Conceptualization
The roles that each person plays within their family context is defined by a plethora of factors ranging from their upbringing to culture specifics to mental health problems that may be present in the family in question, and many other issues. However, despite the fact that there is an array of permutations that are acceptable and can be seen as healthy relationships, some shifts in the core of the family dynamics causes dire outcomes. Therefore, it is important to identify what counts as a norm in order to locate problematic aspects of some of the relationships within a family and between its members.
Normal Family
As a rule, in a regular family, the relationship dynamics between parents and their children implies that parents take the leading role until their children get old enough to enter the adult life and make their own choices. Afterward, the support between parents and children becomes mutual, leading to balanced relationships. However, in the case under analysis, the elder sister, Mary Gonzales, has undertaken the role of an actual parent to her sister.
Development
In the case under analysis, Mary’s tendency to view every problem that her family members face as her personal responsibility has led to the creation of a problem that may potentially lead to a mental health disorder (Carlson, 2017). Namely, Mary’s conviction that she is responsible for her sister and has to accept the role of a parent instead of their actual parents, coupled with the fact that the sister has been showing significant distress with her behavior, indicates that the current situation needs to be changed with the help of the Cognitive Behavioral Therapy approach.
Behavior Disorders
Mary presently shows the signs of the OCD since she appears to be incapable of refusing the responsibilities that have been forced upon her.
Conditions for Change
For the change to be successful, it is necessary that Mary should recognize the problematic situation in which she currently is. Moreover, it will be necessary to involve the parents and help them to recognize their problematic attitude of detachment. Finally, Gladys will have to change her behavior so that she could develop a healthier attitude toward socializing.
Stages of Treatment
Applying the Cognitive Behavioral Therapy (CBT) will help to improve the situation that Mary and her family are facing presently. Specifically, both Mary and her family members will have to recognize the harmful impact of the current behavior to which they succumb. For instance, Mary needs to accept the fact that she is not responsible for the choices that her family members do and, therefore, should not reproach herself for the failure to address Gladys’ behavior issues (Carlson, 2017). Once the specified assumption is accepted, it will help to relieve most of the strain under which Mary currently is due to the perceived need to control the behavior of her younger sister.
From the perspective of the theory mentioned above, the stages of treatment will have to include the involvement of the patient, the assessment of the situation, the development of an understanding of it, the acceptance of change, and the learning of new behaviors. The specified change will help not only the patient but also her family members, introducing them to the idea of personal responsibility and helping them to handle new roles that they will need to learn.
Goals for Therapy
Short-term Goal
Presently, addressing the issue of emotional pressure that has been put on Mary should be seen as the main priority. Moreover, engaging parents in the process of managing Gladys’ behavior will be a critical short-term goal since the specified issue currently generates most problems within the family. While exploring the core factors driving Gladys’ rebellion against her family members will require much more time, the foundation for the specified change will have to be laid now. Finally, it will be necessary to build awareness about the need for change and increase the family’s preparedness toward it (Carlson, 2017). The current behaviors that each of the participants adopts are quite misbalanced and unhealthy, leading to the breach of connection and, ultimately, trust between Gladys and her parents, as well as the increased psychological pressure on Mary.
Long-term Goal
In the list of long-term goals, the development of and adjustment to new roles within the family will have to be considered one of the main priorities. In addition, behavior modifications will have to be seen as long-term changes since both Mary and her family are unlikely to accept then newly proposed models of interactions naturally and, therefore, will feel the urge to return to the traditional behaviors. Finally, helping the parents to build the rapport with Gladys and earning her trust as parent figures will be needed (Carlson, 2017). Since Gladys currently states that Mary is the only person who understands her, it is crucial to ensure that Gladys and her parents manage to rebuild their relationships based on understanding.
The latter goal will also require reframing the current situation and helping the participants to set their priorities in order. Mary’s ovarian cancer and the burden of responsibilities that she has to face needs to be viewed as the major tragedy with which the family will need to cope. Namely, the parents and Gladys will need to extend their support to Mary. Afterward, the issue of culture as the main stumbling block in rebuilding the relationships between Gladys and her parents will have to be addressed (Carlson, 2017). Specifically, an intervention during which Gladys will explain her fears and concerns regarding the inability to culturally fit into the new environment, whereas her parents will provide their perspective and explain their concern with Mary’s health, will be needed. Finally, each of the participants will have to be introduced to new behaviors that will allow them to build healthier relationships and improve the current situation.
