CASE STUDY

CASE STUDY

 

INTRODUCTION

            Mei Ling described that she is feeling down and depressed most of the time. She said she would burst into tears frequently, without knowing why. She said it was difficult to motivate herself to go to work and stopped going for most social activities. She said she felt on edge and agitated when she mixed with people because she felt she had to pretend to be happy all the time. She had also noticed she felt short-tempered with her sons and did not feel strong enough to spend much time with them often. The type of depression that Mei Ling felt is that of exogenous depression. This kind of depression refers to factors outside of the individual which contribute to the individual’s negative feelings and stress, and which contribute to the depressive state (1997). An example of such factors and one which contributed to Mei Ling’s state is marital stress. Mei Ling’s depression is just a normal psychological response to her fear of her husband cheating. But it is not healthy to not do anything about this, that’s why there is a need for intervention in the form of a therapy.

 

BODY

Mei Ling has to undergo a Family Systems Therapy. The therapy should involve not only Mei Ling but the whole family since in reality each member of the family has played a part in the dysfunction or depression on the part of Mei Ling. Perhaps Mei Ling’s husband acted strangely which led her to believe he is having an affair. Mei Ling’s past also contributed to her state at present. When she was 9 years old, her parents divorced and she and her sister and twin brothers moved to a different home with her mother. Mei Ling’s mother became depressed after the divorce and seemed to withdraw emotionally from the children. Mei Ling, being the eldest, took on the role of helping her mother to look after her younger siblings and begun to worry a lot about whether her mother would be okay.

The use of family therapy can repair family relationships and solve problems that have been eating away at families for years and family therapy can also become part of the solution if just one member of the family is having problems, just like the case of Mei Ling. Family therapy is often recommended in many situations including families with problems across generational boundaries.

The basic idea about family therapy is that the family is a system. Family therapy is based on family systems theory, which understands the family to be a living organism that is more than the sum of its individual members. Family therapy uses “systems” theory to evaluate family members in terms of their position or role within the system as a whole. This family systems approach looks at problems within the system of relationships in which they occur, and aims to promote change by intervening in the broader system rather than in the individual alone ( 1988). What is happening to one person in the family system will have an affect on others in the family system. A very clear manifestation of this in Mei Ling’s case is her experiencing short-temperedness with her sons and her lack of interest in spending time with them. Problems are treated by changing the way the system works rather than trying to “fix” a specific member. Family therapy provides an opportunity and a place for family members to come together and work through issues that might be affecting the entire family. 

            Family therapy is more than a collection of techniques used by practitioners who work with the whole family as the medium of change. It also provides a different perspective on the problems presented to members of the helping professions. In family therapy, problems are viewed as parts of repetitive sequences of interaction which maintain and are maintained by the problem. Such sequences may be observed in the present or identified as recurring themes throughout a family’s history. These repetitive behavioral patterns and enduring beliefs are interconnected into what might be called a family system. Practitioners using a systemic approach aim to identify and change the meaning and function of a presenting problem within the context of such a system (1988).

            Culturally competent family therapy with a particular case proceeds along the same steps as most other forms of therapy: Intake, diagnostic assessment, designing a therapeutic strategy, carrying out and monitoring the process and outcomes. What distinguishes this form of therapy, however, is that the family’s cultural programs are high priority for the therapist throughout the therapeutic process (Ariel, 1999).

Motivating a family to begin therapy is the first and most crucial intervention to initiating systemic change. Attention should be paid to who is convened, where therapy takes place, and how people are invited to participate. A non-blaming stance on the part of the therapist towards family members is recommended as essential to facilitate their involvement. A range of convening strategies is offered that ranges from enabling to enforcing ( 1988).

As a general rule the therapist should invite all the family members living in the household (1988). However, in specific cases others significant to the problem should also be convened, for example, members of the extended family, office staff, neighbors, etc. This would include Mei Ling’s husband and her two sons. If Mei Ling’s parents and siblings are still alive and within reach, they can also be invited into Mei Ling’s therapy session. Mei Ling’s fellow nurses working in the hospital can also be invited into the session. The composition should be determined by who is significant to the problem ( 1988).

At the start, a genogram can be constructed by the therapist. The genogram can provide an overall view of complex family constellations in an extremely concise and efficient form ( 1988). A complete genogram should include: 1) names and ages of all family members in Mei Ling’s family; 2) exact dates of birth, marriage, separation, divorce, death, and other significant life events; 3) notations, with dates, about occupation, places of residence, illness, and other changes in life course; 4) information on three or more generations. From this basic format and the concepts about relationships plus some ingenuity, it is possible to map out a diagram of most families seen in therapy ( 1988).

The therapy will start with hearing about what each family member thinks about the presenting problem. The children can be asked about how they felt with their mother behaving that way. The husband could also be asked about his views. Mei Ling can be asked about why she felt that her husband is having an affair. But this kind of marital issues should be asked without the children present. As this proceeds, the problem tends to be enacted in the session. How the problem is connected to life as a family now and in the previous generation is then available for exploration. Initial meetings will focus on figuring out what is not working and why, and goals for the therapy will be agreed upon.  Often families need some help with conflict mediation, learning how to communicate more clearly, and developing more effective ways of coping with stress.

            However humble or elaborate the service offered to a family, it should generally be presented in a confident, clear manner indicating that the therapist values it. Otherwise the recipient is unlikely to value the service. Before inviting a family to a session it is useful to be clear in your own mind just what you are asking a family to participate in. This includes who, where, when, for how long, and how often ( 1988).

