u10a1 Course project - Cindy Ransomcindy.reidransom.com.s3.amazonaws.com/u10a1 Course project -...
Transcript of u10a1 Course project - Cindy Ransomcindy.reidransom.com.s3.amazonaws.com/u10a1 Course project -...
Buckman/Huffner Family Course Project Cindy Ransom
COUN 5271 Marriage and Family Systems U010a1 Marriage and Family Systems
Email: [email protected] Instructor: Dawn Shelton
Running Head: BUCKMAN/HUFFNER COURSE PROJECT 2
Table of Contents Abstract……………………………………………………………………………………3
Buckman/Huffner Family Case Study and Genogram……………………………………4
Larger Family System Relation…………………………………………………………...5
Intergenerational Themes and Relationship Patterns……………………………………...6
Life Cycle Transitions………….………………………………………………………….7
Inherited Family Strengths and Weaknesses……………………………………………...9
Introduction of Family System Theories………………………………………………...10
Family Therapy Models Presentation……………………………………………………11
Solution Focused Therapy……………………………………………………….12
Applying SFT to the Buckman/Huffner Family…………………………………14
Narrative Therapy………………………………………………………………..16
Applying Narrative Therapy to the Buckman/Huffner Family……………….….19
Comparison of Two Models……………………………………………………………..20
Solution Focused Approach for Treatment Plan…………………………………………21
Treatment Plan…………………………………………………………………………...21
Initial Phase of Treatment………………………………………………………..22
Working Phase of Treatment…………………………………………………….25
Closing Phase of Treatment……………………………………………………...27
Author’s Reflection………………………………………………………………………27
References………………………………………………………………………………..30
Running Head: BUCKMAN/HUFFNER COURSE PROJECT 3
Abstract
Families are complex and unique systems that vary in the way they handle
difficult situations. In the movie Parenthood, we are introduced to the Buckman family
and various subsets with differing issues. In this paper we will examine one of these
subsets, Susan and Nathan, create a family genogram and explore numerous
intergenerational themes and relationship patterns. WE also compare and contrast two
possible family system theories, Solution Focused and Narrative, and apply them to
Susan and Nathan’s family. The Solution Focused therapy approach is also used to
present a possible treatment plan and the author shares personal reflections on how her
culture and value system may affect working with such a couple.
Running Head: BUCKMAN/HUFFNER COURSE PROJECT 4
Families are complex and unique systems that vary in the way they handle
difficult situations. In the Movie Parenthood we are able to see a variety of family
subsystems and watch as their intergenerational problems weave in and out of each
other’s lives creating multifaceted interactions and dynamics. The following paper will be
focused on one particular subset of this family, Susan and Nathan, and will present a
family genogram while examining the system relational patterns. Specific life cycle
transitions and an exploration of the family’s’ strengths and weaknesses will be assessed.
A comparison of two possible family therapy models, Solution Focused and Narrative,
will also be presented as well as the reasons why they would be beneficial in addressing
Susan and Nathan’s presenting issues. Finally a treatment plan using Solution Focused
Therapy approach is presented and the author shares some personal reflections.
Buckman Huffner Family Case Study and Genogram
The Buckman Family shows numerous hardships faced in different stages of the
family life cycle. Each unique family subset faces specific challenges, which could be
addressed in a therapeutic setting. In order to gain a better understanding of these specific
dynamics, we will analyze the Buckman/Huffner subset of the family and look at it in
relation to the larger family system. We will also explore some intergenerational themes,
relationship patterns and life-cycle transitions.
Susan is a middle-school teacher married to Nathan Huffner, a rather neurotic
scientist. Susan is distressed to see their daughter, Patty, becoming a shell of a child due
to Nathan's advanced home-education methods for cognitive development. She wants to
have a second child but Nathan is against the idea and berates her when he discovers that
she's been poking holes through her diaphragm (IMDB.com, 2012). Susan wishes to
Running Head: BUCKMAN/HUFFNER COURSE PROJECT 5
rekindle the romance in her relationship and plans a couple’s vacation, however, Nathan
insists on bringing Patty as a learning opportunity. Susan binges on hidden junk food in
order to manage her stress. Ultimately, sick and tired of Nathan's obsessive bearings over
the family, Susan tells him, in her own way, that she is leaving him (IMDB.com, 2012).
Larger Family System Relation
Susan is the third child of four in the Buckman family. She describes herself as a
“wild child” during her college days and found herself attracted to the responsibility and
stability that Nathan brought into their relationship. Indeed, he was the one who
encouraged her to become a teacher and get her life “together”. As the years have gone
by, however, Susan has found herself suffocating in structure and missing the spontaneity
that her relationship used to have. Unlike her older brother Gil, Susan and Nathan only
have one child and are more easily able to get away for a vacation just the two of them.
She wants to take advantage of that situation and possibly begin expanding her family.
Nathan is very methodical and has grown very accustomed to controlling everything;
from what the family eats to everything Patty does, wears and goes. He has very little
respect for Susan’s family because they are not “exceptional”. Frankly, he considers them
all to be more “sub-average” in intelligence and in lifestyle compared to his family. His
pretentiousness ultimately hurts Susan as she cares for her family very much and she is
very close to her older siblings. She also shows a great deal of care and concern for their
children and is envious of Gils’ children’s carefree ability to enjoy their age appropriate
activities.
