Clinical Challenge

CASE HISTORY The Lombardo family,* presenting for family therapy, comprised five members: Dave, a 46-year-old white male employed as an investment manager; Caroline, a 47-year-old white female working as journalist; Ryan, their 10-year-old son in fourth grade; John, their 8-year-old son in second grade; and Nick, their 7-year-old son in first grade. The couple had been married for 13 years. The family came to five sessions to complete the intake process, meeting in different configurations. In the final intake session, with the entire family, the therapist provided feedback and recommendations for treatment. Following the intake and over the next several months, the family continued weekly sessions, in the following sequence: a session with the children only, followed the next week by a session with either the entire family or the parents only, followed the next week by a session with only the children again. The family was referred to family therapy by Nick’s individual therapist, Dr. A, who for the past year-and-a-half, had been treating Nick in individual play therapy and with medication management for an emerging mental illness, marked by psychosis, depression, and anxiety. Nick had been hospitalized psychiatrically on an inpatient unit for the first time three months prior to the initiation of family therapy.