Family Assessment; the Gallagher S

Family Assessment; The Gallagher’s

I.Basic Information:

Family Name: The Gallagher’s

Identified Patient (IP):Fiona Gallagher

Date of Birth:09/18/1990

Age:26

Fiona is self-referred and has identified herself as the primary patient. The Gallagher family supports this assertion. The members of the Gallagher family include; Frank (51), Fiona (26), Phillip (known as Lip) (23), Ian (21), Debbie (15), Carl (14), and Liam (6). Fiona is in the difficult position of being the oldest of the Gallagher children. She has taken on the responsibility of child-rearing and maintaining normalcy in the Gallagher home. Fiona describes herself as “headstrong” and sure of herself in most situations, but she has a “wild streak and is often [her] own worst enemy.” She referred to periods of self-sabotage including; frivolous sexual encounters, tumultuous relationships, and drug related arrests/convictions. All members of the family agree, Fiona has exhibited changes which include feelings of hopelessness and rejection for the past year. They also indicate Fiona is overly concerned with their business.

Period of Evaluation

The family entered therapy on December 4, 2015 and has participated in 6 family sessions. They terminated therapy on February 8, 2016.

II. Referral Context:

Fiona is experiencing feelings of rejection and worthlessness. Although her current relationship is going well, she feels preoccupied with her siblings. The concerted effort she devotes to her sister and brothers prevent her from optimal functioning. According to her siblings, Fiona is constantly “all up in our business.” Debbie, the youngest sister, stated “Fiona didn’t approve of my pregnancy, now she wants to be involved. She just won’t leave me alone, and she is constantly sulking around trying to help me.” Three of the brothers (Lip, Ian, and Carl) agree Fiona has some “serious issues” which are causing the family distress. Carl stated, she needs to “deal with her own [expletive] and just let me be.”

Fiona reported having some difficulty with her father’s presence and suspicious interest in his children. “He has never been around and now, all the sudden he wants to be a part of our lives, I don’t [expletive] think so.” Fiona’s siblings seem to be responding favorably to Frank’s increased presence. Debbie reported “it’s nice that he wants to help us and be here, I think it’s great.” Phillip (Lip) seems a bit suspicious of Frank’s recent involvement, but he reports “I’m always at school so who gives a [expletive] what he does.” The Gallagher siblings are getting older and are less reliant on Fiona. The youngest female in the home, Debbie, gave birth to a baby girl in April, and Fiona struggles with allowing Debbie the autonomy to function as a parent and independent contributor to the family system.

Disclosure Statement:

Ethics

The family was receptive regarding confidentiality and informed consent. They asked several questions regarding mandated reporter terms. Specifically, they inquired if the clinician was required to report to probation or the police if the family described illegal acts such as selling guns or drugs, alcohol consumption, sexual activity of minors, and violence outside the home. They were advised of the limits to confidentiality, and accepted the informed consent, which covered circumstances to be reported. The clinician has some concerns regarding the minor children in the home and their exposure to illegal activities. They are very familiar with the court system and Child Protective Services, and throughout the interview offered disclaimers such as “CPS already knows about that, that isn’t happening anymore.”

Values

The values of the Gallagher family are in stark contrast with those of the clinician. The family values autonomy and they have explicitly stated they will do just about anything to get by, which includes acquiring money for rent in ways that are not deemed socially acceptable. They do not seem to value the legal system and they are comfortable “stabbing people in the back if that’s what needs to happen.” These values are deeply seeded in the family history; the clinician had difficulty refraining from judgment. The clinician sought extensive supervision regarding the Gallagher family. Supervision focused on the presenting issues of the family, the values and self-awareness of the clinician, especially pertaining to behavior and attitudes of the family that were morally questionable and conflicting with the clinicians values, and the avoidance of steering the family in a direction that they did not want to go. The family did not desire to change their questionable practices, they merely wanted to return to their previous way of functioning whichwas being disrupted by Fiona’s sadness, intrusiveness, and need for control.

Feminist Values

Feminist therapy strives to bring the wider social context into the consulting room (Fitzgerald, 1994). The underlying assumption is that women are denied full participation in the creation of culture and systematically deprived of the freedom to determine their lives. This was prevalent for Fiona; she did not choose to take on the role of matriarch. Her mother abandoned the family when Fiona was 13, and her father was an absentee parent and unpredictable alcoholic. Therapy sought to challenge patriarchy, critique masculine assumptions, and to validate Fiona’s concerns, perspectives, and interpretations. It was difficult to balance feminist ideals with this family because the Gallagher’s have a fairly malleable structure, with the three eldest siblings often taking on untraditional roles. However, it was understood based on interactions between Frank and Fiona that Fiona remained in an inferior position despite her sacrifices, and Frank and the brothers were in a superior position. The hierarchical arrangement was seen as destructive by the therapist, and there was inequality of power, influence, and value. The balance of power would generally take place between a husband and wife, not father and daughter. However, the family’s adaptability provided the guise of a well-functioning family. Cohesion was the family’s strength, and the disruption of homeostasis was viewed as contributing to the family problem.

