Analysis of Counseling and Therapy in One Family - Case Study Example

Running head: Counselling Counselling [Writer’s name] [Institution’s name] Counseling This section of the paper a fictional case study involving the "T family" will be presented. This will be accomplished via a dialogue with analytical observations find. Interview In such a brief example it is impossible to deal with all of the issues presented by a family. Therefore, the goal is to provide a condensed snapshot of what therapy might look like over three sessions during the beginning, middle and ending stages of therapy. The issue of sexual intimacy will not be addressed in these sessions due to the young age of the two boys. The therapist would likely choose to see the couple separately following the family sessions if they felt there was still a problem. The T-family has come into therapy because Jennifer, the mother is concerned about her marriage to Craig. Three generations of family members are present. They are Jennifer, Craig and their three children: Kris (18), Robby (12) and James (10). Craig's mother, Carol is present, but the couple chose not to ask Jennifer's parents to come. Therapist: "So, tell me why you are here." Family: Silence in the room. Craig crosses his arms and looks at the ceiling. Therapist: "You should know that I am not the one who will be doing the work here. I am here to coach you, not to advice. You are the ones who will decide what you will do with your lives." Here the therapist lets the family know that they are going to have to get to work. He or she lets the family know that they need to take responsibility if they want change to occur. Jennifer (to Craig): "You don't want to be here! Look at you staring at the ceiling." Kris: "There you two go, again. Won't you ever stop? I don't even know what I am doing here". Craig: "That's enough, Kris." Therapist: "How about you, Craig? What do you think about all of this? I just had the ceiling painted a few months ago. How do you like it?" Laughter from the family Craig: The women in this family are far too emotional. Every time I try to work things out, the yelling starts and then crying." Therapist: Tell me more about the family. Craig introduces his mother and goes on to talk about each family member in the session. He talks about Craig's athletic ability with pride. He describes Kris as a difficult child who is unmotivated. He talks briefly about James's illness looking quite uncomfortable as he speaks. In experiential therapy the father is often viewed as the "more peripheral parent." Therefore the therapist attempts to engage him immediately. By bringing the father into the discussion, this symbolizes that change is possible. Craig continues to describe his job and how hard he works at home and hints that he has been under increased pressure since his father died. Therapist: "I'll need your help later, mom (speaking to Carol). I want to talk to Jennifer first." He winks at young James. Carol: "OK". Therapist: "What do you want to get out of this?" Jennifer: "Well, you know...Craig has been really busy, it's true. I just wish he'd spend more time at home. I know his mother is having a tough time, but give me break! I have tried to talk to him but it's like talking to a wall." Therapist: "Let's talk about the wall. What does it look like?" Jennifer: "What?" Therapist: "Is it made out of wood, or brick? Perhaps it is solid concrete." Jennifer: "Well...let me think. It is made out of concrete blocks and it is about 12 feet high. And at the top it isn't as solid. I can see a little bit of light shining through. The bottom half is very solid, though.... I just wish I had a sledge hammer to knock it down!" Therapist: "What would you find on the other side?" Jennifer: "I don't know. Maybe things are different. They way it used to be." The therapist is a real person and will often use his or her personality to catalyze change. During the previous exchange the therapist encouraged Jennifer to visualize the wall. Once this was done, the therapist felt that it was important to coax her into some kind of movement or action. When he realized that he had hooked Jennifer into the fantasy and that she was ready to take action, he asked her to take the fantasy one step further. Anxiety and confusion are often increased through use of metaphors and fantasy in order to bring the issues to the forefront. We were also able to see how the therapist worked toward undoing the scapegoating process. By the third session the family had begun to make gains but there are several minutes where the family appears to become stuck. The therapist notices that the two boys, Robby and James are becoming fidgety and have begun to make faces at each other. He laughs and decides to make a face at Kris, who rolls her eyes at the gesture. Craig: (Directed at the therapist) "We are here to work out our problems. Do you think we are funny? This is costing me a lot of money you know." Therapist: "You're right and I thank you for that. I wonder what I'll buy, perhaps a new TV." Craig: "Very funny. Can we get serious now? It took a lot for all of us to be here." Therapist: "I agree with you, however like I told you in the beginning I am here as a coach, not a player. You people don't seem desperate enough to be working on anything today. What would your father do if he were here right now?" Carol: "I really miss him still. I have been quite lonely." Therapist: "Have you ever thought about killing yourself?" Carol: "Yes, I suppose it has crossed my mind." Therapist: "How do you think you would do it? Would you cut your wrists in the bathtub?" Carol: "I guess I would leave the gas on in the oven and keep the doors and windows shut. But, I wouldn't want to leave a mess behind... I probably couldn't go through with it." Therapist: "How about getting remarried? C'mon you are still an attractive woman." Carol: (Giggling) "I don't know. I guess I'm not that old." By playing along with the children, the therapist was reminding the adults in the family that they were the ones who had to work toward change as opposed to him taking on a mothering role by telling them what they needed to do. He also senses that Carol is having suicidal thoughts when she states that she was lonely. By pushing the image of suicide, he seeks to contaminate the fantasy and forces her to look