Introduction:

 

The Miller family is a family of five; Bill, 38, Judy, 37, Brian, 18, Lauren, 16, and Tina, 7.  Judy’s sister, Linda, is the sister who is always dropping in unexpectedly without knocking, unless her husband is with her.  Both Bill and Judy’s parents are disliked by the family; they love them greatly, but the entire family goes out of their way to avoid them like the plague.

Bill and Judy were high school sweethearts meeting their junior year.  After graduation, both of them started college; however Bill dropped out after three weeks of classes.  Bill is currently working as a salesman, selling toilets in a department store similar to Sear’s, while Judy makes most of the family income as a dental assistant.

The children have their own issues that they deal with on a daily basis.  Brian is always thought to be gay and effeminate, although he is straight and attracted to girls. He is now leaving for the University of Pennsylvania in the fall.  Lauren thinks she is the queen of all and feels that she shouldn’t have to do anything that she doesn’t want to.  Tina is fairly level headed, although she is a bit crude, rude, and quite disgusting.

 

Initial Counseling Call:

Judy called into the office on April 4th, requesting counseling for their family before their son leaves for University.  She described the family as distant and close at the same time, and said that she is concerned for the future of the family since Brian is leaving and that she would like to get some various issues resolved.

Her initial concerns are: (a) Brian is gay and hates his father, (b) Lauren feels as if she is a prisoner in her own home, and (c) she is tired of Bill sitting around the house doing nothing when he is not working.  She is also extremely concerned that Tina plays with fire and sharp objects and has an imaginary friend.  Judy also says that her sister has become overbearingly annoying by coming to their house every day and that suffers from low self-esteem and wallows in her self pity all the time. 

With what Judy has given me over the phone, it is my opinion that there are several underlying issues that this family is dealing with that are the cause and not the symptoms that Judy has described to me.  She also informed me that the family has tried therapy before and it ended in disaster.  She has given me the information of the previous psychologist, and upon contacting him and asking him about the Miller family, he told me that he did not want to hear that name ever again, to never call back and then hung up on me.  Unfortunately I was able to find out any more information in regards to why the Miller’s had been to see this other therapist in the first place.  It is my opinion, however, that in light of this, there are more issues that the family is dealing with than what Judy has told me.

With this information, I set up an initial counseling session with all members of the Miller family to begin in two weeks. 

 

Family Case History:

After having counseled the Miller’s in their first session, I have found that the three main problems that Judy wants to see resolved are not the issues at hand.  She describes the three presenting problems as; 1) the children are “scary” and “weird,” Judy avoids the school programs, and Bill “hates kids.”  2) Bill is lazy when he comes home from work and sits in front of the TV all night drinking beer. 3) They cannot stand the rest of their family; this includes Bill’s parents and Judy’ biological and step parents along with her sister.

After having met with the family during their first session, it is my opinion that their absolute issues are as follows:

  1. Bill and Judy lack responsible parenting skills.
  2. Bill is an alcoholic, lacks responsibility, and seems to check out of the family system as soon as he comes home from work.
  3. Both Bill and Judy are afraid of becoming who their parents are.

After discussing these presenting problems with the family, I have found that Bill and Judy are coming to realize that the problems that Judy came to me for, are actually problems that they actually have more so than anything that has do with the children themselves.

 

Strengths and Weaknesses:

As I discussed the concept of family dynamics with the family, we took an inventory of each person’s strengths and weaknesses.  The biggest common denominator in the family’s strengths is that they are very dedicated to the family, inside the home.  This is also the case with their biggest weakness as well, being extremely sarcastic, especially to each other, and constant fighting and bickering.

Bill’s strength’s lie in his carpentry and culinary skills, ability to hold a stable job, very personable, is overly protective of his children, has motherly and fatherly instincts, and is a very dedicated family man.  His weaknesses however include, paranoia, spending the family’s money frivolously along with Brian’s College Fund (which is kept in a coffee can above the refrigerator), belittling his family, torturing his son, very homophobic, having avoidance issues, and alcoholism.

