Family and Marital Therapy, Suicide Essay Example

distress include increased monitoring of their surroundings, anxiety hen separated from trustworthy adults, irritability, aggression as well as increased need for affection, support, and comfort (Kisser, Nurse, Luckiest ; Collins, 2008).

Feature Article - History of Therapy in the Philippines

Distress caused by trauma in adults often displays as flashbacks, avoidance of intense emotions, or lack of emotional control, depression, fear or concern over the safety of family members, anger, re-evaluation of life values and personal worldview, as well as stress-related illnesses such as diabetes, heart disease, as well as substance abuse (Falsetto, Reside, ; Davis, 2003; Pebbles-Silkier, ; Silkier, 1994).

One can easily deduce that when a child or an adult individual within a family system finds themselves in such aforementioned situations and they experience such emotions and distress, they are to seek assistance of some manner, particularly psychological assistance. Family therapy is one of the therapeutic approaches a psychotherapist would use in assisting the individual.

Family therapy can be defined as any psychotherapeutic endeavourer that explicitly focuses on altering the interactions between family members and seeks to improve the functioning of the family as a unit or its subsystems, and/or the functioning of the individual members f the family (Goldenberg ; Goldenberg, 2004). Family therapy aims on functioning on two levels, focuses on relationship goals or healing the relationship between members of the family, and it focuses also on individual goals such as increasing the families coping with a schizophrenic family member (Nichols ; Schwartz, 2004).

In the early years of family therapy, change in the family system was seen as sufficient to bring out change in the individual, however, recent treatment aims

at changes in the individual as well as in the family system (Stock ; Stock, 2007). This tends to supplement the interventions that focus on interpersonal relationships with specific strategies that focus on individual behavior (Stock ; Stock, 2007).

Research shows that the family therapy approach has evolved throughout the past hundred years and has laid a foundation for the more recent therapist to be able to tailor therapy to a particular family in a creative manner (Corey, 2013). There are prominent theorists or figures that have contributed significantly towards this approach and we shall briefly discuss some of the models erected by these theorists. Models of Family therapy

Deadlier Family Therapy

Of the modern era, Alfred Adler was the first theorists to practice family therapy (Corey, 2013). Adler perceived how the development of a child within a family constellation was significantly influenced by birth order, that is, he believed that what mattered or counted was the interpretation a child assigned to their birth position (Adler, 1927). According to Corey (2013), Rudolf Duckers refined the theory of this approach.

The basic assumption of the Deadlier Family Therapy is that both the parent and the child become locked in repetitive, negative interactions based estates goals that motivate all parties involved (Bitter, 2009). On Murray Bone's interest in the patterns perceived across multiple generations led to development of this model of Family therapy (Corey, 2013). He stated that problems arising in one's current family will not significantly change until relationship patterns in one's family of origin is understood and directly challenged (Kerr & Bowen, 1988).

This approach operates on the premise that a predictable pattern of interpersonal

relationships connects the functioning of the family members across generations (Corey, 2013; Kerr & Bowen, 1988). Human Validation Process Model It was Virginia Stair who erected this model and she outlined four communication stances that individual within a family constellation tended to adopt in an attempt to cope with perceived or experience stress.

These communication stances are as follows:

• Blaming-shifting of responsibility;
• Placating-taking the blame to protect another family member;
• Super reasonable-maintaining control of one's painful emotions;
• Irrelevance-any distraction communication to avoid stress (Stair, 1983).

There have been various other models falling under the approach of family therapy such as the Experiential Family Therapy, Structural-strategic Family Therapy, and all have contributed significantly in the development of the approach (Corey, 2013).

In addition to the models that have been discussed, we moved towards the therapeutic techniques applied in family therapy (this will include the nature of the client- therapist relationship) as well as a case study illustrating family therapy in practice. Therapeutic techniques applied in Family Therapy Family therapy has been shown to be a form of treatment that is effective in cases related to family difficulties, individual difficulties and even within psychiatric grinders, often used, however, as a component within a multimode treatment approach (Stock ; Stock, 2007).

