NCE – Essential Family Skills…


 

PAPER #1 (prior to first session)

Abstract

This assignment focuses on a fictional family, the Banyons. What follows is a consideration of information needed prior to the initial session. Issues involving seating arrangements, the initial greeting, and session goals are also discussed.

Introduction

A family’s decision to enter therapy often comes after much turmoil as they come to terms with the idea they may be unable to resolve issues on their own. Previous experiences and attitudes about therapy amongst family members are likely to vary and influence initial contact.   Patterson, et al, (2009) suggests that the period of time leading up to an initial therapy session is a critical time. Not only can it determine if the family will be willing to commit to therapy, the outcome of the first session can be greatly influenced by a therapist’s preparatory work.

This paper is the first in a series of assignments, which follows along with a fictional family, the Banyons. Mary Banyon is the first to make contact with the therapist’s office after her husband suggests that his mom move in due to declining health.   Concerned about the effects that this might have with the entire family, she desires they enter therapy in order to work through this issue.   She has three kids living at home, including two college age students.

In order to prepare for the first session, it would be the suggestion of this author that a therapist start by mailing out an intake form for Mary Banyon to fill out and return.  Information gathered from this intake form can include: (1) demographic data, (2) a description of the problem, (3) list of family members, (3) history of past counseling, and (4) substance use, medical history as well as (5) criminal background (Patterson, et al, 2009). After receiving this information from Mary, a brief phone interview would be warranted. This could allow the therapist to further assess information such as the family’s sociocultural background, expectations for therapy, and the exact nature of the problem.

Information Needed

Certain information is essential in order to prepare effectively for the first session with the Banyon family. What follows is a list of information needed prior to the first family session. With this information, a therapist can develop key questions that can provide guidance in planning for the initial session.

Defining the Problem

            Qualls & Williams (2013) define Caregiver Family Therapy as a therapeutic framework that address issues related to long-term care needs of elderly members. Based on what information we currently have, it appears that the family is in pre-caregiving stage. During this period, family patterns are unchanged, but accommodations are being considered due to declining health in an elderly family member (Qualls & Williams, 2013). In addition to discussing the concerns of all family members regarding this decision, several other issues can be expected.   Family roles will change in response to gradual increases in the level of care required (Qualls & Williams, 2013). Long-term plans will need to be discussed, in light of grandma’s declining health. Finally, the immediate issue of the providing physical accommodations is likely to involve a big adjustment for the entire family, in addition to causing financial strain.

Prior to the first meeting, it will be important to determine if there is crisis situation at hand and if scope-of-practice issues warrant a referral. How bad is Grandma’s health and is medical intervention necessary? Additionally, while Mary appears to be the spokesperson for the family, it is important to talk with other family members as well prior to the first session. This will make all family members feel more welcome and provide some clarity regarding their concerns.

Who Should Come?           

            In Mary’s initial phone call to the receptionist, she states that it is her hope the entire family attends. While everyone living at the home is impacted by the problem, without further information, it is difficult to determine if this is a good idea. A telephone interview may be warranted first to determine if Mary and her husband are in agreement with this decision. How do they plan to accommodate this change financially?   Who will be providing the bulk of grandma’s caregiver needs as her health declines? What is the current state of their relationship? Issues such as these can determine whether or not to include the children in the first meeting.   If issues such as these are unresolved it may be warranted to exclude the children initially. Finally, I would suggest including grandma only once the family has come to some agreement on the matter. This can allow her to address her concerns and assess her adjustment to these changes.

Expectations & Anxiety

            It is important to note that often families only seek therapy when they find they are unable to handle issues on their own (Patterson, et al, 2009). With this in mind, areas of disagreement are inevitable amongst family members. Prior to the first session, it is important to assess everyone’s expectations about therapy. Has anyone had previous experiences in therapy? Finally, while Mary’s motivations are clear, how do the other family members feel about therapy? With this information, it is possible to develop a clearer idea of any disagreements that exist. The stages of change model, can help address prevalent attitudes toward therapy, and varied levels of resistance amongst family members (Patterson, et al, 2009).

