Analysis of Systems Family Therapy - Case Study Example

? Systems Family Therapy Word Count: 3,476 (13 pages) I. Introduction It is true that family therapy has become a staple of modern health care. “Family therapy has been one of the central fields of psychotherapy participating in the recent massive, electrifying development of the Health Care 'industry'” (Will & Wrate 1985, pp. xii). The family that is being analysed obviously has some issues that could easily cross the line into social work. “Working with families has always been part of social work. Cybernetic theory is basically the study of systems, which is definitely employed in systems family therapy. “Bateson's elegant and thoughtful articulations of cybernetic theory influenced numerous disciplines, including communications, anthropology, and family therapy” (Gehart 2010, pp. 144). Family therapy, however, is being used increasingly in almost all the helping professions” (Burnham 1989, pp. 1). In the following case study scenario in systems family therapy, one will identify: the facts of the case study itself; issues in therapy; and analysis of the various types of therapy available. II. The Case Study Facts Yarek is 56 years old and happily married to Barbara who is 48 years old. They have a very close and solid relationship. They have two children—Shannon, who is 26 years old, and Denis, who is 30 years old. Shannon is married to Mike, but there is conflict and instability in their relationship. When Mike is around, they always get into disputes about little things, which sometimes break out into full-fledged fights. Mike’s dad, Rex, is 50 years old and happily married to Mary, who is 48. They have a good relationship. Mike also has a brother named Robbie. They are tired of helping Mike and Shannon. They do not know how to help them. On the other hand, Denis has a problem not being able to stay in a relationship for more than two weeks, and he blames his dad Yarek for that. At the moment, Denis has managed to keep his relationship with a girl named Jane for more than three weeks, but is having difficulties. Jane’s dad, Philip, is 55, and happily married to his wife Maggie who is 50 years old. They have a close relationship and are trying to help Dennis and Jane. Yarek’s dad is 76 years old. His name is Derek and he is married to Judith who is 74. Their relationship is wrought with conflicts. They are always arguing and have their own problems to sort out and do not have time to help Yarek’s family. Yarek had a sister, Analita. She died in a car crash, when she was 53 years old. Barbara’s parents were happily married. Barbara’s dad Zarek died due to cancer when he was 80 years old. Her mother, Dawn, at 75 years of age, is still alive but has little contact with Barbara’s family. This is due to several disputes she had long time ago with Yarek. Barbara also has two sisters—Amanda who is 43 and Anastasia who is 53. They have lost contact with Barbara’s family because of Yarek’s attitudes and generally arrogant personality. Yarek is a successful, self-employed accountant. He has been on therapies for immobilising obsessions and phobias. These problems force him to take time off from work. His wife Barbara is a full time Deputy Manager, in a big successful real estate company. Barbara is able to cope, even though Yarek takes time off work, sick for weeks. Barbara is of a strong character. She loves her husband dearly so much so that she is ready to take any sorts of challenges in her life. III. Therapy Yarek is a recovering alcoholic; he has been sober for two years. He has been to the Community Alcohol Team for alcohol detox and, since then, he has been doing well and has not drunk any alcohol. Yarek owes a large sum of money on his credit cards and to the Inland Revenue. Recently, the Inland Revenue contacted Yarek’s largest steady accounting clients and requested them to pay them directly. His relationship with the children is stormy with varying periods of communication. The children weathered many years of their father’s active drinking and are apprehensive of his sobriety. Although being aware of his dad’s deeds, Shannon is very close to him. She phones him every day, about her life at home. On the other hand, Denis does get along well with his mother, but not with his dad. Yarek is trying hard to convince the children that he has nothing to do with alcohol anymore and wants to win them back. His wife Barbara is helping him to make it happen. During therapy, Yarek claims that he never felt close to his mother because she was hard-hearted and tough on him. He was punished for every little mistake he made. On the other hand, his dad was gentle and nice to him, a submissive person. He was powerless to overrule his mother’s decisions. It seems to Yarek that most of his childhood is blocked from his memory, but he starts to recall two things. First, he was the only one doing the shopping, where he would spend long hours wandering around, ending up shoplifting. He also recalls that he would go to his neighbour’s house for shelter, which would get him away from mother’s punishment. After this recollection, Yarek located the neighbours to question them about the events. The neighbour, being quite old now, is non-committal and says that it was the only way to protect him from punishment. Yarek also has memories of being lonely and feeling out-of-place as a child. He also enjoyed listening to music, especially symphonies. As an adult he enjoys fishing, camping, reading and watching channels like National Geographic. He has also tried various therapies in the past such as Reiki and Magnified Healing in order to find answers to his worries, especially about his neurotic tendencies. Barbara is the second child in her family. She is a