Kelissa had come to see Soni's tantrums as mainly negative and harmful to herself and Soni. She also thinks they are promoted by Breland because he wants to antagonize her. The therapist can reframe Soni's tantrums as serving a purpose for the family and for the couple. They keep Kelissa and Breland engaged with each other, if not as intimate romantic partners then as co-parents of a tantruming child. Breland's complicity in Soni's tantrums can be reframed as Breland being still invested in Soni and still wanting engagement with Kelissa. These reframes can help Kelissa see the symptom- that is, the tantrums as a function of family structure. The therapist may seek enactment, which is a duplication of relationship, couple, or family transaction. That could be getting Soni to throw a tantrum in the session so that Kelissa discipline Soni in her usual manner. Then the therapist can give feedback on Kelissa's tone, language, methods, and so forth and how she might modify her response. Kelissa and Breland can be guided on how to collaborate on disciplining Soni together when they are both there or only one of them is there.
Focusing on one aspect of Soni's tantrum can help reframe the symptom and alter the dynamics. For example the therapist can focus on the initial interaction between Soni and Kelissa leading up to the tantrum: what was Soni doing, what did she want, what was Kelissa' feeling reaction, what did she think, what was Soni's and Kelissa's tone, or facial expression. Breaking down all these aspects can help Kelissa see the tantrum not as an attempt to dominate her, but as Soni's attempt to get nurturing from her. Additionally, focusing on one aspect of Breland or Kelissa's reaction or response to the other may reveal important motivations. Intensification can also put the symptomatic behavior in a different light. The therapist can raise the intensity so the relationship, couple, or family cannot help but attend to the issues. The therapist can emphasize the dangers of Soni's behavior to herself in both for short-term and long-term consequences emotionally, socially, and so forth. Kelissa can be warned that Soni cannot be appeased, and be given limits that block her normal placating behavior. Breland can be prompted to express his anger more overtly. Intensifying the dysfunctional behavior, emotions, and beliefs may get Soni, Kelissa, and Breland overwhelmed by them, realize how stuck they are, and see what they are actually doing… to themselves.
Inherently dysfunctional systemic or family structure needs to be challenged. An initial assessment would be whether the system or structure had ever been effective for the members. If it had once, the therapist may work to restore the previous dynamics. The current structure allows Soni to have inappropriate power in the family system. Instead of appropriately being at the bottom of the family hierarchy as a child, she intermittently gains equal to superior power. Kelissa and Breland lose effectiveness as the executive subsystem. The parental dyad is all over the place within the family with their conflicts. They had been more in sync and effective prior to their relationship problems. Within the executive dyad, Kelissa has given up power to Breland in her home even though he does not currently live with them. Kelissa is seeking power through Breland's cooperation, as opposed to directly asserting her role and authority as the executive of her household system. When they are together, Kelissa submits to Breland's power rather than asserting an equal authority over Soni. Breland is both overtly dominating with Kelissa and covertly dominating her through Soni. At times, Breland and Soni join as peers in a coalition- an unhealthy subsystem triangulating against Kelissa. The therapist can make boundaries by pointing out to Kelissa that she seems to need Soni's permission to be the mother (by her tantruming or not). "You don't need Soni's permission to instill a set of rules and consequences or contingency contracts- you are the mother!" The therapist can tell Soni that she may not tell her mother what to do, only what she (Soni) wants to do and what she feels. When conversing with Kelissa, the therapist does not allow Soni to interrupt by asserting that it is an adult conversation. The therapist will also prevent Soni from intervening when Kelissa and Breland are interacting. "Soni, your mom and dad need to talk about this. You don't have to help either one of them. They are ok." When Soni is inappropriate with Kelissa, the therapist will direct Breland to support Kelissa by admonishing Soni. In conjoint sessions with just Kelissa and Breland, the therapist will also make boundaries for either partner as needed if communication is intrusive or inappropriate.
The therapist should unbalance the system since the equilibrium of the relationship, couple, and family is dysfunctionally maintained. Kelissa is underpowered in the system. The therapist can verbally align with Kelissa and her attempts to discipline Soni. He or she can also spatially align with Kelissa- for example by sitting next to her as she faces Soni. Physical alignment may also be appropriate (with parental permission) to help restrain her if Soni begins to throw a physical tantrum in the session. The therapist is essentially adding or throwing his or her moral weight against inappropriate power in the system. The therapist can also unbalance the system by telling Breland to verbally, spatially, or physically align with Kelissa when Soni throws a tantrum. Instead of Soni throwing a tantrum "at" only Kelissa, it gets thrown at a unified parental dyad. To increase Kelissa's emotional connectiveness with Soni, the therapist can have them sit together when they are expressing their respective needs. Physical contact often helps two individuals express more appropriately. In conjoint sessions, the therapist unbalances the couple's system by aligning with one or the other partner whenever the equilibrium is dysfunctionally maintained. For example, the therapist should align with Kelissa when Breland is angry and intimidating. "Breland, it looks like you can get Kelissa to back down by being angry. Kelissa, he's being pretty intense right now. Don't shut down. Tell him what you don't like… including him blasting you." The therapist should align with Breland when Kelissa is playing the victim. "She's got you now, because now you're the big bully… the bad guy. Tell her you're on to her 'poor me' routine. Kelissa, say what you need in a more powerful way." With the whole family present, the therapist can expose complementarity by noting Soni's ability to get her mother and father to please her. Soni may deny it. The therapist can challenge her paradoxically by telling her do things to get them to please her. The therapist notes to the couple how Kelissa empowers Soni by naming her as the reason Kelissa is angry at Breland.
