Family Systems Therapy Case Study: Eliza's Family
This case study examines Eliza, a 45-year-old woman who presents with depression, auditory hallucinations, hypertension, and acute family conflict following the removal of her teenage niece, Marie, from her home. Drawing on genogram and ecomap assessments, the paper develops a clinical hypothesis linking Eliza's symptoms to compounding stressors including grief, loss, and disrupted family dynamics rooted in divorce and bereavement. The paper applies Family Systems Theory and supporting research on adolescent delinquency, divorce effects, and voice-hearing to argue that family systems therapy is the most appropriate intervention — one capable of stabilizing relationships among Eliza, Marie, and her two sisters while addressing Eliza's individual psychological and physiological needs.
- Demographic Information and Family Background: Profile of Eliza, her family, and living situation
- Presenting Problem and Clinical History: Auditory hallucinations, depression, and family conflict
- Genogram and Ecomap Assessment: Visual tools mapping family relationships and social supports
- Clinical Hypothesis: Four key clinical concepts informing the diagnosis
- Therapeutic Approach and Family Systems Theory: Literature-supported rationale for family systems intervention
- Outcomes and Conclusions: Reported improvements across family members post-intervention
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What makes this paper effective
- Integrates multiple clinical assessment tools — genogram, ecomap, and clinical hypothesis — into a coherent treatment rationale rather than treating them as isolated exercises.
- Grounds the therapeutic recommendation in peer-reviewed research (Werner & Silbereisen, Clarke-Stewart & Brentano, Ahrons, Nunes-Costa et al.) to substantiate the family systems approach.
- Connects the IP's spiritual life and social support network directly to the proposed intervention, demonstrating holistic clinical thinking.
- Includes outcome reporting that traces measurable improvements across multiple family members, lending credibility to the chosen model.
Key academic technique demonstrated
The paper demonstrates effective use of evidence synthesis in clinical writing: rather than citing each study in isolation, it layers findings from multiple quantitative and longitudinal studies to build a cumulative argument for why family systems therapy is the correct intervention for this particular client presentation. This moves the paper beyond a literature review toward applied clinical reasoning.
Structure breakdown
The paper follows a standard social work case study format: demographic profile and family background → presenting problem and history → visual assessments (genogram, ecomap) → clinical hypothesis → literature-supported therapeutic approach → treatment outcomes. Each section builds logically on the last, making the argument for the chosen intervention progressively stronger before confirming it with reported outcomes.
Demographic Information and Family Background
Eliza's immediate family consists of her two middle-aged unwed sisters, Betty and Clara, and her niece, Marie — the only surviving child of her deceased sister and brother-in-law. Eliza's parents are both dead. Eliza is 45 years old and Marie is 15; they live together in Eliza's home. Eliza assumed care of Marie after Marie's parents died in a car crash two years ago. The relationship began satisfactorily but has gradually deteriorated over time. Marie has become impulsive and reckless, skipping school and drinking alcohol with boys, and smoking marijuana. Eliza shows signs of depression, mania, paranoia, and auditory hallucinations. Her sisters are fighting with her over how to manage Marie and have recently removed Marie from Eliza's home.
Eliza's husband is deceased. They separated five years before he died of alcoholism. Eliza had five miscarriages during the marriage. When her husband left her and became ill, she continued to care for him in his one-bedroom apartment until he died. She is a deeply devout non-denominational Christian who attends church services on Sundays. She has two close friends from her job at a school cafeteria — friends who are closer to her than her own sisters. Her primary friend, Sara, brought Eliza to the clinic after Eliza suffered a nervous breakdown at work.
Eliza's personal history is one of hard work and perseverance. As a young woman she overcame significant obstacles to earn a college degree and obtain a management position at a factory, though she eventually left that position to tend to her ailing ex-husband. She later took another job, which she currently holds, and has been recognized for her exceptional performance. Her family medical history includes a father who was an alcoholic and an ex-husband who died of alcoholism. She has been prescribed medication for hypertension in the past but did not take it consistently. Her strong maternal instinct and desire to care for others explains why the loss of guardianship over Marie has been particularly devastating to her.
Family strengths and resources: Eliza's relationship with her church community and her two close friends from work represent her primary sources of support.
Presenting Problem and Clinical History
Eliza presented at the clinic because she has been hearing voices. The voices are muffled and do not appear to convey specific words, but instead seem to communicate feelings. One voice is warm and reassuring; the other is dark and menacing. These auditory hallucinations have worsened since Eliza began fighting with her sisters over how to handle Marie, who has grown increasingly rebellious — sneaking out of the house, skipping school, and engaging in underage drinking with boys. Eliza's sisters believe she is unable to provide Marie with adequate care.
