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Family Therapy Case Study Report

Assignment Information:

Student Name:
Therapy Model(s) Applied: Trans-generationalCommunication, Psycho Educational, Family Systems Theory
Date of Report: December 4, 2011

Assessment Report and Initial Treatment Plan / Recommendations

Initial information

Family Name:
The Seaver Family
List Family Members and Ages: Dan (age 49), Barbara (age 47), Dianna (age 26), Danielle (age 24), Jesse (age 21)
Identified Patient (If any): Dan Seaver
Reason for Referral / Presenting Problem: Recently the youngest daughter, Jesse (age 21) began to have dreams about her father Dan sexually molesting her after beginning individual therapy sessions. Allegations against Dan were made after the birth of Jesse's child and a subsequent stay in a psychiatric hospital. The oldest daughter Dianna brought the family here (minus Jesse who refused to attend family sessions) to address this issue.

Summary of information provided

Family History

Dan and Barbara Seaver are a Caucasian, middle class couple who have three adult daughters; Dianna, Danielle and Jesse. Dan is employed as an administrator at a state government office and Barbara is a successful real estate broker. Their oldest daughter Dianna, aged 26, is a college graduate working in the finance department of a local bank. The middle daughter, Danielle, age 24, is currently attending law school. Jesse, age 21, is the youngest daughter who recently gave birth to a daughter. The primary reason for the family seeking counseling is Jesse has made accusations against her father regarding various forms of sexual abuse. During the initial sessions, though, several other issues have arisen including Dan's emotional unavailability and alleged misuse of alcohol to manage pain from a chronic medical condition. It has also been mentioned during sessions that Barbara has a tendency to "fix things" in the family. Dianna was seen at this clinic two years ago for issues regarding a "messy" break-up with an ex-boyfriend, and suggested the family seek counseling here. Jesse has been experiencing severe post-partum symptoms after the birth of her child, having been hospitalized for a short period of time. Right now the immediate concern is addressing the issues Jesse has brought up regarding the alleged sexual abuse, but there are several other factors that need to be addressed.

Individual Family Member Description

Dan is a quiet man who appears during sessions to be quite lethargic. He admits to being emotionally unavailable to his wife and children. While he denies ever sexually abusing any of his daughters, he does admit to keeping his family in the dark about his chronic pain due to his medical condition. Additionally, Dan does state he grew up in an emotionally sterile household where no one discussed illness or other feelings. It is important to note that his mother was hospitalized due to an unknown psychiatric condition several times when he was a child, and no one really touched on the specifics of this situation. Dan has expressed regret for not being a better father and husband yet seems to have resigned himself to the fact there is nothing he can do to change the situation.

Barbara is a confident, intelligent woman who is "appointed" to relay the story of the issue that has initially brought her family to seek counseling. She admits she has attempted to be more involved in her daughters' lives in order to compensate for Dan's unavailability. She further admits she has thought of leaving her husband, but religious constraints have stopped her from doing so. During one of the initial sessions, she demonstrates her need to pacify her children when she reaches out to Dianna, but is accused of having to "fix things". Barbara does not believe Jesse's claims of sexual abuse, and makes it clear if she thought at any time Dan were abusing the girls she would have divorced him and had him prosecuted to the fullest extent of the law. Barbara also admits her own mother had been briefly hospitalized in a psychiatric facility after the birth of her younger sister.

Dianna, the oldest daughter, is the family member who suggested they attend therapy to address the accusations Jesse has made against their father. A college graduate who works in the finance department of a local bank, she admit she is unable to sustain a long-term relationship with a member of the opposite sex. She says the reason for this is her father's absence from her life. She is angry at her younger sister Jesse and claims that her stories are false.

Danielle, the middle daughter, is currently attending law school. She is very quiet, yet observant of her environment. She also states she does not believe Jesse's claims of abuse, and further denies her father has ever sexually abused her. Danielle does not reveal much about herself during the sessions, but does reveal she feels her family is in a "mess". She states she wants her family to be "fixed" so they can have a good family relationship.

Jesse, who was absent during the initial sessions, seems to have spurred the family into this current state of turmoil. According to the family, she had a normal childhood and never exhibited any symptoms of mental dysfunction. According to Barbara, she began exhibiting nervous behavior during her pregnancy. Once she gave birth to her daughter, Jesse then began to display what was described by another professional as paranoid and delusional behaviors, such as fears of being followed and hearing voices telling her to "hurt herself". She was hospitalized in a psychiatric facility, then was referred for outpatient counseling. During these sessions Jesse began to have dreams about various forms of sexual abuse she and her sisters allegedly experienced at the hands of her father. When she reported these memories to her family, they did not believe her and she became angry. To date Jesse has not spoken to her family and has refused to participate in family sessions.

