Assignment - w11 - Assessing

Group Project Below

Smith Family Divorce

Group A

February 3, 2019

SOCW-6121: Advanced Clinical Practice II

Walden University

Description of Family System

Tom and Tina Smith are a Caucasian, middle class married couple who have three children, Tom Jr. (16), Paul (13) and Lucy (5) who are presenting due to family discord resulting in Tom and Tina announcing that they are divorcing. The family is seeking treatment over their impending divorce due to Tom’s recent discovery that he is not the biological father of his son Paul. Tom has begun abusing alcohol as a coping mechanism to deal with this newfound information and the families negative communication patterns. Tom is a seventh-grade science teacher and Tina is a high school principal and they have been married for 18 years. Tom moved out of the family home 8 months ago after learning his wife had an affair with one of his best friends from college; Tom’s life has spiraled out of control since discovering his wife’s indiscretion. The family’s unable to function as a cohesive unit due to the lack of communication.

The children are confused and caught in the middle of the issues that their parents are experiencing and do not understand how to properly navigate the new normal of their family dynamics. It is Tom and Tina’s desire to create a more positive climate for the children and learn how to effectively co-parent while figuring out how to bring the family back together to address their concerns without placing additional strain on the families’ relationship with one another. Tom has also expressed his desire to get help with his drinking and develop some healthy coping strategies that will allow him to deal with the family issues and transition into a new relationship with all members of the family. Tom seeks to gain an understanding of any undiagnosed mental health diagnosis he may have. The children will all require age appropriate help dealing with the issues surrounding the divorce and how to process the new family dynamics.

Prior to today’s session, each family member was assessed with a therapist to discuss how they were affected by the divorce and the new family dynamics. The children were assessed individually, with special attention being paid to Paul and his perspective on learning that Tom is not his biological father. During this initial assessment, the family dynamics within the Smith family were cause for concern. The family has been residing in the community for the past 15 years and have a strong support system in place like the local non-denominational church that they have been attending for the past ten years, neighbors with whom the family has close ties and a large extended family that offers help as often as they can.

When working with families experiencing some of the issues that the Smith family is dealing with, it is important to be supportive and give careful consideration to the issues that affect how the family interacts moving forward. Also of equal importance, gaining an understanding of how the family interacts within their systems – work, school, family and community, can affect and play a critical role in how they are able to cope with their issues. Focusing on communication is also vital to the family since misunderstandings can perpetuate the discord and cause additional issues within the unit that is already fractured. With the parents’ lack of communication, reestablishing healthy lines of communication to allow them to express the hurt and distrust they may be feeling as well as allow the children to grieve the “death” of the family they once had in order to move on as a cohesive unit and find a new way to exist and grow together.  

Developing an understating of the family’s interaction within their system and looking at factors that play a role in the family’s development, such as their communication styles within the family are areas to explore. Verbal and nonverbal interactions should be explored as well as each family member’s interpretation. Interpretations can often lead to increased disagreements as well as tendencies to communicate ineffectively. In exploring the nuances of the Smith family, we find that Tom has left the home and developed an unhealthy drinking habit. Interactions between both parents and children within the family could provide the social worker with vital information regarding the strengths of the family and areas for growth.

Scope of the Issue

The increasing divorce rates have left children suffering from toxic stress, which can ultimately effect the behavioral and mental development, among many other aspects of growth (Zare, et., al., 2018).  This type of stress and pressure is similar to the experiences of childhood poverty, whereas a child struggles to have their basic needs met, such as food and shelter (Zare, et., al., 2018). This stress can cause anxiety and depression which, if not dealt with appropriately and delicately, can lead to later onset of substance abuse, medical issues, and mood disorders (Zare, et. al., 2018). According to an online questionnaire conducted by Schaan and Vogele, 2016, divorce has led to children feeling separated from their parents; 44% of children reported inconsistency with their mental health as well as increased level of anxiety and depression. The study found that engaging children in treatment early on in order to process the separation of their parents’had more favorable outcomes then those who did not engage in treatment. Additionally, the study showed the children were more resilient with coping and mental health development (Schaan & Vogele, 2016).

