A 16-year-old Chinese girl was brought by Mum to see me for her difficulties attending school for the past 6 months. The situation worsened when Amy (not her real name) started self-harming. Using a technique I learned from Prof Andolfi, I asked Amy who in her family would get stars from her. She generously gave 5 stars to her mum and maternal uncle, but I was surprised when she gave her Dad zero stars. “How is it that you don’t seem to like your Dad much?” I asked Amy. “He doesn’t like me being a girl. He wanted a boy,” she replied. When the parents were invited to join us, I got a second surprise. When I asked Mum how worried she was about Amy, Mum started crying and answered “10”. However, when further asked, “How much do you (Mum) think Dad is worried for Amy?”, She replied, “Zero”. “Why?”, I asked incredulously. ‘Because he gave up on her 6 months ago’. To that remark, Dad stated, “I’ll just leave it to nature and won’t care anymore.” I wondered whether this could be the reason why Amy’s depression and behavioral difficulties have persisted despite seeing different psychiatrists and changing different medications. I decided to zoom in on this and asked Dad to tell me some happy memories of him and Amy when they were younger. As he recounted one happy memory after another - though slightly slow-going in the beginning - Dad became more activated. After being told that Amy will be having a week’s school holiday shortly, I suggested that Dad come up with a list of activities he could do with his daughter. ’Sure, we can go to the gym together and …’. Amy interrupted with ‘rock climbing’. Mum laughed, “Amy can go with her Dad, I can’t do that.”
Amazing. I just witnessed the “magic” that Maurizio Andolfi has been very good at creating. I experienced in real life a depressed teenage girl brightening up when her Dad (whom she believed had given up on her) got involved in her life and planned to do things with her. What anti-depressants did not manage to do for this teenager, a father’s interest and involvement did during the hour-long session! Truly, as Maurizio often says, “Family is the best medicine”. The above offers a snapshot of the use of the family therapy approach in a clinical setting. Instead of focusing on the identified patient as the source of the difficulties, family therapists look at the whole family as a unit and try to see if the relationships or communication in the family system could be improved. In Amy’s family, Dad’s “giving up” on his daughter resulting from his feelings of helplessness about the situation caused Amy to misconstrue this as Dad no longer loving her. This led to her escalating her behavioral difficulties even involving self-harming with the hope that Dad would “care for her again”. Mum’s increased involvement with Amy due to her increasing anxiety over the possibility of losing her daughter, made any of Dad’s attempts to help redundant. In this family, a conscious move to rekindle Dad’s happy feelings towards Amy and nudging him to be involved in supporting Amy finally paid off.
This piece was written by Dato Dr. Lai Fong Hwa. Dato' Dr Lai is a Consultant Child & Adolescent Psychiatrist who has been practising medicine for 34 years and uses a multi-disciplinary approach to patient care. He is also a Family Therapist at the Andolfi Family Therapy Centre.
Join Dato' Dr. Lai for the upcoming free virtual event on The Use of Psychiatry Medication for Children on Saturday 20 July 2024. Register here.
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