Assessment and Treatment of Marital Systems Case Studies

CASE STUDY 1

The Smiths, a Caucasian couple, are referred to you after a recent argument in which the police were called to their residence due to noise disturbance. The police report states that the couple yelled loudly and broke items that caused the neighbors to call the police. The report states that neither Jen (36 years old) nor Dan (38 years old) retained any injuries from the incident, and they were intoxicated during the incident. From other paperwork, you learn that Dan drinks 8-12 beers daily and Jen drinks 3-4 beers once or twice a month. You learn that the couple has been married for 3 years, it is the second marriage for both, and neither have children. During the first session, you ask each to explain the problems from their point of view.

Dan begins, “She is always telling me what to do and nagging me. She says I drink too much but she is the one who drives me to drink! She is never happy even though her life is good, but she just wants to complain all the time.”

Jen then begins, “You drink all day every day! Ever since you went on disability from work you do nothing all day, and then by time I get home you are too drunk to go out and do anything with me. You never do anything around the house either, it is like I live with a child!”

Upon further assessment, you learn that Jen grew up with an alcoholic father who left her family when she was 11 years old. Jen also suffered from physical abuse at the hands of her stepfather. In addition, you discover that Dan has a history of depressive symptoms that may have increased due to his recent disability and the fact that he can never return to work. It seems like Dan and Jen have frequent arguments and do not possess the skills for conflict resolution.

Based on Case Study 1:

Produce a diagnosis for either or both clients using the DSM-V. Indicate what symptoms led you to the diagnosis. Describe any recommendations you have based on the diagnosis/es.
Apply Systemic Theory to this couple to develop a formulation of the problem.
Discuss how you would use Alcohol Behavioral Couples Therapy (ABCT) to begin treatment with this couple.
CASE STUDY 2

Sandra (26 years old) and Quinn (23 years old) are a lesbian couple who have been dating for 3 years and have recently moved in together. They come to you for couple’s counseling due some recent discord and difficulties adjusting to living together. One of the difficulties they have is that Sandra, who is Latina, comes from a family who is very accepting of her sexuality. Quinn, whose family is Japanese, does not approve of her same-sex relationship with Sandra. Due to these differences, Sandra becomes angry when Quinn does not stand up for their relationship against her mother who speaks ill of it. You discover that many of the couple’s arguments revolve around Quinn’s mother trying to destroy their relationship because of her disapproval. Since they moved in together, this has reportedly gotten worse. When discussing this topic, each report the following:

Quinn: “I know my mom does not approve but she still is my mom and I cannot speak back to her. I try to just ignore her and one day she will probably come around. She just does not know how to cope with the fact that I am a lesbian because my whole life she dreamed of me marrying a man and having babies.”

Sandra: “Well you are 23 so you should be able to express how you feel to your mother. When you ignore her or say “ok” she thinks you agree. She thinks she can change you and you need to tell her she cannot. She also does mean, passive things to me that you think are no big deal, like addressing our house-warming card to only you. Or like the time she purposely had your graduation party on a day when I had to work. My family would never do that to you!”

Upon discussing more difficulties in their relationship, you discover that they are also having a difficult time adjusting to living together. They discussed not knowing what roles to fill, and arguing when things do not get done. They both seem to want to have some control over things and this seems to be one of the areas that elicits disagreement. When they try to have discussions at home, Quinn states that she shuts down because Sandra becomes so adamant about her opinion.

When discussing strengths, the couple states that they are always there for each other emotionally. They also state that they understand each other in ways others never have, which is why they want to work at making their relationship better.

Based on Case Study 2:

Describe a culturally and ethically appropriate assessment that you would use for this couple and explain your reasons for choosing it. Identify the strengths and weaknesses of the chosen assessment.
Evaluate the current research (within the last 10 years) regarding cross-cultural partnership or aspects related to sexuality and gender within a partnership. Identify what are the current trends as well as what research is needed in the future. Reference at least three resources.
Identify the unique issues this couple faces due to being a lesbian, inter-racial couple. What are your personal feelings and beliefs about this couple? Will your feelings and beliefs impact the counseling relationship?
CASE STUDY 3

Develop a case study involving a couple who comes to see you for counseling due to an issue involving an affair or divorce. Identify couple demographics (race, ethnicity, age, gender), as well as any pertinent background information. Explain the conflict in detail.

Based on Case Study 3:

Identify one major approach you would use in treatment with this couple. Explain one strength and one weakness of this approach.
Since this couple is facing a current issue of divorce/affair, describe how your treatment approach may differ from one used when treating a couple without such issue.

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