The Quest Family Case Concideretaion - Research Paper Example

?Running head: FINAL PROJECT Final Project Introduction For the purposes of this final project, the paper will describe theassessment, therapy, intervention plan, and any additional special considerations for the Quest family. The case study of the Quest family is adopted from the textbook, Introduction to Marriage, Couple and Family Counseling. The case was amended to include instances of domestic violence. In particular, the father, Paul, has been described as hitting or otherwise physically hurting his older daughter, Amy. Legal and Ethical Considerations Regarding the Family Circumstances First ethical and legal issue to consider is the issue of confidentiality of the information gathered during the therapy sessions with the family. Confidentiality means respecting and protecting the privacy of the information about the family. As a new therapist, I would need to address this issue at the very first therapy session (or an intake interview) with the family. I would describe my responsibilities as a therapist in protecting the confidentiality as well as the instances when I have to breech the confidentiality as defined by law and ethical standards. These issues would include any type of child abuse, suicide, threat of homicide, drug or any other substance abuse. If any of those issues arise in the therapy sessions later, I would have to report the issue to appropriate authorities. I would explain to the family that this is done to protect the interests of the family members, especially the children, who may not know how to protect themselves otherwise. The issue of protecting confidentiality is further complicated by the size of this family. As a therapist, I need to give enough attention to all the members of the family and I need to address the needs of all the family members. This might be difficult to do during a family therapy session with a family of six. I may decide to have separate sessions with certain family members to address their specific needs. I should be cognizant of the confidentiality issues during those separate sessions, as some family members may reveal the personal information that they do not want some other family members to know. Based on the amended case and the issues described above, I would have to make a report to Child Protective Services (CPS) due to the physical abuse of the oldest daughter, Amy, by her father. This is my legal obligation as a licensed counselor. However, this issue would complicate my ethical decisions in terms of treatment plan and intervention with the family. I can make an anonymous report to CPS, however, the family would probably figure out who made the report. This can make the father very angry and may complicate things both at home and during therapy. Depending on the severity of the abuse, the investigation by CPS may be long, and it may be a while before the father is removed from home to protect all the children. Ethically, I am obliged to be honest and open with my clients. I would encourage the father to seek individual therapy to address his issues of anger. I would continue working with the rest of the family. Multicultural Considerations There are several cultural issues to be considered with this family. One of them is the ethnic background and cultural values associated with it as it pertains to the parents of the family. Both of the parents are of European descent. Both of them were raised in Catholic tradition. However, the way their parents (i.e. grandparents of the children) came to this tradition was different. This might have affected their upbringing and choices they made or could make while growing up. It is hard to explore this issue without actually communicating with the family, but it is important to keep it in mind as a therapist and be mindful of the family values during the development of treatment plan and throughout the course of the therapy. It is especially important to keep in mind that this family as a whole follows Catholic traditions and value, but it is important not to make any assumptions about the Quests’s choices and behaviors solely based on religious values. Another cultural issue that needs to be taken into consideration is the micro-culture of the two blended families, considering that two boys were previously raised by another family and were adopted by the Quests only relatively recently. A lot of the behaviors they are currently exhibiting might be due to the norms of their previous parents. They might have learned kicking, hitting and destroying behaviors from the precious family and they might not know any other way of expressing their frustration or anger or disappointment. It is important to consider their background while developing interventions with this family. Finally, I would consider the range of ages of the Quest family members – from mid- late 40s of parents, to teenage daughters, to little boys. It might be possible that these three groups of individuals may have developed the values that are consistent with their eras of development. Parents might be more conservative, while girls might be more liberal. Additionally, two little boys may have not been taught moral values at all in their previous family. These issues have to be assessed early during the therapy process and they have to be considered during the intervention. Theoretical Counseling Model Used in This Case I would take solution-focused family systems approach to this case. In addition, I would consider