Identification of Family System
The family under the investigation is the Grapes. Their ethnicity is Caucasian. There are five members of this family: Bonnie Grape, age 54, a mother; Gilbert Grape, age 24, the older son; Amy, age 34, the eldest daughter; Arnie, age 18, the second son; and Ellen, age 16, the youngest sister (Ohlsson & Hallstrom, 1993).
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Reason for Social Work Involvement
The family needs assistance because of its inability to cope with the death of their father and husband (he committed suicide) and evolve. Additionally, Bonnies lack of desire to live one and struggle resulted in her extreme overweight. Children, especially Gilbert, are ashamed of her. Arnies mental disease complicates the situation and undermines stability in the family. Additionally, all members might suffer from depression cultivated by helplessness and lack of any opportunities to evolve. Finally, being the only breadwinner in the family, Gilbert has no chance to leave this place and become independent. In such a way, there are cases of diffused boundaries and co-dependence.
Family Background and Situation
The familys background could be described as the extremely complex one. First, Mr. Grape committed suicide being not able to cope with stress and tension. It had numerous adverse effects on the family. At the moment, its financial state is poor, as, in practice, Gilbert is the only breadwinner who must work to support the whole family. He suffers from the inability to live his own life. The mother, Bonnie, cannot earn money because of some psychological and physical problems triggered by her husbands death. She prefers to isolate herself from society and live as an anchoret. She is obese, which also means that her state of health is critical. Arnie is mentally sick and obsessed with the idea of climbing the local water-tower.
He hardly realizes the problematic state of the family. Amy is still single, and she does not have any chances to marry because of the lack of candidates in the small town. She looks after her mother and works about the house. In such a way, Amy is a mother-figure in this home. It seems that she accepted this role; however, it obviously causes adverse effects on her. Ellen is a student, and she works at Dairy Dreme (Ohlsson & Hallstrom, 1993). She dreams of being an adult. Despite numerous conflicts, family members try to help each other and demonstrate some intimate feelings. However, growing in this household means to suffer from a high level of stress and change of roles. For this reason, conflict and outbursts of feelings are inevitable.
The family could be characterized by an untraditional pattern of relations and interactions as maternal and paternal roles are performed by children, Gilbert and Amy, correspondingly. It impacts the hierarchy within the family as the mother is deprived of any power and depends on her children. Gilbert and Amy accept their roles and act from these positions. The older son earns money, and the eldest daughter looks after the house and family members. Gilbert also has specific relations with Arnie as he must take care of him. Ellen gets along with all family members; however, she is also ashamed of her obese mother. Altogether, relations could be described as stable; however, there is a tendency towards their deterioration because of the gradual accumulation of dissatisfaction and tiredness.
The family is characterized by the unusual distribution of roles. Gilbert could be called “The Father” or “The Breadwinner” as he is the only person who earns money to support all members. Amy is “The Caregiver” or even “The Mother” as she looks after all family members and performs maternal functions. Arnie is “The Lost Child” as he does not have any opportunities for this development or personal growth. Ellen is “The Loner,” as her main desire is to grow and become independent. At the moment, she is not understood by her family members. Finally, Bonny, the mother, is also “The Codependent” as she obviously cannot live alone and survive without her children. She could be named “The Sufferer” as she emphasizes her poor destiny and her husbands suicide.
There are no specific myths in the family. The only thing is that all members try to avoid speaking about their fathers suicide and its reasons. Additionally, their mothers obesity is taboo. All the Grapes try to ignore Arnies mental problems. Gilbert forces the idea that “nobody touches Arnie,” which indicates his desire to protect him (Ohlsson & Hallstrom, 1993). These issues obviously impact their behaviors and choices when acting in particular situations. Finally, these myths result in the development of the problems mentioned above and stipulate the need for an intervention.
Physical Functioning and Health of Family Members
The physical health of the family is not excellent. First, Bonnie suffers from obesity. She is extremely overweight, which means that she has a high risk of stroke, heart failure, and other problems with the cardiovascular system. She has limited mobility and cannot perform functions traditionally associated with the maternal role. It is essential for the assessment as these health problems precondition to the deterioration of the climate within the family and growth of psychological problems. Arnie, the younger son, has some severe mental disease that deprives him of an opportunity to live as a common person and transforms him into a great burden for the whole family. These two health problems create the background for the intervention as they significantly affect all family members.
