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eJOURNAL OF THE INTERNATIONAL CHILD AND YOUTH CARE NETWORK (CYC-Net) – ISSN 1605-7406

ISSUE 117 NOVEMBER 2008 •  CONTENTS •  HOME PAGE

PRACTICE

Intervention in the home: A case study

Mike Bass

ABSTRACT: Intervention in the home has as its target the entire family, even though the initial referral may indicate problems with a single member. Focus is placed on the parents as the family members with the greatest responsibility for change, and as having the rightful power to effect change. This case study examines some of the issues in dealing with this focus.

The family
Randy is the identified referral. Once labelled hyperactive, he clearly did not possess adequate social skills for his thirteen years. He was a constant irritant to his step-father Fred, a source of guilt and confusion for his mother Harriet, and a cause of friction between the parents and amongst his three siblings. Randy was the second oldest of four boys in an eight-year common-law relationship involving their natural mother Harriet, and Fred.

Randy’s past and then current behaviors included petty thefts from home and school, lying, temper flare-ups, and power struggles with his brothers and Fred. Additionally, he had a general sense of inadequacy and exerted great energy in attempts to avoid homework, chores and the learning of life skills and responsibility. Fred saw Randy as “handicapped” and feared both parents would be responsible for him forever. Randy had returned home three months earlier from two years in foster care where many of his behaviors had been stabilized. His old pattern was quickly returning, raising fears in Fred that Randy would destroy the family if he remained, and raising fears in Harriet that the family would be destroyed if he was removed once again. Randy’s presence was tenuous and intense. The referring social worker was concerned that this family might not hold together, yet it was potentially a normal, middle-class family if provided with the knowledge and techniques to deal with a problematic child.

Asked to label their roles, each family member’s self-identity was quickly confirmed by the others. Randy saw himself as the problem while fifteen-year-old Lyle, the oldest, was the conscience of the family. He indeed often provided insights such as the view that arguments were the family’s means of communication, and was quick to identify the errors of everyone else. Mark, eleven years old, saw himself as the family joker while Gregory, nine, readily called himself the baby. Fred, their dad was the cop, while Harriet, their mom, was playmate to the boys, worrier and rescuer. She was the only one with a multiple label. As a result of the rigidity of these roles and my general intent to validate the power and responsibility of parents to effect change, the focus of family problems was placed upon the entire family, and away from Randy.

The intervention process
The total period of involvement was five months. Weekly evening visits involved a one-hour family session followed by a two-to three-hour parent session. As well, two private sessions were conducted with Randy.

Two major areas or goals of involvement were contracted after an initial assessment period of three visits:

1) Parents to develop a knowledge of consequences and disciplines.
2) Randy to learn and use assertive communication skills to politely make his point and thus avoid power struggles with Fred.

Attempts to introduce logical consequences for behavior had mixed results. The parents resented problems such as Greg taking the family camera to school against instruction, with damage resulting. A consequence involving restitution would then be worked out, role played and declared satisfactory by both parents. The following week Fred would present a number of reasons why he did not attempt to follow-through. As logical consequences were only working for Harriet, and Fred showed interest in Thomas Gordon’s “No-lose method” introduced to them in concurrent parenting course, I switched the emphasis to teaching problem solving via a family meeting. Although Fred was enthused with early results, he quickly gave up because the third such meeting failed to resolve the problem of chores not being done on time. By the end of the third month, despite dramatically insightful sessions and the family’s apparent cooperation, the acting out behaviors of all four sons had escalated and there were no parental controls enforced.

Simultaneously, the parents decided that rules had to be enforced and I had decided to reassess the approach based on my conclusion that the parents were passive-resistant. Exploration of the resistance revealed that Fred had been a victim of severe physical abuse as a child. As a result he saw all attempts to control child behavior as “wrong.” Any use of controls, including emphasizing consequencas, resulted in tremendous pangs of guilt and anger! Secondly, both parents saw Social Services involvement as indicative of their failure as parents. They viewed all means of behavior control used prior to my involvement as “wrong” and, therefore, stopped placing limits on their children. As a result, Lyle was ignoring curfew, and all three younger boys were involved in petty thefts, refusal to do routines, severe swearing, talking back to their parents, and fighting amongst themselves.

Both parental problems received the same approach. A “List of intolerable behaviors” was drawn up. This included all the behaviors the parents could not tolerate and consequences which the parents had used in the past. The behaviors, not surprisingly, included stealing, lying, talking back to parents, not following rules and routines, not completing chores, failing to keep agreements amongst siblings and running to their parents to act as judge and jury over disagreements. Room confinement and lost privileges were the main means of consequences. By-and-large, these controls were appropriate. However, they were often meted out in fits of anger and were often retracted later. I applied some fine-tuning (the analogy of putting in new spark plugs instead of replacing the motor was used) by suggesting time limits and discussions about more appropriate action the child can do in the future. Fred particularly liked my idea of sending the kids into the garage to work out their problems, out of ear shot of the parents. Role plays were used to distinguish between appropriate consequences and abusive punishment. More role plays, discussion, role modelling and feedback led to successful use of family problem solving meetings.

