Worldwide, a significant number of families face problems ranging from marital challenges, mental disorders, and financial issues to conflicts between siblings and parents. Sometimes, the struggles they attempt to overcome are too big for them to handle. Regardless of the complexity of situations, people are dealing with, family sessions have proved to be useful in providing short-term solutions. They achieve these results through a change in behavior and modification of the interaction patterns as well as the family structure. This type of therapy is aimed at enhancing communication between relatives, resolving conflicts, and improving the home environment to support the quality of life. The sessions are rendered by psychologists, trained clinical social workers, and qualified therapists (Carr, 2019). This paper aims at providing an analysis of the case study involving a family with issues, which require professional interventions. The problems in this situation are identified, and their theoretical causes are sufficiently explained. The optimal approach for resolving the challenges, which people faced, is discussed through the lens of theoretical knowledge of family treatment therapies.
The case under discussion involves a 36-year-old woman (Irma) who took her 9-year-old son (Jose) to a clinic for therapy. The selected mental health facility was the one focused on providing services for children and teenagers in need, and it fully corresponded to their purpose. She claimed that his behavior changed at some point in the past, and this fact adversely affected their family life. The shift in the boy’s attitude was noticed not only by his relatives but also by his teachers and classmates. Surprisingly, he had an insight into this transformation and recognized it as disrespect to his mother in the first place but thought that it was not of concern. Jose had developed this conduct a year before the decision to seek help was made. He yelled at his mother and his siblings, physically assaulted Irma, and, at some point, even hurt himself. Subsequently, the situation became critical, especially considering the demonstration of such negativity from a nine-year-old boy. Hence, quick interventions were viewed by the family as the necessary measure to preclude the progression of the problem.
Irma compared her son’s behavior to the conduct of her abusive husband she had divorced before marrying another man named Carlo. In this way, she associated Jose with his biological father and perceived him accordingly. Despite the lack of support from her current husband in managing the children, she tried hard to maintain the closeness of all members of the family. Meanwhile, life had never been easy for Irma since childhood due to the fact that her parents belonged to a low socioeconomic class. The problem of abuse was also typical for her mother, who frequently changed partners, and she followed this relationship model as well. At the time of the visit, however, she was more concerned with protecting her youngest son, Luis, from harm caused by Jose. She longed to gain happiness and hope in life through the resolution of the specified issue. From this perspective, the need for therapy was inevitable for the restoration of normal communication patterns. Thus, the principal challenges identified in the family included a flawed structure, the lack of finances, and Jose’s behavior. These factors increased the overall level of stress in Irma’s life.
Causes of Family Problems
A thorough analysis of the case of Irma and Jose is needed for the provision of evidence for critical challenges of the patients, which require corresponding interventions. According to the family system theory, this kind of problem is likely to be related to some other neglected issues (Carr, 2019). For example, the conflicts between parents might have a tremendous impact on their children’s behavior. According to Carr (2019), the theory explains that the dynamics are influenced by numerous factors. They include the presence of extended families, bad parents’ relationships, negative events such as divorce, the history of prior generations, their communication models, and the nature of attachments (Carr, 2019). As follows from the case above, the behavior of Jose was influenced by such circumstances surrounding his family. Some of the factors, which can be connected to his problem, include the divorce of her mother from his abusive biological father and the lack of support from his stepfather. In this way, it can be concluded that the issues of Jose’s conduct come from the absence of association with his extended family.
The parents also had a poor socioeconomic background, which implies that the children were not financially supported, and their primary needs, such as education and clothing, were not met. Carlo was less involved in raising Irma’s children from the previous marriage than his own son, and she, in turn, had no job and could not financially sustain the family. The situation was complicated by Irma’s negative experience with her parents and her history of abuse. As a result, she got stressed and became hopeless because of her son’s behavior and the challenge of rearing the children alone without any support from Carlo. It is evident from previous studies that children who grow up under poor socioeconomic conditions full of stressors become overly emotional (Carr, 2020). Therefore, it can be concluded that the problems in the family were directly related to the dynamic flaws in existence.
Also, the bio-ecological systems theory states that the personal characteristics of children correlate with the environment of their upbringing. This concept is related to communication with peers at school, family relationships, and economic circumstances, which partially define the success of interactions with other people (Carr, 2020). In the case of Jose, the developmental milestones leading to the emergence of problems were connected to his parents’ financial issues, the lack of support, and a history of abusive behavior. Moreover, high quality of life is possible only in the case if the environment is characterized by love, peace, and emotional support (Carr, 2020). As can be seen from the challenges the patients faced, it presents one of the principal obstacles on the way to successful communication and affects Jose’s conduct.