Running Head: BUCKMAN/HUFFNER COURSE PROJECT 6
Intergenerational Themes and Relationship Patterns
The genogram proves to be an incredibly useful assessment tool in detecting
intergenerational themes and family relationship patterns. By having the entire family
tree laid out in such a diagram it becomes easier to distinguish multigenerational
transmission of family patterns. McGoldrick, Gerson, and Petry (2008) wrote, “Families
repeat themselves. What happens in one generation will often repeat itself in the next –
that is, the same issues tend to be played out from generation to generation, though the
actual behavior may take a variety of forms” (p.15). In creating the Buckman/Huffner
genogram, Susan and Nathan’s counselor will be able to have them recognize these
patterns easier and ultimately provide them with an opportunity to change the cycle for
themselves.
One noticeable intergenerational theme is that Susan displays a distant (eventually
hostile) relationship between her and her husband, just like her parents. Although not
outwardly abusive, Frank is dismissive of Marilyn and even his own mother. In the film,
Marilyn appears to be sweet natured, patient, understanding but quiet regarding Frank’s
inconsiderate nature. Nathan is similarly dismissive of Susan’s feelings, thoughts and
opinions regarding vacations, Patty’s upbringing, and their relationship. In essence, Susan
is repeating a pattern of being the silent and obedient wife that she grew up with.
Some relationship patterns can also be made intergenerationally. Initially looking
at the Buckman/Huffner subset, a triangle pattern can be examined in the family. “Any
triangle tends to be a part of a larger systemic pattern as well” (McGoldrick, Gerson, &
Petry, 2008, p.170). Nathan is fused to Patty the same way that Frank is fused to Larry.
Running Head: BUCKMAN/HUFFNER COURSE PROJECT 7
Each of these relationships has a negative affect on the third party of that triangle, Susan
and Gil, in these respective cases. Franks permissive ways with Larry create a great deal
of animosity between the brothers. As previously mentioned, Nathan’s incredibly close
relationship with Patty is causing him to neglect his romantic relationship with Susan.
“Whether parents maintain close or distant extended family relationships, they can expect
to inherit major unresolved extended family issues and patterns” (McGoldrick, Carter, &
Garcia-Preto, 2011, p.213). These themes and patterns can be seen repeating from
generation to generation, however Susan is in the process of breaking that cycle by
leaving Nathan, since she feels underappreciated and unheard.
Life Cycle Transitions
Nathan and Susan are in the early Adulthood stage of development as a young
family with a small child. They are faced with the challenge of balancing their new roles
as parents along with work responsibilities. McGoldrick, Carter, and Garcia-Preto (2011)
cited; “The birth of the first child represents tremendous changes for the system. Several
studies done in the United States indicate that marital happiness decreases after the birth
of the first child, even if other forms of happiness do not (von Sydow, 1999). The shift
from being a couple to parenthood is very exciting but still a difficult adjustment. Nathan
chooses to focus his energies on Patty, while Susan attempts to reconnect with her
husband and possibly expand their family.
The psychosocial crisis for early adulthood is Intimacy versus Isolation.
“Intimacy in a relationship supports independent judgments by each partner. It also
permits the disclosure of personal feelings, as well as the sharing and developing of ideas
Running Head: BUCKMAN/HUFFNER COURSE PROJECT 8
and plans” (Newman & Newman, 2012, p.468). Susan is in a state of isolation which is
apparent by her secret binge eating. Another example of her not feeling comfortable in
her relationship is regarding her desires for another child. Susan cannot freely disclose
her feelings about having another baby to Nathan and has resorted to sabotaging her birth
control in the hopes to have an “accidental” pregnancy. She also has the added
responsibility of being a dual income family.“Now that most women are combining work
and family responsibilities, they are increasingly overburdened” (McGoldrick, Carter, &
Garcia-Preto, 2011, p53). Susan worries about Patty and how her inability to relate to
other children her age makes her “weird”. She can see that the entirely academic
approach Nathan has instilled is detrimental on her daughter socially and struggles with
how to get his attention to this fact.
Nathan is unable to notice Susan’s struggles because he is completely enmeshed
in his daughters academic abilities and takes a great sense of pride in her intelligence.
Newman and Newman (2012) wrote, “Parenting during this period has the potential for
boosting an adult’s sense of pride in the skills and knowledge already accumulated [in
their children]” (p.500). Nathan accredits Patty’s intelligence to his diligence and
commitment to excellence. He does not see past his daughter’s success, despite his
personal relationship falling apart around him. Nathan and Susan will need to reach an
understanding where they can balance having a romantic relationship as well as Patty’s
academics and social skills.
Running Head: BUCKMAN/HUFFNER COURSE PROJECT 9
Inherited Family Strengths and Weaknesses
Susan has inherited some family characteristics that can be considered
weaknesses as well as strengths. An inherited weakness would be her mother’s quiet
acceptance of her husbands demanding nature. This has caused Susan to be unhappy in
her marriage and unable to express herself and her desires. This repression has caused her
to initiate negative behaviors, such as binge eating, as her coping mechanism. This
behavior leaves Nathan to resume his overbearing and commanding demeanor. He
continues to act unaware of Susan’s feelings and dismiss her desires. This behavior
causes the family to begin a vicious cycle of communication impasses. It also continues
the family pattern previously discussed of the wife remaining silent to her domineering
husbands attitude.
A strength inherited by her mother, however, is a nurturing and caring manner as
well as a love of her family. Despite being married to a man with such a hard exterior,
Marilyn has been able to develop close relationships with all of her children. She even
ultimately cares for Larry’s son after he abandons him. Susan cares for Nathan a great
deal and confides in her sister in law that she “misses” the connection they used to have.
