Analytical Essay on Family Therapy: Case Study of the Solitano Family

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Introduction

Research has shown that family plays a vital role in a person’s spiritual, emotional, and physical development. However, no family is perfect, and some families will encounter struggles, trauma, and disagreements. The key to having a strong family system is being able to acknowledge the needs of each family member. Family therapy can help families identify needs, changes, and behavior patterns in the family structure. Family therapy is a form of treatment that seeks to reduce discomfort and conflict by improving the system of interactions between family members (Walsh, 2013). Family therapy allows for different members of a family (parents, grandparents, aunts, uncles, cousins, and siblings) to work together to focus on the family system, structure, and patterns of communication (Walsh, 2013). This paper will discuss an overview of two major family theories Bowens Family System theory and Structural Family theory and how these theories can help the Solitano family.

Family Case

Pat Solitano is a thirty-four-year-old and is the son of Mr. and Mrs. Solitano. Pat was diagnosed with bipolar disorder, and the illness was triggered by his wife’s affair. Pat was admitted to a psychiatric hospital for eight months after assaulting his wife’s lover. The lover, wife, and Pat all worked at the same school as teachers. After being released from a psychiatric hospital Pat moves in with his parents in their home. Pat is mandated to visit a therapist during the week and is required to take medication, which he refuses to take. Throughout the therapy session and day-to-day life Pat is learning more about his diagnosis, triggers, and how both impact his daily functioning. Pat is infatuated with the idea that he will get back together with his wife, who has ordered a restraining order against him. Pat expressed that he enjoys going for long runs around his neighborhood for exercise and to “clear his mind”.

Mr. Solitano, Pat’s father is a Philadelphia Eagles fan and behaviors show symptoms of obsessive-compulsive disorder. He has rituals and many outbursts when watching the game; in addition, he is superstitious and has a gambling problem. Mr. Solitano recently was laid off from his job at the post office and is working to start his own company. Mr. Solitano has a quick temper and often blames others for his actions. Mr. Solitano will like to spend more quality time with his son Pat and strengthen their relationship. Mrs. Solitano, Pat’s mother is a recently retired store clerk. She is dedicated and loyal to her family specifically about Pat’s well-being. She constantly expresses her concern about her husband’s gambling problem.

The Solitano family is experiencing multiple challenges that are placing a strain on the family system. Since moving to his parent’s house Pat had an episode one night that results in him knocking down his mother and his father violently hitting him. The scene is loud and extremely intense, this altercation wakes up the neighborhood and the police are called. During the movie, Pat has constant flashbacks of beating up his wife’s lover after catching them in the shower together. Pat has been through a traumatizing experience, which affects his current relationship with his parents. There has been multiple occasions during the night where the parents were both asleep and Pat has woken them up to ask questions concerning his marriage (i.e. looking for his wedding video). The family’s sleep cycle is constantly interrupted because of Pat’s episodes, which may be a result of Pat not taking his medication. The family is also facing financial hardships since Mr. Solitano was laid off, Pat is not able to work in the school system again and Mrs. Solitano is retired.

After observing the dynamics and structure of the Solitano family they would benefit from family therapy. Attending family therapy sessions can help address individual member behaviors and form techniques to improve interactions between the family systems. The two theories that will be used are Bowen’s Family System Theory and Structural Family Theory.

Bowens Family System Theory

Murray Bowen is acknowledged as the founder of the Family System Theory. The Family System Theory emphasizes individuality and togetherness. As humans it’s important to have family interactions, however, it is crucial that we are able to learn and practice independence. Family systems also highlight how familial relationships influence different relationships an individual has in adulthood (Walsh, 2013). According to this theory the more success a person has in individualizing their emotions from their families, the more successful they are in non-familial relationships.

Bowen’s interest in the family started in the 1940s when he worked at the Menninger Clinic as a psychiatrist focusing on schizophrenia. While working at this clinic Bowen was captivated by the emotional relationships between patients and their mothers. After looking at many maternal interactions he also focused on how humans react emotionally in other relationships between family members. In 1954 Bowen relocated to the National Institute of Mental Health (NIMH) where he focused on entire families that contained a schizophrenic family member (Bowen).

After this project ended in 1959, Bowen moved to Georgetown University where he began working with families who did not have severe challenges. However, Bowen discovered that no matter what challenges families face if they shadow the following models this would mend family relationships and cause stronger relationships within the family system. Bowen’s major concepts are differentiation of self, triangles, multigenerational emotional processes, emotional cutoff, and societal emotional processes (Walsh, 2013).

Structural Family Therapy

Salvador Minuchin created Structural Family Therapy in the 1960s, which has become a prominent intervention in family therapy. This theory focuses on family structure and how family members interact with one another. This theory does not focus on the emotional dynamics of family members, however, it focuses on the configuration of the family. Salvador Minuchin was born in Argentina in the 1920s and become a pediatric physician (Walsh, 2013). He eventually relocated to the United States where he studied child psychiatry with a family theorist by the name of Nathan Ackerman. In the late 1950s Minuchin moved to New York and became a psychiatrist at the Wiltwyck for Boys, he had the opportunity to work with boys and people of color (McAdams et al., 2019).

