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 family systems approach would best help the client’s parents regain control by examining hierarchical positioning, challenge shifting boundaries, assigning tasks, and reframing?
(A): Contextual family therapy
(B): Structural family therapy
(C): Strategic family systems therapy
(D): Multi-generational therapy

Correct Answer: Structural family therapy
Explanation: Structural family therapy’s primary purpose is to strengthen the boundaries within family systems. One objective of structural family therapy is to help parents regain control by assessing the family structure and assisting families with setting appropriate boundaries. Treatment phases include joining the family, reconceptualizing (diagnosing) the family, and applying restructuring techniques. Restructuring techniques include: assigning tasks, reframing, shifting boundaries (unbalancing), escalating stress, psychoeducation, blocking transactional patterns, and developing implicit conflict. Multigenerational (Bowenian or Extended) family therapy focuses on eight interconnected concepts. Bowenian family concepts include differentiation of self, emotional triangles, sibling positions, society emotional process, multigenerational transmission process, nuclear family emotional system, family projection process, and nuclear family emotional system. Strategic family therapy differs from structural family therapy in that strategic family therapy places much less emphasis on boundaries and instead focuses on patterns of communication and interactions. Some techniques of strategic family therapy include positive connotation (similar to reframing), paradoxical intervention, pretend techniques, and hypothesizing. Contextual family therapy emphasizes ethical elements of each family, including loyalty, trust, and relational principles. Therefore, the correct answer is (C)
Competency: counseling skills and interventions