Case Example

Referral   Interpretation   Follow-up
Anamnesis   Problem-solving process    
FAST representation   Evaluation of therapy    



Gabriel (age 19) is referred by his father to therapy for frequent drug consumption (cannabis).


The family consists of the parents, the patient, who is socially well integrated and an average high school student, and his two-year older sister, who attends college in another city. The mother, a trained seamstress, works part-time in the father's consulting business. The father, an economist, comes from a poor and alcoholic family, and is becoming increasingly worried that his son's drug consumption will prevent him from finishing school. Gabriel, like his mother, feels that he is in control of his drug abuse and that it does not interfere with school performance. Both stress that the many points of disagreement between the parents have now shifted primarily to the issue of the children's future.

FAST representation
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As the family sets up the group representation, a heated discussion ensues between the parents about child rearing issues. Gabriel (his sister is not present) treats his father with little respect and disqualifies him often. He also tends to align himself with the mother who in turn reproaches the father repeatedly. The typical family relations are portrayed as having a labile-balanced structure. Significant features are the relative centrifugality of the father and the hierarchy reversal (P - C2). In the follow-up interview the father maintains that he feels closer to the mother than the representation shows and expresses surprise that mother and son should perceive relations differently than he does. On the other hand, there are no differences of opinion regarding the structure of hierarchy.

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The unclear generational boundaries and the problems in communication manifested in the FAST are seen as resulting from conflicts surrounding the approach of Gabriel's leaving home and problems in redefining the parental and marital relationship. This interpretation is supported by the information that the daughter (who is an occasional cannabis user, as well) was also frequently at the center of parental conflicts until she left home for college. The father's fears that she would turn into an addict proved unfounded. There appear to be many protective factors in Gabriel's favor resulting from his well-developed sense of autonomy. Therefore the risk of subsequent psychosocial disorders is thought to be minimal.
Problem-solving process
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The father who initially proposed indiviudal sessions for Gabriel is now, like the mother, willing to participate in several family and parental sessions. Gabriel has little motivation to participate in family sessions.

In the course of therapy Gabriel and his parents redefine the rules that guide their living together. Although Gabriel consumed cannabis several times after a self-imposed period of abstinence, the relationship to his father is more relaxed. The mother decides to stop work in the father's consulting business and takes up her profession as a seamstress again. At the same time the number of arguments between the parents regarding their own relationship increases. Both feel, however, that they can solve these marital problems themselves without therapeutic support.

Evaluation of therapy
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For an evaluation of therapy the FAST is administered again to the parents and son together. While setting up the family representation the parents begin a constructive discussion. No longer is the focus on child-raising issues but rather on the future course of their marital relationship. Unlike the first time, Gabriel remains in the background and does not attempt to disqualify his father. The typical family relations are portrayed as having now a balanced structure. Based on the relational structure depicted in the FAST at the start of therapy we see that perception of cohesion at the family level and between the parents is nearly unchanged. Relations between the parents, however, have become more egalitarian due to a perceived increase in the father's power. Generational boundaries are more clearly defined due to hierarchical parent-son relations (no hierarchy reversal or egalitarian relationships) and less cohesion between mother and son. Another indication for stronger generational boundaries is the direction in which the figures are facing. The represented transformations of the interpersonal structures reflect a positive individual and family development. Gabriel is about to complete high school and plans to begin college.

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In a follow-up interview two years later all family members agree that their relationships are continuing to improve. Since Gabriel moved out of the house, the marital relationship of the parents has become more satisfactory for both. Gabriel completed an internship in a drug therapy center and has begun studying psychology at the local university.