Family Assessment: Integrating Multiple Clinical Perspectives

5 Initial Interview with a Family (p. 81-82)
Volker Thomas

Summary

The chapter describes the initial assessment and evaluation of the Smith family, who sought family therapy because the parents were unable to manage their 9 year old son’s behavior effectively. The case illustration is structured according to the assessment guidelines provided in the previous chapters.

1. Phone Contact

Ms. Smith called asking for her husband and their 9 year old son Ben to come in for family therapy because they were at their "wits end" trying to manage Ben. Ms. Smith reported that Ben had recently hit her when she tried to discipline him for hurting their family cat. On the phone Ms. Smith sounded hopeless, helpless, and desperate. Although Ben was an excellent student and the parents had not received any complaints from school about his behavior, Ms. Smith had phoned the school and had a long conversation with Ben’s school counselor. The counselor had not noticed any defiant or oppositional behavior at school, but at Ms. Smith’s request referred the family to our family therapy clinic.

Ben’s early development was within normal range with no unusual behavior. Ms. Smith stayed home from her job as an elementary teacher to fully concentrate on raising her only son, while Mr. Smith advanced quickly in his career as a systems analyst for a large company. The family had a good income, moved 4 times before Ben started kindergarten. By then he could read and comprehend math on a 3rd grade level. Ms. Smith and Ben had developed an extremely close relationship in which she partially compensated for missing her husband, who was rarely home due to increasing work responsibilities. When Ben entered kindergarten, Ms. Smith looked for part-time employment as a 4th grade teacher, but could not find a job. She became increasingly depressed, while Ben enjoyed the company of other children and excelled in the very individualized full-day kindergarten program.

It was not until Ben entered 2nd grade that Ms. Smith found employment at the same elementary school. The next two years were rather uneventful, until Ms. Smith lost her job, when Ben entered 4th grade. Ms. Smith became severely depressed again, was hospitalized for a short period of time and stabilized with anti-depressive medication. It was at this time that Ben became increasingly difficult to manage at home. He challenged his mom frequently about rules, threw temper tantrums when he did not get his way, and openly complained to his dad about mom’s poor parenting skills. Mr. Smith who had been oblivious to his wife’s emotional state sided with his son’s concerns and grew increasingly critical of his wife’s parenting. When he was home he would interfere when Ms. Smith tried to discipline Ben, which, after initial relief would worsen the situation. When Ben also began ignoring his father’s disciplining attempts, Mr. Smith withdrew into his work, which left his wife resentful and helpless with their young son. At the same time Ben continued to excel at school with the support of a gifted education program and a supportive teacher who knew Ben’s home situation quite well.

Ms. Smith was the oldest of three girls. Her mother, a school teacher, stayed home with the girls until the youngest was 4 years old and attended a pre-school. By that time Ms. Smith was in 4th grade. Her father was an accountant in a small local company, where he maintained his position throughout Ms. Smith’s childhood and adolescence. Her mother had a drinking problem through which she masked and self-treated depressive tendencies while she stayed home and raised her three daughters. Ms. Smith remembered taking care of her younger sisters when she would come home from school finding her mother drunk and withdrawn in her bedroom. During her elementary school years Ms. Smith worked very hard to maintain her good standing in school and manage the stress at home. Her mother hid her drinking from her father who colluded in the denial explaining his wife’s strange behavior (when she was drunk) as being overwhelmed with three young children. He would willingly pitch in, prepare the evening meal, and take care of the children. Ms. Smith felt guilty for keeping the secret of her mother’s alcoholism from her father, yet she needed the relief so that she could get her homework done. When Ms. Smith was 8 years old her mother caused a car accident with her three daughters in the car while driving drunk. Fortunately, nobody was hurt in the accident. However, the accident revealed Ms. Smith’s mother’s alcohol problem and broke the denial cycle. She underwent inpatient alcohol treatment and managed to maintain her sobriety from then on. As part of her recovery, Ms. Smith’s mother sought employment and found a teaching position in her children’s elementary school.