Abstract
The role of the therapist requires
them to appropriately diagnose and treat individuals experiencing
conflict. Therefore, as clients seek
professional assistance, the proper assessment tools and therapeutic strategies
must be applied. When utilized effectively,
these techniques enable clients to realize constructive resolutions. The following illustrates the genogram,
structural assessment, behavioral parent training, experiential therapy, and
structural family therapy in order to evaluate and assist a family in the midst
of detrimental conditions.
Scenario
Jeff is a
40-year-old single father with one 13-year-old child, Roger. Jeff’s wife
abandoned the family when Roger was only 6. She is a drug user and has serious
financial problems. Further, she might even have bipolar disorder since it
seems to correspond to her behavior. Also, her mother was diagnosed with
bipolar disorder.
Recently, Roger has not been focusing at school, is scoring low academically,
and is withdrawing emotionally from everyone. He is also asking his father many
questions about his mother. Jeff has informed Roger that his mother is “no
good,” and that Roger had better begin to do better in school or he is not
going to leave the house except to go to school, as he will be grounded
indefinitely.
When he is at home, Roger rarely leaves his room and spends many hours playing
video games, some of which contain violent content. Further, his personal
hygiene has diminished.
Jeff is an engineer and considers
himself to be “the only stable force in Roger’s life.” He prides himself in
trying to teach Roger about “a strong work ethic and traditional values.”
Recently Jeff has started dating Sherry, a 32-year-old co-worker with whom he
is spending an increasing amount of time.
Family
Therapy Assessment Tools
The role of a
family therapist requires the practitioner to responsibly and effectively
diagnose and treat families experiencing problematic or traumatic issues. In effort to address and overcome these
concerns, one must consider specific circumstances and implications, apply appropriate
strategies, and assist the family in achieving favorable, long-term resolutions
(Nichols, 2010). Regarding Jeff and
Roger’s given situation, the family is experiencing various problems fostered
by abandonment, single-parent crisis, and hereditary depression. Hence, family therapy would enable the father
and son to overcome such issues and create a functional environment beneficial
to the welfare of each individual (Nichols, 2010). In order to properly attend to the father and
son, the therapist may begin by utilizing a genogram, apply additional
information, identify relative questions, implement strategies to modify
behavioral patterns, and employ certain techniques to alter family
transactions. Acknowledgment and usage
of the aforementioned factors promotes the probability of success.
Within
the initial stage of the therapeutic process, utilizing a genogram would be
advantageous. As an assessment tool, the
genogram illustrates the life cycle of families amongst the generations,
indicating social relations, medical history, spirituality, and other pertinent
facts (Carter & McGoldrick, 2011).
In relation to Roger, the genogram would reveal that his mother and
grandmother apparently suffer from bipolar disorder. This implies that he is prone to such
conditions as well as drug abuse or addiction.
Furthermore, a genogram would disclose the occurrence of divorce,
culture, religious practices, behavioral patterns, financial status, and the
connectedness of the extended family.
However, the effectiveness of this tool is contingent upon the accuracy
and detail of the information provided.
In effort to assure cooperation prior to compiling the genogram,
effective counseling skills such as eye contact, rephrasing, sensitivity, and
encouragement are beneficial.
Furthermore, the therapist should relay how the client’s issues may be
related to familial history in order for the client to understand the
connection (Counselling Connection, 2012).
Additionally, these considerations may be biased or insufficient. As the only adult, Jeff is responsible for
providing the majority of the data.
Therefore his contribution may be limited. The therapist must also consider the fact
that Jeff has a negative perception of his ex-wife and possibly other family
members, which may compromise his opinion of relations or knowledge of
occurrences.
Aside
from the information provided by the genogram, the therapist should consider
additional factors regarding Jeff and Roger.
These include (1) the environment, (2) Roger’s current academic
standing, (3) how Jeff and Roger interact and address one another, (4) how much
time they spend together, and (5) what types of activities or hobbies they are
involved in, joint and separate. First,
a change of environment or a stressful environment may cause anxiety, irregular
sleep patterns, low energy, depression, high blood pressure, projected anger,
or hopelessness. Any of these may be
triggered from an altered setting or a traumatic or stressful event (The Center
for Victims of Violent Crimes, 2010).
Such factors may be affecting Roger.
As he enters his teenage years he has become isolated, careless in
regard to hygiene, and experienced an academic decline, each of which could be
an indicator of hopelessness or depression.
Second, with a decline in academic performance, the therapist should
inquire as to whether or not Roger is in danger of failing his grade level
rendering him unable to progress to high school (assuming he is an eighth
grader). This could cause withdrawal and
depression as well. Third, the manner in
which Jeff and Roger interact should be taken into consideration. Does Roger refer to Jeff as dad or father, or
merely refer to him as Jeff? Do they
maintain a balanced dialogue, or is Jeff domineering and commanding in his
approach? How often or how much do they
communicate on a daily to weekly basis?
What is the typical content of those interactions? Within the field it is widely considered
that, “communication is the vehicle of relationship” (Nichols, 2010, p.