It must also be noted that any unforeseen legal issues or medical problems may warrant referral, since these are out of a therapist’s scope of practice.

Cultural Background

            Ariel, (2000) states that “There are good grounds for believing that the coping mechanisms employed by families are at least partially dictated by the specific cultures to which they belong” (p25). For this reason, cultural competence is a vital component of family therapy. The culturally defined features in a family’s belief system, roles structure and modes of affective expression are likely to define how to best proceed during the first session.   Since the intake form includes basic demographic data, it is possible to address this during a telephone interview. This can be addressed in questions that require Mary to elaborate on information provided, such as religious background. Information such as this can provide guidance for the therapist on issues such as seating arrangements, etc.

First Session Goals

            Initial goals for the first session include allowing each family member to an opportunity to discuss their concerns and goals for therapy.   In order to establish a positive therapeutic relationship with everyone attending the first session, it may be warranted to conduct a telephone interview with each individual beforehand. Naturally, the therapy goals are limited by the levels of resistance amongst family members to participating in therapy.   What follows is a list of goals for the first session.

  1. Administrative issues: Issues of confidentiality, fee structure, and Release of Information should be addressed during the first session.
  2. Establishing a Connection: Patterson, et al, (2009) describe joining as a key goal at the onset of family therapy (p25). This involves developing a connection that can set the foundation for a positive therapeutic relationship with all family members.
  3. Clarifying Goals: It is important to give all participants an opportunity to discuss their concerns regarding grandma’s long-term care needs and goals for therapy. Areas of conflict and previously unstated agendas can delineate areas of disagreement that need to be addressed in future sessions (Patterson, et al, 2009).
  4. Motivational Interviewing: It is likely that some family members are less motivated to participate in therapy. Motivational interviewing techniques can be utilized to address resistance while taking time to listen to concerns with a goal of eliciting participation.
  5. Scope of Care & Competence Issues: If it is determined, that grandma’s health is worse than previously stated referrals may be warranted. Additionally, areas outside one’s skill set may require a referral to someone more adept at handling the Banyon case.

Initial Greeting & Seating Arrangements

In addition to observing each individual’s role within the family system, it will be important to provide some structure during the first session. The initial greeting is critical in establishing a connection with the family as a whole. Arranging seating thoughtfully, can allow each member to feel like an equal contributor to the conversation.   Patterson, et al, (2009), state that the manner in which a family interacts during therapy holds clues to the nature of family interactions in the home (p6). Careful observations coupled with the mindful rearrangement of seating, such as described in the textbook’s Cinderella story, can address these issues (Patterson, et al, 2009).  Actions such as this are based on initial hypothesizing coupled with careful observation (Patterson, et al, 2009). Paying “close attention to what is known” (Patterson, et al, 2009) can help the therapist structure and guide the discussion during the first session. Based on the information received throughout this session, interpretations can be made that can clarify the issue at hand, and everyone’s expectations for therapy (Patterson, et al, 2009).

References

Ariel, S. (2000). Culturally competent family therapy: A general model. Westport, Conn: Greenwood Press.

Patterson, J., Williams, L, Edwards, T., Chamow, L. & Grauf-Grounds, C. (2009). Essential Skills in Family Therapy: From the First Interview to Termination. New York: Guilford Press.

Qualls, S. H., & Williams, A. A. (2013). Caregiver family therapy: Empowering families to meet  the challenges of aging. Washington, DC: American Psychological Association.  doi:10.1037/13943-000

PAPER #2 (the first session)

Abstract

This assignment focuses on a fictional family, the Banyans. What follows is a list of prioritized treatment goals developed after the initial session.  Also discussed are strategies utilized to address them potential issues that will arise in the near future.

Introduction

This paper lists prioritized treatment strategies for the Banyan family after the first session.   Patterson, et al, (2009), state that treatment plans are utilized to define clearly the problems needing to be addressed in therapy and the interventions developed to address them (pp 77-78). Treatment plans provide a way of formally defining the goals of therapy with clients in writing (Patterson, et al, 2009). The initial steps to completing a treatment plan include: developing a problem list, understanding the client’s desire for change, and case conceptualization (Patterson, et al, 2009). With this information in hand, it is possible to then develop a list of long-term goals and treatment interventions (Patterson, et al, 2009).   An overview of these initial treatment plan steps is included below.