Susan also displays this same affection towards Patty and truly wishes for her daughter to
enjoy her childhood. This caring nature is a great strength for her family because, despite
separating from her Nathan, that bond with her daughter is still there. Patty may be able
to avoid the feeling of abandonment such as what Larry’s son experienced.
Eventually, Susan discovers she had also inherited her father’s strong attitude in
expressing himself. This is displayed ultimately when she decides to separate from
Running Head: BUCKMAN/HUFFNER COURSE PROJECT 10
Nathan. If not for displaying this strength, Nathan would never have been made aware to
the fact that Susan felt so unhappy. When he realized just how serious she was about
feeling unheard and dismissed, Nathan was able to display his affection for her. This
continues in the family theme of being caring to one another and supportive through
difficulties.
Introduction of Family System Theories
Family system theories allow counselors to adopt a holistic perspective regarding
the family unit. Corey (2013) wrote, “The one central principle agreed upon by family
therapy practitioners is that the client is connected to living systems. Attempts at change
are best facilitated by working with and considering the family or set of relationships as a
whole”(p.435). When a family member is faced with conflict or hardship all those in the
interrelated system are equally affected and this is very obviously seen in the works with
couples. Two postmodern family systems that are strengths based are Solution Focused
Therapy (SFT) and Narrative therapy. “Postmodern approaches to family therapy seek to
reduce or eliminate the power and impact of the family therapist” (Corey, 2013, p.442).
These approaches differ from the traditional hierarchal therapy models in allowing a
sense of collaboration and respecting the clients as the experts of their own lives.
The Buckman/Huffner couple is faced with some difficult situations in their
relationship and these two therapy models can prove to be incredibly beneficial in
helping their relationship. Both of these approaches have an optimistic and hopeful way
of rearranging the client’s negative thought processes. They empower the clients to
believe that they are in control of the changes they wish to make in their lives. We will
look at both of these approaches and discuss their concepts, therapeutic goals as well as
Running Head: BUCKMAN/HUFFNER COURSE PROJECT 11
some of their interventions. Both models will be compared and contrasted and applied to
the Buckman/Huffner family.
Family Therapy Models Presentation
There are several Family therapy models that could be quite beneficial to the
Buckman/Huffner family. Two that we will further explore are the Solution Focused and
Narrative Family therapy models. Chromy (2007) cited; “Solution-focused therapy can
be viewed as a constructivist approach (de Shazer & Berg, 1992), where therapist and
clients co-construct a different way to view their partners, their difficulties and their
interactions (Hoyt & Berg, 1998)”. Solution focused therapy (SFT) will allow Nathan and
Susan to focus on their present situation and the actions that they would like to take in
order to change their current presenting issues, with little emphasis on the past. SFT is
based on creating a level of hope, optimism and encouraging the clients to know that they
have the tools and strength within themselves to resolve their problems.
Another family therapy model that can benefit Susan and Nathan is Narrative
Family therapy. “A general goal of narrative therapy is to invite people to describe their
experience in new and fresh language. This new language enables clients to develop new
meanings for problematic thoughts, feelings, and behaviors” (Corey, 2013, p.412).
Narrative therapy continues the use of positive language and shifting perspectives in
order to help the clients recognize their control over their presenting issues. Susan will
learn that her words are powerful and that she will be able to shift her perspective.
Nathan will also be able to actively listen to Susan’s “story” in order to gain a
better understanding of her perspective. Brimball, Gardner, and Henliline (2003) wrote,
“Families who experienced more positive relational outcomes following participation in
Running Head: BUCKMAN/HUFFNER COURSE PROJECT 12
narrative therapy reported that they had improved their ability to: 1) recognize multiple
descriptions of the problem; 2) change and soften their affect; and 3) attribute positive
meaning to one another”. These two language focused concepts will really be able to
assist Nathan and Susan in adopting a more positive outlook on their situation and on the
intentions each other holds for their troubled relationship.
Solution Focused Therapy
“Solution Focused brief therapy is grounded on the optimistic assumption that
people are healthy and competent and have the ability to construct solutions that can
enhance their lives” (Corey, 2013, p.400). Unlike a deficits based approach, SFT allows
clients to take recognize their strengths and adopt a proactive stance in changing their
lives. By focusing attention on what is working in the clients’ life, SFT also parallels
positive psychology creating an atmosphere of hope and optimism. The therapist acts as a
collaborator and a guide to help the clients recognize the exceptions they have already
encountered in their lives when dealing with similar situations.
SFT therapeutic goals begin small and attainable in order to establish a sense of
accomplishment and encouragement within the client. The goals must be well defined in
order to be successful. Corey (2013) cited;
Walter and Peller (1992) and Murphy (2008) emphasize the importance of
assisting clients in creating well defined goals that are (1) stated positively
in the client’s language; (2) are process or action oriented; (3) are
structured in the here and now; (4) are attainable, concrete, specific, and
measurable; and (5) are controlled by the client (p.404).
Running Head: BUCKMAN/HUFFNER COURSE PROJECT 13
Other goals that SFT center around is to change the client’s view of their situation, the
actions that they are specifically doing about the situation, and recognizing their inherent
strengths and resources to accomplish these changes. SFT also has the client participate
in solution talk rather than problem talk with the belief that you can produce negative
situations by speaking them aloud.
