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CNL-521 Topic 8: Vargas Case Study Discharge Summary Outline

Directions: Review the Vargas Family Case study again in its entirety. Consider the progress over the past eight sessions. Complete the sections outline below as your discharge summary for the Vargas family.

1. A brief summary of what was going on with the family at the onset of counseling:
   1. At the onset of counseling, the Vargas Family presents relationship, behavior, communication, and boundaries problems. There are increased marital tensions between Elizabeth and Bob. Elizabeth is experiencing low self-esteem, stress, and depression due to Frank’s impulsive and recent changes in behavior. Bob is frustrated of Elizabeth and blames her of overreacting and defends Frank’s behavior citing that this is normal for boys. Also, Bob’s frustration is making him uncomfortable talking his bondage and feelings with Heidi his daughter. Frank is labelled bad and the cause of all problems into the family because of his unusual behavior he exhibits both at home and in the school. Elizabeth and Heidi blame Frank for all Vargas family problems. Bob and Elizabeth have parenting discord and are no longer collaborating to parent their children. Heidi and Frank are not together bonded and each has attached themselves to same sex parent, this is unhealthy for the Vargas family.
2. A review of the initial treatment goals:
   1. Vargas family initial treatment goals are centered more on improving communication quality for the whole family. Elizabeth needs improved self-concept, improved self-esteem, and improved/ proper understanding of Bob’s intimacy concerns. Bob and Elizabeth seek to reestablish their marriage and to partner together in bringing up Frank and Heidi. The other goal is to understand the cause of Frank’s impulsive behaviors and finding means to transform him. Last is to understand Heidi needs as a child.

• Theories and interventions used
  1. Week 1: Family assessment and rapport building
     1. Family assessment was used to guide the therapist so as to improve the understanding of Vargas family functioning patterns. This assessment helped the counselor in choosing the right intervention in the context of the Vargas family’s presenting problem. Also, it helped the counselor determine the urgency of family issues, access the problem-solving skills of the family, identify needed changes, and set counseling goals for the next sessions.
     2. The main intervention used in session 1 was rapport building. In rapport building, the counselor used his active listening skills to understand the Vargas family and their story. The counselor showed empathy for each member of Vargas family which helped establish a strong counseling alliance. Each member was given an equal opportunity and hence helped build a strong rapport with the counselor.
  2. Week 2: Cognitive Behavioral Therapy and Psychoanalytic theory
     1. The two psychoanalytic interventions used in treating the Vargas family were free association and interpretation. These two interventions were done through talk therapy which sought to dig dipper into Frank’s unusual behavior and address the problem to help restore unity in the family. Interpretation enabled the counselor provide the right treatment.
     2. From a cognitive-behavioral perspective, the counselor used guided discovery and cognitive reframing interventions. Under guided discovery, the counselor listened to both Bob and Elizabeth’s opposing views towards Frank’s behavior. Under cognitive reframing, the counselor asked the Vargas family of their thoughts to restructure a positive pattern of thoughts amongst all.
  3. Week 3: Bowen Therapy
     1. In session 3, Elizabeth and Bob, after discussing the history, structure of family, and their childhood events, the counselor tasked them to each create a genogram or family tree to show if there is any connection between their ongoing family issues to their backgrounds/ origin. The counselor wanted to explore both positive and negative connections. Some concepts applied here included differentiation of self, emotional fusion, and emotional triangles.
  4. Week 4: Structural family therapy
     1. The two structural interventions applied in the Vargas family include role-play and observation. Here, the counselor used the genogram/ family diagram drawn by Bob and Elizabeth to identify the hierarchy, boundaries, subsystems, and sub-relationships within the family which are connected to their family backgrounds and history. This helped understand the family problems better.
     2. In role-play, Elizabeth and Frank role played by arguing in front of Heidi and Frank. In this situation, Elizabeth was unable to calm down. The counselor took notes out of this argument over how Bob reacts to Elizabeth in support of Frank’s behavior. Also, counselor took notes over Heidi’s feelings when Bob cannot defend him from Frank’s damaging and hurting behavior.
  5. Week 5: Strategic Family therapy
     1. Bob and Elizabeth were tasked to help Frank seek attention from his peers other than focusing on his parents. Bob and Elizabeth were to get Frank enrolled in a sport, group, or activity where he has peers of his age to help, support, or encourage him form bonds and friendships with the peer group members.
     2. Another intervention used was activity scheduling. The counselor told Bob and Elizabeth to schedule good time alone in absence of Frank and Heidi. In this time, the counselor encouraged them to feel open through which they will get to know each other in a better way and discuss the matters they need to partner together in addressing like the pillars of the family.
  6. Week 6: Experimental Interventions
     1. The three experimental interventions used in session 6 were beach balls, the family gift, and penny for your thoughts. In the beach ball experiment, Elizabeth and the family were asked to write their emotions, sad, frustration, lonely, or joy on the ball. All tossed the ball back and forth, and all had equal opportunities to describe a time they experienced the emotion facing them
     2. In the family gift intervention, this sought to break the ice and enable the family to have fun. It made members of Vargas family to understand each other better and also provoked a thoughtful discussion. Also, the counselor understood each family member better through this approach.
     3. Under penny for your thoughts, this helped start the self-disclosure process through which nonthreatening family activities were used. In this intervention, the family was able to use humor. In the end, the exiting gap in emotional congruence was closed.
  7. Week 7: Re-authoring conversations
     1. In a series of scaffolding questions, Bob’s story of not partnering with Elizabeth to correct and discipline Frank and his frustrating behavior of blaming and accusing Elizabeth of overreacting was reauthorized. This was done using two questions, one on landscape of action and the other on landscape of identity questions.
  8.  Week 8: Integrative family therapy models
     1. The two integrative couples/ family models used include the integrative problem-centered therapy (IPCT) and client-directed outcome-informed therapy (CDOI). In the context of Vargas family, IPCT would help the counselor in treating both the family and individual problems including behavior, communication, and psychodynamic problems.
     2. Using CDOI, the counselor would use preferences and ideas proposed by the Vargas family in making treatment decisions. Frank would benefit from CDOI since his parents will be encouraged to enroll him into sports where he seems to enjoy more fun and make more bonds with peers at. The therapist would form a strong therapeutic alliance which is more solution-focused than problem based.
  9. A brief discharge summary for the family treatment:
     1. Throughout all the therapy sessions, the Vargas family showed significant improvement. Each members of the family expressed satisfaction in the counseling process and the techniques adopted by the therapist to treat the family. The clients were pleased with the rapport established since the start until the end; all showed the desire to experience positivity in their relationship and interaction patterns. The entire family showed improvement in their ways of communications and interactions. Bob credited Elizabeth and expressed how important she was to the family. Elizabeth showed willingness to relax; she proved to Bob that she loved and was proud of him. Both Frank and Heidi showed increased level of comfortableness with their parents, and even Frank learned to be compassionate and quiet when his parents were expressing their feelings about him. The marital tension between Bob and Elizabeth has considerably decreased and eased down. Such kind of interaction was impossible in the 1^st session when the Vargas family came to seek for therapy.
  10. Clinical recommendations for sustained improvement or referrals for additional services:
      1. Each member of the Vargas family has made significant progress to recovery. In advanced sessions, I recommend individual therapy in which each individual client would be treated on a one-on-one basis with a counselor.
      2. Also, I recommend that continued therapy starts with marriage /couples therapy for Elizabeth and Bob to help strengthen their relationship and understanding of collaborative parenting roles when their children need support, correction, and encouragement while pursuing individual child therapy.