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Recalling that social treatment suggests that
the locus of the problem is the situation and not the person I offer the
following brief/condensed example from a family counseling agency
located in the Mid West during the 60's.
The Case
I received the intake report. It was six pages single spaced more than
three times the norm. With each page the level of pathology grew. It was
the task for the intake worker to find as much pathology as possible.
There were even comments about the look in his eyes that radiated
pathology. These were very troubled people.
The couple arrived and told about the trouble they were in. They were
newly weds. She had become ill shortly after they were married and the
medical bills had ruined them financially. She could not return to work
because of her health. Far away from her family without the funds to
visit them she was alone. Her meals were a disaster. He was treasurer of
an association and had used the funds for personal reasons. There was
more, they were in trouble.
During the session I learned that they had a neighbor who lived alone
since her husband died. (During the session there was no discussion of
the pathology in the intake report.) Although I did notice that his eyes
were close set like Montgomery Cliff's. A plan was developed. She would
visit her neighbor and ask for help... meal "planing," etc. He would get
a loan to cover the treasury problem before his personal use of the
funds was discovered. A second appointment was set for three weeks
later.
My supervisor was not pleased. A case with this much pathology should be
seen at least weekly. While she agreed that the plan was practical it
would not effect the underlying pathology. Note that when mental
patients behave normally it is called a flight to health, an very sick
effort to avoid the hard work of overcoming their illness.
I saw the couple waiting for their second appointment with me. They were
holding hands. During the interview they gave their report almost
bubbling with enthusiasm. He had been able to get a loan and solve his
treasury problem. The neighbor as I had expected had become a member of
the family. Cooking had improved. In fact the three of them often shared
meals together.
They were excited about their plans for a shared thanksgiving diner.
Although there was no treatment reason to have them come in again I set
the next meeting for after the holidays. As you could expect the
supervisory conference did not go well. I had again allowed them to
avoid confronting their real problems. But with so much pathology I
could be difficult to break thru the defenses.
The third session was a surprise. The couple brought their neighbor.
They were a family so I agreed her sitting in on the session. This
session was a victory lap. They had had a great holiday that included
getting a puppy at the local SPCA. I listened while all three reported
how they were enjoying life. I closed the case and wrote a very brief
closing summary. The case entered the closing process. The supervisor
added a note to the case file indicating that the reason for closing the
case, resistant to treatment. While we had helped them we had not been
able to reach the real problems. These problems were so severe that they
may have required psychiatric treatment. The positive was that I had
established a positive relationship.
In supervisory conference it was suggested that I call them back in 6
months and see if they were ready to work on their problems. However, my
internship was over in 3 months. That would have required them to be
transferred to another staff member. Complicated. It was decided to let
things go and they would come back when there problems inevitably became
unbearable.
I worked at the agency after my internship. The couple did not return
for treatment. |
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