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Case Conceptualization

Mrs. Mesa and Sister Benedict diagnosed Maria as suffering from delayed-onset dysthymic disorder according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., Text Revision; American Psychiatric Association, 2000). The therapists conceptualized this disorder as a posttraumatic symptom. The specific traumas in Maria's case were (a) the psychological and physical battering from Mark, (b) her family's rejection of her because of her out-of-faith marriage and subsequent divorce, and (c) her misperception that she could not fully participate in the sacramental life of her parish because she was divorced.

Treatment Planning

The therapists felt that Britney's and Mark Jr.'s acting out was a symptom of the children's vicarious traumatization. This traumatization took place and was maintained by living in a family system with a parent who herself was a trauma victim. Mrs. Mesa and Sister Benedict believed that if they could adequately address Maria's traumas, they could remediate the family structures that maintained Britney and Mark Jr.'s problematic behaviors.

To address Maria's alienation from her family of origin, the two therapists proposed that Maria bring her parents and siblings to the next session. Maria groaned and stated that she doubted if they would all come, because "We don't talk about problems in the family." Sister Benedict proposed that she call each family member and invite them to come to the next session. Maria thought that they might consider an invitation from Sister Benedict, and she eagerly gave her permission. Sister Benedict did call the family members, and after some persuading they all agreed to come.

Trauma survivors such as Maria pose intense challenges for family therapists (Balcom, 1996). Unfortunately, most trauma treatment techniques are oriented toward individual or group work, tlowever, art has been shown to be effective with both family dysfunctions (Sobol, 1982) and trauma resolution (Appleton, 1993). Haley (1990) held that metaphor was a basic means of family communication, and Sobol (1982) drew upon this idea in designing her family therapy interventions. She chose art because its inherent metaphorical qualities can facilitate productive family communication, specifically by permitting family members to express and represent problems in a less destructive way than do words or action.

Mrs. Mesa and Sister Benedict decided that they would ask the members of the Flores family to participate in a series of drawing tasks and then use the information obtained through the art products to set goals and plan directives. They felt that art tasks could help restructure the Flores family system, specifically by reconnecting family members via culturally powerful symbols. As in narrative therapy approaches, the metaphor that would emerge from the Flores family's art processes helped family members to rediscover their deep interconnectedness to each other (i.e., familismo).

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