Eliza wants to care for Marie but feels that Marie is unresponsive to her. Eliza is also suffering from depression and was prescribed medication by her doctor; however, she stopped taking it after a few days because she disliked how it made her feel. That was six months ago.
Problems at work stem from Eliza's disapproval of management's decision to cut the budget for cooked cafeteria meals — a decision she viewed as cruelty to children, arguing that the school meal was the only hot meal some students received given their home circumstances.
Eliza's relationship with Marie is a source of deep concern. She loves Marie very much and has always been close with her, but she admits to not knowing how to respond to Marie's rebelliousness. She fears that Marie's reckless behavior could lead to serious trouble, and she is anxious about raising the subject directly for fear of pushing Marie away. Instead, she established house rules and locked the doors at night, believing these measures would be sufficient — but Marie was sneaking out nonetheless. The situation came to a head when Marie was picked up by police at a party for underage drinking and provided her aunts' contact information rather than Eliza's, which also hurt Eliza deeply. Subsequent family therapy sessions revealed that Marie had been afraid of hurting Eliza and did not want her to know about the incident. The situation escalated when Eliza's sisters overreacted and removed Marie from the home.
Eliza's recent nervous breakdown occurred just days after her sisters removed Marie from her house, and she has since been unable to sleep or perform daily activities without intense anxiety.
Genogram and Ecomap Assessment
The genogram depicts Eliza's relationships within her family. She is divorced from her husband, who is now deceased. Eliza herself suffers from depression. Her parents are both deceased, and they were divorced as well — suggesting that separation anxiety may be a contributing factor in Eliza's condition. She is surrounded by death and loss, having experienced five miscarriages as well as the deaths of her sister and brother-in-law. She now serves as caregiver to Marie, though her two other sisters disapprove of her parenting approach and have intervened — albeit in questionable ways. This constellation of stressors suggests that Family Systems Therapy intervention would be beneficial (McGoldrick, Gerson, & Petry, 2008).
Figure 1. Genogram
The ecomap illustrates the following relational dynamics:
Eliza — Her two friends from work (strong, supportive connection)
Eliza - - - - - Marie (strained, distant connection)
Eliza -/-/-/-/- Her two sisters (conflicted, broken connection)
Figure 2. Ecomap
Clinical Hypothesis
Four relevant clinical concepts inform the hypothesis for Eliza's presentation:
First, Eliza's spirituality is central to her identity and could be a meaningful resource in her treatment. She is a regular churchgoer, and her faith provides structure and comfort in her daily life.
Second, her grief and experience of loss — including five miscarriages — have created a profound sense of lost opportunity. This has intensified her desire to care for Marie, much as she cared for her ex-husband even after he left her.
Third, her friends are highly supportive and recognize her self-sacrificing nature. At the same time, there are indications that Eliza holds grudges and finds it difficult to let go of perceived slights, as evidenced by her expressed frustration toward her sisters during therapy sessions.
Fourth, Eliza's religious and cultural background is rooted in non-denominational Christian practice. Prayer is central to her daily life; she reports praying a rosary and maintaining a strong personal devotion to Mary, the mother of Jesus, though she is not Catholic. She states clearly that the voices she hears are not those of Mary or God, but are of an unknown origin that she does not understand.
The clinical hypothesis is that Eliza's depression and hypertension are primary diagnoses, and that her auditory hallucinations are a product of the compounding tension she experiences. Corstens, Longden, and May (2012) suggest that engaging with the voices through dialogue may allow practitioners to more fully address the underlying factors driving their presentation.
References
Ahrons, C. (2007). Family ties after divorce: Long-term implications for children. Family Process, 46(1), 53–65.
Clarke-Stewart, A., & Brentano, C. (2006). Divorce: Causes and consequences. Yale University Press.
Corstens, D., Longden, E., & May, R. (2012). Talking with voices: Exploring what is expressed by the voices people hear. Psychosis: Psychological, Social and Integrative Approaches, 4(2), 95–104.
Goldenberg, H., & Goldenberg, I. (2013). Family therapy: An overview (8th ed.). Brooks/Cole.
McGoldrick, M., Gerson, R., & Petry, S. (2008). Genograms: Assessment and intervention (3rd ed.). W.W. Norton and Company.
Nunes-Costa, R. A., Lamela, D., & Figueiredo, B. F. (2009). Psychosocial adjustment and physical health in children of divorce. Journal of Pediatrics, 85(5), 385–396.
Werner, N. E., & Silbereisen, R. K. (2003). Family relationship quality and contact with deviant peers as predictors of adolescent problem behaviors: The moderating role of gender. Journal of Adolescent Research, 18(5), 454–480.
Yalom, I. D. (2005). The theory and practice of group psychotherapy (5th ed.). Basic Books.
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