Introduction
Marriage counseling is indeed an important function which enables the couples to identify the root causes of problems existing in the marriage. Couples often experience challenges in their marriage at some point in time and may, therefore, decide to seek professional assistance. The existing problems in the marriage are usually caused by a number of factors including disorders and also the socio-cultural differences existing between the individuals (Dattilio, 1998). Conversely, the therapists need to examine the issues critically in order to guide the couple effectively, thus assisting them come up with viable solutions (Dattilio, 1998). The paper provides information on the assessment, diagnosis and the treatment plan for a couple.
Vignette of Derrick and Michelle:
Derrick and Michelle have been married for five years and were in their early 30’s. Derrick is an only child in his family, and his parents moved to the United States from Greece when he was thirteen years old. Derrick suffered some self-esteem issues because he felt very isolated while in high school and college. However, his wife Michelle comes from a large Swedish family. Michelle’s family has been living in the United States for many decades. Unfortunately, Michelle was abused by an uncle when she was a child, but she did not disclose the incident to anyone because she was too afraid and ashamed. Consequently, Michelle did not receive counseling services, and this has apparently affected her over the years. Additionally, Michelle is in the habit of visiting her family often. Derrick and Michelle usually argue about Derrick’s frequent business trips out of town, the amount of time Michelle spends with her family and when they should start having children. Derrick desires to have children, though Michelle claims that she still needs more time to fulfill her career. The couple also drinks a bottle of wine every day.
A month ago, Michelle discovered that Derrick had an affair with a co-worker during the previous summer, and she became furious. When she confronted Derrick, he refused to discuss the subject and only stated that it was a “mistake”. Derrick however admits that he has been depressed and has also felt unhappy in the marriage though he does not think to talk about it will help salvage the situation. Michelle feels betrayed and is unable to concentrate in her work. She, therefore, pleads with Derrick to tell her what he needs, but he remains silent and withdrawn. Derrick’s drinking has since increased, and he is becoming more depressed. Michelle has secretly been going through Derrick’s mails both in his phone and computer. She discovers the current messages that Derrick had written to another woman describing his hopeless feelings about his marriage. Michelle becomes devastated and filled with suicidal thoughts. One evening, Derrick finds Michelle dangling in the roof top. Fortunately, she is not dead and is rushed to the hospital. The couple decided to get marriage counseling since the incident frightened them both.
The above is an example of an extreme case of a marital problem. Therapists need to understand the situation better in order to know the best theoretical approach to applying. In this case, it is prudent to incorporate a solution focused therapy since it conceptualizes the couple’s strengths while exploring solutions. The solution focused therapy is conducted through directly observing the clients’ responses to a given series of precisely constructed questions. It is a collaborative approach and the goal-directed method of achieving psychotherapeutic change.
The Solution-Focused Therapy (SFT) therefore aims at achieving the clients’ vision of solutions. When applying this approach to Derrick and Michelle, it attempts to shift their focus from “failure” to “effectiveness”. Therapy is, therefore, the process and hence it takes time to obtain solutions. During the counseling sessions, Derrick and Michelle are invited to explain their various goals surrounding the counseling experience and what they hope to achieve. Counseling is necessary since it provides them with an opportunity to air their views (Dattilio, 1998). However, in the event that the couples fail to present a concrete sense of their expected outcomes, therapists usually ask miracle questions to guide their thoughts towards a resolution. Examples of the miracle questions that may be asked include: “Has any of this ever happened before?”, “If you no longer had issues with your spouse, what are the things that would be different.”
In addition, once the common goals have been identified, the therapist can then use a genogram. The genogram is a family tree that allows the user to visualize psychological factors and hereditary patterns that affect the relationship hence it will be beneficial to Derrick and Michelle (AAMFT, 2012). Derrick and Michelle have different backgrounds and also different past experiences. They also have diverse cultures hence the use of a genogram seeks to explore the different cultures. Consequently, exploration of the cultural norms will enable Derrick to have an in-depth understanding as to why Michelle spends time with her family. Also, the therapist will praise and congratulate both parties for taking a bold step to engage in counseling hence this is their common strength (Gurman, 2008).
