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JJ: OK.

First Therapy Session

First session plan: Create an effective therapeutic system with the therapist as its leader, develop

enactments, and use them to diagnose the family system, and begin to reduce negativity.

It is 6pm on Tuesday and JJ is not there. Mom Therapist reaches out directly to JJ. While later

is present with her three younger children, and in therapy, Th will ask mom to reach out, in

so is grandma. When JJ has not arrived at five this first session, Th continues to defer to JJ’s

past 6, the therapist calls JJ on JJ’s cell phone. position of power, while avoiding mom calling

and pushing JJ away from therapy.

Therapist: Hello JJ, I am here at your house.

Are you on your way?

JJ: Yeah, Yeah!

Therapist to family: Is it OK with you all if we

meet in half hour when JJ gets here. Therapist

makes sure that JJ can hear him asking the

question.

Mom: I told you JJ is no good.

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Therapist: Mom, I know it is an imposition, but Therapist minimizes the negativity and politely

could we meet in half an hour? asks if the session can be postponed to

accommodate JJ. Th does not want to set the

precedent of initiating the session without

everyone there.

Mom: OK, but he better be here.

Therapist to Mom: Thank you.

Therapist to JJ: Your family agreed to wait for

you. We will all meet you here in half hour.

Thank you, too.

It’s 6:30 p.m….

Therapist: Thank you all for your willingness

to reschedule the session.

Mom: You see, JJ can’t be counted on. He

comes and goes like he wants to.

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JJ comes in, and therapist starts session, by

thanking for coming.

Therapist: Mom, I am going to get to know Therapist engages in maintenance (a joining

everyone a bit. I had a chance to talk with you technique) by making contact with every

(Mom). Do you mind if I spend a bit of time member of the family. It is important that as a

with the rest of your family? Let me introduce first step, we begin to create a relationship with

myself. My name is Ada and I like to work on each and every member of the family.

first name basis. I am from Sanders Family The open question is an exploratory task to

Services and I have come to work with your allow the family’s usual structure to emerge

family. Who would like to introduce me to the unaltered (enactment). This way we can

Johnson family? observe the patterns of interactions that will

inform our diagnosis later on.

Lila, the 11 year old, takes the lead in A first glimpse of the hierarchy in the family is

introducing the rest of the family. She that Lila may be the second most powerful

introduces the children first, the grandmother, member of the family. That mom and grandma

and mother is last. did not take the lead suggests that they are not

in a powerful position in the family.

In the conversation, one of the young children Therapist is alert to any other family members

mentions Milton. The therapist is interested in that might need to be included in treatment.

learning who Milton is and whether he is

someone that lives in the household. As it turns

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out Milton is Mom’s live-in partner.

Therapist to Mom: How long have the two of

you been together?

Mom: Five years about.

Therapist to young child who mentioned Explores the extent to which Milton might be

Milton: You were really little when he came involved with the family and specifically the

into your life. Do you ever do things together? children.

Lanisha: He takes me to school sometimes.

And he takes me to the park- sometimes.

Therapist: Gee, I am happy to learn about

Milton. He seems to be important to many of

you.

Grandma: He don’t pay the bills but he help

out.

Therapist: I would like for him to join us. Is he Having determined Milton’s role in the family,

at home now? Th requests to include him in the session.

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Lila: I’ll go get him. Another show of Lila’s leadership.

JJ: I don’t want him here. I thought this was Spontaneous enactment which reveals hostility

about me, and I have nothin’ to do with him. in the JJ-Milton relationship. Another sign of

how important Milton is to include in therapy.

Therapist: I understand how you feel, JJ. How Joining followed by reframing aimed at getting

you feel is very important to me. And, it is just JJ to allow for Milton to be part of the session.

because of how you feel about him that we

need him here.

Mom: I am sick and tired of the fights between Confirmation of the JJ-Milton conflict, and

the two of you (JJ and Milton). possible indication of mother-Milton-JJ being

in a triangulated relationship.

