Upload
others
View
1
Download
0
Embed Size (px)
Citation preview
The Berkman Family Cindy Ransom
COUN 5275 Utilizing Systemic Approaches: Infancy through Adolescence
U09a1 Demonstrating a Systemic Approach
Email: [email protected] Instructor: Blaine Everson
RUNNING HEAD: THE BERKMAN FAMILY – SYSTEMIC APPROACH 2
Table of Contents
Abstract……………………………………………………………………………………3
Presentation of Family Case………………………………………………………………4
Developmental Issues for Consideration…………………………….……………………5
Developmental Risk Factors for Adolescents……………………………………………..7
Risk Assessment…………………………………………………………………………..8
Parent Considerations……..………………………………………………......................10
Family Life Cycle and the Impact of Divorce…………………………………………...11
Berkman Family Genogram………………………………………….……………….….13
Reflection on the Family Genogram……………………………………………...……...14
Family Challenges and Strengths………………………………………………………...15
Solution Focused Therapy Approach…………………………….………………………17
Family Relationships and Interpersonal Exchanges………………………..…………....18
Assessment Findings...………..………………………………………………………….19
DSM-5 Relational Diagnosis………………….……………………………………........19
Treatment Goals and Interventions……..…………………………………………..........21
Ethical and Legal Considerations………………………………………….…………….23
Author’s Reflection………………………………………………………………………25
References………………………………………………………………………………..28
RUNNING HEAD: THE BERKMAN FAMILY – SYSTEMIC APPROACH 3
Abstract
For the topic of this paper the author has chosen to examine the characters in the
film The Squid and the Whale written and directed by Noah Baumbach. The paper will
explore specific developmental issues and familial counseling considerations in order to
assess the family for therapy. A family genogram will be observed along with risk
assessments and possible ethical considerations in working with minors. The author will
present some of the family strengths and weaknesses and apply the Solution Focused
Brief Therapy approach. DSM-5 diagnosis options will be considered and their reasons
explained as well as a look into possible treatment goals and interventions for the family.
Finally, a brief reflection on how her personal background could affect working with this
particular family.
RUNNING HEAD: THE BERKMAN FAMILY – SYSTEMIC APPROACH 4
For this assignment the author has chosen the film The Squid and the Whale written
and directed by Noah Baumbach. The film was selected because this author has an
interest in working specifically with adolescents and their families. Divorce is a growing
and prevalent issue in the country with more than half of all marriages resulting in it
(APA, 2014). Family counselors are faced with the issues these changes bring frequently
in their work. Each family situation, however, is unique and therefore must be tailored to
each of the client and family needs.
Presentation of Family Case
The Squid and the Whale is a movie centered around the Berkman family and
takes place in the 1980’s. In the movie, Bernard and Joan are both highly educated
writers and the parents who are divorcing. Bernard is opinionated and condescending,
constantly putting down Joan or anyone who he thinks is not of intellectual superiority.
Joan is a writer who is beginning to receive acclaim for her work. The tension between
her and Bernard were elevated as she began to show small signs of success in her career.
The strain of Bernard’s continued domineering attitude also resulted in her having an
affair. Walt is their 16-year-old son who idolizes his father and mimics many of his
characteristics, especially towards belittling his mother. Frank is the youngest at 12 years
old and shows intense emotional distress upon learning that his parents were divorcing.
He is a very sensitive boy who begins to act out by experimenting with drinking and
masturbating at school.
There are several developmental issues that a counselor must take into
consideration when working with this family. The first is to look at both the boys’ ages
and stages of development. Second, the counselor must look into the ages and stages of
RUNNING HEAD: THE BERKMAN FAMILY – SYSTEMIC APPROACH 5
development for the parents and where they are in their life cycle. Finally, one must
consider the family life cycle stage and the impact divorce has on the family unit.
Developmental Issues For Consideration
At the ages of 12 and 16, both Frank and Walt would be considered in the stage of
early adolescence. “This stage is characterized by rapid physical changes, significant
cognitive and emotional maturation, newly energized sexual interests, and a heightened
sensitivity to peer relations” (Newman & Newman, 2012, p.336). Both boys are facing
different challenges that are influenced by the changes they are experiencing physically
and mentally. It is important for the counselor to examine the issues for both boys in four
domains; physical, cognitive, social and emotional.
Physical Issues
An important consideration that a counselor must take into account for both Frank
and Walt is that they are simultaneously experiencing different stages of puberty.
“Puberty encompasses a group of interrelated neurological and endocrinological changes
that influence bran development, changes in sexual maturation cycles and levels of
hormone production, and physical growth” (p.337). The boys’ bodies and minds are
changing and they are trying to make sense of these new emotions and concerns. Frank
begins to be concerned with his physical appearance and which features he has inherited
from both parents. He also begins experimenting with bizarre masturbation behaviors.
