psychology case study and need a sample draft to help me learn.
Attached is a sample paper for this assignment. The paper must done utilizing Solution Focused Therapy and applying it to the following case: Julia is a 29 year old woman. She is the youngest of six siblings. All were born in the United States. Her parents grew up in Columbia and immigrated just after they were married. She has a large extended family and most of them live in South Florida. She describes her family as “very affectionate, loud, and loving.” Andrew is a 30 year old man. He has one younger brother. While he identifies himself as an “Irish-American,” his family has been in the United States for more than four generations. His father and brother work as prison guards. He describe a lack of emotion and affection in his family-of-origin, in fact, he noted that there was a disdain for it. Andrew describes this approach to emotion as the “O’Bryan curse.” He states that he liked the emotional closeness in Julia’s family. They met eleven years ago when they were both working in the same grocery store. They were instantly attracted to each other. They were married within six months after meeting and now have two daughters, Samantha, 10, and Carly, 8. They describe their children as having “regular” problems and state that Julia is the primary disciplinarian. Julia stays at home to care for the home and the children, but works part-time jobs on occasion to bring in extra money. Andrew is a manager at a national grocery store chain and recently accepted a promotion which meant he would have to commute three hours per day. Their presenting issue in therapy is that Julia “is always the last to know,” about meaningful things in Andrew’s life. This includes 1) the recent promotion, 2) a gambling habit, 3) a ten-year friendship with a male friend who Julia did not like, and 4) anonymous internet “chatting” that was sexual in nature. They say their relationship is “on the brink.”
Requirements:
The O’Bryan Family: Applying Narrative Therapy with a Focus on the Whole Family
Treatment Plan
Problem 1: Julia expresses concern about being “the last to know” things from Andrew
Goal 1: Increase communication in the family
Methods:
Open communication in therapy through a collaborative approach
Situate the clients (inform them of narrative therapy techniques and encourage the family to ask the therapist questions)
Find out how each family member spends his/her time
Get each family member’s story
Construct a genogram to visualize transmissions of emotional expression
Externalize the problem: “Emotional Distance” is interfering with their lives
Minimize totalizing views
Ask questions
Deconstruction questions:
What conclusions about your relationship have you drawn because of Emotional Distance?
Opening space questions:
Was there a time when you overcame Emotional Distance?
Preference questions:
Do you think this time was a positive experience?
Story development questions:
How did that time differ from other times you were faced with Emotional Distance?
Meaning questions:
What do you think it means that you were able to overcome Emotional Distance that one time?
Questions to extend the story into the future:
What do you think will happen next year?
Relative influence questions:
How does Emotional Distance affect family life?
Landscape of action questions:
What were the circumstances surrounding the time you were able to overcome Emotional Distance?
How do you think your parents managed to pull it off?
Landscape of consciousness questions:
What do these new realizations tell you about what is important to you?
How does this affect how you see your parents?
Assist in re-authoring each family member’s story/help family members develop thick stories that are not problem-saturated
Date: Review progress and adjust goals on January 14, 2016
Problem 2: The family is physically distant
Goal 2: Improve their relationship by increasing positivity and physical closeness
Methods:
Open communication in therapy through a collaborative approach
Situate the clients (inform them of narrative therapy techniques and encourage the family to ask the therapist questions)
Find out how each family member spends his/her time
Get each family member’s story
Externalize the problem: “Physical Distance” is putting them down
Minimize totalizing views
Ask questions
Deconstruction questions:
What conclusions about your relationship have you drawn because of Physical Distance?
Opening space questions:
Was there a time when Physical Distance was not a problem?
Preference questions:
Did you prefer that Physical Distance was out of the question?
Story development questions:
How did that time differ from the times you were faced with Physical Distance?
Meaning questions:
What do you think it means that you were able to overcome Physical Distance that one time?
Questions to extend the story into the future:
What do you think will happen next year?
