The successful academic study of the conceptual foundations of psychology is not limited to the study of lecture information or attendance at seminars. On the contrary, for a full and thorough mastery of the material under study, it is necessary to engage in the practical implementation of the knowledge and skills acquired, supported by the reflective study. In particular, the theories of family therapy proposed for this semester are among the fundamental areas for the practicing psychologist, and therefore a timely critical analysis of current knowledge is of crucial importance for the student.
Consequently, this research paper’s primary purpose is to present a coherent and detailed medical case study with parallel analysis and author commentary. This paper can be useful both for the author personally, as it brings together disparate knowledge and structures it, and interested students who seek to explore more cases in family therapy.
Clinical Case Study
A Brief Conceptualization of Family Therapy
Among clinical psychology practice areas, family therapy plays a special role since its implementation requires the professional to possess specific interpersonal communication skills, strict adherence to a code of ethics, and recognition of the family as a central structuring environment for the individual. In particular, existing family therapy theories are based on the idea that the family is a complex, dynamic social system within which the mutual influence of the included members takes place (Minuchin, 2018). It is important to note that this theory does not examine individuals personally but measures their family behavior.
Regardless of the model chosen, all conceptual teachings focus on an in-depth study of the family members’ connections, modifications in personality behavior under the influence of family members, and extra-therapeutic exploration of relationship development. Nevertheless, for a thorough clinical case study, it is necessary to concentrate on only one theory that will consider the family from a unique paradigm. For this academic paper, mindfulness-based cognitive therapy, MBCT, has been chosen as the central theory of family therapy.
Description of Family Members
For this critical analysis, a real patient family, represented by six members, was proposed. Within the confidentiality and professional ethics framework, the paper presents people’s false names and does not indicate the center where counseling took place. Briefly, the family included two parents, two adult children, and two young children. The father of the family, John, a fifty-year-old man, has a teacher’s degree but has not worked in the field for twenty years. Instead, his work is based on construction in the countryside, which is in high demand during the seasonal periods: from spring to fall.
Closer to winter, the locals abandon building due to weather conditions, so John finds himself unemployed for almost three months. The father is a hard worker, so he tries to find additional part-time jobs that bring any finances to the large family during these periods. However, John has an alcohol addiction, and then he begins to drink heavily when he is not having success in his job or relationship. His wife, Helen, a fifty-year-old woman, also has a teacher’s degree, but along with her husband, she stopped working in school when she was young, and now, she is an administrator in an urban clinical organization.
It should be noted that the woman comes from a small village near the city, which is probably why her character displays traits relevant to rural residents: frugality, modesty, the desire to create a “proper” social reputation. The latter is one of the mother’s main qualities, so patterns showing a strong dependence on social recognition are relevant to her behavior. In parenthood, father and mother are not strict but support discipline and children’s desire for self-development. Pedagogical education barely shaped their view of parenting, so the basis of children’s childhood was friends, nannies, and siblings.
Children form the majority in the family and are represented by two adult children ages 25 and 23 and two younger children ages 15. The character of the adult children is generally similar: they are hardworking, educated, and reserved. Alice seeks social recognition, submission to overbearing men, and a deep search for self-identity: she pursues poetry and enjoys creativity and travel. The middle child, 23-year-old son Tim, has explorer qualities and regularly shows a desire to explore the nature of elements, structure and comprehend them. Both children graduated with honors, and it is perhaps true to acknowledge that the perfectionist and hero syndrome is true for their characters (González Hernández et al., 2018). When they fail to achieve positive results, whether in school, work, or recognition from other family members, they become frustrated and blame themselves for the breakdown.
Finally, the last family members are the 15-year-old twins, boy, and girl Sam and Ani, who grew up together all their childhood. According to the parents’ and older children’s reports, by now, the twins have gone through three stages of a mutual relationship. In the very beginning, they did many household chores together, went to a dance club, and sat at the same desk at school. Closer to the age of 9-13, Sam and Ani tried to avoid close contact with each other, and being forced to socialize or do activities together made them dislike each other. Now they spend time together again and have a common group of friends. Within the family, the younger children are the center of communication for all other relatives since the interaction between parents and adult children is often tied to the younger.