After an initial testing period of two weeks, everyone reported satisfaction with the new rules. After four weeks disrespectful comments had been eliminated, there were fewer reports of acting out, and problem solving sessions were a routine. Significantly, the parents reported feelings of being adequate and successful parents. Fred momentarily reverted to using threats of the “belt” but this was quickly eliminated by pointing out its abusive nature and agreeing on more appropriate action. (I suspect this was his way of testing the new rules!)

Development of Randy’s communication skills was the second major focus. In the family sessions he had expressed fears that if he behaved, his parents would pay less attention to him. This was challenged as false-thinking and he readily agreed that recent family recreation, including tennis and hunting gophers, resulted in positive and satisfactory attention from his parents. Also, power struggles and increased tensions between Randy and Fred were reported and observed. The two individual sessions were used to practice and identify communication skills, such as identifying nonverbal cues including tone of voice and facial expressions, and to use polite means of interrupting (i.e., “excuse me”) or disclaimers, such as “I’m not trying to be smart, I am trying to make a point.” Maintaining control of his own anger and analyzing power struggles were also role played and discussed. Randy noted that he had been taught this before by his foster parent. Randy used these techniques, especially the disclaimers, with success during family sessions. By the last month, Randy and Fred reported greater satisfaction and fewer power struggles in their interaction.

Discussion
The structure of the sessions proved valuable. There was clear focus and clear changes of pace during the relatively lengthy sessions (average 3 ½ hours).

The family sessions took the focus away from Randy and placed it on the other boys. This resulted in significant acting out, especially by Greg, who indicated he disliked me and wanted me to go away. Randy, on the other hand, expressed enjoyment that he was no longer the family problem. A risk in reinforcing this belief was taken in conducting the individual sessions. However, it was clear that Fred would not initiate change in the interaction pattern of power struggles, and, therefore, change had to be initiated by Randy. Critical to overcoming the risk was discussing the risk with the parents and identifying the behaviors to which Fred would respond favourably. The positive results validated the risk at that time.

The parent-only sessions led to freer discussions on examples of misbehavior, disagreements between parents and between parent and myself. It also permitted the practice of new techniques before presenting them to the children, leading to more confident parenting and successful reduction of the children’s misbehaviors.

The most striking feature of this case study for me was the impasse or state of stagnation reached in the third month. The key to overcoming this problem was clearly the validation of Fred and Harriet’s previous parenting skills. As an assessment tool, the “List of intolerable behaviors” gave me a basis to provide feedback to the parents as well as providing a “base-line” from which I could fine-tune discipline. Even if the previous consequences had been inappropriate and abusive, at least a focus would have been placed on the behaviors which the parents found most troublesome. By my validating the “right” ideas and the “wrong” application, Fred and Harriet could then recognize that they were not totally inadequate as parents. Once they could accept that I was only going to build upon a foundation they had already had, they were prepared to accept me as a helper and teacher.

Clear communications between the parents contributed to this breakthrough. Finding agreement through the recognition of the other spouse’s right to disagree was a critical first step. Early in intervention, the parents began addressing each other and not me, clearly demonstrating they had the skills of communication. Upon questioning, however, they indicated that they did not talk openly when I was not present. Consequently, I jokingly suggested that a cardboard lifesize picture of myself be kept in their closet, to be brought out when they wanted to discuss parenting concerns. Clearly these early counselling sessions prepared the parents for the negotiations that followed the development of the “List of intolerable behaviors.”

There was one final issue. It became apparent that the parents and I liked each other. Discussion occurred about continuing a friendship after termination. This was a delicate matter as I was clearly in danger of becoming enmeshed with this family. This was discussed and Fred and Harriet agreed not to initiate contact of a social nature for three months after termination. This, they agreed, gave them the power and permitted me to feel that my professionalism was not compromised. Social contact has not occurred in the five months since termination although two phone contacts have occurred as a result of a crisis. In the suburban and rural setting of my area, social contact with clients in community recreation or bumping into them in the community is not unusual. This requires a delicate balance of professionalism and common courtesy.

Summary
Despite apparent agreement, failure to follow-through and feelings of stagnation on the part of both parents and the helper indicated a need to thoroughly reassess. This coincided with the parents’ decision to take control. The past and resulting attitudes were addressed and redefined. Validation of Harriet and Fred as capable parents who could develop appropriate consequence on their own permitted the effective fine-tuning necessary for change.

Postscript
While progress in the home occurred, it did not happen in the school. Randy was suspended in December and a crisis resulted, during which I was contacted. By mid-March, Randy was attending a private boarding school in Edmonton and was home on weekends. Tensions between Fred and Randy, and between Fred and Harriet had returned. There was, however, some indication of planned resolution and hope.


This feature: Bass, M. (1988). Intervention in the home: A case study. Journal of Child Care, 3, 5. pp. 31-35.