2. Intake w/o Temperamental Focus - RonaldMah

Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
Consultant/Trainer/Author
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Born that Way, Temperamental Challenges in Relationships and Therapy
Chapter 2: INTAKE W/O TEMPERAMENT FOCUS
by Ronald Mah





When looking at a relationship or a family without a temperament focus, the therapist may miss key elements and dynamics that can de-pathologize individual members and guide therapy.  Samuel married Aliya who has a son, Charlie from a previous relationship.   The blended family presents both parenting issues (or child behavior issues depending on the adults' or therapist's perspective) and couples issues.  The issues with Charlie's behavior are most intense not with his stepfather Samuel, but with his mother.  Samuel and Charlie were best buddies when Samuel and Aliya began dating when Charlie was one year old.  When Samuel moved in with Aliya four years ago (Samuel was four years old), they formed one happy family, or so it seemed.  Samuel and Aliya have always had their own issues.  Samuel has a small construction company.  He's a contractor.  Samuel had hired Aliya as a secretary originally.  Besides the immediate attraction and romance, Samuel had come to increasingly depend on her at work.  Aliya had become the administrative manager.  She did all the administrative stuff: the billing, making reports, getting inspections done, legal compliance paperwork, and just about anything else that is not out in the field.  Samuel was great with tools, machinery, and people.  He was glad he had Aliya to do the paperwork, because he hated it.  They were a great team in the business.  But at home, it could be testy at times.  At work, Samuel is clearly the boss.  At home, well…

Often they were triggered over conflicts about how to deal with Charlie.  Charlie has always been a very active child.  Samuel thinks that Charlie may be hyperactive.  Charlie has been a very happy kid up until recently.  His overall mood has turned more and more negative since the beginning of the first grade.  He's now in third grade.  It seems like he loads up over the day.  He's usually happy and excited to get to school.  But the school he likes is the school with his friends.  He's off like a shot into the playground to play his friends with barely a goodbye and hug for whoever drops him off.  He's reluctant to go in when the bell rings.  He doesn't like reading.  It's a struggle getting the "b" "d" "p" "q" letters correctly.  He's below grade level in reading, at grade level in math and most other subjects.  He loves art, music, and especially P.E.  Charlie used to think it was P.T. for "play time" instead of physical education.  Over the day, he gets more and more active.  By the afternoon, Charlie is pretty over-stimulated with all the noise and activity of the classroom and playground.  By the afternoon, he does not handle the classroom and the teacher's guidance very well at all.  He gets wild and bothered by the smallest things.   When asked to slow or quiet down, he cannot do it for long.  If he wants something or something does not go his way, he cannot let it go.  He will not give up.  Charlie keeps on pushing at whichever person he's interacting with.  It doesn't matter if it's another kid or the teacher's aide or the teacher.  He won't take "no" for an answer.  When the adults suggest he do something else, he has a lot of trouble coming up with alternatives especially when he is already frustrated.  He gets more and more upset.  Eventually, more times than anyone would like, he starts throwing tantrums.  Charlie gets angry and lashes out at anyone around, "It's your fault!  You're mean!  I hate you!  I wish you weren't my mother.  I want to live with my father!  You don't care about me!"  Charlie has been admonished over and over for not sitting still, for touching things, for blurting out and interrupting others, for his tantrums, for getting into fights at school, for not listening, for not behaving, and so on and so forth.  As a result, his self-esteem has suffered quite a bit.  He does not see himself as a good kid.  He instead he thinks he cannot be a good kid.  He has tried so hard, but been a failure at being good.  He sees himself as a failure.  He alternates between being depressed, being angry, and being excited and happy.

At the first meeting with the family, the therapist is struck by how similar Samuel and Charlie are energy wise.  If not for having been told ahead of time, the therapist would have thought they were biologically related.  Later in an individual session with Aliya, she reveals that Samuel and Charlie's father are very similar in their energy.  Charlie is like Samuel because Charlie is like his biological father.  The therapist realized that Aliya is attracted to a certain type of guy.  Not too surprisingly, when the therapist explores this with her, the original "wild and crazy guy" archetype was Aliya's father.  Samuel is very similar to Charlie in so many ways. Samuel can be pretty excitable as well.  He's totally passionate about just about anything he is into.  It's one of the things that Aliya found so attractive.  That is, it's attractive when it's good passion.  He's fun and so energetic.  Their problem together is that when he's mad, he's really mad.  That is much like Charlie… Charlie's dad… and Aliya's dad.  Samuel can be very relentless and tenacious about going after what he wants.  That's also great when it's what Aliya and Charlie are interested in too.  When it's not, he can wear them down.  Then Aliya feels worn down by Samuel and Charlie.  

