Amelia and the Patel Family: Helping Parents of Boomerang Children Shift from Stressors to Strengths

Amelia, the Seasoned Counselor

The ethical practice of counseling requires clinicians to continuously expand their knowledge, evaluate their effectiveness, and monitor their personal wellness. Advancing in the profession—through years of professional experience—is typically associated with the acquisition of expertise and an increase in the cognitive complexity of clinical approaches (Granello, 2010). Having worked in private practice for over two decades, Amelia possesses a wealth of knowledge and clinical experience. However, running a busy private practice includes numerous responsibilities and challenges that extend beyond one's clinical work. Maintaining clinical records, managing various administrative duties, and scheduling sessions can leave little time for collaborating with colleagues or attending to self-care. Consequently, operating a private practice can not only provide a dynamic and rewarding career path for counselors, but it can also hold the potential to contribute to isolation and impairment (Corey et al., 2019; Herlihy & Corey, 2015).

Amelia's practice includes a small group of counselors she met in graduate school; however, the case does not indicate the frequency or regularity with which these counselors offer each another consultation and support. As the case illustrates, Amelia's recent family transitions and personal issues have impaired her clinical objectivity and effectiveness. Accordingly, Amelia has experienced feelings of loneliness and possible mild depression for several months, but it is unclear if Amelia has implemented any steps to address these issues. Seeking out consultation or peer supervision, starting her own personal counseling, creating a self-care plan, and developing a strategy for monitoring her professional performance are beneficial safeguards that Amelia may need to implement to ensure she is practicing in an ethical and effective manner.

The phenomenon of adult children returning home to reside with their parents has garnered consistent interest from researchers over the past 15 years, given its increase in prevalence due to the Great Recession of 2009 (Caputo, 2019; Payne & Copp, 2013) and the COVID-19 pandemic (Fry et al., 2020; Khan, 2021; Manhertz, 2020). The academic literature and print media use a variety of terms to describe this living arrangement. Terms such as boomerang kids (Yu, 2022), failure to launch (Bell et al., 2007), and stuck in the nest (Mazurik et al., 2020; Rampell, 2011) tend to reflect a more critical stance, while the use of the term coresidence reflects a neutral (White & Rogers, 1997) or culturally sensitive perspective (Evans et al., 2022 ). Recent survey data and print media indicate that this living arrangement is increasingly common among 20–34-year-olds (Fry, 2017; Fry et al., 2020 ) and has, consequently, become a more desirable option for young adults (Parker, 2012; Pinsker, 2020) and a less stigmatized experience for parents (Casares & White, 2018; Khan, 2021; Weale, 2018). However, research on the benefits and disadvantages of parent adult–child coresidence is mixed. One qualitative study indicates that this arrangement is predominately positive for parents and contributed to the emotional and financial well-being of the adult children involved (Casares & White, 2018). Quantitative studies indicate that parent–adult child coresidence can increase familial closeness and support (Aquilino, 2006; Leopold, 2012), but may also contribute to marital tension (Ward & Spitze, 2004 ) and diminished relationship satisfaction for parents. Anecdotal examples presented in print media have increasingly portrayed coresidence as a prudent financial arrangement (Davidson, 2014; Hoder, 2012; Manhertz, 2020), a safety net during periods of difficulty or transition (Rampell, 2011; Swartz et al., 2011), and a beneficial opportunity to increase familial closeness (Khan, 2021; Weale, 2018). Thus, the academic literature and print media offer clinical insights—as well as hopeful illustrations—that can inform a clinician's work with individuals, couples, and families experiencing coresidence.

Other ethical dilemmas relevant to Amelia's work with the Patels pertain to cultural sensitivity and clinical competence. Firstly, Amelia's culture and values differ significantly from the Patel's. While Amelia has inquired about the couple's history, it is unclear if Amelia has broached issues related to race and culture (Day-Vines et al., 2021). Moreover, Amelia has worked with the Patels for only one month and information is not provided about the level of trust and rapport that has been developed with the couple during their first five sessions. Notably, certain cultural views and expectations that the Patels may hold regarding the counselor's role and the nature of therapy may require Amelia to adopt a more directive style (Sandhu & Madathil, 2008). Lastly, the Patels have expressed a desire for their son, Ajay, to attend future sessions to address some of their lingering concerns. Since Amelia primarily works with couples, shifting to a family counseling format may exceed Amelia's current scope of competence. These issues and other pertinent ethical considerations will be explored in greater detail.