Relative influence questions:
How does Physical Distance affect family life?
Landscape of action questions:
What were the circumstances surrounding the time you were able to overcome Physical Distance?
How do you think your parents managed to pull it off?
Landscape of consciousness questions:
What do these new realizations tell you about what is important to you?
How does this affect how you see your parents?
How does this affect how you see the family?
Assist in re-authoring each family member’s story/help family members develop thick stories that are not problem-saturated
Date: Review progress and adjust goals on January 14, 2016
The O’Bryan Family: Applying Narrative Therapy with a Focus on the Whole Family
The O’Bryan family presents with concerns about emotional and physical closeness. Julia expresses that she is always “the last to know about meaningful things in Andrew’s life.” Meanwhile, Andrew engages in sexual chatting with another woman and recently accepted a promotion to work that requires him to drive 3 hours per day. According to the parents, Carly and Samantha have “regular” problems. However, it is likely that Carly and Samantha are affected by their parents’ relationship, which is currently “on the brink.” The present paper will develop a narrative therapy treatment plan for the O’Bryans by focusing on the theories of social constructionism and social constructivism and by emphasizing the importance of including the whole family.
Social Constructionism and Social Constructivism
According to George Kelly (1955), individuals perceive situations through subjective lenses. He proposed personal construct theory, which states that people create constructs of the environment and that these constructs organize their worlds (Nichols, 2013). It follows that if people view themselves and the world through a negative lens, then the goal of therapy should be to try on different lenses (Nichols, 2013, p. 60). Social constructivism addresses how we view ourselves and social constructionism explains that the way we perceive things is influenced by our language and culture (Nichols, 2013). Both of these theories are important because each emphasizes client-centered experiences. Social constructionism and social constructivism suggest that each family member is unique as a result of subjective inner and environmental experiences.
According to social constructivist theory, in therapy, families need to reframe certain ways of thinking. For example, children who are seen as “hyperactive” are treated or viewed differently from children who are seen as “misbehaving” (Nichols, 2013, p. 60). The goal is not to change problem behavior, but to change the perspective. Similarly, according to social constructionism, therapy should deal with deconstruction, or “freeing clients from the tyranny of entrenched beliefs” (Nichols, 2013, p. 62). Therefore, both social constructionism and social constructivism deal with the client’s interpretation or meaning of experiences.
Nichols (2013) explains that constructivism is not about what therapists do, but rather what they do not do. He explains that under the collaborative language-based systems model “therapists don’t adopt the role of expert, don’t assume that they know how families should change, and don’t push them in any particular direction” (p. 61). Therefore, the therapist takes an attitude of “not knowing.” This attitude of “not knowing” lends to a collaborative exploration process. This theory fits the O’Bryan family because their presenting problem involves communication deficits. A collaborative approach will provide each member of the O’Bryan family with the opportunity to develop an organized and coherent story.
Social constructionism and social constructivism differ from family systems theory. According to family systems theory, observing the sequence of interactions between family members is more important than understanding why family members behave in certain ways (Nichols, 2013). Social constructivism and social constructionism differ from this perspective because they focus on the meaning people attribute to their problems instead of focusing on processes of interaction (Nichols, 2013).
Within the study of interactive processes, family systems theory emphasizes the effects of cybernetics. Cybernetics is the study of family interactions and involves feedback loops (A affects B, which leads to C, which “feeds back” to A). Some have theorized that this system maintains stability in families (Jackson, 1959, as cited in Nichols, 2013). Cybernetics assumes that people function in a mechanistic way and gives the therapist more knowledge-credit than the client. Therefore, the relationship between the client and therapist is more vertical than horizontal, with the therapist taking on the role of the expert. Cybernetics also focuses on patterns of communication in families. Families with poor communication are likely to overreact or underreact to change (Nichols, 2013).
