Read the entire “Vargas Family Case Study” (all eight sections). Consider the progress (or lack thereof) over the past eight sessions. Using the “Discharge Summary Outline” template; include the following in your outline:
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Attached is an outline that needs to be followed.
Bob and Elizabeth Vargas have been married for 10 years. They have two children, Frank (8) and Heidi (6). Bob teaches high school PE and coaches football, wrestling, and baseball. Elizabeth recently quit her job where she was an attorney in a law firm that specializes in Family Law. She enjoyed her work, had a passion for adoption cases, but decided to stay home for a few years while the kids were young. Elizabeth believes that Frank might have ADHD. She complains that he cannot sit still, does not listen, is forgetful, and is always getting hurt. She believes that much of these injuries are due to Frank’s impulsivity. Elizabeth suggests you talk to Frank’s teachers who have noticed that he has trouble waiting his turn, will often blurt out answers without raising his hand, and frequently loses things. Elizabeth acknowledges that Frank has always been an active child, but believes these behaviors, including picking on his little sister, are getting worse. Bob seems to be amused by these anecdotes and accuses Elizabeth of “overreacting,” stating that, “Boys will be boys.” Bob suggests you talk to his parents, both retired teachers, who agree with him and don’t think there’s anything wrong with Frankie. You notice Heidi sitting close to Elizabeth, playing on her mother’s cell phone. She glances up occasionally when her brother approaches, but is otherwise engrossed with the game. Frankie began the meeting sitting between his parents, but noticed Legos in the corner and was immediately attracted to them. He interrupts several times to share stories about his teacher, classmates, and his grandparents, despite numerous reprimands from his mother. After a few minutes, Frank asks to use his Dad’s phone (in a hurry, Bob had left it in the car), wanders around the office, looks out the window and comments on a squirrel, then grabs the phone from his sister who, of course, protests. After Elizabeth had quieted the commotion, you question any recent changes. Bob and Elizabeth both acknowledge an increase in marital tension and admit to having several arguments a week, some in front of the children. Bob blames Elizabeth for being “too high-strung” and says she just needs to relax. Elizabeth says she is unable to relax, fearing Frankie will end up damaging things or hurting himself or Heidi. She says that if Frankie would be able to control his behaviors, their marriage would improve dramatically. This, they report, is the reason for seeking therapy for Frankie.
Vargas Case Study: Topic 2
Elizabeth arrives on time with Frank and Heidi for the second session. Elizabeth appears somewhat frazzled and tells you that she had just heard from Bob who said he would be “a little late” because he “lost track of time.” You note Elizabeth’s frustration, which she confirms by saying this is “typical.” She proceeds to share that she feels “completely disregarded,” especially after having shared with Bob the night before how important these sessions are to her. You notice that Heidi seems upset as well and looks as if she has been crying. You ask her how her day is going and she tearfully tells you that Frankie tore up her school paper with the gold star on it. Elizabeth elaborates that Frank had become angry and ripped up the picture that Heidi was proudly sharing with her. Frank, who had gone directly to the Legos, appears oblivious to the others in the room. When you ask him about his sister’s sadness, he replies, “Who cares? She always gets gold stars!”
As you were about to further explore these feelings, Bob arrives stating, “She probably told you I’m always late, but hey, at least I’m consistent.” You notice Elizabeth’s eye rolling and direct your attention to the children, asking them about what brought them to your office. Heidi says, “I’m good but Frankie’s bad at school, and it makes Mommy and Daddy fight.” Frank, who had helped himself to one of your books to use as a car ramp argues, “I hate school. It’s boring and my teacher is mean.” Bob attributes Frank’s boredom to being “too smart for the second grade…what do they expect?” Elizabeth responds that they, like her, expect him to follow rules and be respectful, and suggests that Bob should share those same expectations. Bob dismisses Elizabeth’s concerns by saying, “He’s a normal boy, not like all your friends from work who you say are ‘creative.’”
You notice Elizabeth’s reaction and decide to redirect your attention to Frank. You ask him what bothers him most about school, to which he replies, “I get in trouble, then I don’t get to have all the recess time, then I can’t play soccer because they already started and they won’t let me play.” You notice Frank’s interest in sports and probe for more information. You learn that he is quite athletic and has been asked to join a competitive youth soccer team that plays on Saturdays and Sundays. You discover another source of discord when Elizabeth shares that Bob “feels strongly” that Sundays are to be spent only at church and with family. Bob confirms that after church on Sundays, they spend the rest of the day with his parents, siblings, nieces, and nephews. Elizabeth says that Sunday mornings are the only time she gets to be by herself and that she typically joins the family around 1:00 p.m. Bob adds, “Apparently Liz needs time to herself more than she needs God and her family,” and suggests she should appreciate his family more because “it’s the only family she has.”
