Subsystems within a family household consist of each member of the family interacting with one another. According to

Milberg, (2020),a system can be defined as a set of interacting elements. The family is a unit as with each member being

interdependent within the household and if there is a change with one of the members, it can effect the family system, having

their family system to change and go in a different direction which can cause the family to have dysfunctions (Milberg, 2020).

There are several reasons that can impact a family’s suprasystems within their community. One example is when a family go

through a divorce and the family members are divided. The way interdependence can influence the family’s system of

interdependence is the parents continuing to have a close relationship with all the children no matter which parent they live with.

Not allowing their children to see them fighting or being bitter towards one another, helping their children to understand

that both parents love is sincere no matter what, so they can remain close netted and continue to be able to have that

interdependence within the family. The next example, is when a family that has a two parent household and the family depend

on both parent’s income and one family member was laid off or fired from their job. The interdependence that will influence the

suprasystem concept will be for the one family member to support the other one who loss their job, and the family can get together

to develop a plan to reduce their household expenses while the one member can file for unemployment to help the family financial

stability until the other member can get another job.

The final example, is when a family member becomes ill physically, emotionally, and mentally as well as becoming dependent

on drugs and alcohol. This example can have the family to suffer from poverty, and if the family suffers from one or more member

becoming addicted to drugs and alcohol could have the other family members to feel neglected and abandoned. The other

members that are interdependent and became dependent on drugs can turn to the streets and indulge in a life of crime which can

have the family to be involved with the system in one area or another. The interdependence that can influence the suprasystem in

the family will be to the member who became ill overcome their illness and continue to grow as a unit. According to Goldsmith,

(2011), the healthiest way we can interact with those close to us is becoming truly interdependent. This is where two people, both

strong individuals, interact with each other but without sacrificing themselves or compromissing their values. What they have is a

balanced relationship, and unfortunately it is not all that common. It is attainable with just a little awareness and understanding

(Goldsmith, 2011). No matter what happens, the suprasysytem of a family structure will help to gain understanding and knowledge

of the situation families can overcome

Reference:

Goldsmith, B. (2011). Interdependence Day (S) – How To Create a Balanced Relationship

www.psychologytoday.com

Milberg, A. (2020). Sense of support within the family: a cross-sectional study of family members in palliative home care

www.ncbi.nlm.nih.gov

Robin A

In a family system, the basic system is the family itself. The family has subsystems, such as the subsystem which occur with parents, siblings, and individuals. Supra-systems fall in the other direction and consist of extended family members, members of one’s community and country (Warner, 1980). They are often cultural, political and economic in nature, and include social and physical constructs which have an impact on the lives of the family (Wetchler & Hecker, 2015). In my community school is an example of a supra-system that has seen significant changes over the last several months. I live in a very small town and the school here is K-12. To give you a better idea of how small it is, last year there were 12 kids in the graduating class, a number which is actually high for the school. When the school was closed in March due to the pandemic, it had a profound impact on the community. The kids were obviously not in class and some did not have internet access at home to keep up with their work. Working virtually was simply not an option for some families who had seen job loss due to the pandemic. So, the teachers made copies of the work the kids were doing and mailed them to the home each week. While it was certainly a viable alternative, it was one which left the kids with a void; they were not able to work directly with their teachers or share in learning with the other students. In addition, the work was not always done, causing the kids to fall behind.

Economically, the school was at the center of distributing lunches to children every day and eventually was instrumental in providing drive-up food banks for the public. Prior to the pandemic, the school was, at times, a source of a social outlet for the kids as well as the community; sports, plays, and musical concerts were cancelled. The after-school recreation program for the younger kids was cancelled. None of these have resumed and likely will not in the foreseeable future. Church in this community is a staple and for such a small town, there are a lot of churches. However, church services were not being held and the sense of community and fellowship was impacted. Those churches that decided to keep their doors open saw a rise in Covid, which then spread to other members in the community, such as those manning the food banks. Graduation was virtual and those attending college either could not due to Covid or chose not to out of an abundance of caution. Some community members believed the virus was a hoax and chose not to wear a mask in public, something we are still seeing here even now. Others believed the virus would disappear in the spring and chose not to take precautions because of that belief. I have seen a few signs outside of houses that show a mask with a line through it, indicating that it is either not needed to enter their house, they do not believe in masks and the virus, or both. Recently I went to a store in town and a family walked in without masks. They were asked to wear them while in the store and an argument over it ensued, with the family stating they had the right to go without a mask and the employees simply trying to follow the store’s policy. Perhaps it is the stress of this time in our lives, but I opted to leave my cart of groceries in the store and go home. It seems that behaviors we would not have witnessed prior to the pandemic are coming to the forefront and we will be a long time recovering from them.