There are several goals that family therapy has and these include: reduction of pathogenic conflict and anxiety within interpersonal relationships, enhance the perception and fulfillment by family members of one another's emotional needs, to promote appropriate role relationships between the sexes and generations; to strengthen the capacity of individual members and family as a whole to cope with destructive forces inside and outside the surrounding environment (Nichols

& Schwartz, 2004).

Various techniques and models of intervention are applied in family therapy for various cases, we shall discuss but a few. Psycho-dynamic Experiential Models These models place great focus on the maturation of the individual within the family system and are free from unconscious patterns of anxiety and projection rooted in the past (Scholar & Showier, 2003). The therapist seeks to establish intimate bonds with each family member, and the session proceed with exchanges of the therapist to each family member as well as exchanges between each member of the family (Stock & Stock, 2007).

According to Scholar and Showier (2003), what is deemed as of utmost importance in the session is the clarity of the communication and honestly admitting feelings. Body language of the members of the family is perceived as an aid in uncovering the unconscious pattern of family relationship (Stock & Stock. 2007). The therapist may use family sculpting to view personal view of relationships that are in the past or present, and through the therapist's interpretation and modification of the sculpture, new relationships can be formed (Stock ; Stock. 007; Scholar ; Showier, 2003). Structural Model With this model the family is viewed as a single, interrelated system assessed in terms of significant alliances and splits among family members, hierarchy of power, clarity and firmness of boundaries between the generations, as well as family tolerance for each other. This model uses both individual and family therapy (Goldenberg ; Goldenberg, 2004).

There are various other models and techniques which family therapy makes use of, such as the following:

• General Systems Model-views the family as a system and any action in
  

the family produces a action in other members of the family;

These models and techniques can be applied in different cases of family therapy. The paper now focuses on a case study depicting how family therapy can be put into practice. The case of Suzie Suzie is a sixteen-year-old girl with a two year history of depression, suicidal behavior and self-harm in the form of cutting, who presented to hospital emergency following a suicide threat. In the individual or intake interview Suzie appeared sad and anxious, reporting suicidal intentions and that a few months ago she actually ran towards a cliff, but was captured by a friend.

Suzie added, 'Sometimes I have desires to cut myself to feel better. I carry a razor in my bag and if I feel depressed, go into he bathroom at school and cut myself, little skin cuts which usually heal'. Her last cutting episode was the previous week. Suzie clarified, 'The smallest thing that gets to me, I get into a mood and it takes me weeks to get out of that state of mind'. A frequent trigger is being in trouble with her parent's or feeling down about school, where a few weeks ago she wanted to fade into the background' and thought

of cutting 'deep enough to make it bleed a lot'. She rated her current desire to kill herself as six or seven out of ten, noting that it fluctuates in severity.

This case may rove to be traumatic to the social network or family of the patient or even the patient herself, taking into consideration the duration of Size's depression (2 years) with accompanied suicide attempts Mumping off a cliff, as well as her age. Suzie reports to only confide in her friend. When asked about her father, with whom she has lived since a parental separation three years ago, Suzie said, 'He thinks that when I make a mistake it's his fault. He has high expectations of me, he hates failing and he is competitive. I feel I can't live up to his expectations, I don't want to spotting him, when I do I feel like I have killed someone. ' This narrative provides a focus for therapy in addressing her concerns about failure and expectation. In the second individual therapy session Suzie was diagnosed as having a major depressive episode and suicide risk.

Protective factors included strong family and social supports, varied interests and ability to communicate with firm voice, occasional smile and eye contact. There was no evidence of psychosis, but weekend alcohol binges added risk. Size's depression and self-harm appeared to be a response to primate from teachers and parent's, reflecting an intense adolescent struggle with personal identity, particularly in relation to cultural and family expectations about conformity and achievement. As stated earlier in this paper, family therapy focuses its therapy on two aspects, the actual individual within the family constellation

with the distress, as well as the family members or social network (Stock ; Stock, 2007).

