Treating Multidimensional Presenting Problems with a Mutually Integrative Approach Using the Genogram

• DOI: http://doi.org/10.1111/famp.12470
• Date: 01 September 2019
• Author: Rachel Hull,Scott Browning
• Published date: 01 September 2019

Treating Multidimensional Presenting Problems with

a Mutually Integrative Approach Using the

Genogram

SCOTT BROWNING*

RACHEL HULL*

The present article introduces a case study and describes a mutually integrative

approach to treating a complex presenting problem. This article examines the spec ific

issues surrounding integration when a supervisor and supervisee hold different theoretical

perspectives. On occasion, such a relationship demands that the supervisee adhere to the

model being taught by the supervisor. Examining integration in this format presents many

advantages for both treatment and training. The key to the mutual integration is that two

schools of psychotherapy can be combined in a way that creates a synergy; in that, together

they are more powerful than either may be in isolation. A genogram with symbols from

each model is incorporated to focus the treatment and create a format for the mutual inte-

gration.

Keywords: Integration; Genogram; Obesity; Psychoanalytic; Strategic

Fam Proc 58:656–668, 2019

The case is conceptualized using a fusion of systems and psychoanalytic theory, pulling

from the Strategic family systems approach and a traditional psychoanalytic approach

influenced by Freudian ego psychology (Fenichel, 1945; Hall, 1999; McWilliams, 2011).

The traditional systemic genogram (with interactional symbols) is transformed into an “in-

tegrated” genogram, with the addition of new symbols to represent psychoanalytic defense

mechanisms. The presenting problems in the case are relational concerns and self-esteem

issues in an adolescent “identified patient,” obesity, and a history of sexual trauma. Ratio-

nale for the mutual integration in this specific case is provided along with rationale for

intervention.

A MUTUALLY INTEGRATIVE APPROACH

The authors of the present article intend to describe the process of integrating two unre-

lated theoretical models in order to provide therapy for a case in which either model of

therapy, pursued alone, would likely be less successful. The central organizing component

of this model of integration is the genogram.

Mutual integration, which involves two practitioners working on the same case, may

occur in two configurations. The first configuration prescribes that colleagues with dif-

ferent theoretical orientations may treat different family members while coord inating

the treatment. The second mutual integration is common in supervised therapies. In

*Department of Professional Psychology, Chestnut Hill College, Philadelphia, PA.

Correspondence regarding this article should be addressed to Scott Browning, Chestnut Hill College,

St. Joseph’s Hall, 4th Floor, North Wing, SJ446; 9601 Germantown Pike, Philadelphia, PA 19118. E-mail:

scobrown@chc.edu

656

Family Process, Vol. 58, No. 3, 2019 ©2019 Family Process Institute

doi: 10.1111/famp.12470