Case Study directions
You are to do an actual case of your choosing – based on a book, movie, or even an actual case or family/couple you know. Refer to the guidelines on the announcements page and the example case study included in Module 14.
The criteria for the grading of the case write-up paper is as follows:
(1) Paper turned in by deadline – 10%
(2) Style and Readability (APA, grammar, clarity, logic) – 22%
(3) Detailed family history of both nuclear family and spouses families of origin (who, what, where, when, and how) 22%
(4) Clearly defined presenting problem and case conceptualization using theories and models we have studied (who, what, where, when, and how) – 23%
(5) Intervention strategy that demonstrates knowledge and skill in the application of theories/models we have studied ( who, what, where, when, and how) – 23%
Thought this would be helpful as you begin work on your papers.
book reference from class if needed: http://www.integralpsychology.org/uploads/1/5/3/0/…
Jeff and Melissa Smith came into the office for counseling. The first session was used as an assessment of their situation and their desire to seek counseling. This session was used to gather pertinent information in regards to family history and current marital problems. One of the main goals of this preliminary meeting is to understand how the problems have developed to their current point. A history gives valuable insight into the evolution of problems and historical significance.
Jeff and Melissa are a Christian couple that have been married for 45 years. They have one living child, age 40 and one deceased child. Jeff is an engineer for the government and Melissa is a high school Speech teacher. They live in a suburb of New Orleans in the small city of River Ridge, Louisiana. Jeff and Melissa met in college and got married after they graduated college. Jeff was in the Navy at the time and the couple moved around the United States. Jeff would spend months at a time on submarines . Melissa had to adjust to being by herself, often hundreds of miles away from her close knit family. Before marriage, Melissa had never been away from home. She grew up in a large family that was led by her father, who was a Baptist minister. Melissa explained that her father made the decisions for her and her 4 siblings their whole lives. They were very sheltered and as a result, Melissa liked to push the limits as she got older. Melissa was first attracted to the rigid personality of Jeff , which she feels reminded her of her father. Jeff says he loved Melissas spontaneity and genuineness.
After marriage Melissa knew that Jeff would take care of her, but she did go through a stage of resentment because she felt that she had to experience pregnancy and the birth of her first child without her sisters and the rest of her family. Two years after the birth of her son , Lance, Jeff and Melissa moved back home. Two years later their daughter, Ashley, was born . Jeff and Melissa say that they went through the next twenty five years without any real problems. Most of their arguments stemmed from their very different personalities but they say that their marriage was strong . They were happy and got along .
The last five years has put a lot of stress on their marriage. Ashley was diagnosed with Acute Lymphoblastic Leukemia (ALL) 5 years ago, at the age of 31, and lost her battle a year after diagnosis. Melissa moved to MD Anderson in Texas with Ashley so she could receive treatment. Jeff stayed in New Orleans for work. He would visit Melissa and Ashley in Texas whenever he could. Lance got married right before Ashley was diagnosed with Cancer. His marriage had problems from the beginning. While Ashley was going through treatment, Lances now ex wife started to have an affair. The stress of Ashleys diagnosis and Lances failing marriage put Melissa and Jeff under a lot of stress. Divorce was not something that either of them had much experience with and feared Lance was heading towards divorce. The stress began to impact their relationship and after 40 years, Jeff and Melissa began fighting like they never had before. They started to blame each other for things that were out of their control.
As the fear of losing a child became more and more real with each passing day, Melissa and Jeff found ways to cope as best as they could. Ashley passed away and Jeff and Melissa began the grieving process. They had a support system, but even after 4 years, they both agree that they were never able to fully grieve their unimaginable loss. The main reason for this was that right after Ashleys death, Lances marriage completely fell apart. Melissa and Jeff had to shift their focus from grieving to supporting their son who lost his sister and wife in a matter of weeks. The next year was spent trying to pick up the pieces of their life and adjust to their new normal. After being out of work for a year, Melissa had to go back to work right after Ashleys death. Soon after, Melissa began to have health problems and Jeff spent his time working and taking care of her. As expected, Melissa and Jeff had good days and bad days. They were both very tired and mentally and emotionally drained. There were constant reminders of Ashleys death.
Melissa and Jeff made a conscience effort to get back involved with their church and both agree that church became something they looked forward to . As the years have passed, the grief has made the couple feel like they have alienated each other. They miss the way that they used to interact and they miss the family time that they once took for granted.