Step One: Listing Problems

A brief description of the client’s presenting problems is available for purposes of this assignment. Writing down a list of problems with clients can initiate the treatment planning process and provides a way of ensuring everybody is “on the same page”. What follows is a brief problem list for the Banyan family.

  1. Couple/Family: Ben is concerned about his mother who has Alzheimer’s and wants her to move into their home.   While Ben and Glenda are very close, Mary feels she has been a controlling and divisive force within the family.   The entire family is affected greatly by this decision. With limited space and financial resources, everyone may need to sacrifice in order to accommodate Glenda.
  2. Mary Banyan: Mary is a housewife who has never been employed outside the home. Since she is home during the day, it is expected she will take on the lion’s share of caretaking duties for Ben’s mother, Glenda, should she move in. Since she was the one to first seek therapy, this appears to concern her greatly.
  3. Ben Banyan: Ben has a mother who was recently diagnosed with Alzheimer’s. Since his siblings are unable to provide her assistance, he is her only resource. While he owns a construction company, it appears he has had to seek financial assistance from his wife’s parents at times. This indicates his ability to financially assist Glenda is limited. Finally, since Ben is very close to his mother, this diagnosis is probably devastating news.
  4. Thomas, Julia & Jacob Banyan: While Thomas is having difficulty in school and has no direction, Julia is excelling academically. Not much is known about Jacob, as a quiet shy child, outside of an array of medical issues.
  5. Glenda Banyan: With declining health and a new diagnosis of Alzheimer’s, Glenda needs to make plans for her future long-term-care needs. Her resources are reportedly limited, and the only family she can rely on is her son Ben.

Step Two & Three: Client Expectations & Case Conceptualization

            The family enters therapy in the hopes that everyone can come to an agreement on how to handle Glenda’s declining health. While Ben wants Glenda to move in, Mary is resistant to the idea.   The family comes to therapy in the hopes of coming to an agreement on how to address Glenda’s long-term care needs. Addressing this disagreement will first require that the family clearly understands the nature of Glenda’s issues. With this knowledge, the family can determine how they can realistically address them (Qualls & Williams, 2013). As they contemplate this decision further, everyone must also come to terms with the role restructuring that will occur and sacrificed that are required (Qualls & Williams, 2013).   In this respect, Mary is right that everyone needs to sit down and discuss there thoughts on this matter.