As the session comes to a close, you share your observations of the family by noting their common goal of wanting to enjoy family time together. You also suggest that while Frank’s behavior challenges are troubling, perhaps you could focus next week on learning more about each parent’s family of origin in hopes of gaining a better understanding of the couple’s relationship.
Vargas Case Study: Topic 3
Bob and Elizabeth arrive together for the third session. As planned, you remind the couple that the goal of today’s session is to gather information about their families of origin. Bob begins by telling you about his older sister, Katie, who is 36 and lives nearby with her three children. Katie’s husband, Steve, died suddenly last year at the age of 40 when the car he was driving hit a block wall. Elizabeth speculates that Steve was intoxicated at the time, but Bob vehemently denies this allegation. He warns Elizabeth to “never again” suggest alcohol was involved. You note Bob’s strong response and learn that his own biological father, whom his mother divorced when Bob was three and Katie was five, had been an alcoholic. When asked about his father, Bob says, “His name is Tim, and I haven’t seen him since the divorce.” Bob shares that he only remembers frequently hiding under the bed with Katie to stay safe from his violent rages. He adds that 5 years after the divorce, his mother, Linda, married Noel who has been “the only dad I’ve ever known.” He insists that his sister married “a devout Christian who never touched alcohol” and attributed the 3:00 a.m. tragedy to fatigue. He adds that a few days before the accident, Katie had complained to him that her husband had been working many late nights and “just wasn’t himself.” Bob speaks fondly of his sister and confirms that they have always been “very close.”
From Elizabeth, who is 31 years old, you learn that she was adopted by her parents, Rita and Gary, who were in their late 40s at the time. They were first generation immigrants who had no family in the United States. Their biological daughter, Susan, had died 10 years earlier after Rita accidentally ran over the 5-year-old while backing out of the driveway. Elizabeth surmises that her mother never fully recovered from this traumatic incident and remained distant and withdrawn throughout Elizabeth’s life. Elizabeth describes her father, Gary, as “a hard worker, smart, and always serious.” She shares that most of her family memories were of times spent with her dad in his study, surrounded by books. She states, “He could find the answer to all of my questions in one his many books.” Elizabeth describes herself as the “quiet, bookish type” and attributes her love for books to her father. Like her father in his study, Elizabeth remembers spending most of her adolescence alone in her room, reading, so she would not upset her mother. Looking back, Elizabeth tells you she recognizes her mother’s struggle with depression, “but as a kid, I thought it was me.”
You comment on the vastly different childhood experiences and normalize the potential for relationship challenges under these circumstances. Acknowledging the differences, Elizabeth remarks that Bob’s relationship with his family was one of the things that she was attracted to early in their relationship. Bob agrees with her and comments that Katie and Elizabeth are very close, “each being the sister neither one of them ever had.”
Vargas Case Study: Topic 4
The Vargas family arrives for the fourth session at separate times. You have been chatting with Elizabeth and Heidi about Frank’s recent school suspension when Bob and Frank enter. They are having an animated conversation, laughing hysterically, and Heidi comments on how Frank is wearing socks, not the rain boots he left the house in. Bob and Frank proceed to share the story about how Frank’s top scoop of ice cream just fell into his boot when Elizabeth interrupts. She questions Bob and appears surprised to learn that instead of going to work with Bob who had agreed to “put him to work” as a consequence of his suspension, the two of them had spent the day having fun. Frank talks about his new bike and had begun a story about the movie they saw when he looks at his dad and instantly stops talking. You notice Bob’s stern look when Frank apologizes stating, “I forgot I’m not supposed to tell.”
The tense silence is broken by Heidi who begins to tell her parents that she got another gold star on her spelling test, the teacher picked her to be the helper, she scored two soccer goals at recess, and made three new friends. You notice that Frank has squeezed into the same chair next to Bob; Heidi scoots closer to her mother on the couch. You note Elizabeth’s distress and invite Bob to comment. Bob minimizes the incident that resulted in Frank’s suspension and accuses Elizabeth of “overreacting.” Frank agrees that “Mom always gets mad” and begins recounting the “funny” incident that was, according to him and Bob, “no big deal.”
Vargas Case Study: Topic 5
The Vargas family arrives to their fifth session together and on time. As a follow-up to the last session’s focus on the family structure, you decide to consider a strategic approach this week. To check in, you invite them to share any feedback from last week’s session. Bob reports that he apologized to Elizabeth for “mishandling the suspension thing” then complains that Elizabeth is still “holding a grudge.” He admits that he often does not understand why she gets so upset and that he wants her to be happy. Elizabeth acknowledges that the apology “is a start” and suggests that the reason Bob doesn’t understand is that he “doesn’t ever listen” to her. Bob tells Elizabeth that he listens, but gets frustrated because he doesn’t know how to “fix it.”
