- A brief summary of what was going on with the family
- A review of the initial treatment goals
- Theories and interventions used
- A brief discharge summary for the family treatment
- Clinical recommendations for sustained improvement or referrals for additional services
While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
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Attached is an outline that needs to be followed.
Bob and Elizabeth Vargas have been married for 10 years. They have two children, Frank (8) and Heidi (6). Bob teaches high school PE and coaches football, wrestling, and baseball. Elizabeth recently quit her job where she was an attorney in a law firm that specializes in Family Law. She enjoyed her work, had a passion for adoption cases, but decided to stay home for a few years while the kids were young. Elizabeth believes that Frank might have ADHD. She complains that he cannot sit still, does not listen, is forgetful, and is always getting hurt. She believes that much of these injuries are due to Frank’s impulsivity. Elizabeth suggests you talk to Frank’s teachers who have noticed that he has trouble waiting his turn, will often blurt out answers without raising his hand, and frequently loses things. Elizabeth acknowledges that Frank has always been an active child, but believes these behaviors, including picking on his little sister, are getting worse. Bob seems to be amused by these anecdotes and accuses Elizabeth of “overreacting,” stating that, “Boys will be boys.” Bob suggests you talk to his parents, both retired teachers, who agree with him and don’t think there’s anything wrong with Frankie. You notice Heidi sitting close to Elizabeth, playing on her mother’s cell phone. She glances up occasionally when her brother approaches, but is otherwise engrossed with the game. Frankie began the meeting sitting between his parents, but noticed Legos in the corner and was immediately attracted to them. He interrupts several times to share stories about his teacher, classmates, and his grandparents, despite numerous reprimands from his mother. After a few minutes, Frank asks to use his Dad’s phone (in a hurry, Bob had left it in the car), wanders around the office, looks out the window and comments on a squirrel, then grabs the phone from his sister who, of course, protests. After Elizabeth had quieted the commotion, you question any recent changes. Bob and Elizabeth both acknowledge an increase in marital tension and admit to having several arguments a week, some in front of the children. Bob blames Elizabeth for being “too high-strung” and says she just needs to relax. Elizabeth says she is unable to relax, fearing Frankie will end up damaging things or hurting himself or Heidi. She says that if Frankie would be able to control his behaviors, their marriage would improve dramatically. This, they report, is the reason for seeking therapy for Frankie.
Vargas Case Study: Topic 2
Elizabeth arrives on time with Frank and Heidi for the second session. Elizabeth appears somewhat frazzled and tells you that she had just heard from Bob who said he would be “a little late” because he “lost track of time.” You note Elizabeth’s frustration, which she confirms by saying this is “typical.” She proceeds to share that she feels “completely disregarded,” especially after having shared with Bob the night before how important these sessions are to her. You notice that Heidi seems upset as well and looks as if she has been crying. You ask her how her day is going and she tearfully tells you that Frankie tore up her school paper with the gold star on it. Elizabeth elaborates that Frank had become angry and ripped up the picture that Heidi was proudly sharing with her. Frank, who had gone directly to the Legos, appears oblivious to the others in the room. When you ask him about his sister’s sadness, he replies, “Who cares? She always gets gold stars!”
As you were about to further explore these feelings, Bob arrives stating, “She probably told you I’m always late, but hey, at least I’m consistent.” You notice Elizabeth’s eye rolling and direct your attention to the children, asking them about what brought them to your office. Heidi says, “I’m good but Frankie’s bad at school, and it makes Mommy and Daddy fight.” Frank, who had helped himself to one of your books to use as a car ramp argues, “I hate school. It’s boring and my teacher is mean.” Bob attributes Frank’s boredom to being “too smart for the second grade…what do they expect?” Elizabeth responds that they, like her, expect him to follow rules and be respectful, and suggests that Bob should share those same expectations. Bob dismisses Elizabeth’s concerns by saying, “He’s a normal boy, not like all your friends from work who you say are ‘creative.’”
You notice Elizabeth’s reaction and decide to redirect your attention to Frank. You ask him what bothers him most about school, to which he replies, “I get in trouble, then I don’t get to have all the recess time, then I can’t play soccer because they already started and they won’t let me play.” You notice Frank’s interest in sports and probe for more information. You learn that he is quite athletic and has been asked to join a competitive youth soccer team that plays on Saturdays and Sundays. You discover another source of discord when Elizabeth shares that Bob “feels strongly” that Sundays are to be spent only at church and with family. Bob confirms that after church on Sundays, they spend the rest of the day with his parents, siblings, nieces, and nephews. Elizabeth says that Sunday mornings are the only time she gets to be by herself and that she typically joins the family around 1:00 p.m. Bob adds, “Apparently Liz needs time to herself more than she needs God and her family,” and suggests she should appreciate his family more because “it’s the only family she has.”
As the session comes to a close, you share your observations of the family by noting their common goal of wanting to enjoy family time together. You also suggest that while Frank’s behavior challenges are troubling, perhaps you could focus next week on learning more about each parent’s family of origin in hopes of gaining a better understanding of the couple’s relationship.
Vargas Case Study: Topic 3
Bob and Elizabeth arrive together for the third session. As planned, you remind the couple that the goal of today’s session is to gather information about their families of origin. Bob begins by telling you about his older sister, Katie, who is 36 and lives nearby with her three children. Katie’s husband, Steve, died suddenly last year at the age of 40 when the car he was driving hit a block wall. Elizabeth speculates that Steve was intoxicated at the time, but Bob vehemently denies this allegation. He warns Elizabeth to “never again” suggest alcohol was involved. You note Bob’s strong response and learn that his own biological father, whom his mother divorced when Bob was three and Katie was five, had been an alcoholic. When asked about his father, Bob says, “His name is Tim, and I haven’t seen him since the divorce.” Bob shares that he only remembers frequently hiding under the bed with Katie to stay safe from his violent rages. He adds that 5 years after the divorce, his mother, Linda, married Noel who has been “the only dad I’ve ever known.” He insists that his sister married “a devout Christian who never touched alcohol” and attributed the 3:00 a.m. tragedy to fatigue. He adds that a few days before the accident, Katie had complained to him that her husband had been working many late nights and “just wasn’t himself.” Bob speaks fondly of his sister and confirms that they have always been “very close.”
From Elizabeth, who is 31 years old, you learn that she was adopted by her parents, Rita and Gary, who were in their late 40s at the time. They were first generation immigrants who had no family in the United States. Their biological daughter, Susan, had died 10 years earlier after Rita accidentally ran over the 5-year-old while backing out of the driveway. Elizabeth surmises that her mother never fully recovered from this traumatic incident and remained distant and withdrawn throughout Elizabeth’s life. Elizabeth describes her father, Gary, as “a hard worker, smart, and always serious.” She shares that most of her family memories were of times spent with her dad in his study, surrounded by books. She states, “He could find the answer to all of my questions in one his many books.” Elizabeth describes herself as the “quiet, bookish type” and attributes her love for books to her father. Like her father in his study, Elizabeth remembers spending most of her adolescence alone in her room, reading, so she would not upset her mother. Looking back, Elizabeth tells you she recognizes her mother’s struggle with depression, “but as a kid, I thought it was me.”
You comment on the vastly different childhood experiences and normalize the potential for relationship challenges under these circumstances. Acknowledging the differences, Elizabeth remarks that Bob’s relationship with his family was one of the things that she was attracted to early in their relationship. Bob agrees with her and comments that Katie and Elizabeth are very close, “each being the sister neither one of them ever had.”