SFT interventions are centered on changing the client’s perspectives and having
them explore their lives in order to identify their strengths and resources. Pre-therapy
change is a simple question at the beginning of the therapeutic relationship that can set
the tone for positivity and control within the client. By asking the client “What have you
done since you called for your appointment that has made a difference in your problem?”,
the client is encouraged in their abilities to face and handle their presenting issues in the
following therapeutic sessions (Corey, 2013, p.406). Exception Questions posed to the
clients encourage them to look at some of the ways they have been lessening their
presenting issues and gives an idea to some possible actions that can be increased for the
same effects.
The Miracle Question is probably the most well known intervention for the
Solution Focused therapy approach. The client is asked to imagine that they finish the
rest of their day as normal but that when they go to sleep a miracle occurs overnight
where their presenting issues that brought them to counseling has been resolved. Because
the client was asleep they are not aware the miracle has occurred so they are talked
through imagining what things they may notice as different upon waking. The client(s) is
then encouraged to talk about the actions that they would be doing differently. Gehart
(2014) wrote, “When successfully delivered, these questions help clients envision a
Running Head: BUCKMAN/HUFFNER COURSE PROJECT 14
future without the problem, generating hope and motivation” (p.340). “The common
guidelines for effective use of the miracle question include phrasing the question
correctly, creating goals, joining, actively looking for exceptions to the problem, being
patient, using pauses, remaining future oriented, and responding to clients constructively”
(M. Stith, Miller, Boyle, Swinton, Ratcliffe, & McCollum, 2012). The Miracle question
allows the clients to focus on specific behaviors that they may be able to apply to their
lives in order to make their “miracle” a reality.
Scaling questions are another technique used in SFT that can help the clients
move into more positive mindframes. “Therapists can use scaling questions to a) assess
strengths and solutions, b) set goals, c) design homework tasks, d) measure progress and
e) manage crises with safety plans” (Gehart, 2014, p.342). The Formula First Session
Task is a technique presented to the clients to accomplish between their first and second
session. The client is asked to take note of the things that they wish to remain the same in
their lives and asked to report them back at the following session. This provides the
clients with the opportunity to identify strengths and notice what is working in their lives.
Video talk and the changing of compliments to requests are also examples of SFT
interventions specifically geared in helping couples to communicate and listen better.
Applying SFT to the Buckman/Huffner Family
Nathan and Susan are a couple presenting several communication issues and SFT
can prove to be quite effective in improving their relationship. SFT will allow them to
open up to considering the perspective of their partner. SFT therapists are able to do this
thorugh establishing a collaborative, non judgmental and neutral stance throughout
therapy. Chromy (2007) wrote, “The therapist does not take one partner's view over the
Running Head: BUCKMAN/HUFFNER COURSE PROJECT 15
other, but instead shifts back and forth to gain multiple perspectives on the problem. Such
interviewing techniques may expand client's abilities to entertain multiple perspectives,
which may increase empathic understanding and reduce conflict in the session.” With
SFT, the counselor can help Nathan to be more understanding of Susan’s desire for
spending more quality time and expanding their family. Conversely, Susan can better
understand why Nathan has placed so much attention on their daughter and what thoughts
preoccupy him currently about expanding their family. Once these basic perspectives are
shared and understood, Nathan and Susan can begin really listening to one another and
strengthening their relationship.
The hopeful and optimistic tone of SFT can also encourage Susan and Nathan
immediately in the counseling process. “From the very beginning of an SFBT session,
talk is about what clients want in the future instead of how and why their life has not been
fulfilling. Having a positive view of the future through the development of goals and the
discussion of compliments, strengths, and exceptions invites hope for a client, which
helps people to cope with current hardships, which leads to more hope” (Reiter, 2010).
Helping to raise Nathan and Susan’s hopeful expectations can implement more positive
and solution talk with one another and improve their connection.
The effectiveness of this approach has been presented in many studies. Lethem
(2002) cited;
The concrete goals and rating scales of SFT lend themselves to outcome
research and many of the centres of solution-focused activity have
followed up clients with positive results. For example, de Shazer (1991)
Running Head: BUCKMAN/HUFFNER COURSE PROJECT 16
presents the results of research carried out at the Brief Family Therapy
Centre in Milwaukee, with 86% of those followed-up reporting good
outcome at 18-month follow- up, after receiving an average of 4.6
sessions. Clients who came to more sessions reported better outcomes.
Like many of the studies on SFT (Iveson, 1991; Macdonald, 1994, 1997;
De Jong & Hopwood, 1996), it concerned adult clients and had no control
group.
When experienced counselors apply the SFT techniques and interventions
correctly, they can truly impact their clients’ lives in positive changes filled with hope
and optimism.
SFT allows Susan and Nathan to develop their treatment process, customizing it
to their needs with the guidance of their counselor. Seedall (2009) cited; “Empirical
research has found that couple-responsible process characterized by enactments, therapist
accommodation, and inductive process decreases struggle and increases couple
responsibility, ultimately leading to more positive clinical outcomes (Butler & Wampler,
1999)”. The counselor and clients truly work as a team in addressing all of the presenting
issues with positivity and optimism. The SFT approach would explain Nathan and
Susan’s discord as they have “lost” their ability to see their strengths and just need some
guidance to help reconnect with what they are truly capable of achieving.