Another aspect of the problem is their lack of involvement in Irma in the process of disciplining her children whenever they are wrong. As a result, they become stubborn when their parents are lenient about their wrong actions (Carr, 2020). In this way, Jose started to yell and lash out at his mother and siblings for almost a year without being punished, and the environment contributed to his actions. Moreover, due to the fact that Irma views men as superior, Jose feels that he is a ruler in the family and acts accordingly. Therefore, the change in his attitude should start with the shift in Irma’s perceptions of their roles.
Meanwhile, the solution to the mentioned problems for Irma is connected to being free from depression and stress and regaining hope in life. Currently, the healthcare system advocates for the provision of patient and family-centered care, which uses evidence-based practice in the process (Carr, 2020). The main goal of the consideration of such cases in therapy is to eradicate the challenges, which hinder the normal functioning of families. According to the discussed case study, one specific goal of treatment is to create an environment, which would promote positive behavior among the children. It will subsequently lead to the normal functioning of the family and thereby improve their quality of life. Another goal of treatment is to eliminate the flaws in the family’s dynamics, which negatively affects the conduct of the parents. It is complemented by the intention to help the involved persons to understand the emotional processes, which accompany the negative events presented above. While setting the goals, all participants need to be active in the discussion to know that they own the outcomes.
Interventions to the Family’s Problems
The planned interventions will be efficient only in the case of the involvement of all family members. In this way, their successful development and implementation are possible if Irma, Carlo, and the children are considered in therapy. However, to promote the family’s growth through the elimination of flaws in their dynamics, there is a need for active inquiry about the challenges they are facing to get an insight into their underpinning (Carr, 2020). As follows from the case study analysis, several flaws in the interaction patterns were identified. They include the lack of support from the father of the family, the low level of extended family involvement, the neglect of indiscipline cases, improper role distribution, and, therefore, the absence of responsibility. After the identification of the flaws, education is vital to help the members understand the ground for the emergence of the issues (Carr, 2019). Through this approach, they will become emotionally stable and supportive of one another.
The stubbornness of Jose was influenced by an inadequate home environment, which allowed improper behavior. Children are expected to respect their parents, but, in this case, a nine-year-old boy did not consider his mother’s feelings, and his actions were not perceived as serious by him. Therefore, the initiation of the change in the family will be achieved through education. Irma required counseling sessions to alleviate the stress that could cause mental health issues. The participants of the treatment process will also be referred for other services such as social support and other welfare groups aimed at the financial aspect of the matter. Unfortunately, Irma did not involve other family members in the efforts of finding solutions to the emerged problems at once. Meanwhile, the head of the family is key to the development of therapeutical interventions vital for their growth.
Strengths Identified in the Family
Even though Irma, Carlo, and their children had problems, there were positive aspects that could be used for treatment. Irma was able to identify the problem with his son, who was disrespectful towards his mother and siblings. Despite the notable differences, they loved each other and were hard to separate. Irma stated that protecting all her children was her responsibility, and Jose yearned to go home to get protection from her mother. Reports from the studies indicate that parents are always attached to their children despite the presence of conflicts (Carr, 2020). Irma also seemed to emotionally understand her son even though she could not discipline his wrong actions. Thus, the mother had a close relationship with her children and mostly addressed their needs regarding support. Despite the financial problems, they were still significant since Irma is still on welfare, but she anticipated getting a job in the nearest future. According to Carr (2020), in strength-based family therapy, once the strengths are identified, more effort should be put into them rather than the weaknesses. From this perspective, the health-seeking behavior of the participants will help them overcome the problems.
Impact of Ecological Contexts on the Family
The family is economically unstable, and his factor adversely affects their physical and psychological well-being. Research indicates that the lack of financial support from the father triggers stressors and conflicts. With such hardships, many needs remain unmet, and marriages break up (Waisbord, 2020). Irma and Carlo with children lived in a housing project because they could not afford to have their own home. As a result, the mother’s life was full of depression and stress. She took care of her children without help and was concerned about the ending of the welfare program because she had no job. Meanwhile, Jose assimilated the disrespect and abusive behavior of his biological father. It allows concluding that abusive behavior in children is mostly associated with financial hardships.
Social support is another critical aspect that touches on the family. It can be initiated either externally or internally, or, in other words, by the government and social groups or relatives (Waisbord, 2020). In this case, no type of support was applicable due to the lack of understanding between the people over the past year. Thus, the siblings were not connected by any occupations and demonstrated no concern about one another. What was more critical, the unpreparedness of the mother for coping with problems of any kind and the lack of help from her husband combined with the physical and emotional abuse worsened the situation.