at other alternatives. This helps Craig to realize that his mom is not as old and helpless as he thinks. In additional the therapist has uncovered an intergenerational pattern, as Carol states she "doesn't want to leave a mess behind" we can guess that she probably had to work hard for her family just as Jennifer does. Therapist: "We are coming to the end of our fifth session. Is there anything burning inside that you would like to talk about?" Jennifer: "James is having quite a bit of difficulty in school. We met with his teacher and she has recommended tutoring and learning assistance." Therapist: "Dad, you're a teacher, maybe you can help." James: (angrily) "He's too busy going to Robby's soccer games..." Kris: Interrupting James says to Craig: "You are such a stupid jerk! What kind of a father are you anyway?" The therapist notices the look of shock on the faces of the family members. He senses that Kris is stepping in as a parent and he feels that is the job of the adults in the room. He will intervene; both defending the children and forcing the father to take responsibility by making him answer the question: Therapist: "If you and Jennifer separated I suppose you'd become one of those deadbeat dads, we always hear about, huh?" Craig: (Sighing) "No, no way." (Looking at Jennifer) "Listen, when James was sick I didn't really get to the hospital very much, I know that. It just that, I can't stand hospitals. I hate them. Carol: "I didn't know it upset you that much, dear. Therapist: "I remember when I was a kid having to spend a week in the hospital. Man those nurses could be mean. And the food, yuck!” laughter from the children. The therapist uses humor and free association in order block Craig's mom from rescuing him. He senses that Craig is finally ready to be a real person Craig: "Yeah, well when I was a kid we used to have to go and visit my grandma every week in this horrible old-age home. I remember the sounds of people crying and calling out. It was awful." Therapist: "I'll bet you couldn't wait to leave." Craig: "In fact, I was almost relieved when she passed away" (Craig begins to sob). At this point the family notices that as Craig is telling this story tears are running down his face. This heightens the intensity of the moment, as even Jennifer has not seen Craig cry since the early part of their marriage. The family cries. The family has been given permission to face their pain. In addition, they see a side of Craig that they didn't know was there. At this point in therapy they are able to realize that Craig, who has been resistant of therapy up until now, really shares the rest of the family's belief that change is necessary. One of the components that make change difficult is often not where everyone thinks there is a problem. As Whitaker and Keith (1981) argued, symptoms can be present for many years but they are adapted to by the family. Thus, Craig is included in the shared belief that something has to be done about this family as an entity. More Therapy Thus, all of the T family's problems have not been solved and there is still work that they have to finish. It may not be likely that change would occur so fast in a real family. What Theory Helped In The Interview? The goal in part two was to offer a window into some of my techniques and to demonstrate how he relied on spontaneity to elicit underlying emotion, rather than a specific formula. Through out my interview I used various different theories, I placed the role of a Narrative therapist, and thus I used several techniques to accomplish their goals (McGoldrick 1998 p45). I tried to externalize the problem. I wanted the members to place the problem outside of the family and see that the problem is not characteristic on the individuals. I used letters to the family members to lay emphasis on constructive ways of I was evaluating the problem that the client has made. When I heard to stories like narrative therapists do I looked for small details in the story. I could then easily point out times in the story when the entire family cooperated with each other. I also kept in mind that therapists also utilize different narratives. “They look for strengths, unique skills, and goal of the family and assist them in looking at their problems in a new manner” (Sprenkle & Bischof 1994 p10). It is likely to utilize narrative therapy if there is some kind of conflict is present among siblings. It allows the children talk about the interactions that they have and to see their relationship in a more positive light (Mahrer 2001 p1025). Currently, family therapists integrate all of these approaches to therapy (Booth & Cottone, 2000 p240). I kept in mind while taking the interview that: Those family therapists make use of more than on theory of family therapy. They are also likely to combine their training as individual therapists with family systems therapy. Approaches that therapists use in working with families are influenced by their own personalities and patient population. As integrative approaches emerge, no single method dominates. Presently, the greater focus is on use of concepts rather than on theory (Sharf 2003 p25). I kept in mind the therapy behind the experiential therapy through out the entire interview. Thus I paid attention to needs of family member as they were trying to improve the family interaction; as a result the individuality of every member was taken under consideration. According to Becvar and Becvar (2000): “The most important feature behind the theory of experiential family therapy is the importance of individuality, individual’s freedom and fulfilment of one’s personal needs” (pp.181). Through the interview I followed "battle for structure" and "battle for initiative". According to Napier (1987): “One of the main objective is to diffuse the scapegoating process by challenging the notion that one member of the family has the problem.” In the interview my main goal I was to change the family’s feeling that “they are undergoing a serious interview to restore the family's narrative of the problem while analyzing a broader viewpoint”. (Melito 2003 p7) I followed what Connell etal (1999) stated that: “Experiential therapists believed the key to disrupting dysfunctional patterns within a family system was to get the family to see themselves as an entity”. The family knew very well that