Walt is at the beginning stages of experimenting sexually with a partner.
Cognitive Issues
It is important to understand that during adolescence the brain experiences what
has come to be known as a “pruning” phase. “Investigations into the changes occurring
during adolescence explore how this natural and extensive process of pruning may lead to
RUNNING HEAD: THE BERKMAN FAMILY – SYSTEMIC APPROACH 6
reorganizations in the adolescent’s brain that help to explain some of the behavioral and
emotional experiences of this time “ (Siegel & Hartzell, 2014, p.122). The neurons that
are encouraged and used frequently become strengthened during this time period, while
those that are unused are weakened. Both Walt and Frank are going through a stage of
neural reorganization that encourages inquisitive exploration about their lives and
choices.
Both of the boys are starting to exhibit intellectual questioning regarding their
lives and circumstances. Frank displays this by questioning his father’s viewpoints on
philistines. He attempts to begin a debate with his father’s perspective and considers
himself a philistine because he is not interested in intellectual things, such as books.
Walt attempts to appear intellectual in class. Instead of stating opinions of his own he
asks his father for his opinion and simply regurgitates his intellectual musings as his own.
He uses this strategy in order to impress a girl in his class, who eventually becomes his
girlfriend, named Sophie. This form of plagiarism escalates as he performs a song in his
school by Pink Floyd, but claims that he was the composer. He claims to have taken
ownership of creating the song because he believes that he “could have written it” so the
fact that he didn’t was simply a technicality.
Social Issues
The psychosocial crisis for this stage of development is group identity verses
alienation. Young people at this stage look to peers and groups in which they can relate
or belong to in order to feel more secure of their place in the world. As siblings, Frank
and Walt find many opportunities to discuss their emotions with each other regarding
their new household situation. Frank has a close friend whom he confides in the news of
his parents divorcing, while Walt turns to his group of guy friends whom also have
RUNNING HEAD: THE BERKMAN FAMILY – SYSTEMIC APPROACH 7
experience with divorced parents. Walt also continues to explore a sexual relationship
with Sophie, who is also a virgin. Newman and Newman (2012) wrote, “Adolescents
begin to think of of themselves as sexual, develop scripts and schemes for how to act
sexually with others, and begin to formulate ideas about the kinds of people they find
sexually attractive” (p.345). Under the guidance of his father, he finds himself discussing
the kind of women he should find attractive and exploring different sexual acts with
Sophie.
Emotional Issues
Adolescence is known as a highly emotional time for both sexes, mostly in part to
the combination of the psychological and physical changes that they are experiencing.
Frank displays emotional unhappiness when he hears that his parents are divorcing and
needs to be consoled, while Walt remains more stoic, unemotional and matter of fact
regarding the situation. Frank begins acting out and displaying negative behaviors as an
expression of this unhappiness. He begins to drink alcohol, use extensive profanity, and is
caught masturbating in school and spreading his semen on random objects. Walt chooses
to deflect his anger of the divorce towards his mother, blaming her affair for breaking up
their family. Additionally, although he has a sexual relationship with Sophie, Walt
continues to keep himself emotionally unavailable in case something or someone better
comes along.
Developmental Risk Factors for Adolescents
Due to the sensitive stage of development they are in, the Berkman boys are in
particular risk. Physically Walt is experiencing adolescence and his body is going
through hormonal changes filled with emotions that he may have difficulty
RUNNING HEAD: THE BERKMAN FAMILY – SYSTEMIC APPROACH 8
understanding. Socially, Walt is beginning to explore the social controls towards
beginning a sexual relationship with his girlfriend. According to Newman and Newman
(2012), ‘these controls are a product of parental socialization and practices, school
achievement and educational aspirations, and the attitudes and sexual experiences of
friends” (p.347). Bernard constantly imposes his past adolescent experiences on Walt in
order to influence the way he makes decisions. This leaves Walt in an emotional paradox
where he wants to establish his own independence but also wants to appease his father,
leaving him confused on how to make his own decisions.
Frank is a few years younger than Walt and also is confused about the physical
urges that overcome his body. He is exploring this through masturbation and has a lack of
group identity, which has pushed him into isolation. The masturbation itself is not
unusual behavior but his wanting to spread the semen on random objects throughout the
school is cause for some concern towards his mental health. “Adolescents who show
strong signs of mental health and adaptive coping strategies have positive communication
and trusting relationships with parents or other close family members as well as strong
feelings of trust and security among friends” (Newman & Newman, 2012, p.371). Due to
the difficult circumstances that Frank is facing at home, he is left with no consistent
support systems with which he could rely. Ultimately he struggles socially and
emotionally.