Current Level of Family Functioning

At this time, it is apparent that there is moderate to low level functioning in this family. According to Barbara, she feels that Dan has been unavailable to her and the children and is constantly in a mental fugue. She further states she feels her husband is an alcoholic. Dianna is angry at both of her parents and seems to take her anger out on the world, which affects her relationships with others. Danielle seems to internalize and is not fully engaging in the family.

Summary of information provided

At this point in time, it is apparent this family has multiple issues that need to be addressed in therapy. The immediate concern is, naturally, the validity of Jesse's accusations against her father. If these dreams she is having are a result of her psychosis, it is a concern why her therapist is not exploring whether these are delusions or in actuality repressed memories.

The one concern that immediately surfaces in this specific instance is the false cases of abuse reported to authorities resulting from alleged repressed memories. This was never reported to the proper authorities. It is important for a mental health professional to proceed with extreme caution when such dreams are reported by patients because of the issues such previous events have caused. Unfortunately, because of Jesse's unwillingness to come to family sessions, this is an issue that cannot be addressed immediately.

One of the major theories in active practice here is the breakdown of the family systems theory. It was this theory that gave birth to trans-generational communication, which is a method widely used in a family therapeutic setting. In this model, family members in opposing generations, i. e., father and daughter, lose the ability to effectively communicate with one another, thereby resulting in a dysfunctional relationship. In the case of the Seaver family, there are several dysfunctional relationships occurring. Both parents are guilty of not effectively communicating with their children which has resulted in a general breakdown of the family dynamic. This is most likely a carryover from both Dan's and Barbara's childhoods where they were taught by their own family dynamics that communication between the generations is not important (even non-existent). This dynamic, which is referred to as Trans-Generational Communication, must be addressed in order to break the cycle of dysfunction.

The family systems theory, developed by Murray Bowen, states that the family unit is one of emotionally stability that is supposed to allow for intergenerational relationships to develop and be sustained through a multigenerational or historical context. Bowen helped to develop methods where professionals could identify where families and couples had a breakdown in communication to the point where no one is listening to anyone else and interaction is either negative or entirely nonexistent. This is assessed by the professional during initial sessions by asking questions of individual family members, discussing communication levels and observing how individuals interact with one another verbally and nonverbally. Nonverbal keys are very important when making an assessment under this model because communication not only includes verbal cues, but also body language.

There also is dysfunction in Dan and Barbara's marriage. Barbara has taken on both parental roles because of her husband's unavailability, which combined with the alcohol abuse has made for a miserable marriage. The children witness this behavior and carry it into their own interpersonal relationships. This is most obvious in the case of Dianna, who has admitted having difficulty in maintaining a healthy relationship with a man. These parents are completely unaware their behavior toward each other has deeply affected all of their children. This is a classic case of where the differentiation of self is not developed to the point where she is not fully able to separate her role as Dan and Barbara's daughter and establish an identity as an independent, productive member of society. Most people who have a good family life with adequate trans-generational communication are able to develop a good differentiation of self, but in the case of the members of the Seaver family, specifically Dianna, there is virtually no sense of self.

Dianna has issues dealing with her father's drinking and absence from her life. She is angry at both of her parents (her mother for trying to make excuses for her father), which has carried over into her relationships with others. She feels Dan is at fault for her inability to have a relationship with a member of the opposite sex and has herself previously sought counseling for a bad break-up. She comes across during sessions as a forceful, strong young woman which could be a way of compensating for her inability to have normal relationships with other people, specifically men. Dianna could benefit from further individual sessions to deal with her feelings about her father's drinking and absence from her life. Furthermore, Dianna seems to be angry at her sister Jesse for making allegations of sexual abuse against their father, yet is quick to point out Dan's other shortcomings as a father. She is further angered by her mother's attempts to overcompensate for Dan's lack of involvement with the girls. It is possible if Dianna observes her parents' relationship improving she can also participate in future sessions to improve her own relationship with her father.

Danielle seems to be somewhat reserved and apt to removing herself from the family dynamics by attending law school. She mostly observes the therapy sessions, but has offered information when asked. Danielle seems to be a quiet, sensitive young woman who denies her sister's allegations of sexual abuse at the hands of their father, yet is empathetic toward her sister's plight. Because of the lack of information offered during the initial family sessions, it is difficult to determine at this time what specific course of action should be taken with Danielle. Unfortunately, at this time there are no current recommendations regarding Jesse. Until she decides to accept an invitation to family counseling, nothing can be done to help her. Right now the best plan of action for the Seaver family is to work on their own issues and encourage the youngest child to attend family sessions when she feels ready to do so.

Initial Treatment Plan and Recommendations

Assessment

As previously stated, this family has suffered a breakdown of Trans-generational Communication as well as a need for Psycho Educational therapy. Both of these issues are a breakdown of communication between family members, with the former being generalized with all members and the latter mainly between Dan and Barbara. Unfortunately, signs of transference from the parents to the children have already surfaced. At least one of their children has admitted they have difficulty maintaining healthy, functional relationships with members of the opposite sex.

