Parent marital relation's of a boy (13 years old) with severe bronchial asthma was successfully treated with approaches based on L'Abate's family psychology.

　　The parent had had marital process dysfunction characterized by repetitive reactivity, between critical attitude of the wife (39 years old) and withdrawal of the husband (43 years old). When the wife sought for psychotherapy she was depressed and thought of divorce. A marital therapy was suggested.

　　The first intervention was a proposal of non-destructive contract based on TA model, which was accepted by the couple. They confirmed to each other not to divorce. Then several writing tasks were assigned to them as educational approach. Especially effective was the intimacy experiential exercise of “sharing of hurt” through which real intimacy problems were disclosed. The approach/avoidance questionnaire led the wife to expand awareness of her own behavior patterns. She realized that she avoided intimacy. Fifteen sessions of marital therapy brought about stability and release from repetitive reactivity patterns. The hospitalized asthmatic boy also recovered.

　　Forty-two months after the last session, follow-up session was conducted. Good relation was still maintained.

　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.

　This article aims to clarify balance of power and improvement of communication patterns (verbal and nonverbal) in family members during the last session of family therapy. This was done through an analysis on quantity of utterance, objects of utterance and objects of glance in the Storytelling Scene with the Diagram Method.

　In family "A", the mother possessed the greatest power, while the IP had the least power during the first session of family therapy, however, power distribution among members was balanced during the last session of family therapy. Family "B"’s power distribution among members was also balanced in the last session of family therapy.

　As for objects of utterance and glance, family "A"’s parents directed most of their utterances and glances toward their sister during the first session of family therapy, but they were balanced during the last session of family therapy. The IP didn’t direct utterances towards the father during the first session, but these utterances were balanced between both parents during the last session. Family "B"’s parents directed most of their utterances towards the therapist and didn’t communicate with the family members during the first session, but the objects of utterance were balanced during the last session, while objects of glance didn't balance. It is estimated that family "B" had unsolved problems.

　Power distribution and objects of utterance were balanced during the last session

　　“Saying good-bye” is a T・A Gestalt technique used for resolving an unfinished business (hanging on situation) with a dead or separated loved one. It can be also applied as a tool to help a neurotic patient to become more autonomous, especially in family relations context.

　　This case of a neurotic woman with psychosomatic symptoms illustrate an interesting application of this technique. The therapist incidentally got a chance to make intervention to the patient's hanging on situation with her grand-mothoer and successfully implemented "Saying good-bye" to the grand-mother.

　　The resultp was good. The symptoms decreased and the patient reported that she gaind interpersonal competence. The thrapeutic process is discussed from the view point of promoting the autonomy of the patient.

　　The present article emphasizes on the concept of “needs” and “media” in family therapy. These two concepts have originally been used in the field of marketing and advertisement.

　　Families sometimes can't cope with the change of their “needs”, and occasionally ever lose “needs”. In such a case, family therapist should present technical informations for them to solve the problem, searching their lost needs or encouraging to cope with their needs.

　　In searching for the real needs of the family, therapist can use “media”, which is information process to search and realize the needs.

　　A case study is presented to clarify how to use "needs" and "media" in family therapy.

　　The case of 17 years old non-attendance-at-school boy was participated the joint family session for one year, 2 sessions a month. The family declared their “needs” after 25 media were employed and they developed self-organization toward the needs.

　　There is premise in the area of advertisement that the media is selected from the interactivity of a client and producer, because a producer is also a consumer when he/she is at home. The author considers that the premise can be applied to therapeutic situations.

　Although atopic dermatitis is generally said to be an allergic disease, I had many experiences in obtaining good results through the psychosomatic treatment by myself for those cases of atopic dermatitis in which allergen removal therapy had proved to be ineffective. On the basis of these experiences I propose to regard atopic dermatitis as a habit disorder in which the patient get accustomed to the bad habit of scraping. Children with atopic dermatitis are apt to scrape every itch they feel. The treatment consists in cutting off this vicious cycle of scraping by means of family therapy including paradoxical approach.

　A case of a 4-year old boy: The patient, who was also complicated with asthma received alimentary allergen removal therapy without good results. Then, the patient was kept on family therapy for his supposed psychosomatic disease and his family was encouraged to make him scrape enough for a definite time. The result was remarkable remission of his eruption.

　A case of a 10-year old boy: The patient, who had been suffering from atopic dermatitis since one year of age, was in remission of asthma. The patient presented severe type of atopic dermatitis and was autistic. Then, with a view to cutting off the vicious cycle between the patient and his mother, hospitalization therapy of the patient alone without any help from his mother was started. In anticipation of the effect of group therapy, other two children with the same disease were also hospitalization with him. The patient, who was only weeping initially in hospitalization became remitted of eruption as he tended to be yearned after by the other two children. The patient himself also recovered his natural child- like traits. But, after leaving hospital, eruption recrudescenced, suggesting a strong degree of intrafamilial vicious cycle. Subsequent family therapy, in which his mother made him scrape itches as much as he liked led to the remission of his skin erruption. The patient is now in quasi-healing thereof.

　Under the mask of atopic dermatitis, the family of a patient with the disease is apt to repeat the word "don't scrape!", and in such circumstances the disease will become more and more difficult of healing. Generally, eruption seems to become naturally better in the neglect of the patient's scraping on the part of his family.

　I view school refusal problems from a systemic perspective and assist families by utilizing school consultation and family therapy approaches.

　It has been noted that school refusal problems stem at the point where the two systems, the school and family, meet. Thus the approach should not be in chosing between one or the other system, but to take the perspective of seeing the system as including both the school and the family.

　The paper describes the following approaches which were utilized in working with five male high school refusal cases:

　a. intervening in the family system by utilizing family therapy

　b. considering parents as co-therapists and providing parenting skills at a Parents' Group

　c. intervening by utilizing school consultations

　The results of the three approaches were reported and the importance of intervening in both systems were emphasized. Furthermore, different problems and issues in each type of interventions were discussed.