u10a1 Course project - Cindy Ransomcindy.reidransom.com.s3.amazonaws.com/u10a1 Course project - Cind… · The psychosocial crisis for early adulthood is Intimacy versus Isolation

Buckman/Huffner Family Course Project Cindy Ransom

COUN 5271 Marriage and Family Systems U010a1 Marriage and Family Systems

Email: [email protected] Instructor: Dawn Shelton

Running Head: BUCKMAN/HUFFNER COURSE PROJECT 2

Table of Contents Abstract……………………………………………………………………………………3

Buckman/Huffner Family Case Study and Genogram……………………………………4

Larger Family System Relation…………………………………………………………...5

Intergenerational Themes and Relationship Patterns……………………………………...6

Life Cycle Transitions………….………………………………………………………….7

Inherited Family Strengths and Weaknesses……………………………………………...9

Introduction of Family System Theories………………………………………………...10

Family Therapy Models Presentation……………………………………………………11

Solution Focused Therapy……………………………………………………….12

Applying SFT to the Buckman/Huffner Family…………………………………14

Narrative Therapy………………………………………………………………..16

Applying Narrative Therapy to the Buckman/Huffner Family……………….….19

Comparison of Two Models……………………………………………………………..20

Solution Focused Approach for Treatment Plan…………………………………………21

Treatment Plan…………………………………………………………………………...21

Initial Phase of Treatment………………………………………………………..22

Working Phase of Treatment…………………………………………………….25

Closing Phase of Treatment……………………………………………………...27

Author’s Reflection………………………………………………………………………27

References………………………………………………………………………………..30


Abstract

Families are complex and unique systems that vary in the way they handle

difficult situations. In the movie Parenthood, we are introduced to the Buckman family

and various subsets with differing issues. In this paper we will examine one of these

subsets, Susan and Nathan, create a family genogram and explore numerous

intergenerational themes and relationship patterns. WE also compare and contrast two

possible family system theories, Solution Focused and Narrative, and apply them to

Susan and Nathan’s family. The Solution Focused therapy approach is also used to

present a possible treatment plan and the author shares personal reflections on how her

culture and value system may affect working with such a couple.


Families are complex and unique systems that vary in the way they handle

difficult situations. In the Movie Parenthood we are able to see a variety of family

subsystems and watch as their intergenerational problems weave in and out of each

other’s lives creating multifaceted interactions and dynamics. The following paper will be

focused on one particular subset of this family, Susan and Nathan, and will present a

family genogram while examining the system relational patterns. Specific life cycle

transitions and an exploration of the family’s’ strengths and weaknesses will be assessed.

A comparison of two possible family therapy models, Solution Focused and Narrative,

will also be presented as well as the reasons why they would be beneficial in addressing

Susan and Nathan’s presenting issues. Finally a treatment plan using Solution Focused

Therapy approach is presented and the author shares some personal reflections.

Buckman Huffner Family Case Study and Genogram

The Buckman Family shows numerous hardships faced in different stages of the

family life cycle. Each unique family subset faces specific challenges, which could be

addressed in a therapeutic setting. In order to gain a better understanding of these specific

dynamics, we will analyze the Buckman/Huffner subset of the family and look at it in

relation to the larger family system. We will also explore some intergenerational themes,

relationship patterns and life-cycle transitions.

Susan is a middle-school teacher married to Nathan Huffner, a rather neurotic

scientist. Susan is distressed to see their daughter, Patty, becoming a shell of a child due

to Nathan's advanced home-education methods for cognitive development. She wants to

have a second child but Nathan is against the idea and berates her when he discovers that

she's been poking holes through her diaphragm (IMDB.com, 2012). Susan wishes to


rekindle the romance in her relationship and plans a couple’s vacation, however, Nathan

insists on bringing Patty as a learning opportunity. Susan binges on hidden junk food in

order to manage her stress. Ultimately, sick and tired of Nathan's obsessive bearings over

the family, Susan tells him, in her own way, that she is leaving him (IMDB.com, 2012).

Larger Family System Relation

Susan is the third child of four in the Buckman family. She describes herself as a

“wild child” during her college days and found herself attracted to the responsibility and

stability that Nathan brought into their relationship. Indeed, he was the one who

encouraged her to become a teacher and get her life “together”. As the years have gone

by, however, Susan has found herself suffocating in structure and missing the spontaneity

that her relationship used to have. Unlike her older brother Gil, Susan and Nathan only

have one child and are more easily able to get away for a vacation just the two of them.

She wants to take advantage of that situation and possibly begin expanding her family.

Nathan is very methodical and has grown very accustomed to controlling everything;

from what the family eats to everything Patty does, wears and goes. He has very little

respect for Susan’s family because they are not “exceptional”. Frankly, he considers them

all to be more “sub-average” in intelligence and in lifestyle compared to his family. His

pretentiousness ultimately hurts Susan as she cares for her family very much and she is

very close to her older siblings. She also shows a great deal of care and concern for their

children and is envious of Gils’ children’s carefree ability to enjoy their age appropriate

activities.


