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Typically, substance abuse is viewed as an individual problem, and the addicted family member is treated apart from the family system. However, through the readings in this unit, you have learned to understand substance abuse as a family issue.
Discuss your clinical impression of how substance abuse can be viewed as a coping mechanism and as an indication of an underlying family issue. Be sure to include your understanding of how addiction impacts the family as a system.
Substance Abuse Case Study
Alan is a 66-year-old male who is retired for the last two years after working as a physician. He has been married to Abby for 42 years. They have a daughter, Lisa, who is 35. Lisa has contacted you for family therapy. She has noticed that Alan’s alcohol consumption has increased since he retired. He usually has his first drink around 11 a.m., when he is done running his errands and going to the gym.
Abby and Alan have had less and less to talk about as time has gone on. Abby prefers not to talk to Alan when he is drinking. Alan prefers not to talk to Abby, either, because he feels that every time they do talk she is being critical of him. She tells him that he is drinking too much and does not want to do anything but go to the gym, run errands, and come home to drink. Abby feels that they both retired to travel together, take dance lessons, take courses at the local university, and do all types of different activities with each other. Abby believes their retirement is not how it was supposed to be.
Using the model you chose for your final paper, address the following:
- How would you engage with this family in treatment according to the model?
- What is the role of the therapist according to your model?
- What relational issues might be occurring to cause stress within the family system?
Family Therapy Within the Context of Violence
Statistics show that much of family violence goes unreported. Family violence can occur in many forms, including physical, verbal, and emotional acts. And all of them should be assessed. It is essential for marriage and family therapists and all mental health counselors to understand the context of family violence, including how to recognize and assess it, and how to support families through effective treatment interventions.
Angela and Andy have been married for five years. Angela is 30 years old, and Andy is 33. Angela is a lawyer, and Andy is an accountant. They live in a small Southern city and are expecting their first child in five months. They live about 3 miles from Angela’s parents and 5 miles from Andy’s parents. Angela is an only child and has always been close to her parents.
Angela’s mother was a stay-at-home mom, and her father was a lawyer in one of the big firms in the area. Angela currently works in the same firm as her father. Andy is the youngest of three children and was close to his mother. His mother was a stay-at-home mom, and his father owned the local car dealership. The family struggled financially through the years, depending on how well the dealership was performing.
Angela and Andy met in graduate school and married when they both completed their graduate degrees. Both would agree that they had an exciting courtship. They recall romantic dates planned by Andy and exciting travel adventures. They decided to begin a family after marrying and starting their careers.
Recently, Andy lost his job and has been drinking more than he used to. Angela has been working more hours to make up for the loss of income, and she does not want to be home, because Andy has not been nice to be around.
One night, she came home and found Andy very angry. As she walked in the door, he yelled, “Where have you been?!” When Angela explained that she was at work, like she has been all the other nights, Andy continued to yell at Angela, questioning why she was later than usual. Andy’s anger scared Angela, and she wanted to resolve the conflict as quickly as possible. She apologized multiple times for being late. Andy stormed out of the house and did not come back until later that night. When he came back, Angela was in the bedroom reading. Andy was apologetic, saying, “I don’t know why I got so angry. It just has been hard being unemployed for two months, and we have a baby on the way.” Angela told Andy that she understood and agreed it has been hard but said she is working hard to make up for the missing income. Andy promised to work on his temper, and Angela said that she will call if she will be late.
A month later, Andy still is unemployed and became angry again when Angela forgot to call and came home late. When Angela walked in the front door, Andy began to yell, and Angela yelled right back at him. Andy then pushed Angela, knocking her backward into the table and onto the floor. Angela was stunned and hurt. Her hip was bruised, and she thought that her finger might have been broken. Angela got up off the floor and quietly told Andy that she needed a doctor to check on her and the baby. Andy was alarmed and drove her to the hospital, apologizing the whole way. Andy repeatedly told Angela that he loves her and suggested that they tell the doctor she fell down. Angela was embarrassed about the situation, so she agreed.
The next day at work, Angela called your office to make an appointment for her and Andy, telling you about the incident.
Based on what you have read in the assigned readings for this unit, discuss how you would work with the client family experiencing this case of family violence. Address each of the following:
- How would you approach this family?
- How would you join and engage all members of the family system?
- What model of the therapy would you use when working with this family?
- Based on your model, what type of interventions would you develop?
- What are your legal and ethical responsibilities as a marriage and family therapist or a mental health counselor?
- What would be some cultural factors for this family system that the therapist/counselor might consider?
- Reflect on how you think you would feel and what assumptions you might be making when you walk into the first session with this family.