How the symptom is lived out in the family
Most importantly, what can be ascertained from the ‘here and now’ in the interaction with the parents in this first session? This may also throws light on the presenting problem. We may, for example, find an over-concerned and involved mother with her anxious and obsessive son, and a disengaged father. Or we may find an over-involved father with his daughter who makes himself her main confidante and excludes his wife from meaningful contact.
In summary, the presenting problem of embedded obsessive behaviour, whilst it is acknowledged as a serious problem for the young person, nevertheless still represents the opportunity. This necessitates that we do not become blinded by the symptom and then take action that would limit the therapeutic engagement and understanding of the problem. By persisting with the inclusion of the parents and giving time to the assessment, we begin the process of formulation that encompasses the inter-personal and systemic domains. By the end of this assessment meeting with the parents, we are in a position to offer a summary of what we have understood and begin to make even tentative connections between events, experiences and the young person’s behaviour that will not have been evident hitherto to the parents. Making these connections, summarising and integrating what has been discussed, further provides containment for the parents, and sets the scene for the continuing therapeutic engagement with them, as well as with their son or daughter. What the behaviour may mean for the young person within the domain of the intra-psychic is described next.