Formulating Therapy for this Family

Robert and Christine, a Latino couple in their early 30’s, were referred by Robert’s managed care insurance for family therapy. The couple’s 2 children, 10-year-old Robert Jr. and 8-year-old Madeline are present for the intake session. Christine complains that their son Robert Jr., “has no respect for me and calls me awful names, just like his father”. Robert smirks while Christine talks. He tells you that Christine is, “just like her mother, lazy and fat”. Christina shoots back with,” at least my dad was around when I was a child”. Robert’s reply is, “look what that got you.”
During the psychosocial assessment, you learn that Robert’s father left him when he was 11-years-old and that he was the caretaker of his younger siblings while his mother worked 2 jobs. Christine was raised by both parents, in a very strict, abusive home. Her father was an alcoholic. He sexually abused Christine and her sister. Her mother told both her and her sister to not speak to anyone about the abuse. You notice Madeline hiding in the corner with fear in her eyes during the session. Robert Jr. sits with his arms crossed, smirking like his father.

  1. Utilizing the information in the reading assignments, in consideration of ethical and cultural factors, discuss how you would formulate therapy for this family?
  2. When families are unable to adjust to change, they often try the same solutions over and over again without success. What do you see in this family that illustrate this process?
  3. Discuss your treatment of this family with regard to each of the following:
  • Bowen’s Family Systems Therapy
  • Structural Family Therapy
  • Strategic Family Therapy
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Sample Answer

 

Formulating Therapy for this Family
When formulating therapy for this family, it is crucial to consider ethical and cultural factors. The following steps can guide the therapeutic approach:

Establishing a Safe and Non-Judgmental Environment:

Create a safe space for the family to share their experiences and emotions without fear of judgment or retribution.
Communicate empathy, understanding, and respect for their cultural background and individual experiences.
Cultural Sensitivity:

Recognize and respect the Latino cultural values, beliefs, and practices that may influence the family dynamics and communication patterns.
Understand and address the impact of intergenerational trauma and cultural norms on their experiences.
Trauma-Informed Care:

Acknowledge the history of trauma experienced by both parents and its potential impact on their current relationships.
Incorporate trauma-informed strategies to ensure emotional safety, such as grounding techniques, validation, and psychoeducation about the effects of trauma.
Individual and Family Assessment:

Conduct thorough individual assessments of each family member to understand their unique experiences, strengths, and challenges.
Explore the family’s interaction patterns, power dynamics, and communication styles to identify areas of concern.
Collaborative Goal-Setting:

Engage the family in the therapeutic process by involving them in goal-setting.
Emphasize the importance of building respectful and healthy relationships within the family.
Integrative Approach:

Utilize an integrative approach that combines evidence-based techniques from various therapeutic modalities.
Tailor interventions to address the specific needs of each family member while considering the overall family system.
Illustration of Repeating Unsuccessful Solutions
In this family, the process of repeating unsuccessful solutions is evident in their communication patterns and relational dynamics. Some examples include:

Robert Jr.’s disrespectful behavior towards his mother mirrors the negative dynamics between his parents.
Christine’s response of attacking Robert verbally mirrors the abusive environment she grew up in.
Robert’s smirk and dismissive attitude towards Christine’s complaints reflect a pattern of invalidation and disrespect.
Madeline’s fear and hiding in the corner may suggest that she has witnessed or experienced traumatic events within the family.
These repeated patterns indicate that the family is stuck in a cycle of dysfunctional interactions that perpetuate negative behaviors and maintain unhealthy relationships.

Treatment Approaches
Bowen’s Family Systems Therapy:

Bowen’s approach emphasizes understanding the multigenerational patterns of behavior within families.
Therapy would focus on exploring the family’s emotional cutoffs, intergenerational transmission of trauma, and differentiation of self.
The therapist would work towards helping family members gain insight into their roles and relationship dynamics to promote healthier interactions.
Structural Family Therapy:

Structural therapy emphasizes examining and restructuring the family’s organization and boundaries.
The therapist would assess power dynamics, hierarchies, and alliances within the family.
Interventions would aim to modify these structures to create more balanced relationships and promote healthier communication patterns.
Strategic Family Therapy:

Strategic therapy focuses on altering problematic interactional sequences within families.
The therapist would identify maladaptive patterns of communication and behavior.
Interventions would be directed at interrupting these patterns through techniques such as reframing, prescribing actions, or creating paradoxical directives.

In summary, therapy for this family should prioritize creating a safe environment, incorporating cultural sensitivity, addressing trauma, and utilizing an integrative approach. Bowen’s Family Systems Therapy, Structural Family Therapy, and Strategic Family Therapy can be used as effective frameworks to address the complex dynamics and challenges present in the family system.

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