Conceptualizing Identified Family Problems
A brief discussion of the central principles underlying MBCT deserves preliminary attention. According to its authors, the source of a patient’s pessimistic state is the negative thoughts and assumptions that form the future vision (Schimelpfening, 2020). Depression or substance dependence, for example, can be indicative of a disturbed, non-optimistic individual’s reasoning. Hence, MBCT recognizes the refusal to judge or punish oneself for any thoughts, and the “mindfulness” element of this therapy encourages the patient to think consciously, thoughtfully about their own cognitive processes. The main forms of experimental therapy are meditation, breathing exercises, and moments of mindfulness.
Perhaps one of the central problems of the family is the father’s alcoholism, which is seasonal. During periods when he is not working, it is as if John withdraws from the family and drinks heavy alcoholic beverages like brandy or port every day. In counseling sessions, the rest of the family stated that the father’s condition could be characterized as frightening, aggressive, or unacceptable. Helen also admitted that there had been domestic violence episodes in the family when a drunken John would beat Tim or her. The MBCT paradigm clarifies that the driving force behind the developed alcoholism is the father’s pessimistic attitude during his time away from work (Riemann et al., 2016). Apparently deprived of work, John does not consider himself a full-fledged man capable of providing for a large family and tries to escape the problem.
The man has personally admitted that his addiction problem is a difficult family in which the adult children have grown up and do not give their father the attention and care he needs. In turn, Tim justifies such behavior by his unwillingness to show sympathy to John, who does not want to get rid of the disease. Alice views the problem differently and, as the eldest daughter, tries to help her father. Her attempts have included taking vacations together, moving out of the home, and finding doctors, but John has always returned to alcohol. Since thoughts precede moods, it can be concluded that Alice feels her own guilt towards her father and thus wishes to justify herself. The exact reasons for the possible guilt have not yet been elucidated, and this remains to be found out in the future. Nevertheless, it is appropriate to assume that Alice blames herself for being John’s most beloved daughter, and therefore must help him own.
Another family problem identified is the tension between Helen and the two younger children, Ani and Sam. Since John is no longer a full-fledged father, and his involvement and trust in him have been minimized, the mother has remained the only authority in this unit. As it was found out, the teenagers do not want to put up with Helen’s authority and protest against it in every way, which in turn provokes anger from the mother. In fact, communication between the two parties is reduced to a passive-aggressive one, in which any slip-up of a family member can be seen as a personal failure and a reason for insult. For instance, Helen often scolds the children for not cleaning up, not doing their homework, or taking long walks. The MBCT indicates that there are internal motives guiding the person at the moment (Frostadottir & Dorjee, 2019).
In this sense, Helen’s initially hostile attitude toward her own children may be the result of internal anger that has accumulated over years of an unhappy marriage. The woman likely sees her children as a reflection of their father’s personality traits, and this brings her discomfort and pain. To get rid of them, Helen takes an attacking stance and first blames the children for their failures. On the other hand, the younger children come into open conflict because of internal resentment, lack of parental acceptance, and trust. Ani and Sam cannot adequately perceive Helen as a woman, as a person, and therefore their communication has a negative connotation.
The pattern of relations between adult children and the rest of the family also deserves psychological analysis. As was shown in the consultation, both Alice and Tim suffer from a perfectionist complex, in which they have to perform all the time perfectly. Failure to complete a task, lose, or score poorly leads them to states of severe melancholy and apathy from which it is difficult to escape on their own. Several potential sources of such a problem have been suggested from an MBCT perspective. First, Tim and Alice are older children who must set an example for younger ones. The thought that they might seem like failures — which, moreover, correlates with the maternal character trait — is frightening to them. This leads to a desire to be overproductive, even to the detriment of their own health.