            There is often a great debate about the best place to hold family meetings—the family’s home or therapist’s clinic/agency. There are different advantages to both venues. In the case of Mei Ling, the family’s home would be more suitable to hold the business. Therapy done in the family’s home either as a one-off visit or as a regular way of working offers: 1) a powerful engaging move—showing the family how motivated the therapists are to help; 2) a valuable insight into how the family lives—room size, seating positions, etc.—which could not be gained in a clinic setting; 3) a better chance of convening the whole family —especially a potentially ‘reluctant’/non-attending member; 4) a chance to see who is in the ‘network’ (neighbors, etc.); 5) a start to change in the place where things happen, the home ( 1988). Research has indicated that traditional office-based family therapy services are not always effective with at-risk families and that there is an increasing trend toward home-based delivered services (2004).

            When interviews are held in the home, they should be conducted as if in an office. The following type of statement sets the ground rules: ‘Of course, I realize that this is your home, but I would find it easier to help you if I could work as I do at my office. I’d like all the family to sit in this room for the next three-quarters of an hour or so while we discuss things (your problem). I would like the chairs arranged so we can all see each other.’ The format of the session then approximates to an office interview.

            The issue of time is extremely important. Negotiating a time when all the family can be present at the same time as the worker can often be a stumbling-block during therapy as well as in the convening phase. There should be some flexibility in the time of day offered in order to accommodate family members’ working patterns, etc. However, making ad hoc arrangements means time-consuming negotiations each session. It can also give an impression of indecisiveness or poor organization.

            Moving away from a strict focus on individuals and their psyches, consideration began to be given to relationship systems and the contexts in which people live, problems emerge, and solutions may be found. Often perceived as merely a different technique, this shift to working with families, in fact, signaled the beginning of a scientific revolution and the emergence of an alternative paradigm (2003). The therapist can adequately provide therapy if and when he or she “joins” into the sessions not as some outsider but as someone Mei Ling knows or consider as a friend. There is a joining process that takes place in the therapy process. Joining lets the family know that the therapist understands and is working for them (2004).

            Why should it be considered so essential to make culture an integral part of family systems theory? It is important to remember that the family is the vehicle by which the culture preserves its own equilibrium (1999). The multicultural movement of the 1990s has revitalized these concerns within newer, postmodern epistemologies that stress a social constructionist lens, a strength-based orientation, and a collaborative engagement with clients (2003).

            Family therapy has emphasized contextual issues since its earliest days. With its foundation in systems theory, family therapy has always regarded the behavior of families as contextual and ecological (2003).

            Defining specific “collective identities,” such as ethnic, class, gender, or social identities, appears at first glance both possible and practical. We look at the worldviews, values, and customs of certain groups and assume these traits to be normative and stable (2003). Perhaps in Mei Ling’s culture, the idea of divorce is something that is scorned upon by society. And the idea of her husband having an affair elicits fears within herself.

            Gender, race, class, religion, nationality, and even cohort (the historical generation into which a person is born) all contribute to cultural identities. Consistencies of language, meaning or belief systems, worldviews, and experiences often lend a sense of familiarity and community for people who share the same culture. But inconsistencies, variabilities, and novelties along some of those dimensions exist as well. Cultural identities are also influenced by the constructs supplied by the dominant discourses.

            Two constructs encompass family therapy’s current focus on multiculturalism: (1) a cultural diversity practice that respects cultural preferences among clients and critically examines existing models of the family and theories and techniques used in psychotherapy; and (2) a social justice practice that focuses on the effects of power differentials (due to gender, economic, and racial inequities) on individual and family well-being and on the relationship between clients and therapists (2003).

            Clients’ beliefs or behaviors that are part of a cultural meaning system other than the one in which the therapist has been schooled could potentially be judged as dysfunctional or at least problematic. In the newer modes of family therapy, where a respect for or a consideration of differences is at the core of the principle of therapeutic respect, we see families as all different, all uniquely organized, and all needing description, rather than categorization, in order for us to understand them (2003).

            A practice based on curiosity and respect for cultural diversity explores the healing resources within the client’s culture and develops a stance of empathic “sociological imagination”. When we attend to issues of race, ethnicity, social class, gender, religion, or sexual orientation, critical questions are raised about the customary assumptions of mainstream psychotherapy. In family therapy, issues of boundaries, hierarchies, communication styles, or life-cycle norms may come into question and lead to transformations and accommodations of taken-for-granted therapy concepts and techniques (2003).

            Behind the scenes, culture plays important roles in the creation of family -mediated distress in the individual (1999). The environment where Mei Ling grew up and lived perhaps scorn on the situation which she is in. This in return created her depression and evidently affected how she functions in the family. Culture also partly dictates the attempted solutions. Culturally acceptable and unacceptable ways of becoming “sick” and how to recover or be cured are present in Mei Ling’s society. And the way her society behaves and views things can contribute to Mei Ling’s cure. Culture must therefore be made a part and parcel of family therapy theory and methodology (1999).

            In addition to attending to cultural diversity and social justice issues, a fundamental part of the multicultural equation consists of the therapist attitudes that incorporate beliefs about individual and family resilience, and support clients’ personal agency and creativity. Therapy must not become a form of social and cultural reductionism, whereby a client’s gender, race, or social class automatically explains that person’s beliefs, attitudes and behavior. Although interlaced with historical moments, cultural discourses, and sociopolitical forces, the client’s biography is always unique (2003).

 

CONCLUSION / EVALUATION

            Mei Ling has to undergo a family systems therapy. This is the most appropriate therapy for her since her problem is something that is borne out of family experiences and issues. Due to the depressed and down state of Mei Ling, she has been neglecting her roles, most importantly her role as a mother. One of the most important tasks of the family systems theory is to lend support for Mei Ling’s integration into a solid family unit. At the same time, the family unit – her husband and sons – should support the process of differentiation that leads to Mei Ling’s healthy autonomy and eventual progress.

 

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