Comprehensive exams for Mental Health Q 136
A 16-year-old girl has returned home following hospitalization for treatment of anorexia nervosa. The parents tell the family nurse performing a home visit that their child has always done everything to please them and they cannot understand her current stubbornness about eating. The nurse analyzes the family situation and determines it is characteristic of which relationship style?
A. Differentiation
B. Disengagement
C. Enmeshment
D. Scapegoating
Correct Answer: C. Enmeshment
Enmeshment is a fusion or over involvement among family members whereby the expectation exists that all members think and act alike. The child who always acts to please her parents is an example of how enmeshment affects development in many cases, a child who develops anorexia nervosa exerts control only in the area of eating behavior. Enmeshed families are families in which the individual is expected to give up their own needs and desires. In enmeshed families, there is a total lack of boundaries, which usually leads to codependent relationships and a dysfunctional family.
Option A: Differentiation is the process of becoming an individual developing autonomy while staying in contact with the family system. “The ability to be in emotional contact with others yet still autonomous in one’s own emotional functioning is the essence of the concept of differentiation.” (Kerr & Bowen. 1988) “Differentiation is a product of a way of thinking that translates into a way of being. Such changes are reflected in the ability to be in emotional contact with a difficult, emotionally charged problem and not feel compelled to preach about what others “should” do, not rush in to “fix” the problem and not pretend to be detached by emotionally insulating oneself.” (Kerr & Bowen 1988).
Option B: The lines of responsibility and authority are strictly enforced and must be followed; however, they are not necessarily communicated or explained. Access to all family members, especially parents or those in authority, is limited. Appropriate communication and expression across subsystems (e.g., children to parents) is stifled.
Option D: In Family Systems theory, scapegoating in a dysfunctional family system is understood to be fueled by unconscious processes whereby the family displaces their own collective psychological difficulties and complexes onto a specific family member. ‘The Scapegoat’ is one of the roles ‘assigned’ to a child growing up in a dysfunctional family system (I say more about this process in my answer to question 2). The scapegoating typically (but not always) begins in childhood and often continues into and throughout adulthood, although the role may be passed around to different family members at times.