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Running head: TOWNSEND FAMILY TREATMENT PLAN

Townsend family treatment plan Kenneth M. Letizia MFCC 561 November 2, 2011 Patsy Pinkney Phillips, Ph.D., LMFT

TOWNSEND FAMILY TREATMENT PLAN

Townsend family treatment plan Theoretical Approach and Description of Family The Townsend family will be treated from a Structural Family Therapy (SFT) approach. SFT addresses many problems of functioning within the family system. The therapist joins the family system attempting to understand family operation dynamics, family functioning, and emotional connections within the family. The main goal is to intervene and disrupt dysfunctional relationships existing within the family system. Disruptions of old patterns can lead to stabilization and more positive, healthier patterns can emerge. Structural family therapy aims to reframe the organization of the family. Structure is a primary component of a healthy family. Every family has a structure and organization based on family values, beliefs, and interaction. Family structure can be positive, negative, too rigid, or too diffuse structure can be damaging. Subsystem interactions play an important role in SFT. Evaluation of familial roles within the subsystems will help the therapist identify relations that exist between the family members. Mr. Townsend a 51-year-old White male father of four and husband have been referred to counseling for the treatment of depressive symptoms brought on by an injury. Because of the injury to Mr. Townsends, back which occurred during a chiropractic visit, Mr. Townsend accepted disability leave from his job as a skilled artisan. Over the next six months, Mr. Townsend slipped into a deep depression. Mrs. Townsend age 53 will also be seen, and three of the four siblings attended family assessment: Roger age 25, Greg 24, and Brad 19. Daughter Lois 22, married living outside the local area could not attend. Initially treatment was limited to Mr. Townsend but further assessment suggested family therapy would better suit the needs of the

TOWNSEND FAMILY TREATMENT PLAN

Townsends. His family does not identify Mr. Townsends pain and depression as the presenting problem associated with treatment. Post-family assessment, the Townsends display diffuse enmeshed boundaries and no clear establishment of who is in charge within the family dynamic at this time. Hanna (2007) stated, Symptoms are regarded as consequence of organizational difficulties. Organization must evolve to meet the developmental tasks for each stage of the family life cycle (p. 10). (Note while serving in the military 30 years prior, Mr. Townsend was diagnosed as schizophrenic; however, negative psychiatric history after this occurrence would suggest questionable diagnosis at the time). Precipitating Event/Primary Problem Initially therapy began with Mr. Townsend seeking help for depression brought on by an injury occurring in chiropractic care. About one-month ago, Mr. Townsend was prescribed antidepressant medication that had emotional and conduct order side effects. Adjustment disorder with mixed disturbance of emotion and conduct 309.4 (American Psychiatric Association, 2000, p. 680). Therapist belief, the medication brought on these new symptoms associated with an already depressive situation and through proper therapy and psychiatric evaluation, these problems should cease within a two-month period. Emmerson, Ph.D. (2006) stated, The use of antidepressant may allow a period of time for other ego states to gain a habit of interacting with the outside world (p. 163).

Presenting Problem

TOWNSEND FAMILY TREATMENT PLAN

The family moved the assessment discussion away from the external issues presented to a deeper concern for the family emotional strength and cohesion. Mr. Townsend becoming ill has left the family in a state of flux emotionally, financially, and hierarchically. Over the past six months, the parenting subsystem has broken down and become enmeshed with the sibling subsystems and familial role confusion has created deep anxiety and disorientation within the family system. Wordan (2003) stated, Family boundaries including the interpersonal boundaries between individual family members; ideally, the boundaries are permeable but at the same time protect the individual and various subsystems (pp. 173-174). Diffuse boundaries have led to familial enmeshment and Roger was asked to step into the void created by Mr. Townsend. The family has focused on Greg as a scapegoat because of his dyslexia and is characterized as unhelpful because of family implied serious case of dyslexia. Brad sees the family as coming apart and loosing cohesion and has become overly concerned with the possibility of this event happening and as a result is attempting to find familial leadership. The Townsend family lacks proper boundaries at this time, the hierarchy has broken down, and the family has become overly enmeshed throughout the familial subsystems. Strengths/Challenges The Townsends are a close-knit family one of their greatest strengths. The Townsends are willing to come together in time of distress and work as a familial unit to overcome this situation. A dysfunctional family system occurs when a stressor overloads the familys adaptive and coping mechanisms (Walsh & McGraw, 1996, p. 46). This may also be the biggest challenge the Townsends face, how to help each other appropriately without becoming more diffuse or enmeshed. Brad is looking for familial leadership, Roger is in a position to take the family lead,

TOWNSEND FAMILY TREATMENT PLAN

but is not the father, and this would create an unbalanced system within the family unit. Greg has taken the financial lead and done so appropriately; however, Greg is being labeled as the one neediest by family members involved in this current situation. Mrs. Townsend appears unwilling to lead the family, and will turn over control to anyone willing to accept responsibility until Mr. Townsend is ready to re-establish himself. These are the challenges to be addressed within the framework of the Townsend family system. Therapist believes that proper roles, subsystems, and boundaries will provide structure, allowing the Townsends to overcome Mr. Townsends incapacity and grow through this experience. Legal/Ethical Considerations Legal consideration concerning addressing the medication issue. Therapist is not a licensed practicing psychologist and would be prudent to know exactly what the limits are concerning this topic. Countertransference may become a slippery slope if the therapist is unaware of his feelings and level of care with this particular family. Confidentiality becomes a problem in the familial setting. Ethically, maintaining secrets in a family therapeutic environment could lead to breakdown of the therapeutic alliance. Secrets should be discouraged in family therapy; any secrets to be revealed or kept should be done in individual or group therapy outside of the family therapeutic setting with another therapist. Because a triangulated family group does exist in this situation, it becomes imperative for the therapist to avoid becoming part of the triangulated subsystem; further, it becomes more important to focus on detriangulation to support family wellness and wholeness. Therapist will participate in session to help facilitate de-triangulation. Counter-transference becomes an issue if the therapist becomes overprotective of one client over the family. Family is a social environment, and the therapist

