After a year of therapy, Jack’s parents decided that family work and parenting guidance were insufficient to address their marital problems. They were desperate to salvage their marriage. They requested a referral to a couples therapist. My colleagues and I agreed. We carefully chose a marriage counselor who matched well with the parents and with the rest of the team.
. . . and then there were four.
As a trainee, I was expected to become fully capable in the biologic treatment of my patients. A new supervisor for Jack’s case wondered whether I should be the person both giving medication to Jack and discussing the meaning of his need for medication. This supervisor, who used an analytic model, did not think that Jack would be free to discuss all of his feelings about the medicine if I was the prescriber. I referred Jack to a psychopharmacologist.
. . . and then there were five.The multipronged approach
In the past few years, I’ve begun to see multiple family members in individual therapy. Often this begins in the context of a child treatment case. Janet was a wiry, tall, blonde nine-year-old. She was referred to me for failure in school that was leading to low self-esteem and feelings of hopelessness. It was impossible for Janet to read a book and then recount the main idea of the story. Her neurocognitive style left her bogged down in details. To put it simply, in all areas of life, Janet couldn’t see the forest for the trees. Janet’s parents, Dan and June, were schoolteachers, who thought that they were in a good position to help their daughter with her schoolwork. Unfortunately, Janet wanted no part of their supervisory or tutorial help.
I started Janet’s treatment with an individual child psychotherapy model. I met with her once a week and with her parents twice a month. Janet and I played and we talked about her life at school and at home. She spent much of our time together drawing pictures, which she immediately scribbled over because they just weren’t good enough.
She enjoyed board games, but became despondent when she didn’t win. Janet’s psychotherapy was rich with material that we could make use of to help her feel better about herself. I met with her parents to help them understand their daughter’s learning style. Despite being fully trained teachers, they were not sophisticated about learning disabilities. I also tried to help them with the pain they experienced when Janet rejected their help.
Soon Janet’s mother, June, asked me to treat her individually to help deal with her sorrows around her aging and critically ill mother. I tried to refer her to a colleague, but June insisted that she couldn’t bear to get to know another therapist when both her mother and daughter were in crisis. Dan also wanted her to be in my care. "We trust you," he calmly explained. Ultimately, I did take on June’s care, feeling I could effectively serve them all.