Warner, J. (1980). Family therapy: a search for foundations, systems and definitions. Journal of Family Therapy. Retrieved from https://onlinelibrary.wiley.com/doi/pdf/10.1046/j.1467-6427.1980.00531.x.

Wetchler, J. & Hecker, L. (2015). An Introduction to Marriage and Family Therapy: Vol. 2nd ed. Routledge.

Some coping mechanisms to help these individuals deal with their daily life stressors and/or emotional regulation include various techniques pertaining to psychoeducation such as teaching the patients and their respective relatives how to integrate their emotions and experiences associated with mental/mood disorders into therapy.. The therapist is additionally challenged with the primary responsibility of teaching the client and their family about the disorder and how to supportively help the person suffering from it (Metcalf, 2011). I find this modality the most effective, especially when dealing with family members who’ve never experienced psychotic episodes or mental disruptions as their counterpart member has because they are genuinely ignorant to the issues which plague this person on a daily basis. This is troubling because ignorance fosters destruction sometimes. One way in which I found this practice can be exercised is through talk of course, but also informative handouts to reference in terms of what the person’s experience may look like when in an psychotic episode, what the family should do to help and how to practice a schedule that is beneficial and also helpful to the avoidance of these symptoms in the clients everyday life. The structure of the family dynamic and mannerism in which they manage the person’s diagnosis is practically just as essential as literal therapy to the client considering our knowledge on how essential family and upbringing is to the overall clients health.

References

Metcalf, L. (2011). Marriage and family therapy: A practice-oriented approach. New York, N.Y.: Springer Pub. Co.

Darren E

The writer had to first get an understanding on the concept of exactly how psychoeducational model will help the clients. This

theory was designed to help people who suffer from severe and persistent mental illness. “Family psychoeducation is an evidence for

people diagnosed with mental illnesses and their families. Evidence-based practices are the type of treatments that has been

documented several times in many different research studies, and have been clinically proven to be effective treatments for specific

clinical problems. Some researchers believes that evidence-based practices will help clients more effectively because it’s proven to

work and help people with severe and persistent mental illnesses to help them live a productive lifestyle” (Corrigan, Steiner, McCraken

Blaser, & Barr, 2001, para.56) The other type of psychoeducation therapy is with multi family group therapy that usually consist of 5 or

more families in the group.

“The two family psychoeducational models that receive the most attention included in multifamily psychoeducation (involving

groups of five to six families) and family focused therapy (FFT). This treatment is used for the people who suffer from schizophrenia

also their family. The (FFT) is used for people who are bipolar. Research for multifamily psychoeducation groups (i.e., Dixon, McFarlane,

et al., 2001; Dyck; Hendryx, Link, Dushay, Marchal, & Crilly, 1995; McFarlane Luckens, et al.,1995) and research for FFT (i.e., Miklowitz

et al., 2007; Miklowitz, Rea, et al., 2003; Miklowitz, Richards et al., 2003; Miklowitz et al., 2000) this represents that they are

evidence-based practices. One of the first technique that the counselor will use while integrating in his family group practice, is joining

with individual patients and families.

According to Metcalf, (2011), this will help to build a close relationship with the client and their family. It helps to create collaborative

treatment which help’s the counselor to seek other help for their client, that they might not be able to provide that will help the family

members to become more engaged in the daily life of their ill family member. The next technique that the counselor will integrate in his

family group therapy, is engagement, and this is when the counselor meets with the family after their client is admitted into the facility they

need to be in. The counselor will ask the family members to be a team with the counselor as partners while helping their ill family member.

The counselor will invite the family into the groups to help work out their family needs.

