Family Therapy and Family

Dana is a young and beautiful woman with family members that seem to constantly put her down whenever they get together. They appear to be self-centered and attention seeking. The mother has set expectations she places on her family and seems angry whenever they do not meet those expectations. For example, the mother suggested Dana get breast enlargement surgery to appease her boyfriend Matt. Her sister, Joanie also commented on Dana's appearance, making sure to let Dana know she appeared overweight or had a large rear end. These comments can and do affect people's self-esteem especially when the source of such comments are from people that person loves or is supposed to trust.

Dana takes everything and says nothing, agreeing with the remarks and feeling like she truly is overweight even if objectively people see her as very attractive. She also cannot say how she feels even around her boyfriend. Matt for example, wished to engage in coitus with her and she did not want to. However, she did engage in coitus and then later proceeded to binge and purge. Dana appears to lack assertion in her actions and acts in a submissive, complacent manner.

Dana does not communicate her feelings, her desires, and that results in loss of self-esteem, self-worth, and potential body image issues. She needs to communicate with her mother, her sister, and her boyfriend how she feels when they comment on her appearance or ask her to do something she does not want to do. She must voice her concerns in a way that shows her expectations but does not result in unnecessary conflict. Dana appears to not handle stress well from not being able to graduate from college and binging and purging every day. Therefore, cognitive behavioral family therapy may be the best option as it involves addressing specific issues in a shorter time frame and allows the therapist to direct the behaviors. While it can come with many issues, cognitive behavioral family therapy may help address long standing family problems in a creative, imaginative way (Poulsen et al., 2014).

The reason why the mother and sister must be present and not the father and brother is because they do not contribute to the problems as much as Joanie and Dana's mother do. The brother is in Peace Corps and the father takes a suggestively submissive role besides the mother. The main problems in communication appear to come directly from Dana's interactions with her sister and mother. Here the relationships must be analyzed to see why Joanie makes such negative remarks of Dana and why the mother is always making remarks on Dana to improve her appearance.

While there are other models useful in such a case as Dana's cognitive behavioral family therapy seems the most useful due to the family dynamic and the lack of communication among the family members, especially towards Dana. Nevertheless, solution-focused therapy and narrative therapy have their uses. For example, narrative therapy helps the patient identify skills, value, and the knowledge to live these values so that person can successfully confront whatever problems he or she faces. Instead of directing where the family goes in the therapy, with this model Dana gets to see who she is and her identity is formed via her own self-awareness of her skills and values (Lopes et al., 2014).

By fortifying a patient like Dana with a means of discovering her own identity and understand her true desires, she can then forge a means of achieving them. This therapy model also allows someone like Dana to build self-esteem and self-worth, enabling her to confront the problems she may have with her and perhaps with her family. However, it seems her family needs to be a part of the therapy for there to be any resolution in communication between them and Dana. Therefore, narrative therapy may not be the best option. The second option, solution-focused therapy.

Like cognitive behavioral therapy where the therapist directs the conversation and the direction of the therapy, solution-focused therapy aims to looks for ways to solve problems rather than simply discussing them (Gingerich & Peterson, 2013). Solution-focused therapy looks for previous solutions or other means of solving issues. Dana has a previous issue with finishing college. With solutions-focused therapy the aim would be to try to get Dana back into school and graduate if she wanted to achieve that goal. The problem with this kind of therapy model is the limited recognition of core problems Dana has such as her interactions with her family. Solutions-focused therapy does not consider how problems may arise outside of someone's control and may not be enough to help someone like Dana cope with the negative self-image and doubt brought on by her mother and sister's constant negative remarks.

