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Assessing The McPherson Family

Injury-Prone Behavior, Delinquency

Christine “Lady Bird” McPherson Is a 17-year-old high school senior living in the suburbs of Sacramento, California. She attends Immaculate Heart, an all-girls Catholic high school, where she feels like a misfit due to her working-class background and lack of many friends. She daydreams about attending college in New York or some place with “adventure and sophistication” (Yakoub & Gerwig, 2017). She works part-time at a local coffee shop where her older, adopted brother Miguel also works. She takes up drama her senior year, experiences her first romance, and embarks on a secret mission to get accepted into a New York college against her mother’s wishes to have Lady Bird attend school someplace local and more within the family’s financIal means. At home she clashes often with her mother, Marion McPherson, and brother Miguel who has moved back home after finishing his bachelor’s degree at UC Berkeley.

While Ladybird does not have any medically-diagnosed condition she is prone to impulsive, self-injurious behavior. In a traumatic exchange with her mother in which her mother accuses her of being snobbish and inconsiderate of the family’s financial constraints for wanting to apply to New York colleges, Lady Bird throws herself out of the moving car and breaks her arm (Yakoub & Gerwig, 2017). She smokes cloves and exhibits problem-drinking behavior, at one point requiring hospitalization for her intoxication level. She steals a Cosmopolitan magazine from the grocery store her brother works at when her mother refuses to buy it for her. Commendable behaviors include her insistence on using a condom the first time she engages in sex.

Areas of Stress ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

Body image Sexuality Dating Scholastic pressures Competitive pressures Relationship with mother Relationship with siblings Relationships with peers Finances Career/College planning

“I want to go to the East Coast -- I want to go where culture IS like New York.. or at least Connecticut or New Hampshire where writers live in the woods...” --Lady bird

Meet The McPherson’s Marion, 48

Marion McPherson works as a counselor at a psychiatric hospital. She works long hours and is the sole provider since her husband’s recent layoff. Lack of money and time are major stressors on her family life. She has a strained relationship with her daughter due to her belief that her daughter’s wants and aspirations exceed the family’s financial abilities. She is hurt by her sense that Lady Bird is embarrassed of the family’s socioeconomic status relative to Lady Bird’s peers at Immaculate Heart, the preparatory school Marion pushed for Lady Bird to attend after Miguel witnessed a stabbing in the public school system.

Larry, 51

Larry McPherson has recently been laid off from his work in engineering. He has an outwardly happy disposition which belies the fact that he has suffered from clinical depression for years. He assumes the “good guy” disciplinarian role in the family, and Lady Bird confides in him more readily than with Marion. Larry finds himself in the demoralizing circumstance of sitting interviews with hiring managers half his age and applying to the same entry-level tech positions as his son Miguel. His stressors include lack of money, history of depression, and the acute damage to his ego of no longer being able to provide for his family. He has taken a notably more passive role in family decision making processes and problem-solving since his lay off shifting the head-of-household role to Marion.

Lady bird, 17

Christine “Lady Bird” McPherson is like a typical adolescent in some ways and is outstanding in other ways. She wants to attend a “sophisticated” East Coast college but lacks the grades and extracurricular involvement to qualify. She is not happy with her high school life and is vocal about her dissatisfaction. She butts heads with all members of her 5-person household except her father, and misrepresents herself in school (lying about where she lives) in hopes of befriending the “popular” crowd at Immaculate Heart. She engages in impulsive behavior, including throwing herself out of a moving car after an argument with Marion. She binge drinks to the point of having to be hospitalized for it. Her first experience with dating as a young adult ends in dismay when she discovers the boy from theater who has been courting her is in fact gay.

Miguel, 23 & Shelly, 22

Miguel McPherson is the adopted older brother in the McPherson family. He has recently moved back home with girlfriend Shelly after wrapping up a bachelor’s degree in computer science at Cal Berkeley. Unable to find work related to his degree, he now works two jobs at a local grocery store and a coffee shop. Stressors for both Miguel and Shelly include having to share space in a small, one-bathroom home with five family members, lack of money, and disillusionment with their job prospects after finishing their bachelor’s degrees.