The Clients: Patel Family

Raj and Priya Patel married in their early 20s. Shortly after their first anniversary, they immigrated to the United States from Pakistan. The Patels have a history of successfully overcoming challenges as a couple and hope that Amelia can assist them in working through some recent family stressors. During their initial counseling sessions, the Patels recounted their experiences with learning a new language and culture, starting a small business, supporting one another through difficult times, and raising two children into adulthood. These stories exemplify the couple's supportive and resilient nature, and illustrate their core values of handwork, perseverance, and self-sufficiency.

Currently, Raj and Priya are experiencing issues related to their 27-year-old son, Ajay, who has lived with them for the past two years. The Patels disagree on the benefit of their son's return home to reside with them and hold conflicting views about how to best support Ajay through the process of securing adequate employment. They report very few disagreements with their son; however, his constant presence is considered a nuisance, as it has disrupted his parents’ schedules and marital relationship. Ajay's prolonged stay at his parents’ home has also contributed to disagreements between Raj and Priya. The couple wants Amelia to provide an “objective third-party opinion” and have proposed bringing Ajay to their next counseling session.

Cultural Differences

Amelia and the Patels come from differing cultural backgrounds, and thus, it is necessary for Amelia to broach the topic of culture with her clients. By approaching the Patels with sincere curiosity and cultural humility, Amelia can better understand Raj and Priya's cultural experiences and beliefs. Accordingly, it would be helpful for Amelia to offer context and a rationale for broaching cultural issues with the Patels, for the purposes of modeling multicultural sensitivity and diminishing the potential for her questions to be perceived as inappropriate or intrusive. If conducted appropriately, these efforts to explore the Patels’ cultural values will further strengthen the therapeutic alliance (McAuliffe, 2008), enable Amelia to assess their level of acculturation, and provide helpful insights into her clients’ unique needs, expectations, and goals for counseling (Sandhu & Madathil, 2008).

Clients’ Conflicting Expectations and Goals

While Raj and Priya have not explicitly shared information about their cultural values and beliefs, they have expressed expectations and goals for counseling that are clearly at odds with one another. Raj and Priya disagree about the benefit of Ajay continuing to live in their home and report holding differing views on their son's lifestyle, level of motivation, and the merits of his daily activities. Raj acknowledges attempting to be understanding and empathic toward his son; however, Raj has firm expectations about household responsibilities. Additionally, the couple's conflicting opinions about establishing a timeline for Ajay's departure is a significant stressor—which has contributed to ongoing disagreements—as Priya has expressed fears that Ajay will not be able to afford living on his own.

Professional Impairment

Amelia is exhibiting several signs of professional impairment. For the past two months, Amelia has experienced despondency regarding her daughter's moves and subsequent feelings of loneliness. Further, Amelia's struggles have notably crept into her clinical work. Amelia is routinely distracted during sessions, thus diminishing her ability to focus on important client information, remain present, and safeguard the therapeutic alliance. Moreover, Amelia's impairment impedes her ability to remain objective and has resulted in at least one instance of countertransference.

Cultural Sensitivity

Counselors must always practice cultural sensitivity as they counsel clients. Section A of the IAMFC Code of Ethics (2017) states in The Counseling Relationship and Client Welfare, Paragraph 1: “…couple and family counselors understand that each family presents diverse cultural backgrounds and actively attempts to promote their cultural awareness and knowledge” (IAMFC, 2017). This code requires Amelia to have general knowledge of the values and characteristics of diverse cultural groups and strive to understand the unique cultural expressions and experiences of each client. Further, “Couple and family counselors respect the dignity, worth, uniqueness, and potential of couples and families in their cultural contexts” (IAMFC Code of Ethics, J.1). Consequently, counselors should be familiar with the Multicultural Counseling Competencies (MSJCC; Ratts et al., 2016), endorsed by the American Counseling Association, which are to be implemented throughout the therapeutic process (J.2).

