Develop an initial treatment plan using one of the family therapy models

Assignment 2: Treatment Plan

Florida State College at Jacksonville

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Jeff Fields is a twenty eight year old man, who has decided to seek help with dealing with

the emotional turmoil he has been feeling after the divorce of his high school sweetheart and

wife of five years. Jeff and his wife, Jenna, have a two year old son, Lincoln, who has recently

been diagnosed with asthma. Jeff has been very distant and has been absent as a father and

husband for approximately two years. For Jeff and Jenna, I will address their problems using the

Intergenerational Family Therapy Model. Along with using this model, I will develop a

treatment plan which will include early, middle and late phase goals. In this paper, I intend on

addressing reasons why I choose the Intergenerational Family Model, the differences between

this theory based treatment plan and symptom based treatment plan and the merits of a theory

based treatment plan.

The Intergenerational Family Therapy or the Bowen Family Systems was created by a

man name Murray Bowen. Bowen was a “Psychoanalytically trained psychiatrist who worked

with persons with schizophrenia, often focusing on the individual” (Geheart&Tuttle, 2003,

p.151). After time, Bowen eventually realized that individual focus was not as important as

treating the family as an “emotional unit”. According to Michael Nichols, author of The

Essentials of Family Therapy (2014) Bowens theory describes how the “Family, as a

multigenerational network of relationships, shapes the interplay of the individuality and

togetherness using five interlocking concepts, differation of self, triangles, multigenerational

emotional process, emotional cutoff and societal emotional process” (p.71).

The Bowen theory was chosen for Jenna and Jeff over all other family therapy models

because for them, I wanted to get to the root of the problem and show Jenna and Jeff how

patterns of family problems could be passed on to them from previous generations. I want them

to understand reasons why Jeff is choosing to be absent and disconnected. This sudden attitude

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change in him could have been a learned pattern that has been taught in previous generations. I

also want them to understand that their actions are modeled by the influences of the past, present

and future. “Human relationships are driven by two counter balancing life forces, individuality

and togetherness, we need compassion and independence” (Nichols, 2014, p.69). In Jeff and

Jenna’s case, Jeff could feel he lost his individuality when he lost his football career. Jenna could

feel when Jeff lost his football career; she lost her companionship with Jeff.

During the initial call to the agency, Jeff explained his and Jenna’s story and struggle.

Jeff explained how he has never been close emotionally to his father. The only relationship he

ever had with his father was a “coach and player” type of relationship. His father never talked to

him about personal issues or asked how he was. He never gave Jeff the storybook father- son

relationship, that Jeff so longed for. Jeff then explained that Jenna had a need to please everyone

and to always excel. With the background that was provided, I wanted to meet with both Jeff and

Jenna to discuss the treatment plan, goals and the genogram.

This is another reason why the Intergenerational Family Therapy Model was used for this

couple. The genogram is an excellent tool to distinguish if Jeff’s distancing towards their son is

because of past patterns. Also, Lincoln has been diagnosed with asthma, using the genogram will

help me detect if asthma has been problematic in past generations.

Patricia Holkup, author of Our Parents, Our Children, Ourselves: A Therapy Group to

Facilitate Understanding of Intergenerational Behavior Patterns and to Promote Family

Healing (1998) explains the use and understanding of the Intergenerational Family Therapy, as

it can relate to Jeff and Jenna’s case stating “The parent child relationship is one of the most

influential in a person’s life, forming the conscious and unconscious reality out of which the

person functions for the rest of his or her life, because all families are imperfect, painful behavior

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patterns can be passed from one generation to another” (p.20). Thus, the Intergenerational

Family Therapy Model is the one model that will detect and explain the reason for both Jeff and

Jenna’s actions.

The Intergenerational Family Therapy or the Bowen Family Systems is a theory based

plan and is different from a symptom based treatment plan. Dian Gehart and Amy Tuttle, authors

of Theory Based Treatment Planning for Marriage and Family Therapist (2003) define both

symptom based treatment and theory based treatment plans. Symptom based treatment plans

derive from the “Medical model and are plans prompted by third party payers, therapist using

this treatment plan, identify client symptoms outlined in measurable goals and corresponding

interventions” (p.4).

