Case Analysis and Theories

Description and Rationale
A series of case applications will be completed throughout the semester and are worth a total of 30 points of your grade. These applications will help you to articulate a particular theoretical lens and how that lens shapes the work that you do with families.

Each application requires you to apply a particular theory to a case that is provided to you (Elena). This assignment is more than just answering each question; you will need to show that the theory has been adequately applied and then appropriately explained. You need to write in complete sentences and fully explain your answers.

Each assignment must use this case application format by listing each question as a heading, so I know where you intended to answer the question. Your case application should be 2-3 double-spaced pages. You’ll apply the assigned theory by thinking through each of the following questions in light of the case material and then answer each of the questions fully. Your write up needs to incorporate class readings on the topic.

1. Elena has problems because___________.
2. Elena will be healthy when __.
3. What influences thoughts, feelings and behaviors? Why do they change or not change?
4. What is my role in change?
5. What is Elena’s role in change?
6. What interventions from this model would I use to address this problem? Why?
7. How would I evaluate Elena’s progress toward change?
   Grading
   Each numbered question will be worth 1 point (questions are worth 1 point each if fully answered from the lens). Following the heading and formatting directions will be worth 1 point. Writing, grammar, staying within page length will be worth 1 point. The Structural Family Therapy case application also requires a genogram worth 3 points.
   Due Dates
   ● Case Application 2 – Structural Family Therapy: due Module 5, worth 12 points
   ○ The Structural Family Therapy case application requires a detailed genogram to accompany the case application. You may hand draw the genogram, but you will need to scan it (or take a picture of it) and upload it with your assignment.
   ● Case Application 3 – Narrative Family Therapy: due Module 6, worth 9 points
   ELENA
   Reasons for Referral
   Elena was strongly encouraged to seek counseling by her parents out of concern of her shifts in mood during the past 2-3 months. Her parents also recently found a bottle of vodka in her room and wanted her to be evaluated.
   Behavioral Observations
   Elena is a 17-year-old second generation Mexican-American female. She is currently in her junior year at a local Catholic high school. She arrived on time for her appointment and was casually dressed. She made periodic eye contact with the counselor but frequently cast her eyes downward. Her posture throughout the session was somewhat slumped. Elena appeared a bit anxious, as evidenced by frequently fidgeting with her hands. Her tone, body language, and content suggested she was tense and frustrated throughout the session. Elena responded appropriately to questions and became increasingly willing to talk as the session progressed. Insight and level of psychological mindedness seemed age-appropriate.
   Presenting Concerns
   Elena’s most pressing concern is feeling conflicted about her decision to apply to college next fall; although she wants to go to college, her mother is terminally ill and expects Elena to stay with and attend to her. Elena expressed feeling “down” and “pressured” regarding this decision. She feels guilty that she may fail to measure up to what a “good daughter” “should” be (i.e., devoted to family) and as a result may lose her parents’ acceptance and approval. Elena explained that her family is extremely important to her and she believes she has an “obligation” to her parents. Yet she also desires the opportunity to meet new people and to have new experiences; she expressed concern that “If I stay with my family my whole life, I’ll be a failure… I’ll have wasted all my potential.” Elena reported trying to explain her perspective to her parents, but said she felt they were unable to understand her because “they hear what they want to hear.” She also stated that she is receiving conflicting sources of pressure about the college decision and does not want to “disappoint” anyone. While her parents want her to stay home, her boyfriend and friends, whose parents tend to be very supportive of their applications to college, believe Elena should leave. Elena described feeling pulled in two different directions and said she is “stuck in the middle… If I make the wrong decision I’ll regret it forever.”

