Overview/Family Dynamics

• School Phobic Teenager by Joseph C. O'Rourke, LCSW, 9/10/98
  • Experience not suggestion by Stephen Lankton, 9/12/98
    
    

Stephen,

Thank you for your response. I found your admonition that the key element to success using hypnosis is not suggestion, but rather experiential learning, to be a very helpful and clarifying. In my purposefully brief description of the current problem, I hope that I in no way implied that a child could develop “independently from the context of the family (environment).” Nothing could be further from the truth, or my experience and beliefs. A more detailed history follows:

After the Christmas 1997 school break, this young man refused to go to school and was admitted to a day treatment program. He was started on Clonidine At that time he was “feeling bad about everything,” sleeping 12 hours a day, and, subsequently, threatened his mother with a knife which hastened his admission to an Adolescent Inpatient Program for 8 days. He returned to the Partial Hospitalization Program until April 1998 at which time he came to me for continuation of treatment. He had been diagnosed with Social Phobia. He had no axis II diagnosis. He, reportedly, “always had a history of anger problems and avoidance of social situations, but prior to January, 1998, the young man had no treatment history. While seeing me, he continued being seen by a Psychiatrist for medication management.

At our intake session, the greatest problem the patient and his family identified was anger management. He had a history of angry, assaultive outbursts, usually targeted at family members, especially his older (17) sister. By August 1998 the abusive incidents had stopped. (Through adjustment of medication, therapy, use of anger logs, and time-outs) With the resumption of school, two weeks ago, the patient refused to go to school.

This teenager comes from an intact family where his father is a career military officer and his mother in a stay at home Mom. He has a 17 year old, older sister who just left the state to attend college. As the frequent target of abusive behavior by her brother, she has been looking forward to leaving home for some time. She refused to participate in therapy. There is no family history of substance abuse or domestic violence (other than the attacks on family member’s by the patient).

The patient’s parents have different parenting styles. The patient’s father is more authoritarian, while his mother is more permissive. The patient’s mother appears to handle the day to day crises, until the behavior escalates toward out of home treatment, at which time the patient’s father seems to be handle the situation.

Through the threat of fits and intimidation, the patient has been allowed to rule his family. Aberrant behavior has been reinforced within the family context in several ways. For several years, the patients eating has centered around going to McDonald’s, on average, twice a day. The family's schedule has revolved around this demand. His asaultive outbursts, including potentially deadly behavior has had few proportionate consequences. The police have not been called when he attempted to smother his sister with a pillow, or threaten his mother with a knife. Or, not go to school. I view these as family system issues. The family interaction is, and has been, a focus of therapy in inpatient, partial and outpatient therapy.

The suggestion failed or was not used. The patient continues to refuse to go to school. It has been recommended that his parents call the school and report him as truant, in order to hasten police and court involvement, as the normal consequence of his truancy. It is also likelihood that he may be readmitted to the Partial Hospitalization Program.

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