Write a formulation report, drawing on systemic approaches
Amy is a 15-year-old female who has been referred to systemic therapy by social
care and her family to overcome her risk-taking and aggressive behaviour. She lives
with her biological mother Jo - (full housewife), stepfather Richard – (full-time
warehouse operator), and two younger half-brothers Alfie and Ethan who are doing
well at school. Jo had postnatal depression after giving birth to Amy and fled Amy’s
biological father when Amy was 2 years old.
Amy’s behavioural problem developed 10 years ago when Richard moved in.
However, recently Amy’s aggressive outbursts (i.e. damaging the property in the
house) and risk-taking behaviour (i.e. shoplifting, truancy at school) has increased
and worsened. Amy is at risk of permanent exclusion at school due to her aggressive
behaviour and lack of compliance. Amy feels out of place at home but at ease with
her friends (some who Jo thinks are negative models) and runs away when she
feels that Jo is unconcerned about her worries. Both parents shout and threaten to
send Amy away if she does not change. So far, nothing has worked to manage
Amy’s behaviour, not even embarrassing her on Facebook for shoplifting. Richard’s
parents support the family but are currently taking a break from having Amy around.
Both parents think that Amy may be suffering from mental illness, although a
diagnosis has been ruled out by the local specialist Child and Adolescent Mental
Health Service (CAMHS).
The couple’s relationship is strained from the frequent arguments on how best to
manage Amy and are worried about the impact of her behaviour on her half-
brothers. Jo has walked out of the family home and disappeared for hours when
she’s felt overwhelmed. Both parents are worried about Amy’s future and wish to
stop the boys from being exposed to Amy’s aggressive and chaotic behaviour. They
are willing to improve their communication with Amy. Amy wishes to feel welcomed
in her home; have fewer conflicts and is willing to engage in some pro-social
activities with her parents/family.
What has caused the problem?
The problem began 10 years ago when Richard moved in, but the family sees Amy
as the problem. Opposed to this intrapersonal view is the belief shared by systemic
approaches to counselling and psychotherapy that individual distress and mental
health problems are shaped and connected to the relationships, interactions and
language created within their social systems (family, friends, society, employment
etc.) (Vossler et al., 2017). Therefore, Amy’s behavioural problems are interpersonal
as it is located within her systems, which as a result maintains and stabilises the
family (The Open University, 2018c) albeit dysfunctional.
Amy feels she doesn’t ‘belong’ at home. It is possible that Amy felt neglected or even
replaced by Richard when he moved in and was exacerbated by her
needs (i.e. welcoming environment and attention) being unmet by the family, and
how she feels seen and treated by the family compared to her half-brothers. As a
result, Amy feels insecure with her family and out of place at home. It is possible that
Amy’s insecurity arises from not having a secure attachment with Jo when she was
younger. Perhaps the postnatal depression and severe domestic abuse Jo suffered
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