Family conflict and negative family interactions are justifications for the use of therapy. An example of a therapy that can address these is strategic family therapy, a cross-cultural intervention designed to address family needs (Szapocznik & Hervis, 2020). Strategic family therapy addresses factors that contribute to family dysfunction and instability, particularly in adolescents with problems with emotional regulation or behavioral issues. The therapy’s focus is to enhance family dynamics that may contribute to unhealthy behaviors among adolescents. It is a short-term type of therapy that requires approximately 12-16 sessions (Santisteban et al., 2003). Strategic family therapy is based on the idea that family unit challenges can encourage adolescents to engage in risky behaviors, such as unsafe sexual practices, substance abuse, and delinquency. Its primary goal is to improve relationships between a family unit to discourage adolescents from the behaviors identified (Szapocznik & Hervis, 2020). The therapy is strategic because it disrupts unhealthy communication and equips family members with the necessary skills to help them develop and sustain healthy communication.
Vignette
Jose is a 45-year-old immigrant parent from Mexico who identifies as cisgender, heterosexual, and with a masculine expression. As an immigrant parent, he could not come with all his three children to the US; he only came with Joshua, a 7-year-old who identifies as cisgender with an androgynous expression and likes girls. His two other children, Daniel and Miguel, remained with their mother, Maria, in Mexico. Daniel is a 24-year-old who identifies as cisgender and heterosexual with masculine expression. Miguel, a 15-year-old, identifies as cisgender and gay with an androgynous expression. Maria, Jose’s wife, is a 42-year-old who identifies as cisgender and heterosexual with a femme expression.
Maria and her two children managed to join Jose in the US after several years. As a family that is now together, various issues have presented themselves. For instance, Jose has expressed guilt about the relationship gap between him and the two older children, as he feels close to Joshua. He is struggling with relating with the older children, who are now teenagers. Due to this, Maria has expressed her frustration with Jose. She demands more from him because she has taken care of the kids while their family was in the US. She is stressed due to the tension between Jose and his older children. They do not understand creating a relationship with their father. Attempts to create the relationship have been futile, with the older children feeling that their father does not understand them. Specifically, Miguel believes that the father does not understand him since he has a different sexual orientation.
Presenting Problem
The family is looking for therapeutic services because of the communication problems between some of the members. For instance, Jose has communication problems with his two older children, Daniel and Miguel. Despite attempts by the two children to initiate conversations with their father, they always stall. According to the two children, they always get “stuck” whenever they communicate with their father. The situation is problematic considering that Miguel believes that Jose “does not get him at all.” Another reason the family is looking for therapeutic services is caregiver stress. Maria feels overwhelmed with taking care of the children, yet she has an able partner who can assist her. She believes that Jose is not doing enough to assist her in taking care of the children, despite her performing the task since he left for the US. The problem is severe, as she states, “I feel more stress.” Another problem within the family setup is conflict around sexual orientation. Miguel believes that his father does not understand him since he came out as gay.
Case Conceptualization
Strategic family therapy is about solving problems and finding solutions (Powell & Fuller, 2021). Therapists play a vital role here because they act as referees and coaches. They do not observe things passively, as they show concern about where and how problems within a family setting started and effective ways to address them. In strategic family therapy, communication is critical because it is used to understand the problem. In this case, communication between the family members is necessary to understand the impact of the problems.
Communication between the therapist and the family members requires building a rapport and a therapeutic alliance (Powell & Fuller, 2021). Through these, the family members will manage to share their perspectives about the presenting problems. In this case, the presenting problems identified include communication issues, caregiver stress, and conflict around sexual orientation. Addressing the problem of communication requires understanding the existence of any triangulation that may be occurring. In this case, there is no triangulation, as the family context does not involve outside parties.