Intergenerational Themes and Relationship Patterns

The genogram proves to be an incredibly useful assessment tool in detecting

intergenerational themes and family relationship patterns. By having the entire family

tree laid out in such a diagram it becomes easier to distinguish multigenerational

transmission of family patterns. McGoldrick, Gerson, and Petry (2008) wrote, “Families

repeat themselves. What happens in one generation will often repeat itself in the next –

that is, the same issues tend to be played out from generation to generation, though the

actual behavior may take a variety of forms” (p.15). In creating the Buckman/Huffner

genogram, Susan and Nathan’s counselor will be able to have them recognize these

patterns easier and ultimately provide them with an opportunity to change the cycle for

themselves.

One noticeable intergenerational theme is that Susan displays a distant (eventually

hostile) relationship between her and her husband, just like her parents. Although not

outwardly abusive, Frank is dismissive of Marilyn and even his own mother. In the film,

Marilyn appears to be sweet natured, patient, understanding but quiet regarding Frank’s

inconsiderate nature. Nathan is similarly dismissive of Susan’s feelings, thoughts and

opinions regarding vacations, Patty’s upbringing, and their relationship. In essence, Susan

is repeating a pattern of being the silent and obedient wife that she grew up with.

Some relationship patterns can also be made intergenerationally. Initially looking

at the Buckman/Huffner subset, a triangle pattern can be examined in the family. “Any

triangle tends to be a part of a larger systemic pattern as well” (McGoldrick, Gerson, &

Petry, 2008, p.170). Nathan is fused to Patty the same way that Frank is fused to Larry.


Each of these relationships has a negative affect on the third party of that triangle, Susan

and Gil, in these respective cases. Franks permissive ways with Larry create a great deal

of animosity between the brothers. As previously mentioned, Nathan’s incredibly close

relationship with Patty is causing him to neglect his romantic relationship with Susan.

“Whether parents maintain close or distant extended family relationships, they can expect

to inherit major unresolved extended family issues and patterns” (McGoldrick, Carter, &

Garcia-Preto, 2011, p.213). These themes and patterns can be seen repeating from

generation to generation, however Susan is in the process of breaking that cycle by

leaving Nathan, since she feels underappreciated and unheard.

Life Cycle Transitions

Nathan and Susan are in the early Adulthood stage of development as a young

family with a small child. They are faced with the challenge of balancing their new roles

as parents along with work responsibilities. McGoldrick, Carter, and Garcia-Preto (2011)

cited; “The birth of the first child represents tremendous changes for the system. Several

studies done in the United States indicate that marital happiness decreases after the birth

of the first child, even if other forms of happiness do not (von Sydow, 1999). The shift

from being a couple to parenthood is very exciting but still a difficult adjustment. Nathan

chooses to focus his energies on Patty, while Susan attempts to reconnect with her

husband and possibly expand their family.

The psychosocial crisis for early adulthood is Intimacy versus Isolation.

“Intimacy in a relationship supports independent judgments by each partner. It also

permits the disclosure of personal feelings, as well as the sharing and developing of ideas


and plans” (Newman & Newman, 2012, p.468). Susan is in a state of isolation which is

apparent by her secret binge eating. Another example of her not feeling comfortable in

her relationship is regarding her desires for another child. Susan cannot freely disclose

her feelings about having another baby to Nathan and has resorted to sabotaging her birth

control in the hopes to have an “accidental” pregnancy. She also has the added

responsibility of being a dual income family.“Now that most women are combining work

and family responsibilities, they are increasingly overburdened” (McGoldrick, Carter, &

Garcia-Preto, 2011, p53). Susan worries about Patty and how her inability to relate to

other children her age makes her “weird”. She can see that the entirely academic

approach Nathan has instilled is detrimental on her daughter socially and struggles with

how to get his attention to this fact.

Nathan is unable to notice Susan’s struggles because he is completely enmeshed

in his daughters academic abilities and takes a great sense of pride in her intelligence.

Newman and Newman (2012) wrote, “Parenting during this period has the potential for

boosting an adult’s sense of pride in the skills and knowledge already accumulated [in

their children]” (p.500). Nathan accredits Patty’s intelligence to his diligence and

commitment to excellence. He does not see past his daughter’s success, despite his

personal relationship falling apart around him. Nathan and Susan will need to reach an

understanding where they can balance having a romantic relationship as well as Patty’s

academics and social skills.


Inherited Family Strengths and Weaknesses

Susan has inherited some family characteristics that can be considered

weaknesses as well as strengths. An inherited weakness would be her mother’s quiet

acceptance of her husbands demanding nature. This has caused Susan to be unhappy in

her marriage and unable to express herself and her desires. This repression has caused her

to initiate negative behaviors, such as binge eating, as her coping mechanism. This

behavior leaves Nathan to resume his overbearing and commanding demeanor. He

continues to act unaware of Susan’s feelings and dismiss her desires. This behavior

causes the family to begin a vicious cycle of communication impasses. It also continues

the family pattern previously discussed of the wife remaining silent to her domineering

husbands attitude.

