Treatment Planning
Susan (40) and Robert (43) arrive with their 10-year-old daughter Lily, who has been refusing to go to her father's house for weekend visitation following the divorce. Lily says she 'doesn't like how it feels at Dad's house' and complains of stomach pains before visits. Susan is sympathetic and has quietly allowed Lily to miss several visits. Robert is angry and says Susan is 'alienating' Lily from him. Both parents sit on opposite ends of the couch in the session. The structural assessment has identified the parental conflict as the likely driver of Lily's symptoms. What is the MOST appropriate strategic intervention?
Your answer: A•Correct: B
Rationale: Strategic family therapy holds that the identified patient's symptom (Lily's visit refusal) is a solution to the parental conflict — specifically, it provides Susan with a reason to be aligned with Lily against Robert. The most powerful intervention is to restructure the parental subsystem: get Susan and Robert to co-create one visitation plan and present it to Lily as an agreed parental decision. This removes Lily from the triangulated position, removes Susan's secondary gain, and reduces Robert's alienation narrative.
Treatment Planning
Richard (58), a pastor, and his wife Catherine (56) arrive with their 26-year-old son Daniel and Daniel's fiancée Rachel (24). Richard has been uncomfortable with Daniel and Rachel's interfaith relationship and has made several comments that Daniel describes as 'trying to drive a wedge between us.' Richard says, 'I'm his father, I have a right to share my faith.' Catherine is torn and says privately to the therapist, 'I've never been able to stand up to Richard about this, but I love my son.' The therapist recognizes an intergenerational triangle. What is the MOST systemic Bowen intervention?
Your answer: A•Correct: C
Rationale: Bowenian intervention when an adult child is struggling with an anxiety-provoking parent (the 'together-apart' polarity) is to assess and strengthen the adult child's level of differentiation. The 'differentiation of self' scale — a therapeutic tool used in Bowenian therapy — helps Daniel assess how much of his emotional response is reactive fusion with his mother versus his own authentic position. Strengthening Daniel's differentiation is more systemic than coaching his mother or advising his father, as it addresses the root Bowenian dynamic.
Clinical Evaluation
James (36) and Maya (34) have been married for eight years. In session, James reveals that his mother, Mrs. Chen, has criticized Maya at every family gathering since the wedding. James either defends Maya aggressively or shuts down entirely. Maya reports that James has missed three consecutive holidays with her side of the family. When asked about his relationship with his mother, James says, 'That's just how she is. You can't change her.' The therapist recognizes triangulated loyalty as a central dynamic. What is the therapist's FIRST step?
Your answer: A•Correct: B
Rationale: A genogram is the foundational structural assessment tool in Bowenian therapy. Before attempting any intervention — including individual differentiation work — the therapist must map the multi-generational transmission of emotional process, triangulation patterns, and sibling positions. This provides the clinical map that guides all subsequent work. Without it, interventions risk addressing surface behavior rather than the underlying family structure.
Clinical Evaluation
The Wang family arrives with their 14-year-old daughter Lucy as the identified patient. The parents, Helen and David, disagree about everything: discipline, school, screen time, and Lucy's friendships. David says Helen is 'too permissive.' Helen says David is 'a tyrant.' When Lucy is asked about the conflicts at home, she rolls her eyes and says, 'Whatever.' In the waiting room before the session, Lucy was on her phone while both parents stared at their own devices. What is the therapist's FIRST step?
Your answer: A•Correct: B
Rationale: Strategic family therapy holds that the identified patient's symptoms are generated and maintained by the family system. Lucy is a symptom-bearer in a conflict-paralyzed parental subsystem. The first intervention is to interrupt the parental deadlock: getting Helen and David to identify ONE area of agreement and co-create a single shared behavioral expectation. Once the parental coalition is restored and aligned, Lucy's need to triangulate diminishes.
Clinical Evaluation
Tom (38) and Lisa (36) arrive in crisis after their 13-year-old son Ethan was hospitalized for a drug overdose. Ethan says, 'Everyone's overreacting, I do it at parties all the time.' Lisa says, 'I told you this would happen if you kept working late.' Tom says, 'I'm the only one paying for this family's insurance.' Lisa's mother — who lives with the family — has been giving Ethan 'space to figure things out' and has a history of substance use. What is the FIRST clinical priority?
Your answer: A•Correct: B
Rationale: Ethan's overdose is a family system event. The grandmother's role as an alternative authority figure, the parental conflict over Tom's work schedule, and Ethan's position as eldest child in a stressed system all contribute to the presentation. A structural assessment mapping subsystems — including the grandparental subsystem and its relationship to the parental subsystem — is the essential first step before any individual treatment recommendation or external report can be clinically appropriate.