70). Without effective communication,
Jeff and Roger’s relations are obstructed.
Often, individuals attempt to solve issues, yet distressful dialogue or
behavior cultivates additional stress (Nelson & Figley, 1990). Jeff feels as if he is acting as a
responsible parent and provider, yet as he condemns Roger and his ex-wife the
child is detrimentally affected.
Furthermore, as Jeff overindulges, taking a domineering, intruding role,
Roger counters by isolating (Benjamin, 1977).
The key is to focus on interactions which foster conflict, confusion, or
inadequacy and then modifying those interactions (Nichols, 2010). Other factors to be taken into consideration
are the amount and quality of time Jeff and Roger actually spend together. Do they have shared interests? Is Jeff spending more time with Sherry, his
new girlfriend, in comparison to his son, Roger? Exactly how often does he leave Roger
unattended? Does Roger have any hobbies
other than playing video games? What
enjoyment or fulfillment is Roger receiving from playing violent video games in
particular? Answering such questions
would provide insight into the quality and dynamics of their familial relations
as well as Jeff and Roger’s thought processes (Nichols, 2010). As a parent takes interest in the child’s
hobby, the activity transforms from a child’s pastime to a family pastime. This may encourage the child to become more
active outside of the home and more interactive with others as well. Additionally, such activities enhance
academic proficiency, demonstrate the correlation between work and money,
provide a sense of self-satisfaction, and boost confidence (West, 2012). However, Roger prefers to play violent video
games. Research indicates that violent
video games are the foremost risk factor for delinquent behavior. The therapist should also note that children
exposed to these games tend to have enhanced aggressive thoughts and emotions
and sexualize women (Karlsson, Pagan, Harris, & Massarelli, 2010). Furthermore, if Jeff continues to neglect
Roger while spending more time with Sherry, Roger may continue to withdraw or
begin to act out. Roger may even feel as
if Sherry is trying to replace his mother.
Often, as couples intimately transition, the child’s need for security
and connectedness is ignored. The
child’s losses and divided loyalty must be properly addressed (Papernow,
2012). Additionally, it would behoove
Jeff to realize and relay to Roger that Sherry can not replace his
ex-wife. Although she may be an
ex-spouse, she is not an ex-mother.
Also, Jeff must understand that a stepfamily can not function as a
biological family and work on maintaining a balance of loyalty between his son
and his new partner (Lofas, 2011).
Now,
in effort to modify Jeff’s behavior, initially, the therapist may utilize
behavioral parent training. This method
tends to “accept the parents’ view that the child is the problem” (Nichols,
2010, pp. 250-251). Hence, an
individual’s parenting techniques are modified in order to coerce the child to
respond in a favorable manner as opposed to acting out or withdrawing. This may be achieved by employing operant
techniques such as shaping, token economies, contingency contracting, and
contingency management (Nichols, 2010).
First, shaping involves a gradual step by step process which progresses
toward the desired behavior. Over time,
this technique transforms the child’s actions and response. Second, the concept of token economies may
enable Jeff to reconfigure Roger’s behavior by rewarding appropriate
behavior. This positive reinforcement
cultivates improved behavioral patterns.
Third, contingency contracting is a type of agreement which requires
Jeff to modify his behavior once Roger has made certain changes. On the other hand, contingency management
requires Jeff to reward or confiscate rewards depending upon Roger’s behavior
(Nichols, 2010). Although time-out is
another notable operant technique, it would be disadvantageous and perhaps not
age appropriate in regard to Roger. He
is already distant and withdrawn, thus sending him to his room would be
potentially hazardous and undoubtedly ineffective.
In
terms of directly modifying Roger’s behavior, the therapist may employ an
experiential approach. This methodology
requires the practitioner to encourage the client to disclose his or her
underlying emotion. In modern times,
underlying emotional issues have emerged as critical to cognitive behavioral
formulations (Pascual-Leone & Greenberg, 2007). In essence, enabling clients to express their
emotions “helps them as individuals to discover what they really think and feel
– what they want and what they’re afraid of – and it helps them as a family get
beyond defensiveness and begin to relate to each other in a more honest and
immediate way” (Nichols, 2010, p. 211).
As the therapist explores underneath the surface to Roger’s true
feelings and motivations, he or she may begin to break through Roger’s
defenses. Once his defenses are broken
down, the therapist is more capable of assisting Roger and Jeff as they reconnect
their bond and communication (Nichols, 2010).
The process of evoking, exploring, and restructuring harmful emotion is
a beneficial procedure (Pascual-Leone & Greenberg, 2007).
Concerning
the negative aspects of behavioral parent training and experiential therapy,
both are slightly insufficient in treating Jeff and Roger. Behavioral parent training may give Jeff a
false sense of innocence. He may feel as
if only Roger is responsible for their familial distress and ineffective
communication. Jeff must be made aware
of his role in the destruction as well.
Furthermore, experiential therapy may be too focused upon Roger’s
emotional experience, omitting the influence of family structure in
perpetuating that experience (Nichols, 2010).