The last technique the counselor will use in his family groups, is preventing relapse through problem-solving groups attended by

patients and families. The counselor will meet with the client and families to teach them problem solving skills, such as being able to

describe the problem,list possible solutions, discuss positives and negatives, then choose the solution that best benefits the family and

the client, develop a plan to carry out the solution, and go over the how to implement into their life. The technique that the counselor is

less likely to integrate into the counselor’s family groups, is conducting an educational workshop for families where the client usually don’t

participate in the workshop, and the workshops includes the functions of the brain, medication side effects, symptoms, and signs of the

mental illness the client is suffering from (Metcalf, 2011). The reason the counselor wouldn’t use this last technique, because if the client

is not participating in the workshops, how can the treatment be accurate while it’s not the counselor job to focus on side effects that a

doctor should have knowledge of. The doctor can help the client in those areas, while the counselor and family can help the client in other

areas, but it’s hard for the counselor to be successful with the workshop if the client is not able to participate in their own recovery process.

Reference:

Metcalf, L. (2011). Marriage and family therapy: A practice-oriented approach. New York, N.Y.: Springer Pub. Co.

When it comes to consulting other stakeholders in family therapy, this writer feels as if it is important to consult pediatricians as well as school counselors. The reason this student feels as if it is important to include pediatricians in family therapy is because pediatricians are ultimately going to be the first point of contact for children. This especially goes for children who may or may not have a behavioral issue. Among this student’s research, she found that primary care physicians and pediatricians are often the mental health care providers for children. This could include evaluating toddlers for autism, starting medications for symptoms of ADHD or depression, or even just giving parental advice to oppositional children. The unfortunate reality is that primary care physicians (PCPs) are finding themselves to be the primary source of treatment for patients with mental health issues (Rettew, 2014). Due to the fact that pediatricians are the first point of contact for children, it only makes sense for family therapists to consult them. School counselors should be consulted for the sole reason that they are the ones that see the child’s behavior outside of the home and therapy. Children might act differently at school than they do at home, which is why the school counselor’s input would be beneficial for the family therapist.

Children in schools today are coming from very different, complex families. In addition, divorce is more common than it used to be, which often has a negative impact on the children. Among this student’s research, she found that about 13.7 million single parents are raising children. In addition, about one in every three Americans are stepparents, stepchildren, stepsiblings, or just a part of a stepfamily (Butler, Crespi, & McNamara, 2017). A divorce can affect a child’s school performance, which is why it is important for family therapists to consult school counselors. Just like pediatricians, school counselors are a point of contact for children to have access to services if needed. However, it is important to note that school counselors are not trained in family dynamics, which is why they won’t be familiarly with the basics to family counseling. (Butler, Crespi, & McNamara, 2017). That does not mean that they will not be able to help the family or have a significant input into the family therapy aspect to it. This is because systems only work effectively when working together. Just like mental health providers might have to consult primary care physicians, the same goes for school counselors and family therapists. With that being said, this student is now going to discuss an ethical challenge that might arise when working with families in her future career as a counselor.

An ethical challenge would be confidentiality. This is because there will be situations where there is either a patient and a ‘collateral contact’ or more than one patient. There could be confusion as to who is able to consent for a treatment plan. For example, for the case of a minor, one parent might agree with the counselor’s proposed treatment plan while the other parent might be completely opposed to it. Before that is discussed, the patient and the collateral client need to be identified (APA Practice Orientation, 2014). This is because the counselor has to know who they are essentially ‘treating’. The first step of Welfel’s model inquires ethical sensitivity, which would consist of getting a basic understanding of everyone’s side to the ‘problem’. This is because the affects of one person might be taking a negative toll on the rest of the family. The next step basically involves the counselor clarifying who the essential stakeholders are. As previously discussed, there are other stakeholders to take into consideration, especially for a situation where the children is displaying signs on a mental health disorder. Thirdly, the ethical concerns are addressed, whether it be that divorced parents cannot come to an agreement of a treatment plan for their child or it’s an issue of confidentiality. The next step would inquire referring to the code of ethics to validate that they are abiding it. If the counselor is having trouble or concerns with how to address the situation, then that is when they should consult with other colleagues or professionals to get professional input. The next step would just include the counselor will evaluate the potential circumstances to which they can break confidentiality. This especially goes for situations where there are potential signs of abuse. If it seems as if the child is being abused at home, then the counselor should take the proper steps to help that child. The final steps include consulting with either a supervisor or other colleagues to ensure they handled the situation appropriately and professionally. The next step, the counselor should make a final decision. The counselor should then inform all stakeholders, as well as the family of their plan. Finally, the counselor reflects on his/her decision to ensure they did everything in the proper format (Jungers & Gregoire, 2013).