Elena also worries about “bombing in school” because her schoolwork no longer seems important, she has difficulty concentrating, and her various sources of worry (i.e., mom, college, grades) feel like “too much” to handle. Elena further described feeling “blah” toward working on the school newspaper, of which she once served as editor. Elena admitted that she sometimes thinks it would be easier “if I wasn’t here,” but noted she would not hurt herself by stating, “I wouldn’t do that to my family, especially my mom.” She admitted drinking Vodka by herself one night in the hopes it might make her feel better, but insisted that her parents “freaked out” over nothing when they found the bottle; she swore that drugs and alcohol are “not the kind of thing I do; I’m not really into that.”
Family Background
Elena’s parents are both Mexican; they immigrated from Mexico 30 years ago. Most of Elena’s extended family still lives in Mexico. Elena’s family currently enjoys middle-class standing; her father owns a small business and her mother worked part-time as a secretary before her illness prohibited her from working outside the home. Elena is the youngest of 3 children. Her older brother is in his first year of college, aspiring to be a dentist. Elena said she is proud of and close to her brother, yet she feels resentful that “he got away [from the family], while I have to stay here.” She described “hating” her older sister who has a history of drug usage and infrequently visits the family. Elena reported that her sister “ruined everything for me,” explaining that their parents unfairly compare Elena to her sister and “if I make one wrong move… [they think] I’m going to end up just like her; I’m going to be a total failure and a bad daughter.”

Elena does not speak Spanish; her parents had a “hard time” when they came to the US and, not wanting their children to experience similar anti-immigrant discrimination, refused to speak Spanish to them. Elena said that although her parents have learned English, she sometimes wonders whether not communicating in a shared native language hinders their ability to understand one another. She recalled an incident when she was younger: she asked her mother to pick her up from a friend’s home at a certain hour; her mother misunderstood her directions and arrived 6 hours late. Elena recalled feeling abandoned by, angry at, and ashamed of her mother. Elena reported also feeling that her parents don’t “get” that American youths are traditionally afforded more independence and freedom than Mexican youths. Elena’s mother’s illness has greatly impacted the family. Although her mother may live 10-15 more years, her imminent death and compromised physical state have cast a shadow upon the family. Elena stated that her mother needs a good deal of help. She apparently feels conflicted in that she wants to provide this help yet is angry in being the only child expected to care for her.

Elena said she has always been “really close” to her parents, especially her mother. She expressed gratitude for the sacrifices they made on her behalf. While she noted feeling they can be unfairly strict with her, Elena qualified her concern by saying that, “They are strict because they care.” Elena described the customs—i.e., cooking Mexican food and visiting Mexico—and the qualities—i.e., rigidly Catholic and close-knit—that she believes makes them a “traditional Mexican-American” family. She noted that although her father is the primary breadwinner, her mother has the “real power” in the family with regard to making decisions.

Relational and Interpersonal History
Elena reported a supportive circle of friends but admitted feeling that her friends “don’t listen to me.” She explained that her friends, like most students in her high school, are white European Americans and she feels they “don’t want to hear about how my family works” differently from theirs. She noted that some friends have recently expressed concern that she has started acting “like I don’t care anymore.” However, Elena doesn’t feel she can really talk to her friends about her problems. She experiences their concern that she be allowed to go to college as yet another source of pressure. Elena’s boyfriend of 5 months is also white. Elena said their relationship has recently been strained by her indecision over college. She described him as “inconsiderate” and as unfairly judging her parents to be “stupid and ignorant” regarding their stance on Elena’s future, rather than they considering that they simply “think differently.”
Coping Strategies
Elena has no history of previous treatment for an emotional problem. She generally perceives her friends and family as supportive, yet expressed disbelief that anyone really understands her. When probed for coping strategies, she noted that writing in her journal, taking walks, and spending time alone sometimes helps to ease her feeling that “people are always on my back.” She denied regular use of alcohol but admitted that her recent experimentation with Vodka somewhat helped her to relax. To cope with her mother’s illness, Elena said that her family relied largely on religion and family solidarity.
Career Progress
Academically, Elena reported she has traditionally done well, particularly in English. She expressed interest in studying journalism because she is intrigued by people’s stories and unique cultural experiences. Elena said she thinks her parents are supportive of her education but they believe that “family comes first.”