Counseling Psychology Case Studies

A Couple in Conflict Seek Help Over Money Issues

One of the more troubling issues to be addressed in this case is the fact that both members of the couple seem inclined to resort to harsh labels for each other’s behavior, coming dangerously close to outright name-calling. Tess uses hurtful terms like “pinchpenny,” whereas Bob says she needs to be “bailed out.” A reader can practically hear the tone of contempt and see the eye-rolls—another sign of contempt, which of course is anger plus disgust, both emotions very hurtful to interpersonal relationships—as the words appear on the page. The couple needs to be made aware of the ways in which they force extra distance between each other by describing behavior in the harshest language they can think of.

In addition, it is troubling to hear that Tess invites the children into the couple’s bed while her husband sleeps on the couch, though this is admittedly also of his own choosing at least on a subconscious level. Having the children sleep in the same bed with Tess implies poor boundaries and even runs the risk of turning them into substitute husbands; the eldest child will be particularly vulnerable to that misguided role-casting, especially if male like Tess’s partner, due to the fact that Tess will be relatively more able to place responsibilities and burdens on the eldest child’s shoulders. However, it sounds as if the couple managed to resolve the issue of who sleeps where after working with the therapist simply because they began to feel closer to one another again. Whereas a counselor working with this couple might be fully aware of the fact that the situation is potentially harmful for the children, it would also be important to keep in mind that the primary function of a counselor, in this case, is to help the couple present. In that vein, the strategy of having the couple form a budget together was wise; sometimes people simply need to see things on the page in order to work out what needs to change.

Challenging Stereotypes

Naturally, before any intervention, the therapist would need to consider the role race might be having on influencing perceptions of the clients. As Sue and Sue (2012) put it: “For practicing professionals and trainees in the helping professions, understanding the differing worldviews of our culturally diverse clients is tantamount to effective multicultural counseling” (p. 1). Therefore, it would be ideal if the therapist came from a similar cultural background as the clients, or else if multicultural awareness training had been a part of that therapist’s education. Regardless, once counseling begins, the therapist must take into account the strange sense of distance suggested by the family’s words and gestures—the mother cautiously mentioning that she appreciates their affluent life before giving criticism, the father holding back from chastising his son. The fact that the family is affluent indeed might influence thoughts around this area, because what jumps to mind—perhaps erroneously, but present nevertheless—is the stereotype that African-American people living upper-class lifestyles must keep more of a “stiff upper lip” than their white counterparts to avoid jeopardizing their standing by looking “too black.” The father in particular may be fighting his own sense of shame around the common racist attitude that black men are angry and dangerous. This may be why he represses his anger such that it comes out in his interactions with his wife as a patronizing tone, as in when he very carefully gives her an explanation prefaced by the diminutive word “sweetheart.” Her interaction with him, in its caution, indicates she is at least on some level well aware of his hidden anger.

Because of the heavy use of playing the victim by both the father and the mother, however, questions about their parents’ and grandparents’ use of money must be approached tactfully where they interact with race. Nevertheless, open-ended questions such as, “Tell me about your father’s (or mother’s, grandfather’s, grandmother’s, etc.) attitude toward money,” could help open the issue gently. In addition, relevant background on the family might include the couple’s history, such as how long they have been together and whether either of them had been involved in previous marriages. With this question as with the others in this exercise, I learned about myself that I believe I actually can competently counsel an African-American family, in spite of my initial hesitance to touch this topic, regardless of my own background.

Counseling a Latino Family

I strongly admire the cultural awareness that the counselor brought to the case, in spite of the fact that he himself knew he was not exactly of the same heritage as the family, being both somewhat removed from his Latino ancestors and presumably more familiar with Mexican culture than Mrs. Ortiz’s El Salvador roots. It would be natural to assume from the outside that Mr. Diaz’s background was “similar enough” to that of the clients, but he himself showed good awareness in letting the eldest child, Magdalena, translate. That way he did not have to leave Mrs. Ortiz in the dark. Of course, in a perfect world, there would have been an entire separate translator on-hand so that Magdalena would not be forced into, as the text puts it, a “pseudo-adult” role, but with the limited resources available, this was an acceptable second-best solution.

In addition, the counselor made an effort to work with limited resources in that whereas he insisted upon having the entire family present, he made sure to pursue an exit strategy that would allow for the fact that the family could not continue to rely on him for help. Gonzalez, Borders, Hines, Villalba, and Henderson (2013) discuss the need for “flexible formats for involvement that respect families with limited time” (p. 185) when discussing Latino families’ involvement with their children’s education. “Flexible” is the key word here, and Mr. Diaz shows a great deal of flexibility in coordinating a plan that works around everyone’s schedule, with night classes for Mrs. Ortiz to improve her English and simple things for the children to do when they would be in school anyway, such as reducing their isolation. Overall, this counselor deals with this case in a very appropriate manner.

