CLINICAL DEMONSTRATION
Family Background and Family Genogram
The family was referred by the 24 year old married daughter who lives and attends college in Chicago. The family consists of the father who is a 57 year Caucasian male who has been married for 30 years to a 57 year old Caucasian female. They also have a 19 year old son who attends college in Lawrence, Kansas. Both adult children are attending college and live away from home. The parents are struggling financially and they have begun the process of filing for bankruptcy. This has proven to be a source of increase stress and tension in the family.
Session Transcription Saturday, May 15th, 2010.
Client(s): 210.0054 Start Time: 9:09 End Time: 9:21
2nd Session Assessment Phase
Description of Therapeutic Content: This section of the video illustrates the process of continuing the alliance established during the first meeting, by eliciting their story and their experience and definition of “the problem.”
Goal: The goal of the session is to continue building an alliance with the clients, assess their motivation and elicit the client’s definition of “the problem.”
Rationale: The selected segment demonstrates my skills and techniques in assessing the family’s “readiness, willingness and ability” to do the work.
Session Description: The segment of video is during the couple’s second session which continues the assessment and joining phase of therapy.
Session Information: The therapist has welcomes the clients back to therapy and asks about their experience of the first session.
Segment begins: 9:09
Therapist: Well, Thank you for coming back. Tell me how last week went after sitting in therapy? What did you think?
She: Um (sighs) when (our daughter) set it up I thought it was gonna be a onetime deal, so I was really surprised when we were talking about doing more sessions.
Therapist: Okay. Process: this statement makes me curious because their daughter has returned to Chicago and they kept their appointment.
She: …because she talked to him (looks at husband) and he said she set up a session for us, so, I thought it was going to be a one-time deal. So, I think she… I think what she wants from it… I’m putting words in her mouth probably, but, I think what she wants from it, is for us to change our ways… as far as the whole financial thing, so…
He: (clears throat) Yea, she’s the… she’s the Dave Ramsey guru.
Therapist: Okay. (The daughter has influence. Dave Ramsey comment appears to be a half-compliment)
He: Yea, I mean it’s kind of… and I mean obviously she’s watched us over time… and I said something to her about it… how’s (our daughter), her husband, feeling about it? She said, “We both weren’t that surprised. We kind of saw it … we saw it coming.” I said, “fine.” “…because everyone else tells us they saw it coming.” I said, “I’m glad you did because… um”
She: Well, we just kept… Process : Wife continues to look at husband, husband doesn’t seem to notice her glancing at him, but is turned towards me.
He: We just kept thinking we could…
She: thinking we could…
He: work our way through it.
She: Yea, but anyway, um… it was… you know it was fine. We… I guess there were a couple things I thought was interesting (our son)’s… he was just like I knew he’d be (laughter)…
Therapist: How’s that? Process: They finish one another’s sentences and thoughts.
She: Stoic.
Therapist: Okay. Process: Waiting for them to tell me more.
He: And...
She: You know… “I’m not bothered. I’m fine. I’m fine.”
He: “I’m fine. I’m fine. I’m fine. I don’t need…Thanks for the money.”
She: (laughing) Process: Her laughter seems more of a nervous laughter. They appear to be dismissing their children in an indirect way.
He: That’s uh…um, you know, I think a portion of it is (our daughter) does like to fix things…
Therapist: Okay. Process: Waiting for them to tell me more.
He: …and she…I think she…since she’s going into this field. Uh, I see some problems when she isn’t going to be able to push her way around in order to… “I said!” (pounds couch) you know…um, after we got back …like it’s a Saturday afternoon she came up when I was do…fixing doing laundry and taking care of some stuff and she said, “Why don’t you come down and have a beer with your kids?” Which is fine, I figured okay, I’m being set up for something.
Therapist: Okay. Process: Daughter is in the field of therapy, he isn’t quite convinced she knows what she is doing. Waiting for them to tell me more.