Milton walks in, and therapist thanks him for Therapist joins with Milton.

joining and lets him know they are just getting

started with the meeting. Th says, “Now that Although therapy started with the first phone

all the family is together, let’s start our work.” call, the therapist emphasizes that the work

She asks the family, “What would the family only happens when all the whole family is

like to fix?” present, and indicates to Milton that he has not

missed anything. What would the family like

to fix is the “work” signal to the family that

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indicates that in this therapy we “don’t just

talk.” Rather, we work to find solutions.

Mom: We ‘r here because JJ gives nothin’ but Mom brings the focus back to the Iphood.

trouble. He got arrested, last time for stealing a We diagnose here that Mom and JJ are very

car. He don’t help at home. He don’t listen. He direct and specific with each other. However,

pushed me and I fell on the floor, and had three there is a lot of anger expressed in the form of

stiches on my head…. blaming. The intensity of the interaction shows

a strong connection between Mom and JJ, even

though it is very negative. The high levels of

reactivity between Mom and JJ are suggestive

of an enmeshed relationship.

JJ: Because you threw a pan at me. Almost hit

me on the head. Look, you still see the bump.

Therapist to Mom “Wow that is a lot of Strong affective bond, even when they are

trouble. Sorry to hear the two of you are negative, make therapy easier because bonds

having such an ugly time with each other. But I are available to be transformed into positive
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hear something else. Even though it is not ones, even before we fully understand the

pretty, you two are very connected with each nature of the interactional patterns in the

other. You immediately respond to each other. family.

That is a strong connection. You both care

what the other does. I have to believe that

there was a time when you had a very nice

relationship.”

Mom: “You ‘r right it’s not pretty. I am f…g

angry with JJ. I don’t deserve how he treats

me.”

JJ: “I don’t deserve how you treat me either.” JJ diffuses by changing the direction of the

conversation, moving the role of who is the

greater victim from mom to himself.

Therapist: Yep, you sure have a lot of feelings

about each other. And you know that families

that feel so much anger are families that care Dyads with so much negativity are usually

about each other. I bet you’re never so angry enmeshed.

about the neighbor down the street. That’s

because you don’t care as much. Grandma, Therapist has a choice of continuing to work

when you hear them fighting like this, let them on the dyadic conflict, or moving the focus for
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know how it makes you feel. a moment away from the conflict, and toward

how the conflict may affect other members of

the family.

Grandma: Makes me feel bad when they‘r

fighting. They used to be so close when JJ was

little. JJ’s not so bad. She never listened when

she was young, either.

Therapist: Grandma, please say that to your Therapist decentralizes herself, and tasks a

family instead of me. family enactment.

Grandma: They heard me.

Therapist: But I want you to tell them directly Therapist insists on redirecting the

with me here, because what you said is conversation and emphasizes the importance of

important and I want to make sure they hear grandma statement which supports Therapist’s

you. positive reframes that mom- JJ relationship

was (is) very close, and was very positive at

one time.

Grandma looking at Mom: I can’t stand your

fighting no more. JJ’s not so bad.

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Therapist: Mom, what do you want to say to

Grandma about that?

Mom to grandma: What you talking? You were Mom diffuses by changing the topic to her

always busy with the little ones. Never minded relationship with grandma when mom was a

me. child. While this is important, the therapist

needs to stop the diffusion to keep the family

on one topic at a time.

Therapist to Mom: Do you agree with grandma The negativity between JJ and Mom must be

that you and JJ had an great relationship? reduced in the course of the first session. For

that reason, the therapist uses the rest of the

first session to thematically deepen the

reframes that were already introduced to the

family about the meaning of hostility as

connection and caring.

Mom: Yes, that’s right. That is why it hurts

me so much that things have gotten so ugly.

Therapist to JJ: Do you also remember those

good times with your mom when you were

younger?
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JJ: Yep! That is when she used to be nice to

me.

Therapist: Let’s make a deal that we are work

to get those good times back, keeping in mind

that JJ now is much older.

Therapist: Milton, how about you? How do For diagnostic and joining purposes, the

you see all this? therapist turns her attention to other members

of the family.

Milton: “No m’am. I not get involved with Milton is suggesting a triangle in which mom

none of that. His momma don’t want me and JJ are allied in keeping Milton out of their

interfering with her and JJ. relationship.