Intellectual Functioning (Mental Status) of Family Members
The familys intellectual functioning is at the appropriate level. Their judgments are logical, and they can analyze the situation and correctly understand the complexity of their situation and its financial aspects. Attention and memory are within the norm. The only family member who is not able to analyze the situation critically is Arnie because of his mental disease. Gilbert, Bonnie, Amy, and Ellen have satisfactory intellectual levels and participate in diverse discussions within and outside the family (Spielman, 2017). At the same time, they avoid discussing difficult issues like their psychological problems, mothers inability to perform her functions, etc. In such a way, the intellectual functioning of the family is typical for all families in crisis (Spielman, 2017). Preserving the rectitude of judgment, they cannot trace negative alterations in their relations and psychological climate within this system.
Emotional Functioning of Family Members
The general mood is depressive. The family lives perfectly, realizing the absence of any perspectives for the improvement of their state because of the sick mother, her inability to accept the husbands suicide, and her self-isolation. They demonstrate restricted affect (Aronson, Wilson, Akert, & Sommers, 2015). This assumption is evidenced by the lack of emotional response to the problematic situation in which they exist (Spielman, 2017). All emotions are blunted, and family members (except Arnie) try not to show their real feelings and cease the outburst of negative effects. Additionally, the mood is congruent with the subject as the Grapes realize the complexity of their situation and want to change it. However, there are no positive alterations. On the contrary, negative swings could be observed as the high level of stress contributes to the accumulation of negative feelings, which makes their outburst inevitable.
Interpersonal and Social Relationships of Family
All family members try to support each other. Gilbert cares for Arnie while Amy looks after the rest of the family members. They have stable relations. At the same time, they also communicate outside the family. Gilbert has an affair with a married woman Betty Carver. However, he cannot build close relations with other girls because of his mother. He is ashamed of her and does not invite people to the house. In such a way, Bonnie becomes the barrier to enhanced relations. Ellen also has appropriate social skills as she interacts with peers during her study. Amy spends most of her time at home; however, she also can maintain friendships. Only two persons cannot socialize. These are Bonnie because of her unwillingness to speak with other people and Arnie, who has limited opportunities because of the mental disease. Therefore, there is no significant social support from other residents of the city. However, they demonstrate some compassion because of their awareness of the situation in the Grapes family.
In general, all family members have the same level of education. Gilbert has a high school degree and no better perspectives for the future. The same goes for Bonnie and Amy. Arnie cannot attend traditional schools because of his mental disability. However, he does not go to any specific educational establishment. Ellen is a student. She works at Daily Dreme. Gilbert works at the local shop. They are the only two employed persons. However, Gilberts employment is unstable because of the huge supermarket that threatens other shops in the area. It means that their financial situation could become even worse.
There are no reports of legal involvement. Their fathers death was not criminal. There were no other issues that could attract authorities attention.
There is no history of substance abuse in the past. At the moment, family members do not use drugs or alcohol.
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Religion and Spirituality
The family does not adhere to any specific religion. Additionally, it does not play a significant role in their lives. They are not comforted by faith and do not consider it significant power.
There are no past experiences of any psychological treatment reported by the family.
Strengths and Problem-Solving Capacity
The central strength of the family is the ability to support each other and perform maternal and paternal functions. They look after the most vulnerable members and try to protect them. They solve some insignificant problems and manage to survive. At the same time, there are particular problems they cannot resolve. These are financial, psychological, and relations problems. In the past, these issues were handled by their father and Bonnies participation in family issues. Nowadays, they manage to solve some by collaborative practices.
Use of Community Resources
The family does not use any community resources. In fact, there is limited access to these in the town.