He: So, I said, “Well, let’s go on the deck.” And she goes, “Oh, it’s too cold out there.” I said, “It’s where I feel comfortable when I’m yakking and talking.” So, we went out there and set out a couple of chairs and (our son) was sitting there and lasted about two and a half minutes before he went over on the trampoline, which is… he hasn’t been on in years. And I’m like okay, so, he doesn’t want to be any part of this.
She: Yea.
He: …and (our daughter)’s like trying to convince me that I need to change jobs and you know that I should do this and I should do that and I should do all these types of things and I said, “Sweetheart, I’m 57 years old, tell me where I’m going to go and say, “Hi, I need to be …come in on a entry level of some type or other at such a salary?” I said,” those things don’t exist in a lot of...”
She: But she has a good point because if you keep making the checks you make, January, February, March…you are the eternal optimist…
Process: A pattern of communicating is emerging. They both communicate through their children. She is defending her daughter’s position.
He: I know.
She: … you keep making the checks that you made then…
He: Uh huh.
She: …we
He: Yeah
She: …this…even the bankruptcy’s not gonna help. So, she has a point.
He: I know.
She: So, you got… you can’t just blow her off…her ideas off… I mean…
He: Um.
She: …she’s got a point (clears throat) that this just… I mean… you know… this just isn’t working. And as hard as you try… it…a lot of people try things and it doesn’t always work....and so, I… I definitely understand where she’s coming from.
He: We took a credit counseling online thing yesterday which is a requirement before you can file bankruptcy. And you know…we were on it …hour and a half or something like that but…and it comes out sort of like, “You’re spending too much on your …on your dog… but you know you could possibly take a look and see if you can (chuckles) give your dog, you know…to another family member that will be more able … able to handle… to take care of it type of stuff and um…you know, you’re spending too much on food you should…you know, you should make all meals at home and take your …take lunch. You know and… I mean, it’s all very good ideas, but, it’s um… Process: He continues to dismiss and disregard any alternate suggestions.
She: Really, what we need to do is make more money.
He: Yeah, basically, basically it’s a money issue, you know? Um, it’s an income…it’s an income issue. Um…and we let …we let the debt take over and control us, so that’s…
Therapist: May I ask how long ago the debt began to kind of overwhelm you? How many years has that been? Process: Wanting a timeline when they recognized this was first a problem. How long have they been able to do this avoidance dance?
She: Oh, it’s been a long time. I mean, we…we had this, um, inherited IRA from my aunt and uncle
Therapist: Uh huh. Process: Waiting for them to tell me more.
She: … that we would pull from so when we …when we needed to. And so, there was kind of always that steady …um, well, we pull it out…we’ll pull you know, 5,000 dollars out to help pay for this and that…
Therapist: Okay. Alright, Process: Waiting for them to tell me more.
She: … and somewhere around two years ago, I suddenly realized that there wasn’t that much left and that’s uh, I remember that…that first weekend when I suddenly started just feeling totally overwhelmed.
Therapist: Okay. Process: Waiting for them to tell me more.
She: …and, I remember we went out to eat and I couldn’t eat… stomach just … you know… I just remember that first weekend…when I … just like suddenly it hit me, “You are going to run out of money!”
Therapist: Uh huh. Process: Husband is sitting back with his arms folded. He doesn’t look at her nor appear surprised at her revelation.
She: (clears throat) and um, so I would say for me it’s been a couple years.
Therapist: Okay.
She: But, I… (turns and points to husband) and here’s …here’s part of the problem! I pay the…what I call the family bills.
Therapist: Alright. Process: He doesn’t look surprised at her revelation. He lowers his head, but continues to sit back with his arms folded.
She: ...the gas, heat… anything to do with the house, the gasoline, blah, blah, blah. He would do his business bills.
Therapist: Okay.
She: He never really let me in - on what was going on
He: True. Process: He validates her statement and accepts the blame without protest.
She: so most of the … most of the charge card debt is his and it has to do with trying to keep his business going.