Many of the boys had behavioral challenges, criminal records, and emotional problems. Minuchin worked to find effective interventions for these boys to decrease negative behaviors and teach tem coping skills. After much research, Minuchin noticed that using family interventions were most effective and provided positive outcomes for the boys at Wiltwyck (McAdams et al.,2019). Minuchin was able to use family interventions for any family problem especially relating to the boys. Over the years Minuchin worked with children and families from low-class urban areas.

Structural Family therapy has multiple concepts: executive authority, subsystems, boundaries, rules roles, alliances, triangles, flexibility, and communication. For this theory, it is important to have someone adopt the position of decision-making (Walsh, 2013). The structural theory emphasizes the importance of every family member exercising decision-making power at some point. During the assessment, the social worker should acknowledge who has power in the family dynamics and who does the decision-making for the family. In many cases, power shifts depending on the situation for example if a family consists of a mother, father, son, and daughter, sometimes the father is in power, and other times the mother is given power.

Subsystems are any family that is comprised of two or more people. Some examples of subsystems are “parents, adult members, nuclear-versus, extended-family members, siblings, and some adult/child alliances (McAdams el al.,2019).” Boundaries are internal and external. Internal boundaries are the barriers that regulate the number of interactions the family is expected to have with one another. “For example in some families each family member is allowed to have their own room, while in other families, it is desired that members share rooms (McAdams el al., 2019).” External boundaries refer to a parting of the family but outside systems such as other family members and different communities. Most families believe the motto “what happens in this house stays in this house” they prefer to keep their internal business (finances, struggles, and health) private from people outside the immediate family (Walsh,2013).

Rules are ways family members are expected to conduct themselves and adhere to their responsibilities within the family system. This can be difficult for certain family members depending on their age, maturity, and development. Rules may pertain to household chores, academics, respect, and finances. Every family is different when communicating rules some families articulate their expectations while some may follow just follow rules through custom (McAdams el al., 2019). For a successful family, environmental rules should be clear and understood by everyone in the household. Roles are important in a family system and structure (Walsh, 2013). Each member plays a vital role and all these roles help manage the day-to-day operations of the household. Examples of roles are (breadwinner, money manager, and housekeeper). Circumstances may occur in each family such as divorce, job, illness, death, moving can all cause roles to change.

Alliances are when two family members or subsystems cooperate together. These collaborations provide a positive atmosphere for the family structure. Triangles represent alliance when two family members turn to a third family member for relief when in a conflict with each other. For example, if two siblings get in an argument with one another they will blame their youngest siblings for their problem (McAdams el al.,2019). Flexibility is when a family needs to make alterations to their structure and roles based off changes in their members’ lives. Changes may include different life stages, birth, death, injury, and illness. Lastly, Verbal and nonverbal communication is essential when developing a positive family structure.

Compare and Contrast

Family System Theory and Structural Family Theory have similarities and differences. Both theories are used to promote change in family dynamics and structure. Family systems and Structural theory both work with families to increase communication and coping skills, identify behavioral patterns and overall create a positive home environment (Crago, 2005). Each theory teaches therapists and social workers to meet the family where they are, use the strength perspective, emphasize communication and establish rapport with families. The differences between the two theories are Family Systems focus on genograms, questioning, the concept of differentiation, and interdependent individuals (Crago, 2005). The structural theory focuses on restructuring family roles and adapting to these new changes.

Interventions for Family Case

When working with the Solitano family the social worker has to make sure they set the tone for the client/ professional relationship. During the first session, the social worker has to make sure they create a safe and comfortable environment that will make interventions possible to occur. In the early stages of the intervention process, the social worker has to make sure that the family is interacting with one another and motivated and willing to change (Klever 2009).

When finding interventions to help the Solitano family it would be helpful to use a genogram. The Family emotional theory uses genograms as a tool to gather information about the family and assist the social worker to find appropriate interventions to help this family. A genogram is a pictorial diagram that has the ability to display two or more generational information (Klever, 2009). By having the Solitano family create a genogram it will give them a visual map of their family’s structure history, mental health background, past conflicts, interpersonal relationships, roles, and patterns of communication. Pat is diagnosed with bipolar disorder; Mr. Solitano shows symptoms of obsessive-compulsive disorder completing a genogram can also gather information of the family’s mental health history.

Detriangulation would be a suitable intervention for the Solitano family (Walsh, 2013). When Mr. Solitano wishes to spend time with Pat but is unable to he begins complaining to his wife and his temper quickly rises. Instead of Mr. Solitano communicating to Pat regarding his frustrations about spending quality time together, he takes his angry and frustrations out on Mrs. Solitano.

