Case of Stan

Summary of Case of Stan

The case of Stan presents a complex set of psychological and interpersonal challenges that
contribute to his alcohol abuse and overall distress. The client is a 35-year-old man who seeks
counseling due to his issues with drinking, which resulted in a DUI conviction. He acknowledges
that he has problems but is unsure if he is truly addicted to alcohol. He works in construction but
aspires to work in a profession where he can help people, particularly troubled children. He feels
socially isolated, struggles with making friends, and uses alcohol as a coping mechanism to
alleviate anxiety in social situations. He also experiences intense feelings of inadequacy, anxiety,
guilt, depression and have self-destructive tendencies. His autobiography reveals a challenging
past, including a troubled marriage, parental criticism, comparisons to his siblings, and
involvement in substance abuse.
The client is a 35-year-old male who seeks counseling due to his issues with drinking, which
resulted in a DUI conviction. He acknowledges that he has problems but is unsure if he is truly
addicted to alcohol. He works in construction but aspires to work in a profession where he can
help people, particularly troubled children and is currently studying psychology part-time. He
feels socially isolated, struggles with making friends, and uses alcohol as a coping mechanism to
alleviate anxiety in social situations. Stan has abused drugs in the past and feels overwhelmed
and intimidated around attractive women. He also experiences intense feelings of inadequacy,
anxiety, guilt, depression and have occasional suicidal ideation. He reflects on pivotal moments
in his life, such as his supervisor's belief in his potential while working at a youth camp, which
inspired him to pursue college education. His autobiography reveals a challenging past, including
a troubled marriage, parental criticism and comparisons to his siblings. Looking ahead, he
desires to improve his self-esteem, overcome his self-destructive tendencies, and learn to trust
others. He hopes to become a counselor and find happiness and fulfillment in his personal and
professional life.