I had the courage it would take to be one of them and this could take many forms. “Napier (1987) asserted that the family needs to know that the therapist is strong enough to deal with their problems, Sometimes the family is in such turmoil that a more confrontative stance is required from the therapists from the early interviews." During my interview I also used the humanistic approach as it attends to the feelings of the family and works with them on day-to-day functioning and their own emotional experiences. I focused on developing a sense of self worth and bring flexibility into family situations. I emphasized that the family members should use clear statements, level with each other and coordinate their facial expressions, body positions and voice (Fowers &Richardson 1996 p130). I ascribed five style of relating within the family. These were: 1. the placater 2. the irrelevant, 3. the blamer, 4. congruent communicator 5. Super- reasonable. (Greenberg & Paivio 1997 p90) I used techniques like family chronologies and family sculpting to facilitate change. I used this cause I knew that humanistic family therapy may be useful to an adolescent who is feeling smothered or misunderstood by a parent or parents. It may also be useful to a child who feels neglected or unwanted (Atkinson Etal 2005 p10) “This technique allowed the family to productively express feelings that they may not have been comfortable expressing prior to counselling” (Corey 1996 p34) This was especially apparent in this insistence that the whole family be involved in interview and that “they take responsibility for the content, process and pacing of sessions” (Dean 2001 p629). In addition, I perceived the family as a multi-generational system. This family system I believed experienced different levels and rates of differentiation. When a family has experienced a high degree of undifferentiation for several generations, I sustained they could "go from a good level of functioning to a marked impairment." (Whitaker and Keith, pp. 249) As Becvar and Becvar (2000) stated: “Even though the therapist may have an idea of what normalcy is, and that growth will be only measured after interviewing the family. By explaining what pathology of dysfunction is and that it is incoherent with the viewpoint that considers all behaviour to be rational or normal according to the environment it is exhibited in." There is also an emphasis on the process rather than the content.” Family systems therapy focuses on the entire family as the context of the problem.” (Elliott 2001 p15). I also used solution-focused therapy are concerned with how the family views solutions to the problems. As I was more interested in possible solutions than in how a problem developed. Goals are clear and concrete. I also had small objectives and so several goals were met quickly. These were explicit messages given to the client at the end of session about progress (Melito 2003). I knew that Questions, however, are basic tools of solution-focused therapy. Among other functions (Schwartz &Nichols 2006 p78), it help the family describe what changes have already been made. I used 3 stages: 1) Engagement, 2) Mid-phase and 3) Disentanglement. (Nichols& Schwartz 2001 p50) During the engagement stage of the interview the I used the following intervention strategies: expanding the symptom highlighting cross-generational intergenerational influences Redefining pathology. (Schaeffer 1968 p17) In the involvement or mid-phase I saw how due to the interview they were breaking patterns, avoiding arguments and thus they were almost forming intimate relationships. After therapy had gotten under way, Whitaker (1981) relied more on "being with" families than on any particular techniques. The third phase of interview was the disentanglement or termination phase (Griffin& Greene 1995 p19). My goal was that family achieved individuation and rebirth and an independent peer relationship. “They refrained from intervening even if I had something useful to say” (McGoldrick, 1998). Cultural Value The family had no cultural conflicts; however I was aware that if my culture turned out to be different then that could cause a problem. Throughout the interview I was aware and knowledgeable to incorporate the right elements of the patient’s ethnic and cultural background and this made the intervention strategy possible, I made sure my values matched with the patient’s cultural values. I kept one the important thing in mind during the interview that should I needed to focus on how “the family processed, stored, and used information and how this information influenced what they attend to, perceive, learn, remember, believe and feel and how those feeling were then de-coded based on their ethnic and cultural background” (Cardemil.& Battle 2003 p278), their age, gender, and past experiences so I could “attempt to understand the cultural influences on their identity development, the, and develop a culturally appropriate relationship with the family”(Wong, 2005 p86). “The goal of the interview to find out how the family experienced their way of life as real, while becoming aware of his potentialities and becoming able to act on the basis of his own discoveries “.( May 2005) As the family gained “insight and knowledge about their relationship they seemed to make appropriate decisions” (Denborough 2001 p21). One thing is certain, ethnic background combined with culture could have had an intense effect on attitudes, emotions; behaviours and that failure to consider ethnicity could have been an obstacle in the interview “. “Associated idea that may have an influence on the family. (Davis& Coleman 1997 p67)” I had kept in mind during the interview that culture would “influence my relationship with the family and would form the nature of the relations between the me and the family. Conclusion This paper gave a complete overview of how the interview a was taken and what theories were kept in mind during it. The interview was of family who was having problems, the fact that family therapy could have helped them. By the interview it can be concluded that they need more then 5 sessions to solve their problems. It has been so long that they have talked about their problems and so their attitude towards each other has become like strangers. 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