MONICA-MCGOLDRICK-purpose-of-the-genogram-and-the-therapy-session-psychology-help
Assignment 1
Monica McGoldrick
Based on the video The Legacy of Unresolved Loss: A Family Systems Approach and your readings from the DeMaria, Weeks, and Hof text, consider the scenario presented in the video. The client, David Rogers, seemed to be getting annoyed with the questions regarding his family. He did not seem to feel the questions were a proper use of time. Address the following:
- How do you think McGoldrick explained the purpose of the genogram and the therapy session?
- How did the therapist engage each family member in the therapeutic process?
- How did she develop the clinical relationship?
Transcript:
I am Monica McGoldrick. When I work with families, I try to place their problems whether individual, couple or child focused into a brighter context that includes extended family, community, gender, class, ways and cultural background. I do this because believe that we are all connected to all that came before and to all the will come after. It is when these connections are severed whether through death, divorce or estrangement that a part of us also dies and that deadness can sip into all of our relationships affecting people long after the loss has occurred. Problems often evolve in a family because of their inability to adapt to or mourn in their losses.
This program presents a family in which the intergenerational ghosts of loss are hiding behind the symptoms of the present. Kathleen Rogers, the second wife of David Rogers, not their real names made the initial appointment for her family. The Guidance Counselor of her step daughter Michelle had referred them to me, because Michelle had been cutting school and generally acting remote and upset.
You must be Michelle. Hi. So, we spoke on the phone. What I would like to do is hear a little from each of you what you see as the problem and then I am going to ask you some questions. We will try to put it in some context, if that is okay? So, whoever wants to go first?
David Rogers
I guess I will begin. Well, I think you know that you were recommended to us by Michelle’s Guidance Counselor. She has been having some difficulty at school. There had been several incidents this year. The last one was her getting caught cutting classes. Additionally, we are very concerned about the group of kids that she has been hanging out with. They are sort of a fast crowd wherein never quite sure where she is and so forth. Also, she seems to have this big chip on her shoulder. A lot of anger and hostility, and we are really not sure how to deal with it and that is principally it.
Monica McGoldrick
Okay. So Kathleen, what is your view?
Kathleen Rogers
Well, I agree. I mean, there is just a lot of tension in the household and it is not very pleasant to live like that, and I have tried to help her deal with her anger.
Monica McGoldrick
Something about this family’s presentation seems very flat. I think the Guidance Counselor’s referral at an indication, there is something wrong, but so far, all I have heard is a description of a typical teenager.
What is your sense? What she is maybe angry about?
Kathleen Rogers
Well, I do not know.
Monica McGoldrick
Okay. So, what is your view, Michelle? Would you agree that there is a lot of tension in the family?
Michelle Rogers
I guess so.
Monica McGoldrick
Yeah. Are there some things about what is happening at home that are upsetting you? Do you want to talk about it?
Michelle Rogers
No.
Monica McGoldrick
How about school? You are okay with school? You like things are going?
Michelle Rogers
School is fine. It is great!
Monica McGoldrick
Yeah. So, is there anything that you think would be good for us to change about the way things are going from your point of view?
Michelle Rogers
I would not be so angry if they are not so —
Monica McGoldrick
So what?
Michelle Rogers
— so wrapped up in their own like little world. Everything has to be just so. Everything is — the baby this or the baby that. The baby needs to —
Monica McGoldrick
And how old is the baby?
Kathleen Rogers
She just turned two.
Monica McGoldrick
She just turned two. I see. You are saying what? That family revolves around the baby?
Michelle Rogers
It seems so.
Monica McGoldrick
I see. So, have things changed since the baby came, since the baby has been born?
Michelle Rogers
Yeah. It is like that is the only child in the house.
Monica McGoldrick
Well, you know what, maybe what would be good if it is okay with you is, well, I think a little background and ask a little bit so I kind of know who is who?
I like to do a genogram very early in the first session. So, the rest, I listened to details of the presenting problem. I have a context to which to put them.
Now you were married before?
David Rogers
That is right.
Monica McGoldrick
And you have an older brother. Is that?
David Rogers
Julian.
Monica McGoldrick
And how old is he?