Theory based treatment plans, “Inspires a careful and rich case, conceptualization beyond

basic behavioral problems and may include psychological, relational, cultural and social factors”

(Gehart&Tuttle, 2003, p.5). Two critical elements in theory based treatment plans include the

“Therapist and the clients perspective” (Gehart& Tuttle, 2003, p.5).

In counseling, theory based treatment surpasses symptom based treatment in many ways.

First, because symptoms based treatment focuses solely on symptoms, therapist who used this

method “Limits case conceptualization and treatment possibilities, limiting the potential to be

helpful to the greatest number of clients” (Gehart&Tuttle, 2003, p.5). Secondly, when symptom

based treatment is used, it fails to incorporate the “majority of professional knowledge in the

field and limits the therapist to behavioral and medical models” (Gehart&Tuttle, 2003, p. 5).

This intern causes the therapist to entirely miss the bigger picture. When counselors

choose to use theory-based treatment plans, they are more likely to provide “consistent and

coherent treatment from the initial to final stages of therapy” (Gehart&Tuttle, 2003, p.6). This is

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why theory based treatment triumphs symptom based. Being able to maintain a relationship with

the clients and create goals that will progress constantly throughout the sessions is what the most

important in the therapeutic relationship.

In the case of Jeff and Jenna Fields, an initial treatment plan has been created based off

the intergenerational family therapy model. To begin, initial goals have been set up to address

the entire therapeutic process; these include goals for the clients and goals for myself, as their

counselor. The goals that I have developed, going into this session for myself is to create a

successful and working relationship with both Jeff and Jenna. To “decrease anxiety and increase

differentiation in one or more family member” ( Gehart&Tuttle, 2003, p.155).

As well as “Learning about themselves and their relationships so they can assume

responsibility for their own problems and help them get past blaming others” (Nichols, 2014,

p.75). Once the session began, fifteen questions were developed based off the Intergenerational

Family Therapy Model and asked to Jeff and Jenna. Once the questions were answered, the

general treatment plan goals and interventions were put into place.

First, early phase goals for the family were addressed. These goals “generally address the

development of the therapeutic relationship problem assessment, goal setting and early referrals”

( Gehart&Tuttle, 2003, p.7). One early phase goal would be to establish a therapeutic

relationship with both Jeff and Jenna. To follow the Intergenerational Family Therapy Model,

this includes staying neutral and “avoiding triangulation” (Nichols, 2014, p.76). As well as

getting each party to “Accept responsibility for their actions” ( Nichols, 2014, p.76). And

maintain a “Clear sense of differentiation of self” (Gehart& Tuttle, 2003, p.166).

Secondly, I would want to explore the history of both Jeff and Jenna’s family of origin, as

well as the history of the nuclear family. By doing this, it will allow me to get insight into the

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patterns that have been occurring throughout their relationship. To do this, I would need to

construct a genogram. Elizabeth Taylor, author of Postmodern and Alternative Approaches in

Genogram Use with Children and Adolescents (2013) describes the genogram as a “Cross

generational road map that documents the structure of the family household, by observing the

dynamics of family relationships over generations, noting intergenerational behavior patterns and

historical trends” (P. 279).

The genogram will help Jeff and Jenna understand the conflicts and cutoffs that have

been patterns throughout their family history. I would also like to identify multigenerational

patterns of father absentee issues and parenting styles, as well as issues of emotional cutoff. I

would also like to identify each members “Sibling positions and determine how this has affected

the family process” (Gehart& Tuttle, 2003, p. 71).

Third, I want to get a feel for Jeff and Jenna’s anxiety and differentiation levels. In the

Intergenerational Family Therapy Model, differentiation of self is the “capacity to think and

reflect, to not respond automatically to emotional pressures” (Nichols, 2014, p.71). Anxiety is

what drives people in this theory. “The more anxiety people have, the less tolerant they are of

one another and the more they are polarized by differences” ( Nichols, 2014, p.72). In order to

get a feel of both of their levels, I want to ask Jenna how Jeff being distant over the past few

years has affected her and her son. I want to ask Jeff, how his father being emotionally

disconnected has affected him.

