Case Conceptualization

I have chosen the family for my case conceptualization, and have used Minuchin's Structural Family Therapy in my case conceptualization plan. I like Minuchin's (2007) therapy for several reasons, but his use of metaphor struck me as infusing a little humor into the therapy without it being at the expense of any one. I like the idea of metaphor in counseling - I suppose it is somewhat like props - it's like a bit of comic relief to lighten the situation. Like any technique, it must be used appropriately. I also like Minuchin's (2008) perception of family members as subsystems of the major family system. Minuchin saw the family as a "psychosocial system embedded within wider social systems" (Vertere, 2001, p. 134) In this case, the subsystems are the father/self, mother/self, daughter/self, father/daughter, father/mother, and mother/daughter. Each subsystem must be supported and nurtured to strengthen the family system. In his 4 step plan Minuchin (2008) believes the therapist should proceed to "(1) open up the presenting complaint; (2) highlighting problem-maintaining interactions; (3) (create) a structurally focused exploration of the past; and (4) an exploration of alternative ways of relating" (p. 9).

After listening to the family, the apparent primary issue is a breakdown in the father/mother subsystem. As the family grew, the father had a strong sense of autonomy and nurtured his own sense of development (father/self subsystem), but failed to attend to the relationship with his wife ( the mother/father subsystem.) The wife was not able to develop her own sense of autonomy (mother/self subsystem), and as her relationship with her husband deteriorated, her boundaries with her daughter (mother/daughter subsystem became more diffuse. The mother replaced the relationship with her husband with the relationship with her daughter. As the power between the mother and daughter's relationship increased, it increased the separation between the father/mother subsystem. The strength of the mother/daughter subsystem further jeopardized the father/daughter subsystem as well as the father/mother subsystem.

The daughter's drinking is a secondary issue (rule out alcohol abuse). Because the mother sees the daughter as a friend and confidante, she is accommodating, and diffuses the boundaries of their relationship. As a result, the mother allows the daughter to drink with her. Because the mother has relinquished her role as parent, the daughter does not perceive her mother as a parent, but as a friend and "cool Mom". Minuchin (2007) said "the enmeshed parent-and-disengaged-partner dynamic can be brought into focus by asking, 'when did you divorce your partner and marry the children'" (p. 7). Perosa and Perosa (1993) found that girls who have a less than well-defined relationship with the mother, have a weaker sense of identity "and had more problems with their drinking behavior" (p. 488).

When the daughter describes her relationship with her father, she may be parroting the concerns of her mother, rather than her own dissatisfaction with the relationship. In some ways, the daughter has taken on the mother's frustration with the degradation of the relationship with her husband. Because of the enmeshed mother/daughter subsystem, the daughter has not had the opportunity to individuate and create her own relationship with her father. In essence, the daughter has not had the opportunity to nurture her self subsystem.

The father, on the other hand, has become more rigid in his boundaries, perhaps overcompensating for the mother who has relinquished her parenting boundaries with her daughter. The boundaries between the father and daughter have become rigid because their need for nurturing continue to be unmet. The mother is not parenting, but over-nurturing the daughter. The father becomes the sole authority figure who is perceived by the mother and daughter as cold and ruthless. The rigid boundaries between the father and mother/daughter prevent genuine warm contact between the two sides. He has become disengaged with his wife.

The primary diagnosis for this family is a breakdown of the family structure. (Rule out alchohol abuse in daughter.) Strengthening each of the subsystems will help to re-establish clear boundaries. The short and long-term treatment plans are designed to strengthen each individual as well as their relationships within the family system. Vetere (2001) suggests for structural family therapy to be effective, the counselor must help the family design or re-establish a working system by changing the subsystems. For this reason, I have focused on the individual subsystems.

Goals:

Short-term plan #1: Rebuilding the husband/wife subsystem. Their homework will be to have a date night once per week. Additionally, they may benefit from couples counseling once per month until they have regained some of the structure to their partnership.

Short-term plan #2: The father and daughter need to re-build their relationship, starting by spending one hour per week in an environment that will allow them to engage in interpersonal communication. Their homework for the first week is to write a letter to the other, telling them how they would like to re-create the relationship, not expressing what they do not like, but how they want to rebuild.

Short-term plan #3: The mother needs to become involved outside the home once per week doing something that fulfills her, and has nothing to do with the daughter or husband. Her homework is to return with at least three ideas toward this involvement. This plan is aimed toward strengthening her self subsystem.

The long-term goal for this family is to re-establish clear boundaries for each role and to support each member's autonomy through nurture, support, and respect, and re-establish a hierarchy of authority wherein the parents function appropriately with their daughter.

Indications of the Family's Progress

I will be able to tell the family is getting better by several indications:

1.  The mother and father talk happily about their date night, and are mostly on the same side of the issues related to their daughter;

2.  The mother has found some fulfillment from her hobby, advocacy, volunteerism, or other involvement outside of the home;

3.  The daughter and father talk to each other calmly and are in general agreement about the daughter's plans for the future. The daughter openly respects her father's guidance and the father accepts his daughter's self-sufficiency;

4.  Finally, each member expresses satisfaction about the changes in their family.

References:

Minuchin, S., Nichols, M. P., & Lee, W. (2007). Assessing families and couples: From symptom to system. Boston: Pearson/Allyn and Bacon.

Perosa, S. L., & Perosa, L. M. (1993). Relationships among Minuchin's structural family model, identity achievement, and coping style. Journal of Counseling Psychology, 40(4), 479-489. doi: 10.1037//0022-0167.40.4.479

Vetere, A. (2001). Therapy matters: Structural family therapy. Child & Adolescent Mental Health, 6(3), 133-139.