“My mom, never appreciates my efforts!”, “My father, thinks I’m not putting enough efforts into my studies.” “My husband doesn’t love me anymore.” Do these sound familiar to you? Most conflicts at home can be fixed with communication, however in many homes even in the Philippines, the lack of communication or too much of it causes a lot of conflicts.

Personal Perspective


Each family member’s perspectives and expectations can highly depend in their position in the family. This situation is highly visible for families with children and young adults who wish to please the parent. To be accepted and recognized for who they are. These family members also want to be accepted and recognized for who they are. The sense of belongingness is also very important here.

While children wants to be accepted for who they are and what they want to be, in most families parents want their children, especially their young adults to reach what the parents want to consider a successful life. When a parent’s expectations are not met, the parent usually feel let down.

Siblings have an idea of who their sibling should be, and this idea often is fixed and immutable. They may ask, “Why won’t my sister help me out?” “Why can’t she be a good sister?” “Why is my brother so jealous of me?”

Unconscious psychological processes


The two main unconscious psychological processes that tangle up families are projection and projective identification. Projective identification is an unconscious process in which aspects of the self are split off and projected onto another person. In 1946, Melanie Klein introduced the term “projective identification” as follows: “Much of the hatred against parts of the self is now directed toward the mother. This leads to a particular form of identification which establishes the prototype of an aggressive object-relation. I suggest for these processes the term ‘projective identification’ ” (Int J Psychoanal. 1946;27[pt 3-4]:99-110).


Family process perspective


Families function as a system or unit, and each person in the family has a role or function. When change occurs, basic rules of systems theory apply. For example, if the mother functions as the emotional barometer, no one else needs to pay attention to emotions, as that is the mother’s job. If she leaves or becomes ill, someone else will take on that role or the family will fall apart. If the father becomes depressed and unable to function in his role as a parent, the oldest child may have to step up to become the parent. When he gets better and his depression resolves, there may be tension – as the older child may not want to give up that role. There may be a disagreement in the family vision.

When the children grow and develop their own identities and lifestyles, the family has to adjust to include the adult children or cut them off. Individuals also may cut themselves off from the family if there are significant disagreements. There are variations, such as “semi-cutoffs,” where there is little contact except at ritualized holidays and significant family events. Therefore, tensions arise most clearly at these times when family members come together.

Boundaries protect the family


A family functions like a pack. As with most species, families and parents protect the young until they are able to care for themselves. The marriage contract specifies that spouses care for each other but additionally that they join extended families together. Family cares for family before caring for strangers. It is the elder’s role and responsibility to keep the family together, or the family members may drift apart or be subsumed into other family groups.

Lastly, our families provide memories of where we have come from and where we are going, both as individuals and as a clan. Powerful stories serve the next generation with a sense of belonging and a specific orientation to the world. The studies of third-generation Holocaust survivors attest to the power of family narratives. Individuals can choose to embrace the family narrative or alter it to allow individual growth.

Explaining families to families

When helping patients work through issues with their families, it is helpful to provide them with context. Among the important points we can make are:

●  Families came into existence as a way to protect our young; this is true across the animal kingdom. Humans congregated into clans or tribes that demanded conformity and obedience to the chief. There was a clear sense of who was in and who was out. Many of the difficulties that we experience are tied to the primitive tension of needing to decide who is in and who is out. This is a normal function of families.

● These days, families have much looser boundaries, and individuals have the freedom to strike out on their own. Families have to grapple with their collective identity only when they get together at holiday times or transitional events like marriages, births, and deaths. So, is it worth getting upset about this? If so, ask patients what they would like to change – and why.

● With this background, the family can dive deeper. Ask your patients, “Is the issue a problem with roles within the family? Has there been a role transition? Has there been a death, serious illness, or birth? Has someone left, retired, or joined the family? How would you as a family like to proceed?”

● Lastly, is there a complicated tangled web or relationship that might be explained by mutual projective identifications? If so, refer to a colleague with family therapy skills.

Key points to keep in mind

1. Families should be placed in the context of clans and tribes.

2. Transitions and family events cause families to question their family identity, boundaries, and values.

3. Patients should explore their individual expectations about what families should do. This conversation can be extensive, and include cultural and generational flash points.

4. If there is a tangled web that makes no sense to you, refer to a colleague with family therapy skills.