Communication of Knowledge of Content – Theory
The problems described above precondition the choice of Becks theory of Cognitive therapy. It emphasizes the necessity to analyze a case considering that thoughts, feelings, and behaviors are interconnected (Deblinger, Pollio, & Dorsey, 2015). In such a way, to eliminate the problematic behavior, a person should identify a stressor and distressing emotional experiences. It will help to develop and appropriate skills to cope with psychological problems and achieve significant alterations in thinking that will stimulate the emergence of positive shifts (Fenn & Byrne, 2013). The efficiency of the theory is proven by numerous research works that emphasize the use of CBT regarding unresolved psychological traumas and a persons inability to cope with them (Fenn & Byrne, 2013). For instance, the death of her husband affects Bonnie, and she is not able to alter her behavior. CBT will help to shape her attitude and responses to this event by demonstrating her current state and cultivating positive shifts in the way she evaluates the situation (Hesselmark, Plenty, & Bejerot, 2013). Changes in Bonnies mood will also impact other family members as they will feel free to act in the way they want, and the level of stress will be decreased. CBT could also be applied to them to show basic stressors and alter attitudes to them.
Communication of Knowledge of Content –Assessment
Considering the fact that the family needs intervention and assistance because of their inability to develop appropriate behaviors, cope with the high level of stress, and resolve unrevealed traumas, all members could benefit from the application of CBT (Hitt, Tahir, Davies, Delahay, & Kelson, 2018). First, Bonnies inability to live on is the central problem in the case. In such a way, the selected theory will help to accept the death and cultivate behaviors needed to cope with the problem. Additionally, it will help to understand her childrens emotions and realize her role as the mother. CBT could also help to resolve Gilberts shame and inability to engage in long-term relations because of problems within the family. At the same time, his responses to Arnies problematic behaviors might be altered and improved. Finally, Amys priorities and attitudes to her future could be reconsidered. At the moment, she does not have her own family. Instead, she looks after this one. However, it is critical for her to marry as she suffers from particular incompleteness. CBT will help to reconsider her priorities and understand this aspect.
Communication of Knowledge of Content –Treatment Plan
Two critical treatment goals should be formulated regarding these conditions.
Treatment goal 1: Acceptance and overcoming of the fathers suicide
Objective 1: Identify the untreated trauma and demonstrate the impact it has on the functioning of each family member, their lives, and current status; 4 out of 5 sessions.
Objective 2: Elaboration of actions and skills that would help to cope with the trauma and attain positive shifts in thinking and behaviors; 6 of 7 times
Treatment goal 2: Reconsider distribution of roles in the family and develop supportive behaviors to stimulate improvement.
Objective 1: Identify the existing wrong patterns that are accepted in the family and their negative effect on moods and relations within the family; 3 out 5 sessions.
Objective 2: Development and implementation of new patterns to introduce traditional distribution of roles and eliminate stressors that impact all family members; 4 out 6 times.
Communication of Knowledge of Content –Evaluation
The family demonstrates supportive behaviors, and they are ready to engage in the process of treatment to attain outlined goals. In the beginning, Bonnie demonstrated resistant behaviors because it meant radical changes for her. She refused to talk about her husband and her pain about his death. However, the emphasis on her childrens needs helped to solve the problem. During sessions, patients were demonstrated the existing issues and factors that triggered their emergence and evolution. Having realized the beneficial impact of this intervention, the Grapes supported each other and which obviously preconditioned positive results and overall success.
Saint Leo Core Values
The work with this family was organized regarding the Saint Leo core values such as respect for dignity and patients wellness. Additionally, the ethical code was considered. Patients were the focus of the process.
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Deblinger, E., Pollio, E., & Dorsey, S. (2015). Applying trauma-focused cognitive–behavioral therapy in group format. Child Maltreatment, 21(1), 59-73. Web.
Fenn, K., & Byrne, M. (2013). The key principles of cognitive behavioural therapy. InnovAiT, 6(9), 579-585. Web.
Hesselmark, E., Plenty, S., & Bejerot, S. (2013). Group cognitive behavioural therapy and group recreational activity for adults with autism spectrum disorders: A preliminary randomized controlled trial. Autism, 18(6), 672-683. Web.
Hitt, D., Tahir, T., Davies, L., Delahay, J., & Kelson, M. (2018). The clinical effectiveness of a cognitive behavioural therapy intervention in a work setting: a 5-year retrospective analysis of outcomes. Journal of Research in Nursing. Web.
Ohlsson, B. (Producer), & Hallstrom, L. (Director). (1993). Whats eating Gilbert Grape [Motion Picture].United States: Paramount Pictures.
Spielman, R. (2017). Psychology. Houston, TX: 12th Media Services.