Case Study DSM IV-TR diagnosis and Family systems theory utilization
This is a DSM IV-TR diagnosis of the case study provided below. It will contain a Five Axis Diagnosis including all v codes. Family systems theory is also to be provided in conjunction with the diagnosis. It can be assumed that the diagnosis will be Adjustment disorder for the Identified patient, Joe. All five axis must be filled out, but not in any table form. Instead use a heading and list each axis in conjunction with its corresponding fill in. The Family systems theory is to be somewhat described and used to justify the diagnosis and issues faced by the family. The Case study is below. Thanks very very much.
Case Study
Presenting issue:
Joe and Dante are a same sex couple who want to come to counseling because they have been faced with an issue they “do not know how to deal with.” Joe and Dante have a daughter, Alexandra, together (with the help of a surrogate), and recently she has been asking if she has a “mommy.” The couple does not want to lie to their daughter, but does not know how to tell her. Joe was the one who initiated coming to counseling because he says he has been feeling “overwhelmed” and has a lot of things on his mind concerning his partner, daughter and job.
Identified Patient:
The identified patient is Joe, because he is the one who initiated counseling and reports struggling the most with this adjustment.
Case:
Joe and Dante met in college and have been together for 15 years. Both Joe and Dante identify as gay, and are open with their sexuality. Joe is a 35 year old Italian male who works as a firefighter. He is very dedicated to work and often puts in long hours at the fire house, causing him to be away from his family. Dante is a 36 year old Dominican male who works from home as a programmer. Although he is dedicated to his work as well, he has more flexibility in terms of his hours.
Joe and Dante moved in with each other 10 years ago and were committed to their relationship. About 7 years ago, Joe and Dante wanted to expand their family and have a child together. After much discussion and research, Joe and Dante decided to have their friend Cathy be the surrogate mother. The couple decided that Joe should be the biological father since he has less health problems that run in his family. Dante would adopt the child as his own after the birth. Cathy would conceive the child through in vitro fertilization.
Joe and Dante wanted to be able to trust who the mother of their child would be, and knew Cathy would be a good choice since they both were close to her since college. Cathy is a 34 year old single Italian woman who identifies as heterosexual. Cathy works in sales and was recently promoted to vice president of her company at a Marketing Consulting firm. She works 80 hours a week and travels regularly for business. Cathy decided years ago that having children was not part of her life goals and was excited at the opportunity to help her friends fulfill their life dreams. Cathy would remain a close family friend and continue to be involved in Joe, Dante and the child’s life as that.
Alexandra was born 6 years ago this past September. The couple raise their daughter together. However, due to his work flexibility, Dante became the stay-at-home dad and primary caregiver to Alexandra. Recently, Alexandra has been coming home from school asking about her “mommy.” Mother’s Day is approaching and the teacher has assigned a project. Both Joe and Dante agree they do not want to lie to Alexandra about Cathy being her mother, but they are struggling in how to tell her, and how it will effect their family. Joe admits that he and Dante have often talked about the day this question might surface, but never came about with a good way of handling it. Joe is also feeling pressure, because he feels if Kathy gets too involved it might make trouble in the family.
In addition, Joe tells you that he has been feeling that he has not been a good father and lover. He believes that the long hours at his job and his extreme masculinity blocked him from being a caring and nurturing person. When he sees his daughter and his partner together he feels he has denied them so much love and care. Joe also states that Dante is an expert at nurturing and shares a great bond with Alexandra, and this often makes him very jealous because he so wishes he could do the same. Joe also states he wishes he could be a better lover to Dante and not be so masculine and distant sometimes.
Treatment Plan
I. Problem Identified
Joe and Dante want to find an appropriate way to tell Alexandra who her biological mother is (Cathy) and explain the structure of their unique family. Both Joe and Dante want to set boundaries, but also continue to incorporate Cathy in their child’s life. Joe wants to be more involved in Alexandra’s life and feel like he is a loving partner to Dante.
Interventions (Have to match theory)
V. Five Axis DSM-IV-TR Diagnosis
Axis I.
Axis II.
Axis III.
Axis IV.
Axis V.
VI. Prognosis
CFS 410U, Winter 2001, C. Morgaine, Ph.D.
Family Systems Theory
This theory emerged from General Systems Theory by scholars who found it had many
applications to families and other social systems. Any system is defined as a bounded set
of interrelated elements exhibiting coherent behavior as a trait. (Constantine, 1986).
Another definition is an assemblage of objects related to each other by some regular
interaction or interdependence (Webster). Families are considered systems because they
are made up of interrelated elements or objectives, they exhibit coherent behaviors, they
have regular interactions, and they are interdependent on one another.
The Components of Family Systems Theory are as follows:
Family Systems…
• have interrelated elements and structure. The elements of a system are the
members of the family. Each element has characteristics; there are relationships
between the elements; the relationships function in an interdependent manner. All
of these create a structure, or the sum total of the interrelationships among the
elements, including membership in a system and the boundary between the
system and its environment.
• interact in patterns. There are predictable patterns of interaction that emerge in a
family system. These repetitive cycles help maintain the family’s equilibrium and
provide clues to the elements about how they should function.
• have boundaries and can be viewed on a continuum from open to closed. Every
system has ways of including and excluding elements so that the line between
those within the system and those outside of the system is clear to all. If a family
is permeable and vague boundaries it is considered “open.” Open boundary
systems allows elements and situations outside the family to influence it. It may
even welcome external influences. Closed boundary systems isolate its members
from the environment and seems isolated and self-contained. No family system is
completely closed or completely open.
• function by the Composition Law: the Whole is More than the Sum of Its Parts.
Every family system, even though it is made up of individual elements, results in
an organic whole. Overall family images and themes are reflected in this
wholistic quality. Unique behaviors may be ascribed to the entire system that do
not appropriately describe individual elements.
• use messages and rules to shape members. Messages and rules are relationships
agreements which prescribe and limit a family members’ behavior over time.
They are repetitive and redundant. They are rarely, if ever, explicit or written
down. They give power; they induce guilt; they control or limit behaviors; and
they perpetuate themselves and reproduce. M
ost messages and rules can be stated
CFS 410U, Winter 2001, C. Morgaine, Ph.D.
in one or a few words. For example, More is good, Be responsible, and Be
Perfect are all examples of messages/rules.
• have subsystems. Every family systems contains a number of small groups
usually made up of 2-3 people. The relationships between these people are
known as subsystems, coalitions, or alliances. Each subsystem has its own rules,
boundaries, and unique characteristics. Membership in subsystems can change
over time.
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