Optionally, Mary might consider moving with her husband away from her family once the parents regain the trust of and authority over Gladys. Despite the high probability of improvement in the current relationships between Mary and her parents, it is important to reduce the threat of a relapse, where Mary will feel obliged to continue to take care of her sister, and her parents resume their hapless attitude toward their children. However, since the decision to move will also demand financial resources, it may be delayed for a while. Thus, establishing healthy boundaries and shaping the current relationships by reassigning roles and responsibilities to each member accordingly should become the main priority.
Therapeutic Techniques
When approaching the case in question from a CBT perspective, one will realize that the roles that each person plays in Mary’s family have been skewed slightly, thus leading to the loss of responsibility by the parents and the younger sister and the creation of additional strain placed on Mary in return. Therefore, to familiarize the participants with alternative behavior models and encourage them to accept the problem, one may need to consider cognitive restructuring combined with role playing. Whereas the former will help Mary and her family members to recognize the problematic effects to which the current distribution of responsibilities leads, the latter will help to foster the acquisition of appropriate roles.
The issue of culture clash within the family, as well as between Mary’s family and the local community, also has to be addressed. Namely, it will be needed for Gladys to recognize that she has more agency in building relationships with her peers by starting a conversation that will allow them to explore each other’s cultural differences. Thus, instead of rejecting her culture for the sake of the local one, Gladys will learn to appreciate both and provide her peers with an opportunity to gain the same insight as well (Carlson, 2017). Overall, it is currently critical to ensure that the family members communicate their concerns and problems, being completely honest with each other.
Referral
The patient is currently experiencing a severe threat of developing a mental health disorder due to the presence of multiple family issues and the increase in emotional pressure. Since the family roles have been reversed, with Mary having to accept the one of a caretaker of her younger sister, Mary has been exposed to vast emotional distress. Therefore, it is highly recommended to start CBT sessions aimed at helping Mary to realign her priorities and shape her role in the family to reduce the amount of pressure that she experiences.
In addition, it is necessary to convince the patient that her personal health concerns currently represent the issue of the highest priority. Since she is facing fatal ovarian cancer, it is needed to help her adjust her life so that she could be prepared toward the challenges of palliative care. Additionally, it is advisable that family therapy should be included in the list of CBT strategies to be adopted in this case. Thus, Mary will be able to reconcile with the challenges that she is currently facing and accept the fact that she has the right to refuse the responsibilities and roles foisted upon her without her consent.
Analysis
Developmental Context
Viewing the case form a developmental standpoint will help to realize that the patient has gained the agency that she needs to become a responsible adult. However, given that she is currently in the seventh stage of psychosocial development according to Eriksson, she is likely to prioritize nurturing, which can be seen in her attempts at keeping control over the family and especially her sister with delinquent tendencies (Niiyama, Kontkanen, Paavilainen, & Kamibeppu, 2018).
Cultural Context
Approaching the issue form the cultural context, one will notice that Mary has distanced herself form her family a lot since she has made a successful attempt at integrating into the local community. For instance, the fact that she married a local man of a Scottish descent and started a career of an interpreted points to her willingness to incorporate the experiences of both cultures.
Sociocultural Context
In the sociocultural context, the issues that the family has been experiencing with the adjustment to the local culture can be seen as a major factor playing a huge role in the development of the younger daughter’s health concerns. Namely, the fact that Gladys, the younger daughter, has been experiencing hardships adjusting to the new setting and is highly embarrassed by her family’s origins indicates that the family has been suffering from the challenges of acculturation.
Critical Interpretation
Accessing the case from a critical perspective, one will have to utilize the theory of CBT. Namely, the vignette in question represents a case of several problems being closely intertwined and triggering each other. Specifically, Mary’s need to control her family’s well-being leads to her developing mental health issues, including a rise in stress and the probability of depression, as well as possible OCD. In turn, her tendency to ignore her own needs and assume the role of a parent to her sister causes the parents to step down and take the role for observers instead of active participants of the relationships within the family (Carlson, 2017). The parents’ unwillingness to move away from the status quo and change their life, including the adjustment to a new cultural environment, causes severe distress in their younger daughter Gladys, which leads to her displaying deviant behaviors.
Reference
Carlson, M. (2017). CBT for psychological well-being in cancer: A skills training manual integrating DBT, ACT, behavioral activation and motivational interviewing. John Wiley & Sons.
Niiyama, H., Kontkanen, I., Paavilainen, E., & Kamibeppu, K. (2018). A comparison of personality maturity among Japanese youth and Finnish young adult students: A cross-sectional study using Erikson psychosocial stage inventory and sense of coherence scale. International Journal of Adolescence and Youth, 23(4), 482-495.