Applying Bowenian and Structural Theories
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For this assignment, two different theoretical approaches will be discussed, Bowenian family therapy and structural family therapy, and they will be used individually to construct a treatment plan to help clients reach their goals. Within each treatment plan discussed, short-term and long-term goals of therapy will be established and the family’s presenting problems will be defined. Two techniques that will be assigned to help them reach their therapeutic goals and any expected outcome from using those techniques will be discussed. The Presenting Problems
Judy, Adrian, and Pamela are a family of three that have all come into counseling seeking help (Psychotherapy.net, 2012). Judy and Adrian want to understand their thirty-year old daughter’s behavior and both parents are frustrated because they have been having a hard time communicating and getting along with their daughter Pamela (Psychotherapy.net 2014). Their chief complaint is Pam’s anger and disrespect. She ignores their attempts to communicate with them and she frequently displays anger towards her parents (Psychotherapy.net, 2014). Although Pamela appears to withdraw from her parents she is in fact fused, or undifferentiated, with her parents (Psychotherapy.net, 2012).
Her poor differentiation indicates an emotional dependency on her parents (Psychotherapy.net, 2012; Gurman, 2008). There is a lot of emotional reactivity, Pam vents her frustration through verbal and physical displays of anger, Judy withdraws from Pamela, and Adrian reacts with pressure and anger (Psychotherapy.net, 2012) All of them are cutoff, which is when individuals distance themselves from their families (Gurman, 2008), This occurs when Pamela ignores her parent’s attempts at communicating with her, and by her emotional distance from Judy. Pamela uses “I don’t know” a lot when asked why she does things (Psychotherapy.net, 2012) so she either is unable to express her feelings her she is using that statement to cutoff emotionally from her family.
There appears to be a demand/withdrawal pattern between Pamela and her parents. Pam is emotionally closer to her father Adrian than she is with her mother Judy (Psychotherapy.net, 2012). Judy believes that the reason may have a lot to do with her having to take Pamela to medical appointments for treatments when she was a child (Psychotherapy.net, 2012). There is a strained relationship between Pam and Judy and Adrian is constantly pushing Pam to have a better relationship with her mother (Psychotherapy.net, 2012). Applying Bowenian Family Therapy
Bowen family therapy, or as some like to refer to it as transgenerational family therapy, is an approach that looks at the family unit as an emotional system, that although delves into the family history, is primarily focused on the present (Gurman, 2008). This theory operates on the premise that there is an underlying anxiety that is present because of the stresses of living, and manifests in both the emotional and physical expressions of all living things (Gladding, 2010). When this theory is applied to the family in focus, these goals, techniques, and expected outcomes emerge. Short-term Goals
1. Develop rapport with the family and work on establishing trust and a therapeutic alliance with all family members. 2. Identify to what extent the family is anxious or differentiated. 3. Reduce anxiety for each individual to lessen emotional reactivity. Long-term Goals
1. Increase healthy communication between all members of the family. 2. Decrease Pamela’s dependency on her parents and increase her independence. 3. Help all members of the family to have healthy levels of differentiation. Two Interventions
Two interventions will be used to try and reach the family’s therapeutic goals. The two have been chosen based on the family’s presenting problems and the goals they have come into counseling to achieve. Nonanxious presence
This technique is one that can be used to help diffuse tension and emotional reactivity so conflict can start being addressed from a nonanxious approach (Gehart & Tuttle, 2003). This technique was chosen because Pamela uses anger and/or shutting down to cope with perceived threats within her family. The entire family could benefit from this technique so that they may go from using emotionally reactivity to shifting towards a more functional cognitive process while engaging with one another (Gladding, 2010). Differentiation of self
This a good technique to use because there is a high level of fusion occurring between Pamela and her parents (Psychotherapy.net). Pamela is dominated by her automatic emotional responses (anger and shutting down) and appears to lack functional levels of adaption and flexibility, especially during high stress times or when expected to do things independently. Pamela cuts herself off from the family emotionally in attempts to avoid being controlled or overwhelmed. Judy has given up on being close with Pamela and has accepted the emotional distance present between them. Expected Outcome
The expected outcome for using both of these techniques is to decrease the symptoms plaguing the family but more specifically increase the overall wellness of the entire family system. Using nonanxious presence will help demonstrate lower levels of arousal and better communication skills (Gladding, 2010). The family may learn not to react as emotionally with one another, thus lower the intensity when they attempt to communicate (Gehart & Tuttle, 2003).
