Ana García comes from a financially struggling Hispanic family . Ana envisions attending college to pursue her ambition with the support of her father, Raúl, and her sister, Estela. However, her mother, Carmen, does not buy that idea. There is a conflict between mother and daughter is due to age and traditional differences. Carmen embraces traditions who wishes her daughter could lose weight so that men can like her, join her sister in their dressmaking business, and get married. To justify her perceptions, Carmen argues that if Ana attends college in New York, it will split the family. Her mother knows that a college education will bring Ana exposure, which will influence her to change. Interestingly, Carmen is also an overweight woman who justifies her weight, saying that she is already married. On the other hand, Ana has a different perception as she does not buy any of her mother’s ideas. She is after pursuing her college education and later find true love. Moreover, Ana confidently states that she is proud of her body regardless of how people see her. Her perceptions seem to upset her family. These disagreements (family fights) seem to ruin the relationships within the family.
During the summer holidays, Ana returns to Los Angeles from New York to reunite with her cross-generational family. However, she reports having problems relating to others at school, although she performs excellently in her academics. Ana’s family lives in a predominantly Latino neighborhood; thus, coming from an immigrant community with people of color, Ana finds it hard to make friends during her stay at the college. Likewise, being a first-generation college student in their family makes it difficult to share her college experiences with other family members. Basically, Ana's family is uninformed of college, making it difficult for Ana to share her experiences with them.
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Marriage and Family Therapy (MFT) Theory
Murray Bowen’s Family Systems Theory
I will use Murray Bowen’s family systems theory to solve the family relationship issues with Ana’s family. This theory views families as emotional units, where the family members are intensely connected emotionally through thoughts, feelings, and actions (Watson, 2012). This theory holds that family members are inseparable from their emotional relationships, making them interdependent (Watson, 2012). Consequently, a change in one member's functioning influences a change in the other members. In other words, the interdependence between the family members makes them react to each other’s needs, expectations, and anxieties. Thus, the emotional interdependence of family members promotes cohesiveness and cooperation. Further, when tensions among the members heighten, they adversely affect the family functionalities that promote unity, leading to problems (Watson, 2012). For instance, tensions with one family member can spread infectiously to the rest, which stresses the family members' emotional interconnectedness.
The accommodating family members, when tensions arise, absorbs the system anxiety, making them more vulnerable and consequently affecting their daily activities (Brown, 1999). There are eight concepts in Bowen’s theory. Among these concepts is the emotional fusion and differentiation of self concept, which the theory centers around. The differentiation of self concept "refers to an individual’s ability to maintain a self-directed, principle-driven course of action while maintaining contact with emotionally significant others” (Watson, 2012, p.188). In Bowen’s differentiation scale, people with the lowest scores of differentiation levels are considered the symptom bearers of the family fusion; hence, increasing the differentiation of Self leads to less emotional reactivity, calm emotions, less vulnerability to stress, etc.
Therefore, based on Bowen’s theory, Ana’s family can be conceptualized based on the emotional fusion and differentiation of self concept. Brown (1999) describes differentiation “as the capacity of the individual to function autonomously by making self directed choices, while remaining emotionally connected to the intensity of a significant relationship system” (p.2). Carmen, Ana's mother, doesn't seem to be getting along with her daughter due to their disagreements. Carmen wishes her daughter could lose weight, join her sister in their dressmaking business, and get married. However, Ana disagrees with her and continues to attend college in New York. Ana’s decisions seem to have affected the family adversely. As her parents claim, since joining college, they have been struggling financially due to the working gap left by Ana. Therefore, Ana is stranded in making decisions between returning to college or staying back to reunite with her parents. Although Ana has stood her ground on the past occasions, she is stranded that her decisions may leave her family more vulnerable.