Advocacy for the Family
Family advocacy is aimed at speaking in the best interests of the affected persons. Various groups provide assistance and serve as a liaison between the family and relevant bodies, depending on the issue at hand (Carr, 2020). The advocates identify the needs and address them on behalf of the family. As for children, the advocacy groups protect their rights and ensure the sufficiency of resources available to them. The issues include child abuse or neglect and violence from parents.
In this situation, Carlo neglected the needs of Irma and her children from the first marriage. Meanwhile, Irma did not have enough financial support for her family and relied solely on the welfare program. Considering this circumstance, the problems started with an improper attitude of Carlo. Since they cannot solve them on their own, effective advocacy seems a better option. It means that the gap in the family emerged due to paternal negligence and requires interventions of advocacy groups alongside therapists.
Women empowerment is another issue of concern in the case study. In this situation, the perceived role of a mother was to take of children while her husband was supposed to provide for the family. Nevertheless, Irma has never been in a relationship with a man who supported her. Instead, all of her partners were abusive, both emotionally and physically. This fact did not alter her belief that the specified task should be a man’s responsibility. Therefore, she needs to change her attitude as well and either start supporting her family or find a man capable of performing this duty.
Interface Issues Related to the Family
Ethically, psychotherapists consider the diversities in their clients during service delivery. Families might have unique cultural practices defining their norms and beliefs. Culture and ethnicities determine what they expect from interaction. Failure to recognize these specificities results in conflicts during care (Waisbord, 2020). As follows from Irma’s history, divorce was not an issue, and women from her family could be married as they wish. In contrast to this case, my family culture does not allow a divorced woman to get married to another man and prohibits her from providing for him. This difference makes it clear that the orientation of the client’s views should be prevalent.
When dealing with patients, countertransference issues are possible and sometimes get accompanied by ethical dilemmas. From the problems and the family dynamics, one can develop feelings, which may be transferred to them. Countertransference can have both negative and positive impacts on treatment interventions. A therapist can develop a personal perspective on Jose’s behavior. As for the positive aspect, self-control might be helpful in protecting the nurse-patient therapeutic relationship in the long run (Waisbord, 2020). Hence, I will talk to the client to get to the base of emotions and find a solution after deep consultations with my supervisors. Additionally, I will try to develop clear boundaries aimed at determining the allowed habits.
Mostly, ethical dilemmas arise when rendering services, especially as a result of countertransference. For example, in the case study, they might arise from confidentiality, consent, and welfare issues. The first step when handling such situations will be to identify the main issue causing the dilemma. Alternative courses of action will be developed by applying ethics to the decision-making process. When determining the best approach, role consultations are significant for a successful outcome (Waisbord, 2020). They will help weigh the consequences of each option. However, client involvement is vital, and the care provider should only act as a facilitator.
Families face conflicts, which become difficult to solve without professional intervention. The problems affecting them can result from mental illnesses, substance abuse, behavioral issues, and violence. Psychotherapists assess the issues and identify the needs and factors hindering normal functioning. Therapy involves observation of interactions, evaluation, and resolution of relationship challenges, diagnosis and treatment of mental health disorders, identification of undesired behaviors, and provision of care with the consideration of self and client’s emotions. The sessions are aimed at enhancing communication in families and improving the environment to support the quality of life.
In this case, Jose developed conduct adversely affecting his relations with his mother. The visit to a mental health clinic revealed the interrelation between this problem and the financial and social circumstances of the clients. The identified issues were caused by an unhealthy environment and flaws in the family structure and dynamics. As a result, the mother was stressed, depressed, and lost hope in life. The goals of treatment were set with interventions by applying the family system and the bio-ecological theories. Nursing practitioners were encouraged to incorporate evidence-based practice in solving the problems through the use of theoretical knowledge. Additional research on family therapies is recommended to support the already established approaches.
Carr, A. (2019). Family therapy and systemic interventions for child‐focused problems: The current evidence base. Journal of Family Therapy, 41(2), 153-213.
Carr, A. (2020). Evidence for the efficacy and effectiveness of systematic family therapy. In K.S. Wampler, R.B. Miller, & R.B. Seedall (Eds.), The handbook of systemic family therapy (pp. 119-146). Hoboken, NJ: Wiley.
Waisbord, S. (2020). Family tree of theories, methodologies, and strategies in development communication. In J. Servaes (Ed.), Handbook of communication for development and social change (pp. 93-132). Singapore: Springer.