A strength inherited by her mother, however, is a nurturing and caring manner as

well as a love of her family. Despite being married to a man with such a hard exterior,

Marilyn has been able to develop close relationships with all of her children. She even

ultimately cares for Larry’s son after he abandons him. Susan cares for Nathan a great

deal and confides in her sister in law that she “misses” the connection they used to have.

Susan also displays this same affection towards Patty and truly wishes for her daughter to

enjoy her childhood. This caring nature is a great strength for her family because, despite

separating from her Nathan, that bond with her daughter is still there. Patty may be able

to avoid the feeling of abandonment such as what Larry’s son experienced.

Eventually, Susan discovers she had also inherited her father’s strong attitude in

expressing himself. This is displayed ultimately when she decides to separate from


Nathan. If not for displaying this strength, Nathan would never have been made aware to

the fact that Susan felt so unhappy. When he realized just how serious she was about

feeling unheard and dismissed, Nathan was able to display his affection for her. This

continues in the family theme of being caring to one another and supportive through

difficulties.

Introduction of Family System Theories

Family system theories allow counselors to adopt a holistic perspective regarding

the family unit. Corey (2013) wrote, “The one central principle agreed upon by family

therapy practitioners is that the client is connected to living systems. Attempts at change

are best facilitated by working with and considering the family or set of relationships as a

whole”(p.435). When a family member is faced with conflict or hardship all those in the

interrelated system are equally affected and this is very obviously seen in the works with

couples. Two postmodern family systems that are strengths based are Solution Focused

Therapy (SFT) and Narrative therapy. “Postmodern approaches to family therapy seek to

reduce or eliminate the power and impact of the family therapist” (Corey, 2013, p.442).

These approaches differ from the traditional hierarchal therapy models in allowing a

sense of collaboration and respecting the clients as the experts of their own lives.

The Buckman/Huffner couple is faced with some difficult situations in their

relationship and these two therapy models can prove to be incredibly beneficial in

helping their relationship. Both of these approaches have an optimistic and hopeful way

of rearranging the client’s negative thought processes. They empower the clients to

believe that they are in control of the changes they wish to make in their lives. We will

look at both of these approaches and discuss their concepts, therapeutic goals as well as


some of their interventions. Both models will be compared and contrasted and applied to

the Buckman/Huffner family.

Family Therapy Models Presentation

There are several Family therapy models that could be quite beneficial to the

Buckman/Huffner family. Two that we will further explore are the Solution Focused and

Narrative Family therapy models. Chromy (2007) cited; “Solution-focused therapy can

be viewed as a constructivist approach (de Shazer & Berg, 1992), where therapist and

clients co-construct a different way to view their partners, their difficulties and their

interactions (Hoyt & Berg, 1998)”. Solution focused therapy (SFT) will allow Nathan and

Susan to focus on their present situation and the actions that they would like to take in

order to change their current presenting issues, with little emphasis on the past. SFT is

based on creating a level of hope, optimism and encouraging the clients to know that they

have the tools and strength within themselves to resolve their problems.

Another family therapy model that can benefit Susan and Nathan is Narrative

Family therapy. “A general goal of narrative therapy is to invite people to describe their

experience in new and fresh language. This new language enables clients to develop new

meanings for problematic thoughts, feelings, and behaviors” (Corey, 2013, p.412).

Narrative therapy continues the use of positive language and shifting perspectives in

order to help the clients recognize their control over their presenting issues. Susan will

learn that her words are powerful and that she will be able to shift her perspective.

Nathan will also be able to actively listen to Susan’s “story” in order to gain a

better understanding of her perspective. Brimball, Gardner, and Henliline (2003) wrote,

“Families who experienced more positive relational outcomes following participation in


narrative therapy reported that they had improved their ability to: 1) recognize multiple

descriptions of the problem; 2) change and soften their affect; and 3) attribute positive

meaning to one another”. These two language focused concepts will really be able to

assist Nathan and Susan in adopting a more positive outlook on their situation and on the

intentions each other holds for their troubled relationship.

Solution Focused Therapy

“Solution Focused brief therapy is grounded on the optimistic assumption that

people are healthy and competent and have the ability to construct solutions that can

enhance their lives” (Corey, 2013, p.400). Unlike a deficits based approach, SFT allows

clients to take recognize their strengths and adopt a proactive stance in changing their

lives. By focusing attention on what is working in the clients’ life, SFT also parallels

positive psychology creating an atmosphere of hope and optimism. The therapist acts as a

collaborator and a guide to help the clients recognize the exceptions they have already

encountered in their lives when dealing with similar situations.