high-achiever, well-educated, and resourceful in most areas. She shares her husband’s love for classical music and enjoys organising large parties, in which a large group of couples attend a concert. She is also well-known for fundraising for the local Symphony and for children’s programs in fine music. Jung found that people find different senses of meaning at different stages of life (Cox, 1968, pp. ix). The husband has done well at the first stage, establishing his ego, fulfilling his biological needs as a father, and having achieved relative success as a professional accountant. His troubling difficulties in his childhood and adolescence, however, remain painful memories. “Adolescence is one of the most ambiguous stages of the family life cycle” (Haley & Haley 2007, pp. 66), proving the difficulty in which a child finds himself at this stage of life. However, the husband's ten years of sobriety coincides with his movement into the second stage of life in which one seeks inner understanding. The husband, at this point, is quite bewildered because he has no clear sense of self aside from his roles and external achievements--father, accountant, owner of house, camper and boater, and community leader. A traditional Freudian-Jungian approach would encourage the husband to examine his dreams. Currently he has been having nightmares and is sometimes apprehensive about going to sleep. IV. Analysis Traditional psychoanalysis would demand that the husband explore the true nature of his relationship with his mother. What are his honest feelings about her? What are his feelings about women? He can be encouraged to fully explore the strength of his anima and determine whether it is now a positive or a negative force in his life (Cox, 1968, pp. 144). A psychoanalytic approach to the wife's difficulties would suggest that she also explore her deeper self. She, like the husband, recalls little of the details of her childhood. There were picnics and family outings, but suspiciously, all of what she does remember takes place outside the childhood house, and nothing occurs inside the house. Her two adult sisters do not speak to her, and she does not know why. In psychotherapy, the wife could determine the nature of her relationship with her mother and father and explore how it came to be that she is the only high achiever in the family. Neither of the parents achieved well in their respective careers. She can look at similarities in personality between her mother and her husband. Jung describes marriage as a psychological relationship, and if much of what propels a person's behavior is hidden in the unconscious, patterns will repeat (Campbell, 1971, pp. 163). A traditional therapist would encourage the wife to examine her dreams and memories. What are the conflicts? How did she happen to marry a man who exhibits so much dependency? Group work, in addition to individual psychotherapy, would assist her understanding that the substance-free spouse may contribute considerably to the problems in an alcoholic marriage. The wife may wish to examine her own goals and pursuits to gain a greater sense of self aside from her husband's difficulties and needs. Did she actually intend to become a real estate salesperson for the love of the work, or was it a financial necessity? As a youth, what were her dreams and life fantasies that she set aside for the responsibilities of caring for a husband and a family? Regardless of the view that people are driven to compensate for all that was left unfulfilled in the lives of their parents (Campbell, 1971, p. 165), this family would greatly benefit from the Bowen family systems approach to therapy. For Murray Bowen, the goal of the family therapy work is to increase the differentiation of individuals within families. Pathology in current relationships is viewed as related to unfinished business in family of origin relationships (Anderson & Stewart, 1983, pp. 16). Bowen's approach to this couple would center first on the wife. She is the strongest member in the entire extended family. She has the most capacity for change, and she is the most motivated to act in order to see improvement in the marriage. The wife's entire thinking-feeling system is occupied with the husband's neurotic sickness. As part of the family projection process, she, the children, and her parents have focused on the husband's inadequacies, his drinking, his financial problems, his sobriety, and his underlying emotional weaknesses. This projection has to stop. The wife is asked to imagine that he is not sick, weak, or neurotic. She is not to respond to any conversation of that nature from anyone else in the family (Boszormenyi-Nagy & Framo, 1965, pp. 235). It is likely that as she withdraws her mothering of his sickness, he will escalate his symptoms for a brief period of time. She is instructed not to respond in any way to his escalation of symptoms, even if he shouts, cries, or questions why she has stopped loving him. In this family which spans three generations, the undifferentiated family ego mass causes the family to behave and feel with emotional oneness (Boszormenyi-Nagy & Framo, 1965, pp. 219). All of the members are emotionally interconnected, bound together with their problems. There are no clear emotional or psychological boundaries between the family members. This set of behaviors is unhealthy for the marriage and unhealthy for every family member. “An overarching defining characteristic of those things that we call ‘paradoxical interventions’ is the context of therapy itself” (Palazzoli, Cecchin, & Boscolo 1995, pp. 44). In this type of family, it is as if the entire family is a jigsaw puzzle with each member holding a piece of the puzzle. The pieces may be traded among members, but no person is complete without the