Assignment: Building alliance in the case study
- Discuss how you would build alliance with this family.
- Develop some hypothesis about the family patterns that you believe are maintaining the problem.
- Conclude by outlining your expectations for each phase of treatment (rapport building, assessment and intervention, and closure).
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.