Final Application Project - Term Paper Example

?585056 Final Application Project When one spouse suffers from emotional/behavioral disorders as Jeff’s wife does, which results in them abandoning the family there will always be contingent issues surrounding the abandonment that should be addressed immediately. In this scenario they have not been and the effects on Roger are just now manifesting themselves in a negative way. Jeff also has trouble dealing with the abandonment issues caused by his wife’s leaving. With therapy, including CBT, parenting strategies, and changing the propensity for negative feedback into positive feedback, this family can become a strong functioning social unit. Introduction Jeff and Roger seem to be suffering from abandonment issues. Obviously Roger seems more affected than Jeff because he was younger when the event occurred. However, Jeff’s attitude toward his wife’s leaving has not helped Roger to adjust into a healthy, normal young man despite his mother’s absence. While he should have sought treatment seven years ago when the wife/mother first left the family, Jeff did not, so he and his son have been dealing with the issue for more than half of his son’s life now. However, it is not too late for this family. With therapy they may be able to establish a strong family bond, learn to communicate, and turn the negative situation into a positive family system. Assessment To assess Jeff and Roger the best method to use would be a strategic intervention like a genogram. However, a family map of the biological indications would be useful too, but more for a physician who treats physiological problems than one who treats emotional and psychological issues. With a family map a therapist could see that the bipolar disorder of the grandmother and possibly of the mother may figure into Roger’s issues, and be aware of the issue, but still treat the emotional aspects of his problems. If he has a genetic propensity to the same disorder, then it is not too early to get him help with that. Vostanis, Grave, Meltzer, Goodman, Jenkins and Brugha found that “The association between parental and child psychiatric disorders is well established. The psychological and social development of children of mentally ill parents is at high-risk of a range of emotional, behavioural, cognitive and social difficulties” (Vostanis, Graves, Meltzer, Goodman, Jenkins, & Brugha, 2006, p. 509). Yet, the other issues for which Jeff and Roger seek therapy might best be determined through a genogram. Therapeutic Reasons for the use of a genogram Since Roger was quite young when his mother left the family, it seems plausible that his behavioral issues began there. Jeff, too, may have some issues surrounding that particular event. Using a timeline approach may help Jeff and Roger to see that an event over which they had no control affected them in particular ways. For instance, Roger might express feelings of abandonment stemming from his mother’s leaving. Jeff might also feel issues of abandonment, which causes him to frame his wife’s behavior in terms of “good” and “bad” rather than portraying it as symptoms of an illness, which is the case even if she did not inherent the bipolar disorder. Drug addiction is also an illness and having that information would give Roger an entirely different perspective of his mother’s behavior. He may be thinking that he is “bad” because his mother is “bad.” A genogram will demonstrate to Jeff and Roger how significant the event of the mother leaving was to both of them Positive and Negative Aspects of a Genogram The success of a genogram in therapy can only be determined by the participation of the clients. Since genograms use “a chronological chart to track family interactions in relation to specific events,” they require that clients reveal their reactions to and feelings about past events in order for the therapist to see which event may be affecting their current behavior (Deacon & Piercy, 2001, p. 364). If Jeff and Roger are honest about their feelings, if they can even remember them since the mother’s abandonment occurred seven years previously, then a genogram would work well. They would see that each of them was affected by the mother leaving the family and perhaps it would help them to sympathize with each other more. As it is now, they both seem to be wrapped up in their own feelings of abandonment and unaware that the other is dealing with issues resulting from the same event. Even if the genogram were not effective in making Jeff and Roger more sympathetic of each other’s pain, then it would at least show them the significance of the mother’s leaving on their own lives. To construct a genogram, “Each family member writes his or her age at the time of the event and reaction to the event in the box corresponding to his/her name and the particular event. From this, the therapist and family discuss the family history. The therapist can use this information to assess historical influences on the family’s current issues. Additionally, the therapist can see the intrapersonal and interpersonal impact of events across time” (Deacon & Piercy, 2001, p. 364). For instance, Jeff