For every case use different style of therapy below:

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The style of therapy:

  • Role Play of Cognitive-Behavioral Therapy
  • Role Play Narrative therapyR
  • Role-Play of solution-focused family therapy

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The Case of Isaac and his Mother
Age/Gender: 17, Male
Involved Family: Mother & Child
Members in therapy:
Statement of Problem: Drug use since age 11 related to mental health problems including
severe anxiety, depression, and PTSD symptoms stemming from exposure to domestic and
community violence. Isaac was both using and selling drugs. Prior to MDFT, Isaac had several
unsuccessful treatment episodes with other treatments including a residential program. He was in
constant, and often violent, conflict with his mother, had few social ties, and was failing in
school. Isaac had strong feelings of resentment toward his father who left him and his mother
and started another family.
Isaac, age 17, started abusing drugs and alcohol when he was 11 years old. He smokes marijuana
every day, all day (“wake & bake”), and also takes dozens of anti-anxiety pills on a daily basis
primarily as a way to cope with severe anxiety, depression, and PTSD stemming from exposure
to domestic and community violence. He has a long arrest record, including being arrested for
using and selling marijuana and prescription medicines. Isaac participated in several treatments
with little evidence of change prior to coming to therapy, including a residential treatment
program where he relapsed quickly after being “successfully” discharged from the program.
Isaac has no sense of his future, has few social ties, and fails in school. Isaac lives with his
mother and other extended family. Isaac’s father is not involved in his life: Isaac and his Mom
report that his father left them behind many years ago to start a new family. Isaac’s mother, who
had Isaac when she was a teenager, feels like she is out of options. She struggles to keep a job
and does not feel confident in her abilities as a parent. She also suffered a recent personal loss in
the period prior to treatment and struggles with depression because of it. She was a victim of
domestic violence. Isaac and his mother love each other very much. At times their relationship
seem less mother and child than friends or equal partners. Isaac reported that sometimes he feels
suffocated by their relationship and his mother’s emotional needs. These feelings often lead to
angry outbursts and aggression toward his mother.
Primary Components of Treatment:
Improve communication between Isaac and his mother, including listening, talking in
a way that they could understand each other and not get defensive, and problem
Develop Isaac’s emotional regulation skills to reduce violence and confrontational
dialogue, and increase understanding by being able to listen without reactivity.
Help Isaac establish personally meaningful long-term goals and build self-awareness
of how his continued drug use and criminality interfered with a positive life plan.
Build Isaacs’s belief in himself and hope for his future
Improve Mom’s self care practices and help her engage in therapy for her own issues
Help Isaac’s mother set developmentally appropriate expectations, function as the
mother in the relationship even when not feeling her best, and begin to believe in and
trust Isaac
Improving the Relationship
One of the first interventions should focus for Isaac and his mother to improve their
communication enough that they could have conversations without resorting to yelling, hurtful
statements and aggression.
Therapist should help them to listen to each other more and speak in a less confrontational way.
Develop new strategies for coping when heated arguments arose.
Work early in therapy to help re-establish trust between mother and son by working with Isaac to
find areas where he could show that he was making a sincere effort to change. School is as an
area where he could do this, and Isaac can make a major effort to do better in school.
Help Isaac to talk directly to his mother about what he needs from her. For example,
unbeknownst to her, sometimes her depression could affect him in a negative way, and he felt
that she was not as available as he needed her to be.
Strategies for Targeting Substance Use
The therapist should immediately target Isaac’s drug use. Early in therapy, the therapist should
focus on helping him identify his reasons for using i.e. automatic responses he had developed
rather than conscious decisions, and that he could make a choice to do something else instead.
Develop reasons to stop using drugs and engaging in criminal activities and to do better in school
Connect him to an NA group as well for support.
The Case of Dani
Dani 16
Dani, 16 years old, has been “forced into coming” to family counseling according to her opening
statement. Her parents just want to talk about Dani’s recent behavior. As they talk it is evident
Dani and her parents have very different relational and social values.
According to Mom, who does most of the talking, Dani used to be an A and B student until the
last semester. Her grades are now mostly D’s, C’s and one F. She has also become very reclusive
at home. When she arrives home from school she drops her backpack on the floor in the living
room and walks up to her room. She stays in her room most of the afternoon and evening only
coming out to eat or watch TV. Despite repeated reminders from her parents to do her homework
after dinner she ignores them. Dani’s cell phone is glued to her hand at all times as she spends
almost every waking moment texting, checking Facebook, or browsing Pintrest.