Conversely, additional strengths can also be examined to facilitate the problem-solving process. Counseling will be more effective if the therapist is also a victim of the various issues being raised. For example, if the therapist is a victim of rape, she will be in a better position to share her personal experiences hence she will have sincere empathy for the couple. Thus, this will allow Michelle to feel at ease. In the event that the therapist is not familiar with a particular issue e.g. the Swedish culture, he, or she must conduct extensive research in order to understand better the existing behaviors. Additionally, the couple’s ideology may differ from that of the therapist however the therapist should remain calm and neutral and maintain a professional stance at all times (ACA, 2013). For example: in the issue of infidelity, the therapist should allow Derrick to explain his viewpoint on infidelity and also explain why he had an affair. However, if Derrick tries to justify himself, the therapist should let him express his opinions after which she will address the situation.
Ethical Issues:
The counselors must always maintain confidentiality when dealing with their clients hence ensures that all the information is kept confidential. However, there are unique circumstances in which the disclosure is essential so as to protect the clients' from serious harm (ACA, 2013). Therapists usually advise their clients that they have the responsibility of making sound decisions regarding the relationship. There also exists individual therapeutic sessions though the couples still need to be informed that no secrets will exist between them. In this case, no secrets should be kept between Derrick and Michelle hence it is important to uphold transparency at all times. Additionally, in trying to solve the problem between Derrick and Michelle, the therapist also incorporates the need cultural sensitivity. As a result, Michelle and Derrick will be more flexible with each other’s cultures. The therapist will not try to persuade the couple but will only provide education on the benefits and consequences of the couple’s decisions (AAMFT, 2012).
Diagnosis:
A comprehensive assessment is usually undertaken on the individuals so as to determine the type of disorder that an individual is suffering. In Derrick’s case his level of depression can be determined through the Beck Depression Inventory (BDI-II) or the Diagnostic Inventory for Depression (DID). The therapist also discusses Derrick’s feelings in order to try and identify if he has an anxiety disorder given that he has a history of isolation. The therapist can also administer the Beck Anxiety Inventory (BAI). Subsequently, Derrick’s drinking habits had increased and can be diagnosed for alcohol abuse. The couple will also be instructed to undertake the Michigan Alcoholism Screening Test (NAADAC, 2008). Michelle will also be examined for severe depression that led her attempt to commit suicide. In this case, the DSM-5 needs to be incorporated (Hewison, 2014).
Treatment Plan
Marital problems are usually handled systematically so as to improve the effectiveness in the long-run (Hewison, 2014). In this case, the proposed treatment plan comprises of a 16-week group sessions and also a six-month individual session. Common issues are tackled during the joint sessions however the individual issues are addressed during the individual sessions (Gurman, 2008). Derrick and Michelle will be expected to device coping mechanisms. The therapist can also ask questions like, “whether things are any different from the last session?” Such questions enable the therapist to know whether they are making progress. The therapist might even make a suggestion to the couple and ask them whether they wish to start their relationship all again and make things right. Individual sessions are necessary because certain individuals might not be comfortable discussing certain issues in the presence of their spouse. Group sessions will enhance the couples understanding of the genogram. Additionally, this will allow the exploration of changes towards a revolution. Treatment is, therefore, important because it enables the couples to achieve their marital goals. The couples also learn to endure one another hence strengthening their relationships (ACA, 2013).
Conclusion
Otherwise, in the event that the therapist is not able to handle a particular case, and then the therapist must maintain competency and therefore make referrals to another professional. Couples must include dialog and communication at all times so as to avoid misunderstanding. However, in the event of a crisis between the couples, the therapist must incorporate a solution focused therapy since it is goal-oriented hence more appropriate.
References
American Association for Marriage and Family Therapy. (2012, July 1). AAMFT Code of Ethics. Retrieved from<http://www.aamft.org/imis15/Documents/Final%202012%20AAMFT%20Code%20of%2 Ethics.pdf. > On 16th November, 2014.
American Counseling Association (ACA). (2013, Jan 16). Ethical issues related to conversion or reparative therapy. Retrieved from < http://www.counseling.org/news/updates/2013/01/16/ethical-issues-related-to-conversion-or-reparative-therapy> On 16th November, 2014
Dattilio, F. M. (1998). Case studies in couple and family therapy: Systemic and cognitive perspectives. New York: Guilford Press.
Hewison, D., Clulow, C. F., & Drake, H. (2014). Couple therapy for depression: A clinician's guide to integrative practice. Oxford: Oxford University Press.
National Association for Alcoholism and Drug Abuse Counselors. (2008) .
NAADAC code of ethics Retrieved from <http://www.naadac.org/index.php?option=com_content&view=article&id=185%3Apr11&> On 16th November.
Gurman, A. S. (2008). Clinical handbook of couple therapy. New York: Guilford Press.