may realize how hurtful it was to have been rejected by his wife and how overwhelmed he was to have been left with a small child to care for which he may have been ill-equipped to handle. Roger may be able to recognize that his feelings changed when his mother left. He may be able to identify feelings of rejection and fear that his father may reject him too. In fact, that may be the issue he has toward all people with whom he interacts. Another way the genogram might be useful is if it traces the history of the mother and the grandmother before Roger was born. In that way, it would portray the erratic behavior of the mother who may also have a bipolar disorder. Roger may be able to see that his mother’s abandoning of him was not rejection but just a symptom of her illness whether that illness is a bipolar disorder or a drug addiction or both. He may be able to trace other instances of the same type of extreme behavior and put to rest the belief that his own mother thought he was so unlovable that she abandoned him. If Roger has blamed the mother’s absence on Jeff, then seeing a timeline of the mother’s unpredictable behavior may also help to put those feelings to rest and change the way Roger feels about his father. The main negative aspect of using genograms in family therapy exists in the fact that the clients are the ones who ultimately construct the events and timeline. The way certain events and the circumstances that surround these events are viewed may vary among family members. For instance, Jeff may be aware of his wife’s drug use, but at six years old, it is doubtful that Roger was. They may have varying accounts of the mother’s behavior or beliefs about what the behavior meant. That might make it difficult to construct a genogram accurate enough to assist in therapy. However, since there are just the two of them involved in the construction of the genogram, and not a larger family unit with more opinions and perspectives on the various events, a genogram might be just the tool to use especially owing to Roger’s young age at the time of the significant event. But that brings up another possible negative feature of the genogram: Roger, who does not get along well with his father, may blame Jeff for the mother’s leaving. He may see Jeff’s account of the events as ways of justifying his own behavior that “made her leave.” Of course, if such a thing occurred, then a therapist is the perfect person to help Jeff and Roger to work out those feelings. Strategies Many options exist that a therapist might suggest that would help both Jeff and Roger to deal with their current difficulties. Specific parenting strategies will be very helpful to Jeff in dealing with Roger’s behavior. Those strategies may include punishment, time-out, or positive reinforcement, but probably more effective for Roger would be cognitive behavioral therapy (CBT). This sort of therapy theorizes that there are three levels of cognition: “full consciousness, automatic thoughts, and schemas. Consciousness is defined as a state in which rational decisions are made with full awareness. In contrast, automatic thoughts are the more autonomous, often private cognitions that flow rapidly in the stream of everyday thinking and may not be carefully assessed for accuracy or relevance. . . . Schemas are fundamental rules or templates for information processing that are shaped by developmental influences and other life experiences” (Wright, 2006). Roger definitely struggles with making logical decisions when it comes to behavior, and, one could argue, so does Jeff. Both may have developed schemas out of their mistaken reasoning about wife/mother’s abandonment. Both father and son could benefit from cognitive behavioral therapy. Therapeutic Reasons for using CBT CBT is essentially “talk therapy” in that it involves working with a person’s thought processes rather than altering the chemical composition of their bodies through drug therapy or changing their subconscious through hypnosis. Wright lists several methods used in CBT beginning with Socratic questioning, which consists of asking questions in such a way that the person answering the questions must think and explore their answers. This method may help Roger to see that Jeff did not cause his mother to abandon him, or that he, himself, was not the reason the mother decided to make the choices she did. Other CBT methods relevant to the issues Jeff and Roger are struggling with include examining the evidence, for which the genogram would be quite useful in proving to Roger that both his mother and grandmother may have suffered from a disorder over which they had no control. It may also point out to him the potential for his having the same disorder. Other CBT methods that would be useful for Jeff and Roger consist of identifying the cognitive errors in the way both of them reason, generating rational alternatives to those errors, and then perhaps role playing and rehearsing the better alternative behavior so that when issues arise outside of therapy they can deal with them in a way they have learned in therapy. Positive and Negative Aspects of CBT One negative to using CBT is that it