The O’Bryan curse reflects Don Jackson’s concept of family homeostasis, which describes families’ tendency to resist change (Nichols, 2013). Andrew fears being as emotionally suppressed as his family, but maintains the O’Bryan curse through his poor communication with Julia. Applying cybernetics to the O’Bryan family, we find that the O’Bryan curse is a self-fulfilling prophecy, which is a positive feedback loop. Andrew fears continuation of the O’Bryan curse, which leads to a decrease of communication with Julia, which justifies his fear of continuing the O’Bryan curse. Another feedback loop in the O’Bryan family involves interactions between Andrew and Julia. Julia enters therapy with complaints about Andrew’s tendency not to share information with her. However, it is unclear how she reacts when she finds out something aversive about Andrew. Does she scold him? Does she blame it on the O’Bryan curse? Does she criticize his family background for being closed or does she simply not understand it? Since the level of communication appears to be low, it may also be that Julia and Andrew simply do not confront these issues. Either way, the feedback loop would be constructed differently, with Andrew’s tendency to hide information somehow getting reinforced along the way.
Although cybernetics is an important aspect of family systems theory, it negates social constructionism and social constructivism. Unlike cybernetics, social constructionism and social constructivism treat the therapist-client relationship in a more horizontal manner, with the therapist maintaining a “not-knowing” stance. Though cybernetics seems to theoretically fit the O’Bryan family, it is likely that using a more collaborative approach between the therapist and client will lead to the best outcomes. A collaborative, “not knowing” approach is a better fit for the O’Bryan family because the focus of treatment will be on low levels of communication and distance in the family. The vignette suggests that Julia presents the problem to the therapist, so the therapist is unaware of Andrew’s and the children’s points of view. What are their stories? How does distance and poor communication affect them? Therefore, therapy with the O’Bryan family should include an approach that emphasizes communication and meaning.
Narrative Therapy
Narratives are a way for family members to organize and make sense of their lives (White, 1993). Narrative therapy is based on the assumption that people have personal narratives that contribute to expectations and that these expectations influence future behavior. Therefore, actually telling a story will shape a person’s perspective and behavior (White, 1993).
Narrative therapy has components of constructivism and constructionism because it involves the way people interpret their problems and the way others interpret their problems (or the way others may have contributed to their problem). Also, in line with social constructionism, narrative therapy is strongly associated with cultural experiences. White (1993) explains that inevitably, stories are “co-authored” within a community because society influences people’s stories (p. 38). A large component of narrative therapy is deconstruction, which is driven by the theory that people’s lives are guided by their interpretations of experiences, by language, and by culture (White, 1993).
Because narrative therapy suggests that people’s perceptions are influenced by language, narrative therapists are trained to phrase the client’s problem as an externalized force that affects the client’s life. After externalizing and villainizing the problem, the client is characterized as a knight who will defeat the problem (Omer, 1996). Narrative therapists also attempt to limit totalizing views in clients’ narratives. Totalizing views are generalized judgments about a person’s behavior. For example, in the O’Bryan family, Julia sees Andrew as secretive. She says that she is “always the last to know.” Therefore, a goal of narrative therapy with the O’Bryans would be to minimize totalizing views of Andrew.
A main objective of narrative therapy is to be nonjudgmental and to help clients understand and bring meaning to their experiences (Nichols, 2013). The therapeutic process is collaborative with the client and therapist filling in the gaps of the client’s narrative (Omer, 1996). During narrative therapy, the therapist adopts a “not-knowing” stance, allowing the client to be the expert. This is in line with social constructivism, which emphasizes the subjective nature of problems. Therefore, narrative therapy is a collaborative process with the client and therapist working together to develop the client’s story. Furthermore, because therapists are likely to be influenced by culture and language, narrative therapists are careful not to let those influences interfere with the therapeutic process (Becvar, 2008).
