Family Intervention

Case scenario

The client is a 14-year-old female referred for therapy services after being discharged from a day Hospital regarding behavioral issues. She was diagnosed with anxiety and depression. She admits having issues with anger, yelling, fighting, guilt, and anxiousness about getting into trouble, but she still disobeys. She has been verbally and physically aggressive both at home and school. She physically assaulted her mother, and her symptoms were first noticed at the age of 13 years when her aunt and grandmother moved out of their home. She states that she had learned a lot of negative conduct from them and was frustrated when they left her. Her yelling, fighting, physical aggressiveness, and disobedience were exaggerated when her mom re-established home rules and consequences for breaking them, making her grow more rebellious. However, the client had received psychiatric services for seven months, was prescribed Lexapro 10mg, and was admitted due to inconsistencies. After this, she was referred to the day hospital, where she participated for four weeks before being referred to the agency. A cousin had touched her inappropriately the previous year, but no one disclosed his name to the mother. However, the client is currently engaged sexually with a 19year old male whom they met through a dating App that her aunt had introduced her to. Since she was 13, she has been smoking cigarettes but has not smoked marijuana for about five months. She is transferring to a new middle school this year, although she world engages in disputes with female students in school.

Preparation issues/ decision.

The family intervention process requires the therapist to adequately prepare to deal with the client and family members without hurting their feelings or touching on sensitive issues without being involved. The process entails the preparation and beginning stages, the middle and termination stages (Shulman, 2019). During the preliminary stage, the therapist should set clear family, agency, and authority themes to avoid deviating from the main goal. After addressing the main therapy themes at the beginning of the sessions, the therapist must clarify the session's purpose and rules in the family intervention. This could also include getting the family's perspective in the meeting and their expectations and clarifying authority issues (Shulman, 2019). For instance, in the case scenario, the therapist should seek to understand the client's main problem and expectations to help in establishing a hypothesis. These strategies could be applied in the case scenario by interrogating both client and her mother. The therapist could ask what triggers the client to act aggressively, verbally and physically. This could include exploring the client's relationship with her mother and communication between the mother and the client. Also, the mother could give her perspective on the possible triggers of her daughter's inappropriate behavior. Thus, the preparation stage involves interrogating the family to comprehend the problem and their expectations from the therapy.

Engagement strategies and techniques

However, various techniques and strategies for family engagement could be used to establish a therapeutic environment. Initially, it is crucial to meet with all the family members and have an overview of the issue. A hypothesis and a genogram should be established in the first meeting to comprehend the family's connections and interactions (Nichols & Davis, 2020). After establishing a therapeutic environment and having a clear overview of the problem, other techniques towards establishing an appropriate intervention are to move the family from a linear to a systemic perspective of the problem to enhance the family's function and involvement in the session. In this case, the therapist should shift the mother from viewing her daughter as the problem and shifting the daughter from feeling guilty about causing the family problem to view the issue holistically to help establish an appropriate intervention and reduce resistance (Nichols & Davis, 2020). During this process, the therapists should assess the social context, culture, religion, and family interactions which play a critical role in understanding the root cause of the current problem. It could also be wise to ask for past attempts to solve the presented problem and warmly answer the questions asked by the family members to create a sense of trust. For instance, in the case scenario, the client has been to a psychiatrist for seven months and a day Hospital for 4weeks, where she was diagnosed with anxiety and depression. Thus, the engagement process is crucial in clearly understanding the family problem and creating a therapeutic relationship to reduce resistance and enhance family disclosure.