David Rogers
Twenty-one.
Monica McGoldrick
He is 21. And Michelle, you are 15? What is your birth date exactly?
Michelle Rogers
November 5, 1979.
Monica McGoldrick
Okay. And your first wife’s name?
David Rogers
Dianne.
Monica McGoldrick
She died when?
David Rogers
She died August 15, 1991.
Monica McGoldrick
I will come back to her, but let me understand that. The two of you were married when?
Kathleen Rogers
June 10, 1992.
Monica McGoldrick
:
Okay. And you together have a daughter —
Kathleen Rogers
Jade.
Monica McGoldrick
Okay. And she was born when?
David Rogers
Excuse me –, is this really necessarily for us to kind of go to all these dates? It seems like we are here because of Michelle’s problem. And I am just wondering whether we can use the time a little better.
Monica McGoldrick
Right! Well, I will tell you. From my perspective, you never know what part of the history may turn out to be relevant to the presenting problem, but very specifically, what your daughter said was that she has been upset since Jade was born and that may — I do not know exactly what that means, but surely, the specific time when she was born would make some difference in that. You must have had to do a lot of family rearranging around her birth now. Okay. And Julian by the way, where is he?
David Rogers
He is at Colorado College.
Monica McGoldrick
And he is what year — he has been away for how long?
David Rogers
He is 21.
Monica McGoldrick
He is 21, but how many years has he been away from —
Michelle Rogers
He is a junior.
Monica McGoldrick
He is a junior. Now, let me get a little bit about your background. How many were in your family that you grew up in?
David Rogers
Well, just me and my mother and father.
Monica McGoldrick
I see, but I had no brothers or sisters?
David Rogers
No.
Monica McGoldrick
Really? They did not want to have any other children? Do you know anything about that?
David Rogers
Well, there was actually a child one before me, but he died before me.
Monica McGoldrick
Asking why a person was an only child can sometimes uncover important family history.
It was a son or daughter?
David Rogers
A son, and he was born with only a partially formed stomach and so he could not take any nutrients.
Monica McGoldrick
What was his name?
David Rogers
David.
Monica McGoldrick
In fact that he was a given the same name as his dead brother, suggested that he may have been a replacement child for his parents.
And everything kind of — I do not know, spooky or something. You have the same name and —
David Rogers
It is not really, why?
Monica McGoldrick
Although David makes a lie of this, I wonder if it intensified his role as an only child.
Now, is your father alive?
David Rogers
No.
Monica McGoldrick
When did he die?
David Rogers
He died December 30, 1977.
Monica McGoldrick
What did he do for work?
David Rogers
Banker.
Monica McGoldrick
And how did he die?
David Rogers
Well, complications due to liver disease.
Monica McGoldrick
Really? Was he a drinker?
David Rogers
Well, he is certainly was an alcoholic, but he enjoyed drinking.
Monica McGoldrick
Asking about the cause of death especially if it was premature can sometimes reveal problems such as alcoholism or suicide.
I know this is sort of hard to talk about sometimes different things in your family, but did anybody else ever think that he had an alcohol problem?
David Rogers
No.
Monica McGoldrick
No.
David Rogers
No.
Monica McGoldrick
Not your mother for example?
David Rogers
No.
Monica McGoldrick
Really?
Although David rejects the suggestion of alcoholism, I am not totally convinced. I may revisit this question once we have established the greater level of trust.
Now, is your mother alive?
David Rogers
No.
Monica McGoldrick
When did she die?
David Rogers
She died in ’87.
Monica McGoldrick
And how old was she?
David Rogers
I think she was 65.
Monica McGoldrick
What was her name?
David Rogers
Edith.
Monica McGoldrick
Edith. So, they never had any other children? Your parents — there were no miscarriages or anything?
David Rogers
Yeah. There were a couple, I think in my early childhood, mid ’50s, ’54 or ’55 something like that. I guess they wanted one more child and did not happen.
Monica McGoldrick
I see.
I asked about miscarriages and stillbirths because these losses are often glossed over with little resolution and can be more important than anyone realizes.
So now, can we talk a little bit about your family?
Kathleen Rogers
Sure. Yes.