SFT therapeutic goals begin small and attainable in order to establish a sense of

accomplishment and encouragement within the client. The goals must be well defined in

order to be successful. Corey (2013) cited;

Walter and Peller (1992) and Murphy (2008) emphasize the importance of

assisting clients in creating well defined goals that are (1) stated positively

in the client’s language; (2) are process or action oriented; (3) are

structured in the here and now; (4) are attainable, concrete, specific, and

measurable; and (5) are controlled by the client (p.404).


Other goals that SFT center around is to change the client’s view of their situation, the

actions that they are specifically doing about the situation, and recognizing their inherent

strengths and resources to accomplish these changes. SFT also has the client participate

in solution talk rather than problem talk with the belief that you can produce negative

situations by speaking them aloud.

SFT interventions are centered on changing the client’s perspectives and having

them explore their lives in order to identify their strengths and resources. Pre-therapy

change is a simple question at the beginning of the therapeutic relationship that can set

the tone for positivity and control within the client. By asking the client “What have you

done since you called for your appointment that has made a difference in your problem?”,

the client is encouraged in their abilities to face and handle their presenting issues in the

following therapeutic sessions (Corey, 2013, p.406). Exception Questions posed to the

clients encourage them to look at some of the ways they have been lessening their

presenting issues and gives an idea to some possible actions that can be increased for the

same effects.

The Miracle Question is probably the most well known intervention for the

Solution Focused therapy approach. The client is asked to imagine that they finish the

rest of their day as normal but that when they go to sleep a miracle occurs overnight

where their presenting issues that brought them to counseling has been resolved. Because

the client was asleep they are not aware the miracle has occurred so they are talked

through imagining what things they may notice as different upon waking. The client(s) is

then encouraged to talk about the actions that they would be doing differently. Gehart

(2014) wrote, “When successfully delivered, these questions help clients envision a


future without the problem, generating hope and motivation” (p.340). “The common

guidelines for effective use of the miracle question include phrasing the question

correctly, creating goals, joining, actively looking for exceptions to the problem, being

patient, using pauses, remaining future oriented, and responding to clients constructively”

(M. Stith, Miller, Boyle, Swinton, Ratcliffe, & McCollum, 2012). The Miracle question

allows the clients to focus on specific behaviors that they may be able to apply to their

lives in order to make their “miracle” a reality.

Scaling questions are another technique used in SFT that can help the clients

move into more positive mindframes. “Therapists can use scaling questions to a) assess

strengths and solutions, b) set goals, c) design homework tasks, d) measure progress and

e) manage crises with safety plans” (Gehart, 2014, p.342). The Formula First Session

Task is a technique presented to the clients to accomplish between their first and second

session. The client is asked to take note of the things that they wish to remain the same in

their lives and asked to report them back at the following session. This provides the

clients with the opportunity to identify strengths and notice what is working in their lives.

Video talk and the changing of compliments to requests are also examples of SFT

interventions specifically geared in helping couples to communicate and listen better.

Applying SFT to the Buckman/Huffner Family

Nathan and Susan are a couple presenting several communication issues and SFT

can prove to be quite effective in improving their relationship. SFT will allow them to

open up to considering the perspective of their partner. SFT therapists are able to do this

thorugh establishing a collaborative, non judgmental and neutral stance throughout

therapy. Chromy (2007) wrote, “The therapist does not take one partner's view over the


other, but instead shifts back and forth to gain multiple perspectives on the problem. Such

interviewing techniques may expand client's abilities to entertain multiple perspectives,

which may increase empathic understanding and reduce conflict in the session.” With

SFT, the counselor can help Nathan to be more understanding of Susan’s desire for

spending more quality time and expanding their family. Conversely, Susan can better

understand why Nathan has placed so much attention on their daughter and what thoughts

preoccupy him currently about expanding their family. Once these basic perspectives are

shared and understood, Nathan and Susan can begin really listening to one another and

strengthening their relationship.

The hopeful and optimistic tone of SFT can also encourage Susan and Nathan

immediately in the counseling process. “From the very beginning of an SFBT session,

talk is about what clients want in the future instead of how and why their life has not been

fulfilling. Having a positive view of the future through the development of goals and the

discussion of compliments, strengths, and exceptions invites hope for a client, which

helps people to cope with current hardships, which leads to more hope” (Reiter, 2010).

Helping to raise Nathan and Susan’s hopeful expectations can implement more positive

and solution talk with one another and improve their connection.

The effectiveness of this approach has been presented in many studies. Lethem

(2002) cited;

The concrete goals and rating scales of SFT lend themselves to outcome

research and many of the centres of solution-focused activity have

followed up clients with positive results. For example, de Shazer (1991)


presents the results of research carried out at the Brief Family Therapy

Centre in Milwaukee, with 86% of those followed-up reporting good

outcome at 18-month follow- up, after receiving an average of 4.6

sessions. Clients who came to more sessions reported better outcomes.

Like many of the studies on SFT (Iveson, 1991; Macdonald, 1994, 1997;

De Jong & Hopwood, 1996), it concerned adult clients and had no control

group.

