
between parents and children
➢ Common among boys who have lost
their father or passed through an
important formative years (ages 4 to
8) without a father figure present or
with one present who serves
inadequately in the paternal role
EMOTIONAL DEPRIVATION
➢ Children reared in emotionally
nurturing environment and raised
where care is impersonal and
inadequate often shows
developmental difficulty, and high
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FAMILY PSYCHODYNAMICS Semester
2
DR. PERET-CLARION

susceptibility to diseases and can also There are 5 major forms of family
affect the child’s IQ disorganization

1. Uncompleted Family Unit

Adults can also experience emotional
2. Willed Family Dissolution
deprivation.
3. Empty Shell Family
Expectation that one’s desire for a normal 4. Externally Caused Crisis
degree of emotional support will not be 5. Internal Catastrophe
adequately met by others. The three major
forms of deprivation are:

>Deprivation of Nurturance: Absence of

attention, affection, warmth, or
companionship
>Deprivation of Empathy: Absence of
understanding, listening, self-disclosure, or
mutual sharing of feelings from others
>Deprivation of Protection: Absence of
strength, direction, or guidance from others
ENURESIS
➢ A relationship has been shown
between incontinence in children and
the strength of maternal relationship
during the early formative years
➢ Bedwetting is greatest if total
disruption of the family occurs
through either divorce or dissertion
ACCIDENTAL INJURIES
➢ More from large families
➢ Half of the family have either serious
or physical or psychological illness
➢ 1/3 from divorced, separated, or singe
parent family
➢ Dysfunctional home relationships
were the most common factors
placing these childish over 1 y/o in
developed countries
TROUBLED FAMILY
UNCOMPLETED FAMILY UNIT
➢ Ilegitimacy
o Potential mother and father
fail to assume the role
obligations of marriage and
parenthood
o The out of wedlock pregnancy
implies failure of the parents
of the families of orientation
➢ Four possible solution to illegitimacy:
o Chastity = PROHIBITS
o Birth Control = PREVENTS
o Abortion = DISRUPTS
o Coerced marriage = PROVIDES
legitimacy
WILLED FAMILY DISSOLUTION
➢ Annulment
➢ Separation
➢ Divorce
➢ Dissertion
EMPTY SHELL FAMILY
➢ Individuals may live together with
minimal contact and communication
and fail to provide for the basic
personal and social needs of the
family member
➢ Families of professional and
managerial men seem prone to this
type of existence

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 Family Medicine and Community Health 1st year D2
2024
FAMILY PSYCHODYNAMICS Semester
2
DR. PERET-CLARION

EXTERNALLY CAUSED CRISIS CATEGORIES:

➢ Unwilled absence of a family member 1. Normative

➢ Maybe lost to death incarceration or 2. Non-Normative
war
➢ Loss of family member means that the
relationship between remaining NORMATIVE
members have to be rewoven to
compensate for the lost individual ➢ Life events that are part of the
planned, expected or normal process
INTERNAL CATASTROPHE of family life

➢ Unwilled major family failures Example: Birth, Marriage, Moving to a

➢ Severe mental, emotional, and
physiological disorders result in role
failures
➢ While the individual is present, he is
unable to meet obligations because of
his disabilities
➢ Acute episodes call for mobilization of
family resources to meet the needs of
the afflicted individuals
➢ Chronic disabilities present a different
problem- chronically ill person must
reshape his personal and social needs
so that they are consistent with his
capabilities
FAMILY CRISIS
➢ Many crises are major family
disruption which results from
repeated subtle stresses that have
been inadequately managed and have
weakened family dynamics until they
ultimately culminate in a major threat
to family stability
CRISIS
➢ Any event, past or present that
changes the lifestyle or presents a
significant strain upon family
organization
new community
NON-NORMATIVE
➢ Due to unexpected or adverse life
experiences that have greater impact
on family function
Example: Infidelity, Unplanned
pregnancy, Sudden fame
➢ EXTERNAL NON-NORMATIVE
-Manmade and natural disasters
-Usually leads to transient dysfunction
-Rapid pooling of resources
➢ INTERNAL NON-NORMATIVE
-As in marital infidelity, criminal
activity
-May lead to extended period of
dysfunction
HALL’S TAXONOMY OF CRISIS
➢ ADDITION
-A crisis identified with short and long
term addition of one or more to the
family structure
Example: Abortion, birth, marriage,
separation, unplanned pregnancy
➢ ABANDONMENT
-associated with the threat of loss or

