Comprehensive Case Conceptualization Presenting Problem

Don is a 25 year old male working on his MBA while living at home with his parents. Don is sensitive about sex and sexuality as a result of his religious upbringing, from which he learned that premarital sex is wrong. This presents problems for him whenever he begins dating a girl, as, not surprisingly, sex inevitably comes up and Don does not know how to deal with it in a manner that would allow him to be firm in his religious principles while at the same time maintaining a healthy relationship. His lack of a girlfriend is upsetting for his parents because they want to see him be in a serious relationship as this would undoubtedly signify that he is maturing and ready to enter into the next phase of life. To them, Don currently seems stuck in a type of extended adolescence. Even though he is excelling in school, he is not succeeding in the real world in the sense that he still lives with his parents, does not exhibit a great deal of independence, and has no steady girlfriend which means no prospects towards getting married and starting a family of his own.  Don’s parents are worried about him; meanwhile Don is worried about his own sexuality, as he also feels conflicted in the sense that he feels he could be attracted to men as well as women. He is thoroughly uncomfortable when it comes to sex and does not know how to reconcile his sexuality with his religious upbringing so just avoids the issue altogether by abandoning a relationship as soon as it gets serious—i.e., sexuality rears its head.

From a family counseling perspective, the problem as presented is two-fold: 1) Don needs to understand that he can have a meaningful relationship that is healthy and sexual while still maintaining religious dignity; the pressure he feels to engage in premarital sex is psychological: in reality, many people still wait till marriage to engage in sexual activity. Indeed, this is the traditional norm. Don needs to be able to feel more confident about his own beliefs, and for this to happen he needs to better understand how sexuality is part of life and is perfectly normal, and how one can even feel sexual feelings for men and women. Don must figure out if he wants to maintain his religious beliefs and if he wants to have a family of his own one day. These two decisions on his part will help to dictate a plan moving forward. For his parents’ part, they need to understand that Don is confused about sex and sexuality with regard to his religious teachings. They need to understand that what he is experiencing is perfectly normal and that the best thing they can do for him to help him transition into the next stage of the family life cycle is to be supportive and empathetic and to allow him the freedom to explore on his own the next path of life that he chooses to take (Hanline, 1991; Ballard, 2012; Settles, 2016). Through support, family members can help other family members to make important transitions in life.

Rationale for Using Solution-Focused Therapy

Two models of therapy that could be used for this case are solution-focused therapy and narrative therapy. However, solution-focused therapy applies best because for Don there is a need to identify goals and work towards them by altering his behavioral patterns, whereas narrative therapy focuses more on separating the problem from the person by allowing family members to explain where they are coming from and how they perceive things (Gonçalves, Ribeiro, Silva, Mendes & Sousa, 2016). While narrative therapy can be helpful, it would not provide Don in this case with the clearest indication of direction or of how he might like to behave were all his anxieties and stresses neutralized.

One of the best techniques of solution-focused therapy is the “miracle question,” which allows the client to imagine that he woke up one day to find that all his problems have been solved and then to answer the question of how he would communicate this fact to others (Franklin, Biever, Moore, Clemons & Scamardo, 2001). Other techniques and interventions that can be applied via the solution-focused therapy method include scaling and goal setting, both of which can help the client to rank the seriousness of issues they are having so as to more objectively see them and their impact and to figure out...

80). Narrative interventions include telling one’s story, externalization, and deconstruction—but for Don, these interventions may not be as effective as the more direct approach that solution-focused therapy provides. Don’s meandering approach to life and his stalling in the life cycle in which he is in indicates that solutions are what’s needed. He has most likely already spent a great deal of time in introspective activities—now it is time for him to make decisions about moving forward into the next stage, and for that reason solution-focused therapy will be key.
Collaborative Treatment Plan

Goals

The goals of solution-focused therapy are to allow the client to identify and define objectives and goals on his own. The counselor may provide some guidance or may have a goal in mind, but the most important thing is for the client to decide what goals to achieve. This makes the intervention more meaningful as goals emanate organically from the client’s own mind and will. The way to reach this point where the client is able to identify goals is to use a variety of interventions, such as scaling and the miracle question. The ultimate aim of solution-focused therapy is to assist the client in identifying goals that would help the individual to overcome obstacles or challenges in his or her life by applying behavioral methods that can be applied. Helping the client to identify personal goals is the first step; identifying behavior patterns that would facilitate achieving those goals would be the next step.

Scaling

Scaling or rating an issue on a scale of 1 to 10 can be a way for the client to identify where problem areas are: for instance, the client might be asked to rate his confidence in communicating with a girlfriend issues of religion or sexuality. The client might be asked to rank his sexual feelings for men or for women to see if one is felt more strongly than the other. Don might be asked to rank his conviction in his religious beliefs, whether he is firm in them or whether he is fearful of what they mean. The idea behind scaling is to give Don a sense of what the real problem is and what issues require the most attention. By focusing on the issues that rank highest, some clarity of purpose can be provided to help remove obstacles that get in the way of the main issues. Scaling can help to rid Don of distractions. Don would be able to identify what activities are hardest for hiim by scaling, which can lead to the development of a better awareness of himself. The same can be applied to his parents, who would also benefit from the scaling intervention, as it would help them to see where their problem areas are. For example, they might be asked to rank their ability to communicate with their son; or they may be asked to rank their ability to show supportive feelings and empathy with his transition to the next cycle in life

Miracle Question

The miracle question intervention can be used to help Don better understand how he might like to behave were he to wake up one day and find that all his problems had been solved. The key to this question is to frame it in such a way that it is not important to know how problems have been solved but just that they are no longer felt. The question then is how Don might communicate this to someone else. By showing that he is problem-free, Don can visualize the patterns of behavior that he can implement within his own life to truly bring about that problem-free state. By imagining himself as problem free and seeing how he would act and how he would show it, he is able to visualize himself in a new light that is separate from his current state. Instead of focusing on the problems, this intervention encourages the client to focus on the solution—the type of behavior that would represent positivity and a stress-free life. The underlying point of the miracle question is that provides the client with an organic way to envision how he himself would like to behave were he more comfortable with himself and his environment.

This exercise helps to provide the framework for establishing the…