Stan is a 35-year-old construction worker who recognizes the problems in his life but is unsure
about his addiction to alcohol. Through his autobiography, it becomes evident that Stan struggles
with low self-esteem, social anxiety, fear of intimacy, depressive symptoms, and self-destructive
tendencies. Additionally, his upbringing in a dysfunctional family environment, marked by
constant criticism, comparison to siblings, and an emotionally distant and conflictual relationship
between his parents, has likely shaped his negative self-perception and difficulties in forming
meaningful relationships
Clinical Formulation of the Case
Theoretical Background: Structural Family Therapy
Salvador Minuchin- 1970s
View of human nature – Family as functional unit and interdependent.
Family structure.
Restructuring dysfunctional patterns.
Create healthier relationships and improved functioning.
Key concepts
Family Structure and Dynamics: Structural Assessment
a) Structure, boundaries and hierarchy: Stan's family system consists of himself, his parents
(Angie and Frank Sr.), and his siblings (Judy, Frank Jr., and Karl). The family exhibits
rigid boundaries and a hierarchical structure where his parents exert control and
comparison among the children.
b) Subsystems and Coalitions: There are apparent alliances within the family, particularly
between Stan's parents and his older siblings. Stan and Karl have a strained relationship
due to frequent conflicts and parental favoritism towards Karl.
c) Communication Patterns: The family communication patterns are characterized by
criticism, judgment, and comparison. There is a lack of emotional expression and open
dialogue, inhibiting the development of healthy relationships.
d) Negative Family Beliefs: Stan internalizes the negative beliefs imposed by his parents,
feeling inadequate, unlovable, and burdened by guilt. These beliefs perpetuate his low
self-esteem and contribute to his self-destructive tendencies.
e) Poor Conflict Resolution Skills: The family lacks effective conflict resolution skills,
leading to unresolved conflicts and emotional distress. Stan's inability to cope with
conflict contributes to his social anxiety and avoidance of close relationships.
Turning Points:
Supportive Supervisor at Youth Camp: Stan's supervisor at a youth camp recognized his potential
for working with young people and encouraged him to pursue college education. This support
inspired Stan to believe in himself and consider a career in counseling.
Marriage and Divorce Experience: Stan's short-lived marriage to a dominant and critical woman,
Joyce, left him feeling inadequate and fearful of closeness. His poor sexual performance during
the marriage intensified his insecurities.
Aspirations for Change: Despite his struggles, Stan demonstrates a desire for personal growth
and positive change. He has taken proactive steps by enrolling in college to pursue a degree in
psychology, which aligns with his goal of becoming a counselor for troubled youth. This
aspiration suggests that Stan possesses inner resilience, determination, and the potential for
growth and healing.
Goals for the therapy (themes and identified problem)
Themes:
1. Family dynamics and dysfunction
2. Self-esteem and self-worth
3. Substance abuse and self-destructive tendencies
4. Fear of intimacy and difficulties in forming close relationships
5. Career aspirations and personal growth
Identified Problems:
Dysfunctional communication and constant fighting within the family
Low self-esteem and feelings of inadequacy
Alcohol addiction and history of drug abuse
Fear of judgment and social anxiety
Negative self-image and difficulties in intimate relationships
Guilt, depression, and thoughts of suicide
Doubt in own intelligence and academic abilities
Need for personal growth and improvement.
Goals for the therapy
Increase awareness of the impact of family dynamics on his current issues
Restructure Family Hierarchy
Improve Communication Patterns
Address Boundaries and Coalitions
Enhance Problem-Solving Skills in the family
Improve social and relationship skills
Reducing family conflict and build family cohesion
Address Enabling Behaviors
Develop healthy coping strategies and alternative outlets
Addressing Self-Destructive Behaviors and Suicidal Ideation:
Developing a stronger sense of identity and self-esteem
Incorporating Stan's Aspirations for Change
Foster a support network
Monitor and Relapse Prevention
The goal is to empower Stan and his family to recognize and modify dysfunctional patterns,
improve their communication and relationships, and support Stan's recovery and personal
development
Therapeutic procedure
Joining, accommodating and establishing rapport
Assessing Family Structure
Mapping Family Interactions (family structural mapping)
Tracking and enactments
Restructuring
Boundary Making
Externalizing the Problem
Enhancing Support Systems
Termination and Relapse Prevention:
Throughout the therapeutic process, the therapist maintains a collaborative stance, respecting
each family member's perspective, and encouraging their active participation.
The efficacy and effectiveness of its interventions and methods (Cite and discuss at least (3)
primary source research (clinical or empirical) studies in support of your analysis.)
McAdams, C. R., Avadhanam, R., Foster, V. A., Harris, P. E., Javaheri, A., Kim, S. H., Kooyman,
B., Joe, J. R., Sheffield, R., & Williams, A. W. (2016). The Viability of Structural Family
Therapy in the Twenty-first Century: An Analysis of Key Indicators. Contemporary Family
Therapy, 38(3), 255–261. https://doi.org/10.1007/s10591-016-9383-9
Edwards, M. E., & Steinglass, P. (1995). FAMILY THERAPY TREATMENT OUTCOMES FOR
ALCOHOLISM. Journal of Marital and Family Therapy, 21(4), 475–509.
https://doi.org/10.1111/j.1752-0606.1995.tb00176.x
Carr, A. (2009). The effectiveness of family therapy and systemic interventions for adult-focused
problems. Journal of Family Therapy, 31(1), 46–74. https://doi.org/10.1111/j.1467-
6427.2008.00452.x
Joanning, H., Quinn, W. J., Thomas, F. M., & Mullen, R. T. (1992). TREATING ADOLESCENT
DRUG ABUSE: A COMPARISON OF FAMILY SYSTEMS THERAPY, GROUP THERAPY,
AND FAMILY DRUG EDUCATION. Journal of Marital and Family Therapy, 18(4), 345–356.
https://doi.org/10.1111/j.1752-0606.1992.tb00948.x
Von Sydow, K., Beher, S., Schweitzer, J., & Retzlaff, R. (2010). The Efficacy of Systemic
Therapy with Adult Patients: A Meta-Content Analysis of 38 Randomized Controlled Trials.
Family Process, 49(4), 457–485. https://doi.org/10.1111/j.1545-5300.2010.01334.x

Baum, R., & Pender, D. A. (2022). Using Structural Family Theory in Treating Family Conflict.
The Family Journal, 31(1), 35–41. https://doi.org/10.1177/10664807221123561

