MATEI – WEEK 2 – ASSIGNMENT 2

Treatment Plan Bowenian and Structural Therapy

As stated in the research literature, a treatment plan is the way, methods and strategies in

which the therapist, in collaboration with the client(s) determines how he/she can address the

problems (Gehart & Tuttle, 2003). The treatment plan includes clinical goals, short term and

long-term goals, strategies for continuing care management and relapse prevention plan.

Treatment plans are not set in stone; their components can be modified, changed, added or

removed according to the real situation and development. Target goals are periodically reviewed,

assessed, evaluated and, based on the results, marked as completed or under review, or changed

to fit the client’s needs (Gerhart & Tuttle, 2003).

Based on the theoretical perspective the therapist there are different models of treatment

plans that match the theory from where they derived (Gerhart & Tuttle, 2003, p. 5).In the case

presented on video, we encountered two theories, that while having the same goal, client (

family) wellbeing and strive for better communication, use different angles to approach the

problems at hand.

The vignette presents a triad (mother, father and daughter) who agree to come in therapy

for developing better communication with their daughter (Psychotherapy.net, n.d.). Mother Judy,

Father Adrian and daughter Pam are having a hard time communicating properly and have a

normal functioning life. They stated they have been in counseling for a while and situation did

not improve. The daughter is not listening to simple instructions, is defiant with mother’s

requests, throws temper tantrums and cries a lot. Pam seems to be mostly resilient to mother’s

requests while often suffocating the father with affection. Pam states she does not know why.

Mother, Judy suffers from lack of affection from her daughter and learned to hold in the pain.

Father, Adrian is annoyed with daughter anger and lack of responses and sometimes admits to

MATEI – WEEK 2 – ASSIGNMENT 3

impose his will by yelling and using his prerogatives as a head of the family. Important to note,

all three are willing to work their disagreements out and have a calmer, happier family. Also

important to note that the family has strong bonds with each other, while their daily life depends

on the other individual’s actions.

The same family is presented with two counselors: one is Philip Guerin, MD presenting

the bowenian theory approach and the other is the structural approach presented by Harry

Aponte, LCSW.

Treatment plan for the Bowen Theoretical Approach

The structure of a working plan includes at first establishing goals. In the vignette, the

counselor is asking the father, Adrian about the reason he is there. At the core of the

intergenerational family therapy there I a recognition of the relationship between parents and

child (Gerhart & Tuttle, 2003, p. 151). First goal in treatment is to identify the nature of

relationships, patterns and emotions and evaluating the links with the social environment or

extended family (Gerhart & Tuttle, 2003, p. 157). In this situation, the therapist discovers that

Pam is more attached to the father, ignores and disrespects her mother and relies on friends that

she identifies with extended family members such as a grandmother. The father is annoyed by

the tension between the daughter and the mother and takes action when he feels like his

tranquility is shattered.

The next goal in treatment will be to create a genogram and a family map. In this specific

case, it is difficult to create as genogram since Judy admits that Pam is adopted. There are no

explanations if the family attempted or engaged in relationship with Pamela biological family,

however, through the therapist exploration and information transpires that there has been another

child, male, who committed suicide. The family is reluctant to discuss that subject. The balance

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of the relationship is father and daughter against mother where the father sometimes is the

mediator.

As short-term goals, the therapist should lead the family towards decreasing anxiety.

Since we have found out from the vignette that Pam is responsive to Jessie’s interaction, while

Jessie is treating her like her grandchild, I will suggest the family to explore Jessie’s methods in

how to deal with Pam and make some adjustments. The completion of this goal should have as

result decreasing the feelings of anxiety from Judy, since Pam might be more affectionate and

responsive, Pam’s anxiety might decrease by having a better relationship with her mother and an

extra reliable relationship beside work and Jessie, and Adrian anxiety might decrease by

witnessing a better atmosphere in the house.