others fulfilling various aspects of the family's problems. The wife in this case can look at the fact that she has had a rigid role to play out in this multi-generational matrix of problems. In her family of origin, she was the victim of family projection process. Her parents were unhappy in their marriage and in their professional lives, so the entire family, weaker siblings as well, projected their needs for achievement and acclaim upon her. She was, in effect, part of a triad, a process of triangulation, in which her presence preserved the tenuous instability in her parents' marriage (Boszormenyi-Nagy & Framo, 1965, p. 223). The husband’s tendencies are also part of a triadic pattern. Undoubtedly, even before he was born, his unhappy mother was looking for an outlet upon which to vent her frustrations concerning her weak husband. Being an only child, the husband received the full force of his mother's wrath, which rightfully should have been directed at her own husband and her own parents. The grown daughter is in danger of becoming a victim of triangulation. Her relationship is closer to her father because he can easily relate to her during her times of weakness and sickness. Yarek is thoroughly fed up and intimidated by his strong mother and wife and welcomes a softer woman, his sick daughter so that he has some sense of being a helpful, masculine man. In this relationship, as in many other relationships within this family, pity is confused with love. Taking care of someone and sympathizing with them is perceived as love. Emotional cutoffs occur when anxiety becomes high (Anderson & Stewart, 1983, p. 16). In this case, emotional cutoffs are happening more in the third generation. The college-aged son goes for months at a time without speaking to his parents. The daughter, during times of stress, cuts off her mother and relates more to her father, whom she perceives as more loving. The husband goes through episodes of experiencing cutoffs from his mother, but more of the time he is emotionally intertwined with her. Systemic family therapy is going to come out of the therapist’s own wealth of information about the experiences he has had in counselling other families. “[One] current model of systemic therapy, that which gives [therapists] inspiration in [their] work with individuals, was developed through a series of experiences” (Boscolo & Bertrando 1996, pp. 3). The type of therapist who is being employed is of singular importance, as he may effectively hurt or help the family’s situation. “In 1991, de Shazer states: The therapeutic relationship is a negotiated, consensual, and cooperative endeavor in which the solution-focused therapist…” operates (Piercy, Sprenkle, & Wetchler 1996, pp. 136). The therapist utilising the Bowen approach will assist this family to see things differently and help it to gain some perspective in the process. He will act as a coach—avoiding power struggles, preaching, and confrontation. “Murray Bowen's approach can be thought of as a first-generation approach. At its core, it is a classical psychodynamic approach that has been updated and informed by systems…” family theory (Winek 2009, pp. 81). With humor and patience, the therapist’s indirect style and neutral attitude can assist all to become more differentiated from the family ego mass. He may employ paradoxical interventions in order to save the family’s home life. “Most, if not all ethically based objections to the use of paradoxical interventions relate to concerns about therapist power, manipulation of clients, and informed consent” (Cullin 2005, pp. 139). The wife is the most likely point of entry because she is the least resistant to change. The other family members can observe her efforts to disengage from the family "game," and, in time, emulate her example (Anderson & Stewart, 1983, pp. 17). The wife remembers that she gave up drama and dance in college in order to pursue a more respectable career to satisfy her parents. She de-selfed herself in order to compensate for her mother's emotional immaturity. This type of undeveloped mother makes two demands on the triangulated offspring--that she remain helpless (tied to the mother) and that she become a gifted, mature person (Howells, 1971, pp. 78). These demands are obviously contradictory and eventually create a person with no individuated self. This is a trade-off the wife has willingly made in order to keep peace in the family. With the help of the therapist, she sees that her role has benefitted all in her family of origin but not herself. She decides to reject her part of the triad and become her own person. She continues to relate cordially to her parents, children, and husband—but does not allow herself to be cast in the roles of problem-solver, achiever, or nurturer. She continues working in her career as a successful real estate salesperson and spends free time participating in the local community theatre. This diversion does much to take her thoughts and energy away from too much preoccupation with her husband. V. Conclusion In therapy, getting to the ‘truth,’ or the heart of the matter, may take some time. Even then, it might take awhile for all the participants in therapy to come face to face with reality in therapy. “The question of truth and reality are intimately related, for within a modernist paradigm, ‘truth’ stands at the pinnacle of universal claims about the nature of reality” (Flaskas 2002, pp. 69). Obviously, the good therapist will have thought about all of the possible outcomes of therapy sessions, and will try to orchestrate them in a manner that is most beneficial to the entire family in therapy. Erickson carefully made special plans for all of his clients, and was very active and directive in his sessions (Goldenberg & Goldenberg 