It is vital to encourage engagement in the family to address the communication problems between Jose and the older children. The therapist will improve communication between them by identifying issues that may have been ignored or repressed (Powell & Fuller, 2021). According to Sommers-Flanagan and Sommers-Flanagan (2018), strategic family therapy focuses on the idea that families are struggling because of their inability to adapt to appropriate developmental stages. In this case, the problem of caregiver stress will be understood based on the inability of Jose to adapt to the appropriate developmental stage, which requires him to be more involved in the activities of all the children. The therapist then designs interventions to help Jose learn to be more involved in the family’s current tasks. One of the goals of strategic family therapy is to change how families deal with one another (Powell & Fuller, 2021; Gasior, n.d.). Therefore, the therapist will ensure that they inform the family members about the importance of changing the way they deal with each other. In this case, addressing the conflict around sexual orientation will involve changing how Jose deals with Miguel. Here, the covert change technique will be applied to ensure that more subtle suggestions are provided to Jose regarding how he can change the way he deals with Miguel. Indirect feedback will be necessary to encourage the change.
Contextual, Cultural, and Diversity Factors
Various contextual, cultural, and diversity factors can influence counseling sessions involving families. It is necessary to understand their influence for therapy to be effective (Gasior, n.d.). On cultural factors, it is essential to note that the Mexican culture tasks males with being the head of their families, which allows them to make unilateral decisions. Understanding this is key in addressing the communication issues that are present between Jose and the older children. The communication issues may be due to the cultural setup of Mexican families, which gives parents the authority to make unilateral decisions for their children.
Another cultural factor is the roles that have been assigned to various genders. Males are supposed to perform masculine tasks, while females are expected to perform feminine tasks, as stipulated in Mexican culture. It is essential to consider this in understanding the problem of caregiver stress, whereby the Mexican culture places more responsibility on fathers. Another factor to consider is the social location of the clients. In specific, the social location of Miguel is essential because of his sexual orientation. He identifies as a gay person, which may impact how he relates with other family members. Individual identity is critical in family therapy, as it allows clients to express themselves.
Another factor to consider is the social context. The family members’ social relationships are vital in determining an ideal solution to the problems. Jose relates well with the younger child compared to the two older children. Also, the therapist’s social location is essential (Rosen, Lechtenberg, & Stith, 2014). In this case, I belong to a different culture, race, religion, and country of origin with the family in question. It is essential to understand how these may impact the therapy session.
Clients’ Strengths
Various individual and family strengths can be identified from my interaction with the family members. On family strengths, all the family members are hopeful to have a well-functioning family unit. Determination of family members is crucial in the success of family therapy, which is evident in this family. On individual strengths, the two older children are willing to address the communication issue at hand, as they have attempted to communicate with their father. Willingness to solve a problem is a significant strength in family therapy. The LGBTQ family, which Miguel identifies with, is linked to support to its members. It means that Miguel will likely get the necessary support he requires from the LGBTQ family.
Clients’ Goals and Desired Outcomes
The family members want the therapy to achieve various goals. For instance, Jose wants to relate better with the two older children and avoid preferring the younger one over them. It means that the client wants to get rid of disruptive repetitive interactive sequences, which are linked to conflict. In this case, the sequences denote Jose’s relationship with the children that need to be changed. The two older children want to communicate and relate better with their father, Jose. They desire to interact with him freely, as this has not been the case. In strategic family therapy, this is understood as breaking the repetitive and negative cycle. Maria wants Jose to be more involved in the family by being responsible for the children more than before. It involves reorganizing the family system to a different level of functioning. Miguel wants Jose to understand him, which involves changing the way he deals with him.
Proposed Treatment Plan
First Goal and Interventions
The first goal of therapy is to improve communication between Jose and the two older children. The goal will address the presenting communication breakdown problem between Jose and the two older children by encouraging them to interact and discuss issues openly.
First Intervention
Use of pretend techniques can help address communication problems (McGoldrick & Hardy, 2019). In this case, Jose and the two older children will be asked to pretend to be other parties and communicate openly. By pretending to be others, communication between them will be different from usual.
Second Intervention
Hypothesizing will help in addressing the communication problem between Jose and the two older children. They will be asked to consider what would happen if they were not there for each other. It will help them realize the significant role that they play to encourage them to communicate with one another.
Third Intervention
Neutrality will also help address the communication problem between the family members. It will be essential to avoid being judgmental and asking the involved parties to focus on the future, as they all need each other.
Second Goals and Interventions
The second goal of therapy is to reorganize the family system to a different level of functioning. It will involve reorganizing the family set up to provide each family member with specific responsibilities to undertake.
