Reference no: EM13809336

Short Questions:

1. Relational Context is different from systems therapy because the system is larger than the specific context of a specific closely identified issue. For instance, what is called fairness in relational context may be referred to in systems theory as the parent child subset. Relational Context lessons the range of speculation and removes ambiguity when treating clients presenting problems. The presenting problems according to the client may be favoritism by the parents to the youngest child and the middle child may be the identified patient and have an older sibling. Family Systems would look at the sibling position and I believe that a Contextual therapist would look at the issue of fairness. It shrinks the patient's frame of reference while giving the problem a name and label.

2. I understand ontic dependence as needing another to maintain one's sense of self. In class Dr. Nagy said, "I can not be a doctor without patients needing my help." I believe the same statement applies when I say I cannot be a nurturing mother without my child needing nurturing. The clinical implications of the ontic self could include seeing a couple who's self delineation is unclear and the wife may find herself nagging her husband about coming home late from work, while even if the husband does begin to come home on time, the wife's ontic image of herself depends on the husband being late from work, thus she will continue to reference the times when he used to come home late to maintain that image of herself, and her perception of her husband is.

3. Often I see the merger relational mode appearing in the families of single women that we serve at my practicum site. A lot of the single women raising children often see themselves and their children as one. Therefore, when they are dating men, living with men, or even marrying they have a hard time letting someone else raise and chastise their children. This becomes problematic because the men feel isolated and peripheral within their new family system.

4. Transactions and power alignments of dimension III represent themselves within this example and are frequently represented in the family cases we serve at my practicum site. Tiffany was experienced sexual trauma as an eleven year old and she became a teen mother at fifteen. Her daughter became our identified patient at fifteen and their relationship with each other was hostile and lacked appropriate communication patterns. Often Tiffany would yell, scream, or ignore Lashawna. When Lashawna felt ignored or rejected by her mother, Tiffany, she would run away exhibiting behaviors of promiscuity, lying, and hostility. Myself and my co therapist was able to complete a genogram with this family and assist with raising Tiffany's consciousness of how the patterns are repeated within the family dynamics. By increasing Tiffany's level of autonomy she was able to regulate her reactions in response to her emotions more adequately and in return Lashawna has been able to do the same.

5. In the above example we were able to use interventions with this family that increased her awareness in understanding that unless she was willing to be vulnerable and exposed Lashawna would not be willing to be vulnerable and exposed. This could have decreased our chances to reach the healing moment if Tiffany would have coped with her past memories by not allowing us back in her home, or if she would have stopped Lashawna's services to sedate her own fears. Without that balance in the session the family would continue to repeat the same identified patterns. Through Tiffany trusting the therapeutic process she was able to give her daughter a piece of her own self that she had protected. In turn, Lashawna was able to receive from her mother, and that process created a balance within the relationship. This is an example of the healing moment in Contextual therapy.

Essay I: Clinical Manifestations of Loyalties

I am newly married and I am pregnant with my sister who is expected to deliver her baby two weeks prior to my delivery date. My sister is seven years younger than me, and I raised her independently for seven years. My mother is a recovering addict and had relapsed, thus leaving me to care for my little brother who is eleven years my junior and my little sister. This all happened in my freshman year at Temple University. I want to use my own family as the case where clinical manifestations of loyalty arise, because it may help me at a very difficult time in my life to put assess my current familial situation while writing it all down. I do not have time to journal consistently, but I am fortunately in a Master's program that allows me to talk about me and get good expensive feedback a My mother, 50 years old was a single mother and raised me as the matriarch of the family so that she could assume the role of the patriarch of the family and go out and make the monies necessary to provide for the family.

Working class citizens who also had problems with alcohol raised my mother in a two parent home. My mother describes her parents as unemotional. My mother started using crack cocaine in 1986, I was four years old. At the age four I was taken away from my mom and raised by several different family My mother came to get me when I was eight years old, and from there we went into the shelter system. When I left for college I was seventeen, and my mom would not allow me to go away to school because she said I was only seventeen and not old enough to be far away from home. Temple University was my mother's choice; while she wanted me to live at home and commute I moved out the house and lived off campus.