The family presents for treatment due to the parents’announcement of their pending divorce, which has been devastating for the three children. The issue lies in the lack of family functioning – inability to communicate and lack of cohesion. These are two important goals that that will allow the family to move forward together as a cohesive unit. The youngest child Lucy is between a toddler and school-aged child and is at a stage in her life where she is looking at the divorce possibly being her fault, although she may not understand the split, she is more fearful of her place with the separation (Cohen & Weitzman, 2016). Paul, the 13-year-old boy may exhibit feelings and emotions such as anger, confusion, and abandonment (Cohen & Weitzman, 2016). The eldest sibling Tom Jr. is old enough to understand what is going on between his parents, however, due to the circumstances surrounding the divorce, he may feel more depression and aggression with the matter (Cohen & Weitzman, 2016).

The concept of divorce can be both humiliating and stressful and although the family are all experiencing this together, they may feel alienated not only from the world, but from one another as well (Cohen & Weitzman, 2016). Divorce is a painful process where everyone involved is searching for a way to cope with these deep unfelt feelings. The parents are going through legal matters as well as trying to keep it together for their family. The children are going through emotional issues and are unsure of how to cope with school and feeling “different”.  The family may go through such discord that they are failing to communicate with one another and through treatment can understand where they need to reconnect. Divorce can separately effect each family member and cause long-term negative reactions when individuals are experiencing a family stressor such as divorce, however with therapy everyone’s personal difficulties and differences can be addressed and allow for growth and acceptance (Cohen & Weitzman, 2016).

Engagement and Assessment

The role of a social worker is to build rapport with the family that would assist in engaging and assessing effectively. Careful considerations are taken by the social worker during this phase of the planned change model to ensure respect of the clients and the right to self-determination. Clients remain the focus of therapy as well as experts of their lives while working in a collaborative effort with the social worker to become empowered and identify strengths.  Engagement is a fundamental tenant to foster a positive relationship between the worker and the client. Successful engagement of the client or family system may include working through barriers such as cultural or hesitation from the client.

The process of engaging with clients creates unknown vulnerabilities that takes time to share. Most clients are not immediately willing to share their deficiencies with strangers in a therapeutic setting. Therapy may occur in an involuntary matter, and the effectiveness of the session relies on strong engagement skills. As such, the role of the social worker is to determine how to gain this level of engagement to get to the root of the problem.

Those seeking counseling are in pain and eager to get the help they need to improve their lives. The assessment process should reflect these attitudes and affirm the seriousness of each family member and their uniqueness. In doing this, I am saying to my client that they are special and I want to get to know and understand them better so that I can determine the best possible way to help them. Assessment is ultimately the collaboration between the helping professional and the client in that both gain knowledge and understanding while continuing to build a strong therapeutic relationship. Assessment serves a multitude of purpose, from establishing options and alternatives, assess and quantify behaviors and habits, promote insight into an individual’s self-esteem, assess and promote inspiration toward positive change and client-counselor collaboration, to facilitating planning and decision-making.

Engagement

The relationship between the client and social worker can be a strong mechanism to engage the entire family (Rice & Girvin, 2014), therefore, social workers must have tools that will allow them to break through these barriers.  Skills such as attentiveness and open discussions regarding worker and client expectations are necessary. The Smith family has described barriers to effectively communicate. Steps should be taken to listen to each family member and gain a clear understanding of their interpretations of the problem and any probable solutions.

The overall goal at the beginning of therapy is to create an alliance with family members by creating a relationship with each individual in which the counselor is warm, supportive, understanding, genuine, and empathic. In other words, all individuals in the room will feel that the worker understands their experience and able to explore new behaviors and new ways of interacting with each other. Open-ended questions will allow the family to expand with the social worker on their individual experiences leading up to the divorce. It is also vital for the social worker supporting the Smith family to inform them of agency expectations and limitations to the assistance that may pertain to the family. During this time, the family should be allowed to express any concerns or questions they may have regarding treatment to ensure efforts are made to match them with a provider or agency who best meets the needs of the family.

