Post Modern Approach to Family Therapy

 Case History
Background information
Fatal attraction is a 1987 film written by James Dearden. In the movie, Dan is a successful lawyer who lives in New York and works for a printing press. He is married to a beautiful wife named Beth and they have a loving daughter named Ellen. Dan meets Alex, who is a successful editor for the company. During the weekends when Dans wife and daughter
are away from home, Dan has an affair with Alex. The affair is a onetime thing for both of them; however, Alex wishes the affair to continue. When Alex informs Dan of her intention, Dan refuses to take part in any of it. He explains to her that he must go; however, Alex cut her wrist in a suicide attempt (Goldberg, 2011). Dan helps bandage her and leaves thinking the affair is in the past, but Alex keeps showing up in different places. Alex keeps showing up at Dans office and calls his home at odd hours. She informs him that she is pregnant and intends on keeping the baby, however, Dan wants nothing to do with her.
Dans wife finds a good house they can move into in the suburbs. Beth is busy selling their apartment when Alex calls her and shows up at the apartment posing as a buyer. Dan visits her later that evening to confront her, but Alex is not backing down. Dan and his family move to the Bedford village, however, this does not deter Alex. She sends a tape recorder full of insults and stakes Dan in the parking garage. She pours acid on his vehicle and follows him home to spy on his family from behind the bushes. The sight of Dan and his family make Alex sick to the stomach. Fearing the issue is getting out of hand, Dan goes to the police and request a restraining order; however, he is not ready to own up to his adultery, so there are no justifiable grounds to issue one (Goldberg, 2011).
Description of the problem
When the audience first meets Alex, she is a young, beautiful, sophisticated woman who seems to have everything under control. The first signs of trouble emerge at the party when she is openly attracted to Dan despite the knowledge that he is married. After a simple fling during the weekends when Dans wife is out of town, she becomes too clingy. She attempts suicide by cutting her wrist; however, Dan bandages her and does not think much of it. She starts to stalk him at his office, apartment, and garage (Goldberg, 2011). When Dan continues to ignore her, she results to destruction of his property, such as when she pours acid on his vehicle. Things take a turn for the worse when Dan moves away from the city into the suburbs.
Alex follows Dan home and spy on his family through the window from the bushes. She starts to visit their home more frequently and at one point when they are not home, she kills Ellens pet rabbit by boiling it on a stove. At this point, Dan realizes that he cannot continue hiding the truth and tells his wife about the affair. She also informs his wife that Alex is pregnant with his child. Beth is so enraged by this news that she does not wish to have Dan living in the house. The following day, without the knowledge of Dan and Beth, Alex takes Ellen from school and takes her to the amusement park (Goldberg, 2011). She buys her ice cream and takes her on a roller coaster. When Beth realizes her child is missing, she drives off in a panic and ends up in an accident. In a fit of rage, Dan barges into Alexs apartment and chokes her but manages to stop himself. Before Dan can take a step back, Alex Lunges at him with a kitchen knife, which Dan manages to take from her, puts it down and leaves. Alex is left on the floor smiling. Later in the night, Beth is preparing a bath when Alex appears in her bathroom with the kitchen knife in her hand. She explains her resentment to Beth and cuts her own thigh before attacking Beth. Dan hears the struggle from the bedroom and rashes to help. He seemingly drowns Alex, but she suddenly emerges after a while. Beth shoots her in the chest killing her (Goldberg, 2011).
Diagnosis
Alex is a textbook case of borderline personality disorder (BPD). People suffering from BPD can come across as organized and seemingly normal initially just like is the case with Alex during the party. She is an attractive woman with a successful career as an editor in a publishing house. People suffering from BPD also have an intense anger that emerges with the slightest provocation or even non-at times. At the party when jimmys wife makes a pass at Alex, she looks at jimmy with a look that could kill. The intense anger and inappropriateness is also evident in the recurrent confrontations she engages in throughout the movie. She kills the pet rabbit and attacks Dan with a knife at her house. She also attacks Beth and cuts herself with the knife (Goldberg, 2011).
