Term Paper on "Psychotherapy in 2006, 1.89 Million U.S. Children"

Term Paper 6 pages (2013 words) Sources: 6

[EXCERPT] . . . .

Psychotherapy

In 2006, 1.89 million U.S. children had a least 1 parent in the military (Chandra, Lara-Cinisomo, Jaycox, Tanielian, Burns, Ruder & Han, 2010), which leads us to question, what is the experience of parental deployment and absence for youth from families with a parent in the military? What if the parent returns with a disorder such as PTSD and/or depression? What is the toll that it takes on the family?

The DSM-IV-TR states that relational problems "include patterns of interaction between or among members of a relational unit that are associated with clinically significant impairment in functioning, or symptoms among one or more members of the relational unit, or impairment in the functioning of the relational unit itself" (American Psychiatric Association, 2000, p. 736). In looking at the vignette for this assignment, it is plain to see that the Jones family is undergoing some relational problems, which in turn, seem to be manifesting some dysfunction individually as well as relationally with others. Perhaps one of the most important factors from this vignette is the fact that Shirley was deployed overseas for the past 18 months, however, she has now returned and has been home for three weeks. During her absence, the eldest child, Ben (13) became quite withdrawn and was often truant from school. His father, Harold, also suspected that he was using drugs. Looking at this issue alone, it would be difficult not to suspect that Sam's withdrawn nature and his problems with school (and possibly drugs) stemmed from his mother's absence. During her absence, another generation of the family was brought it to help out -- Harold's mother.

Looking specifically at Sam, first of all, it is important to understand the delicate point of life that he is in. Sam is a teenager and, as if this wasn't a complex enough time for a child, his life has been made increasingly complex with his mother leaving for such a long period of time and a new caretaker coming in to help. Longitudinal studies have shown that divorce can rearrange parent-child relations (Alquilino 1994) and though this isn't a case of a divorce, the mother has been absent for a year-and-a-half, which also has got to have some effect on parent-child relations in this specific case.

Now that Shirley is back home, she seems to be suffering from Post-Traumatic Stress Disorder (PTSD) characterized by her irritability with the children, her unwillingness to go into town and to visit with old friends, as well as her feeling tired a lot. This inability to give her children the attention that they need may be contributing to Ben's problems as well as to Tracy's temper tantrums. Shirley and Barbara are not getting along, as well, which could be due in part to a power struggle occurring now that Shirley is home again. Perhaps Shirley is feeling out of place, unneeded and like she now longer has control over her children and family life.

Using the DSM-IV-TR, code V61.20, Parent-Child Relational Problem could be used to diagnose the problems arising between Shirley and the children as well as between Harold and Ben. This code is representative of impaired communication, which definitely seems to be occurring between Harold and Ben. Using the Global Assessment Relational Functioning (GARF) Scale in the DSM-IV-TR, this family would most likely be in the 41-60 range (perhaps around 45): "Relational unit has occasional times of satisfying and competent functioning together, but clearly dysfunctional, unsatisfying relationships tend to be predominate" (p. 815). This rating would be given because of the lack of effective communication overall in the family, the fighting between Shirley and Barbara, the son's running away, the daughter's temper tantrums, and, of course, the problem that Shirley seems to be suffering from PTSD, which is interfering with all of her relationships within the family.

It is not clear what Shirley witnessed while she was deployed, but her symptoms (e.g., trouble adjusting, not getting along with her mother-in-law -- arguing constantly, difficulty sleeping, feeling like she is "in a daze," refusing to go to town because of crowds and noise, disinterested in connecting with her old friends, and irritability with her children) all seem to point to PTSD. The first criterion in the DSM-IV-TR for PTSD diagnosis is "the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others" (p. 467). It is clear that Shirley was overseas on deployment, however, it is not clear what, if anything, she witnessed that could lead to a definite diagnosis of PTSD. More information is needed in order to make this diagnosis official. The second criterion of PTSD is, "the person's response involved intense fear, helplessness, or horror" (p. 467). If both of these criteria can be found to be accurate for Shirley, then the diagnosis can be made. It is highly likely that this is, indeed, what Shirley suffers from given the little information in the vignette.

In the article "A new generation of women veterans: Stressors faced by women deployed to Iraq and Afghanistan," Street, Vogt and Dutra (2009) note that while mental health readjustment issues of female service members are probably going to be quite similar to that of male service members, there are also some unique threats for women that men do not face. Some of these threats include sexual assault and sexual harassment (2009). There has been quite a bit of research done on the adjustments of men coming home from war but not a lot yet done of female service members coming home from war and thus a unique outlook may be in order for this topic.

It is important to include social-cultural factors in the assessment of this family. The Jones family is an African-American family and the father has just recently been laid off from his job. Because of this he has had to borrow money from his mother. It is important to understand how the family views their position in society as well as to get a better understanding from Shirley of what it is like to be a female member of the service. There may be unique challenges that come along with that role.

There are certain ethical issues that may arise when assessing and diagnosing a family. One of the ethical issues involved here could be diagnosing too quickly without evidence to back up a diagnosis. For example, diagnosing the mother with PTSD merely based on the fact that she is a service member newly returned home and having adjustment issues. There could be other problems that she is facing -- like substance abuse issues, which could, in fact, be manifested in the same type of symptoms that Shirley is facing. Though rates of alcohol use and binge-drinking are virtually the same across military and civilian samples (Witkiewitz & Estrada 2011), substance abuse is still a major problem in the United States and thus it should not be something that is overlooked because a quicker diagnosis can be made with PTSD.

From a family systems perspective, as well, there are issues to be sorted out concerning the mother-in-law. Perhaps Shirley and Barbara never had a good relationship to begin with and it may be time for Barbara to move out of the family's home. Though she may have been help while Shirley was away, it seems that she is now perhaps overstepping boundaries in the home. In order for the family to start communicating like a family again, the grandmother may need to be removed from the situation. There is another issue that needs addressing and that is making sure that Ben is not being triangulated or being treated as a scapegoat. Ben seems to be having troubles -- clearly, however, too much of a focus on Ben and his possible drug use or his truancy from school could be making matters worse. Perhaps his behavior is merely a manifestation of all the discord going on in the home.

The therapist's own social-cultural background, personal history, values and biases can, of course, impact the diagnostic process. For example, a therapist who is of a different ethnicity or who doesn't have any real experience with military families may find it easy to "diagnose" based on assumptions about military members or about members of a certain ethnic group. A therapist may assume that it is abnormal for the mother-in-law to be living with the family when, in actuality, in some cultures that is actually quite normal. A therapist not sensitive to ethnic or racial issues might also make assumptions about Ben's behavior.

The focus of therapy from a family systems perspective should be on the family; however, the mother-in-law, Barbara, should be eliminated from this therapy if she is to move out of the house. If not, then Barbara should definitely be included in the sessions in order to help ease communication in the household. On a separate note, it is… READ MORE

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