Assessing the Problem
The differentiation of self inventory-revised (DSI-R) developed by Skowron and Schmitt in 2003 will be used to assess the presenting problem. Mustaffa et al. (2013) note that culture influences how people interpret items on family assessment tools; thus, standardized tools and instruments should be used for validity. The DSI-R is a standardized modification of the original DSI developed in 1998 by Skowron and Schmitt. There is well-documented literature that suggests that differentiation of Self is highly correlated to psychological variables, such as anxiety, depression, and relationships (family functioning) (Neophytou et al., 2020). Therefore, the DSI-R has been validated to assess the dimensions of differentiation, namely the intrapsychic and interpersonal dimensions (Neophytou et al., 2020). The DSI-R has subscales “Emotional Reactivity (ER), I Position (IP), Emotional Cutoff (EC) and Fusion with Others (FO) scales” (Neophytou et al., 2020, p.3). The IP and ER subscales have eleven items each, while the FO and EC subscales have twelve items each (Neophytou et al., 2020). The intrapersonal dimension will be assessed using the IP and ER subscales, while the interpersonal dimension will be assessed using the FO and EC subscales.
Anna and her parents will be given the subscales containing the items to fill. They will be required to rate the items on a six-point Likert scale (1=extremely false of me 6=extremely true of me). I will clarify to the family members in case of discrepancies with the items, but I will not influence their answers. I will then analyze the ratings to determine each family member’s level of differentiation of Self. High scores will indicate that the family members have high differentiation levels, while low scores will indicate emotional fusion.
Assessment in counseling is crucial as it enables the therapist to collect all the necessary information about the person or family. According to Mustaffa et al. (2013), assessments help the therapist to understand and predict their clients’ behaviors. Varghese et al. (2020) also assert that family therapists don't concentrate on a single cause of the problem but rather try to solve their problems. Therefore, the therapist must know how each family member has been fairing during family counseling and their future aspirations. Since clients seek therapist sessions for various reasons, the counselor needs to unearth all factors leading to the problem. As Mustaffa et al. (2013) asserted, the success of family therapies depends greatly on the assessment's accuracy, which helps understand the nature of the family problems and come up with an effective solution. Therefore, I will assess all family issues faced by Ana’s family to develop an effective solution that can facilitate change in Ana’s family. Consequently, I will use a multi-dimensional assessment approach, such as self-reports, interviews, and observations of the family interactions during sessions. This will enable me to have a clear picture of the family relationships and determine other underlying issues.
Promoting Initial Investment in the Therapeutic Process with the Family
It cannot be denied that therapy sessions' effectiveness depends on the relationship between the counselor and their clients; therefore, counselors must invest in client engagement. Good Therapy (2019) website reports that approximately 20% of clients exit therapy prematurely. Among the common reasons highlighted for these early exits is poor bondage between them and the counselor. Clients will only be honest and open while sharing their problems when trust is between them and the counselor. Therefore, therapists should strive to create deep connections with their clients, leading to effective therapy sessions. According to Meyers (2018), therapeutic alliances have the following dimensions: the establishment of common goals, collaborating on counseling-related tasks, and formation of an emotional bond. These dimensions are primarily influenced by specific therapist behaviors.
During the first session, I will ensure that I create a match between myself and the clients by establishing a commonly shared baseline. This will call the therapist to learn the client’s worldviews. For instance, in this case, Ana’s mother is a traditionalist while Ana is a modernist woman. Understanding such differences will enhance cooperation in future sessions. Likewise, I will also try to improve the physical environment where the sessions will b conducted to encourage the clients to continue with the sessions. To understand their needs, I will ask for feedback after the first session in a non-judgmental way. This will enable me to understand the clients’ specific needs and make improvements where necessary. Moreover, I will not rush to create trust bondage with the clients. Trust is hard to earn and should be treated as so. Therefore, I will treat the first sessions as surface-oriented with occasional disclosures. However, early interactions with the clients matter in accelerating trust bondage; for instance, showing empathy with the clients when appropriate accelerate trust creation.
