Part II: A Case Reflection on A Family Group Psychosis

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The is Part II of the Case Reflection, A Family Group Psychosis: (See Post from 6/30)

DK: Two weeks later, the Jacksons came with Carol’s family of origin. The estranged brother was the only one absent. Carol’s  father seemed a friendly and loquacious older man. He was a World War II veteran. As is so often the case, he would say little about the war or its impact on him. He was a nice man and playful with his grandchildren, especially the youngest daughter’s 3-year-old child.  However, for all his apparent friendliness, he was hard to connect with. He sterilized the past. I pressured him a little, but he would not change his hyper-normal posture. Again, Kim, the middle child with the eating disorder,  was uncharacteristically sweet and questioned her grandparents, attempting to connect with her mother’s family. The interview was unremarkable. It lacked the infectious quality that came from  Bill’s  family. As the session was ending, Kim suddenly became steely and silent. She left my office abruptly, ahead of the family. I had no sense of what stimulated that action.

The covert Family Group Psychosis unfurled in the following way. The next interview was scheduled for two weeks later, but they cancelled and rescheduled. They cancelled again and eventually and to my surprise, returned almost seven weeks after the extended family interview. I tried to activate a discussion about the delay, relating it to emotional experience but in the family’s estimation the reasons for the cancellations were reality based.

images-7As a group the Jacksons were energized. Bill began by asking what I thought of Carol’s family. Bill was behaving differently with this question. He had always been more covert. He had never taken initiative to open up any new territory except when complaining about Kim, the identified problem. I told him that was the question they had to answer.

“What did you think of Carol’s family?” A version of this question is usually asked of the therapist at the end of the extended family interview or at the beginning of the follow-up interview. It is tempting to try and answer it, but it is always an error to do so. It is crucial that the family use their own words and thoughts to describe their subjective experience of their own family. The practitioner will be unconsciously reacting to his or her own family when he or she speaks of the patient’s family. For example, Bill mentioned something I had not even noticed. He was upset at the way his father-in-law kept cutting off, interrupting Carol. Bill wanted Carol to say more about her family and the family meeting. Then Carol said that the thing not talked about was that her father’s business was in Chapter 11, and he would not acknowledge it was failing. He went into work every day, but there was no work. He was having an identity crisis of late life but reacted by behaving as if nothing was happening and allowed no discussion of pain from the past.

Kim said her anger at the end of the extended family interview was in response to a remark her grandfather made about her driving. Kim’s Dad, Bill, with his startling new psychological mindedness, said the remark was simultaneously a critique of Carol’s judgment as a parent.

Unknown-1There is more about this follow-up interview. Anne, the oldest sister,  and Kim were engaging with me and were more playful with one another. They were laughing and telling stories of their early childhood. A spirit of freedom had entered the family. Kim, who was always guarded, in this sense like her father, was as informal and playful as I had ever seen her. Taylor, the younger daughter, was surprisingly defiant and surly during this interview. It was completely uncharacteristic of her; the way she challenged her parents and her older sisters was almost comical. Bill, continuing with his unusual new self, said he thought they were doing much better as a family. “What do you think it is?” I asked. He felt as though he and Kim were getting along much better and that he and Carol were not so consistently on the opposite side of every issue. Carol thought Bill had eased his attempts to over-manage everything.

They came as a family two more times then said they felt as though they were doing well enough to end. That was four  years ago. Kim visits alone occasionally. She is still troubled episodically by her eating disorder, but she is a wise and appealing young woman, and the interviews have an existential flavor.

At this writing, Carol and Bill are separated. One of the ways the therapy failed was that I was not successful in helping the marriage become a patient. Before I started working with them, their relationship had stabilized with them leading separate lives in the same house. Bill’s family was affectionate with Carol and reflected warmly on their early experience with her. In contrast, Carol’s family was pseudo-normal. Her family’s pattern for nonintimate marriage dominated Carol and Bill’s marriage. She also was implicitly determined not to be oppressed professionally in the way her mother had been. She viewed any kind of teaming as diminishing of her self and took out her resentment on Bill.

imagesThis illustration gives a flavor for the Family Group Psychosis. There were some palpable effects from the interviews. But how do they occur? I suggest that the explanation is in the primary process of the multi generational family. I think family living is a right-brain process. Families tend to be right-brained; they do little on purpose. For me, these interviews have the quality of an aesthetic experience with unlimited ways of describing them. Any translation to narrative is a depreciation of the experience.

In the case of the Jackson family, Kim was more at ease and her being so allowed Taylor to experiment with the role of family problem. The maternal grandfather probably cut off Carol in the extended family interview because she had been the family truth teller for a long time. He was glossing things over and perhaps feared she would open up truths he did not want acknowledged. Oddly, because this was a well-established pattern in her relationship with her father, Carol didn’t even notice. Bill noticed it, however.

At the end of the interview, the grandfather was planning to take his youngest daughter’s daughter out for a banana split. I thought it charming. He seemed a nice guy despite having such a limited imagination. Then he made a comment I did not hear, but it made Kim furious. I think Kim sensed that the playfulness with the baby was part of a cover-up. Maybe she knew at some level that she had been used that way in the past. The support she fantasized from him in her battle with her parents was gone. She fell back into a more comfortable relationship with her own parents. These are my fantasy constructions, offered to activate conversation. I am describing them as a sample of how to think about multi-generational family interaction, how to think about what happens. The reader may think of other interpretations.


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