Matt, age 31, comes to couples therapy at the insistence of his wife Tina, who has threatened to leave him. He has been married a

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Matt, age 31, comes to couples therapy at the insistence of his wife Tina, who has threatened to leave him. He has been married approximately 5 years and works as an insurance broker. Matt states that he doesn’t really need therapy but he is here to placate his wife. He states that his wife is the one who needs therapy because she is always sick and is too sensitive to his helpful comments. Matt says he is just trying to help her improve her life because she makes a lot of mistakes. Matt reports that he works at a “superior” level and that others are jealous of his achievements.

Tina is 30, and complains that Matt is “insensitive” to the many health issues she has had to deal with. She states that she is underweight because she has difficulty swallowing and has a “lump” in her throat. Also, Tina reports having numerous medical workups due to symptoms of dizziness and impaired coordination. She reports that Matt is “selfish” and that he “really doesn’t care about me.” Tina denies feeling depressed, but states she has little energy but to go to work and come home. Also, Tina complains that she is the only one responsible for their two young children. She states that all Matt is interested in is sex.

Matt reports that Tina does not admire his many important achievements. He acknowledges feeling annoyed and irritated by others who do not know what the **** they are doing. Near the end of the session Matt inquires about your credentials as a therapist and asks what school you graduated from. Before leaving, Matt asks you if you would tell his wife there is nothing wrong with him.

Assess and treat Matt and Tina using five of the following Structural concepts or techniques of your choice. Your response should be written in a narrative form. When introducing a concept or technique, use bold print.

Structural

structural family therapy

accommodation

subsystems

boundaries

coalition

cross-generational coalition

enmeshment

disengagement

empathy

enactment

family structure

hierarchical structure

intensity

joining

reframing

structure

shaping competence

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