First Intervention
Positive connotation will help in reorganizing the family system to a different level of functioning. It will involve altering the views of Jose and Maria regarding their expected roles in the family so that they do not conform to cultural contexts.
Second Intervention
The covert change will encourage desired behaviors within the family setup (Carr, 2019). In this case, behaviors associated with better family relations will be praised, while those that suppress the relations will be ignored.
Third Intervention
Directives will be used to reorganize the family system. In this case, it will be necessary to direct Jose to assume specific familial responsibilities to reduce the burden on Maria.
Third Goals and Interventions
The third goal of therapy is to change the ways Jose deals with Miguel. Addressing the strained relationship between Jose and Miguel regarding his sexual orientation is necessary for resolving the family’s problems.
First Intervention
Paradoxical interventions are vital in addressing family problems linked to resistance (Carr, 2019). The intervention will involve prescribing the symptom and double binding to ensure that the resistance is limited. In this case, it will be essential to help Jose understand how he should relate to Miguel based on his sexual orientation. Jose will be made to spend more time with Miguel to understand him better.
Second Intervention
It will be necessary to direct Jose to attend lessons regarding how to relate better with gay individuals to learn what is expected of him. Directives play a significant role in attaining change when used in strategic family therapy.
Third Intervention
Providing subtle feedback to Jose regarding his relationship with Miguel will help in encouraging change. Jose will be commended for desired behaviors linked to his relationship with Miguel, promoting similar behaviors in the future.
Conclusion and Final Comments
The treatment plan can help the family solve the problems they are facing, which are linked to communication, caregiver stress, and conflict around sexual orientation. Strategic family therapy addresses factors that contribute to family dysfunction and instability, particularly in adolescents with problems with emotional regulation or behavioral issues. It was an ideal therapy to apply to the family, considering that adolescents were involved. I have learned a lot during the application of the therapeutic model. In particular, communication is vital in the model’s success, as therapists cannot develop solutions for families if they cannot openly communicate about their problems. The ease of communication and the willingness to address the family members’ problems made the process enjoyable and less challenging.
References
Carr, A. (2019). Family therapy and systemic interventions for child‐focused problems: The current evidence base. Journal of Family Therapy, 41(2), 153-213. https://doi.org/10.1111/1467-6427.12226
Gasior, D. (n.d.). Family therapy techniques: Working with challenging families. High Focus Centers. https://www.monmouth.edu/graduate/documents/family-therapy-working-with-challenging-family-dynamics-in-effective-manner.pdf/
McGoldrick, M., & Hardy, K. V. (2019). Re-visioning family therapy (Eds.). Guilford Publications.
Powell, A., & Fuller, K. (2021). Strategic family therapy: How it works, cost, & what to expect. Choosing Therapy. https://www.choosingtherapy.com/strategic-family-therapy/
Rosen, K. H., Lechtenberg, M. M., & Stith, S. M. (2014). Strategic family therapy. In Joseph L. Wetchler, & Lorna L. Hecker (Eds.). An Introduction to marriage and family therapy (pp. 175-201). Routledge.
Santisteban, D. A., Coatsworth, J. D., Perez-Vidal, A., Kurtines, W. M., Schwartz, S. J., LaPerriere, A., & Szapocznik, J. (2003). Efficacy of brief strategic family therapy in modifying Hispanic adolescent behavior problems and substance use. Journal of Family Psychology, 17(1), 121. https://dx.doi.org/10.1037%2F0893-3200.17.1.121
Sommers-Flanagan, J., & Sommers-Flanagan, R. (2018). Counseling and psychotherapy theories in context and practice: Skills, strategies, and techniques. John Wiley & Sons.
Szapocznik, J., & Hervis, O. (2020). Brief strategic family therapy. Washington, DC: American Psychological Association.