Another short term goal I would ask the family to discuss, explore and enact how all

three as a family, might found common grounds to enjoy free time together. For example, Pam

likes to play games on the computer, Adrian might compromise and purchase internet, and since

Pam does not like movies, find some games they can play together as a family on the computer.

If fulfilled, this goal will increase differentiation between the family members and decrease level

of stress.

As a secondary goal, from the perspective of a bowenian family therapy, I will introduce

in treatment questions about extended family. Specific in this family there will be a goal to

define gender role differentiation (for example, Adrian can also help with house chores in order

for the family to enjoy more time together.) Another goal will be later in therapy to attempt to

discuss as a family their roles responsibilities and benefits in the large picture. This will led to

the long term goal: to have a positive relationship between the family members and give Pamela

MATEI – WEEK 2 – ASSIGNMENT 5

the possibility to learn to survive on her own long after her parents pass away. Pamela’s

independence and capacity of adapting will be the main long term goal.

The psychodrama reenacting might be a technique useful to the family in case. It seems

that all three members of the family see through simple examples. As a therapist it might be

useful to use psychodrama to reenact situation in which anxiety can increase, such as washing

dishes, leaving the house unexpected, situation in which Pam will be able to witness Judy’s

feelings and both parents might be able to answer some questions about why their daughter is so

angry. Then, replacing the scene with a more desirable scenario will prepare the family for acting

on their own while home. As a long-term goal, psychodrama might reveal some ideas about the

family of origin. The new ways of relating to each other might led the family to better outcomes

and open multiple avenues for understanding Farmer & Geller, 2005).

Treatment plan for the Structural Theoretical Approach

The structural view of family therapy opened new angles in dealing with family

counseling. Simple at surface but well developed at a second glance, the structural family

therapy has rules and patterns that govern the family function (Gerhart & Tuttle, 2003, p.

23).The main rule that governs is the “relationship rule” that, in the case of the vignette

presented, is a triad with an imbalanced relationship: father daughter on one side, and mother on

the other , in which the father is a hierarchical figure (Gerhart & Tuttle , 2003, p. 27)

In the beginning of the family session, Harry Aponte is asking the mother (as opposed to

Dr Guerin who asked the father) what do they want to accomplish through the session?. “So if

you can tell me what you want to talk about, what you want us to look at, I will look at whatever

you want to look at.” (Psychotherapy.net, n.d.). Interesting, the mother is asking approval from

the father, who grants her permission.

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In order to fulfill goals as a therapist I need first to determine what type of conflict is

characterizing this family: according to Minuchin this is a type of disengaged family who avoids

contact ( Judy does not speak, Pamela leaves the house or avoids eating) in order to avoid

conflict (Gerhart & Tuttle, 2003, p. 28). While treating the family I will “join”, “accommodate”,

and expect reciprocity (Gerhart & Tuttle, 2003).

Short-term goals will be join in and accommodate the family. This goal can be achieved

by validating their feelings, asking extra questions, rephrasing and making sure, they have the

right understanding. In this case I will also offer the same opportunity to all family members to

state their opinion or answer a question. This will create a balanced approached, a non-bias view

and will increase the therapeutic relationship. The goal will be completed when family members

are trusting the suggestion and are willing to “give it a try”.

Another short-term goal will be to create open lines of communication between the

members. For example, since I know it is a disengaged family, I will attempt to bring them

together to state to each other feelings and thoughts that are left unsaid home. In addition, I will

help enhance the emotions of the family members who cannot express themselves clear at this

point in therapy (Pam stated she loves her parents, the therapist shows she is not a “bad child”

but she is sensitive, or shows that Judy loves her daughter not resent her (Psychotherapy.net,

n.d.). I will also encourage them to give hugs to each other. The purpose of these goals will be

to enhance proper communication between members, increase feeling sharing and come to a

common denominator. Finally, this will develop empathy for the other and smooth down the path

to better understanding. Long-term goals will be to develop clear healthy boundaries between the

family members and provide them with strength to empower Pamela towards independence and

responsibility.