Monday, July 27, 2009

How I've Spent My Summer Vacation: Part II

Same idea, different class, less intro... let's get to the point!

Interview & Treatment Plan of Family Y

I. Introduction to Client and Significant Others

AF: 50, lawyer, Caucasian

AM: 52, entrepreneur, Caucasian, alcoholic diagnosis

CM: 16, 11th grade, athlete/honor student_(Twin A)

CM: 16 (IP), 11th grade_(Twin B

II. Presenting Concern

AF: Blames husband for financial distress within the family, feels that she has to work extra hours so that her sons can afford the life that she had growing up.

AM: Upset that he made such a poor business decision after so many years of being responsible within his own company. Upset that he cannot support his family they way he’d like to and that wife has taken it upon herself to be the “bread winner.”

CM: (Twin A) Very supportive of mother and the decisions she has made to support family. Blames father for throwing business away and causing mom to have to work so much harder. Feels supported in both athletics and academically by mom, but not as much by dad.

CM: (Twin B) Admires all the hard work that dad put into his own business for so many years and understands that mistakes happen. He feels mom and brother should understand that as well and support dad as he picks up the pieces. Argues with mom over his desire to pursue art and not athletics or academics like his twin.

III. Background Information

About 9 months ago Dad lost his business that he had since graduating college in a bad business deal. Ever since that time, Mom has taken on extra cases at work to compensate for the loss of the dual income within the home. Out of frustration over not being the primary bread winner for the family Dad took up drinking excessively over 6 months ago. The two sons have their own outlets for dealing with the family stress. Twin A works hard at school and is a star athlete at his high school. He admires his mom for going out of her way to provide more income for the family, and feels Dad is lazy. Twin B doesn’t care too much for school and uses art as his outlet. He admires Dad for all the years he worked so hard and for the fact he is trying to start another business from scratch. Upset with Mom for spending so much time fighting with Dad and not being more supportive in his efforts to pick up the pieces.

IV. Systematic Assessment

Client/Relational Strengths

Personal/Individual: All four have a distinct way of viewing life and in how to achieve goals not only for themselves, but for the family as well. Parents are both highly intelligent and educated. Sons are their own individuals and taken from the examples their parents set and made their own path.

Relational/social: Parents both come from strong families of origin, and are encouraging of their boys in the futures they hope to pursue.

Spiritual: AF and AM both share strong desire to be more committed and involved in local church. Boys enjoyed the different activities and outings supported by the youth group.

Family Structure and Interaction Patterns

Couple Subsystem (to be assessed): Parents’

Couple Boundaries: Enmeshed & Other

Rules for closeness/distance: Frequently disagree on the choices the other has made for the family financially and in the area of work ethic. Avoid each other when argument becomes too heated and repeat pattern on daily basis. Wife places pressure on husband to conduct self in the same way as she in accordance to values/wishes.

Couple Problem Interaction Pattern:

Start of tension: AF informs AM that he needs to stop playing around with “making up” another business and find a “real job.”

Conflict/symptom escalation: AM gets upset that AF does not respect his desires/wishes in how he wants to support the family.

Return to “normal”/homeostasis: Ends by AM starting to drink and AF withdrawing from conversation to another room.

Communication Stances:

AF: Placator

AM: Blamer

Describe dynamic: AF focues on the needs of the family and how to maintain that financially. AM is focused on what is the best way to support his family based upon his desires (career-wise). AF picks up extra hours while AM struggles with what to do.

Divorce Indicators:

Criticism: AF/AM, Ex: Both critical in the approach to supporting family financially

Defensiveness: AM, Ex: AM very defensive in that he will approach his job search the way he wants to and feels is best for his family.

Contempt: NA

Stonewalling: AF/AM, Ex: Both tend to stonewall when AM begins drinking.

Failed repair attempts: Ex: Neither frequently extends repair attempt.

Not accept influence: AM, Ex: AM refusing to accept influence of AF at this point in relationship due to his sense of duty to be the primary provider for family doing what he desires professionally.

Harsh startup: AF, Ex: AF increasingly harsh in raising issues.

Hierarchy Between Children/Parents:

AF: Inconsistent

AM: Inconsistent

Ex: Both parents show an inconsistent style in that AF is more authoritative with Twin B and more permissive with Twin A, whereas AM is the opposite (authoritative with Twin A and permissive with Twin B). Both CMs would like to see parents support any decision they make towards their future, but find it hard to work through the disapproval when parents do not seem to understand their differences.


AF and CM (Twin A) against AM: Ex: In last few months, AF has grown closer to CM (twin A) in support of his desire to pursue an athletic scholarship for college over an academic scholarship, would like to pursue a career in professional sports, each angry that AM does not feel this is a productive or worthy career choice.

AM and CM (Twin B) against AF: Ex: In last few months, AM has grown closer to CM (twin B) in support of his desire to pursue art as a career choice and possibly open up an art gallery one day. AM admires CM tenacity and joy for the arts. Each angry that AF does not feel art is a “smart” career and stereotypes that artists are “druggies.”

Communication Stances:

AF: Placator

AM: Blamer

CM (Twin A): Superreasonable

CM (Twin B): Irrelevant

Ex: CM (twin A) follows the belief that as he pursues and does well in each area of his life he can distract from problems at home. CM (twin B) is focused on avoiding any and all tension and enjoys the escape that his artwork brings, has no desire to please anyone and is grateful to not have to try to please his father. AF is more focused on the financial needs of the family over emotional/mental needs. AM is more focused on his needs to provide for the family.

Hypothesis (Describe possible role or function of symptom in maintaining family homeostasis):

Both CM’s emotional and mental needs for the support of both parents during this time in their life has forced the family to address dynamics that were only mildly problematic in the past: AF’s obligation to be primary financial provider, AM’s depression/lack of availability in the evenings for family time, and the couple’s unresolved issues related to AM’s professional dilemma.

Substance/Alcohol abuse: Hx: AM’s paternal grandfather and father were alcoholics during bad business times/abuse associated with negative professional outcomes.

Sexual/physical/emotional abuse: NA

Parent/child relations: Hx: Parents on both sides have close relationships with children in which they share common interests which fulfill unmet needs in marriage.

Physical/mental disorders: NA

Historical incidents of presenting problem: Hx: AM was unable to connect with father growing up due to father’s desire to make it in the business world, often times leaving him unavailable. AM related mostly to mother emotionally and mentally. Sister had close relationship with father and was distant with mother.

Family Strengths: Strong work ethic, desire to make it on their own and not become dependent on society; professionals; highly intellectual.

Previous Solutions and Unique Outcomes

Solutions that DIDN’T work: The couple arguing about AM’s job situation and choice to pursue another business venture has not helped; parents have not provided a united front in supporting (equally) the desires/interests of twin CMs.

Solutions that DID work: AM’s desire to get back in the workforce and be the sole provider for his family. AF willing to step up professionally for a season to bring in more income to support family. AM’s support of CM’s (twin B) desire to pursue art and AF’s support of CM’s (twin A) desire to pursue sports.

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