Using differentiation of self will help the family lessen their fusion to one another, and more specifically help Pamela begin the process of becoming more independent. If Pamela gains more independence this would hopefully lower the anxiety and tension in the household because it would decreased the frequency and intensity of the power struggles between Pamela and her parents. The more independent Pamela becomes the more confidence she will gain, thus hopefully increasing her cognitive responses while diminishing her emotional reactivity. Applying Structural Family Therapy
Structural family therapy is an approach that views the family as a system, one where all members are interdependent on one another but also subjected to outside influence that impacts the way that family system operates (Gladding, 2010). In this theory, subsystems are analyzed because they play a large role in the stability and overall function of the family system (Gladding, 2010). Boundaries, rules, and power are also analyzed to gain a clear understanding of how the family interacts and changes over time (Gladding, 2010). When this theory is applied to the family in focus, these goals, techniques, and expected outcomes emerge. Short-term Goals
1. Join with the family to learn their rules, power structure, and communication patterns. 2. Evaluate the boundaries within the family and between individuals within the family. Long-term goals
1. Strengthen alliances between Adrian and Judy so being unified in parenting Pamela becomes easier. 2. Develop clear boundaries between all members of the family to reduce tension. 3. Address issues of anger within the family so lessen communication barriers that prevent conflict resolution. Two Interventions
Two interventions will be used to try and reach the family’s therapeutic goals. The two have been chosen based on the family’s presenting problems and the goals they have come into counseling to achieve.
This technique would be good to use because it allows for the family and how they operate within the system to be observed (Gehart & Tuttle, 2003). This observation is needed to help clarify and identify areas that Judy, Adrian, and Pamela need help in (Gladding, 2010). Family mapping is necessary so that all three family members understand how they affect one another by the use of anger and avoidance. Judy, Adrian, and Pamela align with one another in unique subsystems and it is important to understand how each subsystem influences the overall wellness of the family and promotes or undermines the stability of family system. Conflict Management
This technique is one that the family could really benefit from since many interactions between Pamela and her parents involve anger and avoidance. Their overall communication patterns seems to include a lot of tension, anxiety and anger. Pamela lacks conflict management skills and could really benefit from learning how to resolve conflict in a more peaceful, constructive manner. Adrian has also admitted to having anger issues and learning these skills can also help him learn to resolve issues with his daughter and with his spouse. Expected Outcomes
The expected outcome for using both of these techniques is to decrease the symptoms plaguing the family but more specifically increase the overall wellness of the entire family system. Using family mapping should increase understanding in how the operate for not only the counselor, but for the family as well. Becoming cognizant of their family structure and how they operate as individual parts, and as a whole should help highlight areas that need improvement along with decreasing symptoms through understanding themselves and their family members better. Through understanding they can decide what areas need better boundaries and how to begin working toward their other therapeutic goals. The family may also revise their goals after they better understand how their family works.
Using conflict management should help strengthen bonds within the subsystems and open the channels of communication. Through better communication, symptoms of anger and anxiety should decrease promoting more emotional bonding and less avoidance of each other. Through connection, they can start to work as a cohesive family system, interdependent but also working towards their own personal goals to achieve personal growth as well as growth within the family. Conclusion
Although these two approaches are different, they both address presenting problems to help each individual work in unison to function better within the family unit. Since families are more than the sum of their parts, they are all unique and have their own dynamics and problems. Each approach has a unique perspective on the family and how to help improve the overall wellness. Counselors need to be well versed and familiar with the different techniques used. Both approaches are designed to create a healthier, functional family environment where each member can grow and meet their potential.
Gehart, D. R., & Tuttle, A. R. (2003). Theory-based treatment planning for marriage and family therapists. Belmont, CA: Brooks/Cole. Gladding, S. T. (2010). Family therapy: History, theory, and practice (5th ed.). Upper Saddle River, N.J.: Pearson. Gurman, A. S. (2008). Clinical handbook of couple therapy (4th ed.). New York, NY: Guilford Press. Psychotherapy.net. (Producer). (2012). Bowenian family therapy [Motion picture]. [With Philip Guerin, MD]. United States: Psychotherapy.net. Psychotherapy.net. (Producer). (2014). Structural family therapy [Motion picture]. [With Harry Aponte, LCSW]. United States: Psychotherapy.net.