Pertinent Background Information:

History of Living Situation

Frank Gallagher purchased the family home in 1989. At the time of purchase, Frank was married to Monica. Frank and Monica had the six Gallagher children during their relationship. Although Frank and Monica divorced in 1994, and Frank did not live in the home full-time, the children maintained residence in the home. Fiona and the two eldest boys Lip and Ian helped to provide monetary support of the household. Frank does not currently live in the home, although, according to Fiona, he will intermittently stay there “between benders and girlfriends.”

Four of the Gallagher children live in the family home. Frank is currently living with his girlfriend at a commune in rural Illinois. Lip lives in a dormitory at Chicago University. Ian lives in the home but spends approximately three days out of the week with his boyfriend. Debbie has spent some time away from the family home this year but has returned following the birth of her daughter. Debbie and her infant child live in the home. Carl recently spent six months in juvenile detention for the sale and transportation of a controlled substance. He has returned to live in the home full-time. Fiona is engaged to Sean, her boss at the diner. She has been spending some time (2, 3 nights per week) at Sean’s apartment. Liam, the youngest Gallagher, is six years old and lives in the family home; he shares a room with Ian.

Definition of Problem

The youngest Gallagher female, Debbie, most strongly identifies Fiona’s behavior as a problem. She has recently chosen to have a baby, against Fiona’s insistence she have an abortion or give the baby up for adoption. Debbie has felt emotionally distant from Fiona since the two had an argument regarding the unborn child. During the argument, Fiona stated, “if you are going to have this baby, you cannot stay here.” Debbie left the home and went to stay elsewhere. Lip and Ian agree, Fiona has not been the same since the argument. Lip stated “Fiona told her she shouldn’t have the baby because she’s only 15. She meant well, but it drove Debbie and her apart.” Ian stated, “Fiona was like a mother to Debbie, and what she said hurt Debbie really bad.” The disagreement between Debbie and Fiona created a split in the family. Frank increased his influence and support of Debbie, for he supported her having his first “grandbaby and heir to the Gallagher name.” Frank is often in opposition of Fiona, and he capitalized on the sister’s disagreement, often urging Debbie not to listen to or respect Fiona, for she “wanted to be the boss of everything.”

Fiona reported noticing changes in her family members. She understands the siblings are growing up and she admits to having some difficulty transitioning from a mother figure to a sibling. Her fiancé Sean has encouraged Fiona to focus on herself and to continue to build her own life. However, Fiona struggles with letting go of her role, and often finds herself thinking about and often obsessing over her siblings’ behavior and decisions. “Sometimes I can’t think about anything else. When I think about them getting older and not needing me anymore I get depressed. I worry about them all the time.” Fiona often doubts herself, and wonders if she could have “done more for them.” The disruption of the system is caused largely by life transitions, and Fiona’s struggle with her siblings emerging adulthood.

Academic History

Fiona dropped out of high school at the age of 15. Her parents Frank and Monica divorced, Monica left the state and Frank was abusing alcohol and drugs. With both parents largely absent, Fiona went to work (often working two jobs) and assumed the role of caretaker to her siblings. Academic pursuits were not deemed a priority. She returned to night school at the age of 19 and completed her General Education Diploma.

Substance Abuse History

Fiona consumed her first alcoholic beverage at the age of 12. She stated “Frank thought it was funny to give us alcohol.” She also began to experiment with marijuana at the age of 13; “It was laying around the house so I tried it.” She reported disliking the effects of marijuana, but she has continued to drink. She denied problem use of alcohol, no withdrawal symptoms, black-outs, or increased tolerance. She stated “I drink when we have parties or I go out and need to loosen up.” She has also experimented with cocaine. She first snorted cocaine at the age of 15. In January of 2015, Fiona had a party at the Gallagher home. Her boyfriend at the time had a bag of cocaine. Liam found the cocaine, consumed it, and was hospitalized. Fiona was arrested, convicted of child endangerment, and served three months in county jail followed by three months of house arrest. She has not used cocaine since the incident in 2015.

Legal History

Fiona has been arrested six times. Each of the four arrests were for assaults and were the result of fights. Three of the four fights took place at her high school. She was suspended all three times. She was arrested as a minor and released to Frank’s custody. She was arrested for a fight in a bar as an adult. She was not charged; the incident was deemed self-defense. As previously mentioned, Fiona’s fifth arrest was in 2015 for child endangerment. Fiona completed one year of probation.

