Family therapy intervention with the Bolder family case

Paul -- You can see why this was reworked. I did not do it in the regular format because of our relationship, and I didn't worry about double spacing, and all that jazz. You know there is more here than you need.

So, based on an interview and reading several texts, this is a combination of theory and practice, with an emphasis on questioning and other theoretical constructs. Right now, we do not have complete information, as you know, so we need to discover some of that in order to proceed.

Here's what I need from you:

Look over this and let me know if you need more for it.

Send me an outline detailing exactly what you need to complete the class, format, length, theoretical issues, etc. And EXCATLY when you need it.

Give me the order #s you see on your system so I can cross-correlate.

I will try to put your project to the top of the list and get ya handled. Let me know about this so if we need to adjust we can do so immediately!

Kelvin

Introduction- The Bolder family was experiencing a great upset within their marriage. Recently the Bolder's son had found some pornographic images on the computer that the father had been viewing. His wife found this to be the straw that broke the camel's back so to speak. In order to save their marriage the Bolder's agreed to enter into therapy were they would be able to talk about what had happen and address the issue appropriately. Initially, we do not have adequate information to understand a complete picture of the Bolder family: Are there cultural or religious issues that cause Mr. Boulder's use of pornography to be problematic, or is it that the son found it -- how old is the son? The phrase, "broke the camel's back" implies that there are already seething issues, and this issue is more of a locus of conflict than the individuated problem. The model used in our group was the post-modern narrative in which all of the family; including the wife's parents (who she was estranged from) were involved in solving this family dilemma. For my clinical model I will be using the Transgenerational model to help the bolder family.

Theoretical Background - Everyone in the world suffers pain and difficulty in their family relationships from time to time. Whether due to unexpected loss, chronic illness or simply the transition from one stage of family life to another, the pain and confusion families experience is not wanted and great efforts are made by families to relieve themselves of this suffering. Sometimes they are not able to do this alone. Too, within the structure and long-term ev9olution of life's relationships, individuals go through different issues that may, or may not be important to one of the family member, but extremely important to others. Essentially, there are five modes of Family therapy, outlined briefly on the chart below:

Theory[footnoteRef:1] [1: See: Bowen, M. (1994). Family Therapy in Clinical Practice. New York: Jason Aronson; Madanes, C. (1991). Strategic Family Therapy, New York: Jossey Bass; Datillo, F., ed. (1998). Case Studies in Couple and Family Therapy, New York: Guilford Press; Goldenberg and Goldenberg, (2008). Family Therapy: An Overview. Belmont, CA: Thompson Higher Education.]

Focus

Concepts

Issues

Bowen;

How are husband's issues tied in with wife's past abuse?

Should the extended family be invited to the therapy session; or are there two separate issues: Issue #1 with Mrs. Bolder and her father, and Issue #2, the inner-communication issues within the Bolder family.

Or, can Mrs. Bolder actively connect with her issues with her family without resolving her previous issues? One might say she is projecting some of her previous insecurities on her husband.

Are Mrs. Bolder's parents willing to participate in therapy sessions and will they be honest and productive about past issues. This needs exploring prior to a session so that it doesn't harm the situation.

In family systems therapy, there are eight forces shaping family functioning; listed below are some of the issues surrounding this paradigm as it relates to the Bolders, particularly from Mr. Bolder's point-of-view:

Issue (Goldberg, 2008, 179)

Mr. Bolder POV

Family Dynamic for the Bolders

Differentiation of self

Mr. Bolder wonders why his family seems estranged from him; he is using pornography for sexual release because his wife has been sexually distant from him for a while; he was not sure if this was just part of the cycle of the relationship, or if there were deeper problems.

Mrs. Bolder is obviously finding it hard to communicate with her family on issues she finds important; We are not clear if she is feeling abandoned, but if through therapy we can get each family member to express how they see themselves, and how they see interactions with other family members, we will understand more of the conflict.

Triangles

Mr. Bolder thought for years that there was a stronger bond between he and his wife, and the triangulation was then husband, wife, and children. While he knew she had some past issues and that they were drifting apart, he thought that was an issue of the evolution of the marriage. He had noticed her lack of interest in intimacy, so rather than pressuring her, he decided to view pornography for his sexual release.

