Vignette Analysis III

Pauline and Miriam are a lesbian couple in their mid 20’s. Pauline is Japanese American and Miriam is White. During the intake, Miriam discloses that she was sexually abused by her grandfather and has never told anyone until she met Pauline. Pauline discloses that her parents were culturally traditional, very strict and that it was her obligation to honor her family. Miriam discloses that both her father and grandfather are alcoholics. She admits to struggling with alcohol and cocaine herself, but says she is currently drug free and only drinks 1-2 glasses of wine per week. You notice Pauline rolling her eyes as Miriam speaks.

The couple was referred for family therapy by their adoption agency. They are in the process of adopting 2 children, both female. The girls are natural sisters, ages 2 and 4. They were abandoned by their drug addicted, natural mother 8 months ago. The natural father is unknown. As part of the adoption process, they are required to participate in 10 family sessions to assure the health and well-being of the children. Both women are well-educated professionals. Pauline complains that Miriam is an indulgent parent, “she buys them whatever they want and can’t say no”. Miriam says that Pauline, “is ridiculous. She expects the girls to be perfect. After all they’ve been through, they deserve to be spoiled”. During the session, the sisters start to scuffle with each other. You notice bruises on the upper arms of the 2-year-old.

  1. Utilizing the information in the reading assignments, in consideration of ethical, cultural and diversity factors, discuss how you would formulate therapy for this family?
  2. In cases of substance abuse, unhealthy or dysfunctional methods of responding to the abuse are common. How is this illustrated in this case vignette? How would you incorporate this in treatment?
  3. Discuss your treatment of this family with regard to each of the following:
  • Solution-Focused Therapy
  • Narrative Therapy
Full Answer Section

Treatment Goals

Some possible treatment goals for this family include:

  • Reduce Miriam's risk of relapse: This could involve developing a safety plan, attending substance abuse counseling, and/or participating in a support group.
  • Address Miriam's childhood trauma: This could involve individual therapy, group therapy, or other modalities.
  • Develop a more unified parenting approach: This could involve teaching parenting skills, conflict resolution skills, and communication skills.
  • Promote cultural competence and understanding: This could involve educating the family about different cultures, values, and beliefs.

Solution-Focused Therapy

Solution-focused therapy is a brief-term approach that focuses on the present and the future, rather than the past. It is a goal-oriented approach that helps clients to identify and achieve their desired outcomes.

In the case of this family, solution-focused therapy could be used to help them to:

  • Develop a parenting plan that works for both Pauline and Miriam.
  • Identify and address the triggers that lead to Miriam's substance abuse.
  • Develop coping mechanisms for dealing with stress and conflict.
  • Set and achieve goals for their family.

Narrative Therapy

Narrative therapy is a post-structuralist approach that helps clients to deconstruct and rewrite their stories. It is a collaborative approach that emphasizes the client's expertise.

In the case of this family, narrative therapy could be used to help them to:

  • Develop a more positive and empowering narrative about their family.
  • Externalize the problem (e.g., "substance abuse") and separate the person from the problem.
  • Identify and highlight the family's strengths and resources.
  • Co-construct a new narrative about their family that is more hopeful and inspiring.

Treatment of Substance Abuse

In cases of substance abuse, it is important to create a safe and supportive environment for the client. It is also important to be aware of the stages of change and to tailor treatment accordingly.

In the case of Miriam, it is important to assess her readiness for change and to develop a treatment plan that is appropriate for her stage of change. It is also important to provide her with resources and support to help her stay on track.

Conclusion

This family is facing a number of challenges, including substance abuse, parenting challenges, and cultural differences. However, they are also a resourceful and resilient family. With the right support, they can overcome their challenges and build a bright future for themselves and their children.

Sample Answer

Formulation of Therapy

When formulating therapy for this family, it is important to consider the following factors:

  • Substance abuse: Miriam's history of substance abuse is a significant concern. It is important to assess the extent of her current use and to develop a safety plan in case of relapse. It is also important to address the underlying issues that may be contributing to her substance abuse, such as her childhood trauma.
  • Parenting styles: Pauline and Miriam have different parenting styles, which can lead to conflict. It is important to help them to develop a more unified parenting approach.
  • Cultural and diversity factors: Pauline is Japanese American and Miriam is white. It is important to be aware of the cultural differences that may be at play in this relationship. It is also important to be inclusive and respectful of all family members.