In therapy, it became clear that both Melissa and Jeff were not taking care of their own needs. One of the first things that Melissa and Jeff learned in therapy was that it was never too late to properly grieve and to give each other permission to work through the lost of their child and the stress that their son has gone through.
Going back to the distinct differences in Jeff and Melissas personalities, it was important for them to recognize that there is no right or wrong way to grieve. One resource that helped at this stage of therapy was the introduction of Kenneth Doka and Terry Martins book entitled Men Don’t Cry, Women Do: Transcending Gender Stereotypes in Grief (1999). The authors explain the difference between an “intuitive griever” and an “instrumental griever,” and then show how couples can blend their styles of grieving in a constructive way.
As the couple grew in therapy, they began to see how they were thrown right back into life without properly grieving. They began to make time for open communication and were encouraged to create a list of coping strategies that they would like to explore . In therapy, Melissa and Jeff were able to talk through the parts of the journey with Ashleys diagnosis and Lances situation that affected them they most. Melissa was surprised that Jeff was willing to talk about the emotions that he went through and that he still is dealing with. The fear that they both felt impacted all aspects of their life and in many situations still does. As a result, Jeff began withdrawing and avoiding Melissa because he could not find an effective way to communicate his emotions. It was just too much for him. This led to the turmoil that ultimately led them to therapy. Both , Melissa and Jeff feared that if they did not do something soon then they would be heading towards separating.
Melissa and Jeff learned that both had desire to work through their issues with the help of a counselor and that they both valued their relationship and wanted to stay together. The both also learned that given the magnitude of their losses, they need help to be able to find as sense of normalcy after devastation. A huge breakthrough was the discovery that they will never get over their loss, but rather the loss becomes part of life after loss. The idea of turning toward each other became of great value for this couple. While trying to grieve individually, they were often ignoring the others needs.
As Gottman ( 2015) explains, turning toward can generate enormous results . This was the case for Melissa and Jeff. Once they started to trying to reconnect to each other, they began to see the benefits of working to get their relationship strong again . Through therapy, the couple was introduced to the The Emotional Bank Account exercise that Gottman (2015) presented. This gave the couple doable activities that made big impacts on their relationship. One of their biggest issues was going forward without Ashley. Especially after Melissa dedicated 100% of her time to Ashley for a year, the thought of being able to return to her life before Ashley was sick was impossible in her mind. These exercises allowed Melissa and Jeff to begin to see themselves as a couple again.
Coping with Your Partners Sadness, Fear, and Anger in Gottmans (2015) book proved to be helpful, as well. As previously mentioned, Melissas father was a strict Baptist minister that was the head of the house. Many decisions that are often individual decisions were made for her by her father. This could have inhibited her ability to explore her feelings, but rather shut her feelings down. The reality is that death comes with a lot of feelings that if not explored, could cause many emotional problems. While Melissas feelings were overwhelming her, she did not feel as though she had the support of her husband. Jeffs military background taught him to ignore emotions. The combination of Melissa and Jeffs emotional coping skills were discussed in therapy and the following tips from chapter 6 in Gottmans the Seven Principles for Making Marriage Work (1999) were given to the couple:
- Acknowledge the difficulty . Admitting to your partner that confronting and responding to negative emotions is tough for you is a great step. Just making it known that you are willing to work on the issue can go a long way toward improving the situation.
- Self-soothe. If you fell overwhelmed by your partners emotions, use the self soothe techniques recommended
- Remember: the goal is understanding . Dont try to problem solve or minimize your partners feelings. Just tune in to what he or she is expressing.
- Use exploratory statements and open-ended questions, You want your partner to talk, so frame your reactions to what youre hearing as either exploratory statements or open ended questions. These approaches both exercise support and encourage a response.
- Dont ask Why? People who come from a problem-solving orientation tend to love this word. But in a discussion about what your partner is feeling, Why? will almost always sound like criticism.
- Bear witness. When someone is upset, they want to know that their experiences matters to you, so they dont feel alone.
- Use your partners metaphors.
The author, Gottman, also gives tips for listening to your partner when they are sad, crying, angry or fearful. All of these emotions apply to or have applied to Melissa and Jeffs loss of Ashley. By incorporating these tips into counseling , the couple was able to feel connected and supported be each other. Some of the tips that were most helpful to Melissa and Jeff were:
- Ask whats missing
- Dont try to cheer up your partner
- Dont even tell your partner to calm down
- Dont minimized it
An important factor according to Bowen family system theory is considering which member of the family died. The position of the family member, whether the death was expected or unexpected and age of the deceased member all are important aspects to consider. Bowen theory also takes into consideration the time it took for other families that experienced a similar loss took to grieve and return to a functional level in society.
