Spencer is a 15-year old boy from an upper middle class familyliving in an affluent neighborhood in New York City. Spencer livesat home with his parent. Spencer has a history of depression,anxiety, and substance abuse. His first hospitalization occurred ayear ago when he was 14 due to his threats to hurt himself while atschool. Spencer has a history of abusing multiple substances,including marijuana and prescription pills. He describes hissubstance use as a way in which he can “numb†himself from hisdepression. Spencer has reported having a tumultuous relationshipwith his father whom he reports is verbally abusive (i.e. tellingSpencer that he will never amount to anything). Spencer oftenavoids his father at home and most of their contact is reported as“screaming matches†Alternatively, Spencer is very close to hismother and has been open with her in voicing his feelings ofdepression and hopelessness. Spencer is also very open with hismother in reporting to her any times in which he has engaged withsubstance use, although he does not report any intention or desireto stop using. Spencer’s parents do not agree on how to approachSpencer’s escalating substance use and increased depression. Hisparents also report that it has become increasingly morechallenging to monitor Spencer’s substance abuse when he isinteracting with peers who also engage in substance use. Spencer’sfather believes in “tough love†and sending Spencer off to militaryschool or some other institution where Spencer will be “properlydisciplined. “ Spencer’s father also reports that his wife is “toosoft†and is in denial as to the extent to which Spencer is abusingdrugs. In particular, Spencer’s father reports that his wife shouldlimit Spencer’s interactions with peers, whom are also suspected touse substances and she should also not “give in†when Spencerrefuses to attend school, particularly in cases when he is hungover from excessive drug use. Spencer’s mom in turn does notbelieve that she is being too soft on her son, but rather she feelshelpless in what can be done to stop his drug use, as he isrefusing to stop. She also believes that Spencer needs to betreated for his depression, as she attributes his drug use to hisfeelings of hopelessness. Therefore, she does not agree with herhusband that Spencer is simply “acting out†and needs harshdiscipline; however she is not certain how she may be able to gether husband to become more empathetic towards their son’s emotionalchallenges and be more engaged in finding therapeutic treatmentthat does not require sending Spencer out of the home.
1. What is the organizational structure of this family? Do younotice any examples of triangulation and cross-generationalalliances? And how might alliances within the family’s structurecontribute to maintaining the problem?
2. What is the hierarchy in the family structure? As therapist,who do you identify may have the most power and control in thefamily? Who may have the least? Is there an incongruent hierarchywithin this family? Briefly describe
3. Briefly describe an alternative structure that you maypresent to this family ?
4. Describe some structural therapy techniques that you may usewith this family in session in order to facilitate reorganizationof the family structure. In your description, provide examples ofhow these techniques may be applied to this particular family’spresenting issue.
5. As a family therapist working with a family in which one ormore members may not be motivated for therapy, what are somestrategic therapy techniques that you might employ to help thisfamily solve their problems? Briefly give an example of one or twostrategic therapy techniques .