Therapist to the younger children: Do any of

you guys want to say something?

Lila answering for all: We don’t like them

hollering all the time.

Therapist: I am not surprised that the younger Therapist highlights children being upset,

children are upset by the fighting. But, what followed by a reframe about the caring
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the children missed is that behind this fighting between mom and JJ.

there is a lot of caring. Mom, you are very Th tasks mom to let JJ know that she is

worried about the path that JJ’s life is taking. worried about him. These three steps -

That is why you get so upset. Please tell JJ, in highlighting, reframing and tasking –

your own words, what worries you about him. constitute the restructuring sequence that

directs mom to communicate with JJ in a new

and more positive way.

Mom: I told him a million times that he is In her usual negative way, mom complains

throwing his life away hanging out with those although now the content is closer to a concern

friends of his that are up to no good. But he for JJ.

won’t listen.

Therapist: “I can see that you want the best for Usually the task is not done the first time it is

JJ. You want to protect him from a life of given. The therapist goes into “task

trouble. He already got arrested a few times, management” mode, to break the task into

and you don’t want him to end up in prison. parts to help mom to carry it out. To achieve

this, the therapist reframes again.

Mom: Yea, you are right. But he doesn’t see

that. He just thinks I want to boss him around.

Therapist (Softly): Well Mom I want for you to The therapist is much more specific when she

tell JJ what your main worry is, but say it in a re-tasks mom to tell JJ “her main worry.”

soft voice, so that he knows that you’re doing Therapist models the caring tone, and coaches
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it because you care, and not because you want mom to say it softly, in a caring way.

to boss him around.

Mom to JJ: Like I said many times, if you keep

doing what you’re doing, one day you’re going

to end up in prison, and there goes your whole

life.

Therapist leans forward toward Mom, and in a The therapist is insistent, consistent and

soft and caring voice says: “Mom, let him persistent, critical qualities in a BSFT

know why you worry. You don’t worry about therapist.

the kids down the street. You worry about your

son because he has a special place in your

heart. Explain that to JJ.”

Mom: “JJ, I don’t want you to be in trouble

with the law. I want you to do something with

your life. To get a good job, to get married and

give me grandchildren.”

Therapist to Mom: …because…

The therapist realizes that Mom has still not

said that she cares, so that he works on

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facilitating Mom doing so.

Mom: You are my son and I care what happens

to you.

Therapist: JJ, just for a moment put your guard

down. Take a deep breath. And, be honest. Tell The therapist tasks JJ to listen to mom, and be

her how it feels to hear what she just said to honest so that he can own mom’s feelings for

you- that she cares about what happens to you. him.

JJ: She don’t act like she cares. She act like I

bug her.

Therapist: Mom, you need to say it again, and

you need to say it with as many words as it The therapist tasks mom to do it again, and

takes, so that he believes you and he hears your with more depth and detail.

heart.

Mom: You are my firstborn. I can still

remember the first time I held you. I get real Mom completes the task given her: she

angry because you drive me crazy, but I love communicates her caring without ambivalence.

you just the same as I did then.

JJ smiles!
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Therapist: JJ, are you ready to give your

mother a hug? I now this is not fixed yet, but To consolidate and reinforce the new

this is a good first step to stop all that ugly interaction, the therapist moves to close the

stuff that has been going on between the two of deal in which family members reinforce each

you. other for the new interaction. In this case, the

therapist does so by asking JJ to give a hug to

his mom.

JJ stands up and gives his Mom a hug.

Therapist: “I am very proud of both of you. The therapist praises both of them, and

You rose above everyday ugliness. Mom, JJ, reinforces the frame that JJ is also a good

you are good people.” person.

To sum up session 1, we always want to close the deal in a session when there has been

progress achieved, as a way of leaving the family with a sense of accomplishment, a positive

taste for the therapy, and desire for more.

With regard to diagnoses, this is a family that is strongly connected- with passion,

intensity, although more often than not, the connection is expressed with a negative quality. This

over-involvement and negativity is seen in the relationships between mom and JJ, JJ and Milton,