It is clear there is a need not only for family counseling to help the Seavers relate better to one another, but there should also be individual sessions scheduled to work on each family member's concerns. Additionally, there needs to be some work done with Dan and Barbara separately from their children so they can work on their marriage. Since both admit they do not have a good relationship, this would be a good place to begin work. Perhaps if the adults were to address their individual issues and address the problems they have functioning as a couple, the children can simultaneously work on their own issues then be gradually brought into family sessions as Dan and Barbara show progress on their own goals.

Initial Goals

To work with Barbara on her need to have everyone in her life happy and communicate better with her husband and children. The largest issue that needs to be tackled is the need for her to make decisions that are healthy physically and mentally for herself. There will be a time when she needs to decide if it is feasible for her to repair her marriage with Dan, or to agree to amicably part ways. Barbara eventually will need to work on helping her daughter and son in law, perhaps even offering to help with her grandchild.

To work with Dianna on her anger issues and repairing her relationship with both of her parents. There is a great deal of anger and hurt in this young woman, and it needs to be resolved if a positive relationship with either of her parents would be possible. It also will help her improve her ability to carry on relationships with others, specifically those of the opposite sex.

At this time no initial goals can be set for Danielle because of the lack of information obtained during the initial family sessions.

Approaches to Therapy

At this time, the initial goals for the Seaver family are as follows:

To work on Dan's emotional unavailability, his communication skills with his family and his drinking problem. All of these factors are important to allow Dan to have a positive relationship with his wife and children, and eventually to help his youngest daughter. This will take a great deal of work and a lot of time; right now it is estimated this goal will take approximately one to two years to complete.

First, each family should attend individual sessions in order to work on their own issues. At this time it is unable to be determined how many individual sessions Dianna and Danielle should attend, but Dan and Barbara need to have intensive sessions, both individually and as a couple. Dan will need to attend individual sessions initially twice a week, with Barbara attending her individual sessions once a week.

In addition to attending individual sessions, Dan and Barbara should attend couple counseling once a week. This will allow them not only to work on themselves, but work on their own relationship. It is the hope that once progress is made both during individual and couple therapy, they can make a sound decision as to whether they should continue their marriage or end it on amicable terms.

Dianna should continue individual sessions once a week for a minimum of three months while her parents work out their issues. It is hoped that when the time is right for all parties involved, sessions with Dianna and her parents (or at minimum with Dan) can take place so they can rebuild their relationship as father and daughter.

Because so little information is currently available on Danielle, no approaches to therapy with her can be estimated at this time.

Therapy Techniques to be Applied

There are three major techniques that will be used with all of the Seavers: psychoeducational, intergenerational education and relationship education. All three of these methods combined will help this family not only address their own issues, but also allow them to rebuild their family unit.

Psychoeducational counseling, first developed by Freud, allows a person to explore the reasons why certain behaviors are inside the psyche. For example, Dan's emotional unavailability is something he has admitted was the attitude when he was a child. It is possible he can probe his subconscious mind to determine how many his parents attitudes have affected his own ability to function with his wife and children. It can also possibly find the motivation behind Dan's excessive drinking. Once the underlying cause is determined, the behaviors can then be corrected through other means such as Cognitive Behavioral Therapy.

Intergenerational Communication refers to the ability to communicate between generations; i. e., father and daughter. It is important for all members of the Seaver family to undergo this type of therapy so they can communicate with one another more effectively. It is common for people from opposite generations to lose the ability to communicate effectively with one another, thereby facilitating the necessity to learn alternate forms.

Relationship Education is used to repair those relationships that are deemed dysfunctional, such as husband and wife. This method will be primarily used with Barbara and Dan to attempt to save their marriage. It will use different techniques such as role playing and Cognitive Behavioral Therapy. This method can also be used for Dan and Barbara to rebuild the relationship with their children.

Expansion for Family System

Expansion for the family system will be very important for the Seaver family. Because of the revelation both Dan and Barbara's mother were hospitalized in a psychiatric facility, it would be advisable to invite members of both families to sessions to discuss the reasons of the hospitalizations. By doing this, the family can then understand the nature of illness in the family and eventually help Jesse with her issues and become a functioning family.

Referrals for Family

The most pressing referral would be for Dan to seek professional treatment with a Certified Addictions Professional for his drinking problem. Furthermore, Dan will need to seek a referral to get a second opinion for his medical problem

General Treatment Plan

There are many different components to this treatment plan. First of all, Dan needs to be worked with on an individual basis for a long term timetable. He needs to initially have one on one sessions three times a week for six to nine months, plus couple therapy with Barbara twice a week for at least six to nine months. Additionally, Barbara needs to have individual sessions once to twice a week along with regular couple's therapy sessions. Dianna would also benefit from individual sessions twice a week for six to nine months to assist her with finding her definition of self. The entire family should meet for weekly sessions for a minimum of twelve months to work on trans-generational communication.


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