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 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…
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Strategic Family Therapy Roffman, A. (2007). Function at the Junction: Revisiting the Idea of Functionality in Family Therapy. Journal of Marital and Family Therapy. 31 (2): 259-68. Strategic Therapy -- "The ideas of strategic therapy are deceptively simply. Carrying out these ideas in action is not so simple" (Haley, 2003). Traditional views of therapy hold that the focus should be upon abuse, trauma, and even guilty pleasures or pastimes if they are
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