Appendices
Treatment Plan Form
| Primary client: Jose
Therapist: xxxx |
Theory/Model: Strategic family therapy |
Names, ages and family roles of clients participating in therapy:
- Jose: 45-years-old, father
- Maria: 42-years-old, mother
- Daniel: 14-years-old, son
- Miguel: 15-years-old, son
- Joshua: 7-years-old, son
Plan Date: November 30, 2021
Primary treatment configuration: ☐ Individual ☐ Couple ☒ Family ☐ Group
Additional: ☐ Individual ☐ Couple ☐ Family ☐ Group
Medication(s): ☒ NA ☐
Clients’ presenting problems/needs:
Behavior: Communication problems Frequency: High
Behavior: Caregiver stress Frequency: High
Behavior: Conflict around sexual orientation Frequency: High
Clients’ strengths: Willingness, hopefulness, and desired to address the problems
Desired outcomes (include clients’ words):
- Jose wants to relate better with the two older children and avoid preferring the younger one over them.
- The two older children want to communicate and relate better with their father, Jose.
- Maria wants Jose to be more involved in the family by being responsible for the children more than before. She states. ““I take care of everything, the home, kids, food, and he can’t even help the older kids with their homework. I thought he would help when we were reunited but I just feel more stress.”
Treatment Plan
Goal 1: Improve communication between Jose and the two older children
Intervention(s): Use of pretend techniques can help address communication problems
Intervention(s): Hypothesizing will help in addressing the communication problem between Jose and the two older children
Intervention(s): Employing the concept of neutrality
Goal 2: Reorganize the family system to a different level of functioning
Intervention(s): Use of positive connotation
Intervention(s): Use of covert change
Intervention(s): Use of directives
Goal 3: Change the ways Jose deals with Miguel
Intervention(s): Use of paradoxical intervention
Intervention(s): Direct Jose to attend lessons regarding how to relate better with gay individuals to learn what is expected of him
Intervention(s): Providing subtle feedback to Jose regarding his relationship with Miguel will help in encouraging change
Anticipated duration of treatment: 12 sessions
Contextual factors considered in making plan:
☒ Age ☒ Gender ☒ Culture ☐ Cognitive ability ☐ Language
☐ Religion ☐ Economic ☐ Immigration ☒ Sexual orientation ☐ Trauma
☐ Dual dx/comorbid ☐ Addiction issues ☐ Other:
Describe how plan was adapted to these contextual factors: The plan was age-relevant, considering that it involved children. The interventions suggested applied to the specific ages of the family members. Gender and culture role was also considered; specifically, how Mexican culture assigns the genders specific duties. It was taken into account in determining the intervention for the problem of caregiver stress. Sexual orientation was also considered concerning how Jose should relate with Miguel.
Client offered copy of plan? ☒Yes ☐No
Explained in client’s primary language which is ☐English ☐Spanish ☐Vietnamese
☐Arabic ☐
If not, explain: They could understand English, apart from their primary language
Explained in guardian’s primary language which is ☐English ☐Spanish ☐Vietnamese
☐Arabic ☐
If not, explain: They could understand English, apart from their primary language, which is Spanish
xxxxx xxxxx 30/11/21
Therapist signature License/intern status Date
xxxxx xxxxx 30/11/21
Supervisor signature License Date
xxxxx 30/11/21
Client signature Date
xxxxx 30/11/21
Client signature Date
xxxx 30/11/21
Client signature Date
xxxxx 30/11/21
Client signature Date
Treatment Plan Project – Progress Note
Client Name: Jose
Date and Time: 30/11/21 10 AM
Session Length (minutes): 30 minutes
Present in session (names, ages, role):
- Jose, 45-years-old, father
- Miguel, 15-years-old, son
- Maria, 42-years-old, mother
- Joshua, 7-years-old, son
- Daniel, 14-years-old, son
CPT Code: 90832
Goals of therapy – Progress since Last Session
| Improve communication between Jose and the two older children | Stable | Improve | Worsened |
| Reorganize the family system to a different level of functioning | Stable | Improve | Worsened |
| Change the ways Jose deals with Miguel | Stable | Improve | Worsened |
Crisis Issues: N/A
Presentation: N/A
Interventions/Homework: N/A
Response: N/A
Plan: N/A
Next session date & time: 3/12/21 10 AM
xxxx xxxx 30/11/21
Therapist signature License/intern status Date
xxxx xxxx 30/11/21
Supervisor signature License Date