TOWNSEND FAMILY TREATMENT PLAN

must be mindful to maintain professional distance avoiding social involved in the family dynamic. Items to cover with the family are Dual and Multiple Relationships, Confidentiality, and Informed Consent. Finally, if the insurance does not cover family therapy as diagnosed, this office shall continue to help based on a sliding scale. Treatment Plan Long-term outcome goals: The Townsend family will focus on disruption of dysfunctional relationships that exist in the nuclear family system. Disruption of old familial patterns can lead to healthier patterns and stabilization within the family. 1. Separate the subsystems in an appropriate manner through enactment, separation, and subgoals of re-establishing proper subsystems within each family system level. 2. Address the issue of Mrs. Townsends role within the family, engage family in exploration of the role Mrs. Townsend plays, and allow family to impart feedback in relation to re-establishing a parental hierarchy within the family. Sub-goals are to reinforce Mrs. Townsends confidence level and allow her to discover a new inner strength to lead her family. 3. Greg has been cast in an unfavorable light, yet financially he is helping the family at this time. Greg should realize he has the strength within himself to help the family in times of need. Subgoals include reframing the current view Greg has of himself, reshaping the views of family members through appropriate questioning, and intervention involving Unique outcomessparkling events. Times when they resisted the problem or behaved in a ways that contradicted the problem story narrative approach (Nichols & Schwartz, 2005, p. 255).

TOWNSEND FAMILY TREATMENT PLAN

4. Involves reframing the current way Brad views the family strength and allowing the family to help Brad realize the Townsends can work as a family to move past this life disturbance. 5. A family focused individual goal for Mr. Townsend to return to his familial role and overcome the depression currently plaguing him. Goals will include self-esteem building and evaluation of new roles within the household as a father and husband. Mr. Townsend has been the family sole support and provider. Sub-goals for this exploration include engaging the family members in helping Mr. Townsend define new roles he can assume and reconcile old meanings connected with older roles and integrating both. Interventions Each family member will work to restructure and change the family system along healthy lines, which include communication, self-esteem, and family strength. The therapist enters the family system and challenges the status quo. During family upheavals, and unstable situations the therapist will challenge the family members old behavior/belief. Once the family understands the challenged behavior/belief is in question, the therapist can reframe this particular behavior/belief. Each family member will identify and confront one assumption concerning Greg. The therapist will guide the family in restructuring negative pattern behavior/belief through modeling. Once the modeling is thriving the therapist must resist the temptation to overwork his joined association within the family system, at this point the therapist can observe and guide. Evaluation of the Counseling Process

TOWNSEND FAMILY TREATMENT PLAN

1. Members of the family communicate and identify negative familial patterns therapeutic session. De-triangulation will beginning within the family system. Mrs. Townsend, Roger, and Brad will speak directly to Greg and explain their biases and assumptions about him. Members of the family are identifying negative familial patterns and beginning the process of setting appropriate boundaries, and restructuring the Townsend communication style (At present to ongoing). 2. Mrs. Townsend to attend self-esteem building workshop. (At 2.5 months). 3. The therapist is looking for specific ways that the family system can maintain portions of homeostasis without disruption to the new family communication and patterns being developed. (Depends on subsystem re-structuring 1-3 visits.) 4. The therapists must challenge and accommodate each family system through a process of continuance probing, withdrawing, and advancing. The therapist must remain at a professional distance or he or she can become part of the dysfunction within the Townsend family system. If the therapist does not maintain proper distance within the family, the healing could stop (At 3 months). 5. Through structured confrontation of behaviors/beliefs, therapist can help the Townsends realize that mistaken patterns have led to the current situation t, and that Mr. Townsend was merely a catalyst-presenting problem for much needed family change (At 1 to 3 months).

TOWNSEND FAMILY TREATMENT PLAN

References American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Arlington, Virgina: American Psychiatic Association. Emmerson, Ph.D., G. (2006). Advanced Skills and Interventions in Therapeutic Counseling. Norwalk, Connecticut: Crown House Publishing Limited. Hanna, S. M. (2007). The Pratice of Family Therapy: Key Elements Across Models (4th ed.). Belmont , California: Thomson Brooks/Cole. Nichols, M. P., & Schwartz, R. C. (2005). Essentials of Family Therapy (2nd ed.). San Francisco, California: Pearson A and B. Walsh, W. M., & McGraw, J. A. (1996). Essentials of Family Therapy: A Therapist's Guide to Eight Approaches . : Love Publishing Company. Wordan, M. Ph.D. (2003). Family Therapy Basics (3rd ed.). Pacific Grove, California: Thomson Brooks/Cole.