The Case of Robert and Sophia
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The Case of Robert and Sophia
Renee Bynum
Capella University
The Case of Robert and Sophia
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Abstract
This paper will address the unique marital issues of Robert and Sophia. Specific
methods will allow for the assessment and diagnosis of this couple using family systems
theory and the DSM-IV-TR. Social-cultural factors will be identified as it pertains to the
couple and their marital discord. In conclusion, a treatment plan based on the assessment
and diagnosis of this couple will be outlined.
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In couples or family therapy, the problems are viewed as interactions in which
each one influences the other thus developing characteristics of their particular
relationship (Becvar & Becvar, 2009). The interactions between families and couples are
addressed in the here and now in order to find what is happening that describe the
patterns that have developed.
In the initial assessment, Robert and Sophia will be asked to explain what brought
them to counseling and each other’s view of how the relationship is currently functioning.
A genogram will be constructed during this time, which will allow the clinician to
identify patterns that have developed over time within their families, which may be
contributing to a couple’s current problems. During the genogram interview, the clients
will give information on each other’s parents and sibling interactions, as families tend to
repeat themselves. The genogram explores those patterns of functioning, structure and
relationship through the generations and in utilizing it, the couple can learn ways to avoid
repeating unhealthy patterns (McGoldrick, Gerson & Petry, 2008).
The Global Assessment of Relational Functioning (GARF) found in the
DSM-IV-TR is an assessment tool that focuses on the current functioning of the family or
couple that allows a clinician to identify what part of the continuum they are functioning
from competent to dysfunctional (DSM-IV-TR, 2000). Robert and Sophia would rate
between 61-80 as the functioning of the relational unit is somewhat unsatisfactory, as
conflicts are met with hostility and beginning to become physical in nature. This couple
has significant relational problems categorized, as V61.10 Partner Relational Problem as
there is negative communication that is associated with impairment of at least one of the
partners.
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Initially, Sophia has stated that she has past sexual abuse that has continued to
cause her anxiety due to her having feelings of shame and guilt. This past abuse may be
contributing to current feelings that are causing her to deal in maladaptive ways. In
Robert’s case, he has expressed feelings of depression for over 2 years and has even
mentioned suicide along with having had an extramarital affair thus furthering conflict in
the couple’s marriage. Along with these feelings of depression, Robert drinks nightly
with Sophia to deal with his stressful job, which may be contributing to his depression. It
will be vital to therapy to first make a diagnosis to weather Robert has depression and
address Sophia’s past abuse. Research shows that, “marital conflict reflects a disordered
relational context in which depression occurs, with conflict styles contributing to process
relations between marital adjustment and depression: (Schudlich, Cummings & Papp,
2011). Communication styles in couple’s therapy are crucial to addressing the needs of
the marital relations as well as reducing future depressive states (Schudlich et. al., 2011).
In the case of Robert and Sophia, including social-cultural factors is crucial as
Robert is a first generation German who is an only child and Sophia being from a large
Italian family has lived in the US for many generations. Some of the differences may be
contributed to cultural differences as Robert feels Sophia is always busy with her family
and may be feeling left out. According to Becvar & Becvar, “therapists must raise their
consciousness beyond the level of family to a perspective on the cultural relativity of all
value systems”, as one’s cultural identity consists of many factors (2009). As a clinician
awareness and acceptance to our client’s way of life thus adapting interventions for the
client is crucial in working towards meeting their needs and achieving their goals (Becvar
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& Becvar, 2009). In addition, a clinician’s awareness of their own self-biases and
feelings are critical to meeting the needs of the client and being ethical to the profession.
In working with couples, ethical issues may arise in which the counselor will need
to adhere to the ethical codes of the profession. According to ACA Code of Ethics when
working with multiple clients the counselor in the onset of the relationship will specify
who their client is and avoid any roles that may conflict with each other (2005). In
addition, a counselor working with couple or family upholds the confidences of the
individual unless written permission by the individual is given (AAMFT, 2001).
Robert and Sophia’s key issues that will be addressed in treatment will be as
follows:
Problem
1. Depression as manifested by low self-esteem, sadness, and suicide ideation.
Goal
Robert’s symptoms of depression will reduce significantly and will no longer
interfere with his functioning.
Treatment plan:
a. Robert will identify negative thoughts and feelings and learn to replace them
with more positive ones. Robert and the counselor will explore new ways of
thinking and challenging the negative thought processes.
b. Robert will not report suicidal ideation for 1 month.
c. Robert will learn new problem solving skills and way of coping. This will be
done in session and with homework assignments done weekly.
The Case of Robert and Sophia
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d. Robert will learn new ways of communication during sessions and doing
homework assignments given to the couple.
Problem
2. Child Sexual Abuse
Goal
Sophia will understand how keeping the secret of abuse continues to manifest and
affects her current functioning.
Treatment Plan
a. Sophia will express feeling that are associated with the abuse and how it may
be affecting her present situation.
b. Sophia will learn new coping skills during sessions and with homework.
Problem
3. Infidelity
Goal
Robert will identify how the infidelity is currently affecting his marriage and will
not communicate marital issues with women outside the marriage.
Treatment Plan
a. Robert will learn new ways of communicating with Sophia. During sessions,
the couple will use reframing in that a new reality is created to a situation.
This reframing will be done both in sessions and at home with report on how
it is working at home.
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b. Robert will communicate with Sophia more frequently about his feelings. He
will attend session with Sophia and be actively involved in the
communicating.
Problem
4. Dysfunctional communication
Goal
Robert and Sophia will learn new ways of communication that are more
productive reducing couple conflict. Reduction of arguments will be 1 time a
week over the next 3 weeks.
Treatment Plan
a. Robert and Sophia will learn communication and conflict resolution skills.
During sessions working on conflict resolution and communications skills by
defining the problem in clear and concrete terms. Discussing all solutions to
the problem and coming to an agreement on how to implement a strategy for
change together.
b. Reduce avoiding interactions by having daily interactions on issues that are
important to the couple. Homework will consist of keeping a journal of each
partner’s perspective on how the interactions were and reviewing them during
session with counselor.
Problem
Maladaptive behaviors
Goal
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Understanding how the maladaptive behaviors contribute to current dysfunction
in the marriage.
Treatment Plan
a. Robert and Sophia will distinguish between behaviors that escalate negative
interactions. Robert and Sophia will learn new coping skills and relaxation
techniques during sessions.
In conclusion, as Robert and Sophia continue through therapy they will gain skills
that they can continue to utilize in the future which will allow them to grow as a couple in
a more positive and productive way.
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References
ACA. Code of ethics. In (2005). American Counseling Association. Retrieved from
http://www.txca.org/Images/tca/Documents/ACA Code of Ethics.pdf
AAMFT. (2001, July). American association for marriage and family therapy. Retrieved
from http://www.aamft.org/imis15/content/legal_ethics/code_of_ethics.aspx
Association, A. P., & , (2000). Diagnostic and statistical manual of mental disorders,
dsm-iv-tr.. Amer Psychiatric Pub Inc.
Becvar, D. S., & Becvar, R. J. (2009). Family therapy a systemic integration . Boston,
MA: Pearson.
McGoldrick, M., Gerson, R., & Petry, S. (2008). Genograms: Assessment and
intervention (3rd ed.). New York, NY: W. W. Norton & Company
Schudlich, T. D., Cummings , E. M., & Papp, L. M. (2011). Relations between spouses’
depressive symptoms and marital conflict: a longitudinal investigation of the role
of conflict resolution styles. Journal of Family Psychology, 25(4), 531-540.