Narrative Therapy
The main concept in Narrative therapy is the exploration of the client’s lives as
“stories”. Through active listening and explorative questions, Narrative therapy
Running Head: BUCKMAN/HUFFNER COURSE PROJECT 17
acknowledges the ability to shift the way the story is told in the hopes to help the client
create a more positive outlook on their presenting issues. “The narrative perspective
focuses on the capacity of humans for creative and imaginative thought, which is often
found in their resistance to dominant discourse” (Corey, 2013, p.411). The counselor
adopts a collaborative role and assists the clients in externalizing and deconstructing their
problem stories in order to create new and hopeful ones.
The goals of Narrative therapy are to invite the clients to adopt more positive
language to use in describing their situations. Corey (2013) wrote, “This new language
enables clients to develop new meanings for problematic thoughts, feelings, and
behaviors” (p.412). Another goal is to separate the person from the problem through
externalizing. Also, to have the client explore alternative ways to view, act and interact in
their lives and then assist them in completing these actions. Narrative therapy goals are
as vast and unique as the clients who are encountered in therapy. They are specifically
tailored to the clients needs at the time, therefore there are no “blanket” objectives for
everyone.
Interventions for Narrative therapy are completely focused on language and
shifting the tone from problem talk to solution talk. Questions are used as a vehicle to
begin the exploration that language plays on the presenting issues such as circular, open
and relational. “Narrative therapists use questions as a way to generate experience rather
than to gather information. The aim of questioning is to progressively discover or
construct the client’s experience so that the client has a sense of of a preferred direction”
(Corey, 2013, p. 415). Externalizing is an incredibly effective technique used in Narrative
Therapy. White & Epston (1990) wrote, “In this process, the problem becomes a
Running Head: BUCKMAN/HUFFNER COURSE PROJECT 18
separate entity and thus external to the person or relationship that was ascribed as the
problem” (p.38)” This allows the client to work against the problem instead of attributing
it as an inherent issue.
Narrative therapy encourages the client to seek out exceptions in their lives where
they were successful in dealing with their presenting issues and this known as searching
for “unique outcomes”. The therapist also carefully listens for openings to new stories.
When presented with these opportunities the therapist can help the clients in alternative
stories and reauthoring. “Whether involved in a free-flowing conversation or engaged in
a series of questions in a relatively consistent process, narrative therapists seek to elicit
new possibilities and embed them in the life narratives and processes of the people they
serve” (Corey, 2013, p.418). Therapeutic letter writing is also an intervention technique
that provides the client with documentation of their progress and encourages them to
reflect on their accomplishments in the counseling process.
In regards to empirical data regarding the effectiveness of Narrative therapy, there
is very little for counselors to build upon. Chang and Nylund (2013) wrote, “In the post-
Michael White era, narrative therapy is rapidly growing in many areas of the globe.
Therapists and graduate students are thirsty for narrative therapy training in spite (or
because) of the trend in psychotherapy towards pathologizing practices. Most graduate
programs include narrative therapy in their curricula and many agencies have
incorporated narrative ideas in their work. Two decades later, narrative therapy is vital
and evolving”. This growing approach is able to empower clients to “rewrite their
stories” with more positive connotations allowing them to have more optimistic
perspectives.
Running Head: BUCKMAN/HUFFNER COURSE PROJECT 19
Applying Narrative Therapy to the Buckman/Huffner Family
Narrative therapy can help Nathan and Susan in reconstructing their “stories” and
identifying how they prefer their family dynamic to be. Gehart (2014) wrote, “The key is
defining the ‘preferred’ reality and identify thoughtfully and with intention after
considering the impact of dominant and local discourses as well as the meanings and
impact of the proposed preferred reality” (p.404). Nathan and Susan may be able to
describe a story where they are in a more loving and united relationship, as they had
earlier in their marriage. The therapist can help them to identfy some of the things that
they did early in their marriage or ways that they spoke with one another and encourage
them to do more of these activities in order to bring their “preferred reality” to fruition.
Narrative therapy can also allow them to externalize their problem of lack of
communication by giving it a name. “Disconnect”, for example, could be a term used to
describe their issues. The counselor can then ask them to identify when they first
experienced the “disconnect”, what types of things that lead up to the “disconnect”, and
to pinpoint which of their current difficulties come from the “disconnect”. White and
Epston (1990) wrote, “Externalizing can establish a mutually acceptable definition of the
problem and facilitates conditions under which persons can work effectively together to
resolve their problems” (p.54). Through the use of externalization and this term, Nathan
and Susan can focus their energies to battle against the “disconnect” instead of fighting
against each other. The Narrative therapy approach would describe Nathan and Susan’s
case as a “story” that needs to be revised. By having them focus on how they want their
lives to “look like”, externalizing their problem and collaborating on their shared goals,
Nathan and Susan can create a distinctively unified relationship once more.
Running Head: BUCKMAN/HUFFNER COURSE PROJECT 20
Comparison of Two Models
SFT and Narrative therapy share many similarities in their approach. Both focus
on solution talk and language as key components in the effort for change. Both are
strengths based models and believe that the clients are the experts of their lives, capable
of their own change. They both believe the client is in need of tapping into their strengths
and resources to overcome their presenting issues. Both also allow the therapist to have a
collaborative relationship with their clients and encourage changing language from
problem talk into positive solution talk. They also attempt to reframe the client mentality
to focus on their resilience and the positive aspects of their lives when facing adversity.
Finally, they encourage the client to look at the exceptional situations already occurring
in their lives which allow them to discover the inherent strengths that they use to
overcome their presenting issues.
One of the differences in the approaches is that Narrative therapy interventions
really focus on helping the client to reauthor their story by externalizing the problem.
