Vignette of a Couple: Robert and Sophia

Robert and Sophia are in their early 30’s and have been married for five years. Robert’s parents moved to the U.S. from Germany when he was 15 years old; he is an only child who felt very isolated during high school and college. Sophia is from a large Italian family that has been living in the U.S. for several generations. Sophia was abused by an uncle as a child, but was too afraid and ashamed to tell anyone.

Both Robert and Sophia work long hours at demanding jobs, and they feel exhausted and stressed at the end of the day. Typically, they drink a bottle or two of wine with dinner, and often argue about the amount of time Sophia spends with her family, Robert’s frequent business trips out of town, or when they should start to have children.

Three weeks ago, Sophia discovered that Robert had an affair with a co-worker the previous summer. Robert refuses to discuss this except to say that it was “a mistake.” Robert admits he has felt unhappy in the marriage and depressed for over two years, but he does not think talking about it will help.

Sophia feels betrayed and furious. For the past week she has been unable to concentrate at work, can’t sleep, and feels irritable much of the time. She pleads with Robert to tell her what he needs, but he is silent and withdrawn. His drinking has increased and he is becoming more depressed.

Sophia has been going through Robert’s computer and mail when he is not at home, and she discovered current messages he had written to another women describing his hopeless feelings about the marriage and thoughts of suicide. Two nights ago Sophia confronted Robert with this correspondence, and she became so angry that she threw a glass at him, which shattered and cut his arm. This incident frightened them both, and they have decided to get marriage counseling.

1. Identify and evaluate specific methods you would use during the assessment and diagnosis phase with this couple or family.

2. Apply family systems models used for understanding patterns of dysfunction in relationships to describe how you would incorporate assessment and diagnostic processes into your work with this couple or family.

3. How would you apply the DSM-IV-TR diagnostic system to this couple or family? Review the materials in the DSM-IV-TR about relational problems (pp. 736–737) and the GARF Scale (pp. 814–816). If you decide to give a diagnosis to any of the individuals, what would it be, and how might this diagnosis impact the couple’s or family’s therapy process?

4. How would you include social-cultural factors in the assessment and diagnosis of this couple or family?

5. Evaluate the influence of the clients’ social-cultural background, personal history, environment, and family or relationship systems on their current experiences and the presentation of their symptoms. You will need to support your ideas with evidence from the professional literature.
6. How will your own social-cultural background, personal history, values, biases, and assumptions impact the diagnostic process with this couple or family? For example, might you have difficulty understanding the meaning of some the symptoms these clients present; might you overlook, or over-emphasize, certain symptoms, given your own background and history?
7. What ethical issues may arise when assessing and diagnosing a couple or family?

Apply specific ethical standards (such as those from the ACA, AAMFT, and NAADAC) to the issues you may encounter when assessing and diagnosing this couple or family.

8. Design an effective treatment plan for this couple or family based on the assessment information you have observed and collected during the diagnostic process. Use the following outline for your treatment plan:
What is the focus of the therapy (key issues and concerns that will be addressed)?
What are some of the main goals for this family or couple? What specific changes in the family or couple would be evidence of positive movement or would demonstrate that therapy is being effective? For each goal noted, list examples of specific interventions or counseling techniques that will be used during the sessions.
What interventions will be used during sessions to help the family or couple reach their goals?