a formulation report for family therapy, based on the case study of Jo and her family. Full length 2000 words and includes full reference listing at the end. Written in March 2023.
Relationships started to deteriorate when Smithy moved into the household with Jo and
Jenny 10 years ago. Jo and Smithy blame Jenny for the problems and believe she is suffering
from mental health issues. An evaluation did not support this theory. Jo is unable to control
Jenny and oscillates between being soft or threatening, with very limited results. The
constant fighting is having an adverse impact on Jo’s mental health; her relationship with
Jenny; her sons, and her marriage. Jo recently became so overwhelmed that she left the
home for several hours. Jenny has accused Jo of physical violence, which Jo has refuted. Jo
thinks Jenny’s future looks very bleak and, although sceptical about therapy, would like to
work on her communication with Jenny.
Smithy also considers Jenny’s behaviour to be the root of the family problems, and he
believes she has mental health issues. He works long hour and is often absent from home
but kept up to date by Jo. Smithy is frustrated by Jo’s tendency to switch between being too
soft and too harsh on Jenny, without any results. This has been causing friction between the
couple. He appreciates support from his parents but understands that they no longer feel
they can offer respite space. He thinks therapy is unlikely to help but is willing to try. He is
worried about the impact this is having on his sons, and the rest of the family.
Jenny feels unwelcome at home and often stays away for days without telling Jo where she
is. She likes being with friends and has been involved in anti-social behaviour and
shoplifting. She regularly misses school and is at risk of permanent expulsion. Jenny knows
her parents blame her for the family problems and is resentful of her Mum posting her
photo on social media, and for having her assessed by CAMHS. Jenny gets angry and acts
out by being verbally aggressive with Jo and damaging the property. She has had no contact
with her father since she was two and has no contact with either set of grandparents. She
likes spending time with her aunt, and with Smithy’s mum and dad. She would like to feel
welcome at home and to be listened to. She would also like to spend time doing activities
with her family.
1. What has caused the problems?
Jo and Smithy blame Jenny for the problems faced by the family. However, the systemic
approach to therapy is that problems are developed within the language used, and the
interactions and relationships between individuals, not within the individual (Vossler, Squire
& Bingham, 2017). As issues started when Smithy moved into the property 10 years ago, it is
possible Jenny feels she has been replaced and that Jo has less time for her. These feelings
may have been compounded by the birth of the boys.
It is possible there are attachment issues (Bowlby, 1982, cited in Haley, 2017) in the family
on several fronts. Jenny lived with her father until she was two and has not had any contact
with him since. It is possible that, as their relationship was marred by severe domestic
violence, Jenny’s early understanding of the world was one of caution and she may have
, formed an unconscious representation that relationships are fraught and abusive. Jo
suffered from severe abuse and post-natal depression (PND), so her early bonding to Jenny
may also have suffered, resulting in an insecure attachment. This could help explain the
impact on Jenny’s development and her interactions. She feels there is place for her at
home, and her desire to be welcomed and valued may be a result of these attachment
issues. Jenny may also view the recent decision of Smithy’s parents to step back as a sign of
abandonment or rejection. At present, there is a clear generational pattern of non-contact
that may be at the heart of the issues.
Jo suffered from PND after having Jenny at 17, whilst in an abusive relationship. It is possible
that there are unresolved mental health issues, or post-traumatic stress disorder here. Jo
has no contact with her parents, and this may also point to attachment or abandonment
issues. Jo’s marriage is strained, adding to her stress levels, and the fact that she is mostly
alone in dealing with the issues on a day-to-day basis is unlikely to help her mood. Jo is
concerned that Jenny’s risky behaviour may result in her following a similar trajectory of
teen pregnancy and abuse, and the worry over this may manifest itself in the threats and
punishments she attempts to impose. With the history of domestic abuse, it is possible Jo is
experiencing repeated trauma through Jenny’s violent outbursts and property damage.
There seem to be few boundaries at home that Jenny will adhere to. Although punishments
are harsh, they simply alienate her further and reinforce her perception of being
unwelcome. The inconsistency of approach may leave Jenny confused about her boundaries
and family hierarchy, and where her place is. The lack of warmth at home may push her
further towards her social group, and her knowledge of Jo and Smithy’s disapproval means
she may be secretive about her social life. Jenny’s anti-social behaviour and law breaking
may be a result of peer pressure or a desire to maintain the only group she feels at ease
with. The theme of Jenny refusing to comply with rules at home, at school, and socially may
see her labelled as a ‘difficult teenager’; a socially unacceptable tag that comes with
negative connotations and is currently threatening her school reputation and place.
2. What factors may maintain the problems?
Jenny’s early years with her biological parents were marred by severe domestic abuse.
Various elements of current abuse, such as shouting, property damage, harsh threats, and
punishments, could be the result of learned behaviour from past experiences. There is a
possibility that Jenny and Jo may think this behaviour is ‘normal’, based on their personal
experiences. The frequent disagreements between Jo and Jenny follow a circular, repeating
pattern (Haley, 2017) of ineffectual communication and lack of understanding. There is also
the issue of physical violence between Jenny and Jo, and of Jo ‘shaming’ Jenny on social
media. It is likely that there is unresolved anger on both issues, as well as attachment issues
between Jo and Jenny, Jo and her parents, and Jenny and her father, that are maintaining
the problems.
Following a recent incident, Jo left home for several hours. Avoidance is a maladaptive
behaviour employed when Jo was so overwhelmed, she felt she had no other option but to
escape. The longer the situation is maintained, the more likely that Jo will repeat this
behaviour, adding to the already problematic issue of circularity (Vossler, Squire & Bingham,
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