Narrative therapy uses the client’s words in order to create a unique and tailored
intervention approach that is co-authored with the counselor. The majority of the
questions asked are meant specifically to help “rewrite” the stories of their lives to be
more similar to their decided “preferred reality”. As a result, therapy may take more time
to cultivate all of the detail and intricacies required for change in the client’s “story”. SFT
is designed to be brief. Although still focused on positive talk, SFT “cuts to the chase” by
having the client focus on discovering what “actions” they can do in order to change their
situation quickly and effectively. Questions are geared more towards exploring what
Running Head: BUCKMAN/HUFFNER COURSE PROJECT 21
these behaviors are and used to guide the client on encouraging more of these positive
actions.
Solution Focused Approach for Treatment Plan
Although both incredibly similar and effectual therapeutic approaches, SFT can
provide Nathan and Susan with an effective treatment plan to address their marital
conflict issues. Chromy (2007) wrote;
Solution-based approaches and associated interventions can be applied
effectively to the couple population. Such interventions include
identifying goals, exceptions and solutions; using language that assumes
change and opens possibilities; and amplifying and complimenting
solution patterns. These can be helpful to the processes of reducing blame
and conflict, creating hope and building solutions, important aspects of
positive therapeutic outcomes for couples in treatment.
By properly using the SFT interventions, Nathan and Susan can address their issues
quickly and begin building back trust in their relationship. This is especially important as
they have a young child at home who will need her parent’s disharmony to end as
promptly as possible. By helping them to strengthen their relationship quickly and
effectively, both parents can go back to being a solid foundation for their young child and
her needs.
Treatment plan
An effective SFT treatment plan for a couple, such as Nathan and Susan, must be
thorough at each phase of treatment. The initial phase is focused on establishing rapport,
clarifying the counseling expectations and establishing initial short-term therapeutic
Running Head: BUCKMAN/HUFFNER COURSE PROJECT 22
goals. The working phase has the clients focus on tasks to help build their relationship
and communication interventions to help attain their medium-term goals. The closing
phase of treatment involves establishing a “plan” that will assist the couple in continuing
to improve and work on their relationship beyond the counseling setting. It may also
include discussing bringing the long-term goal to fruition. According to the DSM-5, the
relational code that can be applied to Susan and Nathan are V61.10 (Z63.0) Relationship
Distress With Spouse or Intimate Partner as they are displaying obvious behavioral
difficulties in conflict resolution, cognitively dismissing one another’s positive behaviors
and display emotional sadness and anger towards one another.
An example of a possible short-term goal for Susan and Nathan could be for them
to improve communication by not having Nathan shut Susan down or having her
withdraw into an eating binge. They can do this by allowing the partner to finish their
statements when in a heated discussion. A medium term goal could be for them to have
scheduled date nights to allow them to reconnect on a personal and intimate level. This
can allow them to possibly discuss expanding their family without resulting in arguing. A
long-term goal could be for them to feel comfortable enough to have Nathan go on a
romantic vacation with Susan alone and reach a consensus on whether or not to have
another baby. All of these issues will be addressed using the solution focused therapy
approach and interventions.
Initial Phase of Treatment
At the beginning of the counseling process, Standard HIPPA forms would be
filled out and discussed as well as an opportunity to clarify any questions the clients may
have regarding counseling protocol. Counseling Standards would be established and
Running Head: BUCKMAN/HUFFNER COURSE PROJECT 23
explained, such as the limits of confidentiality in order to inform the family of how the
therapeutic relationship will proceed. The counselor would establish the protocol for
meetings and ask that both Nathan and Susan be present for all sessions in order to create
a “united front” in the efforts to help their marital relationship. A collaborative
relationship will be presented to the couple between them and the counselor with an air of
optimism and hope as the underlying theme for how the process will proceed.
A semi-structured interview would be conducted which involves the clients
briefly describing their presenting issues and then completing a family genogram during
the initial assessment. The genogram allows the counselor to gather a great deal of family
information regarding dynamics, interrelationships and history that can be useful
throughout the counseling process. It also provides a non-threatening activity to help
build rapport and get to hear the couple’s perspectives, verses focusing solely on the
negativity of their presenting issues. However, when appropriate during the creation of
the genogram, the counselor will make reference to how the presenting issues that
brought them to counseling are present as they describe their family dynamics.
The miracle question will be posed to Nathan and Susan and they will be asked to
describe very specific behaviors and actions that would help them to recognize that the
“miracle” has occurred. “Clients are encouraged to allow themselves to dream as a way
of identifying the kinds of changes they most want to see. This question has a future
focus in that the clients can begin to consider a different kind of life that is not dominated
by a particular problem” (Corey, 2013, p.407). Reiter (2010) wrote, “Use of the miracle
question breaks down a self-constructed barrier of things not being possible, allowing the
perception and understanding that desirable behaviors and experiences can and will occur
Running Head: BUCKMAN/HUFFNER COURSE PROJECT 24
in the future, which promotes expectancy and hope”. These “changes” can then be
applied into specific tasks that they may be able to attempt at a later time.
The counselor will also be looking for the exceptions to their conflicts. These
exceptions gives the counselor and client insight on what “works”. They should be
encouraged to be done more frequently in order to increase positive relations between
Susan and Nathan. Reiter (2010) cited; “By focusing on these nonproblem times, clients
are given a sense of hope that the problem will not always be there. This focus on
nonproblem (or reduced-problem) times changes the ambiance of the session. Berg and
Dolan explained this change, ‘The discovery of exceptions led to immediate change in
the tone of our sessions: client/therapist conversations became hopeful and optimistic’ (p.
