Family therapy history theory and practice 6th edition

Treatment Plans

Michelle Blau

Walden University

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Treatment Plans

Treatment planning is crucial to the effective and ethical application of counseling

services (Gehart & Tuttle, 2003). They are created with the intention to convey the counselor’s

proposed strategies, client’s concern/goals, and experienced symptoms by way of an organized

and systematic document (Gehart & Tuttle, 2003). Treatment plans can take many forms and are

to be continuously updated and revised throughout the three phases of counseling: early, middle,

and closing/termination (Gladding, 2015). Though flexible in format, there are two basic

classifications of treatment plans: Symptom-based and Theory-based (Gehart & Tuttle, 2003).

Herein, Symptom-based plans are developed from a medical perspective where by symptoms are

identified, measurable goals are set, and therapeutic interventions are detailed (Gerhart & Tuttle,

2003). It is important to note that symptoms in this context are strictly defined in a psychiatric

sense. The second form of treatment planning is Theory-based. These plans are derived within

the context of a therapeutic model and incorporate a broad range of information including a

greater overview of the problem, socio-cultural influences, client perspective, and the

counselor’s theory (Gerhart & Tuttle, 2003). Using the perspectives of Bowenian and Structural

Family Therapy, the following are simulated Theory-based treatment plans written on behalf of

the volunteer family Adrian, Judy, and Pam.

Bowenian Family Therapy Treatment Plan

Problem: Pam is an adult woman living with her aging parents, Adrian and Judy.

Pam experiences an undefined developmental disability and struggles with

openly and clearly communicating- predominately related to emotions and

feelings. According to Adrian and Judy, Pam will often exhibit aggressive

behaviors and thus it is believed that she experiences a great deal of

Commented [LS1]: Excellent introduction – just be sure to cite any media used.

Commented [LS2]: Use APA heading format

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unresolved anger/resentment towards her parents. There is a clear

maladaptive triangle wherein Adrian and Judy’s marital relationship is

neglected because their focus remains heavily rooted in the anxieties of

their daughter’s behaviors and symptoms (Gurman, Lebow, & Snyder,

2015). Pam lacks a meaningful social support network. The family at large

lacks general insight around Pam’s behaviors, including Pam herself. All

three individuals express anxiety, sadness, fear, and confusion around the

relationship patterns; there is love and a desire to be better connected

amongst all three members.

Early Phase Goals:

1. Create a therapeutic environment and a genuine connection with the family.

a. Open the closed-system family dynamic.

b. Identify transgenerational dysfunction.

c. Identify structure, configuration, and connectedness.

2. Reduce anxiety around the stated problems, by raising Pam’s differentiation.

a. Obtain internet to allow Pam a meaningful activity.

b. Increase Pam’s access to socialization opportunities and friend base.

Middle Phase Goals:

1. Neutralize the dysfunctional triangle.

a. Improve Pam’s and Judy’s relationship.

i. Reframe how family view’s Jessie and Pam’s relationship.

ii. Set a time for Pam and Judy to spend time with one another.

1. On Pam’s time table / using Jessie’s formula.

Commented [LS3]: Excellent application of the theory in defining the problem.

Commented [LS4]: What might a Bowenian theorist call these stages?

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b. Continue to address Pam’s need to increase differentiation.

i. Increase her overall independence in order to decrease her

reliance on parents.

ii. Decrease anxiety around parent’s dying.

2. Address multigenerational family dynamics.

a. Address loss of family members.

b. Address son’s suicide and associated feelings.

Closing Phase Goals:

1. Confront Pam’s fears (Guerin, 1:11:1).

a. Improved social life

b. Improved communication.

2. Confront “strong-will and strong-head” personality traits (Guerin, 1:13:56).

Theoretical Interventions & Proposed Outcomes:

1. Genogram: a graphic chart utilized to map the familial relationships and

lifecycles of a three-generational system (Gladding, 2015). Herein, the

dynamics, rules, associations, boundaries, and structural patterns within a

family are highlighted and organized (Gladding, 2015).

a. A genogram will offer a succinct and pictorial account of Adrian,

Judy, and Pam’s closed family system. It will abridge the sizable

amount of demographics and historical data that will shed light on the

intricate patterns which drive the family dysfunctions and maladaptive

behaviors (Gladding, 2015). This intervention provides an organized

Commented [LS5]: Review APA for correct way to cite – great attempt though!

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tracking system and offers the counselor an opportunity to engage and

connect with the family.

2. Relationship Experiments: tasks assigned, by the counselor, to each individual

family member in order toto initiate the process by which dysfunctional

patterns are reframed and diluted (Gladding, 2015).

a. After a counselor has successfully identified the maladaptive life

cycles and patters that cause distress within the family system, targeted

tasks can be ascribed with the intention of rebuilding new and

productive patterns.