You notice Frank and Heidi sitting together, quietly looking at a book while their parents talk. You inquire about any noticeable changes made during the week. Both parents claim to have made an effort to avoid raising his/her voice and report being pleased with their conduct. When asked about the children, Elizabeth reports noticing improvement. Bob, however, expresses frustration with Frank’s constant need of redirection and numerous reminders to complete his chores. Bob also noted an increase in Heidi’s demands for attention.
Vargas Case Study: Topic Six
The Vargas family arrives five minutes late for their sixth session. Elizabeth apologizes for their tardiness and complains that they had come from an event hosted by her former employer and were having an argument in the parking lot. You notice the children appear somewhat disheveled with red cheeks and grass-stained clothing. They excitedly share stories of coming from a “big picnic” where they “played lots of games and made new friends.” Frank tells you that he was playing Kick Ball and that his team was winning. Smiling and tousling Frank’s hair, Bob adds that he and Frank were “an unstoppable force” who dominated each event at the picnic. Bob and Frank were in the middle of a celebratory high-five when Heidi tells her dad that she wishes he would have been on her soccer team. While still engaged in the celebration with Frank, Bob replies, “Me too; maybe next time.”
Elizabeth states she was “pleasantly surprised” that Bob was enjoying himself, given his strong personal opinion of many of her friends, who are gay. Bob insists that the picnic was “just okay,” and that he “was just trying to be nice.” He tells you he doesn’t have “anything against gays,” but that “they just make me uncomfortable.” Heidi reminds him that he agreed to have her new friend, Dani “and her two daddies,” over for a barbeque. You comment that the family’s mood has changed from how they arrived. Frank explains that his mother got angry at him and admits to running away and hiding from his mother when she said it was time to leave the picnic. Elizabeth immediately denies being mad at him. You ask Frank what made him think his mother was mad, and he replied, “Her eyes were squinty and she had a mean voice.” When asked if his dad was also angry, Frank replies, “He saw me in my hiding place; he was smiling. Then in the car, he yelled at me to ‘listen to your mother.’”
Elizabeth shot Bob an angry look when Heidi shares that she was having fun playing soccer and that she didn’t want to leave either. She adds, “I always listen because I don’t want Mommy to be sad.” She proceeds to blame her brother for “making Mommy and Daddy fight” to which Frank makes a counter-accusation, blaming Heidi for the parental discord. Elizabeth and Bob exchange angry looks, then Bob assures Heidi that, “It wasn’t all your fault.”
Vargas Case Study: Topic 7
Since the last session, you received a call from Elizabeth who stated her family was in crisis. She reported that her nephew Geoff, the 15-year-old stepson of Bob’s sister, Katie, had nearly overdosed. She said that the family had noticed some changes with Geoff since his father’s recent death, but attributed the poor mood and slipping grades to the normal effects of grief. Elizabeth said that Geoff had never used drugs, as far as anybody in the family knew, and that the overdose was “a total surprise.” Elizabeth reported that after learning of this, Bob’s mother, Linda, called the school counselor but complained to Katie that “she was not at all helpful,” and told Katie exactly how she should handle it. Katie spoke with the school counselor who told her that she was not allowed to speak with Linda due to matters of confidentiality. Elizabeth informed you that Katie had shared her frustration with the school counselor’s suggestions to help him “get his mind off the sadness,” and believed he needed more help. You learned that Bob’s father, Tim, was trying his best to help, and that Elizabeth felt his intrusion was making matters worse. Among other things, Tim had taken Geoff out of school on a week-long camping trip against Katie’s wishes. Elizabeth said that the involvement of Linda and Tim, despite their good intentions, had begun to cause widespread family strife and asked if you could possibly see the entire family.
Vargas Case Study: Topic 8
This session with the Vargas family includes Elizabeth, Bob, Frank, and Heidi. You begin by inviting Bob and Elizabeth to sit together on the couch and follow up on the events described to you in the phone call with Elizabeth You learn that there are ongoing concerns regarding Geoff’s safety, as well as with maintaining boundaries with their extended family members. Elizabeth tells you that Bob “had strong words” with his parents, who were initially quite upset. Bob confirms this and states that despite the difficulty, “they need to butt out.” You validate Bob’s struggle and reframe this as bravery. You note the family’s willingness to seek help as a significant strength. Bob expresses concern for his sister having recently lost her husband and nearly losing her son. He shares how unfortunate it is that something bad had to happen to help him realize how fortunate he is. Bob states that he admires his sister’s strength, and becomes tearful as he tells Elizabeth that he cannot imagine what it would be like to lose her. He expresses belief that it would be “impossible” for him to be a single parent and tells his wife that he realizes he has been taking her for granted. Elizabeth receives these words with quiet gratitude, providing comfort, being sensitive to Bob’s vulnerability. Bob wipes his tears and apologizes for what he calls “falling apart.” You notice Frank and Heidi settle in closer to their parents. Eventually, the therapeutic silence is broken when Frank hands his dad a tissue and says, “It’s okay for boys to cry. Mom says so.”
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