Assessment

Assessment contributes to the establishment of rapport, enhances the goals of counseling, and considers the client’s preferences and areas of difficulties. In assessing the Smith family who struggles with cohesion and communication, it may be optimum to administer the

Circumplex Model which is used for systematic assessment of a marital and family system. Family functioning is assessed to identify if a family unit is adaptable, flexible, and cohesive (Rada & Olson, 2016).  The communication parameter helps the families modify their cohesion and flexibility levels. It is not only about clarity, but also about the ability to share with other family members, the capacity to empathically listen, with respect and appreciation, to the emotions generated by their joys and sorrows (2016). Whereas positive communication skills, including clarity, empathy, and effective problem solving, are believed to facilitate healthy levels of family cohesion and flexibility, a lack of communication skills is believed to inhibit the family system’s ability to change when needed (Rada & Olson, 2016).

Literature Review

The Smith family comes in search of assistance with dealing with issues that include the divorce of the parents, which is directly linked to the discovery by Tom that his middle child Paul is not his biological son and is the biological child of one of his bestfriend form college. The family also needs assistance with the family’s negative communication patterns, navigating the families new normal, and supporting the children during this difficult time. Tome specifically needs help dealing with his newly acquired drinking problem since the breakdown of the family unit as well as the possibility of him having an undiagnosed mental disorder. Some interventions that may be used with this family includes Functional Family Therapy, Solution Focused Brief Therapy and Strengthening Families Program. 

Coatsworth, Duncan, Nix, Greenberg, Gayles, Bamberger, … Demi, (2015) conducted a study to test the effectiveness of Strengthening Families Program in conjunction with Mindfulness Training for parents. Which resulted in it being discovered that improvements were made in multiple dimensions of parenting, including interpersonal mindfulness in parenting, parent–youth relationship quality, youth behavior management, and parent well-being, according to both parent and youth reports at both post-intervention and 1-year follow-up. It was also mentioned that mindfulness may be most useful for parents when conceived as one of the instruments used to treat multiple family functioning issues that are present. 

Ahluwalia, Anand, & Suman, (2018), discuss that substance abuse is a familial issue that must be dealt with inside of the family unit as all members are going to be affected by it. It is noted that the family unit can be a risk factor associated with substance abuse and can also act as a deterrent by being involved in the treatment process to help with recovery or even prevent the disorder. The focus of Functional Family Therapy as stated in this article is to intervene in the complex relationship patterns that can exist within family units and change them in ways that are productive for the family unit overall. This intervention is based on the systems therapy which states that positive changes to one part of the system can and will have a positive impact on all or some of the other parts of the system. 

Franklin, Zhang, Froerer, & Johnson, (2017), discuss in this article the importance of specific questioning techniques like miracle questions and scaling questions to increase the positive expectancies and emotions that lend themselves to positive outcomes. Also discussed is the importance of creating new meanings for clients, where clients construct a new outlook of what they desire their future to look like and use past strengths, success, and resources they already have to make that new vision a reality. The use of specific therapy techniques like asking question that elicit positive and empowering responses allows the client to see that they have the tool they need to make the changes they desire to see in their own lives.

Interventions

The Generalist Intervention Model assist in collecting data by utilizing multidisciplinary teams to gauge what programs and techniques may work most effectively for the family and each individual. This methodology can also help in planned changed through problem solving by building upon the client-base’s strengths (Kirst-Ashman & Hull, 2018). This can be used as a means to develop strengths with Mr. Smith’s sobriety. Strengthening Families Program is designed for youth and their families. This program targets improving families’ relationship, parenting skills, and youth’s social life and life skills (Holosko, Dulmus, & Sowers, 2013). The Strengthening Families Program works to help children and families with parents who are in substance abuse treatment, it builds on protective factors and gives families the skills they need to function. This approach is a 14-week training that uses family system and cognitive- behavioral approaches to increase protective factors and reduce risk factors in the youth and their families (Holosko, Dulmus, & Sowers, 2013). This intervention helps with the development of positive disciplining, reducing conflicts, improving parenting skills and the family’s ability to be resilient in difficult times. The sessions are structured and have three components family-life skills, parent-skills training, and child-problem solving and social skills training (Holosko, Dulmus, & Sowers, 2013). 

