Introduction
This paper examines the therapeutic approach for a family undergoing significant transition and turmoil, primarily focusing on the identified patient, VL, a 16-year-old diagnosed with Autism and ADHD. The backdrop to VL's story is a family embroiled in a contentious divorce and custody battle, a situation that strains the familial bonds and exacerbates the challenges inherent in VL's diagnoses. With a multi-disciplinary approach that includes pharmacotherapy, psychotherapy, and culturally sensitive interventions, this paper offers a treatment plan to address the needs of VL and his family. It also emphasizes the importance of having responsive therapeutic interventions tailored to the unique situations of families.
Assessment
The genogram and interpersonal recordings reveal a family structure fraught with tensions and disruptions. KL, the father, age 49, has a history of hypertension, pre-diabetes, depression, and an anxiety disorder; he feels isolated, and clings to his sister as his main support following the loss of his parents. His sense of alienation is compounded by his marriage's intrusion by extended family members who share a closely knit but overbearing relationship.
NM, the mother, age 44, a registered nurse with no medical history, initiated therapy post-separation. Their daughter, CL, age 15, is inadvertently placed in the uncomfortable role of a mediator, a role she is soon to relinquish as she anticipates starting individual therapy sessions.
At the heart of the genogram is VL, the identified patient, age 16, struggling with autism and ADHD, caught in the throes of a contentious divorce and custody battle. The genogram provides a visual map of these relationships, their proximity indicating the blurred lines between support and interference.
Family Background
This is a family that once shared a life together under the same roofa multi-generational family house in Nassau, Long Island, which for 16 years was home to NM and KL's marriage. This house was characterized by its open doors and communal ethos; it epitomized the concept of togetherness; there was a supportive network inside where extended family members flowed freely between the dwellings. In theory, this setup should have offered a nurturing environment for all; however, in practice, it gave rise to a set of challenges unique to such close quarters. The lack of privacy and the over-involvement of family members in the couple's personal affairs culminated in an enmeshed system of relationships. KL, in particular, felt the brunt of this encroachment, experiencing a growing sense of marginalization that was in stark contrast to the familial cohesion the living arrangement was intended to promote.
Identified Patient
Central to the familys current crisis is VL, the 16-year-old identified patient whose life has been significantly disrupted by his parents' tumultuous divorce and ensuing custody battle. VL's challenges extend beyond the familial conflict; he grapples with autism and ADHD, conditions that require consistent management and support. Yet, the instability at home has spilled over into his academic life, leading to a troubling pattern of non-compliance with both school attendance and medication adherence. VL's behavior is a clear manifestation of the psychological toll the family's upheaval has taken on him. In the midst of the storm, VL stands as a young individual in dire need of stability and understandinga need that is currently unmet by the fractured family unit.
Analysis
Theoretical Application
Within this familys dynamics, the application of Salvador Minuchins structural family therapy gives insight on the rigid boundaries and sub-systems that preside over the interactions between family members (Margola, 2019). The framework exposes a pattern of triangulation and a point in which CL is unwittingly entangled as the emotional go-between for her conflicted parents. This role of the mediator subjects her to undue stress and places her in the precarious middle of parental...
…evolving needs. They will also be a platform for open dialogue and mutual feedback between the family and the therapeutic team.Reflective Consideration
Reflective consideration is another aspect of the evaluation process, and it will be important in light of the pending custody outcome. The determination of custody could significantly alter the family dynamics and, by extension, the needs and priorities within VL's treatment plan. A reevaluation of roles within the family may be necessary due to the fact that the custodial arrangement will influence the practicalities of implementing certain interventions, especially those related to pharmacotherapy adherence and the coordination of psychotherapy sessions.
The focus on VL's well-being as the paramount consideration underscores the need for flexibility and adaptability in the treatment approach. The APN, in collaboration with the therapeutic team, will need to remain vigilant to the shifts in the family's structure and dynamics, ready to adjust the treatment plan in response to these changes. This might include revisiting the division of responsibilities regarding VL's care, the logistics of medication management, and the strategies employed in psychotherapy to support VL's adjustment to his new living arrangement.
Conclusion
The therapeutic trajectory outlined in this paper reveals the complicated nature of addressing mental health within the context of familial discord. As VL's family deals with the aftermath of a divorce and custody decision, the importance of a flexible, adaptive treatment plan becomes evident. The interventions proposedranging from individual and family psychotherapy to culturally informed referrals and a nuanced approach to pharmacotherapyemphasize the need for a patient and flexible and overall holistic view in therapeutic practice. Central to this plan is the recognition of VL's autonomy and the importance of establishing an environment conducive to his well-being and development. This case also shows the challenges and considerations faced by mental health professionals in crafting treatment plans that are…
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