Increasing Insight- The social worker will facilitate reflective conversations with the family to help the family acknowledge their behaviors with one another. There are two techniques that support Insight, person-situation reflection and developmental reflection. Person-situation focuses on the family’s current behaviors and developmental reflection focuses on the history of family behaviors (Walsh, 2013). These techniques will help family members evaluate their feelings and attitudes, understand each other, and help identify the root of their behaviors and way that can decrease these behaviors. By the Solitanos using developmental reflection, the social worker has the responsibility to use comments, questions, and accounts of the past to explore patterns in family behaviors. The social worker has to make sure that every member is using “I” statements when explaining and identifying their past experiences and behaviors (Walsh, 2013). This technique will eliminate members from blaming one another and will prevent other members being defensive, building walls to protect themselves, and shutting down.

Structural Family therapy interventions would be helpful for the Solitano household, this type of therapy focuses on behavioral changes within each member of the family. When working with the Solitano family the social worker must remember the necessary steps for intervention (Radohl, 2011). The first step according to Structural therapy is acknowledging the family’s strengths. The Solitano has many strengths which include the parents being supportive of Pat seeking therapy, each family member is able to express there feelings thoughts, and emotions and Mr. Solitano will like to build a relationship with Pat. The second step is relabeling, this process helps the family create a new perspective of their problems and where they stem from. Many might say that Mrs. Solitano is a pushover, but her behaviors might stem from her not wanting the family to separate.

Another technique is problem tracking, this requires the Solitano family to track their behaviors at home so they can identify each other, trigger, behavior patterns, and develop problem-solving skills (Radohl, 2011). The fourth technique is teaching stress management, learning this skill can increase self-control in members of the family. Pat would benefit greatly from this because when he feels stressed and overwhelmed he reacts rather than respond to situations. For example, Pat was kicked out of a tailgate for getting into a physical altercation. Mr. Solitano often gets frustrated and gets into verbal alternations with Pat; Mrs. Solitano is usually the mediator in the household and works to resolve family conflicts. I would say that Mrs. Solitano is the “glue” of the family. She keeps the family together, however working on stress management skills can help decrease verbal altercations within the household.

When observing the family’s behaviors he has become evident that Pat’s parents are awareness of Pat’s diagnosis, however, they have limited knowledge of the bipolar disorder. At some when Pat has episodes or mood changes, his parents are unsure how to provide proper care for Pat. During a few sessions, the family would benefit from psychoeducational lessons on bipolar disorder. The goal is to educate the family on the symptoms and behaviors of Pat’s diagnosis. Hopefully educating the parents will decrease arguments in the household because they are knowledgeable about bipolar disorder and are able to support Pat’s behaviors.

Lastly, communication skills training would be helpful for the Solitano family. The social worker can help the family come up with methods to begin clear speaking and listening skills. Currently, this family screams a lot at one another and walks away, instead of actively communicating. The social worker can teach the family how it is important now to interrupt one another when speaking, the power of nonverbal behaviors, and asking questions if someone does not understand something.

Limitations

Both interventions are used by many social workers and continue to evolve through ongoing practice and knowledge. Bowens Family System Theory is a well-known family therapy that stresses the importance of individual family members’ strengths and behaviors contributing to family dynamics. Even though this is legendary therapy when viewing numerous scholarly articles concerning Family System Theory there is a limited number of empirical evidence to support this approach.

Structural Family Therapy has shown to be an effective treatment. Structural Family therapy has many strengths, however, this theory has some limitations that affect social work practice. This theory can discourage and disempower families the social worker or therapist has certain responsibilities that can be seen as controlling. When the social worker controls the treatment process this can cause the family to be unmotivated.

References

Crago, H. (2005). Clinical Applications of Bowen Family Systems Theory. Australian & New Zealand Journal of Family Therapy, 26(2), 116. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=20472800&site=ehost-live
Klever, P. (2009). The Primary Triangle and Variation in Nuclear Family Functioning. Contemporary Family Therapy: An International Journal, 31(2), 140–159. https://doi.org/10.1007/s10591-008-9082-2
Merritts, A. (2016). A Review of Family Therapy in Residential Settings. Contemporary Family Therapy: An International Journal, 38(1), 75–85. https://doi.org/10.1007/s10591-016-9378-6
McAdams, C., Avadhanam, R., Foster, V., Harris, P., Javaheri, A., Kim, S., … Williams, A. (2016). The Viability of Structural Family Therapy in the Twenty-first Century: An Analysis of Key Indicators. Contemporary Family Therapy: An International Journal, 38(3), 255–261. https://doi.org/10.1007/s10591-016-9383-9
Radohl, T. (2011). Incorporating family into the formula: family-directed structural therapy for children with serious emotional disturbance. Child & Family Social Work, 16(2), 127–137. https://doi.org/10.1111/j.1365-2206.2010.00720.x
Walsh, J. (2013). Theories for Direct Social Work Practice.

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