Her parents have threatened to take her phone away but have yet to take that step because they
fear she would explode and they wouldn’t be able to control her. They are afraid she is going to
fail her sophomore year of high school and need to take summer school and night school to make
up her lost credits. They are also afraid she is making bad relational decisions at school and is
hanging out with “the wrong people”. As Mom wraps up her summary of Dani’s presenting
problems she ends with a sigh and the following phrase, “I just wish she would be more like her
younger sister Jessica (14 yrs old, who is not in the session). She isn’t giving us any problem and
is a joy to have around.”
When Dani gets a change she says: “I don’t even know why I’m here. My parents are freaking
out about something that’s not a big deal. I keep telling them to just leave me alone.”
“If they leave me alone I’ll be able to make my own decisions about what I think is important.
They keep forcing school and ‘good friends’ down my throat. I used to be okay with it but now
I’m getting sick of being told what to do, what not to do, and how I’m supposed to act. If they
want a perfect daughter than they can have Jessica. She’s the one they really love anyway.”
Instructor Feedback Guidelines
An excellent case to use Solution-Focused Therapy in the first session (Corey, 2009). The
therapist is trying to help the client envision how the future will be different when the problem is
no longer present (Corey, 2009). The therapist may ask a client to imagine that they finish the
rest of the day as planned and go to sleep. The next day, all of the problems bringing them to
therapy are no longer present. The counselor may then ask how the client will begin discovering
that the “miracle” has taken place, ask what they will do, and what their life is like now (Burke,
Schroerluck, 2009). The miracle question must be asked slowly while paying attention to
nonverbal cues from the client. The counselor must allow for a reflective silence and for the
client to start out with no idea of how this scenario looks. The counselor may ask the client to
rate their miracle day on a scale with 0 being the worst things have ever been and 10 being the
miracle day. The therapist may ask the client to rate where on the scale they would need to be in
order to no longer need therapy (Burke, Schroerluck, 2009). The counselor may ask the client to
identify how they will begin to know when they are one point higher on the scale. The counselor
wants the client to formulate positive goals focusing on what they will do rather than what they
will not do.
Scaling Questions
Scaling was discussed briefly during the miracle question phase. Scaling is a tool to identify
useful differences for the client and may assist in establishing goals. Usually, the scale ranges
from the worst things have ever been to the best things could ever be (Corey, 2009). The client
should first rate their current position, and then the therapist should ask questions to identify
where the changing points are on the scale. The counselor may ask questions like what keeps the
client from slipping down a point, and they would have the client describe a perfect future in
order to identify at what point on the scale would be good enough for the client.
Coping Questions
Coping questions are designed to bring to the forefront resources that have gone unnoticed by the
client (Corey, 2009). A therapist may acknowledge that things are difficult for a client, but then
may say for example that in spite of all of the difficulties, the client still manages to get up in the
morning, get the children off to school, etc. The counselor may then ask how the client is able to
perform these routine functions. Genuine admiration and curiosity can serve to highlight a
client’s strengths without contradicting the client’s views of reality. Summarizing that a
counselor can see that things are difficult validates the client’s story. However, the second part
counters the problem-focused narrative. Coping questions are supportive and start to challenge
and shift the focus away from the problem-focused narratives.
Family Counseling: Case Study – Kay
Members in therapy:
Kay’s12-year old daughter, Renee
Kay’s Mother, Brenda
Identified Patient
Kay is the family’s identified patient (IP). She has a history of poly-substance abuse (crackcocaine, marijuana, and alcohol). Kay recently completed a 28-day inpatient, detoxification
program, which was precipitated by her desire to be clean and sober during her pregnancy. She is
approximately six months pregnant. To my knowledge, Kay is currently clean and sober.
Kay lives with her mother off and on, though her relationship with her mother is strained. Kay
recently became unemployed. Her relationship with her unborn baby’s father recently came to an
end, as well.
Kay has one daughter, Renee, who is 12-years-old. Kay’s mother, Brenda, stated that she is
Renee’s primary caretaker. Renee’s sees her father rarely, mainly during the holidays. Kay
reported a history of substance abuse in her family (grandfather, one aunt, and two uncles), but
nothing else is known about the other members of her family (e.g., whether or not Kay has
siblings). After completing her 28-day detoxification program, Kay presents with a desire to
engage in family counseling. Brenda and her daughter have also agreed to participate in family
The family is currently seeking help as a result of Kay’s substance abuse. Neither Kay nor her
family have received family therapy prior to their visit. Kay received therapy and counseling
while in the 28-day detoxification program. Kay’s mother, Brenda, reports doing her best to help
her daughter. This includes trying to “motivate” Kay to stop using by “constantly informing her
of the dangers drugs, and letting her know that she is not being a good parent to her daughter.”
Brenda also states that she “sticks her neck out for Kay to keep her out of legal trouble; covered
for her so that she would not lose her job; loans her money; watches over her daughter (Renee),
so that social services will not take her away.” Brenda went on to say that “she has always had to
take care of Kay, and that she wishes Kay would just grow up. I’m getting old, and I don’t make
much money working as a cashier. I love my granddaughter, but I didn’t plan on becoming a
mother again at my age.”
