FAMILY THERAPY WORKSHOP CASE VIGNETTES

Case A: A 14-year old boy was brought to the opd by his mother with complaints that he has been disobedient, having anger outbursts and hitting out at mother and sister for the last 2 years. In the last 6 months he would sometimes kiss and hug the mother inappropriately when she would try to push him away. Mother felt totally helpless with these incidents and she would ask for the help of the father. He was also missing class and going out with some of his classmates for movies during school hours. On some occasions was reprimanded by the school authorities and mother was called in to meet them. The problems started after he had changed school about 3 years ago. This is a nuclear family from a middle class Hindu background from Bangalore. There are 4 members in the family and the maternal grandparents who also live in Bangalore come to help if the mother needs support. The boy has a sister aged 12 years. Before 2 years he was described as diligent at studies, quiet and obedient. Both children were close to the mother as the father was away most of the time on account of his job which involved traveling out of home for many days a month. Mother had always felt resentful and had role strain as he was not available from the beginning for helping in the family affairs. Qs for consideration: 1) What could the boy be communicating by his symptoms? 2) What could be the role of the family in maintaining the symptoms? 3) Why has made the family come now for therapy? 4) What should be the main goals of therapy?

Case B: A 26 year old woman, engineer by education, presented with complaints of sad mood, reduced interest in activities, disturbed sleep, being unable to take care of her child, ideas of hopelessness, of 6 months duration, increased in last 1 month. The couple was married for the last 3 years and had a 1 yr old child. Her husband is also an engineer and currently in a job. She had been working earlier but had to give her job up after the child birth. The couple had an arranged marriage and had differences soon after the marriage. These differences centered on the fact that she thought he gave too much importance to his family and he thought she was under her mothers influence. They would have arguments about the way their marriage was conducted and each blamed the other for perceived deficiencies and improper treatment of their respective families. These arguments increased over time. During the fights they would end up shouting at each other and later would not speak to each other for several days before resuming communication again. However the basic issues were never resolved and in the recent past the husband had threatened divorce if the wife did not mend her behaviour and her attitudes. Since the symptoms began she was also not efficient in looking after the house hold activities and in taking care of her child. This lead to further criticism and blaming by the husband. Questions: 1. What is the main conflict between the couple? 2. What should be the goals of therapy? 3. What should be the format of therapy?

Case C: The patient is a 25 year old male diagnosed to have schizophrenia for the last 5 years. He has had a fluctuating course with many positive symptoms mainly voices and delusions of the fathers relatives persecuting him. He also has feelings that he has special powers. The symptoms become controlled with medication and admission but relapses after going home. He is the only child of parents who are 58 and 50 years old. The mother has been a house wife and the father is a clerk in the govt. accounts office. The father got married late as he was not so keen and wanted to pursue religious interests. He is quite traditional and believes his responsibility was more to his parents and wanted his wife to be subservient to his needs. He has also been quite strict and punitive with his son. The mother tended to do most things for the son and protected him from the fathers wrath. In recent 1 year the son has been aggressive with her and this has necessitated intervention by the father. Qs for consideration: 1. 2. 3. 4. What could the boy be communicating by his symptoms? What could be the role of the family in maintaining the symptoms? Why has made the family come now for therapy? What should be the main goals of therapy?

Case D: 37 yrs old male, married for 7 yrs, 2nd of 4 sibs, from joint family. He has one son 4 years old. Has been consulting for about 3 years for his alcohol dependence and depression. Frequent relapses mainly after conflicts with wife over his drinking and frequent quarrels between wife and mother. Currently readmitted for a relapse one month after last discharge from hospital. Current conflict was that wife had refused to speak to him when she thought that the large sum of money he had taken from his almirah was used for drinking, while in reality he had taken this money out to deposit in bank.