Written Assignment 2: (2500 words +/- 10%)
Describe your understanding of a specific systemic model demonstrating both
the theory and practical application through a family or couple case you have
applied it to.
The marking framework for both assignments shows the specific areas that are need
to be addressed. Please ensure that all areas are adequately covered as omissions
will lower your overall mark, however good specific areas are.
It is expected that a sufficient number of citations are given and these are reflected
accurately in the bibliography. All references should be as per the Harvard system.
Referencing should be consistent.
The main area the essay to focus on is the understanding and application of the structural family therapy model (Minuchin and others). However, the essay may make references so some generic systemic therapy/theory (such as Gregory Bateson etc.)
The essay must include a statement that due to confidentiality, all names and identifiable information have been changed!
Linda (name has been changed) has been referred to the secondary mental health services following her suicidal attempt and an admission to a psychiatric hospital. She presents with borderline personality disorder and has been struggling with managing her emotional distress for the past two years.
The work has mainly been focusing on an improvement of emotional management using CBT (including schema focused and compassionate focused CBT), however it has been identified that the client’s difficulties are being, to a large extend, maintained in a systemic level – by the unhelpful patterns of relating and communicating with the crucial family members. Therefore some systemic (ideally, structural family work) has been proposed and conducted.
Brief Formation: Linda (45), mother of two – son 19 and daughter 21, has been divorced and living with her son. She feels lonely and rejected. She believes her mother and her daughter do not care about her, which makes her feel very heartbroken and she describes that it makes her feel a horrible pain. When Linda feels rejected and unloved by her mother and daughter, she experiences a strong urge to seek their love. To this she often responds by contacting her mother or daughter, usually demanding their lover/affection/understanding in some way. However, she also believes she has been hurt by her daughter and mother and she feels she cannot ever forgive them for their cruelty. This comes across to her mother and daughter (daughter particularly) who pull away the more Linda seeks their affection, to the point that they often end up acting defensively! This leads to Linda perceiving the situation as being “rejected” (which corresponds with her maladaptive schema – rejection schema), which she perceives as extremely painful, which she cannot deal with in any other way than cutting herself or considering a suicide.
When Linda attempts suicide (has been hospitalised), her daughter and mother see it as a cry for attention and become rejective and hostile to Linda – upsetting Linda further.
Linda tries to keep her son out of it but not telling him much. She felt, however, that he has been getting more frustrated with Linda’s seeming inability to straighten her relationship with mother and daughter.
The work carried out:
Interventions around understand emotions and emotions management. Schema Therapy work (schemata and modes)
Imagery work – based on compassion focused therapy
Systemic work: bringing some family members into therapy session for one session:
only daughter attended – focus on understanding the current communication and relational patterns between Linda and her daughter. Pointing out the conflicts and difficulties in current communicational/relational patterns – misinterpretation of intention on both sides, addressing the pattern of how one seeks affection/attention and how the others respond – driving the cycle.
Some insights and success has been achieved by the above.
Linda has managed to negotiate with her daughter that she would limit her demand for affection from her and will praise more being mother (being affectionate and supportive to her daughter). He daughter agreed to contact her mother more frequently and include her more. Her daughter also considers more how her rejective behaviour might feed into the cycle. Some work has been attempted to help Linda accept responsibility for her suicidal/parasuicidal behaviour, however, with a very limited effect. This continues to draw a conflict between the members (Linda feels it is their fault, whereas they feels and believe it is Linda’s responsibility)
Please feel free to deviate from the above material if you need to.
Some Minuchin’s papers/books need to be referenced. Other useful/important sources might be: A. Vetere, G. Simon, Fish and Piercy (1987) and otehr