NRNP 6644 Week 6 Family Systems Analysis Example

Family Systems Analysis: One School Morning Traced From First Complaint to Closing Relief, With No One Cast as the Cause

Student Name

College of Nursing, Walden University

NRNP 6644: Psychiatric Mental Health Advanced Practice Nursing Care of Children Through Young Adults

Instructor Name

Month Day, Year

Family Systems Analysis: One School Morning Traced From First Complaint to Closing Relief, With No One Cast as the Cause

The Household, Set Out Plainly

Composite family of the 11-year-old boy with separation anxiety followed since week 1. In the house: his mother, 39, a bank branch manager who works from home on Mondays and Fridays; his father, 42, a pipeline inspector who, since October of this school year, is away three nights a week; his sister, 15, a high school sophomore. Also involved: his maternal aunt, who lives 10 minutes away and drives him to school when his mother cannot. Changes in the past 2 years, dated: his maternal grandmother, who lived with the family for 3 years, died in November two years ago; his father's schedule changed in October of this year.

A Described Genogram

Three generations. Maternal grandmother, deceased two years ago, close to the boy, who shared a room wall with her. Mother and father married 17 years, relationship described by both as solid but strained since October. Mother close to both children and to her sister; father close to his daughter through her sports and more distant from his son, by his own account. Sister close to her father and her aunt. The boy close to his mother and grandmother, and to his aunt.

One Sequence, Traced in Order

A Monday morning, reconstructed with each family member's account. 06:45: the boy comes to the kitchen and says his stomach hurts. His mother asks where, feels his forehead, and tells him he will feel better after breakfast. He eats little and says he might throw up. 07:05: he begins crying and asks to stay home "just today." His mother says he has to go; he pleads. His sister, leaving for the bus, says, "He does this every week." 07:15: his mother calls his father, who is on the road. His father says, "Make him go; he's fine." His mother says she cannot drag him into the car. 07:25: the boy vomits. His mother calls the school and says he is sick. 07:40: the house is calm. He spends the morning on the couch near his mother's home office, feels better by 10:00, and plays video games in the afternoon. That evening, his father calls and his parents argue about the decision.

The sequence closes with relief for everyone in the house that morning: the boy's fear eases when he stays near his mother, his mother's distress eases when he stops crying, and the conflict moves to the evening phone call. Each relief makes the next Monday's sequence more likely. Family accommodation, changes parents make to reduce a child's anxiety, such as allowing avoidance, is common in childhood anxiety disorders and is particularly associated with separation anxiety (Lebowitz et al., 2013).

Roles, Read Out of the Evidence

From the sequence, not as labels: the mother is the one who responds to the boy's distress and makes the decision in the moment; the father sets a rule from a distance and is not present to carry it out; the sister names the pattern and leaves. The aunt, when she drives, reports he goes to school with fewer complaints. In Bowen's terms, the parents' disagreement about the mornings draws the boy into a triangle, with each parent's position hardened by the other's (Kerr & Bowen, 1988). None of this makes either parent the cause: the boy's temperament, his grandmother's death, and his father's new absences all feed the pattern, and the family's responses are understandable attempts to reduce suffering in the moment.

The Same Event in Three Vocabularies

His mother: "He's sick and scared, and I can't make him go when he's throwing up." His father: "He's figured out that if he gets upset enough, he gets to stay home." His sister: "He gets away with everything." The boy: "I'm scared something will happen to Mom when I'm gone." Each is describing the same morning, and each is partly right. A plan that adopts one vocabulary will lose the others.

Strengths, in Equal Detail

Both parents came to the visit and both want him back in school. His mother is warm and attuned; his father is willing to take a clearer role in mornings when he is home. His sister, despite her irritation, defends him at school. His aunt is available and effective on the mornings she drives. The family's warmth is the ground on which change can be built. A parent-based program that reduces accommodation, without direct therapy with the child, was noninferior to child-focused cognitive behavioral therapy in a randomized trial (Lebowitz et al., 2020), which suggests these parents can be the main agents of change.

References

Kerr, M. E., & Bowen, M. (1988). Family evaluation: An approach based on Bowen theory. W. W. Norton.

Lebowitz, E. R., Marin, C., Martino, A., Shimshoni, Y., & Silverman, W. K. (2020). Parent-based treatment as efficacious as cognitive-behavioral therapy for childhood anxiety: A randomized noninferiority study of Supportive Parenting for Anxious Childhood Emotions. Journal of the American Academy of Child & Adolescent Psychiatry, 59(3), 362-372. https://doi.org/10.1016/j.jaac.2019.02.014

Lebowitz, E. R., Woolston, J., Bar-Haim, Y., Calvocoressi, L., Dauser, C., Warnick, E., Scahill, L., Chakir, A. R., Shechner, T., Hermes, H., Vitulano, L. A., King, R. A., & Leckman, J. F. (2013). Family accommodation in pediatric anxiety disorders. Depression and Anxiety, 30(1), 47-54. https://doi.org/10.1002/da.21998