Monica McGoldrick
I appreciate you may not know exactly where I am going with this, but to me, it is really important to kind of get a sense of who people are and where they are coming from. So, how many are in your family?
Kathleen Rogers
Just myself and I have a half-brother named Matthew. My parents are divorced.
Monica McGoldrick
In contrast to David’s rather flat description of his family, Kathleen was actively uncomfortable talking about her working class Irish-German background. The first in her family to attend college, she quit after her second year when her father died unexpectedly. She has very little contact with her mother, step-father and half-brother who moved to Florida shortly after the second marriage.
What is your family background ethnically?
David Rogers
Ethnically? I do not know. I do not have an ethnic background.
Monica McGoldrick
Where did your ancestors come from? Do you know?
David Rogers
England.
Monica McGoldrick
I believe strongly that people’s cultural background plays a profound role in how they see the world and how they define their problems. I tried always to help them locate themselves in this context since our society tries so hard to pretend that culture, what race, gender, class and sexual orientation does not matter when in fact these dimensions structure are very existence.
David Rogers
I am WASP, but I am white bread with the crust removed.
Monica McGoldrick
And where did you grow up?
David Rogers
Westport, Connecticut.
Monica McGoldrick
Uh-huh. Were you pretty close to your parents?
David Rogers
Reasonably so.
Monica McGoldrick
Who were you closer to?
David Rogers
My mother I guess.
Monica McGoldrick
Really? How would you describe your childhood in a word?
David Rogers
Well, I just describe it as a pretty, happy, upper-middle class family.
Monica McGoldrick
Yeah. Uh-huh. Okay.
David seems to have little sense of himself as an emotional being. I wonder if this is just a result of his upper-middle class WASP background or if something else is inhibiting him.
So, is Matthew married?
Kathleen Rogers
No.
Monica McGoldrick
Does he have any kids?
Kathleen Rogers
Yes.
Monica McGoldrick
How many kids?
Kathleen Rogers
One.
Monica McGoldrick
Uh-huh. How old?
Kathleen Rogers
I think he is three.
Monica McGoldrick
And where does he live?
Kathleen Rogers
He lives in Florida.
Monica McGoldrick
Uh-huh. What is his name?
Kathleen Rogers
Ethan, I think.
Monica McGoldrick
You are not in touched with them?
Kathleen Rogers
No.
Monica McGoldrick
Cut off such as this usually indicates something seriously a mess in the family process. I will explore this later with Kathleen hoping to encourage her to reconnect.
Let me go back a little bit now and ask about your mother. Now, her name was —
David Rogers
Diane.
Monica McGoldrick
— Diane and you mentioned before she died in August of ’91.
David Rogers
August of 1991.
Monica McGoldrick
Now, tell me a little bit about her background. What was her —
David Rogers
She grew up in Puerto Rico.
Monica McGoldrick
So, you look like you like that? Do you?
Michelle Rogers
Uh-hmm.
Monica McGoldrick
Do you think of yourself as part Puerto Rican?
Michelle Rogers
Absolutely!
Monica McGoldrick
Yeah?
Michelle Rogers
I am, are not I?
Monica McGoldrick
You sure are, but that is important to you, that part of your —
Michelle Rogers
Yeah.
Monica McGoldrick
Uh-huh.
This was the first sign of life in the session and I went right towards it. I was also very interested in the Puerto Rican connection since this choice of a wife seemed so out of character for David.
Have you ever been to Puerto Rico?
Michelle Rogers
Uh-hmm.
Monica McGoldrick
Really? Tell me about that.
Michelle Rogers
I went a couple of times during the summer.
Monica McGoldrick
Really? Just your whole family went or what?
Michelle Rogers
No, just me.
Monica McGoldrick
Really? How did that happen?
Michelle Rogers
Well, the first time was to visit a family stuff and then after that, my mom got sick and my parents did not think that was the best the idea for me to stick around so they sent me down there.
Monica McGoldrick
And how old were you when your mother got sick?
Michelle Rogers
Ten? Eleven?
Monica McGoldrick
So, you said you had family down there? Who is down there?