For the middle phase goals, I want to address the sources of anxiety for both Jenna and

Jeff and begin to decrease it. By doing this, I will need to use an essential technique called

process question. These questions are aimed at “toning down emotions and fostering objective

reflection, as well as gaining access to information on how the family perceives the problem and

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how the mechanisms driving the problem operate” (Nichols, 2013, p.86). These questions could

include, when Jeff neglects you and your son, how do you react? Or, Jeff could be asked, what

are your thoughts about the current situation that is going on between you and your wife? How

would you take responsibility for your behavior?

Secondly, I would want to discuss the reasons why anxiety might be high between the

two, based on the intergenerational patterns that have shown throughout the genogram. Third, I

would want to explore how triangulation between Jeff and his father has affected his sense of

anxiety. Forth, I would want to coach the couple. Coaching in the Intergenerational/ Bowen

theory means “Helping clients figure out emotional processes and their role in them” (Nichols,

2013, p.86). I would want to coach them on ways to reduce their anxiety and how to undo

influences that have been a common theme over several generations.

Lastly, for the middle phase goal, I want to help Jeff de-triangulate from his relationship

with his father, and the blame he has put on Jenna for ending his football career. I will present

process questions in relation to each member and identify their personal responsibilities. Next, I

will address Jeff’s feeling of blame he has put on Jenna. I will use displacement stories to help

Jeff fully understand his situation. I would also encourage Jeff to “go home again”, to research

emotional cutoffs and identifying triangles throughout his multigenerational family. This will

give him insight as to why he is emotionally distancing himself from his own son.

For the last phase goals, I would “encourage differentiation and the ability for Jeff and

Jenna to balance out individuality and togetherness to facilitate resolution” (Gehart &Tuttle,

2003, p.165). I would also want to use displacement stories to help Jenna understand why Jeff is

emotionally cutoff and distant from Lincoln. I would coach them on how to “maintain a non-

anxious presence in response to new family challenges” (Gehart &Tuttle, 2003, P,167). I will

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also coach Jenna on how to respond to future triangles that may return when dealing with Jeff’s

issues of emotional cutoff.

In conclusion, this paper has laid out a treatment plan for the clients, Jeff and Lisa Fields.

It has discussed the differences between theory based treatment plans and symptom based

treatment plans, and has show why theory based treatment plan triumphs symptoms based in a

counseling atmosphere.

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Works Cited.

Gehart, R & Tuttle, A.(2003). Theory Based Treatment Planning for Marriage and Family

Therapist. Brooks/Cole Publishing.

Holkup, P.(1998). Our Parents, Our Children, Ourselves: A Therapy Group to Facilitate

Understanding of Intergenerational Behavior Patterns and to Promote Family Healing.

Journal of Psychosocial Nursing and Mental Health. 36, 20-26.

Nichols, M.(2013). The Essentials of Family Therapy (6th ed). Pearson Publishing.

Taylor, E.(2013). Postmodern and Alternative Approaches in Genogram Use with Children and

Adolescents. Journal of Creativity in Mental Health. 8, 278-292.

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Vignette

Scenario: A husband and a wife divorce after five years of marriage, after the father become

distant over the last two years, after the first child was born. Conflict between the two increased

to the point the couple separated, now the child is struggling with asthma.

The agency gets a phone call from a man named Jeff, who calls to say he would like to come in

to talk about the struggles he has been dealing with over the past few years and the recent

separation and divorce he has been going through with his wife.

The role play client: Your name is Jeff; your wife’s name is Jenna. You are currently 28 years

old and Jenna is 27 years old. You have a son named Lincoln, who is two. You met Jenna in high

school. You were the captain for the football team, very popular and outgoing. Jenna, on the

other hand was focused on her education and getting into the best college. You and Jenna were

so young and in love, that Jenna sacrificed the college of her dreams to follow you and support

your football career. By the end of your senior year, you got accepted to Florida State and Jenna

did too. You both packed up your lives and moved down south. You remained the jock that

everyone loved. You joined a fraternity, while Jenna remained the same person who focused on

her education. You lived the “frat” boy life. You went to parties every night and lost sight of

what was important. Because of your irresponsible decisions, your grades slipped and you were

suspended from football until your grades changed. You became depressed; football was your

life and your escape from reality. You would do anything to get back on that field, even if it

meant turning to drugs to do so. You turned to aderall to get your grades back up and help you

study. You did not inform Jenna of your poor decision choices. Jenna, one day found a pill bottle

in your dresser and brought it to your attention, you explained and she understood. She didn’t