During the first session, I will get the opportunity to know Ana's family members and how they relate. During this session, I will review the informed consent form, the document containing the therapy framework, to explain the terms of engagement to the clients. After the first session, I will schedule separate meetings with the parents and Ana. Most therapists will want to meet with the whole family together for the first meeting. From there, some therapists like to schedule separate meetings with the different subsystems- maybe just the parents together or the children alone to address specific concerns. Others prefer to work with all members together. The confidentiality of the family members will be maintained throughout the sessions. I will then work together with Ana and her parents in the same sessions near the end of the therapy sessions to ensure that the issue has been resolved and change achieved.
Conceptualizing the Family Therapy Goals Based on Murray Bowen’s Theory
As discussed earlier, the main goal with Bowen’s theory centers around the differentiation of Self. This enables individuals to balance their emotional and intellectual functioning as well as intimacy and autonomy in a relationship (Neophytou et al., 2020). As asserted by Neophytou et al. (2020), highly differentiated people are value-oriented, goal-directed, self-confident, and capable of maintaining a well-defined self in close relationships within and outside their families” (p.2). Therefore, family therapies should focus on improving the level of differentiation with the members leading to greater satisfaction in life (Işık et al., 2020). The therapy sessions' main goals with Ana’s family will be to promote autonomy by eliminating family disagreement and helping Ana pursue her college dreams.
The goal-setting process provides the therapist and the clients with a clear roadmap to solve the existing problems and achieve desired changes. Establishing and setting these expectations with the clients will promote positive changes. The goal-setting process will entail probing the clients’ problems so that I can establish the clients’ expectations from the therapeutic process, challenges hindering them from achieving the desired changes, and their motivations towards achieving the identified changes. Moreover, I will have to ensure that the goals set follow the SMART (Specific, Measurable, Achievable, Relevant, and Time-bound) golden rule. Following this rule will ensure that the desired changes are effectively achieved, making the therapy a success.
Family Therapy Intervention Techniques
Self differentiation has two major aspects, intrapsychic and interpersonal differentiation, that therapists should focus on. Intrapsychic differentiation is more about having self-awareness, while interpersonal differentiation is how people relate with those they are connected with; that is, understanding their emotions. With these aspects, people can effectively become aware of their situations and take actions that do not jeopardize the unity and relationships among people. Therefore, Bowen’s theory holds that people do not exist in isolation. The interactions and emotions of people they are connected to influence them in part. This can be explained through studies on emotion transmission and emotion convergence. According to Zheng et al. (2020), emotion transmission focuses on emotional contagion among group members. On the other hand, as defined by Parkinson (2019), emotion convergence focuses on group members becoming assimilated emotionally over time. Thus, the family emotional systems are created to influence an individual’s emotions and sense of self.
The interventions will be based on these two aspects of differentiation. Firstly, the intervention will focus on mindfulness, which emphasizes being present. Mindfulness calls for people to be aware of each emerging moment, where people examine experiences with acceptance and in a non-judgment way (Foose & Cicio, 2018). Cultivating the state of mindfulness encourages people to be independent thinkers while airing their perceptions and responses. Therefore, people can experience life events in the present as they unfold with courage, which releases the mind from negative thoughts and feelings (Foose & Cicio, 2018). This approach will help the clients escape their differences based on their past by eliminating fears and anxiety, which will improve their self differentiation.
Secondly, the intervention will focus on promoting compassionate listening among the family members. Ana and her mother have a history of engaging in heated arguments due to their differences. Therefore, the intervention will focus on improving their communication through compassionate listening. Compassionate listening allows people to listen to each other in a non-judgmental way (Foose & Cicio, 2018). People can tolerate each other’s emotions without getting overwhelmed. This helps people develop empathy, which is caring about each other’s feelings. People can develop acceptance, which creates space for self-awareness. Consequently, this leads to transformations of people, making the therapy a success.