When experienced counselors apply the SFT techniques and interventions

correctly, they can truly impact their clients’ lives in positive changes filled with hope

and optimism.

SFT allows Susan and Nathan to develop their treatment process, customizing it

to their needs with the guidance of their counselor. Seedall (2009) cited; “Empirical

research has found that couple-responsible process characterized by enactments, therapist

accommodation, and inductive process decreases struggle and increases couple

responsibility, ultimately leading to more positive clinical outcomes (Butler & Wampler,

1999)”. The counselor and clients truly work as a team in addressing all of the presenting

issues with positivity and optimism. The SFT approach would explain Nathan and

Susan’s discord as they have “lost” their ability to see their strengths and just need some

guidance to help reconnect with what they are truly capable of achieving.

Narrative Therapy

The main concept in Narrative therapy is the exploration of the client’s lives as

“stories”. Through active listening and explorative questions, Narrative therapy


acknowledges the ability to shift the way the story is told in the hopes to help the client

create a more positive outlook on their presenting issues. “The narrative perspective

focuses on the capacity of humans for creative and imaginative thought, which is often

found in their resistance to dominant discourse” (Corey, 2013, p.411). The counselor

adopts a collaborative role and assists the clients in externalizing and deconstructing their

problem stories in order to create new and hopeful ones.

The goals of Narrative therapy are to invite the clients to adopt more positive

language to use in describing their situations. Corey (2013) wrote, “This new language

enables clients to develop new meanings for problematic thoughts, feelings, and

behaviors” (p.412). Another goal is to separate the person from the problem through

externalizing. Also, to have the client explore alternative ways to view, act and interact in

their lives and then assist them in completing these actions. Narrative therapy goals are

as vast and unique as the clients who are encountered in therapy. They are specifically

tailored to the clients needs at the time, therefore there are no “blanket” objectives for

everyone.

Interventions for Narrative therapy are completely focused on language and

shifting the tone from problem talk to solution talk. Questions are used as a vehicle to

begin the exploration that language plays on the presenting issues such as circular, open

and relational. “Narrative therapists use questions as a way to generate experience rather

than to gather information. The aim of questioning is to progressively discover or

construct the client’s experience so that the client has a sense of of a preferred direction”

(Corey, 2013, p. 415). Externalizing is an incredibly effective technique used in Narrative

Therapy. White & Epston (1990) wrote, “In this process, the problem becomes a


separate entity and thus external to the person or relationship that was ascribed as the

problem” (p.38)” This allows the client to work against the problem instead of attributing

it as an inherent issue.

Narrative therapy encourages the client to seek out exceptions in their lives where

they were successful in dealing with their presenting issues and this known as searching

for “unique outcomes”. The therapist also carefully listens for openings to new stories.

When presented with these opportunities the therapist can help the clients in alternative

stories and reauthoring. “Whether involved in a free-flowing conversation or engaged in

a series of questions in a relatively consistent process, narrative therapists seek to elicit

new possibilities and embed them in the life narratives and processes of the people they

serve” (Corey, 2013, p.418). Therapeutic letter writing is also an intervention technique

that provides the client with documentation of their progress and encourages them to

reflect on their accomplishments in the counseling process.

In regards to empirical data regarding the effectiveness of Narrative therapy, there

is very little for counselors to build upon. Chang and Nylund (2013) wrote, “In the post-

Michael White era, narrative therapy is rapidly growing in many areas of the globe.

Therapists and graduate students are thirsty for narrative therapy training in spite (or

because) of the trend in psychotherapy towards pathologizing practices. Most graduate

programs include narrative therapy in their curricula and many agencies have

incorporated narrative ideas in their work. Two decades later, narrative therapy is vital

and evolving”. This growing approach is able to empower clients to “rewrite their

stories” with more positive connotations allowing them to have more optimistic

perspectives.


Applying Narrative Therapy to the Buckman/Huffner Family

Narrative therapy can help Nathan and Susan in reconstructing their “stories” and

identifying how they prefer their family dynamic to be. Gehart (2014) wrote, “The key is

defining the ‘preferred’ reality and identify thoughtfully and with intention after

considering the impact of dominant and local discourses as well as the meanings and

impact of the proposed preferred reality” (p.404). Nathan and Susan may be able to

describe a story where they are in a more loving and united relationship, as they had

earlier in their marriage. The therapist can help them to identfy some of the things that

they did early in their marriage or ways that they spoke with one another and encourage

them to do more of these activities in order to bring their “preferred reality” to fruition.

