Research Paper on "Family Therapy Models, Diagnosis"

Research Paper 9 pages (3411 words) Sources: 1+

[EXCERPT] . . . .

These patterns of interaction are necessary for the regular functioning of the family, even though the members do not realize they are part of this structure. Another key component in the Minuchin's model is the notion of subsystems. Families can be differentiated into subsystems based on generation, gender, and function, which are demarcated by interpersonal boundaries. When a therapist observes a family, they may realize that the structure that flows from those patterns of interactions is contained within a sub-substructure and these sub-structures interact within the whole system according to certain rules or boundaries (ibid, 240-247).

Systems or subsystems are created when two partners join with the intention of forming a family, this is the formal beginning of a new family unit. Nevertheless, the new family must walk through many steps until they can create a viable unit. Minuchin explored the subsystems that exist in this family. Each person within the family belongs to a subsystem, that we may call it, dyad (husband and wife), generational (siblings),

gender (men, women) or task (parental subsystem) (ibid, 248-253).

The structural model has three essential theoretical components: family structure, family subsystems and family boundaries. family boundaries are non-visible limits or perimeters that regulate contact with other members in the family. An important task of the parental subsystem is to develop healthy limits or boundaries that keep the whole family system safe from inappropriate intrusion of outsiders or any possible danger. Structural family therapists use an array of techniques to help the family discover the inner strength that they have to overcome their problems (ibid, 240-247).

Joining is a technique used with the purpose of bringing ease and a sense of confidence into the family therapy session. It is generally known among structural therapists that if a therapist wants to help a family in restructuring or finding a way to solve their problems, it is necessary for the therapist to join that family in a way that they see the therapist as somebody in whom

they can trust (ibid, 249).

The first strategy a therapist must implement is to find a way to disarm defenses and ease anxiety so, the course of therapy will be a useful and helpful way to change the family's unhealthy patterns. Joining is not only courtesy or social respect, it is a deeper way of becoming part of the family, of enlisting oneself with them, so the family can be better helped. There are many different ways of joining with a family. For instance, making every family member feel comfortable, being attentive to the concerns of each member, repeating key expressions they might use during the sessions, and showing empathy and understanding. This attitude, when it is showed in a way that each family member is welcome to talk and be listened to opens the way for family members to begin listening to each other and establish a bond with the therapist that enable them to accept the challenges to come. Joining is the process through which a therapist helps a family and its members to open their hearts and minds to each other in a family therapy session.

This process of joining will help the therapist to have a deeper understanding of the structure and dynamic of this particular family. If the family has not created clear boundaries, it is necessary to help them to create them.

Minuchin indicated a starting point in determining the boundaries in a family is how they sit in a session. Sometimes this non-spoken arrangement shows internal alliances, for instance, mother and son against father, or mother and daughter, against father and son. The therapist needs to see the way members talk and if they let other members speak without interruptions.

Establishing or creating a boundary is a technique that helps to create a new structure which makes it possible for a family to find a solution to their problem. An example of boundary making is the therapist's intervention allowing the daughter to complete her statement when the mother tries to interrupt her. Another way is to help the rebellious son to see in his parents the ones from whom he received life and actual economic sustenance. By doing so, he will see a boundary that must be respected, even though he is not happy with his parents' performance (ibid, 243).

The therapist's role is to help the family to find a way to change their dysfunctional patterns. By direct and active interventions, by positive reinforcement, by using a respectful sense of humor and by sporadic and strategic advices. The structural therapist helps the family members to restructure their own family. The goal of a therapist while working in family therapy is to change the organization of the family in a way that the members of the family can experience and see the positive changes. Structural therapists are window openers, who help family members to expand their perspectives and context, to the point of exploring the unfamiliar as a possible solution of the family's problem. The therapist confirms family members and encourages them to experiment with behavior that has previously been constrained by the family system. As new possibilities emerge, the family organism becomes more complex and develops more acceptable alternatives for problem solving.

Psychiatric Diagnosis of Divorce-Case Study-Related to Depression-

The DSM IV defines depression as a complication (especially in the case of minor or brief recurrent depression) that is symptomatic of a deeper underlying condition. Even in the case of major depressive episodes, they are usually arise from bereavement and may persist in normal circumstances from 2 months for 1 year in the wake of the loss. Divorce causes similar effects. Therefore, the use of family treatment in coordination is advisable to preclude over diagnosis in the depression arena that might lead to an inadvertent diagnosis of Major Depressive episodes (First, Frances & Pincus, 2004. 190-192). This might lead to the occasion of inadvertent mixed episodes diagnosis such as hyper manic episodes (ibid, 196) or a major depressive disorders (ibid, 199).

Case Study and Conclusion

From the DSM-IV-TR Case Study book is a case study which deals with Ms. A who is a 28-year-old woman with an ongoing history of mood instability that dates back to her adolescence. Her mood varies from depressed to irritable and to being to rapidly cheerful. This happens several times a day. Her suicide attempts have numbered five, although all were nonlethal.

She is from is the product of a broken home where the parents were estranged. Her father was verbally and physically abusive and left when the patient was aged 9 years. Her mother is an alcoholic and a cocaine addict and has never been reliable. The patient has had several intense relationships with a number of men. None of these have lasted more than 6 months. She has experimented with homosexual relationships, and cannot decide if she is bisexual or not. She takes antidepressants from several different classes. There has been moderate initial relief, but are followed up by the return of her depression. She has tried psychotherapy several times but has always terminated prematurely when she perceived her therapist to be unhelpful (First, Frances & Pincus, 2004, 170) .

This would be a classic time for family therapy to step in and attempt to sort out the issue. Obviously, a transgenerational pattern approach is necessary due to the causes being buried in the past and connected with the lack of a firm parental relationship due to substance abuse, parental abuse and divorce issues in the home. It would be important to try to engage the mother in therapy with the daughter so that she can have some closure on the childhood issues and try to deal with the deeper issues that are bringing on the depression and the need for medication. Obviously she needs to stay on the psychiatric treatment regimen, but we have to try to deal with the older childhood issues as well.

While bringing in the mother might be difficult, is necessary to break the emotional cycle that triggers the depressive episodes as she recalls the childhood traumas. As we saw above, family therapists work on the emotional process in that involves the person and analyzes how this matters to the patient. The therapist must focus on the individuals growth and in the development of person's self-esteem.

In the case of Mrs. A, she has a horrible self-esteem problem. Approval from a mother figure would likely be positive since the father was abusive. While the mother has substance abuse issues, she was uninvolved in the abuse, so it would provide an alternative handle for the issues. In this way, while the cycle may not be broken totally, the therapist has to work with the tools that are at hand.

From a cognitive-behavioral approach, the family therapist predict could work on breaking the illogical beliefs that work as the principal triggers for the emotional distress… READ MORE

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