The Beyers family has come for therapy. Bill and Maria are the parents, and Veronica and Justine are their two teenage daughters, ages 16 and 14, respectively.
BILL: I guess we’ve come to see you because we fight all the time. We don’t have any good times together anymore.
MARIA: (interrupting) Baloney! We’re in trouble because we don’t have any money. Period. Bill refuses to get a job even though he has an MBA. We should be well off. Instead, we live off of the money my father left us—and that’s going fast. If Bill would just develop a little backbone and get a job, we’d all be fine.
(You notice that Bill withdraws, and Veronica rolls her eyes as her mother talks.)
MARIA: I make what little money we earn, and to do it I have to work 10 hours a day. When I get home, no one has done a thing to help the family. Bill is playing computer games like a 12-year-old, and the girls are text messaging everyone in creation.
The other night I refused to cook dinner and took myself out to a restaurant. They could all starve as far as I am concerned.
Of course, I don’t want things to be like this, but what am I supposed to do, give in every single day of my life? Frankly,
I am married to a coward, and the girls are spoiled brats. No one cares about me at all.
BILL: That’s not true, Maria. We all care about you very much.
MARIA: Yeah, well, talk is cheap. Prove it. Go get a job.
BILL: I am trying, but in this market there isn’t much out there. You know I send out my resume to someone practically every day.
VERONICA: I am so tired of listening to this same old battle. Mom says Dad’s a wuss, and Dad tries to calm her down. (Turning to her
parents): Why don’t you get a divorce already? You obviously don’t love each other anymore.
MARIA: See what I mean? She is such a brat. Of course I love Bill. We’re just going through a tough time.
VERONICA: Yeah, for about a century.
(You notice that Justine has remained silent throughout.)
- Clarify the specific nature of the Beyers’s problem.
- What interactive behavior maintains the problem you identified?
- Identify any misguided solutions that the family itself proposes to solve its own problems.
- Identify a goal of treatment. Create a case plan.
- What is one therapeutic double bind you might offer to disrupt established patterns?
- What homework might you assign to the family for the next session?
Full Answer Section
- Bill's Withdrawal: Bill's passive response to Maria's criticism reinforces her perception of him as weak and avoids addressing the core issues. His withdrawal also deprives Maria of the connection and support she craves.
- Veronica's Cynicism and Acting Out: Veronica's eye-rolling, sarcastic comments, and suggestion of divorce are likely attempts to gain attention and express her own frustration with the family dynamic. It also deflects from her own potential contributions to the family's difficulties.
- Justine's Silence: Justine's silence could indicate withdrawal, fear of speaking up, or feeling overwhelmed. It prevents her needs from being addressed and perpetuates the family's dysfunctional communication patterns.
- The Focus on Money: While financial concerns are valid, the family uses money as a proxy for deeper emotional needs. Solving the financial issue alone won't necessarily resolve the relational problems.
3. Identify any misguided solutions that the family itself proposes to solve its own problems.
- Maria's Demand for a Job: While Bill getting a job is a practical step, Maria's demand frames it as a test of his love and worth, rather than a collaborative solution to their financial and relational problems.
- Veronica's Suggestion of Divorce: Divorce is presented as a simple solution to their conflict, ignoring the underlying emotional pain and the potential for positive change.
- Bill's Resume Sending: Bill's passive approach of sending out resumes without actively networking or exploring other job options may be a way to avoid conflict with Maria, but it’s not effectively addressing the problem.
4. Identify a goal of treatment. Create a case plan.
Goal of Treatment: To improve communication, increase emotional connection, and develop more constructive problem-solving skills within the family.
Case Plan:
- Stage 1: Building Rapport and Identifying Patterns: Focus on creating a safe space for each family member to share their perspective without interruption. Explore the history of their relationship, identify recurring conflict patterns, and assess individual needs and strengths.
- Stage 2: Addressing Underlying Issues: Explore the emotional needs driving each person's behavior. Help Maria express her feelings of overwhelm and resentment constructively. Help Bill communicate his feelings of inadequacy and explore his career options. Help the daughters express their anxieties and frustrations with the family dynamic.
- Stage 3: Developing Communication Skills: Teach active listening skills, assertive communication, and conflict resolution strategies. Practice these skills in session through role-playing and other exercises.
- Stage 4: Problem-Solving and Goal Setting: Work collaboratively to address specific problems, such as financial management, household responsibilities, and family time. Set realistic goals and develop action plans.
- Stage 5: Maintenance and Relapse Prevention: Focus on reinforcing positive changes, developing strategies for managing future conflicts, and building a stronger sense of family connection.
5. What is one therapeutic double bind you might offer to disrupt established patterns?
"I want each of you to, for the next week, deliberately do more of the behavior that seems to be causing the most problems in your family. Maria, be even more critical of Bill. Bill, withdraw even more when Maria criticizes you. Veronica, be even more cynical, and Justine, be even more silent. Let's see what happens."
This double bind aims to highlight the absurdity of their current interaction patterns and create motivation for change. By exaggerating the problematic behaviors, the family members may become more aware of how these behaviors impact themselves and others. It also puts the family in a position of "choosing" to engage in the dysfunctional behavior, which can increase their sense of agency and responsibility for change.
6. What homework might you assign to the family for the next session?
- Maria: Keep a journal for the next week, focusing on identifying three positive qualities or actions that Bill or her daughters demonstrate each day.
- Bill: Research three different career paths that interest him and identify one specific networking activity he can engage in during the next week.
- Veronica: Identify one specific thing she can do to contribute positively to the family environment during the next week.
- Justine: Identify one thing she would like to talk about in the next therapy session.
These homework assignments encourage each family member to focus on positive aspects of each other, take concrete steps toward addressing their individual concerns, and begin to open up communication within the family. It also encourages them to start taking responsibility for their own actions and contributions to the family system.
Sample Answer
Clarify the specific nature of the Beyers’s problem.
The Beyers' presenting problem is chronic, escalating conflict fueled by perceived financial insecurity, lack of shared responsibility, and emotional disconnection. While they initially frame it as a lack of "good times" and then specifically as Bill's unemployment, the underlying issue is a toxic cycle of blame, criticism, withdrawal, and unmet emotional needs. Maria feels overwhelmed, unappreciated, and resentful. Bill feels attacked and withdraws. Veronica acts out with cynicism and suggests divorce. Justine's silence suggests she may be internalizing the family's stress. The financial strain exacerbates these deeper relational issues.
2. What interactive behavior maintains the problem you identified?
Several interactive behaviors maintain the problem:
- Maria's Criticism and Blame: Maria's constant attacks on Bill's character ("coward," "wuss") and her daughters' behavior ("brat," "spoiled") create defensiveness and shut down communication.