2007, pp. 276). The therapist will generally most likely have the different family members interact and be able to envision their futures. “[The counselor should] accommodate goals that emphasize the individual family members’ exchange [between one another]” (Carter & McGoldrick 1989, pp. 448). After all, the therapist’s goal is to try to instruct families on how to avoid their old pitfalls. “The [therapist]’s own work with families provides the content of teaching” (Minuchin, Lee, & Simon 2006, pp. 103). The husband, after a period of time, has no choice but to respond to his wife's change. He cannot play his part of the family game--recipient of the family projection process--because no one is watching any more. He joins in therapy with his wife. He finds that his role in his own nuclear family emotional system has painfully affected his life. He has for years been a self-blamer (Boszormenyi-Nagy & Framo, 1965, pp. 224). He has allowed everyone within three generations to blame him for all sorts of difficulties, which was a factor in his escape to alcoholism. He has considerable anger and pain to go through in experiencing the magnitude of his loss of self, but with the consistency of his wife's presence and his therapist's regard, he is able to dramatically decrease his participation in the sick role. This multigenerational transmission process could easily ensnare the adult daughter. As the parents get better, both individually and in their relationship, she experiences increased anxiety. Her former coping mechanisms are no longer effective. Her physical problems escalate as do her pleas for sympathy, but both parents are instructed not to respond to her when she uses the sickness avenue for attention. The therapist will most likely push the daughter (gently) to face her demons, so to speak. “Clinicians have long believed that the family of the patient has an important role to play in a complete management plan for [an eating disorder]” (Fairburn & Brownell 2002, pp. 314). Her position as the oldest child makes her tendency very strong to act out her father's weaknesses again. After a few weeks of futile effort, she gives up and joins the family therapy. She does not really comprehend the processes but is motivated to make her own marriage succeed. The son is relatively distant from the family dynamics, generally coping by disengaging from the family game. However, as he observes from afar the ways in which the group is changing, he examines his own motives for wishing to become an architect. At some level, he always felt a competitive disgust for his alcoholic father and swore that he would professionally outperform him. Without this negatively driven goal, he is undecided about what he really wants to do with his life. At his young age he cannot really grasp the nature of this multi-generational illness nor its effects upon him. For this family, a Bowen family systems intervention helps each person to differentiate from the family ego mass. The wife does not have to be so dominant nor the husband so adaptive (Bowen, 1974, pp. 118). As this particular family is moderate in its dysfunctionality, it is likely that severe problems such as schizophrenia will not develop. Both the husband and the wife are motivated to become emotionally mature individuals, and as they do so, the entire extended family benefits. Here, three main elements have been examined: a case study; information about the family’s particular therapy; and finally, analysis of the therapeutic options available. BIBLIOGRAPHY Anderson, CM & Stewart S (1983). Mastering resistance: a practical guide to family therapy. NY: Guilford Press. Boscolo L & Bertrando P (1996). Systemic therapy with individuals. “What we have learned from systemic family therapy.” US: Karnac Books. Boszormenyi-Nagy I &. Framo JL (Eds.) (1965). Intensive family therapy: theoretical and practical aspects. New York: Harper & Row. Bowen, M (1974). “Alcoholism as viewed through family systems theory and family psychotherapy.” Annals of the New York Academy of Sciences, 233: 115-122. Burnham JB (1989). Family therapy: first steps towards a systemic approach. US: Psychology Press. Campbell, J. (Ed.). (1971). The portable Jung. New York: Penguin Books. Cox, D. (1968). Modern psychology: the teachings of Carl Gustov Jung. New York: Barnes & Noble, Inc. Cullin J (2005). The ethics of paradox: cybernetic and postmodern perspectives on non-direct interventions in therapy. [Online Article]. Available: . Fairburn CG & Brownell KD (2002). Eating disorders and obesity: a comprehensive handbook. “Family Therapy and Eating Disorders.” Dare C & Eisler I. NY: Guilford Press. Flaskas C (2002). Family therapy beyond postmodernism: practice challenges theory. US: Psychology Press. Gehart DR (2010). Mastering competencies in family therapy. USA: Cengage Brain. Goldenberg H & Goldenberg I (2007). Family therapy: an overview. USA: Cengage Brain. Haley J & Richeport-Haley M (2007). Directive family therapy. US: Psychology Press. Howells, JG (1971). Theory and practice of family psychiatry. New York: Brunner/Mazel Publishers. Carter EA & McGoldrick M (1989). The changing family life cycle: a framework for family therapy. USA: Allyn & Bacon. Minuchin S, Lee W, & Simon GM (2006). Mastering family therapy: journeys of growth and transformation. USA: Wiley. BIBLIOGRAPHY (CONT’D) Palazzoli MS, Cecchin G, & Boscolo L (1995). Paradox and counterparadox: a new model in the therapy of the family in schizophrenic transaction. US: J. Aronson. Piercy FP, Sprenkle DH, & Wetchler JL (1996). Family therapy sourcebook. NY: Guilford Press. Will D & Wrate RM (1985). Integrated family therapy. US: Tavistock. Winek JL (2009). Systemic family therapy: from theory to practice. US: Sage Publications. Read More