Counselling Theories and Techniques 3

CIA 1

Family Assessment

The client M.D. is a 22-year-old Bengali male, who was born and brought up in

Assam. His parents and younger sister continue to live in Guwahati, while he moved out of

home to Mumbai to pursue higher studies at age 18. They are a close family, accustomed to

physical proximity. He is currently living in Bangalore and studying further and does not plan

to move back home anytime soon. His family continues to be dependent on him emotionally

despite the distance, and he often finds himself mediating their disturbances and catering to

their emotional needs. His father S.D. is an alcoholic and is resistant to getting help. The

current family assessment was conducted upon speaking to the client and his father.

Demographic Details

Name: M.D.

Age: 22 years

Sex: Male

Education: Bachelor of Arts

Religion: Hindu

Socioeconomic status: Middle class

Interpretation of Genogram

In the immediate nuclear family, the client who is 22 years old is the first son of his

parents and has a younger sister who is 16 years old. His mother has experienced a

miscarriage in the pregnancy before his birth. The client shares an enmeshed love-hate

relationship with his mother, and close bonds with his father and sister respectively. He has

also faced abuse from his father, who used to hit him. His mother has also faced abuse from

his father. He now lives away from these 3 members in his family, who continue to live

together.
Life Cycle Stages

The following are a descriptive account of the family’s successive life cycle stages as

given by Duvall (1977).

Stage 1: Married Couple without Children. The couple got married in an arranged

fashion in 1994. They did not meet before marriage. The client’s father wasn’t consulted by

his own father in “picking” the girl he was to marry, and client’s mother was married off to

the comparatively well-off family with the intention of “unburdening” her own family. Six

months into their marriage however, due to internal conflicts, the couple was thrown out of S.

D’s family home. S.D. did not have a steady job at the time, and the couple was thus thrown

into the throes of poverty early into their marriage. During their struggle, the client’s mother

got pregnant, and faced a consequent miscarriage. This affected their already fraught

relationship. Client’s mother remained positive in her outlook and independent, however, and

coped with her husband’s long absences as he hunted for jobs by making friends with her

neighbours.

Stage 2: Child-bearing family. With no stable income yet, in 1996 the couple got

pregnant once again, this time with their son client M.D. The pregnancy and childbirth were a

complicated affair, and the mother suffered physically through the process. Both the couple’s

respective families remained distant and uninvolved through the journey, and it was only

after the birth that the maternal grandmother came home to sometimes help raising the child.

The paternal side continued to avoid this family, with the exception of the paternal

grandfather who came in secret to play with the newly born. They were still poverty stricken

and S.D. was deeply anxious and actively searching for a steady source of income for the

child. There were many days when meals were skipped, and the client M.D. would often not

receive ideal nourishment. The client’s mother had a close friend who also gave a helping
hand in taking care of the baby. The couple did not grow any closer by virtue of the presence

of the child, despite occasional romantic gestures from the father S.D.’s side. At age one, the

client as a baby, faced possible death from a bout of pneumonia. Since his recovery his father

turned extremely protective and mindful of his health.

Stage 3: Family with pre-school children. At pre-school age the client was still at

home and did not receive formal education as yet. He was not allowed to play with children

his age outside as the parents feared his poor health would suffer for it. As a result, the child,

client M.D., felt lonely and often jealous of his cousins whom he saw playing with many toys

and each other. Father S.D. was busy trying to partner a business and was hardly at home.

The mother took care of the household but often felt stuck and dejected and was emotionally

absent. The grandfather who came to play without knowledge of the extended family, give

the child dry fruits and engage with him was seen as a protective figure. The child was also

very attached to the family help, who he recalls playing with still, and who left abruptly upon

getting married herself. This loss struck the child with an intensity that he still remembers as

he saw her as a mother figure.