10).” By encouraging Nathan and Susan to explore these exceptions, they can be
encouraged in acknowledging the positive aspects of their relationship and the inherent
strengths they possess.
Scaling questions can assist in the establishment of Nathan and Susan’s’ goals.
Looking at where they currently feel they are and where they would like to be on a scale
helps to establish some of the steps that may need to happen in between, with further
detailed exploration. For example, if Nathan and Susan describe their relationship being
at a 2 now and 10 being how they felt when they initially fell in love, the counselor can
ask them to describe what a 3 may feel/look like to them, establishing some concrete
differences in what to work on to get there. These types of questions help the clients to
visualize possible progress in their time in counseling.
When finishing with the clients, the counselor would “assign” the formula first
session task to Nathan and Susan. This task would consist of the couple to identify an
Running Head: BUCKMAN/HUFFNER COURSE PROJECT 25
area or areas of their relationship that IS working and ask that they report this back at the
following session. Becvar and Becvar (2013) wrote, “This question implies that there are
some good things going on in the clients’ lives and moves exploration away from the
dominant focus on the bad things” (p.267). This task is another way of shifting the clients
focus from negative to positive and allows Nathan and Susan to look beyond their
presenting issues and focus on reconnecting as a couple.
Working Phase of Treatment
The initial scale that was discussed to will be consistently referred to throughout
the working phase in treatment. This is in order to monitor the progress and the quality of
the working alliance throughout therapy. Different interventions will be introduced
during this phase of treatment for Nathan and Susan to attempt in bettering their
communication and strengthening their relationship. Video Talk, channeling language
and shifting complaints to requests are all examples of useful interventions that can be
applied to Nathan and Susan’s case.
Video talk is used to distinguish three levels of experience: facts, stories, and
experience. Gehart (2014) wrote, “By using videotalk to separate the behaviors from the
interpretation of the behaviors, couples become less defensive with one another and are
able to engage in conversations in which they better understand each other and identify
meaningful ways to reduce future conflict” (p.347). With this intervention, the counselor
will assist Nathan and Susan to specify the actions that occurred verses statements of
general “feelings” that do not provide a good basis to actionabbly change. This is just the
difference between Susan saying “He never listens!” to “When I asked him to speak with
me he said he was too busy and walked out of the room.”
Running Head: BUCKMAN/HUFFNER COURSE PROJECT 26
Other tactics, such as channeling language, can help Susan and Nathan to “reduce
the sense that a partner is ‘always’ a certain way” (Gehart, 2014, p.352). The counselor
helps to encourage the clients to increase satisfying communication and positive
interactions that help them to reduce conflict. The counselor also heartens the
improvement made through therapeutic compliments. The distinction between
therapeutic compliments verses regular ones are very clear in the effects of the
counseling process. Gehart (2014) wrote, “The key with compliments is to compliment
only when clients are making progress toward goals that they have set or to compliment
specific strengths that relate to the problem” (p.346). Complimenting Susan and Nathan
on the progress they are making and the steps they are actively making for change helps
to strengthen their position of rehabilitating their relationship. These changes in
communication will continue to be monitored and supported throughout the therapeutic
process.
Another beneficial change in communication can be achieved through shifting
complaints to requests. Susan and Nathan are having difficulties expressing themselves
which results in Nathan shutting Susan down and Susan having secret binge eating. By
shifting complaints to requests they will be encouraged to discuss what they want verses
what they don’t want. For example, instead of Susan saying “Let’s carve out some time
for ourselves” she could be more specific in making a request such as “I’d like for us to
take a vacation by ourselves so we can reconnect and spend quality time together.”
Requests like this make the intentions clear and give specific points of action for Nathan
and Susan to build upon.
Running Head: BUCKMAN/HUFFNER COURSE PROJECT 27
Closing Phase of Treatment
The closing phase of treatment consists of acknowledgment of maintaining gains
developing aftercare plans for the end of therapy. The counselor will thoroughly discuss
the progress that has been made and collaborate with Susan and Nathan on how best to
maintain their bettered relationship and communication skills. Coping questions will help
them to identify how they will cope with future problems and possible setbacks. The
scale that has been referred to throughout therapy will be discussed and long-term goals
will be discussed. The counselor will increase a sense of intimacy, shared identity and
connection through the use of scaling questions and therapeutic compliments (Gehart,
2014, p.353). Susan and Nathan will discuss their thoughts on how they have managed to
overcome the initial adversity they faced and share how they plan to continue to do so in
the future. The counselor will also establish an open door policy for returning should
Susan and Nathan wish to do so. Corey (2013) wrote, “Because this model of therapy is
brief, presented-centered, and addresses specific complaints, it is very possible that
clients will experience other developmental concerns at a later time” (p.408). Should
Susan and Nathan wish to return to reinforce or address new issues they will be provided
the opportunity to do so and thus continue the collaborative sense of connection with
their therapist.