 Problem and goal specification

Specifying the therapy problem and goal is fundamental, although it could occur in phases as the family discloses information about their interactions and attitudes. The process involves interrogating the family members to help them identify the root cause of their current situation. It is also crucial to encourage the family members to have a systemic perspective by analyzing their functions and relationships, which mitigates the view of the identified patient as the only problem (Thomlison, 2016). This could also include consideration of the client route of referral, the family structure, communication, cases of substance abuse, domestic violence or sexual assault, the impact of gender, and culture. Once the family can access the underlying issues from different perspectives, it could be easy to specify the goal of the therapy session. Some goals could include enhancing the family's problem-solving ability, improving communication, and comprehending the dynamics in family relationships and the various internal strengths (Patterson et al., 2018). During the middle phase of the intervention process, it is crucial to engage the family members and get their views on the process, analyze each individual’s personality and skills, demonstrate empathy, share feelings about the progress, find a strategy to address family secrets and issues considered a taboo that could be associated with the family issues, help the family members to view their situation from a different perspective, identify potential obstacle to intervention, and share data (Patterson et al., 2018). For instance, in the case scenario, it could take time before the family discloses the client's substance abuse, sexual behavior, being touched inappropriately, and the incidence of physically assaulting the mother, as they could be kept as family secrets. However, by enhancing an appropriate relationship, the therapist could trigger the family to disclose various secrets, which could be crucial in determining the most appropriate intervention strategy. Thus, a therapist should therefore ensure that they establish a trusting relationship by being flexible in terms of attitudes and strategies used, being informal in communication to establish a rapport, offering material support, encouraging and rewarding any positive outcomes, and paying attention to changes in the family structure and functioning to encourage possible development (Sousa & Rodrigues, 2012). Goals and problems in family therapy are established through constant interaction with the family members and encouraging them to share information.

Assessment of family functioning

However, it is crucial to assess the functioning of the family to establish a collaborative session to empower the family. Vulnerable families have endured long-term hardships in getting along, learned resilience, increased helplessness, and chronic crisis, making it difficult to establish a successful intervention process. Thus, the client could have acquired learned resilience since, despite being guilty and anxious, she still breaks the rules meaning that she has been used to punishment and developed rebellious behavior (McGoldrick et al., 2016). It could be concluded that there is poor communication and relationship between the client and her mother, evidenced by the client physically assaulting her mother, considering the information provided. Also, the client's mother was not actively involved in bringing up the client, making her get used to the extended family and rebellious toward her mother. Therefore, the main identified problem is a lack of emotional, psychological, and physical support, as the mother is busy setting rules and consequences to tame her daughter. This leads to anxiety and depression coupled with the client's feelings of guilt, anger, anxiousness, fighting, and yelling. The goal/ focus of the therapy is to improve the relationship between the client and her mother.

Genogram and ecomap

Intervention strategies

Various intervention strategies could be used in the case scenario. First, the client had been diagnosed with anxiety and depression and hence could be prescribed to continue taking Lexapro to mitigate the depression and anxiety symptoms (Hawkins et al., 2017). The therapist should deal with the client's cause of anxiety and depression, and the client could continue having therapy sessions to help improve the communication between the client and the mother, their relationship and interactions and help enhance their coordination. The therapy should also aim at dealing with the increased aggressiveness.

References

Hawkins, N. A., Soman, A., Buchanan Lunsford, N., Leadbetter, S., & Rodriguez, J. L. (2017). Use of medications for treating anxiety and depression in cancer survivors in the United States. Journal of Clinical Oncology, 35(1), 78–85. https://doi.org/10.1200/jco.2016.67.7690

McGoldrick, M., Carter, E. A., & Garcia-Preto, N. (2016). The expanding family life cycle: Individual, family, and Social Perspectives. Pearson.

Nichols, M. P., & Davis, S. D. (2020). The Essentials of Family Therapy. Pearson Education, Inc.

Patterson, J. E., Williams, L., Edwards, T. M., Chamow, L., & Grauf-Grounds, C. (2018). Essential skills in family therapy: From the first interview to termination. The Guilford Press.

Shulman, L. (2019). The skills of helping individuals, families, groups, and Communities. Cengage Learning.

Sousa, L., & Rodrigues, S. (2012). The collaborative professional: Towards empowering vulnerable families. Journal of Social Work Practice, 26(4), 411–425. https://doi.org/10.1080/02650533.2012.668878

Thomlison, B. (2016). Family assessment handbook: An introduction and practical guide to family assessment. Cengage Learning