The Assignment:

Respond to at least two of your colleagues by providing feedback on each colleague’s therapeutic approach based on a narrative family therapeutic perspective. Support your feedback with evidence-based literature and/or your own experiences with clients. Support your responses with evidence-based literature with at least two references in each colleagues response.

Colleagues #: 1

The family client is made up of a father, mother, and their son, a ten-year-old boy. The family is biracial and is made up of four people; father, mother, a ten-year-old son, and a seven-year-old daughter.  Initially, they had visited the clinic on a referral basis from the family’s psychiatrist. They had concerns with the behavioral issues their ten-year-old son exhibited while at home as well as at school.  The son is currently in fifth grade and attends a public school, the mother runs a local coffee shop in their neighborhood, and the father is a construction worker. The mother was talkative and soon started talking about stressors in life, including their son’s behavioral issues. She states that besides receiving services and extra help her son gets while at school, he is still lagging behind.   The exact services had not been explained. The father did not talk much. In fact, he sat away from the family and always displayed a sarcastic grin on his face every time the mother complained. The son was friendly but did not talk much.

After assessments and evaluations, diagnostic evaluations established that the kid had ADHD. In addition to this, the family displayed tendencies of dysfunctional interactions. Once the family unit was mentioned, the mother was quick to state that she believes that there was an issue with the way the whole family functioned. She further suggested that they needed help as a family to understand their situation better as we as know why their son was having behavioral issues. Family therapy was suggested. Everyone but the father readily consented to the suggestion. He later on consented.

           Over the past two sessions, the father seemed uncomfortable and hardly participated. He would once in a while tell his wife to shut up when confronted and criticized. The mother always brought up her dissatisfaction with the way her husband lacked warmth and concern for their son’s issues. She felt that the whole burden of raising their kids was on her. She further stated that without him interfering, the son would soon influence their younger daughter, which was already happening. The son spent much of the time stooped over the table due to attention being always on him. He was always silent and uncomfortable.

           Interactions between the clients were more complicated than anticipated, and too much time was spent on the interaction between the mother and the therapist. A therapeutic relationship was easily formed between the mother and the therapist. The other members of the family hesitated, with a continual alliance between the mother and the therapist, father’s resistance and withdrawal increased. After the first session, improvement in the son’s behavior was noted. He became more attentive and stopped arguing and beating up his younger sister. However, as the spotlight shifted to the husband and their marital problems, the son took the husband’s seat, sat in a darkened corner, and hardly participated. Being constantly blamed for his behavioral issues was replaced by total exclusion, which triggered behavioral issues. At the moment, as reported by the mother, he hardly listens to anyone, always argues, and beats up his sister; he talks back at everyone, including adults, and is always withdrawn. More so, now that he is confined at home, he gets angry quickly, and it is tough to calm him down. He is more irritable and will not listen to anyone. The mother is concerned that the therapy sessions are not helping.

Technique used

Structural family therapy focuses on family as a whole rather than individuals within a family. It focuses on subsystems, family interaction patterns, as well as how they respond.  I have had two sessions with this family so far. A structural family therapeutic technique was used. This is because there was a need to present a united front when it came to parenting and interaction with the child. The main problem existed within the parental subsystem. Therefore, the focus of the therapeutic activities mostly lied on strengthening the parental subsystem. Some of the therapeutic activities employed included; role-playing, paradoxical tasks, interpretations, boundary-making, restructuring, joining and reframing. The goal was to ensure the family’s interactions and communications were more flexible. It has been proven that the use of this technique results in good or rather positive behavior among children, especially adolescents. In addition to this, parental authority is reinforced (Jiménez et al., 2019)

With structural family therapy techniques, patterns of interactions that create issues within the family unit were to be assessed. The purpose of using this technique was to change the whole family unit rather than focusing on individual family members. From the family’s interactions, it was obvious that the son, who was the dysfunctional element in the family, enabled the couple to avoid conflicts which led to a surge in unresolved issues in the parental subsystem. Additionally, it was established that there were boundaries between the father and the son, which were characterized by infrequent interactions between the two, harsh criticism by the father, and the son always provoking criticism.

With the technique, I expected that the communication and interactions between this family unit would improve. At the initiation of the therapy sessions, the mother would bring up family complaints, mostly her problems and the problems she perceived in others. She further would try to engage the therapist as a judge at times sympathizer and sometimes a supporter. Efforts to pull away from this pattern proved futile.  However, through observations and charts following the progress of the family, interactions between the family members are still dysfunctional. The son, who was the primary cause of the therapy, is not benefiting from the session. Blaming has been replaced by virtual exclusion resulting in his behavioral issues remaining unresolved.

Colleagues #: 2

This discussion presents a case of a family client who is not progressing well with therapy. It identifies the pertinent issues, the areas of concern, and discusses the additional information that may help change the potential outcomes of therapy with this family.

The client’s family described in this discussion comprises S, a 12-year-old female, who is torn in between her mother and father who are separated. S lives with her mother and grandmother but often visits her father. When she visits her father, he criticizes her mom. The situation has worsened after S’s father discovered that her mother has a boyfriend. S’s grandmother reported that the mother’s boyfriend is ‘nothing like’ S’s father who makes everyone feel bad all the time. Since initializing therapy, S’s mother and grandmother have continually depicted S’s father as a bad person. On the other hand, S’s father has been defending the need to remain with his daughter. At the moment, therapy with this family client is not progressing as expected because there is mistrust, alliances against one party, and S is further torn in between. The two sides appear to be competing to win a point. As a result, S continues to be distressed and her wellbeing is further deteriorating.

The therapeutic approach used with this client family is structural family therapy. This approach aims at understanding the communication patterns and behaviors of the family to highlight the dysfunctional family interactions (Jiménez, Hidalgo, Baena, León, & Lorence, 2019). This intervention has been beneficial in terms of helping the family members understand how the behavior of each individual is affecting S’s wellbeing who is being asked to choose sides. At the same time, this therapy has been beneficial in uncovering the alliances within the family that are contributing to the problem. However, there are still issues regarding the best way forward for all the family members to coexist together.

Additional information that can help to change the therapy outcomes regards the understanding that the behavior of each person in the family is contributing to the problem. While S’s father needs to stop the criticisms against S’s mother, the others, including S’s mother and grandmother, need to reflect on their behaviors to understand how it is affecting the child’s wellbeing. Because it is the child who is suffering when the adults fight, making each member understand this fact may help change the outcomes of therapy (Jiménez, Hidalgo, Baena, León, & Lorence, 2019). Additionally, making the family understand that the father and her daughter as well as the mother and father will be linked together is an important step towards a successful therapy.