Case Study
Patient Demographic: Client Age: 14 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: Asian-American (Karen) Grade: 8th Counseling Setting: Child and Family Services Agency Type of Counseling: Individual and Family Presenting Problem: Substance Misuse and Acculturation Difficulties Diagnosis: Substance Use Disorder, Moderate (F2.911 ); Acculturation difficulty (V62.4 Z60.3)
Mental Status Exam: Mental Status Exam: The client is polite and cooperative. He is neatly dressed and is the only member of his family who is not wearing traditional Karen clothing. His affect is restricted, and his eye contact is poor. The client denies suicidal and homicidal ideation. He reports feeling anxious and sad frequently. He expresses that he is particularly worried at school and has had a difficult time adjusting. The client states that he lived in outdoor homes and buildings before coming to the United States. He explains, “Here, I feel like I’m trapped in a c
Presenting Problem: You are working as a counselor in a child and family mental health agency. A 14-year-old Asian-American male presents with family members who are concerned about the client’s drug use. The family is part of an ethnic population from Southeast Asia who resettled in the United States just under two years ago. The client is fluent in English and interprets for the family. The client goes to a public school specifically designed to improve English proficiency and has, until recently, done well academically. The parents have limited English proficiency (LEP). The parents provide a letter from his school stating the client was suspended after administrators found marijuana and amphetamines in the client’s locker. The client expresses remorse and says he became highly anxious and fearful when the school resource officer became involved. He explains, “Where I come from, the police are not there to protect or help.” The client willingly completes a substance use screening assessment, and the results indicate he is at risk for meeting the diagnostic criteria for substance use disorder.
Other Contexts: The client is now attending family therapy with his parents and has made progress. His last four drug screens have been negative, and the client is beginning to show insight into his problem. The parents have improved with limit setting and are learning how to help the client achieve a healthy sense of identity. The parents are becoming better acclimated to the United States and have developed stronger connections within their church and community

Question: Which graphical depiction would you use to represent the client’s family dynamics, including cross-generational coalitions, subsystems, and other significant interactions?
(A): Family map
(B): Sculpting
(C): Ecomap
(D): Genogram

Correct Answer: Family map
Explanation: SalvadorMinuchin, credited with developing structural family therapy, used family maps to graphically depict family dynamics, including cross-generational coalitions, subsystems, and differentiated intersectional boundaries. Family maps also show community supports and stressors, making it a good option for assessing protective factors and risk factors within the client’s community. A genogram is also a visual depiction of family dynamics and is commonly associated with multigenerational (extended) family systems therapy, also known as Bowenian therapy. Family maps differ from genograms in that family maps show family dynamics and identify social supports and connections. Genograms depict family interactions and generational relationships to reduce inappropriate boundaries (eg, triangulation) by increasing diffusion. An eco-map is similar to a family map, but the emphasis is on intrafamily dynamics within their current social context. For this client, identifying social relationships and connections within the community can help determine protective factors (eg, church, school) and identify risk factors (eg, social isolation, peers) for the parents and the client. Eco-maps differ from genograms and family maps by viewing family boundaries as either open or closed to their social environment. Virginia Satir used sculpting as a human validation process model technique. Sculpting is a nonverbal exercise in which counselors instruct family members to physically position themselves to represent certain aspects and patterns of family relationships and interactions. Therefore, the correct answer is (B)
Competency: counseling skills and interventions