2024Scenario

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Feb 20, 2024

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Case Scenario Slide 2 : Troubled Marriage Olivia is a 35-year-old Hispanic female married to her husband Josh, and together, they have three biracial children ages nine, six, and five. Josh and Olivia have been married for 12 years and enjoyed their time as a married couple before having children. Once the children were born, Olivia and Josh would plan family trips and vacations almost yearly. Their marriage shifted after their last child was born, leading Olivia to feel isolated, frustrated, and stressed. On the outside, they appeared to be a happy family, but when in the comfort of their own home, frequent fights would break out about Josh’s impulsive behavior, sleepless nights due to video games, and agitation. As a response, the oldest son chose to distance himself by staying in his room, the middle daughter felt lonely and scared, and the youngest started to wet the bed. All these changes felt and appeared to be sudden for Olivia and Josh. Josh recently turned 37 and struggled with not being able to fully enjoy his life without being medicated. During Josh’s adolescent years, he was diagnosed with anxiety and bipolar, leading to a lifetime of medications. Josh believed that Olivia would not understand his reasoning if he conveyed how he felt to her. This thought stemmed from feeling different and less of a man because Olivia would make racial remarks about mental health being a white person’s problem. Since stopping his medication, Josh’s anxiety has been out of control; he is experiencing moments of high energy and disengagement. A few months ago, Josh and Olivia’s oldest son introduced this new world of video games to Josh, which later distracted internal and external noise, worry, and doubt. Frustrated with Josh, Olivia gave him an ultimatum between their family or video games. With the fear of losing his family, Josh said he would change ways to help be a better spouse and father. Though this seemed promising, the change was temporary. Soon after, the family was back to their everyday habits. Disappointed, Olivia took their children and left to stay with her parents, which set Josh into a spiral until he was able to confess to Olivia why he had suddenly had behavioral changes. With this new information, Olivia agreed to come back and work on their marriage if they attended marriage counseling, and he went back on medication. Josh also agreed to the terms and asked to explore other options outside of medication. With both in agreement, working on and towards a healthy marriage, both Olivia and Josh were able to rekindle their marriage. Slide 3 modernism and postmodernism Modernism: Modernism is the idea that if we look hard enough, there is one answer (Glass, 2019). Postmodernism: Postmodernism has evolved into an understanding of different perspectives and constructions. Many current theorists define postmodernism in a variety of ways, yet each definition highlights that all humans have a different set of lenses with which they view the world (Glass, 2019).

Note: When analyzing and looking at Josh and Olivia’s marriage through modernism, the problem would be explored and identified as:  Josh almost lost his family because he invested his time in video games instead of his wife and children.  Another answer would be that Josh failed to communicate with Olivia about stopping his medication, and as a result, it almost cost him his family. Postmodernism, on the other hand, would analyze and interpret Josh and Olivia’s troubled marriage differently by looking at both Josh and Olivia’s reality from different perspectives:  Josh stated he didn't have time, yet he made time for games, making Olivia's isolation a reality as she believed he poured himself into video games, shutting her out.  Josh felt that Olivia judged him because of her remarks and body language toward his mental health and interpreted this judgment from past individuals’ behaviors, which is why he did not communicate his thoughts or decisions.  From Olivia’s worldview, changing was impossible because Josh had returned to old habits, so separating seemed logical. Slide 4 overall definition of social constructionism and include a specific example Social Constructionism Social constructionism as a theory, suggests that what we consider to be true and real is largely shaped by the complex interactions of social groups (Postanowicz,2019). Note: Josh decided to stop his medication to enjoy his life; this was perceived from social interactions. He believed he did not fully experience the joy as his family did due to medication. When regaining his family back, Josh wanted to take a different path in his mental health outside of medication. According to Swords & Houston (2021), social constructionism in views of recovery for mental illness is an individual, subjective experience; one person’s view may look different from another in the path they choose for recovery, which is based on the individual’s distinguished truth in belief and knowledge. To Josh, stopping medication and exploring alternative options means he is in control of himself; for Olivia, it can mean a rollercoaster for behavioral changes, and the children can view it as dad and mom are back together, so we are a family again. Swords, C., & Houston, S. (2021). Using social constructionism to research the recovery movement in mental health in Ireland: A critical reflection on meta-theory shaping the inquiry. Irish Journal of Applied Social Studies , 21 (1), 52–72. Slide 5 : Systems theory and how it is related to your vignette. Systems Theory: The process of looking at family through a systemic lens; also known as, general systems theory, or family systems theory (Glass, 2017). Note: Systems theory relates to Josh and Olivia by looking at how they interact and affect one another in their system to sustain balance. For example, Olivia and Josh have frequent fights about issues; Olivia then feels isolated, frustrated, and stressed, reverting to being silent to keep