I believe this was my mother's first perception of me being disloyal to her and my siblings. I believe that she was so destructive in her own life and entitled to me that this may have been one of the reasons she decided to start doing drugs shortly after me moving out the house. Now, I am married and expecting my own child and my mother continues to constantly call on my services and gets mad at me when I can not oblige her needs or wants. My mother lives on the second floor of my triplex. She lives rent free, and her car is on my husband and I insurance. She rarely pays the insurance bill, stating that she is on a fixed income and can't afford the insurance all the time. Often my mother makes comments about the things my husband purchases and the time we spend together, but will say you never have time for your siblings any more. She asks me to do tasks that she knows will overexert my body, just to see "how much I love her." I believe she is constantly testing my loyalty and this creates a loyalty conflict for me. My loyalty lies with my husband, but as stated in class filial loyalty is almost innate, and I cannot help but to feel disloyal to my mother and her expectations.

I often feel like we are at odds because my loyalties have shifted from her and my siblings to Tyree, my husband, and our unborn child. I try to maintain balance, and be present for them as much as possible, but it does not appear to be enough for my mother. She definitely keeps an account ledger and her math is always wrong, because she keeps me in the negative. While I keep her in the red. It would seem that dimension IV of the V dimensions would be the most relevant to this case because of the filial component of loyalty. I have looked at all five dimensions of relational reality and attempted to gather possible determinants for my mother's perception of what loyalty looks like to her, and who wasn't loyal to her in the past. One intervention according to Contextual therapy that would be helpful is the ability to use multi-directed partiality. I believe to get to the point where my mother and I can have an intimate discussion and genuine dialogue she must see that I can empathize with her feelings, and where the issues arose for her as a child with my grandparents. This also allows us to enter the sixth relational mode of dialogue, but only if she can see that I am being impartial to her and not only focusing on my needs and my own feelings of injustices.

Essay II: Mobilizing Therapeutic Resources

The case that I will be referring to is the case that I mentioned briefly in short answer number four. Tiffany and Lashawna have been in therapy for almost nine months and the agency model that we do therapy from is eco structural systemic. Lashawna was referred to Intercultural family services for truancy, hostile relationship with mother, running away from home, and sexual abuse trauma.

According to Dimension I of relational reality the facts of this case are as follows: the family is African American, the mother suffers from bi polar disorder the family of five receives SSI benefits and have an household income of 3,500 dollars monthly. The family has a pattern of sexual abuse as Tiffany and Lashawna both report child molestation. Tiffany suspects that her own mother also was molested citing a family member, indicating incest. They are not practicing Christians although they have stated Baptist Christianity as their faith.

Dimension II assesses the needs and psychology of the family. This family has patterns of mental illness, including bi polar, ADHD, abandonment issues of parents and intimate partner relationships. Besides the mental illness within the family, the family's perceptions of each other's loyalties and responsibilities have been based on the above psychologies and needs not being met previously. Thus, the generational patterns repeat themselves within this family system.

Dimension III assesses the transactions within the members of the family system. Systems theory refers to this category as feedback loops, if I understand correctly. In dimension three assessing how the family communicates with each other, where did they learn how to communicate, and what roles and perceptions are being maintained by relaying these transactions between each other. This family is use to triangulation and Tiffany does this with the children with simple things, for instance instead of Tiffany giving Lashawna a directive she will send the message through one of the other children which then causes the siblings to argue and fight.

Dimension IV speaks to relational ethics within the family. This family's ethics are blurred. They have a hard time not keeping an account ledger amongst them. There is very little balance in the relationships between the five of them. The term reciprocity is almost a foreign concept to Tiffany, the mother of the five children. Tiffany is a firm believer that her mother never did half of the things she does for her children so therefore they should be grateful and appreciate what she does do instead of complaining about what she does not do.

Dimension V for this family looks like Tiffany being dependent on Lashawna's negative behaviors in order to maintain her sense of self. She views her self as the disciplinarian, very tough parent in the home. She often states that she is the man and woman in the house. When Lashawna is doing well in school and at home Tiffany has a difficult time acknowledging her positive changes. I believe recognition of Lashawna's change means that she herself would have to change. This in return changes her perception of her daughter and her role as the mother in the home. It appears that she is scared for the children's perception of her to change, she seems to be scared to give the children praise because she does not want them to view her as weak.

My rationale for intervening within the fourth dimension of relational ethics is due to the concepts of fairness and reciprocity. This family could benefit from something different. Tiffany has a hard time being fair to the children because of her fear of being taken advantage of by them. This stems from her being taken advantage of by people in the past that she loved and expected to protect her.

As a therapist I would employ multi directional partiality to Tiffany allowing her to feel my empathy for her, while assisting her in feeling her children's pain. If Tiffany can bring herself to show a generous act of kindness and reciprocate the love and attention that her children show her naturally, I believe that this could bring a balance to their relationships inside the home. In turn the children may be able to show generosity by committing the act of forgiving.