Author’s Reflection
Upon creating this treatment plan for Susan and Nathan the author reflects upon
her cultural upbringing, personal experiences and values and how they affect her
assessment and ideas on working with this particular couple. Raised in a somewhat
traditional Latino household, the author recognizes that she has had an experience where
Running Head: BUCKMAN/HUFFNER COURSE PROJECT 28
the male of the family is recognized as the “head” of the household and should be
respected. As she grew older she began to have a better understanding of how this
dynamic poses many challenges to her acculturation into Western society. She
acknowledges feeling empathy towards Susan’s inability to feel heard by a domineering
male and the struggle she faces attempting to balance her roles as a woman. From
personal experience, the author watched as her mother struggled with balancing a more
traditional role of mother/wife with being an independent working woman. It seemed that
her mother played two roles: Accomplished business woman at work and devoted mother
and wife at home who cooks and cleans, caring for her husband and children. The author
was raised watching the struggle her mother experienced with balancing these many roles
and began to appreciate the intricacies of both societal and cultural expectations of
women were at an early age. This is something that must be considered in order to ensure
that she does to show too much sympathy and ultimately come to Susan’s aid or defense
when unnecessary.
The author is able to take from her personal experience the importance of
communication for this couple. Currently she and her husband have created an open
communication approach and also schedule monthly date nights where they are able to
reconnect and discuss interests outside of their children. These are qualities that can be
encouraged for Susan and Nathan in order to help improve their marriage. Married to a
Caucasian man and despite having established a very egalitarian approach to their
childrearing practices, the author still finds herself balancing the roles of being a mother,
wife, friend and sibling and can relate to Susan who struggles with her many roles. These
Running Head: BUCKMAN/HUFFNER COURSE PROJECT 29
are commonalities that can also help to build rapport and connection between the
counselor and Susan.
The author can also relate to Nathan as she has had numerous honest
conversations with her husband in which he describes the pressures of being a “man” and
a “provider” in today’s society. In essence she can use her experiences to look at the
“coin” from both sides. The author ultimately plans to commit to giving both parties
equal time to express their concerns and finish their thoughts in the counseling sessions.
Setting this as a general rule of counseling will allow her to avoid favoring one client
over another and helping them to both feel heard.
Finally, the author truly values marriage and the importance of healthy
relationships, especially when children are involved. It is this passion that ultimately led
her to pursue Marriage and Family therapy as her career. This commitment to healthy and
happy families and the belief in the power of positive psychology can truly be beneficial
to Susan and Nathan, as well as any other clients this author may be faced with in the
future.
Running Head: BUCKMAN/HUFFNER COURSE PROJECT 30
References
American Psychiatric Association. (2014). Other Conditions That May Be a Focus of
Clinical Attention. Retrieved March 13, 2014, from dsm5.org:
http://dsm.psychiatryonline.org.library.capella.edu/content.aspx?bookid=55
6§ionid=41101788
Becvar, D. S., & Becvar, R. J. (2013). Family Therapy: A Systemic Integration (8th
Edition ed.). St. Louis, MO, U.S.A.: Pearson Education Inc.
Brimball, A. S., Gardner, B. C., & Henliline, B. H. (2003). Enhancing Narrative Couple
Therapy Process with an Enactment Scaffolding. COntemporary Family Therapy:
An International Journal , 25 (4), 391.
Chang, J., & Nylund, D. (2013). Narrative and Solution-Focused Therapies: A Twenty-
Year Retrospective. Journal of Systemic Therapies , 32 (2), 72-88.
Chromy, S. (2007). A Solution-Based Approach to Couple Therapy: A Case Example.
Journal of Couple & Relationship Therapy , 6 (4), 71-84.
Corey, G. (2013). Theory and Practice of Counseling and Psychotherapy (Ninth
Edition ed.). Belmont, CA, USA: Brooks/Cole Cengage Learning.
Gehart, D. (2014). Mastering Competencies in Family Therapy: A Practical Approach
to Theories and Clinical Case Documentation (2nd Edition ed.). Northridge, CA:
Brooks/Cole Cengage Learning.
IMDB.com. (2012, December). Synopsis for Parenthood. Retrieved January 30, 2014,
from IMDB.com: http://www.imdb.com/title/tt0098067/synopsis
Lethem, J. (2002). Brief Solution Focused Therapy. Child & Adolescent Mental Health ,
7 (4), 189-192.
Running Head: BUCKMAN/HUFFNER COURSE PROJECT 31
M. Stith, S., Miller, M. S., Boyle, J., Swinton, J., Ratcliffe, G., & McCollum, E. (2012).
Making a Difference in Making Miracles: Common Roadblocks to Miracle
Question Effectiveness. Journal of Marital & Family Therapy , 38 (2), 380-393.
McGoldrick, M., Carter, B., & Garcia-Preto, N. (2011). The Expanded Life Cycle:
Individual, Family, and Social Perspectives (4th Edition ed.). Boston, MA,
U.S.A.: Allyn and Bacon.
McGoldrick, M., Gerson, R., & Petry, S. (2008). Genograms Assessment and
Intervention (3rd Edition ed.). New York, New York, U.S.A.: W.W. Norton &
Company.
Newman, B. M., & Newman, P. R. (2012). Development Through Life (11th Edition
ed.). Kingston, Rhode Island: Wadsworth Cengage Learning.
Reiter, M. D. (2010). Hope and Expectancy in Solution-Focused Brief Therapy.
Journal of Family Psychotherapy , 21 (2), 132-148.
Seedall, R. B. (2009). Enhancing change process in solution-focused brief therapy by
utilizing couple enactments. American Journal of Family Therapy , 37 (2), 99-
113.
White, M., & Epston, D. (1990). Narrative Means to Therapeutic Ends (1st Edition
ed.). New York, New York, USA: WW & Norton & Company.