Judy’s strengths actually balance out many of Bill’s weaknesses and compliment many of his strengths as well.  These include, the ability to earn a stable income, the ability to manage a well kempt home, motherly instincts, dedicated to her husband, and very logical.  Her weaknesses however are, spending Brian’s college fund (also known as “The BCF”), hates things that deal with the children’s education, has anger issues, hates people in general, especially her boss and his wife, and is the codependent older sister to Linda.

Brian has many strengths, most of which are, his ability to handle finances, his intelligence, a great outlook on life, and very logical.  Although he has weaknesses, his pale in comparison to his parents, which include avoidance issues, specifically home life itself, anger issues toward his parents for not taking the time to care, and despises his father for ignoring him.

Lauren is in a class all of her own when it comes to strengths.  She is quite beautiful enough to be a model, has multiple talents and the ability to create various craft projects, and has great street smarts.  Her weaknesses though, definitely outweigh her strong points.  These include suffers from depression, low self-esteem, extremely hateful, very vain, and when it comes to school, she struggles with most of her subjects.

Tina is an amazing child with strengths that include, intelligence, having the tendency to outwit the rest of the family, including her aunt and grandparents, being extremely clever, having an exceptional imagination, and the ability to pull the best practical jokes on the entire family.  Her weaknesses are her fears and frustrations; these show through by scaring the crap out of the entire family on almost a daily basis, in her imaginary friend and the tricks that her imaginary friend plays on everyone, and playing with sharp knives, scissors, and fire.

 

 

Theoretical Approach:

In working with the Miller family, I have found that in assisting the family to strive for organizational changes on their structural model and the structural outlook, as presented by Salvador Minuchin, not only will Bill and Judy be able to work together as parents but will also as a whole with the rest of the family.  This will also help them in understanding the proper hierarchical organization and the functioning of the family’s subsystems as a whole.

As Judy originally had described her objective for the family, and we have already refocused what are the true presenting problems, I believe that by using both Bill O’Hanlon’s Solution-Oriented Brief Family Therapy and Steve de Shazer’s Solution-Focused Brief Therapy, the Miller’s will be able to change the presenting problems on their own.

 

Counseling Plan:

As I have already met with the Miller family once, I have described to them the following counseling schedule that I would like to put into action.  I am going to be meeting with the family every two weeks and working predominantly with Bill and Judy to help them find out how to change their presenting problems.

During the second session, I will be meeting with the children to determine wherein the issues lie with their parents, as this is the first presenting problem that has been discussed.  In the following three sessions, I will be meeting with Bill and Judy together and individually.  After these sessions, it is my goal to have helped the Miller’s in making major progress by the seventh session. I believe that I will only need to see them one final time in July to follow up on their progress before Brian leaves for University.

I also have referred Bill and Judy to a child psychologist that specializes in children that are in danger of hurting themselves or somebody else.  It is my opinion that Tina is in need of specialized one on one therapy with the counselor that I have referred them to.  I have personally explained to them that I am concerned with everyone’s safety.

As for Brian, I have talked to him privately about the issue of his sexuality.  He has told me adamantly, that he knows who he is as a young man and that he has no issues with his sexuality.  However, due to the constant badgering, belittling and torturing of the rest of the family about the possibility of him being homosexual, I have recommended that once he has arrived in Pennsylvania to attend school, he might consider finding a counselor who can assist him in dealing with his frustration over this issue.

 

Progress Plan:

I have assigned each of the family members to keep a private diary of the times that are most common that the problems at hand seem to be most profound.  Each of the children will be keeping a diary of the parents and each other, while Bill and Judy will keep progress of each other and two of the children that I have assigned to each.

After meeting with Bill and Judy in the third session, I will evaluate their progress and find the most common times that each of the presenting problems happen the most.  My desire at this time is to assist Bill in understanding the repercussions of alcohol and suggest that he refrain from drinking and to consider attending A.A. meetings.  I also will suggest that by allowing Judy to handle the finances at this time, he will be less likely to go out and have a drink with his buddies.  I will be referring him to see a therapist who specializes in therapy for alcoholics in order to take this step towards change.  I will also be working with Judy to become more involved with the children’s education and extra-curricular activities and I will be assisting her in taking the initiative to do some volunteer work once a month at Tina’s school.