On the other hand, adult children were raised with an emphasis on superiority. Mother and father expected Tim and Alice to get the best grades in school, excel in exams, and enter universities. Although the children met all the demanding parents’ expectations, it did not bring them happiness or enjoyment. Therefore, Alice and Tim are unable to maintain a real, sincere dialogue with Helen and even with each other, constantly reproaching themselves inwardly for their daily mistakes.
Description of Proposed Interventions
Recognizing the tangled interpersonal relationships in the family as a starting point, developing a therapeutic strategy to remove communication barriers and create a supportive full family environment is necessary. First, family members are asked to complete an eight-week course consisting of eight two-hour sessions (Schimelpfening, 2020). During each session, the family will be invited to engage in reflective analysis and openly describe their own feelings when returning to a particular event. Participants are prohibited from making judgments or negative evaluations of anyone’s actions, including themselves. A central part of the MBCT course is breathing exercises and concentrating on the inhale and exhale to clear the mind of extraneous thoughts and deep introspection. Family members will also be offered meditative, participatory practices for self-immersion and sincere, honest discussion.
An illustrative example of such hands-on therapy would be an involved discussion of a particular scenario. As a suggestion, family members will be asked to engage in a collaborative analysis of the episode of domestic violence when a drunken John hit Tim. The therapist will create a comfortable atmosphere with meditative music and appropriate lighting and ask leading questions to make the discussion flow.
Examples of such questions might include the following options: “How did Tim feel the moment his father hit him?”, “What was the reaction of the rest of the family?”, “Why did John do that?” and “What did Helen experience at that moment?” Each family member is expected to express their point of view calmly and not hurt anyone. In addition, as a result of this practice, understatements between family members will be eliminated, and each relative will know the thoughts and experiences of their loved one.
There is no doubt that this family therapy model is an example of a successful, highly effective practice that will bring clarity to confused families. I truly encourage techniques in which each family member is fully involved in therapy, and there is no hierarchy. Thus, in the session described, any barriers should be removed between the overbearing Helen and the subordinate Sam and Ani, and they should become equal partners. Nevertheless, I worry that this technique may at some point cease to be an evidence-based one and acquire the attributes of esoteric healing, which is not welcomed by the academic community. In particular, the session’s trappings, whether it be relaxing music or incense, may give the medical office undesirable traits, which worries me.
Final MBCT Review
Ultimately, MBCT can be seen as a compromise practice that has certain advantages over other theories. In particular, the family’s full involvement, the call for deep self-reflection, and the use of highly spiritual practices are considered positive aspects of family therapy. Nevertheless, it must be recognized that when attempting to involve family members in such methods, the therapist may encounter misunderstanding and derision.
The seeming non-seriousness of such sessions may cause the family to fail and not be completely sincere. Therefore, in deciding to use MBCT as the primary therapy for the family, one must be concerned in advance about creating a medical, evidence-based, yet relaxing environment. As a tool, I would use this model because I recognize its results highly. Nevertheless, I would take the practical implementation with all seriousness and caution.
Frostadottir, A. D., & Dorjee, D. (2019). Effects of mindfulness-based cognitive therapy (MBCT) and compassion-focused therapy (CFT) on symptom change, mindfulness, self-compassion, and rumination in clients with depression, anxiety, and stress. Frontiers in Psychology, 10, 1099-2008. Web.
González Hernández, J., Muñoz-Villena, A. J., & Gómez-López, M. (2018). Stress regulation, physical activity, and perseverance in Spanish teenagers with perfectionist trends. Sustainability, 10(5), 1489-1499. Web.
Minuchin, S. (2018). Families and family therapy. Routledge.
Schimelpfening, N. (2020). What is mindfulness-based cognitive therapy (MBCT)? Verywell Mind. Web.
Riemann, D., Hertenstein, E., & Schramm, E. (2016). Mindfulness-based cognitive therapy for depression. The Lancet, 387, 1-10. Web.