References

APA Practice Orientation. (2014). More than two people in the room. Retrieved December 09, 2020, from https://www.apaservices.org/practice/good-practice/group-ethics.pdf

Butler, K., Crespi, T., & McNamara, M. (2017, May 08). Bringing the family counseling perspective into schools. Retrieved December 09, 2020, from https://ct.counseling.org/2017/05/bringing-family-counseling-perspective-schools/

Christin Jungers, P. L.-S. N., & Jocelyn Gregoire, C. E. L. N. A. (2013). Counseling ethics?: Philosophical and professional foundations: Vol. 1st ed. Springer Publishing Company.

Rettew, D. (2014, September 19). Pediatricians as mental health doctors. Retrieved December 09, 2020, from https://www.psychologytoday.com/us/blog/abcs-child-psychiatry/201409/pediatricians-mental-health-doctors

Robin A

In an example of child abuse, both pediatricians and school counselors are invaluable for the aid they offer to counseling. The same can be said of emergency care providers in a hospital, ambulance workers, urgent care providers, police, and teachers, any of whom may have had direct contact with the child and the child’s parents or caregivers. The stakeholders in this case, those who have worked directly with the child, can provide information that may not be forthcoming from parents or the child’s caregivers. The stakeholders have a moral obligation to ensure no further harm occurs and to offer aid to agencies involved with the child and the family. Likewise, they also have a moral responsibility to prevent unnecessary harm to a child (Harris, 1985). However, abuse may not always be provable, leading to anxiety amongst professionals when suspected cases are not clear cut. The ethical issue in this case is a therapist who is trying to provide therapy to a child and family who have managed care, knowing the obstacles that managed care will throw in their path. I have worked with different forms of managed care for years and have seen the limitations it places on many forms of treatment. Managed care in counseling and other forms of treatment is typically limited, allowing the client a set number of visits. Jones (2008) notes that many therapists will terminate care of a client before the client is ready because of the limitations of managed care. Some change their treatment plans based on this, likely shortening the length and number of sessions according to what managed care will pay for, which could lead to concern for the welfare of the child.

From Welfel’s ethical decision making model, the first step is sensitivity to the moral dimensions of counseling. Insight is needed to better define one’s own personal values and worldview in order to make wise decisions (Jungers & Gregoire, 2013). I do not agree with limiting the number of sessions allowed, however, I have to abide by what managed care dictates. If I believe the family continues to need therapy, I would reach out to the child’s school and ask for the help of the school counselor. I would also look into programs that are available that the family can attend. Step two is defining dilemmas and options that could be an impediment in therapy. In this case, I would refer to step one in reaching out to other agencies for aid. Step three involves defining the issue and the options available. In this case my concern is confidentiality. I do not want to alienate this family from future treatment and if they believe their right to privacy has been violated, they may not attend. The best-case scenario may be to discuss the restrictions of managed care with them and ask if I can share their case with an outside agency for continued treatment (Jungers et al., 2013). Step four refers to the professional standards and seeking out supervision to examine ethical standards and guidelines. I would not hesitate in this case to seek the advice of others as I want to ensure that the rights of the client and his family are not being infringed upon in asking for outside help.

Step five refers to reviewing the literature regarding how other therapists have approached a similar situation. I view this as being a much-needed form of information, not only for the present issue, but for any that may occur in the future. Step six refers to the therapist reviewing any underlying moral principles and values that may need any additional consideration. In this case, the confidentiality issue is one I would revisit to ensure their privacy is not being violated. Step seven is the deliberation and decision phase which entails ensuring that we are certain of our options and are following the best course of action, while step eight is deliberating and coming to an independent decision (Jungers et al., 2013). Steps nine is to notify any stakeholders in the case of the decisions that have been made, while step ten is an opportunity to reflect on the experience and use what has been learned for future cases (Jungers et al., 2013).

Harris, J. (1985). Child abuse and neglect: Ethical issues. Journal of Medical Ethics. Retrieved from https://jme.bmj.com/content/medethics/11/3/138.full.pdf.

Jones, L. (2008). When managed care runs out: Effective, ethical solutions. Social Work Today. Retrieved from https://www.socialworktoday.com/archive/janfeb2008p22.shtml.

Jungers, C. & Gregoire, J. (2013). Counseling Ethics?: Philosophical and Professional Foundations: Vol. 1st ed. Springer Publishing Company.