Ethnic, Socio-cultural, Contextual, and Gender Issues
Ana represents the limited choices women within contemporary America have. She is out to resist the institutionalization of patriarchy in the family structure and labor market. Further, Ana is dedicated to making her sexual expressions known. However, in her path to self-awareness through urban experiences, Ana faces several obstacles while resisting cultural values and clashes with her mother, who embraces values with the older generations. Ana comes from a Latino community in Los Angeles, with people facing economic and physical hardships. For instance, all family members rely on each other's contribution to the labor force to survive. Therefore, Ana’s crossing to New York for a college education also means that she also traverses her social class. While chasing her dreams, Ana gets to learn different social experiences, which had been separated from her by her community's boundaries.
Cultural tensions amongst different generations are portrayed in Ana’s story. Carmen, Ana's mother, is portrayed as the patriarchal head of the family. Ana and her mother are at loggerheads on the politics of body and sexuality. Mother and son can’t agree on what constitutes a woman’s physical appearance to attract husbands, sexual expressions, and ladylike behaviors. These disagreements arise as the younger generation is exposed to urban neighborhoods. Unlike her mother's older generation, Ana and her sister Estela don’t prefer to get married as the primary goal. The two ladies are determined to make their lives better on their own through hard work and academics. Ana understands that her dreams can only be achieved by cutting herself from the family constraints that lead to regular disagreements. Her mother seems determined to make her daughters follow the traditions, which has been the cause of family disputes.
The focus of modern family therapy has shifted to gender and cultural awareness. According to Awosan et al. (2017), although grouping people based on their external markers has no biological basis, it should be included in cultural competency discussions. Awosan et al. (2017) define culture as “the ways in which gender, race, ethnicity, class, sexual orientation, religion, nationality, etc., shape individuals’, couples’, and families’ ideologies, values, and relationships” (p.2). These cultural issues impact the therapeutic relationship and the process significantly. Therefore, therapists must consider cultural backgrounds and gender issues of their clients throughout the therapy. This calls for therapists to appreciate and have knowledge while attending to the cultural similarities and differences with their clients and how it influences theirs.
I will use the Multicultural Relational Perspective (MRP) as proposed by Awosan et al. (2017). This model highlights core competencies that treat relationships as cross-cultural. The (MRP) has three interrelated dimensions: “(1) reality is a subjective experience; (2) the “self” is a major organizing principle in relationships; and (3) the “self” is comprised of multiple dimensions” (Hardy, 2018, p.17). Focusing on these dimensions helps therapists navigate through conversations of diversity with their clients effectively.
Assessing Therapy Progress
Therapy outcomes are measured so that the therapist and the client can determine whether the intervention is helping. This also helps the therapist know whether to terminate the therapy process or change the intervention techniques (Walton, 2019). Tracking the progress of clients in therapy helps to guide or adjust interventions. It allows the clients and their therapists to identify what works, doesn't work and adjustments needed if it has been determined that the therapy is ineffective (Walton, 2019). Moreover, it can help families save costs if the therapy's objective has been achieved or avoid wasting resources on ineffective interventions. According to Walton (2019), the clients' early improvements indicate that the therapy has is being effective. Contrary, if the client does not record any positive change between the first four to six sessions, there is a high likelihood that they won't make significant changes for the rest of the therapy (Walton, 2019). In that scenarios, significant changes to the intervention strategies used are needed.
Among the various evaluation techniques is the use of checklists. The clients and the therapists establish common and specific goals and objectives to be achieved before therapy sessions can begin. The therapist regularly and objectively evaluates their clients' progress based on the accomplishment of these goals and objectives. During these evaluations, I will give the clients items with the Outcome Rating Scale (ORS) during every session. The completed ratings will be evaluated to determine the progress of the therapy. Improved levels of independent decision-making with Ana and her parents would indicate progress with the therapy. Likewise, improved personal interactions by being respectful, showing empathy, and affirming own values will also indicate progress with the therapy. After determining that the therapy sessions have been effective, I will communicate with the clients earlier about the possibility of terminating. Together, we will set a date where the final session for termination can take place. The final session will take place with all family members present. However, after the therapy is terminated, I will make a three-month follow-up.
