A family consisting of two parents and two children came into therapy because the oldest child, a 16-year old whom I’ll call Dimitris, had a drug problem.
Both parents and Dimitris adamantly agreed that if it weren’t for his drug problem the family wouldn’t need therapy. The youngest son who was 13, was very quiet and seemed to be holding back from speaking his mind.
Families often com to therapy as the result of a particular child getting into trouble at school, at home or out in the world. Often the child who is manifesting problematic behavior is perceived as the identified patient (IP) by the family members. Even the child perceives himself in this scapegoat role.
If the family is narrowly focused on the IP as the problem, it is up to the therapist to shift focus onto the family as a whole. However, the therapist needs to be careful about pushing this perspective too soon.
When the parents are strenuously opposed to this idea of broadening the discussion it would be next to impossible to get them to consider early on in therapy other ways of looking at the family problems. Thus, the goal of the initial sessions is to get the family to return for following sessions in order to gain their trust.
The therapist then can artfully shift the focus towards the family system as a whole. In a way it’s like walking a tight rope because you have to validate the parents’ concerns about the IP but at the same time gently let on that you don’t buy into the notion that there are no other problems in the family except the IP’s.
I started to plant seeds that there could be more to the family’s problems than just what was going on with Dimitris. I set the stage for the family to be willing to take a closer look at what other dynamics may be operating in its midst.
It turned out that the parents had a lot of unresolved issues. Dimitris felt very upset that his mother nagged all the time and he liked to escape through smoking marijuana. His father seemed to be walking around with a low level depression.
And while trying to draw out the youngest child, I found out that he was always quiet at home, too. He admitted that he was upset that his father was hardly ever home and, when he was, there was always tension between his parents.
All this seemed to be the signal that the parents had some important work to do on their own and that they needed to be seen alone as a couple for a while.
It is often the case that because parents are so reluctant to look at their own relationship problems, children may unconsciously take the heat off of them by becoming symptomatic.