The triangulation for this family is complex; we do not yet understand Mrs. Bolder's issues, or whether Mr. Bolder is contributing to them in ways as well. As for the son finding pornography, this is completely normal in family dynamics, and depending on the age of the son, time for Mr. Bolder to talk with the son. Mrs. Bolder likely feels rejected, it is a Catch-22, she is backing away from intimacy, yet jealous of Mr. Bolder finding a sexual release. What emotional triangles continue to press buttons?

Multi-generational transmission process

To Bowen, connecting current and past generations is natural. We do not know Mr. B's issues about his parents, or his relationship with his in-laws. But it is clear that our process will, at sometime, require Mr. B to help Mrs. B confront the multi-generational issues that are still traumatic. Bowen is not interested in system relief, but instead, in rooting out causes and fixing those issues.

There were obviously a number of unresolved issues with Mrs. B's past- we need to get to the bottom of them. Was there actual sexual or physical abuse, or just a fear of abandonment; what about Mrs. B's mother during this trauma. Why has the issue been buried so many years? What underlying family factors caused this min-crisis? Was it the communication, or the pornography issue that caused the disconnect?

Sibling position

Bowen sees sibling position determining personality, based on previous work in the field. We do not have this information at this time, but need to explore it to see if it is relevant.

Did Mrs. B. have siblings? If so, what was the relationship between them; are there issues of abandonment that are common? Explore.

Nuclear Family Emotional System

Bowen sees this as the most basic unit in society. For Mr. B., the locus of what he saw as a nuclear family and what was being manifested was a complete disconnect. When relationships form, according to Bowen, people tend to seek out like minded -- thus, what happened between the husband and wife? Mr. B. sees the evolution of the family as moving away from a nuclear family as the child (ren) age, and he and his wife drift apart due to career, life, etc.

Therapy needs to discover what picture the family has about its relationships -- does Mrs. B feel in danger of losing control of her family -- is she caught up in career, or is she feeling her husband and family moving away from her for other reasons? How important is family to her? Using Bowen as a therapeutic model, we would need to establish that framework within a systems design to see what was necessary to engender a more cohesive, trusting family life.

Social Regression

Is there an addiction to Internet pornography? What external factors is Mr. B facing at work, with his peers; does he have social outlets? What is his overall life satisfaction?

Does Mrs. B feel she cannot ever be as sexual as Mr. B's pornography? Are they mutually exclusive. What is Mrs. B's overall life satisfaction index at present? Is she working? Does she have friends? Is her world shattering or just home life?

Emotional Cutoffs

Nature vs. Nurture within the household? Discover from Mr. B's perspective what the last few years have been like -- does the family play together? Dine together? Converse? Do they have lives that intertwine, or are their lives fairly separate at this point?

The emotional system for Mrs. B is clearly at risk right now. What behaviors are she and Mr. B. exhibiting that cause these kinds of disconnects? Do they converse about their feelings? Do they support each other emotionally in and out of the family dynamic?

Family projection process

What is the content; in other words, the specific concerns, fears, needs, feelings, subjectively determined attitudes, values, beliefs -- the family culture that each experiences? The content inherited by Mr. B is clearly not that inherited by Mrs. B. What traits are the B's placing upon their children?

Will working with Mrs. B and her parents also unveil a missing reality step; what is Mrs. B remembering that might be misinterpreted (e.g. anxiety or nervousness, not meanness)? What was the way fear was expressed and handled in Mrs. B's family -- how is that contributing to her current issues?

(Sources: Titelman, 1998, 2003; Blume, 2006, Thombs, 2006; Kerr and Bowen, 1988).

Additional References Consulted:

Blume, T. (2006). Becoming a Family Counselor. New York: John Wiley.

Kerr, M. And Bowen, M. (1988). Family Evaluation. New York: W.W. Norton.

Thombs, D. (2006). Introduction to Addictive Behaviors. New York: Guilford Press.

Titleman, P., ed. (1998). Clinical Applications of Bowen Family Systems Theory. Hayworth,

NY: Hayworth Psychology Press.

____. (2003). Emotional Cutoff: Bowen Family Systems Theory Perspectives. Hayworth,

NY: Haworth Clinical Practice Press.