the peace. Josh, feeling constantly attacked, reverts to video games to help manage his anxiety and bipolar, and the children play their role by staying in their rooms, being out of the way in fear worse can happen, and physical response by frequent bed wetting. The balance is that everyone is walking on eggshells to avoid a fight. Slide 6 : four examples of systemic concepts The first systemic concept is homeostasis: Josh, Olivia, and the children’s homeostasis is constantly treading carefully. For example, Josh and Olivia try their best to communicate and resolve their issues after their middle child expresses her fear of the constant fighting. The family slowly comes together and interacts until Olivia asks Josh to clean up after himself; Josh feels attacked, and they both begin to argue again. Everyone slowly returns to treading carefully, and the system has returned to it homeostasis. The second systemic concept that applies is a closed system; from the outside, the family appears to be healthy and functioning, but Josh and Olivia never discuss their issues with anyone else, and the children know not to speak about their problems at home. The third systemic concept is discontinuous change: Josh's decision not to take his medication brought pronounced change when his mental health took effect and caused impulsive behavior, causing instant change in those around him and homeostasis. The fourth systemic concept is positive feedback: Olivia finally having enough and leaving with the children caused Josh to see his reality without his family. Josh's agreement to marriage counseling and Olivia's agreement to Josh seeking help outside medication brought change as they both actively engaged towards a healthy outcome. Slide 7 : Discuss examples of linear causality: A causes B and B does not have any influence of A (Mantova, 2022) Note: According to Mantova (2022), linear causality is the process of one event causing occurrence of another; A causes B and B does not have any influence of A (Mantova,2022) One example of linear causality is Olivia says Josh ignores her all day by playing video games, so she stays in the room isolated. The second example is: The second example is when Olivia stops giving the youngest water before bed because he is too lazy and tired to leave and use the restroom. Both examples are linear causality and represent A causes B; Josh ignores Olivia for video games, so she isolates. Olivia says the youngest is too tired and lazy to use the restroom and takes away late-night drinks. Mantova, K. S. (2022). Theoretic overview of circular questions in family and systemic therapy. Knowledge: International Journal , 54 (1), 187–191. Slide 8 : Discuss examples of circular causality: circular causality takes into account the many other elements of causation (Glass, 2017) Notes: For example, A is impacted by B and B is impacted by A (Postanowicz,2019). The first example of circular causality is Olivia self-isolates, Josh’s needs are not met, so he stays up late playing video games to calm his agitation and distance himself, Olivia feels ignored and hurt so she detaches.

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Another example is: Olivia puts the children to bed, the youngest drinks a glass of water before falling asleep, Olivia then turns and yells at Josh for not contributing around the house, Josh loses his temper and breaks items around the house, the youngest is scared to use the restroom and tries to hold it causing him to wet the bed. Both examples reveal the other elements that play into causation, illustrating how each person is impacted by each other in the home. Slide 9 : Discuss examples of first-order change Note: A few examples of first-order changes are:  Olivia gave Josh an ultimatum between their family or video games. With the fear of losing his family, Josh said he would change his ways to be a better spouse and father. Though this seemed promising, the change was temporary. Soon after, the family was back to their everyday habits.  Josh and Olivia tried their best to communicate better for the children's sake after they expressed how they felt about the constant fighting and feeling scared. The change between Olivia and Josh was temporary, as they began arguing about their unmet needs. This led Josh back into his world of video games, and Olivia felt isolated and frustrated.  The children begin to cry as a response to Olivia and Josh fighting. The fighting stops as they comfort the children, explaining that everything will be okay. The fighting stopped, but Josh and Olivia began to argue once the children were in their rooms. These examples explain small and immediate changes that were only temporary and focused on the situation instead of focusing on a more lasting, impactful change. Slide 10 : Discuss examples of second-order change Note: Moving on to second order change here are a few examples:  Olivia decided to leave Josh because she could no longer stay in a toxic environment, nor would her children, so she left Josh and stayed with her parents. Olivia told Josh she was not coming, and they could file for a divorce or legally separate.  Josh knew he did not want to lose his family, so he decided to change and started taking his medication, then sought how to handle his mental health with a holistic approach. Once Josh was actively acting out on his changes, he confessed to Olivia that he had stopped his medication, which explained his behavior.  Olivia and Josh never wanted to lose their family, so they both came to an agreement that they would do the work together by joining marriage counseling in all aspects; individual, couples, and family. And they would research holistic approaches for Josh.  From fear of constant fighting to fear of losing their family, the children found themselves engaging in a new environment, finding peace and joy. Each child discovered they no longer needed to distance themselves, felt lonely, or no longer wet the bed. These examples reveal a shift within the family’s hemostasis as they create permanent change for a new healthy environment, their new hemostasis. Slide 11Self -of-the-Theripst Note: When evaluating the therapist's self, it is critical, if not crucial, to understand where you stand in the therapy room and your role. Therapists hold a position of power in their therapy room, meaning they can change or persuade an individual's thought or action and unintentionally

