登校拒否，盗み，祖母への暴力を繰り返す青年期症例に対する家族療法の経験

―Therapeutic-bindに向けての考察―

抄録

　The presenting problem of the identified patient, a 13 years old boy were school refusal, stealing, and violent behavior toward his grandmother. We administered 13-session of family therapy during the period of 6 months. The result indicated improvement of intra-family communication patterns, especially, parental coalition, and the problems of IP. The father of IP was a dealer of wine and provision, who the mother was also busy assisting her husband job. Evidently, she had a sense of guilt as she could not take good care of IP during the childhood. IP was taken care by his grandmother, who was overprotective and controlling toward IP. Inevitable conflict frequently occurred between mother and grandmother over the care of IP, which resulted in difficulty of relations of patrent of IP.

　At the time of the intake interview, IP could be diagnosed as "Conduct disorder, socialized, aggressive 312.23 (axis I)" and "Narcissistic personality disorder 301.81 (axis II)" according to DSM II. He was dependent and aggressive toward his mother and showed symbolic ambivalent feelings.

　IP had a sister (11 years old) who was a compliant good girl. The family’s relatives frequently made intervention with family problems.

Hypothesis

　Based on the above outlined date we hypothesized the following behavior sequences might have caused vicious cycle in this family, and set up intervention plan accordingly

　(1) IP’s symptoms (stealing, school refusal)→Father’s scolding→Grandmother’s protection→IP’s symptoms.

　(2) IP’s symptoms→Mother’s scolding→IP resists and attacks her→Mother gets angry with him→IP’s symptoms.

　(3) IP’s symptoms→Father shows concerns with his family.

Process of change

　IP’s symptoms were improved in line with the following changes of his family.

　(1) His grandmother decided to live in a separate house for 6 months.

　(2) Parent cooperated one another to improve IP’s symptoms. (=strengthened parental coalition)

　(3) His father prevented interference by the relatives and confirmed family boundaries.

　(4) By the use of microbehavior change method we encouraged each family member to evaluate, positively the other members. Consequently, parent changed their attitude to IP into more positive one.

　6 months later, IP began to go to school occationally and other behavior problem disappeared. Family communication patterns became open and flexible. The conflict between mother and grandmother was reconciled. The relation between IP and grandmother also got better.