Treatment Goals & Priorities

  1. Goal One – Increase the family’s understanding of Glenda’s condition and caregiver needs: Based on the information provided from the initial interview, nobody in the family appears to have ever worked in the healthcare field. It is logical to assume, therefore, that the family is unaware of what involved with providing care to an Alzheimer’s patient.   In addition to a failing memory, Alzheimer’s also produces extreme behavioral and mood changes.   Additionally, as the disease progresses, patients often require ever-increasing levels of assistance with activities of daily living (Qualls & Williams, 2013). Before the family can begin to iron any disagreements, they need to educate themselves on the nature of Glenda’s condition.   It is for this reason that I would suggest Ben and Mary meet with Glenda’s doctor to discuss in detail, her current health and long-term prognosis. Referrals to long-term care specialists can help them develop a clearer idea of what the future holds for Glenda. This can allow the family to begin plan accordingly.
  2. Goal Two: Identify a list of alternatives and resources to begin addressing Glenda’s need for caregiver assistance. It appears that Mary and Ben disagree on how to handle Glenda’s declining health. While Ben is against long-term-care, Mary is wary of moving Glenda in, without considering the implications carefully.   Before ironing out this disagreement, they should carefully consider all alternatives first.   I would suggest that Mary and Ben begin listing the ramifications of all options and identify resources that can provide assistance.   This investigation process should involve visits to home health care agencies and long-term facilities.
  3. Goal Three: Discuss implications of these expected changes for the family. With all this information in hand, it will be possible to begin discussing all options.   As Mary stated, this should, at some point, involve the input of all family members affected by this decision. This should eventually mean considering the concerns of Mary and Ben’s children. Initially, though, I would start with private couples sessions between Mary and Ben. This could allow them to process this information privately.
  4. Goal Four: Address any potential conflict between Mary and Ben as it pertains to Glenda. As stated earlier, it is clear that Mary and Ben have different ideas of how to handle Glenda’s declining health. Underlying this disagreement is a long-standing issue regarding Ben’s relationship with his mother. Mary feels Glenda is very controlling and has never gotten along with her. Ben, who is close to his mother, is struggling to cope with this devastating news. It will be essential for Ben and Mary to iron out this longstanding misunderstanding. I suggest that before they do so, they focus initially on gathering all the information they require to make an informed decision.
  5. Goal Five: Discuss ramifications of Glenda’s care needs with Mary and Ben’s children. Help them adjust effectively to these changes. It is fairly clear that Ben and Mary are interested in obtaining the input of their kids as they make this difficult decision. Nonetheless, I believe Mary and Ben have some issues to iron out first. After they have done so, it will then be possible to consider any concerns their offspring may have. Helping the oldest kids adjust to these changes will be essential. Family resources will be stretched to their limit in order assist Glenda. Chances are, they may be on their own financially, sooner than expected. Based on current assessment information, Julia is expected to adjust better than Thomas, who may require greater assistance in this transition. Finally, more information is required of Jacob, who we know little about.

Expected Upcoming Issues

Patterson, et al, (2009), describe problems of family counseling often arise very much like an onion, in layers. Based on the current information known about the family what follows are additional layers that may unfold at some point.

  1. Glenda’s health will continue to decline and she may become more difficult to manage. In addition to requiring greater levels of assistance with activities of daily living, her behavior, mood and temperament are likely to transform over time.
  2. The difficult relationship between Mary and Glenda can’t fully be fully resolved in light of Glenda’s diagnosis. Regardless the family’s decision, Mary will need to come to terms with this fact and resolve this issue independently through a process of forgiveness. This can allow her to help Ben grieve while the family adjusts.
  3. Since Ben is close to his mother, I expect he may struggle to come to terms with Glenda’s slow decline. Helping Ben grieve this loss will be a critical component of therapy.
  4. Thomas is expected to struggle the most in his transition into financial independence. His lack of motivation and direction are likely to hamper the family’s efforts to assist Glenda. A significant amount of energy must also be devoted to help him work through this transition.
  5. Little is known about Ben and Mary’s youngest son Jacob. As a quiet and shy individual, it is concerning that his parents have little to say about him. It is expected that Jacobs developmental needs may receive less attention than needed as this family struggles with this dilemma. It will be important to assess Jacob’s reactions to the upcoming changes.

Overall Strategy

Rather than seeing the family as a group from the outset, I have a different plan. I believe that Ben and Mary have some issues to work out as a couple first, before the children are brought in therapy sessions. In addition to ironing some long-standing disagreements regarding Glenda, it will be important for them to research all options. The financial constraints and feasibility of alternatives will need to be ironed out before the input of their offspring is considered. Finally, Ben also needs time to begin coming to terms with this new information. Only after Ben and Mary have made some headway, would I consider including their children.

References

Patterson, J., Williams, L, Edwards, T., Chamow, L. & Grauf-Grounds, C. (2009). Essential Skills in Family Therapy: From the First Interview to Termination. New York: Guilford Press.

Qualls, S. H., & Williams, A. A. (2013). Caregiver family therapy: Empowering families to meet the challenges of aging. Washington, DC: American Psychological Association. doi:10.1037/13943-000

Paper #3 (assessment)

Abstract

This paper looks at how to assess family functioning. It will begin with an overview of essential components of an assessment from our course textbook. The paper will conclude with the presentation of option for assessing family strengths and weaknesses from research.

