Family Therapy Case Study Essay

This family consists of BJ (65), Jing (40), Paige (16), and Sunny (14). BJ is Jing’s father, and he recently moved in with Jing and her two children. Initially, Jing came in for individual therapy; however, because her stress and depression seemed so related to difficulties going on at home, her therapist recommended that the whole family start therapy together. The intake mentioned that BJ’s wife died eight months ago, and that he moved in with Jing and her children six weeks ago. It also mentioned that Paige and Sunny are both acting out, and that it has recently gotten much worse. Paige is dating tons of boys and smoking weed, and Sunny is refusing to attend school. Paige and Sunny do not get along with BJ, and fighting has increased since they all began living together.
In looking at cultural factors, one consideration for this family would be that they are a multigenerational household due to financial difficulties. Limited income and stress related to

finances may contribute a good deal to the difficulties the family is currently facing, but may also play a role in resiliency. Other unique considerations would be that Jing raised her children independently, after leaving an abusive spouse, and BJ’s military background. All of these factors could be contributing to the recent issues the family is experiencing.
Assessments Needed
Before therapy progresses very far, I would want to assess for a few specific things based on information gathered prior to meeting the family.

On the intake, Paige indicated that she had previously experienced panic attacks and also drug usage. I would want to assess for both of these, in order to better understand if they are related and the extent of her drug usage. If it is extreme or causing significant issues, it may be something that needs to be handled prior to beginning family therapy. I would also assess how grief is impacting each member of the family. Their grandmother died eight months ago, and I am curious how involved she was in her daughter’s and grandchildren’s lives. Grief can look profoundly different for different people, and I am wondering if some of the acting out is a result of the grieving process. I also wonder if it has affected BJ’s basic day-to-day functioning in a way that contributes to the frequent arguments between himself, Paige, and Sunny that were mentioned on the

intake.
In looking at this family through a Bowenian lens, my general assessment would be done by creating a genogram. Especially because three generations of the family are present in therapy, I think conducting a thorough genogram would be beneficial. It would help the therapist to gain an understanding of the whole context of the family, and also allow family members to start recognizing potential patterns. In addition to creating the genogram to gain information about patterns, I would also use this assessment as a time to figure out who in the family seems to be the most motivated to work towards change, so that I can better understand and empathize with where everyone is in regards to willingness to change, and learn who I can rely on later to take the chance (Titleman, 1998).
Conceptualize the Problem
In conceptualizing the problem through a Bowenian lens, I would hypothesize that the symptoms bringing this family in for therapy (mainly the teens’ disobedience and disruptive behaviors) are misguided attempts to adapt to the changes that have occurred within the family in the past year (Crossno, 2011). In his work, Titleman explains that “the family is a system that automatically—below the level of feelings—responds to changes in ‘togetherness’ and individuality’ within and among the membership of the extended family” (Titleman, 1998, p 51). With their grandmother dying and then their grandfather moving in and assuming responsibility over them, the increase in negative symptoms would make logical sense, as so much has changed for this family so recently. I would also hypothesize that the family is currently struggling with high anxiety within the system and a lack of differentiation between individual family members that leads to emotional reactivity (Crossno, 2011).
In incorporating Satir thinking into this conceptualization, I would guess that this family is currently operating as a closed-system, where people are using blaming stances to handle problems and are being incongruent about feelings with others in the system (Martinez et al., 2011). I would hypothesize that all members of this family are simultaneously desperate for connection but are also unaware of how to seek that out in ways that do not involve conflict and emotional reactivity. I think that Sunny in particular is unsure of his place in the family, as the youngest male, especially now that his grandfather has joined in the immediate family. Similarly, I feel as if Jing, Paige, and BJ are also trying to renegotiate their place in the family and that their current behaviors do not truly reflect on how they would like to act or be perceived.
Therapist’s Role
In Bowen Family Systems Theory, the therapist is like a coach who both teaches and encourages clients (Crossno, 2011). A Bowenian therapist uses psychoeducation to talk about human functioning and helps family members to be their own experts on family dynamics, and then encourages them to take active responsibility for their own contributions to the familial patterns that are causing distress (Crossno, 2011). In this model it is also stressed that being connected to our own family of origin and aware of our own family processes is a necessary prerequisite before we can help clients to become their own experts.
In the Satir model of experiential therapy, the therapist is supposed to be an “encouraging resource tool” for the family (Martinez et al., 2011, p. 180). In this model, therapists should focus on a client’s inherent value as a human and work to educate, support, and encourage them to make healthy changes in their lives (Martinez et al., 2011). Although these two models could look very different in the therapy room, I can combine them in my approach to working with this family. Both Satir and Bowen emphasized educating clients, so I will work in session to both validate the feelings of frustration and confusion that must be occurring after the loss of their grandmother and the introduction of BJ into the family home, and I will provide some education on how this kind of change could potentially affect family functioning.
Treatment Plan
My short-term goals for this family would be to join with them and create enough of a sincere dynamic that they feel therapy is a safe place to explore vulnerabilities. In order to join, I would take a strengths-based approach where I would validate their current feelings and help them to see they are capable of making changes and improving their family life (Martinez et al., 2011). I would show each member of the family equal respect and appreciation, and make therapy a safe-place where they could feel comfortable focusing on their own inherent abilities and power (Satir et al., 1991). In order to do this, I would help coach them about ideas like emotional reactivity and a solid sense of self, as well as congruence.
Once I have joined and a sufficient amount of information about the family’s past and current issues has been gathered, I will be able to bring in interventions that will hopefully lead to new insights into family dynamics. Taking the genogram I already made for assessment purposes, I would use it to help the family gain some perspective on intergenerational patterns. As Bowenian and Satir-based therapy are both very reliant on insights as instigators of behavioral changes, I would talk about patterns found in the genogram and how they are contributing to current family dysfunction (Crossno, 2011). I would work to de-enmesh issues, so that people could see the impact the past has on current situations and be able to separate them from each other (Satir et al., 1991).
An additional intervention I would want to do with this family would be to have them sculpt their own unique survival stances, as a way for them to gain new perspectives and see themselves in a different context than they usually do (Satir et al., 1991). This would be a way for them to take what they learned through psycho-education and exploration of their own internal selves and make it external and overt (Satir et al., 1991). I think sculpting these stances would be a good way for the family to understand how they all contribute to problems, and potentially help them to see if there are any alternate ways they could interact with each other (Satir et al., 1991).
For this family, my long-term goals would be primarily to open up the system so that people can engage in more than surface-level ways with each other without feeling like they are losing themselves in their relationships (Crossno, 2011). I would also want them to understand how their coping stances and defenses are products from past events and experiences and that they are capable of updating how they handle conflict with more effective and healthy options (Satir et al., 1991). If people are better able to share their true selves with others and remain congruent in thoughts, feelings, and behaviors, I think that new insights and perspectives would naturally lead to a cessation of the initial symptoms that had them seeking out therapy.
As for termination, both Bowenian and Satir-based therapy follow a belief that the work done in therapy is part of a lifelong practice. In Satir-based, termination is more up to the therapist’s judgment that it is the client’s, but in Bowenian therapy the clients decided when they have done enough to not need therapy anymore (Crossno, 2011). In this case, I would have the decision about when to terminate be collaborative, and discuss it at a point where I feel like they are being more congruent with each other and less emotionally reactive and aware of underlying feelings of others than they were prior to therapy.