Treatment Planning
Marco (42) and Luca (38) are estranged adult brothers who have not spoken in 10 years following a dispute over their father's estate. Their mother Maria (70) has been diagnosed with a terminal illness and has asked the therapist to see both brothers together for 'one last chance to fix this.' Both brothers agree to come to a single session under the condition that the other attends. Neither brother acknowledges any responsibility for the estrangement. Marco begins the session by saying, 'I'm only here for Mom. I don't need Luca, and he doesn't need me.' Which intervention represents the MOST systemic Bowenian approach?
Your answer: A•Correct: B
Rationale: Bowenian family therapy uses the 'family diagram' — a structured genogram-based conversation — to track siblings' emotional process over time, particularly in estrangement. Asking each brother to describe the other from childhood through the estrangement reveals the multigenerational emotional triangles, sibling position dynamics, and differentiation levels that underlie the current cutoff. This is more systemic than addressing content, confronting resistance, or using a surrogate messenger.
Treatment Planning
Danielle (36) arrives for the third session with her court-mandated 14-year-old son Marcus. Marcus has been resistant from the start. Danielle says, 'I don't believe in therapy. I believe in discipline.' Marcus rolls his eyes throughout the session. The therapist has attempted to engage both in a family session twice without meaningful progress. The therapist now suspects Danielle's resistance to the court-mandated process may be rooted in her own experience with systems of authority. What is the MOST appropriate systemic intervention?
Your answer: A•Correct: B
Rationale: Structural therapy prioritizes the parental subsystem before the child. Danielle's resistance to therapy — and possibly to authority more broadly — may be rooted in her own family history, her experience as a Black mother in systems that have historically marginalized her, or her own trauma. Meeting with Danielle alone allows the therapist to join with her, understand her worldview, and begin to address the subsystem that is maintaining Marcus's behavioral problems. Only after establishing a therapeutic alliance with Danielle can the family system be effectively restructured.
Treatment Planning
Adaeze (36), a Nigerian immigrant mother, and Chidi (40) arrive for their fourth session with their 16-year-old daughter Chinwe as the identified patient. Chinwe has been defiant, refusing cultural activities, and dress code violations. The therapist has observed that Chidi is emotionally cut off from the family and that Adaeze is enmeshed with Chinwe. The therapist has completed a genogram that reveals Adaeze's mother also struggled with intergenerational conflict when Adaeze immigrated. What is the MOST appropriate Bowen-informed intervention?
Your answer: A•Correct: B
Rationale: Bowenian therapy uses the multigenerational genogram to help clients see the repeating patterns across generations. The therapist can now use the genogram to help Adaeze see that her own mother-daughter conflict is being replayed with Chinwe — and that her failure to differentiate from her own family of origin is the engine driving her enmeshment with Chinwe. This insight creates the possibility of change without directly attacking Chinwe's behavior or the marital subsystem.