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MinisterSalmon613
Hi How can i be critical about systemic therapy when writing a…
Hi
How can i be critical about systemic therapy when writing a formulation report on the following case. I have included reframing, circular questions and MCT therapy in the report as i think these would be beneficial. I have also mentioned the problems with triangulation. Im just not sure where to be critical on this
Case study
Jenny
You are working as a systemic therapist in a community service for adolescents with anti-social behaviour. You have your first session with Jenny, a 15-year-old female who has been referred by social care, and her family. The social worker who referred the family would like you to assess their suitability for family therapy and provide a formulation report that demonstrates how your systemic intervention could help them to overcome Jenny’s risk-taking and aggressive behaviour and related problems.
Jenny’s history and background
Jenny lives with her biological mum Jo (32y), her stepfather Smithy (40y) and her two half-brothers Theo, nine years old and John, four years old. Jo fled Jenny’s biological father when Jenny was two years old due to severe domestic violence and there has been no contact with him since. Jo suffered from postnatal depression after the birth of Jenny. She married Smithy ten years ago. The two younger boys (Theo and John) are doing well at school. Jo has given up her job to look after the children but does not feel fully satisfied with her life as a housewife. Smithy works full time as a warehouse operator and is mostly away from home as he is often working long hours (sometime seven days a week).
There has been a history of reported behavioural problems with Jenny, and the parents using harsh punishment or threats to try to control it. The problems started when Smithy moved in ten years ago. Jenny reported being hit by her mother a few years ago and made so-called ‘unsubstantiated allegations’. She also started to go missing from home two years ago, staying with family friends and not wanting to go home. The family has support from Smithy’s parents but recently they didn’t want to have Jenny any longer for respite. Jo has no contact with her parents but has a younger sister who lives not far away and who has a good relationship with Jenny.
Jenny’s current situation
Jenny’s risk-taking behaviour has increased recently, and she went missing for several days last month. Although the parents knew where she might have been, they weren’t able to get her home and felt frustrated by the police involvement as the police did not interfere in the houses where they thought Jenny went. In the last months her aggressive outbreaks have become worse. Jenny is hitting out at her mother and half-brothers about once a week and has damaged property in the house (especially in her bedroom). In a typical escalating conflict Jenny will act aggressively and ‘push her mum’s buttons’ to make her listen to her (she often feels her mum is not listening to the things that concern her), which will lead to her mum ‘shutting down’ and shouting at her in an attempt to control the situation (as she is worried the boys could be affected by the conflict, and Jenny could run away again), which gives Jenny the feeling her mum is not really interested in her concerns.
At school, Jenny is at risk of permanent exclusion due to her aggressive behaviour and her refusal to comply with some rules. She is also truanting a day a week on average. After school Jenny likes to hang around with a group of peers in the neighbourhood as she feels at ease with them. She has been involved in shoplifting and anti-social behaviour and her parents see some of her friends as ‘negative models’ for Jenny. Jenny feels she doesn’t belong at home and there is no real place for her there.
Both parents tend to allocate all problems in Jenny and think that she may suffer from a mental health problem, although the local specialist Child and Adolescent Mental Health Service (CAMHS) has ruled out any mental health diagnosis. The parents often shout at her and make threats to send her away if she doesn’t change, rather than looking at alternative ways of understanding and dealing with Jenny’s behaviour. Their couple relationship is strained by the frequent arguments they have about how to best deal with Jenny, with Smithy thinking that Jo is too soft at times but then suddenly switching to harsh punishment, with no real results. In an attempt to stop her from shoplifting Jo once posted a picture on Facebook showing a police officer and a shopkeeper questioning Jenny after she had been caught in a local shop. Jo has also walked out of the family home and disappeared for hours in a situation when she felt overwhelmed. Smithy is very worried about the impact of Jenny’s behaviour on the two younger boys.
Although the parents are somehow reluctant to accept help, as previous interventions haven’t worked, they are concerned about Jenny’s future and have quite a fatalistic view of it. They would like her to do better at school and be safe in the community. They would also like Theo and John not be exposed to aggressive and chaotic behaviours in their home anymore. They are prepared to do some work on their communication with Jenny. Jenny would like to have less conflicts and a welcoming place at home. She would also want to do some pro-social activities with her parents/family.