Introduction

​The purpose of this assignment is to provide a review of how to assess the strengths and weaknesses in a family. Our course textbook provides a nice overview of the general assessment process based on pathological diagnosis (Patterson, et al, 2009). In contrast, a research article I found for this assignment utilizes a strength-based perspective and provides a framework for assessing family resilience (Walsh, 2003). Together, these two perspectives provide an overview of the strengths and weaknesses in a family.

A Diagnostic Perspective

Patterson, et al, (2009) provide an overview of a Generalized Assessment Plan, which includes the following information: (1) the presenting problem, (2) issues of harm (3) substance use, (4) medical issues and (4) a psychosocial background (Patterson, et al, 2009). I discuss each briefly below:

Exploring the Presenting Problem

​Initially, time should be taken to discuss the family’s reason for seeking therapy. In addition to developing a clearer understanding of their concerns, this provides the therapist an opportunity to establish a rapport with the family. Taking time to listen to each family member’s description of the presenting problem is critical to assess variances in how it is conceptualized. Understanding the family’s methods of coping and attempts to resolve matters is also important (Patterson, et al, 2009).

Issues of Harm

​Patterson, et al, (2009) states therapists must remain vigilant of any issues of potential harm such as suicide, sexual abuse, or domestic violence. For example, suicidal ideation involves asking about a history of any suicidal ideation and the details of a plan. Considerations must be made when addressing in front of family members, and the influence this information can have on the overall family dynamic. It is also important to look for signs of violence since it occurs in approximately 15% of families nationwide (Patterson, et al, 2009). Since families are often reluctant to openly discuss sexual abuse and neglect, it will be important to look for any evidence. As a mandatory reporter, clinical judgment is required to investigate intuitive nudges and concerns for a client’s well being. (Patterson, et al, 2009).

Substance Abuse

​Despite the fact that substance abuse is a major health care problem, many new therapists overlook this issue (Patterson, et al, 2009). In addition to being masked by an array of comorbidities, clients and family members are often unaware of the issue (Patterson, et al, 2009). It will be important for therapists to be familiar with assessment tools such as the “MAST”, “AUDIT”, and “CAGE” tests (Patterson, et al, 2009).

Medical Issues

​Frequently, underlying mental health issues are organic and neurological causes that are easy to overlook for those lacking a medical background. A review of the client’s medical history can uncover a history of chronic diseases that might explain some symptoms. Diagnostic tools such as the mental status exam and neuropsychological examinations, can also provide clues of a possible medical issue. Finally, an awareness of organic brain symptoms including disorientation and recent memory impairment can indicate a need for a referral.

Psychosocial Assessment

​Patterson, et al, (2009) mentions affect, behavior, and cognition, as three key areas of psychopathology to assess for purposes of DSM-5 diagnosis. This diagnostic framework is useful in contextualizing the client’s presenting problems. Assessments of meaning provide additional insight into the nature of a family’s understanding of underlying issues. Assessing the family and couple as a system requires an examination of issues such as the familial life, role structures, communication styles, and conflict resolution skills (Patterson, et al, 2009). Finally, Patterson, et al, (2009) briefly mention holistic and spiritual assessments as additional components of a psychosocial assessment frequently overlooked by therapists.

A Resiliency Framework.

In contrast to the diagnostic perspective reviewed above, an article I found for this paper utilizes a family resiliency framework (Walsh, 2003). According to Walsh, (2003), resiliency refers to the “ability to withstand and rebound from disruptive life challenges” (p1). Examining the relational context of resilience in a family system is useful in uncovering untapped strengths. While the deficit-based perspective clarifies the nature of presenting problems, a resiliency framework provides solution-based guidance (Patterson, et al, 2009; Walsh, 2003). From this perspective, crises can be seen as a potential source of growth and relational transformation. Families often respond to crises in a manner that reflects ripples in a pond that span generations. Understanding the nature of this response to crisis, requires a biopsychosocial and ecological perspective. Walsh, (2003) suggests that an assessment of family resilience should look at three key areas (1) family belief systems, (2) organizational patterns, and (3) problem solving processes.