While evidence-based research on treatment of child and adolescent depression is scarce, current guidelines suggest that therapy is beneficial, combined tit medication in more severe cases, and cognitive and family therapy show particularly good results (Denton, Walsh ; Daniel, 2002). The above assessment of Size's depression and suicide risk provided an integrative framework for the following best practice interventions across a period of 8 weeks or more if necessary for the client:

Individual therapy: Individual therapy could afford Suzie with a safe and confidential platform for her to verbally and non-verbally express herself, taking into consideration that the only person she feels safe talking is a friend.

Also, individual therapy will enable the therapist to make use of various therapeutic techniques in assisting the client with depression and suicidal thoughts, techniques such as cognitive behavioral therapy for alleviating self-defeating thought process that are as a result of or one of the causes of her depression (failure and expectation), externalities the depression and viewing it as the problem as opposed to her being the problem. This form of therapy can be conducted from the first to the fourth session, including and taking into consideration the intake interview session. Family Therapy: Several family therapy sessions may aid in exploring Size's depression and suicidal behavior in her social context. These will address cultural and family expectations about failure, achievement and conformity, family communication and developmental tasks for adolescents in families; like autonomy and negotiating rules.

Family therapy can facilitate an emotional and relational environment for Suzie to construct her own narrative identity,

and in Bohemian terms, it can coach family members to be more differentiated and remain true to themselves despite perceived erasures as well as how to assist or cope with Size's situation (Brown, 1999). Models of family therapy applied in this case would be the Bowen model and reframing (constructing own narrative identity); Social network therapy (coaching individuals Suzie is in contact with (teachers, father, friend) on how to assist or cope with Size's plight). Family therapy can proceed from the fourth session until termination is necessary.

According to Stair (1967) family therapy treatment is regarded as complete when family members:

• can interpret hostility
• can see how other see them and how they see themselves when one member can tell others how they manifest themselves
• can give clear messages, be congruent in their behavior (less discrepancy between feelings and what is being communicated
• when one member can tell the other what is hoped, feared and expected from them
• can make independent choices Marital/Couples Therapy Marital or couples therapy is a form psychotherapy that is designed to, in a psychological manner, alter the interaction of two individuals that are perceived to be in conflict with each over a single or various issues, be it they are socially, sexual, motional or economically related Monsoons ; Agreement, 2006).

Within this therapeutic approach, the therapist establishes a rapport and therapeutic relationship with the patient couple and attempts to alleviate the distress, reverse or alter the maladaptive patterns of behavior and encourage personality growth and development, this is done through the use of types of communication (Snyder ; Washman, 2003). In general, marital therapists conduct psychotherapy with individuals, couples and groups;

however, the chief focus rests on the entire interpersonal system, rather than Just one person (Stock ; Stock, 2007).

Thus, a therapist would most often work with the parties involved rather than Just an individual in a situation that involved individual behavior problems (Nelson, 2011). In addition, because marital therapists work from a systemic perspective, focused on understanding and intervening within groups of people, the utility of using this type of expertise within other types of systems (e. G. , communities, substitute families, organizations) is applicable beyond the more traditional family system (Nelson, 2011). In a circumstance that involves trauma-related difficulties between couples, marital hereby as a treatment modality is warranted, as it can provide interventions that both support and promote change within the relationship, to develop a structure that fosters the needs of both parties (Nelson, 2011).

According to Nelson (2011) and Stock and Stock (2007) specific interventions should include handling grief and loss matters, creating different structure, providing psycho-education for post- traumatic stress and other disorders, and forming appropriate rules that fit the current situation. The goals that this approach to therapy has are as follows: to alleviate emotional distress and disability and to promote the levels of well-being of both partners together and of each individual (German ; Jacobson, 2003). The therapist is to move towards these goals by reinforcing the mutual resources for problem solving, improving resistance against disintegrative effects of emotional distress and by promoting the growth of the relationship and of each partner (Stock ; Stock, 2007).

