Assessment, Diagnosis, and Treatment of a Couple - Research Paper Example

? Case Study Analysis in the Assessment, Diagnosis, and Treatment of a Couple Case Study Analysis in the Assessment, Diagnosis, and Treatment of a Couple Couple or family therapy sessions differ greatly from individual therapy sessions, mainly because of the former involving at least two individuals that seek counseling or therapy with regards to their interpersonal relationships, and the latter only focusing on an individual’s intrapersonal well-being (Dziegielewski, 2010). As such, certain aspects of therapy can be affected since aside from focusing on the people involved in the sessions itself, it is necessary that their individual needs and issues be addressed on the context of both their intra- and interpersonal relationships as a whole (Fingerman & Bermann, 2000). This is supported by the “family movement” which is represented by the idea that by involving the family in the course of treatment that a person is able to understand the concepts concerning the relationship of individuals with nature (Bowen, 1993). Thus, due to the influence of family systems in each member, it would be hard not to include this kind of analysis when dealing with relation issues such as those found in families or among couples. For this case study the couple’s vignette is used, showing the relationship of a couple from two different cultural backgrounds, Robert and Sophia. Potential courses of treatment can be made by using a combination of concepts such as family systems theory, DSM-IV-TR, identifying social-cultural factors, and integrating the ethical aspects of counseling and therapy. Methods Used During Assessment and Diagnosis with this Couple Prior to treating the couple, it is essential that a pre-counseling interview, the use of a Global Assessment of Relational Functioning Scale (GRAF), and individual diagnostic testing be done. This is in order to find any possible conditions that could affect what kind of treatment shall be given to the couple, such as the presence of mental or mood disorders that could prevent the therapy to succeed (Gottlieb, et al., 2008; Lebow, et al., 2012). Upon initial observation of the couple, it seems that the couple has communication troubles, as Robert has issues in expressing his problems openly to Sophie, and she bearing the effects of Robert shutting himself and distancing from her, leading her to seek comfort from her family more often. However, after individual pre-counseling and diagnostics were done, it showed that both of them suffered forms of trauma during their childhood, and as a result affected the ways by which they formed relationships (van der Kolk, et al., 2005). For Sophia, it was being abused by an uncle as a child, but was forced to repress the shame and guilt, while for Robert it was the feeling of being isolated since his family immigrated to the US during his teens, which persisted until his college years. However, in addition to Robert’s problem, based on his interaction with his wife, it seems that he has other problems (alcohol-dependence exacerbated by a recurring major depressive disorder), which might need individual therapy and counseling, of which the lack of can affect the couple’s treatment. Family Systems Model used for Understanding Patterns of Dysfunction The influence of family systems in adults and their relationships makes it important that Robert and Sophia’s issue be analyzed using systems theories. The Bowen Family Systems Theory can be used to analyze the couple’s interactions, including their families of origin. This is because individuals can be seen as the products or extensions of their family systems, regardless of whether or not the members are living (Bowen, 1993). There is also a need to have a balance between the differentiation of the individual self with that of the family, as the disruption of this balance causes the dysfunction of human functioning, which causes the manifestation of various mental disorders later in life (Crossno, 2011). Imbalances are showed by Robert having a high differentiation of his individual self from his kin, thus the emotional distance from his family members including his wife, and for Sophia’s strong emotional dependence on her family, showing how strongly her individual self is fused with the kin. Concepts within the Bowen Family Systems Theory can further explain how Sophia and Robert developed their abilities terms in the emotional systems, the intellectual systems, and the feeling systems. It is important to note that the emotional systems are different from the feeling systems in this family systems theory, as Bowen implied that emotions are primal, while feelings bridge the gap between emotion and intellect (Bowen, 1978, as cited in Crossno, 2011). As such, this could also explain why Robert was having a hard time expressing himself, possibly due to his weakness in differentiating his emotions and feelings. In turn, this also explains how Sophia was able to freely speak to her husband and ask for him to be open with her and asking him that they get counseling despite having her feelings hurt and her emotions rocked. Application of DSM-IV-TR Diagnostic System It is possible that therapy sessions for couples might be affected by certain disorders or illnesses, and could affect the outcome of the treatment as well as the dynamics of the couple’s relationship. For Robert and Sophia’s case, the couple seems to be greatly affected by working in long hours in demanding jobs, which causes them to have animosity with one another. However, in addition to some unaddressed past issues, other issues observed in the couple traced back to the initial diagnostics prior to counseling can also be diagnosed using DSM-IV-TR. In the case of Robert, judging from his silences and withdrawn self, as well as his drinking problems and some correspondences showing to some extent his feelings of hopelessness, these show that he has alcohol-dependence problems (303.90), exacerbated by the presence of a recurrent major depressive disorder (296.33) (American Psychiatric Association, 2000). In addition to an unaddressed trauma in his early teens, these two initial diagnoses could provide additional explanations to his trouble expressing himself to Sophia. As for Sophia, it seems that despite seeming to have overcome her childhood traumatic experience, she developed acute stress disorder (308.3) which manifested itself for at least one week, and affected her concentration at work (APA, 2000). This happened after finding out Robert’s affair with a co-worker three weeks prior. Based on the GRAF scale, the couple scored 45, mainly due to the predominance of a clearly dysfunctional, unsatisfying relationship despite occasional times of competent functioning together (Committee on the Family, 1996). The presence of individual issues could affect the course of couple therapy for Robert and Sophia, and it is needed that these would be addressed first before attending to problems regarding their interpersonal relations. Social-Cultural Factors in the Assessment and Diagnosis of this Couple Various factors can affect how the couple may be assessed and diagnosed, especially since it has been mentioned that the two came from two different cultures and family backgrounds, aside from their own individual histories. These differences must be taken into account in order for therapy to