Because narrative therapy is strongly influenced by social constructionism and social constructivism, it incorporates elements that differ from family systems theory. Unlike family systems theory and psychoanalysis, narrative therapists do not believe that problems are inherent in individuals. They suggest that problems are the result of negative and narrow interpretations of the self (Nichols, 2013). According to narrative therapy, the client is not the problem: the problem is the problem. During therapy, narrative therapists externalize and personify problems. Therefore, narrative therapy concerns how problems influence families instead of how families influence problems. Also, cybernetics focuses on “self-defeating patterns of behavior,” whereas the “narrative metaphor focuses on self-defeating cognitions” (Nichols, 2013, p. 268). Therefore, narrative therapy focuses on cognitive flexibility as opposed to behavior modification within families. Furthermore, instead of focusing on negative feedback loops, narrative therapists focus on the family’s story and each family member’s interpretation of a situation.
White (2001) noticed that when clients begin narrative therapy, their stories tend to be problem-saturated (in which people are characterized by their problem). For example, a mother might focus on her son’s oppositional behavior and call him defiant. That same child may view his mother as unfair. Problem-saturated stories lead to the further development of similar stories. That is, problem-saturated stories lead to more problem-saturated stories. These stories are also referred to as “thin” stories because they include negative identity conclusions that need to be “unpacked” (White, 2001). Thin stories are unpacked through the re-authoring process (White, 1993). Externalizing conversations help unpack thin stories by allowing clients to identify times when they were able to overcome their problems (sparkling moments) (White, 2001). Therefore, narrative therapists will take the problems described and externalize them so the client has the opportunity to confront the problem without attaching it as a label to anyone. In line with social constructionism, problems are external to the individual because they are socially constructed. Externalizing problems also gives the family an opportunity to blame the problem and not each other. The narrative therapist helps family members fight the problem, which ends up being a “common enemy” (Nichols, 2013, p. 273). The fight begins by identifying unique outcomes (also called sparkling events), when the client was able to successfully confront the problem.
During the process of externalizing, the therapist asks how the problem affects various aspects of the client’s life (e.g., relationships, attitudes, personal ideas). Narrative therapy is largely based on asking questions. During the course of therapy, therapists ask different types of questions. Each question has a different goal: deconstruction questions externalize the problem; opening space questions help the client discover unique outcomes; preference questions confirm that these unique outcomes are preferred by the client; story development questions are asked to develop a new story based on identified unique outcomes; and meaning questions “challenge negative images of self” (Nichols, 2013, p. 284). Furthermore, questions about how the client’s story will progress are asked with an eye to the future. Questions regarding unique outcomes can either be landscape of action questions (which involve concrete details of how unique outcomes progress) or landscape of consciousness questions (which involve the client’s reflections on those experiences) (White, 1993). After considering the answers to these questions, the client should be able to identify unique outcomes (times when the client was able to overcome the problem). Identification of unique outcomes allows the client to create counterplots, which are new ways to perceive the experience (Nichols, 2013).
Focus on the Whole Family
In relation to the family system, Nichols (2013) explains that “the whole is always greater than the sum of its parts.” The family life cycle reflects how one family member’s adjustment is associated with other family members’ adjustment. It emphasizes the interconnected nature of familial experiences (Nichols, 2013). It is important to note that it would be difficult to understand the O’Bryan family by looking at one person or by only focusing on Andrew and Julia. Andrew and Julia come as a package with their two daughters. It is likely that problems between Andrew and Julia influence Carly and Samantha. Therefore, each family member needs to be given an opportunity to narrate their story and each family member needs to be included in therapy.
It is also important to note that families are embedded in larger systems. In line with social constructionism, society and larger subsystems influence people’s perceptions of themselves and of their experiences. Therefore, it is important to understand how these factors influence each family member. Examining this is particularly important for the O’Bryan family, who has clear traditions and practices that have been passed down across generations. For example, Andrew is following in the footsteps of the O’Bryan curse and Julia is following in the expressive footsteps of her family.