Persons suffering from BPD have unstable patterns of intense personal relationships. They can vary very quickly from extreme idolization to extreme devaluation. This is evident in the relationship between Alex and Dan. Alex is attracted to Dan and intends on pursuing a relationship. This is despite the knowledge that he is a married man. After Dan refuses to continue the affair, Alex threatens to commit suicide and cut her wrist to the effect. Later when it is apparent to her that Dan is unwilling to pursue a relationship with her, she hates him and attempts to kill him and his wife on several occasions. Alex also manifests another symptom of an individual suffering from BPD when she cuts her wrist in attempted suicide. People suffering from BPD have a recurrent tendency to threaten or attempt to commit suicide (Goldberg, 2011). This is also evident in the final scene when Alex appears in the bathroom as Beth prepares to take a bath. She expresses her resentment towards her as she cuts her leg with a knife. The current ending of the movie is slightly different from the ending in the initial script. In the initial script, Alex commits suicide by slitting her throat with a kitchen knife. This is consistent with the behavior of people suffering from BPD. The ending was changed because the viewers felt that Beth should take up an active role in the death of Alex, whom the viewers hate for terrorizing Dans family.
Intervention
Therapeutic approach
People suffering from Borderline Personality Disorder (BPD) find it difficult to differentiate between reality and misperceptions. The disorder may seem like a delusion disorder; however, it results from the emotions overwhelming regular cognitive functions. Someone suffering from this disorder sees things in black and white. Someone is either good or bad. A person can be good at one time and evil at another time depending on what is going on in the patients life. To deal with the patient effectively, the therapist must be the rock in the patients life. The therapist must provide consistency, which contrasts the patients unstable emotions and thinking (Linehan, 1993). This is not an easy job, and often physicians become turned-off because of the constant demands from the patient.
The most effective psychotherapeutic approach in the treatment of BPD is the Dialectical Behavior Therapy developed by Marsha Linehan. The therapy is more effective than most other psychotherapeutic approaches because it helps the patient to cope better with the disorder. The therapeutic approach teaches the patient how to manage their emotions through self-awareness and cognitive reconstructing. The approach is mostly conducted in a group setting. However, the skill set learnt are complex and require an individual who learns new concepts with ease. Treatment of BPD and other personality disorders typically last for over a year and often do not work when the patient is under stress (Linehan, 1993). This is because BPD is intrinsically difficult to treat and individuals suffering from the disorder find it hard to cope with normal emotions and stress. Most of the therapies used to treat BPD overlook the core problem suffered by people facing this disorder. They find it difficult to express appropriate emotions to their significant other because of faulty cognition.
Patients suffering from BPD tend to set the limits of interaction with their therapist. It is therefore important for the therapist to set the rules of interaction at the beginning of therapy to ensure future interaction occurs within well-set boundaries. The therapist must be aware of his or her feelings towards the patient, especially when the patient displays inappropriate behavior. Most of the therapists in the field tend to view people suffering from BPD as troublemakers. This is erroneous because they need more care as their behavior is caused by their disorder. To ensure the effectiveness of the treatment method, the therapeutic process must form an alliance with the therapist and the therapeutic process. The therapist must be able to tolerate episodes of primitive rage, fear, and distrust common when dealing with patients with this disorder. The therapist must encourage bolstering of the ego defenses over uncovering to ensure the patient is more secure to reduce the possibility of fragmentation and loss. The ultimate goal of therapy is to ensure the patient functions independently (Linehan, 1993).
Recovery approach
The mental health field in the world is undergoing a major revolution. Patients and doctors are contributing to these unique changes aimed at improving the chances of success using a method that has been proven numerous times in the drug and substance abuse problem. In drug and substance abuse treatment, spirituality has been widely recognized because of its wide acceptance and therapeutic value. The method offer new insight in the treatment of serious mental disorders, however, it is gaining wide acceptance because of its effectiveness and approaches (Karestan et al, 2013).
Recovery approach takes a new approach in the treatment of mental disorders that offer hope for patients. The approach creates and orientation of hope that makes it possible for patients. Even those suffering from the most severe mental conditions to consider it possible that they can lead a normal life. Recent research has established that people suffering from serious forms of mental disorders, such as BPD are capable of playing significant roles in the society and managing their lives independently. Patients enjoy prolonged periods free from psychotic symptoms if only they believe that it is possible for them to recover and lead a normal life (Karestan et al, 2013). Recovery approach involves personal growth from a baseline, regardless of how low the baseline is.