Family History of Mental Illness/Substance Abuse/Legal Issues

The Gallagher family has a long history of mental illness, substance abuse, and legal issues. The mother of the Gallagher children, Monica, is reportedly diagnosed with Bipolar Disorder. She reportedly has long periods of depression and chaotic manic states which the children can vividly recall. The second oldest Gallagher son Ian is also diagnosed bipolar. He manages his mental illness with medication. In addition, Frank and Monica have continued problems with addiction. Specifically, Frank is a chronic alcoholic who has required a liver transplant. He admits to abusing prescription medications, crack cocaine, cocaine, heroin, and methamphetamine. He describes himself as an “opportunistic user … I use what is available, I don’t discriminate.” Lip is also an alcoholic. He has been arrested twice in the last three months for incidents related to his problematic use of alcohol and impaired judgment. Fiona actively supports her family members and her interactions may be viewed as codependent. She has been exposed to addiction for the majority of her life, and she stated “I really don’t know any other way to live, I take care of them when they’re sick and try to keep em’ clean when they’re sober.”

Past Experiences in counseling

Fiona received counseling for a period of two months (three sessions) in January of 2015. Social services required counseling for Fiona as part of the family unification program, in an effort to keep the Gallagher children together and out of foster care. She recognizes the family needs a “little help getting back on track” and is optimistic therapy may provide results and conclude “sooner than later.”

VI. Behavioral Observations/Validity of Results/Clinical Interview:

The first session with the family was to gather historical information and to assess the family’s view of the presenting problem. The family came into session seemingly on edge and defensive. It was clear by their demeanor and presentation that they did not trust the clinician. Fiona spoke first, and most often answered questions and inquiry from the therapist. Liam and Ian seemed disengaged, often looking away, down, or rolling their eyes at each other. Debbie was defensive and clearly angry. She often scowled at Fiona and raised the tone of her voice to talk over her when she disagreed with Fiona’s version of things. As an outsider to the Gallagher family, I initially felt very awkward. I kept my tone and pace low, and provided each member of the family their time to speak. The family was very resistant in the beginning, and I found it very difficult to keep the family on task without interrupting each other. I found the Gallagher’s to be frustrating as clients, especially in the beginning before rapport was developed. After three sessions, the Gallagher’s’ had allowed the clinician to integrate into their system, and they were more forthright with cognition, process, and emotion. The Gallagher’s have adapted to very unique and challenging circumstances, and have many strengths which eventually became the focus of therapy.

The physical location of each Gallagher member in the therapy room was consistent week by week. The subsystems were clearly defined, as the Gallagher brothers sat near each other, and Debbie sat across from Fiona. Fiona sat next to Liam, the youngest, and she would hand him snacks throughout therapy. Liam rarely spoke, even when addressed directly. Frank only attended one therapy session, where he sat in between Carl and Liam, the youngest members. Coincidentally, the youngest members of the Gallagher family have the highest regard for Frank.

VII.Structural Analysis

Subsystems

In the Gallagher family, there are four primary subsystems; the siblings, the males and females, and the parents. The six Gallagher siblings are a subsystem. In addition, there are two gender subsystems consisting of the five Gallagher males and two females. The parental system includes Frank, and at times, Fiona. Monica does not have contact with the family and she was not considered part of the core system. Although Fiona belongs to the child subsystem, she has taken on the role of parent and the boundary is fluid. The relationship between Fiona and Frank is similar to that mentioned by Nichols (2013) regarding the enmeshed mother/disengaged father. Fiona is not the mother, however, she functions as such, and Frank is disengaged from the family more often than not.

Role Sets

Fiona has assumed the role of caregiver. According to Bank and Kahn (1997), when a family is in crisis, as the Gallagher’s were when their parents left, children will often emerge as mediators between those suffering from an illness and/or addiction and the other siblings. Fiona felt an obligation to help the children, to take on the hero role, and as a result has neglected her own needs. Researchers Sanders, Szymanski, and Fiori (2014) state that children such as Fiona will often mature faster than usual, be driven achievers while putting the needs of their family members first, and may develop feelings of sadness, resentment, anger, and fear. Debbie, the second Gallagher female, is the scapegoat. According to Winton (1995), the rebel or scapegoat often gets poor grades, and gets involved in sexual activity at an early age. Carl is a rebel and is often in trouble at school and has been arrested several times. Debbie and Carl have an alliance with Frank and are often trying to divert attention away from him. Debbie also has the most idealistic image of a family of all the children. Liam is the youngest and his role is the lost child. He stays quiet, out of the way, and spends much time withdrawing into fantasy. The roles of this family are rigid, and at times of adjustment and stress, are intensified.