has become a panacea for all emotional disorders to the unhealthy rejection of other perhaps equally useful treatments. CBT seems like a great way to treat Jeff and Roger’s problems, although other aspects of their issues must be considered too. For instance, Roger should have a complete physical examination to see if he may have inherited his mother’s disorder. It could be that medication would alleviate many of his issues, which may also help to ease the discord between father and son. Another concern that may factor into this particular situation is that Roger will refuse to comply with any therapy. The evidence that this is a possibility comes from several aspects of the scenario: his possible and potential bipolar disorder, his age, and his current rebellious attitude. The way to affect the situation at least in some degree without Roger’s cooperation would be to teach Jeff parenting techniques to deal with and help to modify Roger’s behavior. These may or may not be successful given the Roger’s current behavior and attitude, but they will be more effective than Jeff’s current method that just seems to cause more stress to both of them. Parenting Strategies One possibility for Roger’s behavior is reactive attachment disorder or RAD. This is most often associated with children adopted after infancy or children who spent portions of their childhood in foster care and failed to form attachment to an adult caregiver. However, Charles Zeanah and Anna Smyke argue that “disturbances between child and caregiver may exist that are relationship-specific. . . . The basic premise underlying these forms of attachment disorders is that the child has an attachment relationship with a discriminated caregiver, but that the attachment relationship is seriously disturbed” (Zeanah & Smyke, 2008). In Roger’s case, if he developed an attachment to his mother as an infant, and then she, in a sense rejected him by leaving, that attachment was disturbed. Even though Roger may feel his mother rejected him, her leaving may still have significance for him which may explain why he questions his father about her. Having his father claim that the mother that Roger remembers, loves, and feels attached to is “no good,” may be at least part of the cause of his current behavior. He may see his feelings of love for his mother as wrong or bad. He may resent his father for saying such things about his mother, or there may be a combination of possibilities occurring in Roger’s mind. Besides the obvious suggestions of getting Roger a complete physical and placing him in some sort of CBT, Jeff could very much benefit from some therapy too. Perhaps CBT would work for him also because it is his reaction to Roger that needs to change. Telling someone his wife is “no good” may be fine if the person he is telling is another adult who sympathizes with him, but it is not okay to say that to the son of the woman who he believes to be “no good.” Other than the fact that the woman definitely had issues which were beyond her control and should illicit sympathy and not hatred from Jeff, his son is this woman’s offspring which means he should not put down the only mother Roger has ever known and may feel attached to. He should also be mindful of possible genetic influences on his son and should be looking for signs of Roger’s potential bipolar disorder too. Some parenting strategies that Jeff might try include positive reinforcement when Roger does behave in an appropriate way. An interesting version of this, which may be helpful for Roger is Verbal Judo detailed in Scott Larson’s “Strength-based Discipline that Taps into the Resilience of Youth.” Larson gives the example of a teenager asking, “Why should I care? Nobody cares about me.” To which an adult would naturally respond, “I care.” However, Larson believes it is better to put the responsibility back on the teen’s own shoulders. Larson believes the best response would be to say, “Then perhaps it is up to you to care about yourself” (Larson, 2010). This response may seem cold and callous, but it serves the teenager better than the self-pity and the normal parental reaction to the manipulative behavior. In Roger’s case, he may have logical reason for believing his mother does not care for him, but not for believing his father does not care. Jeff perhaps feels guilt for his wife’s behavior and by taking the firm and positive stance against Roger’s manipulation based on the rejection of his mother, Jeff can not only help his son to consider a more helpful approach to the damage his mother’s leaving has done to him but Jeff can also assert that he is not responsible for the damage, which may help to assuage his guilt. Both first-order and second order changes need to take place in Jeff and Roger’s family. Both Roger and Jeff have behaviors that need changing. Roger needs to focus more on school and to seek help through his teachers/school counselors if he cannot manage to do it on his own. This is a tall order for a kid with Roger’s set of emotional issues though and really it is Jeff’s behavior, specifically parental behavior that needs to change. The first-order change he needs to make is to