The Mask of Family Unity: A Case Story

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Dave: The Martins were referred by a pediatrician from a nearby city. He had referred a number of cases over the years because he found the way I work with the whole family helped him better understand the needs of his patients and their families.

Mr. and Mrs. Martin came to the clinic because of troubles with John, 13, her son from a previous marriage. His sister was Katherine, 11. Her marriage to John and Katherine’s father ended 8 1/2 years before. She implied her ex-husband was a difficult man. Four years ago she married her current husband, a Corrections Officer (prison guard at a nearby state penitentiary) and has a three-year-old daughter with him. John had been a wonderful baby and was comparatively easy to live with until he was around 9, when she started worrying about his behavior.

When entered puberty around 11, John  became an enigmatic problem both at home and at school. He didn’t pay attention. Sometimes ignored them. He did not always mind his manners. His parents punished him by grounding him and unknown-2he had spent most of the last year at home in his room, not allowed to watch TV or to play video games. As part of their sanctions against him he was not allowed to play baseball or basketball. I regard that as extreme, harmful, fruitless punishment for a young boy who is a talented athlete. I was not getting a clear picture of what it was that was so upsetting. He lied a little, yes, but it was fairly small stakes. He wasn’t deceiving them in a major way, it seemed more an effort to get them off his back.

During the session in my office John was a well-mannered 13-year-old boy, unusually well-groomed and courteous, sitting in the chair and listening, he attempted to answer any questions I asked him. That is not how bad boys behave in a family therapy session precipitated by the boy’s bad behavior.

His mother was puzzled why their consequences had so little effect, so was I. In the interview Mother was composed and thoughtful, a tall attractive woman who paid attention to her appearance; clothes, make up and hair. The stepfather was a quiet, sober small man. Not as tall as his wife. He was dressed in his dark prison guard’s uniform. He had an impassive manner, saying little, even when asked questions. He appeared a master of parental consistency and non-reactivity, perhaps a little too cool. I remember wondering what she saw in him. As a matter-of-fact, I asked her this question.  She said he was reliable and honest. I thought, “‘Honest’ but he sure edits what he chooses to be honest about.”

unknown-3John was cooperative during the interview. He did not know why he is like he is. He did not complain about his parents. There was no evidence of defiance in his behavior in the office. He participated in the conversation, talking about his family, but with caution. He thought about questions and attempted to answer them. My method in interviews is to depathologize the identified patients behavior and to contextualize behaviors , that is, to fit them into the family’s living pattern. The effect of this is to destabilize thinking patterns, to disrupt the logic on which their unified family story of  is based. The effect often is to elicit fragments of health in the person identified as the “patient.”

Mother was married to John’s father for seven years. He was a very abusive man. She finally left him when John and his sister were four and two. There was an inference that John’s father had been physically cruel to Mother. But she said nothing explicit it was only implied. Still it was hard to figure out why John was seen as so impulsive, so impossible, what he did to warrant the extreme disciplinary measures was not clear.

As we got to the end of the interview, “Any questions?”, I asked.

“Well what is wrong with John? Can you help us?”

“I hope I can help you. These are the kind of problems I work with. That is why Dr. Sebastian referred you to me. As to what is wrong with John, this may not make much sense, but I think he worries too much about his family, especially his mom.”

“Why would he worry about his family?”

“That I’m not clear about. I keep having the feeling you all are leaving out something important. And what’s being left out is probably what worries him.

“You should go home and think about this conversation. Then come back and talk about it. I recommend you don’t talk about the interview for 24 hours. Give yourselves some time to think about it.”

Mother was the spokesperson here. Her husband, the stepfather was poker-faced and taciturn, disengaged. I remember thinking, but didn’t say, I’m glad I’m not married to this guy. I caught her side-wise glance at him then back to me. I didn’t see anything from him, not even a flicker. “All right”, she said, “we can come back.”

I know now I had just witnessed a very subtle non-verbal communication between them. I know now when I was with them in the office there was a lot I was missing. They were being careful with me and I suspect I was gentle with them so as to reduce their subtle defensiveness.

In the next post I will describe how mother and father’s relationship is stabilized by John’s ‘misbehavior’.

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