Each partner often holds forth a reality that does not bear close objective examination. The dysfunctional sense of "reality" must also be challenged. When the therapist challenges each partner's reality, fundamental deceptions that harm the relationship may be exposed. Secret unacknowledged inequities may underlie the accrual of resentments by partners. Partners or parents may try to recruit the therapist to join in colluding with their false realities. For example, "Therapists can no longer ignore the possibility that when a couple comes to treatment, husbands may theoretically espouse egalitarian beliefs but also perceive actual lack of sharing as fair and may be experiencing tension about the pressure to share from their wives. Men may experience guilt regarding the gap between their attitudes about equality and their actual behavior. Wives probably experience their own distress about lack of power and their resultant inability to actualize their beliefs in their daily lives. Husbands' and wives' different views might also lead to their having different goals for treatment. Men may be more concerned with their sense of tension and guilt, and women may be more concerned with their lack of power and anger. Men may want less pressure on them, and women may want to increase their own influence. For the therapist, these issues uncover a real ethical dilemma. Not taking a position may account to reinforcing one or the other partner's view, but taking a position about what constitutes fairness in marriage may also support one partner at the expense of the other. Therapists cannot dodge this issue by ignoring it; they need to voice discrepancies openly. Bringing these issues out in the open, making legitimate and universalizing them, can be a powerful intervention" (Rabin and Shapira-Berman, 1997, page 328-29).
Kelissa's sense of reality expects spouses would transcend personal issues to cooperate when parenting. Her reality maintains that she an innocent victim and does not contribute to the problems between her and Breland or with Soni. She believes that her needs, her daughter's, and Breland's needs fundamentally conflict. Breland's sense of reality asserts that he is the victim in the relationship. He believes that Soni's tantrums are caused solely by Kelissa's poor parenting skills. These held false realities limit the changes needed for a healthier relationship. The therapist can challenge their cognitive constructs that Soni must have coordinated team parenting- that is, that Kelissa and Breland have to parent in the same way. The therapist can introduce the idea that Soni can learn how to function in two different systems: one with Kelissa and one with Breland. The therapist disputes Soni's inability to adapt to different authority or situations by pointing out that she does well in several different environments: her paternal grandparents and her maternal grandparents' homes, school, her soccer team, and her drama group. A key different cognitive construct would be that they do not have to neglect their own needs to make it work as a couple or to meet Soni's needs. If Kelissa and Breland can both meet their individual needs to be heard, feel connected, and have control in their lives, it would create intimacy and unity as a couple. And, subsequently their healthy relationship would decrease or eliminate Soni's need to act out (be triangulated into their issues) and present more unified and effective discipline for Soni.
A significant negative cognitive construct often is that the individual, couple, or family is fundamentally or largely unhealthy. The therapist can search for relationship, couple, or family strengths by helping members identify positive qualities amidst the negativity. "Soni really wants your nurturing. You must really care about Soni to go through all this for her." Breland can be acknowledged that he really must care for both Kelissa to risk coming to therapy where he would be criticized… and after having had to move out. Both partners can be acknowledged for their commitment to working things through, and for continuing to struggle to care for their daughter. Soni can be validated for trying so hard to support both parents, and for trying to be strong even though their conflict is so upsetting. The therapist can also use paradox to provoke change. Paradoxical interventions present a double bind to clients whereby growth, change, or awareness is facilitated by either compliance or resistance to the directive. Paradox may not be recommended with children with oppositional defiant disorder however. They may engage with a harmful negative response by ignoring or not resisting the double bind. The therapist would need to carefully assess clients to ascertain the propriety of paradoxical directors. When Soni starts to intensify towards a tantrum, the therapist may tell her to hurry up and throw her tantrum right away instead of waiting. Or, tell her what spot on the floor to throw her tantrum. The therapist could tell Soni to throw at least one tantrum during the week between sessions, so that they can talk about it the next week. Complying or not complying with the directives verifies and exposes that her tantruming is under her control. Resisting the directives reduces or eliminates the tantruming behavior.
Kelissa may be told, "Since Soni's tantrums are too much for you to handle, next time don't try to handle it. Let her do whatever. It would be easier for you to clean up the damage than to have to fight it out with her." Or, "Since you can't handle them, you should call Breland to help you when Soni tantrums." Compliance with the directive may make her realize how much more out of control Soni may become, while resistance would activate her to be more flexible and assertive responding to Soni. Regarding her passive-aggressive responses to Breland's aggression, the therapist may suggest, "Since Breland is too much to deal with, I guess you'll just have to keep your mouth shut and get him later some other way. How about not letting him talk to Soni when he calls her? Or, you can shut him out sexually." Accepting permission to be passive-aggressive acknowledges her dysfunctional behavior. Resisting permission may cause her to take a more affirmative and direct approach to express her issues with him. Breland can be told to stop trying to discipline Soni and just have fun with her. The therapist can tell him to just mimic whatever Kelissa does with Soni when they are together rather than try to discipline her. Compliance with the directive exposes that he has abdicating his parental role, while resistance would cause him to be more active and responsible as a parent. He can be told to interact with Kelissa the same way he always does, especially in an argument, but to remember as much as he can so he can tell the therapist the next session. Breland may not be able to comply with this paradoxical directive, which would mean he would interact differently with Kelissa- thus, potentially breaking a stuck negative pattern between them. Or, he may comply with the directive and thus, become more aware of his and her dynamics and interactions when arguing. The therapist has to use his or her clinical judgment and therapeutic skills to determine the propriety of paradoxical interventions. They offer significant benefit but must be skillfully executed.