not put down Roger’s mother while Roger is in earshot. The second-order changes that Roger and Jeff as a family must make is in the way they communicate what is bothering them. Perhaps Jeff needs to tell Roger that he too feels betrayed, abandoned and hurt by his wife’s leaving the same way Roger feels about his mother’s leaving. Both need to understand it is not their fault that she left, that, in fact, it probably was not something she could control, that her disorder caused her to believe leaving the family was the best option. Then they need to work together as a team to get Roger back involved in school and on to a successful life as an adult. Therapeutic Reasons for Parenting Strategies One theory that may apply to Jeff and Roger’s situation is the General Systems Theory which states that the survival of a family as a system depends on one of two things: negative feedback in the face of environmental challenges (the normal fear of change) and positive feedback, or finding a way to see change as a good thing. Clearly, Jeff resents the changes that occurred when his wife left even though she used drugs, had a psychological disorder, and caused financial problems. If he had put a positive spin even on his wife’s leaving perhaps Roger would be better able to deal with his loss now and would have seen his mother’s abandonment as something out of his control rather than something he caused. So, the second-order change both Jeff and Roger need to make is to switch from viewing change as negative and to start seeing change as possibility. A therapist can facilitate this change from negative outlook to positive outlook by establishing and encouraging communication among the family members. The first step is to help the family determine some goals, but just identifying goals is not enough. The family must also clearly qualify these goals in terms of result and quantify them in terms of time frame. During sessions, a therapist must constantly monitor the interaction between family members. One strategy is to reframe the problem while also pointing out to the client the type of thinking that initiated the problem in the first place. Therapists should never assign blame, but instead should find ways to motivate their clients to seek an alternative way to work out disagreements. The second order change may come out of the goals of the first order change in that if Jeff stops putting Roger’s mother down, and Roger stops identifying with her and blaming himself for her shortcomings, then a sea change in attitude will have taken place within the family. That coupled with a more positive outlook may make both Jeff and Roger much happier people. Positive and Negative Aspects of Parenting Strategies Of course, the downside of any therapy that may be applied to this particular scenario is that many of Roger’s problems could stem from the possibility of him having inherited his grandmother’s bipolar disorder. He has just now reached adolescence, which is often the time when such disorders reveal themselves in children. Any gains in family therapy may mask the fact that Roger need medical help, which may delay him getting it. That is, if Jeff sees Roger’s attitude improving he may not think a physical exam is necessary. However, a family therapist should insist upon it in this situation. Another possible negative outcome is that one or the other of the two family members may decide not to cooperate for some reason. In that case, just one of them undergoing therapy will help that one, but the issues that occur between the father and son will not be addressed. First order change may be feasible, but second-order change would probably not occur in that case. Conclusion Clearly Jeff and Roger would benefit from therapy, but it may entail more and various therapies than just family therapy. Medical intervention may be needed as well. Both clients seem to react in expected albeit destructive ways toward the wife/mother’s abandonment of the family. Jeff should have sought intervention seven years ago when the event first occurred. However, it is always better late than never and there is still hope for this family if they are willing to work on their methods of interacting with one another and dealing with the stress of the mother/wife’s leaving. References Deacon, S. A., & Piercy, F. P. (2001). Qualitative Methods in Family Evaluation: Creative Assessment Techniques. The American Journal of Family Therapy, , 29, 355-373. Larson, S. (2010). Strength-based Discipline that Taps into the Resilience of Youth. Reclaiming Children and Youth , 18 (4), 22-25. Vostanis, P., Graves, A., Meltzer, H., Goodman, R., Jenkins, R., & Brugha, T. (2006). Relationship between parental psychopathology, parenting strategies and child mental health: Findings from the GB national study. Social Psychiatry & Psychiatric Epidemiology , 41 (7), 509-514. Wright, J. H. (2006). Cognitive Behavioral Therapy: Basic Principles and Recent Advances. Focus , 4, 173-178. Rptd. at http://focus.psychiatryonline.org. Zeanah, C. H., & Smyke, A. T. (2008). Attachment Disorders in Family and Social Context. Infant Mental Health Journal , 29 (3), 219-233. Read More