Kay is the symptom bearer of the family. Per Brenda, Kay began using drugs and getting into
trouble in high school when Brenda and her husband (Kay’s father) were divorced. Brenda felt
that her ex-husband is partially to blame, as “he wanted to be Kay’s friend instead of her parent.”
During the assessment, Brenda claimed that Kay has always kept her preoccupied with her
problems and that Kay is probably the reason she never got remarried.
Kay admits to using drugs in high school, but only recreationally. She stated that she did not start
to develop a problem till about two years ago. Kay feels that she did not get into a lot of trouble
in high school, but that her mother always overreacted to little things. Kay, admits, however, that
she did not like school and that she would have rather hung out and partied with her friends than
do well in school. She never graduated, as a result
According to Kay, she began to develop a drug problem after her husband left her and Renee
about two years ago. Kay stated that she could not afford to live on her own and had to move
back in with her mother. She feels that her mother’s constant nagging about her poor decisions
(such as “running with the wrong crowd,” dropping out of school, etc) made her depressed and
led to her going out to bars and drinking. Kay stated that she soon made new friends and found a
new boyfriend. Kay revealed that her new friends and boyfriend used drugs more than just
recreationally, and that she was soon doing the same. Kay confessed to having a “full-fledged
drug problem” after about two years of regular use.
Kay is worried that her drug problem will become even worse, since the father of her unborn
child recently left her. Kay is also bothered by potential birth defects her unborn child may suffer
if she continues to use. She states that she does not want to lose her seven-year-old daughter, and
that she would like “to get out from underneath her mother’s thumb.”
Kay has no desire to reunite with the father of her unborn child or any of her old friends. She
feels that they are bad influences for her, as they continue to use drugs. Kay is an only child and
there are no other family members involved in Kay’s life (besides Brenda and Renee). Kay
wishes her father was still alive, because she would have the option of living with him instead of
her mother (Kay’s parents were divorced). Kay said that her father was always more supportive
than her mother, even though he was not around a lot. Brenda visits with her siblings on
holidays, but otherwise has very little contact with any family member outside of Kay and
Renee stated that her mother was gone a lot and that she wished she was around more often. She
also expressed a desire to see her father more often. She confirmed that her grandmother was her
predominate caretaker by stating that she took her to school, washed her clothes, made food for
her, etc. Renee appeared well adjusted, saying that she liked school and had many friends
Issues and Concerns for Family
Kay’s history of drug and alcohol abuse
Kay’s pregnancy
Conflict between Kay and her mother, Brenda
Kay’s parenting abilities
Kay’s relationship with her seven-year-old daughter, Renee
Financial issues for Kay and her family
Kay’s unemployment
Housing for Kay and her children
Renee’s relationship with her father
Below are three different approaches in which to provide family therapy. First, structural family
therapy which has the goal of restructuring the family dynamic in order to make it more flexible.
Secondly, strategic family therapy, which deals primarily with treating the symptoms of the
identified patient. Lastly, solution-focused brief therapy focusing mainly on what was currently
working in the family, as well as on hopeful solutions for the future.
Structural Family Therapy
Construct a Family Map
One can see from the family map that Kay’s position in the family needs to be restructured. Kay
has assumed a position in the family that places her in a sibling-like relationship with her own
daughter. Assuming Kay maintains her sobriety, the goal would be to restructure the family so
that Kay is occupying more of a mother role to her daughter. In so doing, the connection between
Kay and her daughter would also need to be strengthened, while the connection between Brenda
and Renee may need to be normalized (i.e., reduced from a strong connection to a typical
Brenda is obviously the dominant figure in the family. As long as Kay is living at Brenda’s
home, she may remain the dominant figure to a certain extent. However, it would be more
appropriate to have Kay and Brenda be of more equal dominance. This would allow them to
cooperate and function as the parental unit to Renee. To increase this cooperation, the conflict
between Kay and Brenda would need to be reduced as much as possible.
Under ideal circumstances, Renee’s father, perhaps, should be invited to family therapy.
Although he is minimally involved in Renee’s life, it may be appropriate to try to increase his
parental role (provided he is not abusive, etc.). During the first few family therapy sessions, more
information about Renee’s father should be discovered.