Narrative therapy can also allow them to externalize their problem of lack of

communication by giving it a name. “Disconnect”, for example, could be a term used to

describe their issues. The counselor can then ask them to identify when they first

experienced the “disconnect”, what types of things that lead up to the “disconnect”, and

to pinpoint which of their current difficulties come from the “disconnect”. White and

Epston (1990) wrote, “Externalizing can establish a mutually acceptable definition of the

problem and facilitates conditions under which persons can work effectively together to

resolve their problems” (p.54). Through the use of externalization and this term, Nathan

and Susan can focus their energies to battle against the “disconnect” instead of fighting

against each other. The Narrative therapy approach would describe Nathan and Susan’s

case as a “story” that needs to be revised. By having them focus on how they want their

lives to “look like”, externalizing their problem and collaborating on their shared goals,

Nathan and Susan can create a distinctively unified relationship once more.


Comparison of Two Models

SFT and Narrative therapy share many similarities in their approach. Both focus

on solution talk and language as key components in the effort for change. Both are

strengths based models and believe that the clients are the experts of their lives, capable

of their own change. They both believe the client is in need of tapping into their strengths

and resources to overcome their presenting issues. Both also allow the therapist to have a

collaborative relationship with their clients and encourage changing language from

problem talk into positive solution talk. They also attempt to reframe the client mentality

to focus on their resilience and the positive aspects of their lives when facing adversity.

Finally, they encourage the client to look at the exceptional situations already occurring

in their lives which allow them to discover the inherent strengths that they use to

overcome their presenting issues.

One of the differences in the approaches is that Narrative therapy interventions

really focus on helping the client to reauthor their story by externalizing the problem.

Narrative therapy uses the client’s words in order to create a unique and tailored

intervention approach that is co-authored with the counselor. The majority of the

questions asked are meant specifically to help “rewrite” the stories of their lives to be

more similar to their decided “preferred reality”. As a result, therapy may take more time

to cultivate all of the detail and intricacies required for change in the client’s “story”. SFT

is designed to be brief. Although still focused on positive talk, SFT “cuts to the chase” by

having the client focus on discovering what “actions” they can do in order to change their

situation quickly and effectively. Questions are geared more towards exploring what


these behaviors are and used to guide the client on encouraging more of these positive

actions.

Solution Focused Approach for Treatment Plan

Although both incredibly similar and effectual therapeutic approaches, SFT can

provide Nathan and Susan with an effective treatment plan to address their marital

conflict issues. Chromy (2007) wrote;

Solution-based approaches and associated interventions can be applied

effectively to the couple population. Such interventions include

identifying goals, exceptions and solutions; using language that assumes

change and opens possibilities; and amplifying and complimenting

solution patterns. These can be helpful to the processes of reducing blame

and conflict, creating hope and building solutions, important aspects of

positive therapeutic outcomes for couples in treatment.

By properly using the SFT interventions, Nathan and Susan can address their issues

quickly and begin building back trust in their relationship. This is especially important as

they have a young child at home who will need her parent’s disharmony to end as

promptly as possible. By helping them to strengthen their relationship quickly and

effectively, both parents can go back to being a solid foundation for their young child and

her needs.

Treatment plan

An effective SFT treatment plan for a couple, such as Nathan and Susan, must be

thorough at each phase of treatment. The initial phase is focused on establishing rapport,

clarifying the counseling expectations and establishing initial short-term therapeutic


goals. The working phase has the clients focus on tasks to help build their relationship

and communication interventions to help attain their medium-term goals. The closing

phase of treatment involves establishing a “plan” that will assist the couple in continuing

to improve and work on their relationship beyond the counseling setting. It may also

include discussing bringing the long-term goal to fruition. According to the DSM-5, the

relational code that can be applied to Susan and Nathan are V61.10 (Z63.0) Relationship

Distress With Spouse or Intimate Partner as they are displaying obvious behavioral

difficulties in conflict resolution, cognitively dismissing one another’s positive behaviors

and display emotional sadness and anger towards one another.

An example of a possible short-term goal for Susan and Nathan could be for them

to improve communication by not having Nathan shut Susan down or having her

withdraw into an eating binge. They can do this by allowing the partner to finish their

statements when in a heated discussion. A medium term goal could be for them to have

scheduled date nights to allow them to reconnect on a personal and intimate level. This

can allow them to possibly discuss expanding their family without resulting in arguing. A

long-term goal could be for them to feel comfortable enough to have Nathan go on a

romantic vacation with Susan alone and reach a consensus on whether or not to have

another baby. All of these issues will be addressed using the solution focused therapy

approach and interventions.

Initial Phase of Treatment

At the beginning of the counseling process, Standard HIPPA forms would be

filled out and discussed as well as an opportunity to clarify any questions the clients may

have regarding counseling protocol. Counseling Standards would be established and


explained, such as the limits of confidentiality in order to inform the family of how the

therapeutic relationship will proceed. The counselor would establish the protocol for

meetings and ask that both Nathan and Susan be present for all sessions in order to create

a “united front” in the efforts to help their marital relationship. A collaborative

relationship will be presented to the couple between them and the counselor with an air of

optimism and hope as the underlying theme for how the process will proceed.