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want you to be in a depressed state anymore and decided not to make a big deal about the

situation. After your grades were brought up, the suspension was dropped. Your father was very

hard on you growing up and only cared about your football career. He never showed you love or

compassion. You so longed for the picture perfect, father-son relationship. When you were eight,

your parents divorced, because your mother cheated on your father, and then created a new life

with another man. You have half brothers and sisters, but you have only met them once. You feel

like your mother abandoned you. At a young age, you created a bond with football, because it

was the one thing that always was there and would never fail you. Football has always been your

escape route, when any thing is going wrong in your life. Jenna’s parents on the other hand, have

been married for twenty years. Her dad worked two jobs to support her family, and her mother

stayed home with the children. Jenna has one sister, but isn’t very close to her, they talk every

now and then. Jenna has always felt determined to excel in school, because she didn’t want to let

anyone down and feels obligated to excel for her father’s sake.

After you had been playing football for a few months, Jenna reviled to you that she was

pregnant. Because Jenna’s family is very traditional, her dad insisted on marriage. After agreeing

to marriage, you were married less than three months later. In the blink of an eye, you went from

being a football star, to having your whole life changed. You couldn’t run from it or change

anything; you had to accept it. Everything was fine between you and Jenna until the baby came.

You started to work full time and the extra time you did have, didn’t involve football. When you

had to stop playing, that shattered your world. You felt as though a piece of you was being taken

away and the one steady thing in your life was being destroyed.

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Jenna completed college, but you did not. You had to sacrifice your education, for the

sake of your family. The plan was for her to finish, then you would go back to school once she

was done; that never happened. So you continued to work at a job that you hated.

Overtime, you became very distant and started to not come home at night. You felt as

though Jenna and the baby took away the one thing that completed you. You stopped helping

with Lincoln and stopped giving affection to Jenna. She would complain about this issue to you

all the time, so you started to really not come home because you couldn’t face the hurt she felt,

and the emotions you were feeling towards your family. After a few years of continuing this

behavior, Jenna decided she wanted a divorce. After the separation, you had very little contact

with Lincoln and only saw him a few times a month. When you did see him you were very

disconnected.

Five months after the divorce, Lincoln was diagnosed with asthma. When Jenna asked

you to go with her to his doctor’s appointment, you said you were too busy when you really

weren’t. Jenna feels a sense of guilt, because of your depression and feels that the disconnect is

mostly her fault. Jenna feels bad that Lincoln is having to experience an absent father and feels

the weight of the world is on her shoulders. You have reported depression and are seeking help

on how to work through this emotional roller coaster that you feel you are on. You want to repair

the relationship with Jenna but you aren’t sure how to do so, if the relationship doesn’t repair,

you want to seek help on how to build a co- parenting relationship with Jenna

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15 Questions

1. Hello, Jenna and Jeff. Can you tell me what’s been going on in your relationship right now?

2. With the problems that you both have been experiencing, what are you most concerned

with?

3. Can you give me an example of what made you the most upset?

4. Jenna, when Jeff neglects you and your son, how do you react?

5. Jeff, did you know Jenna felt this way?

6. Jeff, how do you see your behavior?

7. Jeff, what are your thoughts about the current situation that has been going on between you

and your wife?

8. Jenna, what do you think?

9. Jeff, did you know she felt this way?

10 Jeff, how would you take responsibility for your behavior?

11 Were you ignoring Jenna’s concerns because you weren’t sure how to react to them, or

how to approach the situation?

12 Jenna, what do you want from Jeff?

13 Jeff, what do you want from Jenna?

14 Have either of you expressed your needs to each other?

15 How would you make the needs that you want happen?

16 Jeff, how has your father being emotionally disconnected affected you?

17 Do you think your father being emotionally disconnected with you, has played a role in

how you have been treating your son?

18 Jeff, what do you need to do to express yourself differently?

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19 Jenna, what do you need to do to express yourself differently?