Michelle Rogers
My grandmother was down there. I use to go and visit stay with her and I also have cousins, aunts and uncles.
Monica McGoldrick
Really? What is your grandmother’s name?
Michelle Rogers
Abba.
Monica McGoldrick
Abba?
Michelle Rogers
That is what I called her anyway.
David Rogers
Carmen.
Monica McGoldrick
Carmen.
David Rogers
Her name is Carmen.
Monica McGoldrick
Okay. So, she is still in Puerto Rico?
Michelle Rogers
Yeah, but buried.
Monica McGoldrick
You mean she died?
Michelle Rogers
Uh-hmm.
Monica McGoldrick
Really? How long ago?
Michelle Rogers
Three months ago, February 15.
Monica McGoldrick
Were you close to her?
Michelle Rogers
Uh-hmm.
Monica McGoldrick
Really? How did she die?
Michelle Rogers
She just died.
Monica McGoldrick
Really? How old was she?
Michelle Rogers
I do not know.
David Rogers
She had been sick for many years. She had Alzheimer’s disease and she was old.
Monica McGoldrick
No matter how many genograms I do, I am still amazed that the hidden family issues, this technique reveals.
But, when you were younger during the time your mother was there, you were very close to her?
Michelle Rogers
Uh-hmm.
Monica McGoldrick
What was your wife’s illness?
David Rogers
Well, she had a kind of leukemia.
Monica McGoldrick
I see.
David Rogers
And so, in the beginning there was a lot of chemotherapy.
Monica McGoldrick
Really?
David Rogers
And during that period of time, first year of her illness, she would have periods where she was sort of okay.
Monica McGoldrick
Uh-hmm.
David Rogers
But at the second year, it got really bad.
Monica McGoldrick
So, you felt maybe it would be easier if Michelle were —
David Rogers
Away from her.
Monica McGoldrick
David seemed to be going along with this painful discussion of his wife’s death, so I was unprepared for his reaction to what I thought was a rather innocuous question about Michelle’s grandmother.
So, it sounds like you were very close to you grandmother, were you?
David Rogers
Excuse, Monica. I really have to ask the question again where this is leading. I mean, we pretty wasted most of the session going back in this ancient history and what I am really afraid of is that we are not going to focus on the problem that we came in here to address, which is Michelle’s misbehavior. And I am very concerned she is going to take this as acute that this is some sort of an excuse.
Monica McGoldrick
Were there something about that that got — I do not know.
David Rogers
No, it is just that she really was not very close to her grandmother. That is the point of fact and I am afraid that if we just keep harping on this stuff here, we are not going to deal with what is going on with Michelle at school. Now, I really feel like if we are going to on with this, I need to know how long this is going to take. I am lawyer and I work with contracts and we have to tell clients, we have to tell them how long some thing is going to take and what is going to cause.
Monica McGoldrick
Well, in some ways this is a little bit different situation, but it is very hard until I get a sense of what the story is, to know how to exactly help you —
David Rogers
I am thinking if you can give us some ball-park figure.
Monica McGoldrick
Sure, sure. And I feel very strongly about being accountable to you, so you are going to have to feel okay with the process in a general way, if that is going to take us a few sessions. What I would say is if after we have met three or four times, you feel as you do now that this is — what if this has to do with anything? Then, I would say let us really talk about it, but until we get a sense of what the history is and how that may relate to whatever is happening right now or in your family and for her at school, I kind of need to get oriented to this.
David Rogers
All right, well I think we have to think about it.
Kathleen Rogers
Dear, I think we should do it, all right.
David Rogers
Well, let us give it another try.
Monica McGoldrick
Okay, all right, but keep letting me know if this is not — and how are you with this idea? What do you think about coming here?
Michelle Rogers
It means being grounded.
Monica McGoldrick
In the first session, we dealt primarily with the new nuclear family and the previous nuclear family as well as with all three families of origin. We will focus on specific relationships as therapy continues.