Risk Assessment
In the case of the Berkman family, the counselor assessing risk must take several
things into consideration regarding the entire families stages of development. The boys
RUNNING HEAD: THE BERKMAN FAMILY – SYSTEMIC APPROACH 9
are in a very sensitive stage of development. Adolescence can be a very confusing time
because there are so many things happening cognitively and physically during
maturation. At this stage of development egocentrism is a common occurrence. Newman
and Newman (2012) wrote,
“Early adolescent egocentrism has two characteristics that may affect
adolescent’s social interactions as well as their problem solving: (1)
preoccupation with their own thoughts, and (2) a belief that others are also
preoccupied with their thoughts. Thoughts about the possible and the
probable, the near and distant future, and the logical extension of
contemporary events to future consequences all flood their minds ”
(p.359).
Both Walt and Frank are exhibiting curiosity about the world around them and their
future in it. While Walt remains preoccupied with the direction his sexual relationship
should go and how that will affect him in the future, Frank is in a mode of self-discovery
questioning whom he resembles, what his interests are and what these things mean for
him. Walt and Frank are met with the challenge of making sense of the world around
them while trying to also understand the physical changes they are experiencing.
Specifically, Franks’ experimenting with alcohol must be explored and addressed.
Two possibilities for his turning to alcohol are to minimize the feelings of stress and, in
addition to the masturbation, sensation seeking. During adolescence, puberty heightens
the awareness of body sensations and alcohol may accentuate these feelings (Newman &
Newman, 2012, p.380). Many struggling youth attempt to use alcohol to suppress their
feelings of helplessness, minimize inhibition and experience these heightened bodily
RUNNING HEAD: THE BERKMAN FAMILY – SYSTEMIC APPROACH 10
sensations. The high levels of family conflict have left Frank feeling vulnerable and
stressed and his alcohol intake is a risk factor that he, along with the entire family, needs
to confront. If left unaddressed it could have very detrimental and negative consequences
in his future, especially if it becomes habitual.
Another risk that may be considered is the possibility of Frank
experiencing adolescent depression. Adolescents are met with several challenges in a
variety of areas. They experience social, familial, personal, physical and psychological
stressors and it can be incredibly overwhelming to young individuals. “Males are thought
to distract themselves from depression by doing something enjoyable, thinking of other
things, or ignoring their problems, instead of ruminating. Though being active and
controlling one’s moods can be very healthy for many males, this behavior can become
problematic when ignoring moods results in other symptoms, like aggressiveness,
substance abuse, or disruptive behavior” (Pruitt, 2007). Frank’s youth has left him ill
equipped with the proper coping mechanisms to address the feelings that he is
experiencing.
Parent Considerations
Bernard and Joan are both in the developmental stage known as Middle
adulthood. Bernard is a narcissistic, pretentious and overbearing man whom believes that
many people are “beneath” him both physically and intellectually. He attempts to treat his
sons as peers, although not at all at his scholarly level of comprehension. He goads them
into competing against him in order to consistently prove that he is superior to them and
show little care or concern to their emotional states or well-being. Joan is a determined
but softer-spoken individual who is emotionally devoid of affection from her husband.
RUNNING HEAD: THE BERKMAN FAMILY – SYSTEMIC APPROACH 11
She cares for her children very much and is concerned about their behaviors, emotional
well-being and seeks comfort in being appreciated by her lovers.
Bernard and Joan have a very contentious bond that leads to their divorce. With
the addition of their combative relationship and parental responsibilities they also have
career challenges they are facing as well. “As people move through middle adulthood,
the management of heir occupational career becomes a task of central importance to their
sense of personal effectiveness, identity, and social integration” (Newman & Newman,
2012, p.485). Bernard is introduced as very succesful published writer whose career has
begun to take a nosedive as he no longer has representation for his next literary project.
Joan has a writing career that is just beginning to succeed and this has become an issue of
great tension between her and Bernard. Joan’s success has challenged Bernards belief of
being superior to all. Bernard struggles with finding a publisher and getting his student to
have intercourse with him. This along with Joan’s affair with a man whom was not
academic, in any way, has left Bernard feeling quite vulnerable and questioning his
current state.
