Name: Lois R. Gender: Female Age: 41
Ethnicity: Hispanic Religion: Catholic
Relationship Status: Married
Description of Presenting Issue:
Lois heard you give a talk on abuse and called for an appointment the next day. She said your talk made her realize that she may be experiencing abuse, and she would like your help in improving her behavior so that her husband won't be so angry with her. Lois has been married to her second husband for three years. When she married, she brought her mother and teenage daughter to live with her new husband. Lois expresses great gratitude toward her husband for allowing her to bring her family with her into his home, and states that he deserves to have the best possible wife because he is so good to her.
Since childhood, Lois has always looked to others to help her and make decisions for her. She cannot tolerate being alone and feels overwhelmed and without direction when she is alone. The focus of her life has always been pleasing and caring for others, asking them to tell her what to do because she feels unable to determine her own direction.
Two major changes occurred in Lois's life a few months after she married. Her daughter left for college and her mother was diagnosed with dementia. Since then, Lois has felt very sad and lonely. Although she has continued her daily activities and responsibilities, she reports having little energy, having even more than her usual difficulty in making even simple decisions, feeling hopeless, and having little interest in eating. Her husband has responded to this by yelling at both Lois and her mother and demanding that they change. Lois has tried to appease him, but his anger has only escalated and she is now afraid that he might hit her.
Occupation History: Lois is currently a homemaker and caretaker to her mother.
Education History: Lois completed high school and two years of college. She wanted to complete her college education, but was unable to due to financial hardship.
Medical History: Lois did not report any medical problems, but she appears to have a curvature of the spine.
Family History: Lois has two sisters, age 44 and 49. Lois's father passed away when she was 11 as a result of a massive heart attack.
Alcohol/Substance Use: During high school, Lois tried a variety of prescription medications and illegal substances (marijuana). She became a heavy drinker during her mid twenties, consuming upwards of 6+ drinks per evening, 5 times per week. At age 29, Lois joined Alcoholics Anonymous. She remains active and sober in the program, attending one meeting per week.
Critically evaluate the client using either a reality or family systems approach. Make sure you address:
- The strengths and limitations to using this approach with this client
- The specific cultural/gender/age issues that need to be attended to with this client
- The ethical or legal issues that need to be attended to with this client
- The overall therapeutic goal with this client
- How you would proceed with this client:
- How would you begin?
- What would be the goals of therapy?
- What specific strategies and/or techniques might you use?
The Family Systems Approach:
The critical evaluation of Lois through the use of the family systems approach is the best mode that can be applied. This family systems approach is a theory of human behavior that looks at the family as a unit of emotional comfort. This system holds the belief that the individual having the problem can not be understood in isolation. The person has to be assessed with the presence of the family members and not when they are separate from the family entity. This is a great system to utilize with this client due to the fact that it is the family setting that is causing her problems as she lacks the ways to relate with the problem (Schimelpfening, 2011).
The Cause of Her Problems:
The major cause of her problems is her personality. Lois is an outgoing person who likes the company of other individuals. She is a people pleaser and likes relating in group context. The family set up is at the moment not providing for her needs. This is based on the fact that the problems that she is experiencing are family related. The act of adjusting to life circumstances as they occur is the other cause of her problem. As she advances in age, there certain responsibilities that she take up. Letting go of her children should have been done at that right moment so that she is does not feel that she is lonely and left alone.
The Strengths and Weaknesses of Utilizing the Family Systems Approach: