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Family Help Case Study: Marital and Parenting Concerns

The questions are below the case study.
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Case Study: The Del Sol Family

Referral Route

Rosa Del Sol was referred by Christopher's teacher to the North Beach Neighborhood Outreach Center. At the time of intake, Rosa's presenting concerns were marital conflict and parenting concerns, especially how to manage her 9-year-old son, Christopher.

Family Composition

The Del Sol family consists of Rosa, aged 35, and Miguel, aged, 37,as well as three children - Christopher, aged 9; Teresa, aged 3; and Tina, aged 18 months. Rosa and Miguel have been married for 4 years. Christopher is Rosa's son from a previous common-law relationship. Christopher's biological father, Jim, aged 36, has not been involved in his life since Christopher was 2 years old, and Rosa does not know Jim's whereabouts. Rosa states that Jim was a heavy drinker and became physically abusive during the pregnancy, and they separated shortly before Christopher's second birthday.

Rosa is the only child of Maria and Juan valdez, aged 55 and 60 respectively' Juan was verbally and physically abusive toward Maria, and they separated when Rosa was 12 years old' Rosa has had no contact with her biological father since that time. Maria continued to parent Rosa on her own and has not remarried.

Miguel is the oldest son of Sophia and Thomas Del Sol, aged 62 and 66 respectively' Miguel's
younger brother, Juan, aged 34, is not married and, according to Miguel, has a "drinking problem." Miguel father "abandoned" the family when Miguel was 7 years old. Miguel remembers the loud arguing and fighting between his parents. His mother was remarried' when Miguel was 10 years old, to Ken Wheeler.

The Family System

Rosa was in tears for most of the initial session, claiming she "just can't take it any more."Miguel is constantly putting her down, insulting her in front of other people (even in the grocery store), and yelling at the children. Rosa feels that no matter what she does' she cannot seem to do anything right according to Miguel. Rosa is beginning to realize that she is being verbally abused as her father abused her mother. She is also uncomfortable with her reactions because she has been yelling back at Miguel and feels like the "war is on." Rosa feels the situation is 'out of control."Sometimes her own anger and Miguel's intensity of anger have frightened her. Physical abuse has not occurred up to this point, according to Rosa. She states that Miguel knows that if he ever touches her, that would end the relationship. She is determined not to raise her children
in an "abusive home" like the home of her own childhood. Rosa says she cries frequently and has had little energy to deal with the conflicts. Christopher has been having difficulty at school as well as the daily "battles" with Miguel.

Miguel feels the problems between Rosa and him can be "solved on their own", Miguel admits that he yells a lot at Rosa and calls her names. However, he points out that he always tells Rosa he is sorry. Miguel is of average height and slim build; he appeared agitated and tense. He admits to experiencing a number of physical symptoms of stress, including a pounding heart' frequent headaches, and constant feelings of edginess of and restlessness' Miguel describes himself as a loner with no close friends. Miguel agrees with Rosa that he is moody but says, "A guy can't be in a good mood all of the time." Miguel's posture and manner appear-defensive, and he indicates that he is only here because Rosa had threatened to leave him if they didn't get help. His family is important to him, and he realizes now that despite not wanting to repeat the actions of his stepfather, he can see that he is doing the same to his children.

Christopher attends North Beach Elementary and Middle School and is in third grade. He is in a regular class after having repeated first grade. Christopher was diagnosed with attention deficit disorder(ADD) six months ago. He is currently on a trial of Ritalin. In the past month, the school has complained to Rosa that Christopher has become increasingly aggressive with his peers. Christopher's teacher reports that he has made no friends in his class and has become socially isolated, either withdrawing or acting out angrily. The teacher notes that Christopher has poor social skills but is quite good in sport activities such as soccer and football. Christopher's favorite sport is soccer, and in the summer he loves to swim, play football, and ride his bike.

Three-year-old Teresa is a talkative girl who is generally good-natured. Tina 18 months tends to be quiet and allows Teresa to do all the talking for her. Both girls have been achieving their respective developmental milestones. Rosa has no concerns in this area. However, Rosa has noticed in the past 3 weeks that both girls have not been sleeping through the night. They have been whining and crying a lot more than usual. Teresa complains of a stomach ache frequently Rosa became upset when she told about Miguel's coming home from work and marching into the bedroom in silence, and Teresa's asking, "Is Daddy mad again?"

Family Background Information

Rosa completed 12th grade and then worked in a bank as a teller until the birth of Teresa.
Her mother helped her raise Christopher when he was an infant and openly stated her disapproval of Rosa's relationship with Jim. Maria lives nearby and, despite what Rosa nom describes as a "conflictual" relationship, is a source of support for Rosa. Maria often babysits the girls, although Maria now refuses to look after Christopher because "he is too difficult just like his father." Rosa describes the relationship between her mother and Miguel as "unfriendly"; "they tolerate one another," as each tends to put the other down. Rosa feels stuck in the middle of a "no-win" situation.

Miguel never got along with his stepfather, Ken. Ken frequently became "drunk' on the weekends with Sophia, leaving the boy to fend for themselves. Ken was not physically abusive, but when he was drinking "you stayed out of his way so he wouldn't yell at you." Miguel says his mother Sophia is an alcoholic, and he has chosen not to have contact with her or his stepfather. Miguel quit school and left home at age 15. He worked at odd jobs to support himself. Miguel admits to "being in the wrong crowd" and being heavily involved with drugs and alcohol as a teenager. Miguel feels proud that he is no longer involved "in that scene," having quit on his own "without anyone's help".

Stress and Demand Factors

All family members appear to be suffering symptoms of stress, both physically and emotionally, and have experienced a number of changes recently. The purchase of their, own home and the resulting high payments hare left little money to cover remaining bills and groceries. The lacks of money and high debt load have become a daily stressor. Rosa and Miguel agree that financial issues regularly precipitate most of their arguments.
Christopher's recent diagnosis of ADD is confusing to Miguel and Rosa. They have little information on this disorder or how to best deal with Christopher in managing his behaviors appropriately. Medication is expensive, and they do not have health insurance.

Marital/Parental Subsystem Miguel has a sixth-grade education and has always worked, and
is employed full-time at a small into repair shop. He also works a second job in an auto part store in the evenings and weekends to make ends meet. Miguel complains about his coworkers, stating that he has nothing in common with them and doesn't want to waste his time with them. Miguel feels that his boss is always pressuring him to do more, and they often have loud disagreements. Miguel aspires to be a manager of his own shop and not have people telling him what to do.

Miguel and Rosa purchased their home 4 months ago. It is located about 45 minutes by car from their old neighborhood, where Rosa was well-connected to the church and a number of friends. The couple enjoys owning their own home, but the mortgage payments are high. This leaves little money for other expenses and has been a source of daily conflict.

Rosa and Miguel had decided that Rosa would stay home to care for the girls while they were young. Lately, however, Rosa has been suggesting that she work part-time at a gardening shop to help out financially and to be out of the house. Miguel then could cut down his on hours of work and spend time with the family. Miguel, reacted angrily to this issue and stated that he was "sick and tired of everyone hassling him about working and can't a guy just make a living." Miguel works hard at his two jobs and is very committed to doing the best for his family. However, all his energies have been devoted to making a living, with little time for any outside interests. Rosa disagrees with Miguel about the importance of money and prefers that Miguel spend time with her and the children as a family. Miguel admits he is getting physically tired and irritable and finds he is less able to handle life's minor annoyances. He would like to be able to spend time with the children and get back into playing recreational soccer.

Resource Factors Rosa describes herself as an outgoing, social person with a sense of humor, but lately she has been feeling alone and "down." The family has one car that Miguel uses to travel to work, and Rosa feels isolated and "stuck in the house." The family has few outside supports. Rosa, due to the move and transportation limitations, is isolated from her previous support network, which included neighborhood friends and the church community. Miguel has few friends and relies on Rosa to be his constant cheerleader to make him feel good. Rosa has said it feels at times that she has four children, not three. The girls don't have friends in the new neighborhood because the children living nearby are much older. The girls are becoming quite bored and cranky with Rosa, adding to the tension in the home. Christopher has made a couple of new friends; his poor social skills and short attention span have made this a challenge for him.

Family Strengths

Competence and Coping Factors Rosa grew up in an abusive home and is determined to not raise her children in that environment. She is very motivated to make changes in her life and has attempted over the last year to involve Miguel in activities to strengthen their family; he has refused to attend any couple enrichment weekends or courses that were available at no cost through the church. Rosa attended the sessions on her own, including a weekend retreat for families.

