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APA Psychotherapy Training Videos are intended solely for educational purposes for mental health professionals. Viewers are expected to treat confidential material found herein according to strict professional guidelines. Unauthorized viewing is prohibited.
In Family Therapy With Patients Having Physical Health Problems, Dr. Susan H. McDaniel demonstrates her biopsychosocial systems approach to working with clients experiencing health issues. In this form of therapy, the focus is on the role medical illness plays in the client's emotional life and in the client's relationships with family members and with health professionals. In this session, Dr. McDaniel works with a 60-year-old woman with symptoms of depression. She meets with the client, her husband, and her son to help them to deal with her diagnosis. This video features a client and family members portrayed by actors on the basis of actual case material. Precipitating Events About a year after her mother's death, Delores began to have sleep problems, to feel extremely tired, and to experience memory problems that were interfering with her work. In an appointment with her primary care physician, Dr. Davis, Delores downplayed the problems with her memory and focused on her sleep disturbance and fatigue. When questioned about the stress in her life, Delores admitted that her mother's death a year ago had taken its toll. The death had been preceded by a year-long period in which Delores was her mother's primary caretaker, which had been quite stressful, given her mother's narcissistic and demanding character. Dr. Davis made a tentative diagnosis of depression, referred Delores to a bereavement support group, and prescribed antidepressant medication. Delores tried both the medication and the group for about 2 weeks and then discontinued them without consulting the physician. Over the next month, Delores's symptoms worsened. She was disoriented and confused more often and had more difficulty covering up her mistakes. Others, including her husband, Harry, and her coworkers, noticed her problems remembering things and sensed that something was "not right." After her supervisor counseled her on the increasing number of mistakes she was making on the job, Delores decided it was time to retire. She reasoned that having fewer responsibilities would allow her time to replenish her energy and get back to normal. But Delores's functioning continued to decline over the next several months. She became disoriented while driving and had to ask for directions to get home from destinations that she had traveled to and from many times. Previously highly independent and given to many outings during her free time, Delores began to stay home more and more, which seemed to increase her feelings of fatigue. When even the local grocery store began to seem like a maze and Delores had to rely on Harry to do the grocery shopping, she felt completely demoralized and made another appointment to see the doctor. This time, Harry insisted on coming with her, and once in the appointment, he described to Dr. Davis the full extent of Delores's decrements in functioning. With this new information, Dr. Davis referred Delores to the neurologist and neuropsychologist for testing. The test results indicated that Delores was experiencing multi-infarct dementia (non-Alzheimer's type). After struggling with the diagnosis and with their changed lifestyle for several more months, Harry appeared to be feeling overwhelmed and Delores seemed increasingly depressed. Noting this, Dr. Davis referred the couple to Dr. McDaniel for family therapy. Questions
Notes on Previous Sessions Session 1: After reviewing the medical records, the neurological assessment results, and the neuropsychological test data, Dr. McDaniel consulted with Dr. Davis and together they decided that family therapy might be helpful. Dr. McDaniel arranged to meet with the couple. At the first session, Dr. McDaniel reviewed with Harry and Delores the history of Delores's symptoms and how the diagnosis had changed over time. She empathized with the painful struggle they had had and were continuing to have regarding the illness. Dr. McDaniel also obtained family systems information on the couple's family of origin and on their own children. She learned that the couple's two grown children had been kept unaware of their mother's diagnosis, at Delores's request. Delores explained that they had purposely raised the children to be highly independent, largely because she had never wanted her children to feel trapped by and responsible for their parents the way she had throughout her life, particularly with regard to her mother. Dr. McDaniel learned that before the illness, Delores had many interests, had been an avid museum-goer, and had been content to do many things alone. Harry had grown accustomed to this independence, and even after retiring from his government job, had also led a quite independent life. The couple had enjoyed hearing of one another's independent outings over dinner at night, going out to dinner and dancing on the weekends, and discussing politics and current events on a daily basis. For both Delores and Harry, her growing dependence on him had required a major shift in their relationship, which both were having difficulty handling. At the end of the couple's first session, Dr. McDaniel suggested that they invite to their next meeting their daughter (Ellen), their son (Michael), and his wife. Dr. Davis would join them for the initial part of the session to explain the diagnosis and answer any questions they might have. Delores was hesitant to involve the children at first, but with Harry's encouragement, she agreed to the session. Harry committed to contacting Michael and Ellen. Before the session, Harry learned that Ellen was on a wilderness camping trip and could not be reached before the appointment was scheduled to occur. Dr. McDaniel offered to videotape the session so that Ellen could be involved at least to some degree. Session 2: In the first segment of the session (not shown), Dr. McDaniel introduced herself and Dr. Davis to Michael. (Michael's wife, who is an attorney, had planned to attend but had been ordered by a judge to be in court that morning on a case that was supposed to be rescheduled for later in the week. She had not learned of her court appearance until late the day before.) Dr. Davis reviewed the history of the first and second diagnoses, spending the majority of time explaining the kind of dementia Delores has and how it manifests in symptoms as well as in terms of daily functioning. He highlighted problems with memory, fatigue, and confusion and explained the normality of the feelings of boredom and irritability Delores was experiencing. He described the limitations in functioning (e.g., not being able to drive and difficulty negotiating the supermarket) that were a result of the illness. Michael asked about the cause of the illness, and Dr. Davis explained that it was most likely related to his mother's late-onset diabetes and high blood pressure, of which Michael also had not been aware. When it became clear that Michael had a basic understanding of what was going on, Dr. Davis left the session for rounds. It is at this point that the taped session begins. Session 2: (continued): To be viewed. Questions
Stimulus Questions About the Videotaped Session Dr. McDaniel transitions to the second (videotaped) part of the session by inviting the Graham family to share their impressions and reactions about the discussion with Dr. Davis. This transition involves a shift from a medical information and education focus to an emotional and interpersonal focus.
Early in the session, Dr. McDaniel strongly recommends, even insists, that the couple's son (and daughter) be involved in the therapy.
Building on Delores's spontaneous links to her own upbringing, Dr. McDaniel opts to construct a family genogram.
Dr. McDaniel comments that the session is being videotaped to allow family members unable to attend the session to learn what the physician related to the family members who were present.
While Dr. McDaniel is constructing the genogram, Delores reveals that her daughter is a lesbian and remarks on Harry's difficulty accepting Ellen's lifestyle. Harry then discusses his gradual adjustment to this revelation and how a friend, who is a psychologist, helped him to understand his daughter's sexual orientation.
About 23 minutes into the session: Harry refers to his friend Joe as a "psychiatrist," while earlier in the session he referred to him as a "psychologist," the correct appellation.
In response to questions about changes in life and self, Delores begins to relate, in an emotional manner, her "enormous changes" and laments that she's "disappearing," "misses me," and has experienced "changes beyond my words." At this juncture, there are multiple choice points for therapist response. For example, the therapist must decide whether to address Delores's own pain or the interfamilial ramifications, whether to direct her response to the whole family or to Delores more directly, and whether to respond to the content or feeling of Delores's message.
In closing the session, Dr. McDaniel suggests that the family get together again as a group and asks them for their sense of when that meeting should be.
This videotape demonstrates family therapy when a patient has a recently diagnosed medical problem. Although most viewers are familiar with family therapy, many may not be acquainted with its application to physical health problems and their sequelae.
General Questions
Return to Family Therapy With Patients Having Physical Health Problems |
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