Stage 4: Family with school age children. The father S.D. was finally able to find

work as a partner in a business, and the family shifted from the smaller town of Tinsukia to

Guwahati. This shift wore especially hard on the mother, who was suddenly bereft of the few

family and friends she had in the form of social support. The father continued to be extremely

busy in trying to make enough money for the family. The mother found herself alone and had

a difficult time adjusting in her rural to urban shift and remained unable to acculturate. She

also experienced physical issues like appendicitis, for which her own brother refused to

contribute despite being well-to-do. The father S.D. had to resort to help from his friends, a

tight social circle that he considers family more than his own. The child started going to

school and did fairly well in elementary academics. He immediately faced a lot of bullying
for being a Bengali child in Assam as well and was put down by his classmates often. He did

not have any friends, was not allowed to play with others, and often longed for company and

attention he did not receive from his absentee parents. In the year 2000, the paternal

grandfather passed away. The whole family felt this loss, and the paternal side of the family

began to reconcile. All at once, the child met cousins and uncles he had never known, and

quite enjoyed the camaraderie the extended family brought into his young life. He also made

his first family friend; someone he continues to be friends with till date. The three members

lived in a one-bedroom house apartment for the good part of the child’s school life. This

house began to be shared by 4 when in 2003 the client’s younger sister was born. Again,

there was a shift experienced, as all the attention was suddenly given to the younger child.

Client M.D. suddenly had the autonomy to go play with kids his age. In 2005, father S.D.

acquired his own business and the family started to suffer lesser with more money influx. The

two children got along with each other, with a certain distance due to gender and age

differences. There was however slight rivalry between the two for attention and love, two

limited resources in the house at the time from the depressed mother and the busy father.

With financial gains, they were able to get a car and host birthday parties. The father with this

growing business and increased travel also began to drink more socially. His alcohol

consumption and dependence grew in this time. The client got beaten often, by both parents,

and stopped paying heed to his academics. The mother stopped mingling socially entirely in

this time and stayed absorbed with household tasks.

Stage 5: Family with Teenagers. The mother continued to miss her parents every

day, suffered from low self-esteem and became increasingly dependent on the client M.D. to

take care of even household tasks like groceries, repairs, medical visits and so on. The client

craved her love and attention but failed to receive it. The mother began to impose her feelings

and thoughts on her daughter, and the two became a team against the father who despite
being a responsible man of the house was increasingly becoming alcohol dependent. The

client was put in a school of greater repute by his father who wanted his potential to be

harvested by good education. Here too, he was bullied, and his self-esteem suffered while

trying to fit in with his teenaged peers who were socioeconomically better off than him. He

also got hit by his father still, but still loved and trusted him. Through his teenage years his

father grew more and more drawn to alcohol but continued to work very hard to earn money

for the family. The son and father grew very close as they shared conversations and physical

affection. They often times slept in the same bed, and the client felt a deep connection with

his father that he was unable to forge with his mother. His mother also suffered from a slip

disc and was bedridden for a whole year. The client grew responsible in this time, taught

himself how to cook and tried to help his mother to the best of his abilities. He also for the

first time in his education got introduced to literature and delved deep into books and

learning. He started to participate in extra-curriculars and played a lot of football. It was also

in this time that the family moved into a four-bedroom apartment as his father S.D.’s business

flourished.

Stage 6: Family launching young adults. The client left the house at 18 to pursue

subjects of his choice in Mumbai. Because of his family’s dependence on him for chores and

responsibilities, as well as his emotional management of internal conflicts, they felt his

absence greatly. They had to readjust tasks and duties. The client’s mothers’ health

deteriorated, but she got closer to her daughter who has learnt her manners and methods of

dependence and fear and doesn’t want to leave home like her brother did. It was the client’s

father S.D. who suffered empty nest and missed his son the most. He fell deeper into his

alcohol dependence which evolved into an addiction. He lost the company and support his

son provided, and worried for him in the big city of Mumbai. Then on, his son has moved to

Bangalore. He visits home in the break, and manages their deepening conflicts phonetically.
Qualitative Analysis

Communication patterns. The family really loves each other and attempts to

emotionally communicate with each other. There are many blocks, however. The father S.D.

and client M.D. engage in open, direct communication. The client M.D. and his mother have

conversations that are largely centred on dealing with her issues that she is vocal about with

him. The client M.D. and his sister have on and off interaction that is open and non-

judgemental sometimes and focused on blame sometimes. According to Virginia Satir’s

interactional styles, both mother and sister display styles associated with that of the blamer.

The mother suffers from low self-esteem and lack of autonomy, and often reclaims power by

blaming the father and children for her state of affairs. This attitude of blaming has been

adopted by the sister who has learnt her communication styles from her mother. The client’s

father in his interaction style stays irreverent, busy with his work. The client M.D. interacts in

a super-reasonable style, wherein he is extremely rational and understanding of each

member’s perspective- which usually places him in difficult positions.