Therapist Issues Likely to Emerge
Some of the problems I anticipate I will face relates to handling Ana’s mother. Her cultural values differ significantly from the rest of the family. Likewise, these values also differ from my cultural values. Being a stubborn woman, she will likely fail to participate in the consequent sessions. This could make me feel upset and angry, which could ruin the rest of the sessions. Likewise, I understand that Ana’s parents reluctantly agreed to come for the first session; they may attend the subsequent sessions without the intention to change, which will jeopardize my work. I understand that some people resist change as it will require them to adjust to the norms. Failure to change will likely impact my work as a reputable therapist. Moreover, I also anticipate suffering from burnout, which could impact my professional life. The Center For Substance Abuse Treatment (2012) warns that counselors risk their personal lives at risk while dealing with complex caseloads. This consumes much of the counselor's personal lifestyle, which poses a challenge to their productivity.
References
Awosan, C. I., Curiel, Y. S., & Rastogi, M. (2017). Cultural Competency in Couple and Family Therapy. Encyclopedia of Couple and Family Therapy , 1–8. https://doi.org/10.1007/978-3-319-15877-8_472-1
Brown, J. (1999). Coming to grips with family systems theory in a collaborative, learning environment. Bowen Family Systems Theory and Practice: Illustration and Critique. Journal of Family Therapy (ANZJFT) , 20 (2), 94–103. https://www.thefsi.com.au/wp-content/uploads/2014/01/Bowen-Family-Systems-Theory-and-Practice_Illustration-and-Critique.pdf
Center For Substance Abuse Treatment (U.S. (2012). Substance abuse treatment for persons with child abuse and neglect issues. U.S. Department Of Health And Human Services, Public Health Service, Substance Abuse And Mental Health Services Administration, Center For Substance Abuse Treatment.
Foose, K., & Cicio, M. (2018, February 7). Differentiation of Self through the lens of mindfulness . Counseling Today. https://ct.counseling.org/2018/02/differentiation-of-self-through-the-lens-of-mindfulness/
Good Therapy. (2019, October 1). 10 Ways Therapists Can Strengthen the Therapeutic Relationship . Www.goodtherapy.org. https://www.goodtherapy.org/for-professionals/marketing/customer-experience/article/10-ways-therapists-can-strengthen-the-therapeutic-relationship
Hardy, K. V. (2018). The Self of the therapist in epistemological context: A multicultural relational perspective. Journal of Family Psychotherapy , 29 (1), 17–29. https://doi.org/10.1080/08975353.2018.1416211
Işık, E., Özbiler, Ş., Schweer-Collins, M. L., & Rodríguez-González, M. (2020). Differentiation of Self Predicts Life Satisfaction through Marital Adjustment. The American Journal of Family Therapy , 48 (3), 235–249. https://doi.org/10.1080/01926187.2020.1732248
Meyers, L. (2018, April 2). Connecting with clients - Counseling Today . Counseling Today. https://ct.counseling.org/2014/08/connecting-with-clients/
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Neophytou, K., Schweer-Collins, M. L., Rodríguez-González, M., Jódar, R., & Skowron, E. A. (2020). The Differentiation of Self Inventory-RevisedInventory-Revised: A Validation Study in the Greek Cultural Context. The American Journal of Family Therapy , 1–19. https://doi.org/10.1080/01926187.2020.1783388
Parkinson, B. (2019). Intragroup Emotion Convergence: Beyond Contagion and Social Appraisal. Personality and Social Psychology Review , 108886831988259. https://doi.org/10.1177/1088868319882596
Varghese, M., Kirpekar, V., & Loganathan, S. (2020). Family Interventions: Basic Principles and Techniques. Indian Journal of Psychiatry , 62 (8), 192. https://doi.org/10.4103/psychiatry.indianjpsychiatry_770_19
Walton, R. (2019). Measuring Therapy Progress, Effectiveness and Outcomes | Colonial Behavioral Health . Colonialbh.org. https://www.colonialbh.org/about-us/news-and-events/measuring-therapy-progress-effectiveness-and-outcomes.aspx
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