Question
Greg, 40, and Melanie, 38, come to therapy with their son Adrian, who is 13. Greg explains that Adrian has always been a little different.
Greg, 40, and Melanie, 38, come to therapy with their son Adrian, who is 13. Greg explains that Adrian has always been a little different. He describes his son as a reader and a dreamer who was uninterested in roughhousing with other boys as a child, but preferred to play with girls, building elaborate dollhouses out of cardboard boxes that they would turn into castles or spaceships or the settings for historic dramas. Adrian says, "I like to tell stories where lots of different things happen to the people: They fall in love, they have adventures, but sometimes they just hang out and make dinner or talk together as friends." He currently has two close friends, both girls. He says they like to get together and watch TV or look at magazines. "Sometimes we cook things. I make really good oatmeal cookies; Mom taught me!"
The family appears to be white and middle-class. You learn that Greg is a high school history teacher, and Melanie works in upper management for a health insurance company. Adrian is slender and does not show signs of entering puberty yet. He wears his hair long and is dressed in skinny jeans, red Converse high-tops, and a baggy red-and-yellow-striped hoodie. You learn that he normally does well in 8th grade but has been failing gym class this year because he refuses to change in the locker room. He says he is not sleeping well lately and is having a hard time concentrating in his morning classes, so his grades are slipping there as well.
When you meet with Greg and Melanie alone, Melanie in particular expresses concern about Adrian's development. She says, "It is time for him to stop being such a child and grow up a bit, make some friends with other boys. I have tried to get him interested in soccer or baseball, but he says he does not like sports, which is no excuse for this gym class thing, by the way. I have made play dates with some friends with boys his age and set them up with computer games and things, but it never seems to go well and he does not want to go back. He is not interested in scouting, even though he likes nature and science. He is just got to stop mooning around and join the real world!" Greg says to his wife, "Look, Melanie, why can't you just say what you are really worried about? You're afraid he is gay." Greg explains that he has a younger brother who came out in his early 20s, and although "It was a bit hard for the family at first," most family members eventually accepted him. "Melanie does not have anything like that in her family," Greg tells you. "Both our families are Christian, and we go to church with Adrian, but her parents were much more traditional than mine. I think she accepts gay people in theory, but it would be hard for her if it were her son." "Adrian is not gay," Melanie retorts with some anger. "He is just behind the other boys. When he starts to develop, he will be noticing girls like the rest of them, you will see. I just do not want him to get murdered in high school for being effeminate."
Meeting with Adrian alone, you ask him why he thinks his parents have suggested therapy. "Mom is freaking out because she thinks I am gay," he says matter-of-factly. "She always has, since I was little." He describes being punished by Melanie for playing dress-up with his female friends in elementary school, when he was playing the role of a princess being rescued from a castle by an ugly troll. "She said it was weird and I should play the troll instead. I told her no, and she sent my friends home and made me sit in my room all afternoon." He says he has "not drawn any conclusions yet" about his sexual orientation. "I'm just not interested in dating anyone, boys or girls or anyone else. Maybe I will be gay, or maybe I will be straight, or maybe I will be something no one has made up yet."
Based on the choice of Structural Family Therapy and case study from Part 1 of this assignment, consider these questions: What would the clinical goals be with these clients? How would the goals be formulated in accordance with your clinical approach? To answer these questions, address the following in 6-8 pages: Using your chosen family systems theory, develop a basic, systemically based treatment plan for use with these clients. One option is to choose at least one short-term, medium-term, and long-term goal targeted at the whole system or chosen subsystems depending on the case, and then identify specific interventions from your chosen theory to achieve each goal. However, your treatment plan should be driven by your choice of theory. Remember, interventions are therapist actions that encourage, invite or support change. You may find that the nature of the case suggests interventions that do not fit with your chosen theory, such as psychoeducation about birth control options if using Bowen family therapy. You may include these in your treatment plan as long as you articulate a clinically sound rationale, grounded in professional literature, for doing so. Discuss how the application of your treatment accounts for the diversity issues relevant to this case.
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