Finally, I have requested that each of the family members spend at least two hours of productive and quality time together with one other family member at least once a week.  This is to include not only each of the other four members in the house, but also to spend this same amount of time with the grandparent’s and with Judy’s sister.  In so doing they will be able to have this part of their homework done by the sixth session scheduled for June 13.

After I had explained to the family how the sessions will go, I ask for their input individually how they would know when things were getting better.  Their consensus came back that ‘mom and dad would be far more productive and active in the children’s’ lives and that dad would stop drinking and help out around the house.  Bill and Judy also agreed that when they are able to sit down with any of their parents and carry on a conversation without arguments or complaints, they know that they are reaching their goal.  Judy also explained to me that she would know the therapy was helping when Bill receives his promotion to management.

 

Techniques Used:

As Bill and Judy have come to understand their parenting skills are in need of dire repair, and that the dysfunction of the family is actually teaching their children to have a misconstrued idea of how the hierarchical organization actually works.  The subsystem functioning will need to be relearned by the children as well in order for the family to come together and work as one.  It is my belief that each of the family members will have to undergo a relearning process on an individual basis of how the family structure is supposed to be.

I am not inclined to change the family, so I am leaving this up to them.  Ultimately, it is their decision if they desire to change the way life is in their home.  It is my goal to help them understand the prospect for change is completely up to each individual member of the family unit, and the family as a whole.  When having my initial counseling session with the family, Bill, Judy, and Lauren were all asking if their way was the correct way in finding the solution, I explained to them that there are multiple perspectives and that no one way was wrong.  Since they have had an issue of thinking that their own ways are always right, I wanted them to understand that many solutions are out there that could assist them in changing the family dynamics.

While it is Judy’s desire to find out how the family developed these problems, I was inclined to make sure that each member of the family understood that speculating about how each problem arose would not get them anywhere.  Because of this, I am having each member work on discovering their own creative solutions to help the whole family wok on changing their situation.  As we work together to find the solutions to the presenting problems at hand, I will be focusing on their strengths more than I normally would since each member of the family seems to focus on the others’ weaknesses.  After explaining this approach for change, I told them that change was inevitable and that the true issue now was when it would occur.

As I continue working with the family I will be asking them various questions that are central to this approach using the: (a) “miracle questions”; (b) exception-finding questions; and (c) scaling questions.  In using these with each member individually, and comparing them as a whole, I believe that I will be able to assist the family in the appropriate manner in finding their solutions.

 

Legal and Ethical Issues:

I am a little concerned that the Miller children may have been neglected.  I also have been just as concerned in the welfare of Brian’s mental health with the constant mental abuse from the family.  In light of these issues, I have been in contact with the Illinois Child Welfare Agency, and informed them of the possibility of neglect and mental abuse.

I also have had a long discussion with Bill about the ethics and standards that I not only have as a Family Therapist, but also as my duty to the AAMFT.  He has offered to buy me season tickets to the Chicago Bears if I allow the family to attend therapy for free. I also had to deal with the issue of confidentiality.  This was a major problem in the family’s prior counseling experience.  Not only has he had tendencies in the past to badger information out of someone, he is insistent upon finding out what everyone has said about him.  I have also explained to him that due to client privilege and my personal belief, I would not be able to discuss anything with him that another family member had shared with me.

 

Conclusion:

In conclusion, it is my opinion that with the exception of Bill, the rest of the family is willing to work on changing their situation.  By using the structural outlook as presented by Minuchin along with O’Hanlon’s Social-Oriented Brief Family Therapy and the Solution-Focused Brief Therapy presented by Shazer and associates, the Miller family should change their presenting problems and many of the underlying issues.  I believe that the family as a whole wants change and is willing to do whatever it takes to be a family without the major dysfunctionality.

Bill is my only concern since he is not apt to change.  I plan on focusing a little more on this issue with him so that he understands that even though change is inevitable, many times it is even beneficial.  Although he is somewhat resistant, and originally was dead set against coming to family therapy, I see that he is already beginning to understand the benefits of family therapy and recognizes that his family is in dire need of change.

I believe that over the course of the next two and one half months, I will be able to help the Miller family in understanding how to have a less dysfunctional family system.  It is also my opinion, that the symptomatic issues that Judy had originally called for will be resolved along with the presenting problems being able to be changed through the family’s cooperation of one another.

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