A semi-structured interview would be conducted which involves the clients

briefly describing their presenting issues and then completing a family genogram during

the initial assessment. The genogram allows the counselor to gather a great deal of family

information regarding dynamics, interrelationships and history that can be useful

throughout the counseling process. It also provides a non-threatening activity to help

build rapport and get to hear the couple’s perspectives, verses focusing solely on the

negativity of their presenting issues. However, when appropriate during the creation of

the genogram, the counselor will make reference to how the presenting issues that

brought them to counseling are present as they describe their family dynamics.

The miracle question will be posed to Nathan and Susan and they will be asked to

describe very specific behaviors and actions that would help them to recognize that the

“miracle” has occurred. “Clients are encouraged to allow themselves to dream as a way

of identifying the kinds of changes they most want to see. This question has a future

focus in that the clients can begin to consider a different kind of life that is not dominated

by a particular problem” (Corey, 2013, p.407). Reiter (2010) wrote, “Use of the miracle

question breaks down a self-constructed barrier of things not being possible, allowing the

perception and understanding that desirable behaviors and experiences can and will occur


in the future, which promotes expectancy and hope”. These “changes” can then be

applied into specific tasks that they may be able to attempt at a later time.

The counselor will also be looking for the exceptions to their conflicts. These

exceptions gives the counselor and client insight on what “works”. They should be

encouraged to be done more frequently in order to increase positive relations between

Susan and Nathan. Reiter (2010) cited; “By focusing on these nonproblem times, clients

are given a sense of hope that the problem will not always be there. This focus on

nonproblem (or reduced-problem) times changes the ambiance of the session. Berg and

Dolan explained this change, ‘The discovery of exceptions led to immediate change in

the tone of our sessions: client/therapist conversations became hopeful and optimistic’ (p.

10).” By encouraging Nathan and Susan to explore these exceptions, they can be

encouraged in acknowledging the positive aspects of their relationship and the inherent

strengths they possess.

Scaling questions can assist in the establishment of Nathan and Susan’s’ goals.

Looking at where they currently feel they are and where they would like to be on a scale

helps to establish some of the steps that may need to happen in between, with further

detailed exploration. For example, if Nathan and Susan describe their relationship being

at a 2 now and 10 being how they felt when they initially fell in love, the counselor can

ask them to describe what a 3 may feel/look like to them, establishing some concrete

differences in what to work on to get there. These types of questions help the clients to

visualize possible progress in their time in counseling.

When finishing with the clients, the counselor would “assign” the formula first

session task to Nathan and Susan. This task would consist of the couple to identify an


area or areas of their relationship that IS working and ask that they report this back at the

following session. Becvar and Becvar (2013) wrote, “This question implies that there are

some good things going on in the clients’ lives and moves exploration away from the

dominant focus on the bad things” (p.267). This task is another way of shifting the clients

focus from negative to positive and allows Nathan and Susan to look beyond their

presenting issues and focus on reconnecting as a couple.

Working Phase of Treatment

The initial scale that was discussed to will be consistently referred to throughout

the working phase in treatment. This is in order to monitor the progress and the quality of

the working alliance throughout therapy. Different interventions will be introduced

during this phase of treatment for Nathan and Susan to attempt in bettering their

communication and strengthening their relationship. Video Talk, channeling language

and shifting complaints to requests are all examples of useful interventions that can be

applied to Nathan and Susan’s case.

Video talk is used to distinguish three levels of experience: facts, stories, and

experience. Gehart (2014) wrote, “By using videotalk to separate the behaviors from the

interpretation of the behaviors, couples become less defensive with one another and are

able to engage in conversations in which they better understand each other and identify

meaningful ways to reduce future conflict” (p.347). With this intervention, the counselor

will assist Nathan and Susan to specify the actions that occurred verses statements of

general “feelings” that do not provide a good basis to actionabbly change. This is just the

difference between Susan saying “He never listens!” to “When I asked him to speak with

me he said he was too busy and walked out of the room.”


Other tactics, such as channeling language, can help Susan and Nathan to “reduce

the sense that a partner is ‘always’ a certain way” (Gehart, 2014, p.352). The counselor

helps to encourage the clients to increase satisfying communication and positive

interactions that help them to reduce conflict. The counselor also heartens the

improvement made through therapeutic compliments. The distinction between

therapeutic compliments verses regular ones are very clear in the effects of the

counseling process. Gehart (2014) wrote, “The key with compliments is to compliment

only when clients are making progress toward goals that they have set or to compliment

specific strengths that relate to the problem” (p.346). Complimenting Susan and Nathan

on the progress they are making and the steps they are actively making for change helps

to strengthen their position of rehabilitating their relationship. These changes in

communication will continue to be monitored and supported throughout the therapeutic

process.

Another beneficial change in communication can be achieved through shifting

complaints to requests. Susan and Nathan are having difficulties expressing themselves

which results in Nathan shutting Susan down and Susan having secret binge eating. By

shifting complaints to requests they will be encouraged to discuss what they want verses

what they don’t want. For example, instead of Susan saying “Let’s carve out some time

for ourselves” she could be more specific in making a request such as “I’d like for us to

take a vacation by ourselves so we can reconnect and spend quality time together.”