Family Life Cycle and the Impact of Divorce
Divorce has such an incredible impact on the entire family system. McGoldrick,
Carter, and Garcia-Preto (2011) wrote, “We can see divorce as an interruption that puts
the family on a new trajectory – an additional family life cycle stage – in which the
physical and emotional losses and changes of divorce are put into effect and absorbed by
the three generational system” (p.318). This “interruption” is very prevalent in the
Berkman family as all parties, but mostly the boys are affected by the separation. In an
article by Hartman, Magalhães, and Mandich, (2011) they do a scoping review of studies
centered on the effects of parental divorce and marital separation on adolescents. In it
RUNNING HEAD: THE BERKMAN FAMILY – SYSTEMIC APPROACH 12
they discusss several themes prevalent in all of the studies. Several of these affected
themes can be seen in the Berkman family such as deviant behavior, views on their own
romantic or sexual relationships, and the parent-adolescent relationship.
Deviant behavior can be the use of “illicit drugs, alcohol, and cigarettes, as well
as other behaviors considered unacceptable by society” (Hartman, Magalhães, &
Mandich, 2011). Frank begins drinking soon after his parent’s divorce, while Walt
blatantly plagiarizes a Pink Floyd song and performs it at his school talent show,
claiming it as an original.
Adolescent personal views on romantic and sexual relationships are also shifted
post divorce. Some studies have shown more permissive attitudes regarding sexual
behavior in divorced families (Hartman, Magalhães, & Mandich, 2011). This is similar to
how Bernard encourages Walt to sleep with Sophie to just “try it out”. Bernard’s
opinions regarding women and dating become incredibly important for Walt to consider
and he adopts the notion that “something better” will come along but Sophie will do for
now. This is very indicative of how Bernard views women as expendable, including Joan.
He had been married three times and one “did not count”, the other two were “difficult”.
He attempts to pass this mentality on to his son Walt.
The parent and adolescent relationship in the Berkman family has an incredible
number of nuances and considerations for the counselor to examine. Hartman,
Magalhães, and Mandich (2011) found that divorce has been shown to decrease the
quality of family functioning, increase mindsets of children feeling caught in the middle,
and display negative affects resulting from parents disclosure of sensitive topics to their
children. The negative effects of disclosure can be seen in the Berkman family when
RUNNING HEAD: THE BERKMAN FAMILY – SYSTEMIC APPROACH 13
Bernard tells Walt about Joan’s affair. Walt immediately disconnects with his mother and
refuses to stay with her. He begins to push her away and refuses to have any contact with
her. He refuses any form of friendly interaction with her despite her best efforts. It is not
until Walt is forced to discuss his relationship with his mother in therapy that he even
realizes that they indeed had a close connection while his father as absent.
The Berkman Family Genogram
RUNNING HEAD: THE BERKMAN FAMILY – SYSTEMIC APPROACH 14
Reflection on the Family Genogram
The genogram is a great assessment tool for counselors to begin to see patterns
within families. Genograms provide a “map” of how the family members relate to one
another. It can also be beneficial to the family to see some of these patterns, which they
may not have previously been made aware of. For example, the Berkmans' are exhibiting
triangulating relationships. Walt and Bernard against Joan, while Joan and Frank are
against Bernard. According to McGoldrick, Gerson, and Petry (2008), “The genogram
allows the clinician to detect intense relationships in a family and, given the family’s
structure and position in the life cycle, to hypothesize about the important relationships
and boundary patterns of that family” (p.168). There are a few things of note that can be
observed by the Berkman Family Genogram.
There are several lines of hostile relationships between ex-spouses as well as
children with their parents. Bernard and Joan appear to have a united front when in the
presence of both children, however, individually they are experiencing a great deal of
resentment towards one another. Joan resents the way Bernard talks down to her and is
emotionally unavailable or attentive to her needs. Bernard is hurt by Joan’s affair but his
pride and constant endeavor to appear intelligent does not allow him to show his
emotions regarding this event. Instead, he chooses to focus his anger on Joan by belittling
her in front of the children and composing himself with an air of superiority over
everyone around him, including his children.
Walt begins to display a hostile relationship with his mother after he learns about
her affair from Bernard. As a result, he spends more time with his father and continues to
emulate his behavior and adopt his chauvinist perspective on women. Frank begins to
challenge his father’s perspectives. For example, during a ping pong game Bernard
RUNNING HEAD: THE BERKMAN FAMILY – SYSTEMIC APPROACH 15
describes Ivan as a Philistine, someone who is not interested in books or other intellectual
things. Despite his father’s objection, Frank contests that he also considers himself a
philistine. He also begins to show signs of disrespect with foul language towards his dad.
Family Challenges and Strengths
The Berkman family has its fair share of challenges and strengths. The major
challenge for the working counselor will be to repair some of these hostile relationships.
A main focus would have to be to help amend the relationship between Bernard and Joan.