Therapist: Okay.
She: And I kept…I, being stupid and trying to save myself some stress (laughs) kept thinking he was dealing with it, that he was doing okay, kind of trying to put the curtain there
Therapist: um huh Process: She attacks him and defends herself. Same scenario when it came to the question of why she is in therapy. She doesn’t want to accept the responsibility directly for her experience.
She: so I wouldn’t see it. I mean, I would ask him. I’d say “we need to look at this,” he’d say “okay” and then it never got done. So you know I could have pushed more. I could have… I knew he was getting phone calls, “oh, you’re late on your payment.” So, I mean I could have… I could have pushed more, but, he really… he didn’t let me open any of his bills. He’d get mad if I opened his bills. He just kept it all from me, for the most part. So, he’s …you know.
He: I’m the one who’s responsible for it.
She: No, not all of it! Process: He accepts the blame and then she withdraws the attack.
He: Well, be honest, because I kept thinking I could make it go. And here, you know I had… I had a lease. So, it’s you know, it’s, um, you know, if I break a lease you are going be in for that. You know, You’re going to rip up your business as it is which is a big portion of what’s affected the short term.
Therapist: Um huh. Process: Not wanting to interfere with the process. Wanting to see more of the pattern.
He: Um, you know and I just…
She: There’s a very, very old, um, poem, article, something, letter to Ann Landers back probably 20 years ago that we saved about a salesman. And I save it … can’t hardly read it anymore but it’s about how they always think that they can do it. They can make the sale. They…they always think if they do this, if they change this, they can make the sale. And I kept it because that’s how he is. He al… I …I in ways I admire him because the… the ways the company has changed… and the jerky people that have taken over it at different times and the way they’ve run the business and he always dealing with this stuff that anybody else would have said, “you guys are crazy, I’m out of here!” And he’s kept, you know, trying to make it work, trying to, you know, back when he…when he first started, he had two…two different months where he got paychecks that were 10,000 dollars, now that was twenty four or five years ago,
Therapist: um huh. Process: Kick and a Kiss! She attacks him and then covers her track with sentiment to soften the impact?
She: you know, um…
He: even, even in 1999 it was about then, about the time…about the time, you know Holly was killed or something like that. Process: He skims over that detail. There is not a Holly in the family genogram. I will put that question on hold because the story unfolding seems to be more impactful than the death.
He: Um, you know, my second cousin who‘s a doctor and he said something about, “are you okay on this?” and I said, “well, you know if I was making six figures,” and he looked “whoa, okay, yea!” And then he kept introducing us to everybody else as an entrepreneur.” And I said “No, I’m not I’m a sales a person. You know. Um, you always, I mean, you always think if you fix it, you know, if you can get them…get them to see what your… what your program is and follow it and when you see somebody succeed with that and you know it’s possible… then you’re like “okay, what’s it going to take for me to get this one in that…in that position?” And you just can’t give up. You just can’t. Um…so…
Process: Language. Where have I heard the word “fix?” I’d like to go towards that because of the connection to a family pattern.
Therapist: So…I heard some interesting um, when we were talking about (your daughter) that she hopes that she can fix it … she’s always trying to fix things and then I hear you saying you know…you just hope that it’s going to be fixed.
She: (laughter and claps)
Therapist: And So, I’m curious who (your daughter) is most like?
She: (continues laughter)
Therapist: …and then in the same manner I hear that (your son) is the stoic. Process: I want both of them to make a crucial family connection to the interaction pattern emerging.
She: Um huh. (She stops laughing and appears thoughtful)
Therapist: … and who is he most like? Process: Waiting for them to tell me more.
She: Probably. Process: I looked towards her and she probably thought I was indicating her.
Therapist: and what is interesting um, is that we’re going to look at a genogram today which then helps pull out family patterns.
Process: This is an opportunity to gather more family information and build a stronger alliance and provide a valuable tool for therapy.
Segment Ends: 9:21