Requests like this make the intentions clear and give specific points of action for Nathan

and Susan to build upon.


Closing Phase of Treatment

The closing phase of treatment consists of acknowledgment of maintaining gains

developing aftercare plans for the end of therapy. The counselor will thoroughly discuss

the progress that has been made and collaborate with Susan and Nathan on how best to

maintain their bettered relationship and communication skills. Coping questions will help

them to identify how they will cope with future problems and possible setbacks. The

scale that has been referred to throughout therapy will be discussed and long-term goals

will be discussed. The counselor will increase a sense of intimacy, shared identity and

connection through the use of scaling questions and therapeutic compliments (Gehart,

2014, p.353). Susan and Nathan will discuss their thoughts on how they have managed to

overcome the initial adversity they faced and share how they plan to continue to do so in

the future. The counselor will also establish an open door policy for returning should

Susan and Nathan wish to do so. Corey (2013) wrote, “Because this model of therapy is

brief, presented-centered, and addresses specific complaints, it is very possible that

clients will experience other developmental concerns at a later time” (p.408). Should

Susan and Nathan wish to return to reinforce or address new issues they will be provided

the opportunity to do so and thus continue the collaborative sense of connection with

their therapist.

Author’s Reflection

Upon creating this treatment plan for Susan and Nathan the author reflects upon

her cultural upbringing, personal experiences and values and how they affect her

assessment and ideas on working with this particular couple. Raised in a somewhat

traditional Latino household, the author recognizes that she has had an experience where


the male of the family is recognized as the “head” of the household and should be

respected. As she grew older she began to have a better understanding of how this

dynamic poses many challenges to her acculturation into Western society. She

acknowledges feeling empathy towards Susan’s inability to feel heard by a domineering

male and the struggle she faces attempting to balance her roles as a woman. From

personal experience, the author watched as her mother struggled with balancing a more

traditional role of mother/wife with being an independent working woman. It seemed that

her mother played two roles: Accomplished business woman at work and devoted mother

and wife at home who cooks and cleans, caring for her husband and children. The author

was raised watching the struggle her mother experienced with balancing these many roles

and began to appreciate the intricacies of both societal and cultural expectations of

women were at an early age. This is something that must be considered in order to ensure

that she does to show too much sympathy and ultimately come to Susan’s aid or defense

when unnecessary.

The author is able to take from her personal experience the importance of

communication for this couple. Currently she and her husband have created an open

communication approach and also schedule monthly date nights where they are able to

reconnect and discuss interests outside of their children. These are qualities that can be

encouraged for Susan and Nathan in order to help improve their marriage. Married to a

Caucasian man and despite having established a very egalitarian approach to their

childrearing practices, the author still finds herself balancing the roles of being a mother,

wife, friend and sibling and can relate to Susan who struggles with her many roles. These


are commonalities that can also help to build rapport and connection between the

counselor and Susan.

The author can also relate to Nathan as she has had numerous honest

conversations with her husband in which he describes the pressures of being a “man” and

a “provider” in today’s society. In essence she can use her experiences to look at the

“coin” from both sides. The author ultimately plans to commit to giving both parties

equal time to express their concerns and finish their thoughts in the counseling sessions.

Setting this as a general rule of counseling will allow her to avoid favoring one client

over another and helping them to both feel heard.

Finally, the author truly values marriage and the importance of healthy

relationships, especially when children are involved. It is this passion that ultimately led

her to pursue Marriage and Family therapy as her career. This commitment to healthy and

happy families and the belief in the power of positive psychology can truly be beneficial

to Susan and Nathan, as well as any other clients this author may be faced with in the

future.


References

American Psychiatric Association. (2014). Other Conditions That May Be a Focus of

Clinical Attention. Retrieved March 13, 2014, from dsm5.org:

http://dsm.psychiatryonline.org.library.capella.edu/content.aspx?bookid=55

6&sectionid=41101788

Becvar, D. S., & Becvar, R. J. (2013). Family Therapy: A Systemic Integration (8th

Edition ed.). St. Louis, MO, U.S.A.: Pearson Education Inc.

Brimball, A. S., Gardner, B. C., & Henliline, B. H. (2003). Enhancing Narrative Couple

Therapy Process with an Enactment Scaffolding. COntemporary Family Therapy:

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Chang, J., & Nylund, D. (2013). Narrative and Solution-Focused Therapies: A Twenty-

Year Retrospective. Journal of Systemic Therapies , 32 (2), 72-88.

Chromy, S. (2007). A Solution-Based Approach to Couple Therapy: A Case Example.

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Corey, G. (2013). Theory and Practice of Counseling and Psychotherapy (Ninth

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from IMDB.com: http://www.imdb.com/title/tt0098067/synopsis

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