Carr, A. (2014). The evidence base for couple therapy, family therapy and systemic interventions
for adult-focused problems. Journal of Family Therapy, 36(2), 158–194.
https://doi.org/10.1111/1467-6427.12033
Florimbio, A. R., Brem, M. J., & Stuart, G. L. (2019). Alcohol Use Disorders in Couple and
Family Therapy. In Springer eBooks (pp. 79–82). https://doi.org/10.1007/978-3-319-49425-
8_433

Jiménez, L., Hidalgo, V., Baena, S., León, A., & Lorence, B. (2019). Effectiveness of
Structural⁻Strategic Family Therapy in the Treatment of Adolescents with Mental Health
Problems and Their Families. International journal of environmental research and public
health, 16(7), 1255. https://doi.org/10.3390/ijerph16071255
Nichols, M. P., & Tafuri, S. (2013). Techniques of Structural Family Assessment: A Qualitative
Analysis of How Experts Promote a Systemic Perspective. Family Process, 52(2), 207–215.
https://doi.org/10.1111/famp.12025
Félix, S., Santos, C., Alves, D., & Dias, P. (2019). Structural and strategic family therapy for
adolescent substance use: A systematic review. Journal of Marital and Family Therapy, 45(4),
640-655
Daly, D. L., Sprenkle, D. H., & Chao, G. T. (2020). A meta-analysis of family therapy process
research. Journal of Marital and Family Therapy, 46(2), 333-353.

Critically analyze your model/ approach with regard to the degree of “fit” of its constructs in
providing a comprehensive explanation (clinical formulation) of the case of Stan and explain
why. You should rate in on a 0-100 scale.
Degree of fit- 70/100
The Structural Family Therapy (SFT) approach offers a good fit in providing a comprehensive
clinical formulation of Stan's case.
Analysis:
Emphasis on family dynamics and structure: By addressing the hierarchical dynamics,
communication patterns, and boundaries within his family, SFT can help identify and modify
problematic patterns that contribute to his challenges.
Systems-oriented perspective: SFT takes into account the interconnectedness of family members
and their impact on one another. SFT's systems-oriented perspective allows for a comprehensive
understanding of Stan's challenges and offers interventions aimed at improving family
interactions and relationships.
Potential limitations: Why not 100?
Stan's personal struggles and psychological issues beyond the family system
Stan's personal aspirations and goals
To provide a more comprehensive understanding of Stan's case, it would be beneficial to
incorporate other theoretical perspectives, such as cognitive-behavioral therapy (CBT) or
psychodynamic approaches.
Baum, R., & Pender, D. A. (2022). Using Structural Family Theory in Treating Family Conflict.
The Family Journal, 31(1), 35–41. https://doi.org/10.1177/10664807221123561
Carr, A. (2014). The evidence base for couple therapy, family therapy and systemic interventions
for adult-focused problems. Journal of Family Therapy, 36(2), 158–194.
https://doi.org/10.1111/1467-6427.12033
Corey, G. (2016). Theory and Practice of Counseling and Psychotherapy. Cengage Learning.
Fall, K. A., Holden, J. M., & Marquis, A. (2017). Theoretical Models of Counseling and
Psychotherapy. Routledge.
Family Systems Approach. (2022, December 19). Newport Academy.
Florimbio, A. R., Brem, M. J., & Stuart, G. L. (2019). Alcohol Use Disorders in Couple and
Family Therapy. In Springer eBooks (pp. 79–82). https://doi.org/10.1007/978-3-319-49425-
8_433
McAdams, C. R., Avadhanam, R., Foster, V. A., Harris, P. E., Javaheri, A., Kim, S. H., Kooyman,
B., Joe, J. R., Sheffield, R., & Williams, A. W. (2016). The Viability of Structural Family
Therapy in the Twenty-first Century: An Analysis of Key Indicators. Contemporary Family
Therapy, 38(3), 255–261. https://doi.org/10.1007/s10591-016-9383-9
Seligman, L. W., & Reichenberg, L. W. (2015). Theories of Counseling and Psychotherapy:
Systems, Strategies, and Skills. Pearson.
Von Sydow, K., Beher, S., Schweitzer, J., & Retzlaff, R. (2010). The Efficacy of Systemic
Therapy with Adult Patients: A Meta-Content Analysis of 38 Randomized Controlled Trials.
Family Process, 49(4), 457–485. https://doi.org/10.1111/j.1545-5300.2010.01334.x