Amato and Keith (1991) cited, “Interparental hostility creates an aversive home
environment in which children experience stress, unhappiness, and insecurity (Maccoby
& Martin, 1983). Obviously, such an environment is less than optimal for the
development of children”. By assisting Joan and Bernard to have a friendlier relationship
the children can feel that they have a more secure “base” with which to support one
another.
Bernard’s’ attitude of superiority will also prove challenging for the counselor as
he will more than likely enter into the therapeutic atmosphere with resentment and
negativity. One tool that could possibly be implemented with Bernard is the intent-impact
model. The intent-impact model explores whether or not the impact of the message on the
listener is the same as what the sender intended. In therapy, the intent-impact model can
be used to look for the positive (or neutral) intent behind messages or behaviors that are
perceived as being negative. An individual who feels hurt or fearful (neutral intent) may
express it as anger, which can create a negative impact (Williams & Day, 2007). When
Bernard expresses anger towards Joan it could be considered his expression of hurt for
her betrayal of their marriage through her affair.
RUNNING HEAD: THE BERKMAN FAMILY – SYSTEMIC APPROACH 16
Another challenge will be addressing Frank’s masturbation and use of alcohol.
This may require some sessions alone with Frank in order to give him the opportunity to
express himself more freely without the presence of his parents. These are all sensitive
topics and must be approached with great care and empathy by the counselor.
A strength the family exhibits is the care and consideration that the brothers show
for one another. Walt and Frank often confide in one another and consider each other’s
feelings throughout the difficult transition of their parents getting divorced. This
connection and their love for one another can prove to be an incredibly powerful tool of
support for both of them. Another strength is the connection that the children have
towards their specific parents. Walt is able to see some things sympathetically from his
father’s perspective and Frank does the same for his mother.
Although this seems like a dividing point for the family it can be used to
strengthen their bonds. In sessions with the boys, the closeness that they share can allow
them to help the other see a perspective from the distanced parent. Circular questioning
can allow them to adopt different viewpoints while allowing them to explore their
personal feelings about their parents.
Indeed it is important for the counselor to take into consideration both the family
strengths and weaknesses in order to establish a positive outlook for change. “Knowledge
of family strengths will help the therapist understand how families cope with problems
and how they promote growth and development”. (Hanna, 2007, p.91). The Berkman
family has a considereable amount of issues to be discussed but there seems to be a great
amount of care and concern from each of the family members. There is no doubt that
with the proper guidance this family can find their way to being a more healthy and
RUNNING HEAD: THE BERKMAN FAMILY – SYSTEMIC APPROACH 17
happier unit. A strengths based therapeutic approach, such as Solution Focused Therapy,
can prove in credibly beneficial to the Berkman family.
Solution Focused Therapy Approach
The counselor working with the Berkman family will be using the Solution
Focused therapy (SFT or SFBT) approach for assessment and diagnosis. “Solution-
Focused therapy is a future-focused, goal oriented therapeutic approach to brief therapy
developed initially by Steve de Shazer and Insoo Kim Berg at the Brief Family Therapy
Center in Milwaukee in the early 1980’s. SFBT emphasizes strengths and resiliencies in
people by focusing on the exceptions to their problems and their conceptualized
solutions” (Corey, 2013). SFBT allows clients and therapists to engage in a collaborative
approach towards resolving their presenting issues. Aspects that make this approach
beneficial in Family counseling are the therapeutic perspective, the role of the counselor,
the theory of change and the interesting intervention techniques that can be applied.
The SFT approach can prove to be very beneficial to the Berkman family because
it is rooted in optimism, capability and hope. The issues that the Berkman family face
results in them becoming incredibly overwhelmed with negativity, destructive responses
and a sense of powerlessness. These clients need assistance in “finding their way” back to
believing in their self-competence and promoting constructive and hopeful outlooks on
their abilities. This focus on positivity empowers clients to concentrate on resolving their
presenting issues more effectively.
RUNNING HEAD: THE BERKMAN FAMILY – SYSTEMIC APPROACH 18
Family Relationships and Interpersonal Exchanges
In the SFBT approach, the counselor allows the client to become the “expert” and
adopts a “not knowing” stance. The counselor does not assume that they know the
answers or that they are there to educate the client. Instead, it is a collaborative
approach where the client is invited to devise their own solutions based on their
current situation. There is little to no emphasis placed on the clients past
experiences and the primary focus is on the here and now.
This approach can prove incredibly beneficial to the Berkman family who tend to
bring up many of their past issues or occurrences in their lives as a main point of
contention. Bernard constantly brings up Joan’s previous affairs and this is a continuous
topic of contention between them. The couple has an enormous amount of difficulty co-
parenting because they display this animosity towards one another and are unable to
communicate effectively. Working on improving this communication will be an integral
component of family therapy.
