Question

Spencer is a 15-year old boy from an upper middle class family living in an affluent neighborhood in New York City. Spencer lives at home with his parent. Spencer has a history of depression, anxiety, and substance abuse. His first hospitalization occurred a year ago when he was 14 due to his threats to hurt himself while at school. Spencer has a history of abusing multiple substances, including marijuana and prescription pills. He describes his substance use as a way in which he can “numb” himself from his depression. Spencer has reported having a tumultuous relationship with his father whom he reports is verbally abusive (i.e. telling Spencer that he will never amount to anything). Spencer often avoids his father at home and most of their contact is reported as “screaming matches” Alternatively, Spencer is very close to his mother and has been open with her in voicing his feelings of depression and hopelessness. Spencer is also very open with his mother in reporting to her any times in which he has engaged with substance use, although he does not report any intention or desire to stop using. Spencer’s parents do not agree on how to approach Spencer’s escalating substance use and increased depression. His parents also report that it has become increasingly more challenging to monitor Spencer’s substance abuse when he is interacting with peers who also engage in substance use. Spencer’s father believes in “tough love” and sending Spencer off to military school or some other institution where Spencer will be “properly disciplined. “ Spencer’s father also reports that his wife is “too soft” and is in denial as to the extent to which Spencer is abusing drugs. In particular, Spencer’s father reports that his wife should limit Spencer’s interactions with peers, whom are also suspected to use substances and she should also not “give in” when Spencer refuses to attend school, particularly in cases when he is hung over from excessive drug use. Spencer’s mom in turn does not believe that she is being too soft on her son, but rather she feels helpless in what can be done to stop his drug use, as he is refusing to stop. She also believes that Spencer needs to be treated for his depression, as she attributes his drug use to his feelings of hopelessness. Therefore, she does not agree with her husband that Spencer is simply “acting out” and needs harsh discipline; however she is not certain how she may be able to get her husband to become more empathetic towards their son’s emotional challenges and be more engaged in finding therapeutic treatment that does not require sending Spencer out of the home.

1. What is the organizational structure of this family? Do you notice any examples of triangulation and cross-generational alliances? And how might alliances within the family’s structure contribute to maintaining the problem?

2. What is the hierarchy in the family structure? As therapist, who do you identify may have the most power and control in the family? Who may have the least? Is there an incongruent hierarchy within this family? Briefly describe

3. Briefly describe an alternative structure that you may present to this family ?

4. Describe some structural therapy techniques that you may use with this family in session in order to facilitate reorganization of the family structure. In your description, provide examples of how these techniques may be applied to this particular family’s presenting issue.

5. As a family therapist working with a family in which one or more members may not be motivated for therapy, what are some strategic therapy techniques that you might employ to help this family solve their problems? Briefly give an example of one or two strategic therapy techniques .

Answer 1

Answer 1:

The family follows a strict and stringent hierarchical structure wherein the father is the head of the family and tends to take decisions for the family by hook or by crook. Triangulation is quite significant in the family among all the three members. Spencer just talks to his mother and wants her to convey it to his father. On the other hand, Spencers father conveys him the messages through his wife rather than directly talking to his son. Since Spencer is only comfortable with talking to his mother and not his father, cross generational alliances is prominent wherein the child likes only one parent and which is mostly the parent of the oppositte sex. This allaince creates lack of communication between the father and the son which further inflates tension between the two leading to more tension in their realtionship. This ultimately leads Spencer to resort more and more to drugs to ignore this tension in his family.

Answer 2:

The family follows a strict unilinear hierarchy wherein the father is the head of the family and has the maximum power. The least control is in the hands of the mother as she is trapped between her husband and son and has to choose at every point, thus, facing consequences. The hierarchy in the family is definitly incongruent. Being a family, everyone should have an equal say irrespective of their age or gender.

Answer 3:

An alternative for the family is to have a flat structure wherein each member of the family has an equal say. It should have the father being bossy in any way. Everyone in the family should contribute equally to all the decisions.

Answer 4:

The main technique which can be used in this case is joining. In this technique, the therapist helps the family by inducing empathy in them in order to bring them close. In case of Spencers family wherein there is so much of negativity creeped in, the best way which can be used under the joining technique is by telling the family about its strenghts. By doing so, the therapist can create hope amongst the family members.

Another method that can be used by the therapist is boundary making. In this method, the therapist can try and make the family boundries either stringent or flexible depending on the case. Since in the above case, there are stringent boundries, the therapist has to work on making them flexible. In Spencers case, this can be done by using the physical boundary making wherein the father and the son are made to sit together in order to make sure that they bond with each other.

Answer 5:

In case of resitence, integrated models can be used. Their should be flexibilty in the therapy and the methods used. The therapist can also have individual sessions with different members of the family to increase the comfort.