The Patels value Amelia's professional role and expertise and have indicated that they want to receive an “objective third-party opinion.” Specifically, Raj and Priya have expressed a desire for Amelia to offer an opinion regarding whether or not Ajay should be given a mandated timeline to move out of their home. It is important to note that collectivism and familism are central values in some cultures and, in general, “…authority and communication flow from top to bottom. Relationships are rigidly structured, and obedience from the young members toward their elders is expected and enforced (Sandhu & Madathil, 2008, p. 359). With these cultural considerations in mind, Amelia must weigh the clients’ values and expectations and reflect on the range of clinically appropriate approaches she might use with these clients. Consequently, she cannot simply default to explaining to the clients that, according to the ethical codes of conduct, it is not permissible to simply render opinions about important life decisions (IAMFC Code of Ethics, A.2). In this instance, cultural sensitivity and concern for safeguarding the therapeutic alliance afford Amelia a broader latitude for sharing clinical impressions and recommendations. However, this must be carried out skillfully and deliberately in an effort to respect the Patels’ cultural values and retain her commitment to promoting client autonomy (ACA, 2014; Remley & Herlihy, 2019). Accordingly, Amelia must share clinical impressions with clients and facilitate client problem-solving (A.2) in a manner that helps the Patels to “…learn to live in a manner that allows them autonomy and independence as those concepts are understood within [their] culture…” (Remley & Herlihy, 2019, p. 31).

Competence and Professional Responsibilities

IAMFC Code of Ethics, C.5 states: “Couple and family counselors do not attempt to diagnose or treat problems beyond the scope of their training and abilities.” Thus, Amelia has an ethical obligation to continually assess her professional competencies, as well as the limits of her training and experience. If Amelia determines that conducting this family counseling is outside of her scope of competence, she must convey this to the Patels and explore potential treatment options based on the couple's needs, cultural values, and stated goals.

Safeguarding against professional impairment is an ongoing task and an ethical imperative. IAMFC Code of Ethics, C.7 notes: “Couple and family counselors do not participate in any professional activity, including but not limited to counseling, supervision, teaching, and research, in which their professional objectivity may be obscured by personal issues.” It is clear that Amelia's personal issues have significantly impacted her emotional well-being and, thus, impaired her ability to remain objective in her clinical work. Continuing to practice without taking active steps to remediate these issues is a further violation of IAMFC's Code of Ethics (2017). Personal distress, if left untreated, may contribute to the development of clinical blind spots and burnout. Consequently, this erosion of competence can endanger client welfare and impede clinical progress. Critically, “counselors must maintain a high level of self-awareness so that they do not inadvertently impose their own values, beliefs, and needs onto their clients” (Remley & Herlihy, 2019, p. 7). Therefore, couples and family counselors must engage in ongoing self-reflection and seek out supervision and/or counseling to address “personal issues that impact their professional objectivity” (C.8).

Referrals

Amelia may need to refer the Patels to another counselor. Relatedly, IAMFC Code of Ethics (2017), Section H: Ethical Decision-Making and Resolution, Paragraph 1 states: “Couple and family counselors engage in ethical decision-making in all aspects of couple and family counseling.” By utilizing an ethical decision-making model, Amelia will be able to identify important issues, seek consultation, evaluate options, and develop a thoughtful plan to proceed with the Patels (Remley & Herlihy, 2019). This practice will enable her to identify and implement best practices which, in turn, will safeguard clients from potential harm (IAMFC Code of Ethics, H, Paragraph 1). In this case, shifting from couples to family counseling changes the focus of counseling, thereby creating blurred boundaries which hold the potential to harm the clients. Accordingly, “[c]ouple and family counselors withdraw from a counseling relationship if the continuation of the relationship is not in the best interests of the client or would result in a violation of ethical standards” (A.10). Discontinuing treatment is only permissible if it is intended to protect clients and advance their therapeutic goals, rather than for “discriminatory reasons such as race, disability, religion, age, sexual orientation or identification, cultural background, national origin, marital status, affiliation, or socioeconomic status” (A.11). If Raj and Priya indicate that they would prefer to address their concerns exclusively within family counseling, Amelia would be obligated to “arrange appropriate termination of the counseling relationship” (A.12) and to provide the Patels with clinically and culturally appropriate referrals (ACA, 2014; A.11; Remley & Herlihy, 2019).