Although cognitive behavioral family therapy does not call for extensive analysis of problems, and promotes actions like agenda setting, it does have room for recognition of said problems through behavioral techniques like mood check in, homework review, homework assignment, and summary, exploring the family's core dynamics. Cognitive behaviroal therapy also seeks for swift change rather than the procedural and at times lengthy changes seen in solution-focused therapy. Both therapies can however allow the person receiving the therapy to understand and develop ways of coping with stresses and hardships by taking a proactive approach to resolving problems. One last difference between both therapies is solution-focused therapy relies on compliments and looking for solutions a patient used in the past instead of looking at the role family members may play in the current handling of stress by the patient.

Dana has what many will consider bulimia. She binges and purges during stressful times. Her mother and sister make negative comments that make her feel less than because of seeking attention for themselves. The mother and sister are the focus of the family therapy in terms of identifying problems within the family. Their behavior needs to be exaggerated so everyone within the family can realize why their actions may be damaging to Dana.

The first task however, is defining objectives. The first objective is building rapport and assessing family structure and dynamic. The second is getting a clear statement of concern like Dana's disordered eating and purging. The next stage would be allowing and observing the family interacting followed by goal setting and then choosing and making interventions. The last step is assessment of results and homework.

Dana has experienced disordered eating because of the stress she endures from her interactions with her family. Her mother and sister engage in attention seeking behaviors that result in negative criticism projected onto Dana. The first objective would be to identify who in the family is attention seeking. Who likes the attention. Who hates the attention, and why? The next objective is addressing the attention seeking by checking the moods of each person that performs the actions or is affected by it. The next step would be to assign a homework assignment that would introduce new meaning into the family related to the behavior by replacing the negative or positive connotations associated with attention seeking with its direct opposite and see how that changes the family's view of the behavior. This is called agenda setting and processing session which is performed during CBT family therapy (Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012).

In terms of interventions and forming a collaborative treatment plan, CBT family therapy, there is a set structure. Aside from mood check in, homework assignments, homework review, Dana and her family members can draw from the main components of CBT family therapy which are: self-instruction, behavioral enactment, self-monitoring, and rational analysis. These four represent the fundamental, core procedures and make up the bulk of the sessions performed under CBT. With self-monitoring for example, the patient must observe and record behavioral, cognitive, interpersonal, and emotional processes. The recording of this information can enable further intervention and offers points of progress (Hayes, Levin, Plumb-Vilardaga, Villatte, & Pistorello, 2013).

Since the main problem in the family may be attention seeking, Dana, Joanie, and their mother can draw themselves the way they see themselves and the way they see each other. They can then review it and show how it makes them feel. This process goes into rational analysis where clients collect information, drafting judgments and conclusion while also making sense of the new information. Interpretation of the information can then move towards self-instruction. Examining the family dynamic, each person has a means of expressing themselves. A common exercise to perform in relation to self-instruction is to have family members list independently what they deem as non-acceptable and acceptable emotions in the family. Each person has their own rules in relation to emotional expression.

Behavioral enactment allows the therapist to intervene by conceptualizing the family, setting sighs on potential maladaptive patterns. For example, whenever Joanie comments on Dana's weight, she may respond by feeling negatively about herself. This core process is an important means of having a CB family therapist understand how the family works and responds to the various actions and reactions within the family dynamic (Arendt, Thastum, & Hougaard, 2015).

In terms of cultural components, Dana's family has pressure to fit in and socialize with others. Her parents were noted to talk to many people as they go out. They greet people on a regular basis and therefore because of such a high level of socialization, care about their appearance. This care for external appearance may explain Dana's mother's need to look good and have her appearance meet a high standard. This also may explain why Dana's mother wants her daughters to follow suit. Dana's parents have high-paying jobs that enable them to mingle among upper-middle class to upper class peers.

Dana's mother is an executive and her father is an attorney. Both jobs require them to maintain a professional look and engage with people often. By Dana not graduating college and not achieving the level of success her parents have, her mother specifically, may be taking it out on her by asking her to maintain an appearance of someone successful. She may also desire for Dana to be more attractive than she is to show she is succeeding in at least one area of her life, her appearance.