Assessment
Maria is a 26-year-old patient who grew up in Honduras and is now going through immigration with her husband and daughter to become US citizens. Maria has a large family consisting of her mother, grandmother, and nine brothers and sisters, but the patient never knew her father, who left them when she was an infant. Maria’s mother was never married but had several long-term relationships. The patient’s family was not well-off, and Maria herself did not graduate from school, as she left after the fifth grade. At the age of 10, Maria was raped, and after that, the patient began to engage in prostitution to help her family financially since her mother and grandmother could not support everyone. At the age of 18, the patient met Jamie, from whom she quickly became pregnant and gave birth to a daughter named Sofia.
The young people illegally moved to the States and settled in Texas, where Jamie began to do part-time jobs since Maria was busy with their daughter and could not work. The family has a lot of difficulties in relationships since Jamie wants more children, as is customary for men of his culture, and Maria does not support this idea. She did not receive proper medical care and support from her partner when she was pregnant with Sofia. Jamie and Maria have used drugs in the past, and the man has some problems with alcohol. Due to such an irresponsible attitude to health and constant quarrels and stress, Sofia was born with a delay in speech and motor skills, which undoubtedly worsens the family’s emotional background. In addition, Jamie constantly cheats on Maria, raises his hand at her, and shouts insults. Fights and attempts to break up are not uncommon in the family, leading to nothing.
Maria became heavily dependent on Jamie due to various social and cultural aspects. Firstly, the patient comes from Honduras, where there is a system of relations according to which a woman is subordinate to her man, fulfills his requirements, and tolerates any behavior on his part. Secondly, the patient did not have a loving and caring father, but only a criminal who raped her at 10. That is why Maria had a perverted concept of relationships and a wrong idea of what a family should be. She subconsciously got used to being in a subordinate position since she never really controlled her life. Maria can be diagnosed with several psychological disorders, primarily associated with rape at an early age. It can include post-traumatic disorder and depression, which makes Maria go with the flow without thinking about the consequences of her actions.
When providing medical services to this family, there may be a lot of other ethical and legal considerations. It is possible to list the illegal status of patients, confidentiality, voluntary participation, the choice of therapeutic goals and procedures that will benefit the client, and the guarantee of the therapist’s qualifications and competence. Specialists are obliged to limit their practice to those areas and treatment methods in which they can be proven to have received sufficient and confirmed knowledge and experience.
Case Conceptualization
Maria meets the diagnostic criteria for prolonged depression and post-traumatic disorder caused by sexual abuse in childhood and moral and physical pressure from Jamie. To work with Maria, it is necessary to remember that she is part of the family, which, in turn, is a true ecosystem. Thus, it would be advisable to use the concept of a family system for psychotherapeutic intervention in this case. Proponents of this trend pay close attention to interactions and other manifestations of the activity of family members, which makes it possible to understand the organization or structure of the family (Finney & Tadros, 2019). How, when, and with whom family members interact is crucial for understanding and subsequent therapeutic changes in the family structure. Since the patient’s problems come from childhood, or rather from her family, close attention should be paid to the consideration of family values and relationships, but already in the present tense.
It would be advisable to use a structural model of family psychotherapy since family psychotherapy can change its structure and change the behavior of each of the members of the family system. Maria pointed out that she had never known her father, who was supposed to protect her family and Maria herself (Finney & Tadros, 2019). Thus, Maria has always felt defenseless, and probably, having not found a defender in Jamie, she still feels this way. Currently, there are severe problems in Maria’s family, which already have an extremely negative effect on the patient’s daughter, Sofia, who has early signs of a sexual disorder. Using a family approach to this problem will help develop some hidden rules that govern the interaction of family members.
For example, the rule “family members should always protect each other” will manifest itself in situations when someone from the family needs care or support. Such an approach will help Maria form her family as a whole and well-coordinated system and understand her and Jamie’s mistakes, which are already adversely affecting their daughter (Finney & Tadros, 2019). In addition, the support and love of Jamie, who also needs to feel like a part of the family, and not a separate independent element, will help Maria cope with depression and post-traumatic syndrome.
Treatment Plan
Based on contextual conceptualization, Maria’s treatment will aim to achieve two long-term goals: strengthening the sense of belonging to the family and increasing self-esteem and self-perception as a woman. To accomplish the first long-term goal, the following short-term goals will be set:
- The patient needs to stop treating the family as a burden. It is recommended to maintain a relaxed and calm atmosphere at home, pay more attention to her daughter’s upbringing, and spend more time with Jamie.
- The patient needs to establish a relationship with a partner and learn to see him as a defender and friend, not an enemy or an abuser.
- The patient needs to take responsibility for her family members and not hide from it or shift it to others;
To achieve the second long-term goal, the following short-term goals will be set:
- The patient needs to become more independent and independent from her partner. To do this, it is recommended to get a job to provide financial support to a partner and not be dependent on him financially.
- The patient needs to set strict personal boundaries in communicating with Jamie, remember about self-esteem, and exclude any physical or moral humiliation attempts.
- The patient needs to change her attitude towards herself, love herself and get rid of the guilt that often haunts victims of sexual violence.
Interventions
Adhering to the chosen approach of structural family therapy, it will be necessary to carry out the following types of interventions in Maria’s situation:
- actualization of family interaction models;
- setting or marking borders;
- escalation of stress;
- assignment of tasks;
- using symptoms;
- stimulation of a particular mood;
- support, training, or guidance (Varghese et al., 2020).
The intervention within the framework of the structural approach will focus not on the previous life experience and its reflection on the later behavior of the patient but the actual communicative conduct. The goal will be not so much to achieve insight as to identify the views of family members about the existing situation change communication stereotypes, which should be followed by restructuring the entire system of intra-family relations (Varghese et al., 2020). Imitation and prescription can be used as examples of psychotherapeutic techniques. In the first case, the therapist imitates, for example, the father and imitates his behavior, manners, and style of communication (Varghese et al., 2020). In the second case, the conflict is brought to classes, and family members demonstrate how everything is happening with them, after which the therapist determines ways to modify their interaction and patterns to create structural changes.
In this approach, the emphasis is on the family hierarchy: parents are deliberately placed in the position of seniority, which implies responsibility for children and excludes the idea of the family as a group of people equal in status. Structural family therapy focuses on the differentiation of subsystems, which can also be used in Maria’s situation (Finney & Tadros, 2019). For example, a psychotherapist encourages parents to talk to each other, preventing unwanted interference from children, or, on the contrary, recommends parents not to interfere in children’s communication with each other (Varghese et al., 2020). However, in cases where the family is separated, it stimulates oncoming traffic between subsystems, ensuring that family members feel more connected and provide more mutual support.
References
Finney, N., & Tadros, E. (2019). Integration of structural family therapy and dialectical behavior therapy with high-conflict couples.The Family Journal, 27(1), 31-36. Web.
Varghese, M., Kirpekar, V., & Loganathan, S. (2020). Family interventions: Basic principles and techniques. Indian journal of psychiatry, 62(Suppl 2), S192.