Functional Family Therapy methodology has a strong social learning focus using systems theory and behavioral and cognitive strategies to influence functioning (Holosko, Dulmus, & Sowers, 2013). The problem is examined in terms of the function they serve for the child and the family. Risk factors are addressed with an emphasis being placed on the familial relationship. This intervention focuses on improving the family’s ability to communicate and acts as a support to decrease negativity and conflicts that may be occurring within the unit. Families are helped to change communication patterns, increase parental supervision, and using new parenting skills to change behaviors (Holosko, Dulmus, & Sowers, 2013). This intervention involves using conjoint family treatment focusing on teaching communication skills, problem solving and negotiation skills. This intervention can assist families in coming up with new family solutions to issues, aid in the development of positive behavior changes and strategies that parents could use to impact their children’s behavior. and introduce a new positive way in which the family can function.

Solution- focused brief therapy is a strengths-based perspective that presumes the individual is equipped with the knowledge, strengths, skills, and insight to solve their own problems (Holosko, Dulmus, & Sowers, 2013). This intervention is not based on the couples issues it works from the perspective of where the couple would like to go and some questions that should be asked include where you want to see the relationship go, what resources are already in place, and what are the details related to the future. This model works under four guidelines including each family is unique, clients possess the strengths and resources to achieve their goals, change is constant and any change in one area can and will affect other areas, and sessions should focus on the present and the future since we cannot change the past (Holosko, Dulmus, & Sowers, 2013). This methodology allows the practitioner to develop desired outcome questions instead of focusing on the issues present in the family unit.

Within the Smith family, each member is affected by loss; loss of communication, loss of a cohesive family, and most importantly, loss of trust. Emotionally Focused Therapy (EFT) is a great intervention that aims to assist couples and families in distress learn how to improve their relationships (Stavrianopoulos, Faller, & Furrow, 2014). When clients are confronted with fear, trust, loss, or a sense of betrayal in their relationship, the impact can be damaging. EFT focuses on the present time to makes changes in the here and now through de-escalating the couple’s or family member’s negative cycle of interactions by helping them to understand what is occurring in the family; restructuring the family’s interaction allows the family to address their fears within the relationship through effective communication; and consolidation which assist the clients to draw on the negative patterns and identify how they can change the patterns (Stavrianopoulos, Faller, & Furrow, 2014.

Another form of evidence-based family intervention that may be useful for this population is community-based programs for a family that is going through a divorce. A family that is going through a divorce not only effects the couple but also the children in the family. The community-based program known as Kids in Divorce Situations. Some of the community-based programs help children of divorce with other programs or forms of counseling. However, Kids in Divorce Situations aim to decrease emotional problems as well as improve the relationship and communication between parents and their children after divorce (Eaton, 2018, pg. 41).  With children involved and with one of the factors for the separation of the parents, with the mother not being religious and the father is, Kids in Divorce Situations, the children could benefit from the community-based program.  

Kids in Divorce Situations program includes role-play, assignments, and conversations that help children learn to recognize their feelings, deal with change, and understand that they aren’t responsible for the separation of their parents (Eaton, 2018, pg. 41). Given these programs’ potential influence on such a large population, evidence in support of their efforts ensures individuals and couples seeking relationship enrichment are receiving an effective intervention and are not being harmed (Davis, 2015, pg. 2)

Advantages & Disadvantages of Interventions

When selecting the best intervention for a client, social workers have to consider the advantages and disadvantages of each proposed intervention in order to determine its’ effectiveness on the client or client system they are supporting. Conducting a proper analysis of the intervention to ensure it is research and evidence-based to support the claims. The Smith family are dealing with a lot of issues within their family system ranging from divorce, infidelity, loss of family unit to Paul’s loss of a father he thought was his biological father so the social worker has to consider the complex needs in order to appropriately address the presenting problem and underlying issues.