According to Jenny Brown in her article Bowen Family Systems and Grief- thinking about variation in the grief response and recovery , Bowens continuum of a familys level of differentiation, or emotional maturity, will be considered to think about why some families recover much faster than others (2012). When grief is examined from a family systems perspective, grief and loss is viewed from how a family deals with the loss rather than the individual . When a family member is loss, the whole familys dynamics are disrupted and roles often must be redistributed. In the case of Melissa and Jeff, Ashleys personality was described as one of a kind, and she was the life of the party and never met anyone that did not adore her. .As one can understand, the loss of a family member , like Ashley, was traumatic for all those that knew her and even more so for her immediate family. Browns research led her to the conclusion that death leads to families to react with varying degrees of avoidance ( 2012 ). This is true for the Smith family. They knew that Ashley was nearing the end of her life, but they clung to hope that they said only God could provide. They prayed for a miracle and when they realized that they were not going to get that miracle, they then coped with emotional avoidance.
The Smith family were interdependent on each other. Melissa and Ashley worked together. Ashley and Lance lived across the street from each other and one block away from their parents. Triangulation was evident in that Ashley was extremely close to her parents and Lance was distanced due to his steady relationship and marriage. When the family loss Ashley, they depended on each other for support, but no one was in the position to support others or themselves.
Bowen identified four factors that impact the way a family reacts and adapts to the loss of loved one. First, the details of the death is important. In the case of Ashley, her death was not sudden but as stated before loved ones were still unprepared. The day she died was described as peaceful, Melissa claims it was a religious awakening that no one that was there will ever forget. Secondly, Bowen looked to family relationships that would support the grieving process. The Smiths had a lot of extended family support that were there to help at first, but they explain that it was for a short period of time and then they had to learn to adjust to their new normal with out Ashely . It was this transition that proved to be difficult for Lance, Melissa and Jeff. Bowen believed that every death is sad, not every death presents the same degree of adjustment (Brown, 2012). Although the youngest child, Ashley held her family together. According to Melissa, she always gave the best advice and she was a natural born leader. According to Bowen theory, Ashleys death presents a more challenging recovery than other deaths may ( Brown, 2012). According to Brown (2012) , the last factor that Bowen identified was the level of family cohesion and maturity. Bowen theory examines how the death change as a result of the death. Can the family reshape its relationships or does the family become more closed ( Titelman, 1998)? According to Bowen in a triangle relationship, like Ashley, Jeff and Melissas, where the child steadies the marriage, the loss of the child can highlight underlying marital symptoms. Ashleys death sent a shock wave through the whole Smith family. For Lance, this meant distancing himself from the family because he thought that his personal issues and failing marriage was going to cause more stress on his parents. For Melissa, she felt alone and felt like she did not do enough to help Ashley through her Cancer diagnosis. Jeff didnt want to talk about the reality of the prognosis and did not emotionally support Melissa . The lack of differentiation in the Smith family could be seen by the lack of open communication and support . Through therapy, Melissa and Jeff have been able to work to improve the differentiation level the family and begin to properly work through the emotions that they have suppressed for years. Melissas willingness is a more natural process, whereas this has proven to be more difficult for Jeff .
According to Jenny Browns (2012) Bowen Family Systems And Grief , the following is a summary of Bowens suggestion using a family systems lens for managing a death of a family member:
- Visit dying family members as often as possible
- Include children (children arent hurt by exposure to death as much as they are hurt by the anxiety of survivors.)
- Involve as many extended family as possible
- Open caskets in order to provide as much contact between the dead and living as possible.
- Prompt obituary notices and communication with relatives and friends.
The Smiths were able to successfully accomplish # 1-3 and 5 of the above list. #4 was not possible due to the chemotherapy and the state of Ashleys body. This was discussed and the family understood that their decision to cremate Ashley was the best decision in their situation.
As a counselor , realistic expectations must be acknowledged and understood. Not all clients can work at the same pace and individual experiences must be taken into consideration . The Smith family has been through a traumatic experience that takes time to heal from. Bowens family system theory can be used to help families deal with the loss of a family member. It is important to consider who the family member that has passed was and the emotional maturity of the family as a whole when entering into a counseling relationship. There should not be expectations set for the mourning family members before detail of the situation and problems are understood. In the case of Melissa, Jeff and Lance , they were all at different points in the grieving process. Bringing awareness to each other helps them be able to support each other in effective ways. The prognosis for healing is good.
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