THE CASE OF MARIA: A FAMILY THERAPY APPROACH
Author's note. The culture-specific interventions described in this case study were used given the results of an ethnocultural assessment (i.e., acculturation level, social economic status, educational status, spirituality, race, and ethnicity) of this particular client family (Evans, Coon, & Crogan, 2007; Falicov, 2009; Interian, Allen, Gara, & Escobar, 2008). Application of the interventions detailed in this case study independent of such an assessment would represent both a technical and ethical error.
Britney (age 8) was suspended by Roosevelt Elementary School for stealing money from her classmates. Britney was suspended along with two other classmates, both of whom had a long history of discipline problems despite their young age. This suspension was Britney's first. After the suspension, Roosevelt's school counselor, Jim Chen, held a conference with Britney's mother, Maria Jones (age 32). He reported to Maria that Britney has recently committed many disciplinary infractions, something they had not seen before in Britney. Maria acknowledged that she was having problems at home with both Britney and Mark Jr., Britney's brother. Mr. Chen noted that the kindergarten teacher was concerned that Mark Jr. (age 6) always seemed sullen and uncooperative.
In talking with Maria, Mr. Chen sensed that she was feeling overwhelmed with her children's behaviors. He asked if she had considered counseling to gain support with these behaviors. Maria said that she had, in fact, consulted her physician and that this doctor had given her a referral to a respected child psychiatrist located downtown. However, Maria reported that she had not followed up on this referral because of the cost and downtown location. Also, she commented that her Catholic faith was very important to her and she was unsure if a psychiatrist would respect her religious beliefs. Mr. Chen suggested to Maria that an alternative existed. He reminded her that because Maria was a school district employee, she could take advantage of the services offered by the school district's employee assistance program (EAP). Mr. Chen said that currently the EAP allowed six counseling sessions per year per family member at no cost. Also, he noted that Catholic Social Services was one of the contracted EAP providers. Maria went home and immediately called the Catholic Social Services office at her local parish, St. Gregory's. She scheduled an appointment for herself, Britney, and Mark Jr. for the next Tuesday.
Mrs. Mesa and Sister Benedict were the cotherapists assigned to work with Maria and her family. They are both staff therapists with the Tucson diocese's Catholic Social Services. Mrs. Mesa has a national certification in family therapy. Sister Benedict holds a national certification as an art therapist and has worked extensively with Latino families.
Family Demographics and History
Maria and her children live in the Flowing Wells suburb of Tucson, Arizona. Maria's former husband, Mark Jones (age 33), is a contract civil engineer working in Saudi Arabia. Maria and Mark have been divorced for 3 years. Maria works as a middle school math and science teacher. Also living in Tucson are Maria's parents – Jose Flores (age 52) and Rosa Flores (age 51) – and Mark's parents – Rob Jones (age 58) and Susan Jones (age 55). Both sets of grandparents interact periodically with Maria and her children, but these relationships are very strained. Besides these grandparents, all of Maria's siblings live in the Tucson metropolitan area. These include Juan (age 31), Enrique (age 29), Ernesto (age 28), and Bonita (age 25). Maria's relationships with her siblings are tension-filled. Especially painful to Maria is Bonita's refusal to talk to her, because they had been close as children.
Maria's marriage outside her Catholic faith caused intense familial discord. This discord exposed subtle tensions and power alliances that existed in the Flores family. Only Ernesto attended Maria's wedding. Bonita blames all current interpersonal conflicts in the Flores family on Maria and her "disloyalty" to the family. Following the lead of Maria's father, the Flores family maintains a strong covert adherence to a rule of not directly addressing personal problems such as family conflict (i.e., a "no-talk" rule). The one exception to this rule is the sacrament of confession with the parish priest. Besides this exception, the Flores family viewed the airing of personal problems as a sign of weakness despite the Latino cultural approbation of desahogo (i.e., getting things off one's chest; Interian et al., 2008). Maria's genogram appears in Figure 13.1.