Roles. The father plays the role of breadwinner and provider staunchly. The mother

plays the role of caretaker but experiences dissonance and role confusion while playing

nurturer because of her own misgivings and regrets about her marriage and childbearing. The

son, client M.D. often is in a state of role reversal where a lot of the technical and emotional

responsibilities are off-loaded on him, and he has to play the role of caregiver instead of

child. He also plays the role of mediator in interpersonal issues, which remain unresolved

unless he intervenes.

Leadership. The father S.D. is the leader of the house, and this role is carried forward

by client M.D. The two take up responsibilities, guide and decide terms for the family. The

mother and sister also have their say but seem comfortable in following their lead and do not
speak up too often. The roles they play in the family automatically delineate their leader and

follower roles as well.

Decision making. The father makes the large financial decisions and big expenditure

calls, as well as decisions about client M.D.’s education. There is allowance of opinion in this

decision from all family members, but they are mostly content with his leading role in macro-

decisions. The mother over time has lost her desire to make her own decisions and is

extremely dependent on the family members for various needs. She does not make any

decisions without consultation. The one aspect that is however entirely under her jurisdiction

is maintaining relations with the extended family, and money calls within the household such

as paying the help, gifts, grocery budgeting and so on. Client M.D. takes all the mental health

decisions such as helping his sister get to therapy, talking to his father about his addiction,

helping his mother cope with her feelings of despondency. He also takes up the mantle of

conflict resolution and decides the verdict when there is a rift between members. The one

situation where the family comes together and has equal say and demand is when there is

planning for leisure time, or for a travel experience. On trips, everyone is a decision maker.

Coping. The family tends to avoid coping with problems together, and usually lets

intra-family issues dissolve over time- unless Client M.D. actively attempts to build

cohesiveness and make everyone cope together, such as in case of someone’s death. Their

individual coping styles are often a matter of contention, such as uncle’s coping with

emotions using work and socializing with his friends, and his consequent and causal alcohol

addiction. The mother also abuses tobacco to cope with stress and reaches out to the

daughter’s company for comfort in troubled times. The two also sometimes cope with life

situations and negative feelings by shopping together. The sister is liable to binge-eat to cope

and is overweight as a result. Client M.D. socializes, journals, and uses therapy as a tool for

better coping. He also turns to work and productivity to avoid his persistent anxiety.
My Impression

This family like many others has developed patterns and role identities because of the

due influence of their circumstances, especially their socioeconomic troubles. They are a

close family, with a clearly enmeshed relationship between the mother and son. The mother

and daughter have a close relationship, but it so appears that the daughter has introjected

several of the mother’s fears and worldviews and has thereby learnt her interaction styles and

patterns of behaviour in the family. They all love each other and are dependent on each other

to play their respective roles in order to maintain their own identities and worth.

The father relies on work and making money as providing for the family financially

is especially important to him. The stress of this role leads him to turn again and again to

alcohol. The mother, who already suffers from loneliness, feelings of dejection and low self-

esteem, feels confused in her role identity as nurturer. She shies away from all other roles

aside caregiver yet continues to be an emotionally absent mother. Her husband’s alcohol

abuse plays a role in this emotional disturbance that affects her role. The role of the daughter

to play child in the family keeps everyone else feeling secure- the father fulfils his need to

provide, the mother finds solace and a team-mate for her loneliness, and the brother exerts his

role as emotional leader of the family by taking care of her needs. In this manner, the sister

remains unable to grow to her fullest as she hardly ever leaves the role of the child and is

uncomfortable when she is made to do so.

The family also seems to have taken the launch of the client hard and have had

difficulty adjusting in his absence. As the client M.D. seems to be the only one with healthy

individual coping tactics, distance between him and the family renders the family incapable

of indulging in adaptive coping or coping together as a family. They all seem to have

unhealthy coping methods on their own. As the super-reasonable and role-reversed caretaker,
the client M.D. has a lot of responsibility with regard to his family and their emotional needs.

This affects his ability to differentiate from them and is a source of distress and disturbance to

him. The father S.D. is also unwilling to admit to the depth of his issue of alcohol abuse and

refuses to get help. The helplessness felt by the rest of the family in this matter is due to their

lack of a voice and their financial dependence on him.

I would recommend family therapy to the client and his family, as well as deaddiction

help for the father. The family could heal a lot of unspoken wounds with the right

intervention and open lines of communication.