Why don't you come here Valerie, we cannot go. I don't know anything about the family, we are going to see a family. And first Valerie, that is the consultee, will tell me... She will...
tell you and me at the same time what are the characteristics of the families and what you want? I've got a lot of notes. Thanks. Just to relax myself. First of all, I want to say that I am just thrilled to work with you.
I have been jumping up and down for the last several weeks waiting for this moment. Okay, this family is a blended family with seven members. The parents have been married five years today. This is their wedding anniversary and this is where they are in family therapy.
It's a third marriage for both parents. All of the seven people do not live in the family. The steady living unit is the mom and the dad and her two sons from her first marriage. There's an 18-year-old and a 13-year-old who's the identified patient.
The father has three children from his second marriage of 12 years, and there's two sons and a daughter, and they all live outside of the family except for... the girl Andrea, who is 19, who has just recently moved in to live with this family. Let's see.
Okay, there's a lot of chronic boundary problems in the family in terms of dad's kids always wanting to come back to move in, and that creates a lot of conflict between the spouses, and the mother has a real difficult time standing up to the dad and saying, I don't want your kids here. because she feels real guilty that he's bringing up her kids. So she has a hard time saying no, but it does create a lot of stress with the spouses.
How long has she been married? They have been married five years today. And the kids are trying to constantly float in and out, dad's kids.
This is a recovered alcoholic family. The dad was an alcoholic, has been recovered for seven years now. And... They are in treatment, actively involved in treatment, in a recovery program.
They asked me upstairs not to disclose what recovery program they were in because it would break the tradition of the program that they're in. They were referred to me about four or five months ago in my private practice by a professional colleague. And who came in at that point was the mother and the dad and her two sons. They were the ones living in the family. Okay, gotta look at my notes.
The presenting problem at that time was a 13-year-old adolescent was acting out. He had poor grades in school. He had poor peer relationships. He was bullying kids. He didn't do chores at home.
The father was the only one that could get him to cooperate. Hold on a moment. Yes.
Is somebody, George, can somebody from the organization spend 10 bucks in a bunch of flowers because I want to take to the room for the couple? Do you think it's possible? OK.
Thank you. The 13-year-old boy was defiant towards his mother. He had poor hygiene. He still has poor hygiene. He wasn't doing chores at home.
He was taking things that didn't belong to him, like the dad's tools. without asking for permission. The dad in the first interview described the situation this way to me, and I wanted to share it because I think this encapsulates what the family system dynamics are. The dad said...
When I asked him what his perception of the family was, he said, well, I play the role of the policeman, and my son, Jeff, who's the IP, is the bus driver. And he's trying to, you know, just drive through this family and do whatever he wants. And I said, well, what does your wife do?
And he said, well, she sits by the bus, stop waiting. And I think that that's really how I see this family a lot. One time I did sculpt the family in the room, and I had them play that out. And the family members really got to see it. see how their interactional style is.
In terms of the systemic dynamics, I don't see the parents, at least when they first came to me, that they were together in the executive subsystem. The mom was very ineffective in being in the parent role with her son, so the dad wasn't getting a lot of support around the parenting tasks. He was doing that by himself. The mother and the identified patient are very...
meshed. They both are obese. The mother gains weight, he gains weight, the kid cries, she cries. So they're sitting up in the room together. I thought they would sit together.
There seems to be a coalition between the mother and the child. mother and the son against the father. And the mother really undermines any consistent parenting with the father by trying to be consistent and then saying, oh, do it anyway. I won't tell them. Usually, the couple's fights are around Jeffrey.
And it seems to me that they do a lot of detouring of their marital issues on the kid. So it seems like there's a rigid triad there. I'm not sure if there's a state stable coalition. So that's one of the things that I wanted you to help me out with. If there's really a stable coalition between the mother and the son against the father or not.
Okay. The siblings, at least Jeff and his brother Bobby, who live in the family, are not united in the sibling subsystem at all. Okay.
So when the family came to me, they wanted an assessment. And they said, this kid's acting out. What do you recommend?
Well, I was going to try to hide this part from you because I pretty much didn't do a very good job on this one. But what I ended up doing is that I decided to defocus off the IP and to give the family another focus which was the mother. She pretty much what I said to the family is you know that the mother needs some individual therapy and she was wanting that also.
So pretty much I said to the kid that what I saw was going on is that Jeff was really trying to teach his mom how to be a stronger parent so he wasn't going to stop challenging her until she got herself together enough to be in a strong parent role with him. So at that point I started seeing the mother in individual therapy. and saw the family in conjoined therapy. Now that is something that I'm still doing, and I wanna find some way to disengage myself out of the alliance that I've created with the mother to have my alliance with the whole family.
