Help Needed

Jim and Marie are a married couple with a blended family. They have been married for three years. Marie has two biological children from a previous marriage, a son named Jake (13) and a daughter named Alyssa (8). Jake is in middle school where he is an honor student and an aspiring track star. He has been offered a sports scholarship to attend a private high school next year. Alyssa is in third grade and participates in the gifted program. She also participates in competitive gymnastics and has won a lot of awards in her age category. Marie and her ex-husband are amicable with one another. They, along with Jim, have a healthy co-parenting relationship. Jim has a nine-year-old biological son, Mason, from a previous short-lived relationship. Mason is currently repeating third grade for a second time. He demonstrates little interest in extra-curricular activities and has difficulty making friends with his peers. Mason’s biological mother battled addiction. She and Jim were never able to have a healthy relationship. Mason has lived with Jim since he was born. Mason’s biological mother had a loving but inconsistent relationship with him. Her addiction became more severe, and she ended up homeless. No one has heard from her or about her since Mason was four years old.

The family presents themselves to therapy due to Mason’s increasing defiant and aggressive behavior. Jim and Marie report that he is very argumentative with Marie and her children. He also demonstrates a high level of defiance towards any female authority figure. Recently, he has become aggressive with his stepsiblings. He has attempted to push, punch, trip, and throw things at them. Jim and Marie had initially thought that Mason was just going through a phase and that he would grow to love his new family. However, the frequency of his aggression has increased significantly, and they now seek help.

Jim and Marie have presented themselves to, Matt Gordon, a family therapist for help with Mason’s behavior. Matt has introduced them to a type of play therapy that is called filial therapy. Using this type of therapy, he has trained them how to facilitate play therapy with Mason on their own (Lindo et al., 2016). He has trained them how to facilitate a session and has set an appointment to observe them facilitating a session. During this session, he has given them the task of using empathetic listening to gain an understanding of what is influencing Mason’s oppositional behaviors (Good Therapy, 2016). During this session, they are to give no feedback, but rather just seek to gain understanding. At the end of the session, Matt will help Jim and Marie to set limitations with Mason.

Role-play

(Jim, Marie, and Mason show up to the counseling session. In the center of the room is a small table with several Mattel Hot Wheels cars and trucks on it. Matt is sitting down in a corner of the room observing the interactions). Jim (to Mason): Mason. I know how much you Hot Wheels, so I thought I’d invite you to play a game of imagination with me and Marie. Are you in?

Mason (looking at the cars and then at his parents): Sure. I guess?

Marie: For this game, you are going to need to pick a car to represent every member of your family. Are you ready?

Mason (picks up a Chevrolet monster truck, a Ford double cab pickup truck, a classic Volkswagen van, a Mercedes Benz sedan, a classic Ford Mustang, and a pink Cadillac): There you go.

Jim (looks at cars and smiles): Those are some cool choices. I’m interested in knowing why you chose these ones. I’m assuming the monster truck is you. Am I right?

Mason: (Chuckles) Yeah. The other truck is you because you’re my dad and I’m kind of like you. The van is Marie cause she’s always dropping off Jake and Alyssa at practice and she drops all of us at school. The Mercedes is my mom cause she’s beautiful. The mustang is Jake because he’s a really fast runner and the Cadillac is Alyssa because she’s super-girly.

Marie: (to Mason) Wow. You made some great choices and did a great job of choosing ones that represent all of us well.

Jim: (to Mason) Now what I’d like to do is invite you to imagine that the cars are each of us and I’d like to play with them and pretend that they are us having a normal day.

Mason: (gives a confused look) Okay?

(Mason takes the monster truck and ford truck and plays as if they both cars are having fun together. He takes the Mercedes and puts it off to the side facing him, but he doesn’t interact with it. He then lines up the van, Mustang, and Cadillac together and begins to run over them repeatedly)

Jim: (to Mason) I noticed that the monster truck keeps running over those three cars. If the Monster truck had a voice, what would he be saying?

Mason: (to Jim) He’d say. Go away! I don’t want you here!

Jim: (Mason) It sounds like the Monster truck is really upset. What is it that is making him upset?

Mason: (Looks down) The other cars get all the attention now. He used to get all the attention, but they took it all away.

Marie: It sounds like the monster truck would like to spend some more time alone with the Ford truck. Is that what I’m hearing?

Mason: (Starts to play with the monster truck and Ford truck again) Yeah. He misses going on rides together just the two of them. Listening to music with the windows rolled down.

Marie: (to Mason) It sounds like those must have been very special times. How do you think the monster truck might feel if the Ford truck made some extra time for him once in a while?

Mason: (Still playing) I think he’d like it a lot and he’d be happier. Maybe he wouldn’t be as mean to others.

Jim: I notice that you haven’t placed with the Mercedes. Why is that?

Mason: That’s my mom. I don’t really see her, but she’s always here whether I see her or not. (He taps on his chest).

Marie: (to Mason) That’s a very sweet thing to say about her. I see that she means a lot to you. We only carry the people that we love the most in our hearts.

Jim: (to Mason) How does talking about her make you feel. Mason: It makes me feel sad. (a bit of silence) And good. I don’t want to forget about her. It seems like everyone has forgotten about her except for me.

Marie: How would it feel if knew that you could talk about her with any of us anytime that you want?

Mason: I think I’d be happier. Maybe I wouldn’t be as angry.

(Matt speaks up after observing) Matt: (To all three) It was really great seeing you all interact the way that you did. Mason, you did an amazing job of choosing the right cars for the right people. Jim and Marie, you did a great job of listening to Mason as he shared his feelings with you. How are you feeling right now?

Jim: I feel sad and grateful. I’m sad to know that my son feels like I don’t spend time with him. But I’m also grateful that I now know what he needs.

Marie: I’m sad to know that Mason has felt that he can’t talk about his mom. I really want to make sure that he knows that he can talk about her any time that he wants to.

Mason: I’m feeling better. It feels good to talk about how I feel.

Matt: Now we need to set some limits and agreements. What are all of you willing to do after your session today?

Jim: I realized that I need to spend more one-on-one time with Mason. I think that I should probably spend at least an hour a week alone with him for some father-son time. He needs that.

Marie: I think that’s a great idea. I also think we need to find a way to bring up Mason’s mom in conversation. I had no idea that he felt so strongly about her absence. I want him to know that he is always welcome to talk about her.

Matt: What about limitations?

Jim: Well, we can’t have Mason going around being rude and hitting people?

Matt: What do you think about that Mason?

Mason: I don’t want to be mean. It’s just what I do when I’m mad.

Matt: What do you think would be an appropriate consequence for when you are mean to others.

Mason: Maybe I should have to spend quiet time in my room instead of watching TV and playing video games.

Matt: (to Jim and Marie) Parents, what do you think about that?

Jim: I think that’s a good place to start. When Mason is rude or aggressive to others, he will be asked to spend quiet time in his room for the rest of the day instead of TV and games.

Matt: This is a great plan.

References

 Good Therapy. (2016).  Filial Therapy. https://www.goodtherapy.org/learn-about-therapy/types/filial-therapy

Lindo, N. A., Opiola, K., Ceballos, P. L., Chen, S. Y., Meany-Walen, K. K., Cheng, Y. J., Barcenas, G., Reader, E., & Blalock, S. (2016). The impact of supervised filial therapy training on attitude, knowledge, and skills. Family Journal, 24(3), 239–246. https://doi.org/10.1177/1066480716648696