Communication Understanding how family members communicate with each other is essential to assisting families with self-care and care management (Denham, Eggenberger, Young & Krumwiede, 2015). Communication is strained between Lady Bird and virtually all of her immediate family members except her father. Every conversation with Marion ends up with either tearshed or with Lady Bird storming off. They fight at meals, while shopping, driving, and during brief exchanges around the house such as coordinating use of the household’s single bathroom in the morning. Lady Bird clashes with her brother Miguel and his girlfriend (by association) over Miguel’s skepticism of Lady Bird’s college hopes. Larry withholds from Lady Bird that he suffers from depression to spare her feelings and judgment (Yakoub & Gerwig, 2017). Lady Bird reacts to her family’s resistance to her college dreams by applying to New York school’s secretly with the guidance of her father only.

Family Dynamics The McPherson family dynamics largely revolve around their work and school lives. Marion and Larry have an ostensibly healthy marriage in that they fight very infrequently, however, Larry’s lack of work places disproportionate amount of the burden of being a provider on Marion. Marion also resents that Larry also assumes a more passive role in parenting, taking on a permissive “good guy” parenting style while Marion must assume an authoritarian role, particularly in their parenting of Lady Bird. Lady Bird and Miguel bicker frequently, however, they are supportive of each other in more important domains of financial subsistence and career advancement. Miguel helps Lady Bird obtain part-time work at a coffee shop he works at; for her part, although Lady Bird is at times curt with Shelly, she does not openly protest Shelly living with them.

Religious Practices

The McPhersons do not practice any organized religion however they celebrate secular (Christian) holidays such as Christmas and Thanksgiving. Lady Bird attends a private Catholic school, Immaculate Heart, but does so out of her mother’s concern for school safety rather than religious affiliation. At Immaculate Heart, she engages in irreverent behaviors such as pranking one of the teachers by putting a “Just Married to Jesus” sign on her car. She snacks on the wafers intended to be passed out at communion as if they are potato chips and publicly mocks an anti-abortion speaker at a school assembly (Yakoub & Gerwig, 2017).

Strengths.. -Immediate family all reside together. -Middle class (home ownership) with food security. -Marion and Larry have been married nearly 25 years and continue to enjoy an intimate relations, with no secrets kept from each other. -Marion holds stable employment, with the same employer for past 18 year, with good benefits. -Larry is unemployed but actively applies for work. -All members of the household are collegeeducated and value education. -Lady Bird has had and maintains a close friendship with the same best friend she has had since elementary school, Julie Steffans. -The family is able to have Miguel (and Shelly) return home from college after Miguel is unable to find work related to his Berkeley degree.

Challenges.. -Space: the McPherson household consists of five adult members in a one bathroom 1400-square-foot house. -While they enjoy food security, money remains tight with Marion having to be extremely careful with spending when grocery shopping. -Marion works extraordinarily long hours, often joking with coworker that she’ll “see them in a few hours” when she leaves work in the evening. -John is both unemployed and suffers from depression which can be emotionally draining for Marion in addition to the financial implications. -Marion and Larry fear they cannot afford to support Lady Bird if she attends an East Coast school for college. -Tough job market, circa 2002: Miguel cannot find work related to his degree from Berkeley; he works instead at both a local coffee shop and grocery store to support himself. -Lady Bird’s first forays i into dating leave her depressed pressed and disillusioned.

Systems Theory


Family Systems Theory has been the most influential of all the family social science frameworks and provides a lens for assessing the McPhersons (Denham et al., 2015). Systems theory holds that family is an open dynamic system designed to maintain stability, where any major impact to one family member affects the family as a whole (Kaakinen, Gedaly-Duff, Coehlo & Hanson, 2015). Systems theory also holds that there are different subsystems within the whole, such as parent to child and child to child, that evolve over time to help the entire system adapt to change (Kaakinen et al., 2015). Applied to the Kaakinens we come to understand how Larry McPherson’s clinical depression and unemployed status can affect the entire family including Lady Bird, even if he only discloses his depression to Marion. Larry’s depression and, arguably, the work of having to keep his depression secret present added stressors for Marion. Not only must she be the sole providing parent, she must also assume an even greater sensitivity in her interactions with her husband. She must act as a psychiatric counselor both at work and at home (Yakoub & Gerwig, 2017).

Main points #1 All parts of the system are interconnected. #2 The whole is more than the sum of its parts. #3 All systems have boundaries. #4 Systems can be further divided into subsystems. (Kaakinen et al., 2015)

Problem #1

Problem #2

[Lady Bird] Injury prone behavior possibly secondary to depression as evidenced by throwing herself out of a moving vehicle and engaging in smoking and binge-drinking activity.

[Systemic] Interrupted family processes related to job loss and chronic depression by the head of household as evidenced by alterations in participation in decisionmaking and changes in communication patterns.