The boys also display specific interactional patterns focused on the past that should
be considered. For example, Walt argues with Frank about how their father is “the writer”
even though he has not had a book published in quite some time. He does not view his
mother in her current role as a burgeoning writer, as Frank does. These differing
perspectives result in a polarity where each brother is defending a parent and what their
roles are supposed to be, instead of what they are presently. SFT will allow the Berkman
family to focus on what their situation is today and how to strengthen their relationships
through this transition of divorce.
RUNNING HEAD: THE BERKMAN FAMILY – SYSTEMIC APPROACH 19
Assessment Findings
In the initial phase of assessment, the SFT approach works on developing a
working therapeutic relationship that is optimistic and hopeful. The clients and counselor
identify exceptions as well as strengths and resources that allows them to become
motivated for change (Gehart, 2014, p.351). Although it may not be apparent at the
outset, the Berkman Family does have many strengths and resources from which to pull
from. The care and concern that the brother’s have fro one another is an incredible
strength. They also can prove to be incredibly powerful support systems for one another.
Additionally, Joan maintains incredible empathy for the boys difficulty in processing the
divorce and she aspires for the family to maintain a loving relationship. Along with his
brother and mother, Frank also has a good relationship with Ivan whom he admires and
respects.
DSM-5 Relational Diagnosis
The DSM-5 discusses relational problems that the Berkman family qualifies for
diagnosis and reasons for each will be discussed in the following:
V61.20 (Z62.820) Parent-Child Relational Problem,
This code is used when “the parent-child relational problem is associated with
impaired functioning in behavioral, cognitive, or affective domains” (APA, 2014). The
hostile relationships between Walt and his mother as well as Frank and his father make
the family qualified for this particular code.
V61.29 (Z62.898) Child Affected by Parental Relationship Distress
RUNNING HEAD: THE BERKMAN FAMILY – SYSTEMIC APPROACH 20
Joan and Bernard have extremely high levels of conflict and disparagement. They
lack the ability to communicate effectively with one another, which ultimately affects
their ability to co-parent. It also creates a polarity between their children where they feel
they need to choose a “side” to defend, in order for each parent to be accompanied and
represented.
V61.03 (Z63.5) Disruption of Family by Separation or Divorce
The Berkman's are going through a divorce which has created an influx of
changes that the entire family must deal with. There are new homes, living and visiting
arrangements, school transportation options, as well as decisions to be made about the
family pet. All of these changes can be incredibly troubling to children and adolescents as
they attempt to make sense of their new environments and relationships with their
parents.
Narcissistic Personality Disorder
Bernard’s’ delusions of grandeur and disconnection to the emotional states of
each of his family members leave him with a possible individual diagnosis of Narcissistic
Personality Disorder. “Typical features of narcissistic personality disorder are variable
and vulnerable self-esteem, with attempts at regulation through attention and approval
seeking, and either overt or covert grandiosity. Characteristic difficulties are apparent in
identity, self-direction, empathy, and/or intimacy, as described below, along with specific
maladaptive traits in the domain of Antagonism”.
Child Neglect
Due to the fact that Frank was left home alone and unsupervised when he was
supposed to be under Bernard’s care the counselor would also consider looking into
Child neglect considerations for the Berkman Family. The APA (2014) states, “Child
RUNNING HEAD: THE BERKMAN FAMILY – SYSTEMIC APPROACH 21
neglect is defined as any confirmed or suspected egregious act or omission by a child’s
parent or other caregiver that deprives the child of basic age-appropriate needs and
thereby results, or has reasonable potential to result, in physical or psychological harm to
the child”.
Treatment Goals and Interventions
Treatment Goals
In SFT, the therapist is viewed more as a guide who helps the client determine
their goals. “The clearer client’s goals are the more likely they are achieved so it is
important for therapists and clients to create well-defined goals from the outset of
therapy” (Iveson, 2002). The Berkman family and the counselor would work together to
establish some of the goals that they wish to achieve. Once the goals are established the
clients and counselor can focus on the theory of change. Some goals for the Berkman
family could include establishing friendlier communication between the parents and
including Frank in more family activities to minimize his isolation.
Interventions
Interventions in the SFBT approach are mostly centered around changing
perspective and language. Corey (2013) wrote, “SFBT focuses on finding out what
people are doing that is working and then helping them apply this knowledge to eliminate
problems in the shortest amount of time as possible.” Clients are encouraged to do more
of what is working for them in order to reduce the tension of their situation. For example,
Frank appears to speak more openly about his feelings with his brother. They
communicate via telephone when they are not physically together. This might be a
RUNNING HEAD: THE BERKMAN FAMILY – SYSTEMIC APPROACH 22
behavior that could be encouraged to continue by having Walt be more physically present
with Frank. The SFBT approach is completely focused on family strengths and puts them
in a better position to celebrate their successes.