The recovery approach enables a gradual development of the patients own worth as a human being. The patient becomes hopeful about future events. Positive belief plays a paramount role in the recovery of physical disorders. Using the recovery approach, most patients regain a productive life and are able to contribute in the society. The persistent belief in the mental health field that mental disorders are permanent does not consider the unique contributions that the recovery approach facilitates (Karestan et al, 2013). Unlike the common medical approach that focuses on the recovery process in a negative light, the recovery process focuses on the individual because he or she is the object of the recovery efforts.
A feature that distinguishes the recovery approach form other approaches is that it is a self-directed treatment. Unlike other treatment approaches in which the therapist designs a rehabilitation plan, in the recovery approach, the patient is in the drivers seat with the therapist playing the role of a coach. The role of the therapist in this approach is to provide support for the patient as he or she endeavors to achieve a set of functional goals. The recovery approach focuses on motivating the patient and enabling him or her to focus efforts towards a progression of functional goals (Karestan et al, 2013). The approach involves dignity and respect for patients suffering from BPD and enables the therapist to maintain a professional relationship with the patient that does not drain his or her determination to help the patient.
3. A treatment plan
The most effective treatment approach is the 12-step approach adopted from the approach used in the treatment of addicts. This 12-step approach serves as an alternative, however, testimonies from both patients and therapist affirm to the superiority of this approach in the treatment of BPD. First, the patient must accept that they have an incurable disorder that is a permanent part of their life without feelings of blame, shame, or fault. The patients must also endeavor to avoid situations that may complicate their situation, such as the consumption of alcohol and other drugs. The patient must play an active role in the ongoing support system as both a receiver and giver of support through group sharing. The patient must change many aspects of their lives to accommodate the disorder and to help grow and overcome it (Karestan et al, 2013).
4. A description of the first one or two sessions
The amount of time the treatment process will take depends on the history and commitment of the Alex to the process. However, a complete treatment targets to involve past memories, present disturbances, and future actions. The three are needed to alleviate the indicators and tackle the entire clinic depiction. The goal of therapy is to enable Alex process completely experiences that are causing her problems and form new memories that lead to better health (Linehan, 1993). Generally, negative emotions and behaviors are caused by unresolved experiences that stimulate inappropriate beliefs, emotions, and body sensations. To tackle the issue, the patient must process these experiences and store them with appropriate emotions. This enables the experiences to contribute positively in the future.
The first two therapy sessions involve the collection of a patients history and the development of a treatment plan. The patient must first reveal the specific problem that has lead to her coming into therapy. For Alex, perhaps when she cuts her hand after Dan insists they cannot continue with the relationship Dan recognizes her destructive tenderness and insists she visits a therapist if there is a possibility they can be friends. An example of a question during the first two sessions include, what event do you remember that made you feel usefulness? a possible answer from Alex would be the affair she has with Dan for one weekend only for him to dump her after his wife comes become from the suburbs. An important thing with therapy is that the Alex does not have to give specific answers; a general overview of the situation is enough to enable the formulation of a treatment plan (Linehan, 1993).
5. Recovery model contributions to the treatment and philosophical challenges
The recovery model emphasizes the capacity of any patient regardless of whatever psychiatric illness he or she is suffering from, the capacity to recover. The model is consumer directed with the support of family and friends. The therapist is a facilitator in the process. The task of the therapist is to identify and use the strengths of the patient in the recovery process. A distinguishing quality of the recovery model is that it integrates natural support from friends and family into the treatment process. The model provides incentives that encourage the therapist to offer recovery-oriented services at the patients pace. Successful outcomes of the recovery models are measured by the ability of the people, who have gone through the process, to live independent lives and to exercise their rights to make independent choices in all spheres of life (Karestan et al, 2013).




 References
Goldberg, F. R. (2011). Borderline Personality Disorder: A Case Study of the Movie FATAL ATTRACTION. Sarasota: Beneficial film guides
Karestan, K. C., Koenen, Rudenstine, S., Susser, E., Galea, S. (2013). A life course approach to mental disorders. Oxford: Oxford University Press.
Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press.