Rosa has a wonderful sense of humor that has helped her cope with a number of adverse conditions. Rosa feels she has no support from Miguel in raising the children due to his drive to make money and his discomfort in being with the children. Rosa is a good mother to her children and is determined to continue to learn about positive parenting approaches.

Miguel is a hard worker, and he feels he must do the very best at any job he takes on. High expectations create added pressure and stress. Miguel has been reluctant to tackle areas in which he feels incompetent. These include parenting, so he tends to avoid it when he can' often choosing work over time with the family.
Miguel grew up in an abusive, alcoholic family and exhibits some of the symptoms common to this environment such as poor self-image, a need for constant approval and anger. He believes strongly that the husband's role is to provide for his family. Miguel has difficulty recognizing that his family has needs other than just money from a husband and father. This pattern was established in his family of origin. His strong desire to raise his children differently and to keep his family together will help him in achieving his goals.

Intervention Planning

Miguel and Rosa have decided on the following goals:
1. To develop appropriate strategies for managing anger
2. To learn effective, respectful communication
3. To learn more appropriate parent/child discipline strategies
4. To expand the current support network of their family
5. To increase their understanding of ADD and parenting techniques.
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Questions:

1. Write an assessment of the family and speci?cally comment on the following elements of the family system.
a. Identify the various family systems.
b. What functions are performed by which family systems and how well do the systems function?

2. Write a statement of the family strengths and resources (protective factors)
a. What are the resources or strengths within the family?
b. Are concrete and instrumental supports su?cient? If not, what else is needed?
c. What information, knowledge, and skills would be of support to the parents?
d. How are emotional and nurturing needs displayed in the family? In what other ways can the parents and the couple strengthen their family attachments?
e. How would you go about strengthening family identity and culture?

3. Family behaviors are best understood from a circular causality rather than a linear causality. Using an example from this case, where might you use a circular question to make a cognitive change, a?ective change, or behavioral change?

4. What stage of development is the family experiencing?
a. What tasks are associated with this stage of development?
b. What stressors are associated with these tasks?
c. How has the stressors impacted family development?
d. What events have impacted the family structure and family membership at this stage?

5. For the Del Sol family, consider their values and likely preferences, and from the research ?ndings comment on the following family intervention challenges and plans.
a. What intervention strategies are e?ective in managing anger?
b. What family therapy technique is e?ective in improving communication problems?

6. What are the di?erences between parent-training, parent-education, and parent-support intervention programs? Which approach is best for this family?

7. Identify parent-training programs that are the most successful in reducing negative or coercive parenting practices.

8. What social support interventions reduce family isolation?

9. What treatments are e?ective in managing ADD in children?

10. What, if any, cultural adaptations are needed to introduce any of the interventions?

Solution Preview

1. Write an assessment of the family and speci?cally comment on the following elements of the family system.
A. Identify the various family systems.
When I think of family systems and family systems and family systems theory, I immediately think of Murray Bowen. He has many ideas about how families interact and how certain relationship function within the family. The first thing I did after reading the case study was to draw a genogram to identify patterns, locate behaviors, and get a better handle on the family relationships. I think that creating and submitting a genogram along with this paper would be appropriate. 'According to Bowen, a family is a system in which each member had a role to play and rules to respect. Members of the system are expected to respond to each other in a certain way according to their role, which is determined by relationship agreements. Within the boundaries of the system, patterns develop as certain family member's behavior is caused by and causes other family member's behaviors in predictable ways. Maintaining the same pattern of behaviors within a system may lead to balance in the family system, but also to dysfunction. For example, if a husband is depressive and cannot pull himself together, the wife may need to take up more responsibilities to pick up the slack. The change in roles may maintain the stability in the relationship, but it may also push the family towards a different equilibrium. This new equilibrium may lead to dysfunction as the wife may not be able to maintain this overachieving role over a long period of time.' (www.genpro.com)

For a really quick and dirty review of Bowen's ideas check out www.genpro.com

The following examples of Bowen's concepts are taken from genpro:

1. Triangles: The smallest stable relationship system. Triangles usually have one side in conflict and two sides in harmony, contributing to the development of clinical problems.