Engaging in evidence based interventions while working with families who are going through divorce is an effective way to be sure that families and children are getting the services they need to cope and heal. There are advantages and disadvantages to these interventions that can assist families going through a divorce and looking to the future. Functional family therapy is an effective approach for children suffering with problem behaviors (Sexton, 2019). This form of therapy focuses on the family functioning and interaction style of the family (Sexton, 2019); this is an advantage as the model looks at the core principles of a functioning family (Sexton, 2019). This form of therapy can create a sense of control and that can be a sense of security in their growth (Sexton, 2019).

Advantages

The Strengthening Families Program (SFP) is a weekly, 14-session, family-skills program designed for high-risk families. Both parents and children (6-16 years) participate in the program; parents and children attend separate sessions and then come together later in a family session. Families also receive weekly home visits. The SFP is designed to build on protective factors by improving family relationships, parenting skills, and improving the child's social and life skills.

Solution-Focused Brief Therapy (SFBT) has its advantages and disadvantages when being used as a method for treatment for the Smith family. The premise of SFBT is that clients are accountable for solutions when in crisis versus accepting responsibility for the current problems. (Turner, 2017). Strengths-based interventions such as SFBT empower clients to create changes in their lives while also increasing the confidence in their abilities. When looking at our case study, the Smith family currently have strengths they may be unaware of such as their willingness to remain functioning through their divorce, community involvement & support, as well as seeking out treatment to resolve family issues. This form of treatment is future focused and offers advantages in building goals and searching for solutions rather than focusing on the problems (Carr, et., al., 2017).

SFBT focuses on what the family can do, this approach would allow the family to examine areas in their lives where they have been successful versus the areas where they have deficiencies (Turner, 2017). By focusing on positive aspects with clients, it allows them to see the capacity they have for change that may not have been present. During times of crisis and chaos, it is not uncommon for families to dwell on the negative that surrounds them which renders them incapable of rationalizing their responses. Social workers with families such as the Smith family have the task of helping the families notice their strengths and successfully apply them to the new dilemmas. (Turner, 2017).

The most beneficial of this form of treatment is that clients are the focus of the therapy. Results are driven by client participation and allows for greater control regarding treatment direction. Individuals and families can decide when they have reached a resolution and define their problems for the social worker. Through this form of interaction, a dialogue occurs between both the social worker and client, with an emphasis on clients constructing their paths and uncovering strengths and resolutions already at their disposal. (Turner, 2017).

Disadvantages

With every form of evidenced-based intervention, there are also limitations and concerns. SFBT is quick and goal-oriented which may not allow therapists the desire amount of time to empathize with what the individual in treatment are experiencing (Netrix Limited, n.d.). In doing so, those in therapy may feel misunderstood if the therapist is not meeting them on their emotional level (Netrix Limited, n.d.).  Critics of SFBT holds that it seems to simply discard or ignore information deemed important by other treatment modalities. Another disadvantage with solution focused is that children find it difficult to look ahead as it is a language too complex for them to understand (Carr, et., al., 2017). While this form of therapy has positive outcomes such as positive family relationships, it can also loose family members in the process if not conducted appropriately. 

Functional Family Therapy is a great intervention, but was designed as a family intervention program for those youth who were at-risk or considered “dysfunctional” between the ages of 11-18. The Smith children are ages 5-16 and are not dysfunctional. Additionally, this intervention does not address the complete needs of the family in improving the family’s ability to function after the divorce.

Recommendation for Treatment

A careful and well-developed treatment plan that is grounded in research on treatment effectiveness, provides assurance that the counseling is likely to be successful. Top on the recommendations for the family is having a family-focused, as well as children focused treatment that is centered on improving the family’s ability to function as a cohesive unit. In the family-focused treatment strategy, the treatment will recognize and utilize individual and family strengths simultaneously utilizing the family’s willingness to solve problems (Barker & Pistrang, 2015). The treatment will prove instrumental considering the discord within this family and is ideal considering the parents recognizes the problem and are willing to work to identify healthy strategies that will assist the family to grow into a more cohesive unit.

The treatment for this family will comprise of a combination of family-focused treatment, emotionally focused therapy (EFT), Solution-focused brief therapy (SFBT, and Strengthening Families Program (SFP) and will be delivered in weekly family sessions aimed at improving communication and cohesion, promoting good parenting skills and positive family relationships that will reduce aggressive behavior while improving the family’s ability to function.

