Family Therapy Applied to the Case of Gwen As a family therapist, I look at Gwen as the index person in the context of her family system. Gwen has a strong extended family system and kinship ties that go beyond blood relatives to close friends who are called aunts, uncles, and cousins. When Gwen begins to experience episodes of depression and feels overwhelmed, the entire family is affected. African American families often become enmeshed due to our collectivistic nature. The cultural theme most often expressed is that "when something happens to one of us, it happens to all of us." It has been challenging to get Gwen's entire family in for a session, but she has managed it. The extended family is a great strength in the African American community, and Gwen's family has provided her with a great deal of love and support. I want to validate these efforts and let the family know that they are already doing many things to support Gwen. I invite everyone in, greeting each one individually. My first step with the family is to join with them by finding out how they feel about being in session. Ron: [Gwen's husband] "I rushed from work to be here, because, well, I want Gwen to feel better. I have to say I was not so sure about this when she first brought it up. I am not used to talking to strangers about my business, but I trust Gwen. I want what is best for her." Therapist: "Thanks Ron, I appreciate you being here. I know that you all have busy lives. But what is it that you want for yourself from these sessions?" Ron: "Well, Gwen, she is an amazing woman, but... when she has these episodes of depression, I feel helpless and nervous. I want to figure this thing out and get past it. I want my wife to feel better, and I want to help her however I can." Therapist: "I get the feeling that you would move heaven and earth to help your wife be happier than she is right now." Ron: "Yes, I certainly would." Therapist: "I appreciate that. And Lisa, what about you?" Lisa: [the youngest daughter, age 26] "I want Mom to feel better, she is such a powerhouse. She helps everyone else, and then she crashes. I am a little nervous to be here. I don't want to find out that she is going through this because of something I did. She helps me out with my bills, and I know I could do more for her. I never help her with grandma, and I know that is just more work for her." Therapist: "Lisa, I am sure that is important for your mother to hear. But before I ask her to respond, I would like to hear from other family members." Brittany: [the eldest daughter, age 29] "I have been really busy trying to get my career established. Mom has been helping me, and I really had no idea she was feeling overwhelmed and depressed. I am not sure I really understand what is happening. I love my mom, and I want to be here for her. She has always had these ups and downs. Is this any different? I love my mom, but she is so busy that I have given up on trying to keep up with her. So when I hear she wants to have a session, I am confused. Dad is so good with her. He keeps everything rolling when she is feeling down." Therapist: "I hear both your confusion and your willingness to be here for your mom. Gwen, what is this like for you?" Therapist: "I hear both your confusion and your willingness to be here for your mom. Gwen, what is this like for you?" Gwen: "I am so thankful that I have such a loving family that is willing to come talk to a complete stranger so that I can get the help I need. Right now I am feeling overwhelmed with life, and I am tired of it. I am juggling so many things and feel like nothing is getting done. I know this has been going on for long time, but I am ready to find a better way of living. I know this pattern has not been easy for any of you, and I feel guilty over that too. I don't want to hide in bed anymore, like I remember my mom doing. I am not getting any younger, and I am so ready to show up in life in a healthier way." Therapist: "What would that look like?" Gwen: "Well, I don't know for sure. I would be happy, I guess. I would not be worried about work or the family so much." Therapist: "And what would your family be doing if you were happier and healthier?" Gwen: "I guess they would be happier too. It seems like if I am happy, then they are too." Therapist: "But how can you be happy and healthy with all these burdens hanging on you?" Gwen: I am hoping you can tell me. Therapist: "Would it be OK with you if I gave that a try?" Gwen: "Yes, please." Therapist: "Here is what I think is almost always true. A super responsible person is always surrounded by people who will let her take charge and handle everything." Gwen: "What do you mean by that?" Therapist: "It means, Gwen, that you have been in charge for a very long time, and you have forgotten how to ask for help. Maybe you never knew how to do that. But as long as you keep pushing forward, your family will let you." Gwen's Mother: "That's right there!" Ron: "Wait a minute. I do everything I can to keep things moving! What else do you need?" Gwen: "I don't know. I am just hearing that I need help." Therapist: "So that's the issue for this family. Mom is the only one that knows everything that needs to happen. She knows how to do everything, but she is overloaded. She doesn't know how to ask for help, and everyone else is hoping she won't because everyone is busy and overloaded. And, Gwen, even if you did ask for help from others, would you worry whether they were doing it right?" Brittany: "Are you kidding? She would be supervising everything anyway." Therapist: "And how many of you would know how to mess it up just enough so that mom would take over again? [pause while family members look at each other; some smile a bit; some hang their heads] Wow. That brought everything to a standstill. Where do we go from here?" Ron: "Maybe we need to go home and think about this. We definitely need to do something differently. I want to talk to your brother and let him know how much pressure your mom is under so he can start taking care of his own business. We better start by making a list of everything Gwen has been doing and see where we need to step up. [pause] And maybe Gwen needs to stay out of this part." Therapist: "Let's see where that goes." We set a time for future sessions, and I let them know that coming in for therapy shows their commitment to Gwen and to each other as a family unit. I want them to know that I understand what it took for them to make it in the door and that their efforts are commendable.