Progressive Narratives
When it comes to language, clients are heartened to address their issues with more
positive words, focusing on their strengths instead of their downfalls. This would be
particularly challenging with Bernard, whose language is very engrossed in negativity,
whether overtly or in nuance. “Therapists prefer ‘progressive narratives’ because it
allows them more range to help their clients elaborate and expand on the positive changes
that they can make” (Becvar & Becvar, 2013). All of this positive feedback results in
higher confidence and an understanding that the clients are in control of their own
actions, perceived roles and lives.
Miracle Question
SFBT therapists use a variety of questions and differing interventions in order to
facilitate this change in their client’s perspective. The most common question used in the
SFBT approach is the “Miracle Question”. “The therapist asks, “If a miracle happened
and the problem you have was solved overnight, how would you know it was solved, and
what would be different?” Clients are then encouraged to enact “what would be different”
in spite of perceived problems” (Corey, 2013). The Miracle question allows clients to
begin establishing the goals of where they ultimately want to be and provides a good
jumping off point of tangible enactments in which they can immediately participate.
RUNNING HEAD: THE BERKMAN FAMILY – SYSTEMIC APPROACH 23
By assessing the answers given by the Berkman family, the counselor can have a
better understanding of what some of the behavioral changes can be suggested and then
collaborate with the family on an intervention where they continue to do more of these
behaviors. This could then be suggested as their Formula First Session Task. The activity
or “homework assignment” is focused around strengthening the client’s perspective and
perhaps even encourage adopting a positive association with how they will address their
issues in the future. These interventions can be extremely beneficial in assisting the
Berkmans to reconsider their perceptions on their presenting issues while developing a
more positive outlook on the control they do have in their lives.
Ethical and Legal Issues and Considerations
There are certain ethical codes that should be taken into account when working
this family, beginning with working with multiple family members. According to the
ACA Code of ethics, “When a counselor agrees to provide counseling services to two or
more persons who have a relationship, the counselor clarifies at the outset which person
or persons are clients and the nature of the relationships the counselor will have with each
involved person” (A.7. Multiple Clients). Another important ethical issue with working
with multiple clients revolves around the nature of confidentiality. Disclosing the Limits
of Confidentiality will need to be discussed at the beginning of counseling so that the
family is aware of what will be shared should there be conjoint family sessions. This is
especially important for working with minors where written consent will need to be
acquired in order to provide services.
Confidentiality when working with minors is also a major issue for counselors.
RUNNING HEAD: THE BERKMAN FAMILY – SYSTEMIC APPROACH 24
“Confidentiality refers to maintaining privacy and not disclosing information to others
outside the counseling relationship unless there is approval or consent by the client”
(Houser, Wilczenski, & Ham, 2006, p.107). It will be important for the counselor to
immediately inform the family of what the limitations of confidentiality may be in their
sessions. One limitation revolves around distinguishing who the “client” is in treatment.
The American Counseling Association Code of Ethics (2005) states; “In couples and
family counseling, counselors clearly define who is considered “the client” and discuss
expectations and limitations of confidentiality. Counselors seek agreement and document
in writing such agreement among all involved parties having capacity to give consent
concerning each individual’s right to confidentiality and any obligation to preserve the
confidentiality of information known.”
Should the counselor be allowed to meet with the boys individually, there is also
an ethical responsibility to their parents. “Counselors inform parents and legal guardians
about the role of counselors and the confidential nature of the counseling relationship.
Counselors are sensitive to the cultural diversity of families and respect the inherent
rights and responsibilities of parents/guardians over the welfare of their children/charges
according to law. Counselors work to establish, as appropriate, collaborative relationships
with parents/guardians to best serve clients” (ACA, B.5.b.) The limits of the counseling
relationship must be very clearly explained in order for all the parties involved to
understand what things will and will not be shared. Written consent forms can provide
clarity with what the expectations will be from the clients and the counselor as they
continue their therapeutic relationship.
Another consideration is to make sure that the counselor obtains the proper
RUNNING HEAD: THE BERKMAN FAMILY – SYSTEMIC APPROACH 25
documentation and permission to work with the minors, Walt and Frank. Although there
will be family sessions, the counselor may wish to work individually with one or both of
the boys. According to the American Counseling Association Code of Ethics (2005),
“When counseling minor clients or adult clients who lack the capacity to give voluntary
consent to release confidential information, counselors seek permission from an
appropriate third party to disclose information. In such instances, counselors inform
clients consistent with their level of understanding and take culturally appropriate
measures to safe-guard client confidentiality” (B.5.c.). Whenever a counselor works with
a minor it is important for them to thoroughly explain the confidentiality expectations and
to obtain the proper documentation allowing permission for participation.
