Individual Therapy From a Family Systems Perspective

In Individual Therapy From a Family Systems Perspective, Dr. Florence W. Kaslow demonstrates her integrative approach to therapy. This approach combines techniques from relational–contextual, Bowenian, structural, and cognitive–behavioral therapies, among others, and focuses on the individual within the family context.

In this session, Dr. Kaslow focuses on interpersonal conflicts and stresses between the client and members of his family as well as on the client's own internal conflicts. The case concerns a son involved in a family business and some of the issues frequently encountered in such situations when the interpersonal problems within the family are not resolved and spill over into the family business arena. Dr. Kaslow proposes possible resolution strategies to help the son individually and within the business context for the benefit of everyone.

This video features a client portrayed by an actor on the basis of actual case material.

Precipitating Events

The client, Alan, made an appointment with Dr. Kaslow after he saw his internist for "stress headaches."

About 6 weeks ago, Alan went to his internist for a physical exam because he was having what he labeled "debilitating stress headaches," including dizziness, visual impairment, and an ashen pallor. His physician indicated that he was "a walking time-bomb of stress and tension" and that he needed to change his work and lifestyle. Although his internist found nothing physically wrong with Alan, he recommended that he exercise and consult with a psychologist for the stress. His physician recommended Dr. Kaslow.

Alan agreed that he probably did need to talk to someone. He was experiencing a lot of stress at work and at home. He frequently felt like he was going to explode. And, he had started having "blow-ups" with his daughter at work. She had entered into the family business 4 years earlier (after getting her MBA from Harvard).

There was always a lot of stress at work, but about 2 months before, Alan had "lost it" with his daughter in front of important potential business associates. Alan's company was considering an expansion of their real estate investments. Their real estate holdings were modest but secure and provided steady income.

Alan's daughter, Julie, had been working in the business as a deputy vice president for several months. Julie had learned the ropes, working with both junior and senior accountants to learn "from the ground up."

Since her latest promotion, Julie had wanted to diversify their real estate holdings. She put together a package to buy and develop some commercial property in an "up-and-coming" area and renovate it to contain dwellings, business space, galleries, and shops. Julie presented her package to the CEO (her father) and the Board of Directors. Her fiancee, Chris, a real estate broker, was present at the meeting.

In the middle of his daughter's presentation, Alan developed a splitting headache and asked the Board of Directors to adjourn. When he got his daughter alone, he started "ranting and raving." "The deal is shoddy! We don't know where this money comes from. Too much is at risk here. We know nothing about developing such property, about zoning, about any of it! You and Chris want to control this business too fast, too soon!" According to Alan, he went on and on, and soon staff were politely closing doors and avoiding the hall near the executive office. Once Alan controlled himself, he felt "embarrassed, overwhelmed, and kinda scared." "Am I flipping out?" he wondered.

Alan recalled two other times that he associated stress with physical pain.

6 Months Ago
The day after Julie's engagement party Alan had a "sick headache." Julie had become engaged to marry a "very attractive, bright, ambitious real estate broker." Everyone thought it was a great match. And, in many ways, Alan had to agree that Julie's fiancee might be good for his daughter. But Alan was somewhat concerned about Chris's "inordinate" interest in the family business. He wanted to know all about the real estate holdings, about the accounting firm's assets, and other investments. Alan wondered whether perhaps Julie should have a prenuptial agreement to keep Chris out of the business.

When Alan expressed his concern to Julie and his wife Joyce before the party, they went "ballistic." Julie was greatly offended and suggested that she should "maybe look for a position in another firm." Alan thought that maybe it was a mistake to be "handing over the firm to his daughter." He and Julie did not speak for weeks. For Alan, the whole incident was accompanied by extreme agitation and blinding headaches.

About 15 Years Ago
About 15 years ago, Alan left a lucrative position as a district manager of an international accounting firm to start his own firm. He was under tremendous financial and personal stress. Julie was in an expensive private school. Alan's wife was just beginning her career. He worried at times about whether he should have stuck with the more secure job.

It seemed as though Alan didn't sleep for a year, and he had continual stomach problems. His doctor prescribed tranquilizers. But he still felt overwhelmed by the uncertainty and the change.

Preceding Sessions

Session 1: In this first session, Alan told his "story." He described his understanding of what had happened; he explained how he had thought about his problems and what goals he had for therapy. Alan established that his primary goal for therapy was to reduce his level of stress.

Alan and Dr. Kaslow explored what Alan had already done to relieve stress that had not worked.

Dr. Kaslow provided the educative concept of "symptom bearer," explaining to the patient that he is the symptom bearer for the larger system, in that his pain is also born by the other members of the system in some way, but he has been designated the "sick" or distressed one.

Dr. Kaslow oriented Alan to family systems therapy. She explained that in this approach one considers the self (individual), the system (or family), and society (as represented in business and work, in Alan's case), and that they would be exploring Alan's problems from these multiple foci: personal-based, family-based, and business-based. She further explained that treatment occurs on all levels of the "system."

Session 2: In this second session, Alan further discussed other high anxiety times in his life, explaining what he had done in the past.

Dr. Kaslow began to mention further strategies for stress reduction including an exercise program, vacation plans, and possible medications.

Dr. Kaslow and Alan began to identify some emerging themes in Alan's problems, primarily issues of loss and grief:

• loss of secure job at secure, international accounting firm
• loss of his daughter through marriage
• loss of youth (and his mortality)
• loss of love or romance in his own marriage

They also discussed a series of interventions both at the business and with other family members:

• meeting with Alan's wife (with Alan present)
• meeting with daughter and future son-in-law (without Alan)
• meeting with Alan and his daughter
• meeting with top executives at the firm (without Alan)

Session 3: To be viewed.