My hypothesis at this point is that David never really mourned the loss of his first wife and rushed into a second marriage. I suspect that Michelle has not gotten over her mother’s death and does not feel a part of the new family. Perhaps, that pain is resurfacing for her triggered by her grandmother’s death. I also suspect that Kathleen has helped David in the coverup of his losses, a typical female task of protecting the husband and children. The first challenge here is to get David and Michelle to mourn Diane. I am also concerned that Kathleen’s role as caretaker will put her at risk for depression down the road.
So, how are the things?
David Rogers
Monica, I have been thinking a little bit last week and I still feel that it is important that we focus on the present and not so much on the past. We spent a good deal of the session last week as an example. Talking about Michelle’s grandmother who Michelle saw for all of about four months total in her entire life, and I really think we need focus on the present and Michelle’s behavior which is continuing to be very difficult.
Monica McGoldrick
I have to tell you that from my perspective, the past really influenced the present in such important ways that we cannot deal with that.
I have not been able to forge a connection with David yet, so I do not have a strong enough footing to confront his resistance.
David Rogers
Monica, I have been thinking a lot about last week and I still feel that it is important that we focus on the present and not so much on the past. I mean, we spent a good deal with the session last week as an example, talking about Michelle’s grandmother who Michelle saw for only about four months total in her entire life and I really think we need to focus on the present and Michelle’s behavior which was continuing to be very difficult.
Monica McGoldrick
I have to tell you that from my perspective, the past really influenced the present in such important ways that we cannot deal with that.
I have not been able to forge a connection with David yet. So I do not have a strong enough footing to confront his resistance. Instead, I will go with his concerns and look for ways to connect them with the family history that seems to be the cause of their current distress.
But I will tell you what let us start with what is happening now that obviously there is something that you wanted me to understand that you think I do not yet understand. So would you tell me what that is?
Kathleen Rogers
May I explain?
David Rogers
Go ahead. Go ahead.
Kathleen Rogers
Thank you dear. Well this past week, Michelle has been listening to this new rap music that goes thug, thug or something and it pounds continually. I think it is these kids that she hanging out with that are —
Monica McGoldrick
Not how Kathleen jumps in to protect David from having to express his feelings. It may be that he is so disconnected from the family that he does not really know what the trouble is.
David Rogers
Kathleen really gets the ran of it because I am at work all day and I come home late and I hear these tales and it is —
Monica McGoldrick
Well I am not really clear. What is it exactly that bothers you? The music bothers you and what they wear bothers you.
There is something here that just does not wash. When parents make superficial criticisms of their children’s friends, I often find it is a code for class or culture.
Kathleen Rogers
The common area that I think is really bad for Michelle to go down to.
David Rogers
We just feel —
Kathleen Rogers
I do not — I am sorry.
David Rogers
Go ahead.
Kathleen Rogers
I just do not feel that she is safe with these kids.
Monica McGoldrick
Now is it — I know you are relatively new to this situation but is it your sense that Michelle has changed the friends she hangs out with, that she used to have a different group of friends?
Michelle Rogers
They are Black and Puerto Rican kids. That is the bottom line.
David Rogers
No, no. That is not it at all because their behavior is got nothing to do with their color or race or anything.
Kathleen Rogers
Michelle, I grew up with Black’s and Puerto Rican’s. I am used to them. No, it is not what they are. It is what they are doing that we are upset about and what concerns.
Monica McGoldrick
Tell me a little bit about your friends, what they are like.
Michelle Rogers
I met them at this summer theatre group that I was in last year and they are all into this just really cool stuff.
Monica McGoldrick
And like what?
Michelle Rogers
Carlos writes poetry. He writes some good stuff too, it is really deep. And Serena is in this Latin folk band and they mix a lot of different kinds of musics on it.
Monica McGoldrick
Do you kind of feel connected to them in some way because it is like part of your heritage we were talking about last time or no?
Michelle Rogers
Yeah. They know where I am coming from. They are my people.
Monica McGoldrick
And what do you think about your father and Kathleen’s concerns about that? I mean, obviously they care about you and they care where you are going. And it sounds like they are really worried about your connection to these friends, should they be?
Michelle Rogers
Concerned? I would think that they would want me to be happy. Hanging out with them makes me happy.
Monica McGoldrick
I am reframing the parent’s criticism as concern to see if Michelle sees any validity at all in their comments.