There are many triangles at work in this family. Let's discuss the reason for referral, Rosa's son Christopher. Christopher is triangulated with Rosa and his stepfather Miguel. Rosa and Miguel are in conflict with one another for a variety of reasons (financial stress, differing ideas about parental and marital roles, communication difficulties, possible jealousy or feelings of inadequacy regarding Rosa's level of education in relation to Juan's, recent home purchase and subsequent move, etc.) Bowen might suggest that Chris' diagnosis of ADD is a result of certain factors coming together that were perturbed by the conflict resulting in Chris acting out in school and losing his ability to focus.

Rosa and Miguel are also triangulated with their other two children, Tina and Teresa. The conflict is affecting their ability to sleep properly and is producing psychosomatic symptoms (stomachache) as well as more frequent crying and whining. The anxiety produced in the children as a result of the parental conflict could later lead to other mental health issues.

2. Differentiation of self: The variance in individuals in their susceptibility to depend on others for acceptance and approval. Think of it as a measure of emotional maturity, the ability to manage and control one's emotions and thinking.

Rosa seems to have a strong sense of self but she is in danger of no longer being able to manage her emotions:

From the case study: 'Rosa is beginning to realize that she is being verbally abused as her father abused her mother (The recognition of the pattern is important, although she is engaged in it). She is also uncomfortable with her reactions because she has been yelling back at Miguel and feels like the "war is on." Rosa feels the situation is 'out of control. "Sometimes her own anger and Miguel's intensity of anger have frightened her. (Again, the recognition is important, but she is unable to control or manage her emotions). Physical abuse has not occurred up to this point, according to Rosa. She states that Miguel knows that if he ever touches her that would end the relationship. She is determined not to raise her children in an "abusive home" like the home of her own childhood. Rosa says she cries frequently and has had little energy to deal with the conflicts.

Although Rosa's mother is cited as a support, it was also admitted that the relationship is often in conflict. Also, Rosa has recently moved away from her major support systems, her neighborhood, her church group, and left her job. She says that she is a social person with a good sense of humor, but it seems as if sometimes she has four children and not three as she constantly has to prop Miguel up. This can add stress and hinder her capability for differentiation.

Miguel on the other hand, is a self-described, loner. He doesn't have emotional supports other than Rosa and is often complaining about his co-workers, stating that he has nothing in common with them and doesn't want to waste his time with them. Miguel feels pressure from his boss resulting in frequent, loud disagreements. His differentiation is lower than Rosa's.

3. Nuclear family emotional system: The four relationship patterns that define where problems may develop in a family.
- Marital conflict
- Dysfunction in one spouse
- Impairment of one or more children
- Emotional distance

This family is experiencing all four of these relationship patterns you could briefly discuss each:

Marital conflict between Rosa and Miguel and what factors contribute to it

Dysfunction in one spouse: 'Miguel admits he is getting physically tired and irritable and finds he is less able to handle life's minor annoyances.' He is having physical symptoms of stress in the form of pounding heart, headaches, and feelings of edginess. Miguel is increasingly unable to cope in everyday situations and is taking his frustration and aggression out on his family (verbally and emotionally).

Impairment of one or more children: Christopher is having problems in school and is diagnosed with ADD

Emotional distance: Miguel is emotionally distant from the rest of the family. Part of this is due to the family's financial obligations and situation forcing him to have to work two jobs. However, he admits that taking care of the children intimidates him and he chooses work over family often.

From the case study: 'Miguel grew up in an abusive, alcoholic family and exhibits some of the symptoms common to this environment such as poor self-image, a need for constant approval and anger. He believes strongly that the husband's role is to provide for his family. Miguel has difficulty recognizing that his family has needs other than just money from a husband and father. This pattern was established in his family of origin.'

4. Family projection process: The transmission of emotional problems from a parent to a child.

Again from the case study: 'Miguel grew up in an abusive, alcoholic family and exhibits some of the symptoms common to this environment such as poor self-image, a need for constant approval and anger. He believes strongly that the husband's role is to provide for his family. Miguel has difficulty recognizing that his family has needs other than just money from a husband and father. This pattern was established in his family of origin. '

Miguel would therefore be in danger of passing on these same patterns and behaviors to his daughters and to Christopher. His emotional detachment from his family reflects the way he was raised. ...

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