Family Systems Therapy for an Asian Immigrant College Student

Client Vignette

The client is a 21-year-old Asian woman who immigrated to the United States 10 years ago. She is an intelligent college student who likes to study, although she has been diagnosed with ADHD and dyslexia. She lives with her parents, younger sister, and older brother. Her younger sister is in high school, and her brother works at their father's grocery store. Her father has high blood pressure and needs to rest but continues to work at the store. Her mother also works at the father's grocery store.

The client is currently taking Concerta. When she skips her medication, she cannot concentrate on her studies and finds it difficult to speak with other students. Her academic adviser is concerned about her ADHD and her difficulties with concentration. At intake, the client reported feeling somewhat depressed, unmotivated, and self-destructive. She added that she felt she set herself up to fail, but she also expressed a desire to be productive, happy, and confident. She reported that she does not like writing essays, citing time constraints, and that she is confused about how to think about her future goals.

During the session, she disclosed that she has been diagnosed with both ADHD and dyslexia. She has trouble concentrating even while reading when she skips her medication. The client clearly explained that her family has been pressuring her and that she feels she should obey her father's wish for her to enter into an arranged marriage. She was crying during the session because she is depressed about her uncertain future. She has had relationships in the past but does not know how to reconcile her own goals with the demands of her parents.

When asked about her family, the client explained that her family lives together and works together. Her family is influenced by their Asian cultural background and is male-dominant. Her mother always defers to her husband. When the client was a child, her mother was strict and offered considerable guidance about women's work and social roles. Her mother concentrates her attention on the younger sister, and the client feels her relationship with her mother is not close; the two disagree on many issues, particularly regarding the client's future.

Treatment Plan Overview

The two primary treatment objectives are to strengthen the client's confidence and sense of self, and to involve her family in strengths-based family counseling. Initially, the therapist will continue gathering information about the client and her family of origin. Treatment goals will need to be clarified, and in the next session the therapist will speak with the client about her concentration issues, how Concerta helps her, and what side effects she may be experiencing.

In the following session, the therapist will ask how Concerta affects her concentration and will investigate the possibility that depression may also be a clinical concern. The therapist also intends to explore the client's views on relationships and gender roles, and will then address her relationship with both her mother and father through the lens of family systems theory.

Family Systems Theory

This treatment plan is grounded in family systems theory, because the client's psychosocial problems appear to be closely related to the conflict between her own values and those of her family. Family systems theory allows for cultural context, demonstrating that it is "necessary to understand the problem and/or to create a treatment plan that shows sensitivity to the norms, rules, and values of the client's cultural group" (Ingram, 2006, p. 340). The client's problems must also be understood "in the context of the entire family system," and not as if the problems she faces are isolated from issues such as social role performance (Ingram, 2006, p. 340). Social role performance is hypothesized to be a major issue for this client, contributing significantly to her distress and dysfunction (Ingram, 2006, p. 340). Whereas family may have been a bastion of social and psychological strength in static and homogeneous societies, in progressive, dynamic, and heterogeneous societies the family can become one of the greatest sources of stress in a person's life.

The Jones-Smith (2013) model of strengths-based family therapy offers a way to focus on the positive aspects of the client's family life rather than the negative. In this way, the client can capitalize on the closeness of her family. Her family is comprised of individuals who care deeply about each other, which is evidenced by the fact that her siblings and her mother work in her father's store. The client may see herself as an outsider because she has different goals than working in the family business. She may feel afraid to confront her parents about this, and she would likely function better if she developed the confidence to express her own values and goals openly. If the client can begin to conceptualize herself as an insider rather than an outsider, this shift in mental framework may help her considerably. As Jones-Smith (2013) points out, "individual family members will have different strengths that they contribute to the unit" (p. 202). Using a strengths-based approach, the client can identify the strong qualities that her mother and father bring to the family while also recognizing her own contributions. When a family counseling session becomes possible — a core treatment goal — the work can focus on helping the client's parents appreciate her strengths rather than emphasizing her divergence from traditional family and gender norms.

To work on strengthening the family, the therapist can begin by recognizing the value of its rituals. The client can talk about the activities, including cultural and religious ceremonies, that bring together her immediate and extended family. As Jones-Smith (2013) notes, "family history can serve as a bond among family members when family members tell favorite family stories" (p. 202). The therapist will invite the client and her family members to share these stories and rituals so that sessions can emphasize what unites them rather than what drives them apart.