Interventions: Refer Lady Bird to dialectical behavior therapy (DBT) for adolescents. DBT programs consist of individual therapy, skills groups which incorporate clients’ family members, and text access to therapists throughout the week, specifically formulated for teens engaged in either self-injuring or suicidal behaviors (Cook & Gorraiz, 2016). The approach has demonstrated efficacy in reducing non-suicidal self-injury, improvement in depressive symptoms, and reduced incidence of psychiatric hospitalizations (Cook & Gorraiz, 2016).

Outcome: Met. Lady Bird no longer engages in heavy drinking and smokes less frequently after completion of her therapy course. She is able to verbalize healthy coping mechanisms for when she has fallings-out with Marion.

Interventions: Assess the strengths and deficiencies of the family system and assist family members to recognize the need for help and teach them how to ask for it (Ackley & Ladwig, 2016). Refer the family to appropriate resources for assistance (e.g. psychotherapy, support groups, social welfare programs) as needed (Ackley & Ladwig, 2016). Effectively managing Larry’s depression will promote his return to a more active role in family decision-making which will alleviate some of the added strain on Marion.

Outcome: Partially met. Larry has been attending regular psychotherapy in addition to taking his antidepressant medications. He is taking a more active role in family decision-making, however he still defers financial matters to Marion. He continues to look for work.

Problem #3 [Lady Bird] Low self esteem & disturbed body image as evidenced by lying to more affluent peers about her place of residence and expressing desire to have an eating disorder to achieve the physique she wants for herself.


Assess the client’s self esteem using valid and established tools like the Rosenberg Self-Esteem Scale to facilitate identification of appropriate nursing interventions. (Ackley & Ladwig, 2016).

Encourage clients to develop their artistic abilities (Ackley & Ladwig, 2016). Lady Bird has demonstrated passion for theater. She should be encouraged to continue to pursue dramatic arts in college as a means of increasing self-worth, as an avenue for career development, and for building expanded social networks.


Met. Lady Bird presents with enhanced selfesteem and body-esteem in her college years. She is able to verbalize more positive self-statements.

References Ackley, B. J. & Ladwig, G. B. (2016). Nursing diagnosis handbook: An evidence-based guide to planning care (11th ed.). St. Louis, MO: Mosby Elsevier Assessment Technologies Institute (ATI) RN nursing care of children 10.0: Content master series review module (10th ed.) [Adobe digital editions version]. (2016). Retrieved from Cook, N. E., & Gorraiz, M. (2016). Dialectical behavior therapy for nonsuicidal self-injury and depression among adolescents: preliminary meta-analytic evidence. Child & Adolescent Mental Health, 21(2), 81-89. doi:10.1111/camh.12112 Denham, S., Eggenberger, S., Young, P. & Krumwiede, N. (2015). Family-focused nursing care. F.A. Davis: Philadelphia. ISBN-13: 9780803629103 Fletcher, R., Dowse, E., Hall, P., Hopwood, N., Bennett, E., & Erickson, J. (2014). Identifying depressed fathers during a home visit: why and how. Australian Journal Of Child & Family Health Nursing, 11(1), 5-9. Harris, M., Penfold, R. B., Hawkins, A., Maccombs, J., Wallace, B., & Reynolds, B. (2014). Dimensions of impulsive behavior and treatment outcomes for adolescent smokers. Experimental & Clinical Psychopharmacology, 22(1), 57-64. doi:10.1037/a0034403 Kaakinen, J., Duff-Gedaly, V., Hanson, S. & Coelho, D. (2015). Family health care nursing: Theory, practice and research (5th ed.). F.A. Davis: Philadelphia. ISBN-13: 9780803639218 Perry, S. E., Hockenberry, M. J., Lowdermilk, D. L. & Wilson, D. (2014). Maternal child nursing care (5th ed.). St. Louis, MO: Mosby Elsevier Yakoub, L. & Gerwig, G. (2017) Lady Bird [Motion picture]. U.S.: A24 Pictures.

Photo References [Lady Bird film poster] [Conversing in car with Marion] [Conversing in care with Marion (2)] [Lady Bird drunk hospitalized] [Lady Bird with Julie Steffans] [Lady Bird trying out prom dress with Marion] ait-to-see-her-next/ [Lady Bird after sex with Kyle Scheible] [Marion, alone] [Lady Bird date with Danny] m-critics-awards-2017/ [Receiving flowers at Danny’s house] [Marion’s outburst, “It’s never enough”] [In car with Larry & Marion] h-smart

McPherson Family Assessment  
McPherson Family Assessment