Couples therapy, however, does not ensure the preservation of any relationship, but can indicate to couples that they are in a nonviable

relationship ND should consider dissolving it (McCormick, Giordano, Garcia-Pedro, 2005). There are various techniques that can be used in therapy to ensure that the aforementioned goals are reached; we shall briefly discuss a few and then make use of a case study of a couple to illustrate how this approach is put into practice. Therapeutic techniques of couples therapy

1. Individual therapy-partners consult different therapists in an attempt to solidify each partner's adaptive capacity (McCormick, Giordano, Garcia-Pedro, 2005).
2. Conjoint therapy-the parties are treated together in a session by two different harpist of different sexes, in an attempt to ensure that no party feels ganged up on when confronted by two members of the same sex (Stock & Stock, 2007, Snyder & Washman, 2003).
3. Four-way session-each partner is seen by a different therapist, with regular Joint sessions where all four individuals participate in a session.
4. The Sound Relationship House Theory (SIR)- Developed by John M. Goodman-stable relationships are described in the three components in the SIR theory: the Friendship System, the Conflict System, and the Meaning System. The iris three levels of the SIR describe the friendship system.
5. Love maps: The most elementary level of friendship, a love map refers to feeling known by your partner. The fundamental processes are asking open-ended questions and recalling the responses.
6. Fondness and admiration: This level describes companions' ability to notice and express what they appreciate about each other.
7. Turning toward: When couples are in each other's company in a relaxed mood, they are often expressing their need to one another either nonverbally or verbally.
8. Sentiment override: If the first three levels of the friendship system are functioning well, couples will
   

be in positive-sentiment override.

They talked about getting married, and he started looking for a ring. They dreamed about life together, a life of beauty and Joy, raising babies and laughing with friends and growing old. Jack dropped out of college and began irking in construction. Jill continued with her studies in nursing and later became a nurse at the local hospital. They have been together for a

period of five years. They had their whole lives ahead of them, being both only 25 years old. They did not envision a motor vehicle accident. Due to the accident, Jack had to have his leg amputated. He could no longer work as a result. He is now walking on crutches as they cannot afford an artificial leg for him. They did not plan for this.

Soon after Jack and Jill got married they were involved in a car accident, leaving Jack with the symptoms mentioned above. With such sudden turn of events, the couple had to find a way to move on with life and adapt to their new situation. Jack became increasingly distant and withdrawn. They hardly spoke to one another, the intimacy has decreased significantly. Jill has resorted to the use of alcohol as she is finding difficult to understand Jacks new behavior. The treatment is focused on increasing the adaptive capacity of both clients dealing with the trauma and promoting the growth and development of the couple. The couples will be seen in a conjoint therapy session as well as individually.

The intake interview session provides the client couple with an environment that is safe and encourages them to express their emotions, feelings and expectations of one another. Within this session there is a three-session assessment process to determine (within the context of the SIR) the strengths in the relationship and the areas that need work. This assessment offers the plan for where to focus the therapy; interventions are carefully chosen to address precise aspects of relationship difficulty. The session is 80 minutes, opening with the couple's narrative about what brings

them to the therapist's office. After attaining the narrative, the second session moves to the oral history, inquiring about how the couple met and how the relationship developed.

The inquiry focuses on courting, the day of marriage and important events in their relationship. The oral history is a significant aspect of the assessment process because how couples tell the story of their relationship is an important indicator of whether the individuals are in negative-sentiment override or positive-sentiment override (Carson ; Cascade-Shoe, 2011). In the third session the client couple is taught on how to manage conflict. They are provided with the opportunity to also discuss typical conflict causing scenarios within their relationship. The clients are trained and afforded a chance to practice their conflict management skills in the session by being provided with problems to solve together.

