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Case Study - Page 2

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The event wasn’t hard to find, so I said: “I’ve been told that all of you were very reluctant to come today, and—as you’ve reiterated—that you’re considering having Sarah live somewhere else. My guess is that what just happened is a reflection of your struggle. I respect and appreciate your honesty, but I need your assistance. Can you help me understand what goes on between the three of you that ends up with this level of discouragement?”

The initial question represented an important core principle of FFT: presenting problems are relational. The goal of the question was to pull them out of an emotional pattern that put the blame on Sarah and shift the focus to the entire family.

Sarah was the first to respond. “What a stupid question! Can’t you see, this is what I have to deal with every day?” she said belligerently. Ellen sighed and turned away again, while Edward said to me, “Now you can see why we can’t take it anymore—she’s so disrespectful.”

“It was a stupid question,” I quickly responded to Sarah. “And it comes from not really knowing how things work in this family. I may never completely understand your feelings or the struggle your parents have in trying to protect you, but what I do know is that the anger you feel gets misunderstood as your unwillingness to try, to listen, and to be respectful. My guess is that what looks to be anger is really fear—fear of losing them.” Before her parents could respond, I turned to them, saying, “And it’s probably not a lot different for the two of you. The anger behind the decision to send her away is less about wanting her gone than about the fear that you won’t be able to protect her and help her in the way your heart tells you that you should.” Again, talking fast before anyone could speak, “That’s why I’m so curious about what happens here.”

Reframing—A Therapeutic Martial Art

This kind of intervention is called a “relational reframing,” a term coined by my colleague Jim Alexander and me. This dynamic form of reframing is really the “judo” of this therapy. As in judo, the therapist “moves toward,” using the powerful emotional momentum already present in the room, to shift the direction of therapy and promote new ways for clients to see themselves and their problems.

Just like judo, reframing happens through a series of interactions, not a single intervention. With Sarah and her family, I tried several different ways in the conversation to redirect their anger toward the theme of the hurt behind the anger. For example, later, when Sarah’s father said he’d exploded with anger about a situation, Sarah gave a sharp, loud, derisive laugh. She then said heatedly that when her father, or anybody else, yelled at her, “It just makes me crazy!”

Reframing again, I suggested that Sarah’s apparently disrespectful laugh was a form of assertiveness—a requirement on the street, where she and her peers thought of themselves as tough. I thus reframed her aggressive response to her father as difficulty hearing her father as a parent, rather than as a challenging peer. Then I said to Sarah that I heard her defiance and volatile anger as pain and frustration, because her father didn’t know how to reach her except by yelling.

At that, Sarah began to cry and, through her tears, said that she’d lost her parents once (her biological parents), and she wasn’t going to lose anyone else. Sobbing, she said she knew her parents saw her as a bad kid, but inside, she was a girl with a heart.

By framing the parents’ behavior as the expression of loss, bafflement, and hurt, as well as a heartfelt desire to protect their daughter, I gave myself room to suggest that while their motives and intentions were noble, their reactions to Sarah weren’t always helpful. In other words, I could help them acknowledge their part in the problem, frame it in a way that wouldn’t make them defensive, and start to build a family alliance. This, in turn, would create a safe environment, in which all could talk about difficult issues without reverting to mutual accusations.

During the first session, the family went round and round in cycles of blame, counterblame, and “it’s-off-to-residential-treatment-with-you,” so as the session progressed, I had to find new relational reframes to promote a sense of the family unit.

By the second session, the mutual blame and antipathy had palpably softened. I finally had the sense that the family was engaged, motivated, and in alliance with each other—and with me—when the issue of placement seemed to vanish from the conversation and all three began talking in terms of “we,” rather than attacking each other. Best of all, we crafted a family-focused definition of the problem together.

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