With all the similarities with Charlie, however, there are two key differences between Samuel and Charlie.  The differences allow Samuel to be fairly successful despite some very challenging traits like his stepson.  Samuel, unlike Charlie seems to be able to deal with noise and activity better.  When it starts to get to him, he's relatively able to recognize it and do something that lightens things up for him or he changes tactics.  This allows him to tolerate the stimulation that sets Charlie off.  Samuel is also very good at coming up with alternatives when he or anyone else in the family has problems.  This allows him to look for, find, and activate new solutions that Charlie never sees.  As a result, Samuel gets frustrated that Charlie is not able to be adaptable like he is.  It really frustrates him because he can see how Charlie gets loaded up and frustrated.  He can totally relate to it because he has some tendency to get overwhelmed too.  He cannot however see why Charlie just does not try something else like he does.  Charlie just will not take and use the advice and tools Samuel knows will work for him.  They have worked for Samuel.  Samuel also gets frustrated with his wife's ineffective discipline interactions with Charlie.  He feels that she just is not strict or creative enough in dealing with him.  He has relatively less trouble with Charlie when it is just him and Charlie together.  It's much worse when Aliya has Charlie alone or the three of them are together.  He also gets impatient and angry that Aliya complains about being overwhelmed.  Sometimes he feels that he and Charlie are on the same side against her.

The therapist quickly sees that Aliya's energy and personality are quite different from both her husband and her child.  It is hard for her to keep up with their high energy.  She complains it's like having two kids: one little kid and one big little kid.  Both Samuel and Charlie can outlast her in conflicts.  They each have more staying power and get more passionate.  It just becomes too much for her to deal with either of them in arguments.  And forget it, when they double-team her!  Many times, Aliya feels herself being dragged into things by Charlie or Samuel way too fast for her own comfort.  When that happens she tries to resist but is often overwhelmed.  She ends up feeling her needs are disrespected by them both.  Aliya catches the brunt of Charlie's temper tantrums and stubbornness.  Dealing with him wears her out.  And, Aliya resents her husband's relatively easier time with Charlie.  She really resents Samuel's critical and impatient attitude toward her parenting.  On top of that, Samuel's somewhat similar traits to Charlie make him almost as much a challenge as Charlie for Aliya to live.  "He's as bad as Charlie sometimes!"  Instead of having her husband as an ally, she experiences him as an obstacle or even an adversary to her in dealing with Charlie.  Aliya sees herself as relatively easy going and easy to live with.  Unfortunately, being easy going seems to make her the doormat to the two of them.  Aliya complains that she does not see what she has done to deserve this.  She feels and sometimes acts like a victim, and gets even more infuriated when Samuel, her husband for goodness sakes doesn't sympathize with her!  

Everyone in the family is challenged to stay on task when there is family chaos.  Charlie tends to get bothered first, Aliya next, and Samuel next but seemingly only for a little while or not at all.  One reason for this is when Charlie has started something active and energetic, Samuel often joins right in.  Frequently Samuel, not Charlie has started the fun that becomes the craziness that morphs into energy swirling chaos.  Samuel the adult, not the kid is often the one who created all the stimulation in the first place!  Samuel to his credit will sometimes notice either the energy or Charlie getting out of control or Aliya's increasing distress.  He'll curtail his own activity and try to direct Charlie to do the same.  Charlie does not respond to this very well or at all.  Once he gets going, it's hard for him to stop.  Samuel gets frustrated at Charlie.  Aliya gets frustrated at Samuel.  Samuel gets frustrated at Aliya getting frustrated at him.  Then she blames him, which may cause him to get angry and blame Charlie for not "just cutting it out!"  Charlie gets mad at Samuel yelling at him, then worried that his mom is upset and that she and Samuel are fighting.  Aliya tries to protect Charlie from Samuel (as she had tried to protect her younger brother from their father's rage) and yells at Samuel to stop yelling and "Don't blame Charlie! You started it anyway!"  Samuel gets mad and yells at Aliya because he and Charlie would have been having fun if she had not been so uptight in the first place.  Charlie starts screaming and kicking the wall to distract his mom and step-dad from going at each other.  Aliya yells at Charlie to stop kicking the wall… and the band played on.

The therapist can look at and work with the family from any of a number of theoretical perspectives.  It may be beneficial to examine the family-of-origin issues that Aliya experienced that cause her to pick high energy passionate men, along with her compulsive protective instincts.  The therapist may choose to uncover if her sensitivity to the noise, activity, and energy may have to do with a trauma.  A structural family therapist may try to create a more functional and unified parental dyad- the executive subsystem between Aliya and Samuel to respond appropriately to Charlie.  The therapist may work on healthier communication to improve the damaged self-esteem within each member of the family.  Cognitive behavioral interventions and principles may be used to uncover problematic cognitive assumptions that led to Aliya and Samuel's choices of behavior.  Parent education including referral to parent education classes may be provided.  Charlie may be referred to an anger management class.  Charlie may be referred to individual child therapy with a play therapist.  Aliya and Samuel may be referred to a work-home balance workshop or training on boundaries and role definitions for couples who work together in a family business.  The possibilities are numerous.  In addition, the therapist may decide that Charlie is essentially collateral damage from the systemic distress between Aliya and Samuel.  The therapist may then kick Charlie out of the therapy and re-structure therapy to become couple's therapy.  Therapy may then examine the functioning of Aliya and Samuel as a couple.

ADDRESS:
433 Estudillo Ave., #305
San Leandro, CA 94577-4915
Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist, MFT32136
CONTACT INFORMATION:
office: (510) 582-5788
fax: (510) 889-6553
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