A Therapist Reports Parental Abuse

A common malpractice in the field of family counseling is overstepping the bounds of what consent forms do and do not allow. This holds special importance to me because of my friend—let us call her Tina—who has struggled with depression for most of her life. Tina, at the age of eighteen, admitted a suicide attempt two weeks prior to her therapist. Her therapist subsequently bullied her into revealing the attempt to her mother, lying by saying that she, the therapist, was now legally allowed to reveal that information anyway. In truth, of course, as Tina was a legal adult at the time, the decision of whether or not to tell her mother about her suicide attempt was entirely her own, and the actions of the therapist where at least a little abusive in using her authority to lord over Tina’s lack of knowledge about the counseling field. Of course, as Tina’s mother had driven her there, she would have known something was going on when Tina went to the psychiatric hospital instead of home with her mother, but all the same, trust was betrayed when the therapist said the consent form gave her permissions it did not actually grant.

Returning to the topic of meaningful questions to formulate regarding revealing family abuse, it can be tricky to find solutions that expose problems without pathologizing normal behavior. However, here are five possible such questions: (1) Do you (suspected victim of abuse) feel afraid of (suspected perpetrator of abuse)? (2) How do you (suspected victim) feel when you approach (suspected perpetrator) with a concern or an area of conflict? (3) (If alone with suspected victim) Is there anything that (suspected perpetrator) has done that really sticks with you in an uncomfortable way? (If so, what; from there the therapist can evaluate whether the behavior was abusive or just a normal part of family life.) (4) (To suspected perpetrator) Tell me about a time when something (suspected victim) did really made you angry. How did you deal with what they did? (5) (To suspected perpetrator) Would you be open to me speaking to (suspected victim) alone? (This question might reveal something even before the hypothetical solo meeting takes place, not necessarily through the words the suspected perpetrator uses, but rather through their body language, pauses, etc.) Those five questions—in conjunction with as many more are needed—could potentially help reveal abuse in a family.

A Therapist Initiates a Solution Process

Aside from the obvious presenting problems of Mrs. Baker’s perfectionism for herself and of the chaotic family environment created by her yelling, parental issues could be examined. It may be that Mrs. Baker still carries wounds from having been yelled at herself as a child, and that her trapped emotions around this have led to her being blind to her own behavior such that she frames it in absolutes—either she stops yelling entirely, or she yells whenever she likes and is a “bad mother” (presumably like at least one of her parents or possibly the exact opposite of how she perceives that parent). This either-or thinking, so often comorbid with perfectionism, could also be addressed, which is essentially what the counselor did indirectly, causing Mrs. Baker to see that there was a third option besides stopping yelling completely and letting herself yell whenever she felt the urge.

As the problem was resolved without further intervention, there might not be any need to apply a psycho educational model in this case. Had Mrs. Baker been more resistant or had she been so entrenched in her perfectionism that she failed to hear the counselor’s words as anything but identical to those with which she had been shaming herself for so long, more in-depth practice might have been required. Ideally, what would be being taught in this instance of a psycho educational model would be how to live a life characterized by reasonable options rather than the black-and-white caricatures that populate the mind of a person focused only on extremes. Even providing Mrs. Baker with reading material on perfectionism might help if she is so locked into her worldview that nothing the counselor says gets through; the printed page can sometimes be a less hostile intermediary for such clients. Regardless, though, Mrs. Baker seems to have gotten what she came for without any such additional measures.

Using Observational Methods for Assessing Family Functioning

Based on the assessment, several overall impressions regarding strengths and weaknesses can be formed. Marta generally has superior function in all three areas except when she gets blindsided by her own smug arrogance about her interpersonal skills. Giovanni rarely shows good understanding of the situation, particularly on the interpersonal level, and his affect seems quite flat throughout most of the transcript. Paolo’s scores suffer due to his typical but nevertheless counterproductive teenage sarcasm, his wisecracks showing cognitive ability but not much else. Angelo, too, seems to have cognitive understanding without the affective or interpersonal skills to back it up, though of course he displays this in a completely different manner, being quiet and giving the impression of being stone-faced even merely from the transcript. Overall, the family suffers from a mutual lack of understanding about each other and a frequent use of affect that doesn’t match the underlying emotion.

Potential triggers to the yelling behavior seem to include one family member being smug about understanding another’s “real” motives and emotions. This resistance to being pigeonholed or diagnosed by an amateur therapist is quite understandable; the family would do well to learn to ask questions rather than make assumptions about each other’s emotional states. Indeed, throughout the session Marta is fond of her self-cast role as therapist’s assistant or armchair psychologist, Giovanni is quite attached to being the sort of tough, stereotypical man he saw in his own father, Paolo wants to be the clever one whose quips are a way of acting out, and Angelo is a natural quiet one. As far as addressing the yelling behavior is concerned, Giovanni’s lack of interpersonal skills and willingness to communicate on a genuine level is probably the biggest concern; one can easily imagine him getting overwhelmed by emotion and resorting to yelling as his only way to let it out. The therapist should point out to each family member the strengths and weaknesses around cognition, affect, and interpersonal skills discussed above, as well as the roles they play in keeping the dysfunctional family dynamics going.

References

Gonzalez, L. M., Borders, L. D., Hines, E. M., Villalba, J. A., & Henderson, A. (2013). Parental involvement in children's education: Considerations for school counselors working with Latino immigrant families. Professional School Counseling, 16(3), 185-193.

Sue, D. W., & Sue, D. (2012). Counseling the culturally diverse: Theory and practice. Hoboken, NJ: Wiley.