Structural Family Therapy Treatment Plan

Problem: Adrian and Judy are generally frustrated by the therapeutic process. Their

goals have not been met within their previous sessions and not enough

improvement has been made. The parents of Pam, their adult daughter, do

not feel that Pam communicates in a positive and healthy manner. Pam has

a tendency totends to react violently out of pent up anger but is unable to

appropriately express her emotions and their inception. It is believed by

tThe family believes, that Pam is more aggressive and more easily angered

by Judy rather than Adrian. Judy expresses frustration by this disparity.

Pam relies heavily on her parents to provide her basic Activities of Daily

Living such as meal preparation. This is an area of contention between

Pam and Judy. It is a collective belief that Pam is spoiled by her parents.

When she does not get her way, Pam will experience a tantrum-like

behavior. Commented [LS6]: Good work applying the theory.

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Early Phase Goals:

1. Joining and Accommodating: establish the counselor as the leader while

adapting to the family’s patterns and worldview.

2. Mapping Family Structure: identify primary systemic patterns of interaction.

a. Focus on day-today interactions in order to shed light on family’

underlining conflicts- primarily between Pam and Judy

b. Compare these transactional patterns to those of Pam and others: such

as co-worker, supervisor, friends, etc.

Middle Phase Goals:

1. Highlight appropriate boundaries.

a. Redistribute power and alter the hierarchical relationship between Pam

and Judy.

b. Improve problem solving skills.

i. Provide psychoeducational training on conflict management

skills.

2. Identify the family subsystems.

a. Covert coalition

Closing Phase Goals:

1. Intervene:

a. Improve communication between all members of the family.

b. Repetition of message.

i. Do not allow Pam to dictate transactional patterns.

Commented [LS7]: How might a structural family theorist label the stages?

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2. Reestablish appropriate and healthy boundaries.

a. Pam will ask her parents to maintain boundaries and to not give into

her spoiled tendencies.

b. Start with small day-today tasks such as making breakfast on Sunday

morning.

Theoretical Interventions & Proposed Outcomes:

1. Spontaneous behavioral sequences: an intervention wherein a counselor hones

in on unprompted interactions between family members. These scenarios

provide a glimpse into the natural mannerisms and interactions between

family members (Gerhart & Tuttle, 2003).

a. When a spontaneous interaction occurs, a counselor focuses on the

relational process and assists the family in understanding their

behavioral sequences (Gerhart & Tuttle, 2003). A counselor will direct

these interactional patterns towards a healthier and mutually beneficial

foundation.

2. Enactments: similar tolike spontaneous behavioral sequences, enactment is a

technique wherein the counselor directly tasks the family with reenacting

natural behavior/interactions in order to observe their genuine and unaltered

exchanges (Gerhart & Tuttle, 2003). Enactments provide the counselor with

the opportunity to make assessments regarding the familial structure,

subsystems, and transactional patterns (Gerhart & Tuttle, 2003).

a. The use of enactments presents an opportunity for counselor

observation, assessment, and confrontation as well as client reflection,

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and response (Gerhart & Tuttle, 2003). This intervention is also useful

in allowing the counselor an opportunity to provide the family with

alternative behaviors, communication patterns, and interactions.

Conclusion

Treatment plans should consist of two components: goals and interventions (Gerhart &

Tuttle, 2003). While traditionally following basic outlines and formats; they are also individually

tailored to the client’s needs and the counselor’s theoretical approach. In addition to the

theoretical model, presenting problem, and proposed interventions/goals, treatment plans should

also provide contextual information such as separating a parent’s needs from that of their child’s

(Gerhart & Tuttle, 2003). In general, a treatment plan that is well structured and written

irrespective of third-party mandates for reimbursement, creates opportunity for organized and

coordinated efforts as well as effective treatment probabilities (Gerhart & Tuttle, 2003).

Commented [LS8]: Excellent work.

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References

Gehart, D. R., & Tuttle, A. R. (2003). Theory-based treatment planning for marriage and family

therapists. Belmont, CA: Brooks/Cole.

Gladding, S. T. (2015). Family therapy: history, theory, and practice (6th ed.). Boston: Pearson.

Gurman, A. S., Lebow, J. L., & Snyder, D. (2015). Clinical handbook of couple therapy (5th

ed.). New York, NY: Guilford Press.

Psychotherapy.net. (Producer). (n.d.). Bowenian family therapy [Motion picture]. [With Philip

Guerin, MD]. United States: Psychotherapy.net. Retrieved from the Walden Library

databases

Psychotherapy.net. (Producer). (n.d.). Structural family therapy [Motion picture]. [With Harry

Aponte, LCSW]. United States: Psychotherapy.net. Retrieved from the Walden Library

databases.

Excellent application. I could clearly see how you were applying the theories and that

you could differentiate the theories as well. Well done.

Commented [LS9]: Remember that citations and references must match. Also, in APA, when two citations are the same, you must distinguish which citation represents which reference by using

a lowercase letter in the year. See APA manual for when and how to do this.