Author’s Reflection
The Berkman family requires an empathetic, understanding and above all, patient
counselor. Upon reviewing the case and considerations for the Berkman family, the
author reflects upon her cultural upbringing, personal experiences and values and how
they affect her assessment and ideas on working with this family. Raised in a somewhat
traditional Latino household, the author recognizes that she has had an experience where
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 Joan’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
RUNNING HEAD: THE BERKMAN FAMILY – SYSTEMIC APPROACH 26
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 Joan’s aid or defense when unnecessary.
The author is able to take from her personal experience the importance of
communication for this divorced but still co-parenting couple. Currently she and her
husband have created an open communication approach and these are qualities that can
be encouraged for Bernard and Joan in order to help improve their relationship post
divorce. By creating a better relationship they will be better able to co-parent and provide
their children with a healthier environment. 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 Joan who struggles with her many roles. These are commonalities that can also
help to build rapport and connection between the counselor and Joan.
The author can also relate to Bernard 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.
RUNNING HEAD: THE BERKMAN FAMILY – SYSTEMIC APPROACH 27
The assessment of the Berkman family has allowed the author to explore a family
dynamic in more depth and detail. By looking at each family member’s perspective the
author was able to better understand the complex and unique views of each of her clients.
She hopes to use this awareness in her future counseling career by allowing each client to
express their perspective and helping the family to listen to one another’s thoughts and
feelings. Finally, the author truly values the importance of healthy relationships in any
form, especially when children are involved. It is this passion that ultimately led her to
pursue Marriage and Family therapy as her career. This belief in the power of positive
psychology can truly be beneficial to the Berkman family, as well as any other clients this
author may be faced with in the future.
RUNNING HEAD: THE BERKMAN FAMILY – SYSTEMIC APPROACH 28
References
Amato, P. R., & Keith, B. (1991). Parental Divorce and the Weil-Being of Children: A
Meta-Analysis. Psychological Bulletin , 110 (1), 26-46.
American Counseling Association. (2005). ACA Code of Ethics. Retrieved August 1,
2014, from Counseling.org: http://www.counseling.org/Resources/aca-code-of-
ethics.pdf
American Psychiatric Association. (2014). Alternative DSM-5 Model for Personality
Disorders. Retrieved September 14, 2014, from Diagnostic and Statistical Manual
of Mental disorders (5th ed.):
http://dsm.psychiatryonline.org.library.capella.edu/content.aspx?bookid=556&sec
tionid=41101793&resultclick=1#103442605
American Psychiatric Association. (2014). Other Conditions That May Be a Focus of
Clinical Attention. Retrieved September 14, 2014, from Diagnostic and Statistical
Manual of Mental disorders (5th ed.):
http://dsm.psychiatryonline.org.library.capella.edu/content.aspx?bookid=556&sec
tionid=41101788
American Psychological Association. (2014). Marriage and Divorce. Retrieved July 28,
2014, from APA.org: http://www.apa.org/topics/divorce/
Hanna, S. M. (2007). The Practice of Family Therapy : Key Elements Across Models (4th
Edition ed.). Belmont, CA, U.S.A.: Brooks/Cole, Cengage Learning.
Hartman, L. R., Magalhães, L., & Mandich, A. (2011). What Does Parental Divorce or
Marital Separation Mean for Adolescents? A Scoping Review of North American
Literature. Journal of Divorce & Remarriage , 52 (7), 490-518.
Houser, R., Wilczenski, F. L., & Ham, M. (2006). Culturally Relevant Ethical Decision-
RUNNING HEAD: THE BERKMAN FAMILY – SYSTEMIC APPROACH 29
Making in Counseling. Boston, MA: Sage Publications.
McCurdy, K. G., & Murray, K. C. (2003). Confidentiality Issues when Minor Children
Disclose Family Secrets in Family Counseling. The Family Journal: Counseling
and Therapy for Couples and Families , 11 (4), 393-398.
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.
Pruitt, I. T. (2007). Family Treatment Approaches for Depression in Adolescent Males.
American Journal of Family Therapy , 35 (1), 69-81.
Siegel, D. J., & Hartzell, M. (2014). Parenting from the Inside Out : How a Deeper Self-
Understanding can Help you Raise Children who Thrive (10th Anniversary
Edition ed.). (J. P. Penguin, Ed.) New York, NY, U.S.A.: Penguin Group.