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 Family Medicine and Community Health 1st year
FAMILY PSYCHODYNAMICS
DR. PERET-CLARION
actual departure of a family
Example: Planned departure,
separation, death, slow away
➢ DEMORALIZATION
-A crisis that occurs when a family
member initiated a change in a
previously ordained family moral code
Example: School suspension,
alcoholism, drug abuse, deliquency,
infidelity
➢ STATUS CHANGE
-Crisis involving gain or loss of wealth,
power, or position in the family or
extra familial society
Example: Loss of income, sudden
fame, expectation, loss of freedom
EVALUATING FAMILY CRISIS
1. Assessing history of coping with
problem and stresses
-Coping and boiling point affected by
unique factors and extreme factors:
>Family psychosocial history
>Quality of life
>Stressors number and intensity
2. Determine stage of family
development
-Timeliness of illness or problems
-Anticipatory guidance
3. Role of patient in the family
4. Monitoring role disruption
-Asses and monitor effect
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-Identify gaps in family roles
-Explore options for filling gaps
FAMILY RESPONDS TO STRESSFUL LIFE EVENTS
1. Family stability returns to normal
level
2. Family improved after resolution
3. Family stability suffers and never
returns to its former level
>In order to obtain a good response pattern,
an essential feature in the family response is
to have adequate resources
>Different families respond to the challenge
of a stressful life event in dofferent ways
THE CYCLE OF FAMILY FUNCTION
➢ Developed as a conceptual framework
for presenting an empirical view of
the response that may result when a
family experience a stressful life
EQUILIBRIUM
State of family homeostasis in which member
interaction results in emotional and physical
nurturing thus promoting growth of family
members and the famly unit
➢ The capacity to maintain effective
functioning under constantly changing
conditions
➢ FAMILY HOMEOSTASIS: ability to
maintain a constant state in the midst
of a continuous interplay of internal
and external forces
STRESSFUL LIFE EVENT
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 Family Medicine and Community Health 1st year
FAMILY PSYCHODYNAMICS
DR. PERET-CLARION
➢ Life experiences that requires the se
of family resources for coping or
adapting not usuallly required for
management of daily activities
DISEQUILIBRIUM
➢ State of impaired functioning that
occurs when an individuals’ resources
are inadequate or unavailable to meet
an intense stressor or an
accumulation of stressor
RESOURCES
➢ Assests that serve to nurture an
individual and those that supply the
means for solving stressor-induced
problems
➢ Familial, extra-familial, social, cultural,
religious, economic, environmental,
and medical support system
*Coping: refers to adjustment by the
family to stressors within and outside
the family (ex: changes resulting
from the illness of one of its
members)
CRISIS
➢ State of family disequilibrium tha
results from the failure of an
individual to identiy or use resources
to resolve a stressor induced problem
MALADAPTATION
➢ The use of pathologic defense
mechanisms to escape from an
unresolved crisis, resulting in a state
of impaired emotional and social
functioning
PATHOLOGIC DISEQUILIBRIUM
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➢ State of impaired interaction or
nurturing withn the family that
folllows the use of of abnormal
defense mechanism to escape from
anxiety of unresolved family crisis.
TERMINAL DISEQUILIBRIUM
➢ Family function is continuously
detriorating decause of failure to
resolve a crisis, may eventually lead to
family dissolution
DEFENSE MECHANISMS
➢ Ways to behave or think to protect or
‘defend’ ourselves from anxieties
➢ How we distance ourselves from a full
awareness of unpleasant thoughts,
feelings, and behaviors
➢ While all defense mechanisms can be
unhealthy, they can also be adaptive
and allow us to function normally
➢ The greatest problems are when
defense mechanisms are overused
DENIAL
➢ Seeing but refusing to acknowledge
what one sees and hear but negates
what is actually being heard
DISPLACEMENT
➢ Involves purposeful, unconsccious
shiting from one object to another to
the interest of solving a conflict
IDENTIFICATION
➢ Actually plays a crucial role in ego
development, but can be used as a
defense mechanism when a person
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 Family Medicine and Community Health 1st year
FAMILY PSYCHODYNAMICS
DR. PERET-CLARION
unconsciously incorporates the
characteristics and qualities of
another person or object into his ego
system
INTROJECTION
➢ Differs from identification in the fact
that this involves internalization of
the charactersitics of another person
or object, creating a radical shift or
alteration in the person
RATIONALIZATION
➢ Individual provides a plausible but
inaccurate justification for his or her
failures
➢ Attributes achievemenets to their
own qualities and skills
➢ Failures are blamed on other people
or outside forces
REGRESSION
➢ Individual retreats to an earlier
developmental stage that was more
secure and pleasant and/or the use of
less mature response in attempting to
cope with stress
REPRESSION
➢ Consist of expelling and withholding
from conscious awareness of an idea
or feeling
TRANSFERENCE
➢ The redirection of feelings and desires
and especially of those unconsciously
retained from childhood toward a
new object
➢ The inappropriate repetition in the
present of a relatioship that was
important in a person’s childhood
INTELLECTUALIZATION
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➢ Taking an objective viewpoint
➢ Reduces anxietty by thinking about
events in a cold critical way
PROJECTION
➢ Perceiving and reacting to an
unacceptable inner impulse and their
derivative as though they were
outside the self
➢ In the family, a child with a health
problem usually may become the
identifie patient onto whom the
unresolved family problems are
transferred
SOMATIZATION
➢ The defensive conversion of psychic
derivative of bodily symptoms,
tendency to react with somatic rather
than psychic manifestations
➢ Is among the most common problems
seen by a physician
➢ An expedient defense mecnism
because it places individual in the sick
role
➢ The physical syptoms usually are
associated with:
-An existing health problem
-Past personal or family experience
with illness
-Previous family experience with
physical disability
ACTING OUT
➢ Performing an extreme behavior in
order to express thoughts of feelings
the person feels incapable of
otherwise expressing
➢ Acts as a pressure release
➢ Often helps the individual feel calmer
and peaceful once again
REACTION FORMATION
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 Family Medicine and Community Health 1st year D2
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FAMILY PSYCHODYNAMICS Semester
2
DR. PERET-CLARION

➢ Reduces anxiety by converting

dangerous thoughts, feelings,
behavior or impulses into their
opposite feelings, impulses or
behavior

MATURE DEFENSE MECHANISMS

SUBLIMATION
➢ Redirecting or acting out
unacceptable impulses or ‘wrong’
urges into socially acceptable actions
➢ Sign of maturity
Example: A person experiencing
extreme anger may take up
boxing/kickboxing. As a means vening
out frustation

SUPPRESSION
➢ Consciously forcing the unwanted
information out of conscious
awareness

COMPENSATION
➢ Process of counterbalancing
percieved weakness by emphasizing
strength in other areas

ALTRIUSM
➢ Satisfying internal needs through.
helping others

References:

>Dr.Peret-Clarion’s ppt and lecture

>D2 2021 Transes

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