succeed. Social-Cultural Background Robert is a German migrant to the US, and is an only child. As such, he is still strongly-influenced by the customs and traditions of his native country, which were carried over to the US where the family settled. Sophia on the other hand is part of a large family that has been in the US for many generations, and while she has already imbibed other customs outside of her family, she still keeps in touch with the Italian spirit of kinship, as she frequently visits her family. These deeply-ingrained values can greatly affect the way how an individual would handle relationships in the future, as exemplified by how the couple acts in their interpersonal relationship (Lebow, et al., 2012). Personal History While the age of 15 seems not to be too young to cause any problems, due to possible reasons such as language barriers, anxieties when meeting other people, or simply not having enough ability to form relations with others, Robert grew up lonely, which affected him in his later years. Meanwhile, while having the chance to grow in a large and close-knit household, due to the shame in disclosing her being abused by an uncle, or the issue that it could upset the household’s peace, Sophia chose to stay mum over such a heavy issue. It could be that the same need to protect the family name prevents her from being fully honest with her husband, and in a way causes her to be distant from him as well. The implications of having unaddressed issues not only cause impairment in abilities to form meaningful relationships, but also contribute to future dissatisfactions in marital relations, in turn causing the appearance of depressive symptoms for either or both parties (Beach, et al., 2006; Fingerman & Bermann, 2000). Environment The couple’s stressful jobs and lack of sufficient rest prevents them from spending quality time with each other, and instead projecting out their stresses to each other. In addition, they do not address issues clearly and early, and do not find compromising ways to resolve them, creating greater friction and distance. Such an environment caused them to turn to others instead of being and seeking each other’s support, causing Robert to entertain extra-marital affairs. Showing a lack of concern and support for a spouse is not exhibited in healthy marital relationships (Gordon, et al., 2000). Relationship Systems Robert was an isolated teen after migrating with his family to the US. Since he had no other relatives, and seemed to not have forged many friendships during his early years, it had an effect on his ability to form meaningful relationships, making him lonely (Fingerman & Bermann, 2000). Sophia had a chance to experience various kinds of relationships by having many family members around her. The large and close-knit family taught her how to form and maintain relationships with others (Fingerman & Bermann, 2000). The different ways that the couple see relationships caused them to act differently from what the other might expect, with Robert expected Sophia to be more open and honest, and Robert expecting Sophia to leave him alone since he believed that talking it out will not help much anyway. Impact of my Social-Cultural Background on the Diagnostic Process with this Couple The couple originating from multicultural backgrounds may cause issues with regards to how I might handle their relationship and individual issues. Because I am not fully aware of the limits of their individual cultural differences over their own values, I might easily pass judgment over Robert’s strong stance in not talking about his problems, or to Sophia’s ease in expressing herself. I could just simply tell them to talk things over, but that would make Robert feel negative over the whole counseling process. In addition, I feel that there is a stronger need to address Robert’s depression and alcohol-dependence first, before proceeding to counseling the couple as a group, since it could be that his silences might be affected by something else outside of the marriage. Possible Ethical Issues in Assessing and Diagnosing the Couple Ethical Standards that may Apply Identifying who the client is can be a problem, especially when one of the couples does not want to be a part of the counseling process. In the case that this happens, couple therapy must not proceed as such, since despite the psychologist agreeing and stipulating his or her role in the therapy session, one of the parties did not give consent over the whole process (American Association of Marital and Family Therapy, AMMFT, as cited in Gottlieb, et al., 2008). Another ethical issue would be the issue of confidentiality and of whether or not secrets will be withheld from each other, and this aspect needs to be defined clearly to the couple from the very beginning of the therapy session. In the case of Robert and Sophie, options such as having individual treatment prior to couple counseling as well as being presented with the issues of confidentiality and of releasing information will come first, so that they will be fully informed and could either choose to continue with any kind of treatment they agree to do. Lastly, should their records be needed in court for various reasons in the future, the couple must be informed of such possibilities, and their consent must be sought before such releases, otherwise the confidentiality of their information must remain (Gottlieb, et al., 2008). Treatment Plan for this Couple The initial goal for the couple is to address their communication issues with each other. But it is recommended that before the couple enters a treatment plan, individual issues must be addressed first, since it might be possible that these disorders could hinder the couple’s healing process (Gottlieb, et al., 2008). This is much more important with Robert’s case, since he has both an alcohol-dependence issue, along with major depressive disorder. He can choose to participate or not, but shall be informed of the possible results of having couple counseling without it. Should he and Sophia respond positively to the individual sessions, they will be given a chance to decide whether or not to continue with their original plan of undergoing couple counseling. If they do so and if after a few sessions it can be observed that the couple had scored higher in the GRAF scale, as well as getting feedback individually that they spend more time talking to each other in a non-hostile manner signifies positive progress with therapy. While the couple’s score was in the 3rd percentile on the GRAF scale, their intent of improving their relationship through counseling is one giant step for conscious change. By choosing to undergo both individual and couple counseling sessions, while both are still in the process of healing childhood trauma it is possible for Robert and Sophia to develop a meaningful relationship with their respective families, with other people, and with each other. References American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Washington, DC: Author. Beach, S. R., Wamboldt, M. Z., Kaslow, N. J., Heyman, R. E., & Reiss, D. (2006). Describing relationship problems in DSM-V: Toward better guidance for research and clinical practice. Journal of Family Psychology, 20(3), 359-368. Bowen, M. (1993). Family therapy in clinical practice. Lanham, MD: Rowman & Littlefield Publishers, Inc. 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