Reference no: EM133317060

Case Study: Jack is a 7-year old Primary 1 student who lives with his parents. He is the only child to his parents, both of whom have completed postgraduate education and are in their early 40s. In his spare time, Jack enjoys spending time with his friends, participating in physical activities such as swimming, running and skating.

Jack also enjoys participating in social events, and is often invited to play with his friends at their birthday parties. It is noteworthy that he did not know his address or home phone number, could not write his surname, and recognises only a few pre-primer words. While Jack interacts well with peers of his age, his parents noted that he can be easily distracted and gets upset when he does not receive recognition or feels that he has been ignored. His teacher has been complaining about his attention-seeking behaviour, difficulties with focusing and sitting still in class, although he can be hyper-focused when he plays games on the phone. His parents and teacher indicate that Jack is restless, and often requires reminders to help him stay on task. He is described as "constantly running around" and presenting with difficulty listening and following instructions. Jack's teacher indicates that he often blurts out answers and interrupts other students in the class.

Jack's mother, Maril reported his difficulties at home with following routines and remembering instructions. His parents described his emotional reactivity as well as confrontational behaviours demonstrated both at home and school.

His teacher noted that Jack is very defiant towards instructions, but generally interacts well with his peers. He is easily frustrated and emotionally impulsive. Jack has had several incidents of hitting, crying outbursts and inappropriate behaviour. Behavioural concerns with aggression, lying, arguments and disruptive behaviour were noted in his pre-school programme.

Jack's parents had a more complex prolonged history of infertility, stress and trauma that went on for a couple of years prior to entering counselling, resulting in more negative views of each other that reduced trust and positive regard for each other. While Maril is physiologically vulnerable to infertility, Jack's father, James has been spending most of his time on his family restaurant businesses and doubling up his roles as the chef at the main branch. Maril lamented that James hardly had time for himself and the family.

Jack's maternal grandmother, who lived with her daughter's family, used to blame Maril for her childlessness issue. Not long after Jack was born, the grandmother took Jack to her home as the grandmother and her daughter live within close proximity to a good school, and it would also be better for Jack to grow up with her cousins though they lived far away from James' and Maril's matrimonial home. Jack was only taken to his parents' home for a few days during the school holidays, as the grandmother was of the view that it would not be good for the child to move from one place to another. James also aligned with his mother's perspectives. In fact, no one in James' family would challenge what the grandmother did as she was the one who started the family business and it expanded significantly under her management.

There is an extended family history of Attention Deficit Hyperactivity Disorder (ADHD) and serious mental health concerns on Maril's side of the extended family. However, this was kept as a secret between James and Maril. Eighteen months ago, Jack accidentally spilled hot water on a cousin who was two years his senior, while climbing on the dining table. This resulted in a large scar on his cousin's thighs. James took Jack home since then, and Maril became the main caregiver for Jack. James and Maril had enough positive regard for each other and were committed to the counselling process because they really valued what they had earlier in their relationship.

Based on the case vignette, answer the following questions using the knowledge you have gleaned from the Structural Family Therapy Approach.

Question a) Suppose you are the counsellor, indicate and discuss the counselling tasks involved at the first session with the family, assuming that all the family members are present.

Question b) Analyse the family structure in terms of the following: i. Flexibility and adaptation ii. Boundary and subsystem within the family iii. Role of symptoms

Question c) Develop THREE (3) key hypotheses about the case from family therapy's perspectives. Stipulate THREE (3) of your counselling goals for the individual family members and THREE (3) collective goals for the family using the structural approach.

Question d) Propose FOUR (4) interventions using the integrative approach to support the family, beyond the structural approach. Provide detailed explanations on how they would work.