cause damage, create a shift in a system, or plant an idea that was not at the forefront of one's mind. This is why it is essential to learn and understand where blind spots are as a therapist and what internal biases, they may be operating in. A therapist’s beliefs or values can harm the clients receiving therapy, especially when they do not share the same values or beliefs, so a therapist will have to be consciously aware when they are projecting or about to project onto a client. If unaware, a therapist should refrain from giving suggestions or tools on a topic or manner and later discuss it with a colleague or supervisor. As I view this case scenario and take a step back to self-reflect, I discover a few areas where I am biased. As I analyze Josh and Olivia’s marriage, I empathize with Olivia because wearing multiple hats and having no time or energy to care for yourself is common with women. Also, seeing Olivia as the default parent and Josh being a man, he can focus on his needs. My assumption about Josh can easily pass over and forget that other factors also come into the picture, with mental health being one of the main focuses. Placing a victim label on Olivia and the children and accusing Josh of a reason for the toxic environment based on personal experiences would not benefit anyone. As I consider my assumptions, biases, and blind spots. I see the true importance of therapists constantly self-examining to understand themselves better and going to therapy themselves so they can be their best selves in the therapy room for their clients. As a therapist, remember that the issues are not your own; these life experiences are the clients, not mine. Oral and colleagues (2023) state that it is essential that therapists do not project personal issues into the therapy room, especially when those issues can relate to couples therapy. Therefore, differentiation takes place individually or during the interaction with the couples by self-talk to separate your external reality from that of the couple (Oral et al., 2023) Oral, S., Zeytinoğlu-Saydam, S., Söylemez, Y., Akmehmet-Şekerler, S., & Aponte, H. J. (2023). Developing the person of the therapist when working with couples. Contemporary Family Therapy: An International Journal , 45 (2), 228–241. Slide 12 : Elaborate on future plans Note: In the future, I plan to work on and through myself and take personal inventory, so I do not unintentionally pass on my internal biases to clients. Part of working on self is attending therapy, reading books, journaling, and workshops. Discovering different parts of myself and creating new changes will help shape my way into better thinking so I can be effective in the therapy room. Also, I will expand my knowledge and become more diverse and culturally aware. Being culturally sensitive will not only help my clients become comfortable but also myself. As D’Aniello et al. (2016) explain, people live their cultures differently. Therefore, it’s important for therapist to be sensitive to their client’s experiences to their culture (D’Aniello et al., 2016).

Learning and understanding family systems theory more and more is also part of my plan so I can see what theories and methods align with my therapy techniques and when to apply them best as issues arise. Slide 13: Conclusion Note: In conclusion, the foundation on applying family systems concepts has shown how theories and models can be applied in the therapy room and how important it is to ask questions to get more context on the way a system functions and the roles each part plays in the system to operate as a whole. When presenting the case scenario and diving into each theory, some were easy to point out well, while others took time to see if they applied and, if so, how they applied. The more I studied and interpreted the case scenario, the more I concluded that every individual’s healing journey is not the same, and although we can empathize as therapists, setting self boundaries is essential to prevent personal disclosure. Sometimes, clients come in, and their troubles mirror our own, which can help build a connection. However, setting a firm foundation of therapist and client, not therapist and friend, will be ethical and serve a better purpose in the therapy session.

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References Adamson & Y. Watters (Eds.), An introduction to MFT: Systems theory and foundational D'Aniello, C., Nguyen, H. N., & Piercy, F. P. (2016). Cultural sensitivity as an MFT common factor. The American Journal of Family Therapy , 44 (5), 234-244. Glass, V. (2017). Building blocks to conceptualizing family: A family system's perspective. In D. Mantova, K. S. (2022). Theoretic overview of circular questions in family and systemic therapy. Knowledge: International Journal , 54 (1), 187–191. Models (pp. 43-60) . San Diego, CA: Northcentral University. Oral, S., Zeytinoğlu-Saydam, S., Söylemez, Y., Akmehmet-Şekerler, S., & Aponte, H. J. (2023). Developing the person of the therapist when working with couples. Contemporary Family Therapy: An International Journal , 45 (2), 228–241. Premium-Vector. (n.d.) [cloud shape dialog box with words planning]. Retrieved January 27, 2024, from https://www.freepik.com/premium-vector/big-word-cloud-shape-dialog-box- with-words-planning-process-thinking-about-activities-required-achieve- goal_33449949.htm#page=5&query=future %20plan&position=16&from_view=keyword&track=ais&uuid=6f25ad5a-3ec4-4539- 907c-2ed9eb8f0bea PowerPoint. (n.d.) [couple clipart]. Retrieved January 27, 2024, from PowerPoint

Swords, C., & Houston, S. (2021). Using social constructionism to research the recovery movement in mental health in Ireland: A critical reflection on meta-theory shaping the inquiry. Irish Journal of Applied Social Studies , 21 (1), 52–72. Therapeutic Partners. (n.d.) [animated women thinking with question marks]. Retrieved January 27, 2024 from https://therapeuticpartners.com/blog/

2024Scenario

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