Kay’s symptoms function in a way that binds the family together. As long as Kay is having
problems, Brenda may remain over involved in her life. Brenda’s enabling behaviors, which
include providing Kay with money, taking care of Renee, and helping her to avoid the negative
consequences of her drug use also serves to keep Brenda over involved. Perhaps, Brenda wants
to be needed and wants to feel as if she still serves an important role in Kay’s, as well as Renee’s
The family is functioning reasonably well, given the circumstances. For example, Brenda is
relatively supportive, and Kay is motivated to stop using. The family is receptive of help, with
permeable boundaries. However, the boundaries between the family subsystems are more rigid,
with Brenda wanting to maintain dominance over Kay and Renee (rather than allowing Kay to be
the parental figure to Renee).
Assigning Tasks: Have Kay spend more one-on-one time (without Brenda) with Renee.
For example, doing activities together three times a week after Renee gets home from
school (go to the park, roller skating, go to library, etc.). This would help to strengthen
their connection, allow her to assume the parental role, while also decreasing the
connection between Brenda and Renee.
Marking Boundaries: In order to allow Brenda to assume the role of grandmother–
instead of mother–to Renee, I would encourage Brenda not always to be available as a
babysitter to Renee. For example, Brenda could agree to baby sit a maximum of three
times per week. When she was not babysitting, she would be free to engage in other
things, such as social activities (which may, in turn, decrease her desire to be overly
involved in Kay’s life).
Reframing: I would reframe Kay’s perception of her mother’s nagging as proof that her
mother is very concerned about her welfare.
New Talk: I would encourage an enactment in which Brenda reframed her nagging and
instead express her hopes that Kay and Renee would live a happy, productive, and
fulfilling life.
Unbalancing: I may somewhat align with Kay to increase her power within the family.
Education and Guidance: I would inform the family of potential withdrawal symptoms
and methods for maintaining sobriety, such as attending AA or NA, attending individual
counseling, possible relapse triggers, etc.
Strategic Family Therapy
The assessment process for strategic family therapy would be similar to the one for structural
family therapy (above). In using strategic family therapy, I would focus more on Kay’s
symptoms (i.e., her drug and alcohol abuse), rather than restructuring the family. In other words,
if Kay’s problems were “fixed” then the family problems may diminish, as well. Therefore, the
goal would be for Kay to maintain her sobriety. The family’s goal would be to help Kay maintain
her sobriety.
In using strategic family therapy with Kay and her family, I feel that using straightforward
directives would be the best approach. Some techniques, such as prescribing the symptom, would
not be appropriate for Kay, due to her pregnancy. The straightforward directive I would use
Straightforward Directives: These directives would be aimed at keeping Kay clean and
sober. This may include encouraging Kay and Brenda to attend support groups, such as
AA or NA, as well as attend individual counseling and continue family therapy. Other
directives could include having Kay attend parenting classes and having Kay be more
involved in Renee’s life (encouraging Kay to participate in activities with Renee). I
would also encourage the family to work together to ensure Kay’s sobriety. That is, I
would help Kay and Brenda develop the best possible plan for ensuring Kay’s sobriety.
Solution-Focused Brief Therapy
Solution-Focused Brief Therapy is very hopeful in nature. In using this approach, I would
encourage Kay and Brenda to realize that change is a possibility. In so doing, they would be
allowed to focus on a hopeful future, rather than dwelling on a regrettable past.
First, I would find out what Kay and her family want out of life. Most likely, Kay would want to
maintain her sobriety, be a good parent to Renee and her unborn child, and establish financial
independence (which would allow her to attain her own housing). Secondly, I would look for
what is working for Kay. She is currently clean and sober, which is very positive and hopeful.
What is more, she has a strong desire to maintain her sobriety, which is why she decided to come
to family therapy. Attending therapy and counseling has obviously helped Kay become clean and
sober, so I would encourage her to continue to be involved in therapy and counseling, as well as
support groups, such as AA or NA. Thirdly, I would discourage Kay from engaging in things
that did not work for her (e.g., associating with her old friends or significant others who use,
going out to bars, and relying on Brenda too much).
Getting by Questions: What has worked for Kay in the past? What motivated her to
attain sobriety? How has she maintained her sobriety so far? How has she been
financially independent in the past? She was employed until recently. How did she get
her last job?
Scaling Questions: On a scale from one to ten, how would you rate your current
problems, such as drug use and conflict with Brenda? One being no problem, ten being a
huge problem.
Exception Questions: When are you better able to cope with your problems? That is,
when does Kay get along better with her mother, and when is it easier for her to avoid
using drugs? I would encourage her to be specific (i.e., specific locations that allow her to
cope more easily, times when she does not want to use, and people who do not encourage
her to use).
Miracle Question: I would ask Kay what her life would look like if she woke up
tomorrow and all her problems were solved. Kay may answer that she would have no
desire to use drugs, be financially independent, and be a better mother.
The Task: Have Kay and Brenda identify (between sessions) times that they were not
experiencing conflict with one another.
The First Step: Have Kay and Brenda identify the first thing they would notice that was
different when Kay and the family were back on track.

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