Although narratives are likely to explicate these processes, a pictorial representation of them will probably be useful to the O’Bryan family. The genogram is a visual representation of familial transmissions. Incorporating a genogram into therapy is relevant for the O’Bryan family, who is in need of a way to reconstruct their perceptions of their familial experiences. Visualizing different transmissions within the family will help the O’Bryans externalize their problem and understand how their environments have influenced their views of themselves and of each other.
Applying Narrative Therapy with a Focus on the Whole Family
The O’Bryan family has two main presenting problems: (a) Julia reports concerns about being “the last to know” about important things in Andrew’s life and (b) there has been increased physical distance between Andrew and the rest of the family. Therefore, the two main problems concern emotional distance and physical distance. The emotional distance is what Andrew refers to as the “O’Bryan curse.” According to Andrew, his family is emotionally closed, partly due to his Irish-American background. Conversely, Julia’s family is emotionally expressive, also partly due to her Hispanic background. Although Andrew claims to be haunted by the O’Bryan curse, he does not want to be emotionally closed. Andrew “[likes] the emotional closeness in Julia’s family.” This shows a motivation to change, which is a good prognostic sign for treatment.
The approach chosen for the O’Bryan family is mostly from a narrative therapy perspective; however, it also includes a genogram. Narrative therapy is a good fit for the O’Bryan family because the focus of narrative therapy is on opening communication between family members. Although it appears that the main problems in the family involve the parents’ relationship, it is important to focus on the whole family. It is likely that the disagreements between Julia and Andrew influence their children, so the whole family will be included in treatment. Also, the therapist asks each family member how he or she views the situation. This can facilitate communication and increase understanding and the uncovering of sparkling moments.
The genogram was added to the treatment plan because the family’s history emphasizes different emotional experiences in the maternal and paternal sides of the family. The genogram will be used as a pictorial representation of the family’s story. According to social constructionism, people’s perceptions are shaped by their environments. The genogram will serve as visual support for the development of their narratives.
The proposed treatment plan has two goals: (a) to increase communication in the family and (b) to improve relationships by increasing positivity and physical closeness. Following traditional approaches in narrative therapy, the therapist will adopt a “not knowing” stance and engage in collaborative story-development with the O’Bryans. The therapist will first situate the family members by telling them about narrative therapy and allowing them to ask the therapist questions. Then, the therapist will ask what each family member does with his or her free time. This will reveal each client’s strengths and how he or she views him or herself (Nichols, 2013). Each family member will then present his or her story and the therapist will ask several questions that will externalize each problem and that should invoke unique outcomes. Treatment will end with the re-authoring process, in which the O’Bryans will incorporate their discoveries of unique outcomes into the reconstruction of their stories.
It is expected that at the end of therapy, the O’Bryans will be more expressive with each other and spend more positive time with each other. The story-telling process and the genogram will provide each family member with a better understanding of the family structure and of familial beliefs and attributions of meaning. Discovering unique outcomes will also provide the family with a coping mechanism to prevent relapse. The family can discuss unique outcomes and continue re-authoring their stories.
References
Becvar, D. S. (2008). From the editor: The legacy of Michael White. Contemporary Family Therapy: An International Journal, 30(3), 139-140. doi:10.1007/s10591-008-9069-z
Nichols, M. P. (2013). Family therapy: Concepts and methods (10th ed.). Boston: Allyn and Bacon
Omer, H. (1996). Three styles of constructive therapy. In M. F. Hoyt, M. F. Hoyt (Eds.), Constructive therapies, Vol. 2 (pp. 319-333). New York, NY, US: Guilford Press.
White, M. (1993). Deconstruction and therapy. In S. G. Gilligan, R. Price, S. G. Gilligan, R. Price (Eds.), Therapeutic conversations (pp. 22-61). New York, NY, US: W W Norton & Co.
White, M. (2001). Narrative practice and the unpacking of identity conclusions. Gecko: A Journal of Deconstruction and Narrative Practice, 1, 1-17.