Family Belief Systems
​Family belief systems influence

how family defines and response to crisis. According to Walsh, (2003) adaptive belief systems have three key elements. Firstly, belief systems that make meaning out of adversity provide as resiliency that allows families to face crisis (Walsh, 2003). Secondly, adaptive belief systems reflect a positive outlook that exists in polar opposition to learned helplessness (Walsh, 2003). This positivity provides families with a well of hope that they will persevere. Finally, a deep transcendent spiritual faith that allows families to see a purpose in life beyond one’s immediate existence (Walsh, 2003).

Organizational Patterns

​A second key component of family resilience, is its organizational pattern (Walsh, 2003). The flexibility of a family’s organizational structure determines its ability to bounce back after crisis and adapt to a “new normal” (Walsh, 2003). The connectedness present with a family’s role structure solidifies its commitment to collaboration through crisis. Based on these insights, a review of the family’s role structure and communication style can shed light on protective factors against crisis.

Problem Solving Processes

​A final critical component of family resilience is its communication style and problem solving patterns (Walsh, 2003). Communication styles that are adaptive to crisis provide its members with open access to information. The clear and effective communication of information, and thoughts and emotional perspectives is found to aid in recovery of crisis. This open communication style, provides a relational resilience for resolving conflicts and problems with a family. Resilient problem solving processes bring family members together rather than drive them apart. They are found to grow and learn from the experience in ways they hadn’t foreseen (Walsh, 2003).

References

Patterson, J., Williams, L, Edwards, T., Chamow, L. & Grauf-Grounds, C. (2009). Essential Skills in Family Therapy: From the First Interview to Termination. New York: Guilford Press.
Walsh, F. (2003). Family resilience: A framework for clinical practice. Family Process, 42(1), 1-18.

Paper #4 (termination)

Abstract

This assignment focuses on a fictional family, the Banyans. For this paper we are to address the issue of termination.   After providing a list of goals for my final therapy session, I will review key issues I hope to address with this family. This paper concludes with a review of theoretical techniques and methods useful during this final meeting.

Introduction

For this assignment we follow a hypothetical family who, after six months of therapy is terminating services. During these six months, the Banyons have seen the therapist for a total of sixteen sessions, twelve of which include the couple’s sessions for the parents. While significant progress has been made, I’m personally concerned the family terminating services at this time. It is important to keep in mind, though, that the family’s reason for entering therapy is to discuss their concerns about Glenda’s declining health.   Although, as a therapist I see an array of other issues, the family’s main concern was how to address Glenda’s increasing self-care needs.   In this hypothetical scenario, it is unknown the reason for termination. At times, insurance companies set limits on the amount of therapy they will pay so this could play a factor in their decision. Alternatively, it is possible that the treatment plan was limited to those issues the family desired to discussed.   While I do believe a client’s wishes should be respected, there are several issues I’m concerned about that are still not addressed. Firstly, Thomas’s history of suicide ideation is concerning, and I’m unsure how he might handle the upcoming transition. Secondly, it is still unclear as to whether or not Mary and Ben have discussed Mary’s secrets openly in their sessions, although this seems unlikely. While I must respect Mary’s right to confidentiality, I have mixed reservations ethically about not providing them a chance to discuss this openly. As we learned in class, keeping secrets such as these are likely to create a well of unresolved issues that will only perpetuate endlessly until addressed openly. Finally, when reviewing past information on this family, I’m concerned about Ben’s relationship with Jacob. At one point, it is mentioned that Ben spank’s Jacob, and he fears his father. This is troubling in light of Ben’s own history of abuse. It is unknown from this case scenario, how bad these “spankings” are. However, I understanding that realistically, not all client relationships terminate as we might hope they do. Additionally, we can’t make a client address issues we are concerned about, if they don’t consider them important.   With these reservations in mind, the next section reviews my goals for the final session.