some behavioral techniques to address some of the family’s issues, in particular, little boys’ behavior at home and at school. This family is presented with numerous issues that may require long-term therapy with the whole family and any additional individual therapy for some of the members. I believe that solution-focused theoretical model empowers the clients by giving them a choice of what to work on as well as choose the ways to accomplish their goals that are very unique to each of the family members and the family as a whole. I also think it would be appropriate considering the age range of the family members. Solution-focused theoretical model can be successful with adults (parents in this case), teenagers (two daughters) and children (two adopted sons). It allows each age group to process their issues on their developmental level and choose solutions that are easy and understandable for them as well as appropriate for their age group. Since the family has numerous issues to work on, I would allow the family to choose the most important issue they want to resolve as a family and I would allow each of the family members to express their opinions and describe their priorities. I would have this family reach a compromise in developing the therapeutic goals that are important for each of the members. However, if certain family members express some individual concerns that may need to be addressed in the therapy, I would acknowledge them as well and depending on the issue, I would either incorporate those into the family therapy course or refer them for individual counseling. Specific Issues Facing This Family Some of the issues that stand out for me as a therapist are: 1) father’s anger and aggression towards the older daughter; 2) the daughter’s helplessness and depression developed as a result of physical abuse; 3) mother’s sense of helplessness and insecurity in terms of protecting her children from abuse as well as providing for her children while the father may be removed from the family; 4) little boys aggressive and oppositional-defiant behavior; 5) Ann’s assertiveness in protecting her own interests while balancing the involvement with the family and help for mother while caring for little brothers. I would need to assess the severity of each of the issues as well as importance of those to each of the family members in order to develop an effective treatment plan for this family. Solution-focused orientation would help me to collect family’s input about the issues and focus on positive goals instead of current or past problems. Assessment Techniques Used in This Case The assessment of this family’s issues would start with the intake interview and gathering the background information. Even though, a lot of the background information was presented in the textbook, I find the family genogram very helpful in assessing the functioning level of the family and collecting information about larger family themes and considerations that may affect the therapy and its outcome. During the several initial visits of the family, I would assess the severity of symptoms and behaviors the family is presented with – such as the severity of the impact of physical abuse, the adjustment of two little boys to the new family and new rules, the severity of their behavior as described not only by family members, but also teachers at school. I would assess the overall support system that this family has – both in the community, and with the extended family members. I would investigate the exceptions to the problems described by the family. This can be a separate assessment technique that gives me more information about the family as well as a therapeutic technique that help the family see their situation in a more positive light. Additionally, I would collect information about various client factors, such as family’s interests, hobbies, favorite activities, support figures and others. These client factors can help me build a successful solution-focused treatment plan. I would use rating scales throughout the whole process of therapy to collect constant feedback from the family members about their progress and about the effectiveness of the therapy sessions. For these purposes, I would use two short forms – Outcome Rating Scale, and Session Rating Scale (Duncan et al., 2003; and Miller, Duncan, Brown, Sparks, and Claud, 2003). Both these forms are very easy to complete and take about 2 minutes to fill them out. They are very popular among solution-focused therapist as they provided a good feedback to the therapist to be able to accommodate to the clients’ needs and ensure the effectiveness and responsiveness of the therapy sessions. The Outcome Rating Scale is a scale that gathers information about the client’s progress on the goals of therapy. Even though, throughout the course of therapy we can observe a lot of changes in the behavior and attitudes of clients ourselves, it is important to assess how clients feel about those changes themselves and whether they notice those changes. This form can be filled out at the beginning of each session and can serve as a starting point for the therapy session. The Session Rating Scale is the form that is helpful to me as a therapist to ensure that I address the needs of the family. Very often therapists make assumptions about their clients’ satisfaction with the course of therapy as the clients may be shy to express their assertiveness and criticize the therapist of not addressing their issues. This form can be filled