Treatment Planning
Patricia (58) and her adult daughter Kerry (30) arrive for a Bowen-informed session. Patricia discloses that she was emotionally abused by her late husband — Kerry's father — throughout their marriage. She says she stayed 'for the children' and that she regrets not leaving. Kerry is now engaged and says she is 'terrified' of repeating her father's controlling behavior with her fiancé. Patricia begins to cry and says, 'I should have protected you.' The therapist recognizes that Patricia is attempting to resolve her own differentiation failure through Kerry's upcoming marriage. What is the MOST appropriate intervention?
Your answer: A•Correct: B
Rationale: Bowenian differentiation work requires tracking emotional process across generations. The genogram of this family would reveal a multigenerational pattern of emotional suppression, control, and fear-based relating — with Patricia trapped in an enmeshed, controlling marriage and Kerry unconsciously fearing she will assume her mother's position. Using the genogram therapeutically with both women present allows the pattern to be seen and named, potentially interrupting the intergenerational transmission. Helping Kerry develop a warning sign list without addressing the deeper family pattern would be individually focused and miss the systemic root.
Treatment Planning
The Patel family — parents Sumit (42) and Priya (38), and their 12-year-old daughter Aisha — has been in therapy for six sessions. The presenting problem was Aisha's declining grades and refusal to participate in family activities. The therapist has observed that Aisha's symptoms intensified after the maternal grandmother moved in with the family eight months ago. Priya is caught between her mother's expectations and Aisha's needs. Sumit is largely silent in sessions. The therapist identifies the grandmother as a structural 'extranuclear' figure disrupting the family homeostasis. What is the MOST appropriate systemic intervention?
Your answer: A•Correct: B
Rationale: Structural therapy uses 'joining' and 'reuniting' techniques to bring peripheral figures into the therapeutic system when they are maintaining the presenting problem. If the grandmother is functioning as an invisible but powerful member of the family system — undermining the parental hierarchy and triggering Aisha's symptoms — including her in a structural intervention is the most direct systemic approach. This allows the therapist to observe and restructure the intergenerational hierarchy directly.
Treatment Planning
Lisa (42) and Tom (44) arrive for their fourth session about their 7-year-old son Ethan, who has been diagnosed with encopresis. Medical interventions have failed. The therapist observes that whenever Ethan's symptoms appear, Lisa responds with anxious attention and Tom responds with visible irritation. Ethan appears calmest when his parents are calmest. The therapist recognizes that Ethan's symptoms may be homeostatically maintaining parental stability. What is the MOST appropriate strategic intervention?
Your answer: A•Correct: B
Rationale: Strategic therapy uses paradoxical interventions when a symptom is maintained by the attention paid to it. By instructing the parents to notice and reward — rather than anxious attend to — Ethan's episodes, the intervention disrupts the homeostatic mechanism maintaining the symptom. This counterintuitive approach is used when direct attempts to solve the problem have inadvertently maintained it. Once the system is disrupted, a new equilibrium without the symptom becomes possible.