Goals for Final Session

Ben & Mary

            Mary and Ben have been married over 20 years and have completed twelve sessions as a couple during the last six months. Mary is a 43-year-old stay-at-home mother who hopes to return to work soon.   Ben is 45-years-old and owns a construction company. His own family includes a history of drug addiction and abuse. The couple seeks therapy in order to work through disagreements regarding Glenda’s declining health and how to address this.   As a therapist, I am also quite concerned about Mary’s drinking lately, as well as the secret she has kept about a previous affair and Jacob’s questionable paternity. However, it appears from this hypothetical scenario, they are terminating therapy, and these issues appear to not be addressed.

Firstly, since Mary revealed this secret in confidence, I intend to respect. However, I would want to schedule one final individual meeting with Mary. I would share my concerns about her drinking and working through her feelings regarding this secret and any complex feelings surrounding it. If she is interested, I would be offer to continue working with her individually. I might bring up this issue, by complimenting her on all the progress she has made. I could offer these services as an adjunct to her current participation in the YWCA women’s group. During this final session, I would focus on the progress they made as a couple, and review many of the skills they have learned. Hopefully, we could take some time to discuss the changes in their relationship, in an effort to motivate them to maintain their relationship improvements.

Thomas

            While it is clear, (for whatever reason), that the Banyon’s are terminating services, I’m still quite concerned about Thomas. Most of the sessions, thus far, have been devoted to working with the couple individually. Thomas is a 22-year-old who has a history of suicidal ideation with one previous attempt. He still lives alone, isolates quite a bit, and has little to no motivation to work or go to school.   As a therapist, I’m quite concerned about this depression since it appears to have been undiagnosed and untreated for many years.   As the Banyon family’s time in therapy comes to an end, we learn that he has six months to move out. It is clear based on prior notes on this case, that that this fact produces a high degree of stress in Thomas. For this reason, I would offer my services to him on an individual basis. Currently, there is inadequate information to determine how open he and his family is to continuing with therapy individually. I would begin by expressing my concerns to his parents, and try to schedule at least one session, so I could assess Thomas more closely.   I would also state to Thomas that this could provide him some guidance throughout this transition into a fully independent life.

Jacob

            Jacob is the youngest of the Banyon children at 12-years-old. In six months time, he will be the only child left in the home.   We don’t know much about Jacob currently, but it is mentioned in this week’s assignment that he is now seeing a child therapist for anxiety. I would forward my case notes and concerns to this therapist. It might mention the “spankings” to the therapist and history of medical issues for further exploration.   Finally, since I plan to continue seeing Mary and Thomas individually, I would work to solidify a working relationship with this new therapist.   For the final session, I would do some brief psycho-education on the importance of parental participation in Jacob’s therapy.

Glenda

            Glenda is 71-years-old and was recently diagnosed with Alzheimer’s. Currently she lives alone and is hoping to sell her house soon. As Ben’s mother, it is unclear how close they are, although it is important to note that his father abused them. This, in all likelihood, adds a layer of complexity to their relationship. The Banyon family originally entered therapy to discuss how they might handle her declining health.   As therapy comes to a close, it appears that Ben and Mary are hoping eventually move Glenda in. They plan to hire a part-time nurse’s aid and utilize adult day care services.   In order to prepare for this final session, I would seek referrals for the Banyons, so they could develop clearer long-term plans for Glenda.   Their current plan is useful for mild to moderate cases of Alzheimer’s cases. Having cared for Alzheimer’s patients before, as the disease progresses, personality changes occur, and daily care needs increase exponentially. This couple really needs to speak with a specialist in neurocognitive disorders like this, in order to understand what is in store for Glenda long-term.

Orientation and Approach

For this final session, I have no specific therapeutic approach in mind. However, goals for this final session are to respect the client’s wishes while voicing my own personal concerns. This involves providing them with an array of information for them to review with referral services as necessary. As stated earlier, I’m quite concerned about this family discontinuing services so early. At the same time, as Patterson, et al, (2009) notes, termination doesn’t always go as we might hope.

References

Patterson, J., Williams, L, Edwards, T., Chamow, L. & Grauf-Grounds, C. (2009). Essential Skills in Family Therapy: From the First Interview to Termination. New York: Guilford Press.

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