Kathleen Rogers
But I am not happy that Celina just got a tattoo and that you think that is very cool.
Michelle Rogers
This one does like washes off in two weeks.
Monica McGoldrick
Adolescence generally do not reveal themselves in front of their parents so, I met with Michelle alone to get to know her better.
Monica McGoldrick
I thought it would be good idea for us to get to talk alone a little bit because I am not really sure what is happening here with your parents. I talked to your guidance counselor and she says, she has known you, she thinks you are basically a terrific kid but you have really been different the past couple of months so, she was sort of worried about it. That is what she said why she had referred you and I do not know what you think about that I mean, you think she should be worried?
Michelle Rogers
I mean, I am not really doing anything major. Yeah, I cut a couple of classes here and there and yeah.
Monica McGoldrick
But what she told is different because she said, you have always been a good student, you have been really hassling some of your teachers, cutting in ways that you never did before and her sense is something is happening. Your parent’s fantasies are obviously going wild. I think it comes from really caring about you. So, you need to know that.
Michelle Rogers
I mean I know that a major thing that we are in comfort with is that they do not like the friends that I have been hanging out with lately and — but they think that — they just assume that just because they are Black and Puerto Rican that they are doing all these things like that is all that we see in the media and TV and stuff and it is not like that. They are really cool kids and know so many things that I can do with them that none of my other friends in the past they would really could understand it — I feel like I can relate to someone them in ways I was never able to relate with anybody else.
Monica McGoldrick
So you feel like you share interests like you were talking about Carlos and writing poems and your other friend Serena. So why are your parents do you think that these kids are going nowhere? Do they know these kids?
Michelle Rogers
I do not know. They have not even given them a chance.
Monica McGoldrick
Really?
Michelle Rogers
They are just going to listen to what other parents are saying or whatever. Just because they are not from the same neighborhood, and by the way, that means that there is something wrong with them.
Monica McGoldrick
But — I mean, you can understand yourself that — because you must see it with other kids that it is easy to get in with the wrong crowd, it is easy to get into a situation where peer pressure can —
Michelle Rogers
Yeah, but that is not me. That is not me.
Monica McGoldrick
Okay, well I am just asking because I do not know you.
Her reaction here seems pretty genuine. I do not think that he knew friends are the problem.
And because it sounds like there has been a recent change. And that is what I am trying to figure out is what happened recently. I mean, I know last time you were saying that at home, the focus seems to be on the baby but the baby is two not — I mean that is– not that recent. What do you think is upsetting your parents so much now?
Michelle Rogers
Just I am hanging out with Puerto Rican kids.
Monica McGoldrick
All right. Why is that so upsetting to them?
Michelle Rogers
I do not know why it is so upsetting to them but you see yourself I mean, when my father is talking about my grandmother, it was like she was nonperson.
Monica McGoldrick
He does not know how connected you are to her?
Michelle Rogers
We are her family.
Monica McGoldrick
Well, I mean, that is true but I do not know. I could not really tell what that was about. Have you ever talked to him about what that means to you?
Michelle Rogers
No. He would not understand. He would not get it.
Monica McGoldrick
Really? Do you miss your mother?
Michelle Rogers
Do I miss my mother? Yeah.
Monica McGoldrick
Was there something that was triggered when your grandmother died?
Michelle Rogers
My father like want us to ignore that and even like had any relevance in my life but –. I was with my grandmother when I found out about my mother died. She was the one that was there for me not my father. And it should have been him.
Monica McGoldrick
So have you ever talked to him about that?
Michelle Rogers
He would not –. No.
Monica McGoldrick
He would not what?
Michelle Rogers
I think he is not fit.
Monica McGoldrick
Okay. But maybe that is the issue. I mean, maybe you and he just need to get connected in a way that it has really been missing for you I do not know but that is what it sounds like, and he does not know where have you been at.
Michelle Rogers
He does not even take the time to try to find out either. So, how can he know?
Monica McGoldrick
This is a real break. So far, I have not seen any way to get David to deal with his grief. Michelle needs to confront him about he is being shutdown with her. If David sees that this is hurting their relationship, it may motivate him to face up to his own unresolved mourning.
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