The utilization of the ecological approach combined with the intervention techniques is imperative as a means to integrate multiple levels of treatment goals on the family-level. This approach helps in the identification of a family’s distinctive coping strategies and stressors (Kirst-Ashman & Hull, 2018). Recognizing these factors can assist in the identification of strengths and knowing certain barriers within the dynamic of the family. This can also help in gaining coping mechanisms that the family has used in the past that can be utilized in their presenting problem. Coping mechanisms can also help in addressing emotional factors of divorce such as anger, guilt, and grief (Kirst-Ashman & Hull, 2018). This can assist the family in allowing the break-down of the marriage to occur while addressing the dissolution of the old structure and the restructuring of a healthier family structure that work specifically for the Smith Family. The methods of coping that could be used to encourage the Smith family are prioritizing what still needs to be done as necessities of the household; communicating about issues that are most stressful within their family’s dynamic; and supporting one another through journaling and activities that involve positive regard.

The family is currently experiencing a tremendous amount of stress due to the father’s absence from the home, the parents’ pending divorce, and Paul possibly feeling guilt and blame for the family no longer being together. The communication therapy and EFT will help rebuild the communication of the different family members as well as help in dealing with the emotional issues that surrounds a divorce. Communication therapy is effective for communication issues brought about by secrecy and trauma. Communication in the family has been destroyed due to trauma caused by infidelity.

The children focused treatment will focus on the parents working together for the well-being of the children. Mr. and Mrs. Smith have three children with the youngest being five years old. Children focused treatment will emphasize on the parents finding a workable solution that will ensure that the children grow without lacking the presence of either parents (Barth, 2017). For example, the family can have a scheduled private family time where detail on the parents and children well-being will be shared.

Evaluation

In considering the interventions presented to be used with an individual and/or family, it is critical to assess the effectiveness of the intervention as well as areas for improvement. Evaluations inform further treatment planning for future clients and inform practitioners of which practices produce the best results. Methods for data collection may be formal or informal (Toseland & Rivas, 2017). Often evaluations are conducted to learn about the efficacy of an intervention method as well as the effectiveness of group work (Holosko, Dulmus, & Sowers, 2013). As the family therapist, I can carry out random home visits during the scheduled private family time where she will shadow the family. My duties during the shadow sessions will be to observe how the family handles itself. In addition, the shadowing sessions will be geared at evaluating whether the children’s protection and safety needs influence the decisions that the parents make as well as ensuring that the treatment is appropriate enough to facilitate the protection of the rights of the children. In addition to the shadowing evaluation, I will schedule individual sessions with each member of the family. The individual sessions will be evaluation sessions to assess whether the family-based therapies and children focused therapies are effective at enhancing communication between the family members that create a positive environment that is conducive to the children’s growth and development. In the evaluation of the individual family members, there can be parameters that describe whether the treatments are effective or not.

For Tom, the treatment parameters can be on how much alcohol he consumes in a day and how often he communicates with his children with special attention being paid to how he deals with Paul (Caselli, 2018). For Tina, the treatment parameters will focus on how effectively she communicates with Tom in regards to the children as well as how she handles the situation with Paul. For Tom Jr., the concentration will be on his relationship with both his parents as well as with his siblings while also examining his feelings regarding the divorce and his mom’s indiscretion that led to the divorce. With the new discovery of Paul not being Tom’s biological son, Paul is faced with the greatest challenge. In focusing on Paul’s treatment, the concentration will be on how he is handling Tom not being his father and what culpability he places on both himself and his mom. Although Lucy is the youngest and only five years old, she will still deal with the loss of her father’s absence from the home. The focus for Lucy will be on how she is dealing with the divorce of her parents.

While not all divorces or its’ impact on children are the same, there is still a sense of frustration, sadness, and angry, however with the proper treatment and coping strategies, they can move forward better able to cope with the stress of not having both parents in the home and become more flexible, tolerant young adults. The results of the evaluation will be important in deciding whether another treatment method will be considered for the family.

References