The Thompson Family Isaac, age 17, started abusing drugs and alcohol when he was 11 years old. When he came to you, he was smoking marijuana every day, all day (wake & bake), and also taking dozens of anti-anxiety pills on a daily basis primarily as a way to cope with severe anxiety, depression, and PTSD stemming from exposure to domestic and community violence. He had a long arrest record, including being arrested for using and selling marijuana and prescription medicines immediately before treatment. Isaac participated in several treatments with little evidence of change prior to coming to you, including a residential treatment program where he relapsed quickly after being successfully discharged from the program. Isaac had no sense of his future, had few social ties, and was failing in school. Isaac lived with his mother and other extended family. Isaacs father was not involved in his life: Isaac and his Mom report that his father left them behind many years ago to start a new family. Isaacs mother, who had Isaac when she was a teenager, felt like she was out of options. She struggled to keep a job and didnt feel confident in her abilities as a parent. She also suffered a recent personal loss in the period prior to treatment and struggled with depression because of it. She was a victim of domestic violence. Isaac and his mother loved each other very much. At times their relationship seemed less mother and child than friends or equal partners. Isaac reported that sometimes he felt suffocated by their relationship and his mothers emotional needs. These feelings would often lead to angry outbursts and aggression toward his mother. Conversations in the home have all ended with yelling, hurtful statements and aggression (slamming doors and throwing objects) by Isaac. This has lead to the household (mom, grandma, grandpa and 2 younger sisters who are both A students) ganging up on Issac during family meetings. Issacs school has recommended you to the family. What roles do you see in the family dynamic thus far? What issues do you see coming up in therapy? What interventions do you believe will be most effective? The Elmhurst Family Joy, 18 years, was brought to you for drug and alcohol abuse by her biological mother, Miri, and her stepfather, Mark. She was an attractive, insightful, verbal, and personable young woman, yet she had just flunked out of her first year of college. Joy admitted to regular, heavy use of alcohol and marijuana and occasional cocaine use since middle school. She had a history of serious emotional problems and instability, including two suicide attempts in high school. Following her second suicide attempt, Joy was hospitalized for two months in a psychiatric unit. At that time, Joy felt betrayed and alienated from her mother and close friends, and gravitated more to drug using peers. She was especially hurt by her mothers reaction to her suicide attempts, which she felt conveyed frustration and anger, rather than compassion. From the very first therapy sessions, Joy expressed the need for more visible and outward expressions of her mothers love. Joys mother, Miri, a soft-spoken woman, acknowledged that she had been generally unexpressive and unaffectionate with Joy growing up. Miri attributed this to the fact that she had not received affection from her own parents, but had understood they loved her, and she thus expected Joy to accept minimal displays of affection based on her own experiences. Joy has explained that she was an affectionate and expressive person and needed that in return. Her mother, on the other hand, is reserved in her manners and emotional style. Joys stepfather, Mark, had become part of the family approximately ten years previously, marrying Miri when Joy was 8 years old. While Mark clearly loves Joy and worries about her, he has had limited interaction with her due to working long hours and spending time with his 24 year old son James. He has always had a somewhat distant relationship with Joy. Mark believed that Miri kept information from him because she thought he might lose his temper with Joy. Miri and Mark have struggled individually and as a parenting team to deal with Joys drug use and other problems. When they became upset with her or tried to set limits, Joy threatened to run away, and they backed down. Miri had generally not wanted to bring Mark into her problems with Joy, and Mark also readily admitted that he had stayed on the sidelines. What roles do you see in the family dynamic thus far? What issues do you see coming up in therapy? What interventions do you believe will be most effective?