The fourth session is an individual session, which focuses on obtaining a brief family history; assessing the level of commitment to relationship; hopefulness for repair; domestic violence; infidelities; individual psychopathology; assessment for addiction or abuse with substances, including behavioral addictions (Carson ; Cascade- Shoe, 2011). From the fourth session, any concerns that have been highlighted in the individual sessions, such as Sill's alcohol abuse, are addressed individually with the clients to ensure that both parties are ready as individuals to strengthen, restore and develop their relationship together as couples. This may take as long as necessary (approximately 4 long sessions) until both parties are ready.

After the individual sessions the clients are brought together again in a therapy session where the couple is given feedback on their relationship in the context of the SIR levels, sousing on the

strengths and difficulties in each level. The feedback is centered on incorporating all information from the previous sessions. The couple is handed a copy of the SIR diagram and each level is explained. They are also provided with as assessment of the strengths and challenges in each of the seven levels of the SIR, accounting for comrade difficulties and family-of origin dynamics (Carson & Cascade-Shoe, 2011; Goodman, 2004). The couple's sessions will proceed until the goals have been reached.

The SIR diagram extracted from (Carson ; Cascade- Shoe, 2011): This paper will now focus on suicide, not merely what suicide is but rather the risk factors, warning signs and how to assess or handle a suicide case as a professional therapist. Suicide There are various theories and models that attempt to conceptualize suicide, however most, in one way or another, conceptualizes suicide as: an individual's stresses have distressed him or her to a point where all plans on alleviating psychological distress have been exhausted or the individual finds it more suitable if they were to take their life and no longer have to deal with the distress dames & Gillian, 2013).

According to Forebear and Litton (1976), there are clues that suicidal individuals give when they may commit suicide and they are as follows:

1. Verbal clues-written statements which may be direct or indirect, about the intention of the act;
2. Behavioral clues-purchasing a grave marker for oneself or self-mutilating;
3. Situational clues-concerns over a range of conditions such as death of spouse;
4. Symptomatic clues-constellation of suicidal symptoms such as severe depression, hopelessness and worthlessness.

As there are clues that can be used to determine if whether an

individual is in fact suicidal, there are also warning signs that help linsang in determining one's suicidal behavior.

Warning signs of suicide According to Rude, Barman, Joiner, Knock, Silverman, Mandrakes, Van Order, White (2006) these are warnings signs of suicide: Someone threatening to hurt or kill themselves Someone looking for ways to kill themselves: seeking access to pills, weapons Someone talking or writing about death, dying, or suicide Hopelessness Rage, anger, seeking revenge Acting reckless or engaging in risky activities, seemingly without thinking Feeling trapped like there's no way out Increasing alcohol or drug use ?

Withdrawing from friends, family, or society Anxiety, agitation, unable to sleep, or sleeping all the time Dramatic changes in mood No reason for living; no sense of purpose in life Protective and risk factors for suicide The potential risk and protective factors are outlined below as listed by the National Strategy for Suicide Prevention (2001) . Protective Factors for Suicide Effective clinical care for mental, physical and substance use disorders Easy access too variety of clinical interventions and support for help seeking Restricted access to highly lethal meaner of suicide  Strong connections to family and community support Support through on-going medical and mental health care relationships problem solving, conflict resolution and nonviolent handling of disputes Cultural and religious beliefs that discourage suicide and support self preservation Skills in Risk Factors for Suicide as listed by the National Strategy for Suicide Prevention (2001) .

Bio psychosocial Risk Factors Mental disorders, particularly mood disorders, schizophrenia, anxiety disorders and certain personality disorders Alcohol and other substance use disorders ?

Hopelessness

Impulsive and/or aggressive tendencies History of trauma or abuse Some major

physical illnesses Previous suicide attempt Family history of suicide Environmental Risk Factors Job or financial loss Relational or social loss Easy access to lethal meaner Local clusters of suicide that has a contagious influence Social cultural Risk Factors Lack of social support and sense of isolation Stigma associated with help-seeking behavior Barriers to accessing health care, especially mental health and substance abuse treatment