Hence, structural family therapy should be utilized in conjunction with
the aforementioned methods in effort to modify both participants behavior.
Structural
family therapy allows the practitioner to “look beyond their (the disputants)
interactions to the organizational framework within which they occur” (Nichols,
2010, p. 169). More specifically,
“structural goals include reorganization of the family structure, and the
lessening of rules/roles dictated by narrow bonds of transactions, i.e. an
increased flexibility in both families and their members” (Fish & Piercy,
1987, pp. 120-121). This approach
emphasizes how each family member is affected by the whole system and grants a
reasonable amount of leeway to each party.
Now, in regard to Jeff and Roger certain patterns of behavior have
developed, particularly since the mother abandoned the family. However, the usage of such patterns limits
the full range of obtainable interaction.
Hence, the therapist is inclined to assist them in restructuring these
behavioral patterns. Shifting the
organization of the family should shift their issues enabling them to improve
familial relations. To begin this
process the therapist must implement a structural assessment. This may be accomplished by identifying the
most evident issue and observing the family’s reaction to it (Nichols,
2010). In Jeff and Roger’s caes, the
presenting problem concerns their varying perspectives of the mother. Roger is growing up and has become more
inquisitive about her. Yet, Jeff cuts
him off and expresses blatant disapproval of the mother. Then, he counters by attacking Roger’s
academic dilemma. This behavioral
pattern spirals into withdrawal and a lack of focus on Roger’s behalf. As a result, Jeff is displeased and bothered
by his son’s response which fosters additional conflict. Furthermore, Jeff is oblivious as to how
these interactions affect Roger emotionally, deterring him at school and within
the home. However, Jeff should realize
that Roger is concerned about his mother’s welfare and his connection to
her. Instead of avoiding the issue, Jeff
ought to set aside his personal feelings and speak respectfully with his son in
terms of the mother. This fosters an
environment in which the child becomes comfortable and respectful as he or she
interacts with the parent. Consequently,
Roger’s behavior is influenced by Jeff’s behavior. Tailoring the father’s communication should
in turn alter the child’s conduct (Nichols, 2010).
After
the initial assessment, the therapist may implement various therapeutic
techniques. Essentially, structural family
therapy consists of the following: (1) joining and accommodating, (2)
enactment, (3) structural mapping, (4) highlighting and modifying interactions,
(5) boundary making, (6) unbalancing, and (7) challenging unproductive
assumptions (Nichols, 2010). In terms of
Jeff and Roger the therapist must implement these steps accordingly:
- Joining and Accommodating – The therapist works to ease the tension
among the family, encourages Jeff and Roger to participate, offers
empathetic and active listening, persuades Jeff and Roger to acknowledge
their need for professional assistance, and motivates them to trust him or
her.
- Enactment – The therapist encourages Jeff and Roger
to role play in their usual manner in effort to observe their
communicative patterns.
- Structural Mapping – The therapist formats the
desired family structure while identifying problematic issues and
modifications along the way.
- Highlighting and Modifying Interactions – The
therapist recognizes problematic behavioral patterns and alters them into
functional interactions.
- Boundary Making – The therapist strengthens Jeff and
Roger’s interaction while setting certain limitations in effort to foster
acceptable behavior and communication.
- Unbalancing – The therapist influences Jeff to change
how he relates to Roger.
- Challenging Unproductive Assumptions – The therapist
modifies Jeff and Roger’s perspective from pessimistic to optimistic and
productive (Nichols, 2010).
From these techniques, unbalancing
would significantly change the communication pattern in this family. The behavioral cycle which Jeff and Roger are
experiencing stems from Jeff’s domineering attitude and lack of constructive
attention. He is denying Roger the
knowledge of the mother and commands him to improve academically. Instead of utilizing argumentative and
aggressive techniques, Jeff should begin to answer his son’s questions in an
honest and pacifying manner. In
addition, Jeff should offer to assist Roger with his schoolwork and seek practical
solutions such as tutoring or a set study time.
Furthermore, Jeff must spend more quality time with Roger as opposed to
merely focusing on the new girlfriend, Sherry.
As Jeff begins to show genuine interest in Roger and reestablishes a
positive rapport, Roger’s responses are prone to become more positive and
interactive versus withdrawn. In short,
Jeff must be made aware of the fact that he sets the tone of their
relationship. If he is able to modify
his own behavior, he is likely to directly influence Roger to improve his
conduct, strengthen their connection, and restructure the family system.
In
conclusion, families inevitably experience conflict and problematic
issues. Often, these concerns derive
from trauma, divorce, transition, or abuse.
In effort to address such issues, the therapist must assess the
circumstances on a case by case basis, and then implement applicable strategies
in effort to achieve long term, advantageous resolutions. Specifically in regard to Jeff and Roger, it
would be appropriate for the therapist to utilize a genogram and structural
assessment to evaluate their conditions.
Following the assessment, individual and joint sessions should include
behavioral parent training, experiential therapy, and structural family therapy. These techniques enable the therapist to
assist the family and empower them to modify relations, attain effective
communication, and conquer their familial issues.
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