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FAMILY THERAPY APPLIED TO THE CASE OF STAN

Theory and Practice of Counseling and Psychology by Gerald Corey

Although it is impossible to provide an example of each family systems approach to the case of Stan, we want to demonstrate at various points in the session the uses of genograms, engaging a multigenerational family, joining, reframing, congruent communication, boundary setting in therapy, and creating new possibilities We have tried to provide an integrative example, but we want to emphasize that this is not the only way to do family therapy.

A therapist with a family Systems orientation begins working with Stan by conducting an assessment of his family of origin (see genogram chart). In addition to considering relationships with his parents, grandparents, and siblings, a systemic therapist is interested in finding out about his interactions at his school, place of work, church, and any friendship networks. Stan's problems cannot be fully understood or fruitfully explored in therapy without addressing his relationships within his family and other key Systems of which he is apart. Many of Stan's presenting complaints are best understood as symptoms of power struggles and dysfunctional communication patterns within his family of origin. The family therapist approaches Stan as part of an ongoing, living unit. Most of Stan's problems have familial roots, and he is still very much engaged with his parents and siblings, no matter how difficult their relationships may be.

Stan's genogram is really a family picture, or map of his family-of-origin system. In this genogram, Stan is the index person (IP) whose problems are the purpose for the family session. The index person is indicated on the genogram with either a double square (for a man or boy) or a double circle (for a woman or girl). All other men are designated with a single square, and women with a single circle. In each square or circle, the name of the person is noted along with the year the person was born. In Stan's family his grandparents tend to have fairly long lives. One grandparent (Joseph) died at the age of 69; the rest are still alive in their late 70s and early 80s. Death in a genogram is indicated by an X through a person's name and square or circle. Next to the person we indicate the year and cause of death. Stan's Uncle Seth died in Vietnam in 1968 at 26 years of age. He wanted to be a career soldier; but his career was all too short. Stan's paternal grandfather died of cancer in 1976.
Stan's maternal grandparents are both alive. The shaded lower half of their square and circle indicates that each had some problem with alcohol. In the case of Ton Stan reports that he was an admitted alcoholic who recommitted himself to Christ and found help through Alcoholics Anonymous. Stan's maternal grandmother a ways drank a little socially and with her husband, but she never considered herself to have a problem. In her later years, however; she seems to sneak alcohol more and more, and it is a source of distress in her marriage. Stan also knows that Margie drinks a lot because he has been drinking with his aunt for years. She is the one who gave him his first drink.
Angie, Stan's mother, married Frank Sr. after he had stopped drinking, also with the help of AA. He still goes to meetings. Angie is suspicious of all men around alcohol. She is especially upset with Stan an-id with July's husband, Matt, who "also drinks too much:' The genogram makes it easy to see the pattern of alcohol problems in this family.
Solid lines between people indicate a formal and direct relationship. The solid lines between Joseph and Emma, Tom and Martha, Frank Sr. and Angie, and Matt and Judy all indicate a marriage, and the year of the marriage is shown above the line. The dashes between Karl and Mary indicate a relationship that is not formalized; they are living together but are not married. The jagged lines between Frank Sr. and Angie indicate conflict in the relationship. The three solid lines between Frank Sr. and Frank Jr. and between Angie and Karl indicate a very close or even fused relationship. The double lines between Karl and Stan are used to note a dose relationship only as you will see, Karl actually looks up to Stan in this family. The dotted lines between Frank Sr. and Stan and between Frank Jr. and Stan indicate a distant or even disengaged relationship.
Frank Sr. was a middle child who took orders and was criticized by his mother; a very strong woman. He married an oldest child, who was also a strong, critical woman. Although Angie has never had a personal problem with alcohol, it has been an issue in her family life for three generations now. She is surrounded by people who have problems or have had problems with drinking. In Stan's family of origin, there are two psychologically "oldest" children (the oldest girl, Judy, and the oldest boy, Frankie; both are very good. Stan is a middle child who never quite lives up to his parents' expectations, and Karl is the baby who was spoiled when he was young and now gets to do things his own way This is the beginning picture of Stan's family system. This genogram serves as a map to guide the family therapist through the initial interviews.
The family therapist starts by helping Stan invite his family into the therapeutic process:

THERAPIST: What will it be like for you to invite your parents, your brothers, and your sister into therapy with you?

STAN. It will be very difficult. I don't really think my dad and mom will come.

THERAPIST: Who do you think will come? Who in your family genogram here can you really count on?

STAN: I think my sister Judy would come, and my brother Karl. We haven't been all that close-any of us-but I think they would want to help if they could.

This brief Sample of dialogue illustrates the therapist's attempt to get the entire family involved in the counseling process. To a family therapist, Stan is part of a system that is part of still larger systems. Whereas counselors and therapists who see individuals may already have enough information to begin work with him, the family therapist often prefers to work with the whole system or as much of it as Stan can get into therapy. The family of origin is essential in his case, because he still lives much of his life in relation to these people. His extended family is also important, because these members can help him understand familial patterns over many generations, find new resources in the system, and perhaps even humanize his parents. Realizing that his family has lived in the same community for many years, it may be important for the therapist to encourage Stan to consider including people from his work, his school, or his neighborhood.
Stan may have many difficulties, but at the moment his difficulty with alcohol is the primary focus. Alcohol is a negative part of his life, and as such it has systemic meaning. It may have started out as a symptom of other problems, but now the alcohol is a problem in itself. From a systemic perspective, the question is, "How does this problem affect the family?" or "Is the family using this problem to serve some other purpose?"
The early phase of working with the family would be devoted to meeting the family joining with various family members, and reframing Stan's problem into a family problem in which everyone has a stake. The chances are great that Stan's problem has a multigenerational context. If this context is explored, family processes that support and maintain alcohol as a problem may be identified. It is possible to track the interactions of the family members and to transform communication patterns into more useful possibilities. Alliances and resources in this family might be explored as a means of creating new possibilities in the life of the family. If the therapist were just listening to Stan, only one point of view would be evident In a family session multiple perspectives and the entire interactive process will become clear in a very short time.

One goal of therapy is to assist Stan in individuating from his parents and help everyone in the family establish clearer boundaries and more useful interactions. Stan has revealed how much resentment lie feels toward his mother; the emotional distance he experiences from his father; and his tendency to compare himself unfavorably with his older sister and brother. One intervention the therapist is likely to use to help change the family's interactive process with Stan is to ask the siblings to talk among themselves without the interference of their parents.

Much more may happen in these sessions; many relationships still need attention. Some family therapists might decide what the clients need to do to address Stan's presenting problem and intervene with directives designed to make a difference. What is clear, however; is that this therapist views the presenting problem as a crack in the family vase. By working to strengthen the vase (the coping mechanisms and interactive processes of everyone involved), she hopes to transform the system and activate solutions that the family designs.