out at the end of the session, followed by a short discussion of what worked and what needs to be further improved. Both of these forms are rating scales ranging from 1 being the least satisfactory to 10 being the most satisfactory. The goal of using these forms is not only to collect the current level of progress or satisfaction with the therapy provided, but also help the clients look into the future and suggest how things can be further improved. Intervention Plan for the Family The intervention plan would consist of several parts. The initial referral concern that the family came into therapy with was the behavior of two little boys. After investigating whether this issue remains a priority, I would include a treatment goal to address this problem. The first treatment goal would be: “Within three months, to reduce the number of inappropriate behaviors of two little boys, as defined by kicking, hitting, destroying things, setting things on fire to a minimum, and replace them with positive behaviors”. I include time limit on the treatment goal in order to reevaluate it again within three months to make the therapy more effective and if necessary change the focus of it within a noticeable time limit. In order to achieve this goal, I would have the family implement the token economy system for each of the boys. This would be a combination of behavioral technique with solution-focused approach. I would create a chart where the family could list the most frequent and disturbing behaviors of each of the boys. Each time the behavior occurs it would be marked on this chart by any of the family members with the boy who was involved in the behavior present to make this aware of it. I would create a second chart with a list of positive behaviors that can replace the negatives. These could also be the behaviors that family members are trying to teach each of these boys. Again, as with the previous chart, I would have family members or boys place a mark in the chart each time the positive behavior occurred. The behaviors listed in both charts would be assigned points, based on the severity or effort involved in performing the behavior. For example, setting a house on fire would be valued at more points, since it is a serious destructive behavior, while not putting a dish in the sink would be weighted less, since it is less critical. Finally, I would have the boys create a list of things they enjoy doing (anything positive), or things they might want to have. This would be their rewards chart. I would incorporate a client factor, the interests of boys, while creating it to ensure these things could work as reinforces of positive behaviors. I would have the boys prioritize their lists and assign points to each item of the list. A responsible family member would calculate the points at the end of the week for each of the boys, and depending on the number of points obtained they could choose an activity or a thing from their lists of rewards to reinforce more positive behaviors. This system would be discussed with the family at each therapy session and compliments would be given to everybody involved in implementation of the system. Additional reinforcement would be given to boys. Another treatment goal that I would include in the plan with this family would be: “To improve the communication and increase support within the core family, as evidenced by higher involvement of each of the family members in family life”. This is a larger goal to address the issues of abuse and lack of support and assertiveness in the family. I would use a variety of techniques to achieve this goal – from miracle questions, to exploring the exceptions to the problem, to giving compliments to each of the family members”. I think this issue is more complex and deep, and might require more time for family to explore it. My general approach with this goal would be to incorporate the strengths of this family and help them problem-solve relying on their own resources and ideas. Prognosis for the Family The Quest Family obviously has numerous issues that need to be resolved. Physical abuse issues usually require a long-term course of therapy and are more difficult to resolve. In addition to physical abuse issues, there are issues of the blended family, with children being adopted and having experienced many inconsistencies and neglect during their early development. However, this family has some strengths that can help them overcome these issues. Both girls were able to stay involved in their schools and make good grades. Both parents have been able to acknowledge they have problems and seek therapy help to resolve these problems. Additionally, it seems that this family has good outside support – both extended family and community. This helps in achieving the treatment goals. Overall, I think the family has a good chance to overcome their difficulties and achieve most of the treatment goals within one year or so, depending on the consistency of their efforts, motivation and involvement in the therapeutic process. References Duncan, B., Miller, S., Sparks, J., Claud, D., Reynolds, L., Brown, J., and Johnson, L. (2003). The Session Rating Scale: Preliminary psychometric properties of a “working” alliance measure. Journal of Brief Therapy, 3, 3-12. Miller, S., Duncan, B., Brown, J., Sparks, J., and Claud, D. (2003). The Outcome Rating Scale: A preliminary study of the reliability, validity, and feasibility of a brief visual analog measure. Journal of Brief Therapy, 2, 91-100. Read More