Denise is a 16-year old female from a middle class family and comes to see you at the insistence of her parents. She arrives with her parents and her 12-year old sister. Her father appears agitated and complains that Denise always needs to be “the center of attention.” As the father rants, Denise’s mother and sister (Sarah) are whispering to each other. Denise appears somewhat underweight and has brightly dyed purple hair. Her first words to you are “this ought to be a challenge.” Mom then interrupts Denise and says “quit embarrassing me!” Denise calmly responds to her mother by saying “This is quite a performance for our new shrink. I hope you can pull it together.” At this juncture, father interrupts and moans. Mother appears frustrated and then turns to Sarah and whispers something in her ear.
When you see Denise alone, she tells you that she likes to hang out with the only family who really understands her- her friends from school. She states that her parents never allow her to have company and that her father spends most of his time at work. In addition, she states that everyone has to do it “mom’s way” or she will tell you that you’re “stupid.” She acknowledges smoking ganja at times “to relax.” She tells you that some day the world will recognize her talents.
1. Describe the basic organization of this system? Include in your discussion the concepts of subsystems and interpersonal boundaries.
2. Describe the concept of the identified patient and how it may apply to this vignette. What would be the function of the symptoms?
3. What are some of the rules this family may be following, either overtly or covertly?
4. Describe the concepts of linear and circular causality and its clinical application to this family system.
5. Describe the concept of enmeshment and how it may apply to this family system.
6. Discuss the concepts of a marital skew and marital schism. Would either of these concepts apply to this family system?
7. What would be your empathic response to the father? the mother? Denise?
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