Okay, I feel like it's worked somewhat that I've pulled her in for individual help because what I've done with this family is to start with the parental subsystem and to try to solidify them and unite them as parents. The kid is getting a lot. better.
When I told him about the conference, I said to him, when they came into me a couple weeks ago, the parents said, you know, Jeff's doing a lot better. We can't believe it. And I turned to the kid and I said, you can't do that. I mean, you can't do this to me. You can't get better yet.
We're going to this conference. with this expert. You've got to keep acting out."So I had the parents keep telling him at home like, Jeff it's 8 o'clock at night you're not acting out come on we're going to this conference. So he looked at me at the end of that session he said I'm gonna tell it what's this guy's name I said Dr. Mnuchin he said I'm gonna tell him that you told me not to change. I said good I think he'll love it. Parents just told me upstairs that he has been doing much better. The enmeshment, however, with the mother is still there because the mother was away this weekend. Jeff called her every day, a couple times a day. Okay. Okay, now, the focus now is that I've restructured the parents sort of in a coalition against the child, so I need to find a way to create some kind of new role for him. Mom and Dad are more united. in the room? Five of them? There's the two parents and the two children, mom's two kids, that live in this family, and dad's three children from a second marriage that have come. Now, I have seen only two of those children when they have visited this family. I've invited them into the sessions when they could come. There's only one son that I have not met until today. You said that the 19 years old daughter is living now? Yes, she has recently moved into the family. So she's part of the... Yes, I did see her one session. She had just moved in a couple of weeks ago and I pulled her in to family therapy at that point. Okay. And they live with their mother? One of the sons is 21 and lives in San Francisco on his own. Another one, the boy David, lives with his mother and Andrea was sort of floating around. How old is? Andrea's 19. The boy? The boy that lives with the mother is 16, and the 21-year-old male is on his own. And they are children of the father's second marriage? Yes, and his first marriage lasted only three months. And he separated from his second wife how long ago? I think their marriage lasted 12 years. So since his family's been, these parents have been married for five years now. It's probably been about three years. about six years. So they came with an identified patient that was 13 years old and the identified patient had what problem? He was having poor grades at school. He was bullying other kids, had poor peer relationships. was very defiant at home. He wouldn't do chores. And he's 13, his brother is? His brother is 18. 18. And he's the good son? He's the good son. And Andrea, it's also a good daughter. Andrea, I don't know much about her. She is now having problems with the dad. I think they've always had a very disengaged relationship. So now that she's... moved back in the family. Jeff's getting better, but Andrea and her father were in battle this week. How long is that she's in the family? I think only a couple weeks, maybe three weeks. Fine. Anything that you want me to do? Any questions that you... I've got a list here. here, what I want from Mnuchin, it's called. One of the things that's going on for me is that I want you to help me structure the therapy better. I want to find a way to get somehow healed or disengaged out of the alliance that I've created with the mother in terms of doing individual work with her. And I want to know. Do we have, how long do we have in this session? Okay, we meet till 3 o'clock or till 4 o'clock? 4 o'clock. Huh? 4 o'clock? Then what do you think if you start working with them for 10 minutes? Uh-huh. And then I enter. What do I think? I'll probably faint. They can take care of me. Then let's not do it. If you feel comfortable, yes. If not, I do it. I want you to take care of me today. Fine. I knew that was part of the deal. I wouldn't have done this. No, no, no. Go ahead. What I want from you is to try to help me figure out some way that I can sell to the couple that they need to be looking at their marital issues. I think they've done a pretty good job in terms of solidifying as a couple. around being parents. And now what I want them to do is I want to find some way to really create some kind of reframe or something where I can get them to start dealing with their marriage. Because both of them have half of their suitcase packed most of the time. And I think that they're not, they've never really bonded. This is what the wife told you? No, this is what I've observed with them. If their conflict surfaces, then, and I can get them defocused off the children. There was one weekend where they both almost split. The dad said, well, I'm going to leave if things don't get better. Okay. Okay. So that's pretty much what I want to do is now that Andrew is in the family, these other kids live sort of on the periphery of the family and are heavily involved, I don't know how to structure the therapy completely. And I want to know an idea about how to get the parents. to look at their marriage. How many times did you see them? I've seen them probably as a family, maybe eight times, six to eight times. Once a week or? I see them usually bi-weekly. Bi-weekly, even once a month. It's like I haven't-It's bi-monthly. Yeah, bi-monthly or sometimes once a monthly. Once a monthly, that's a good one. I'm not nervous. That's... this is my part. I am the one that speaks poorly.