9.9 Case Study

The Johnson family consists of three members: John (45), a father struggling with alcohol use disorder for several years; Mary (43), his wife of 20 years; and their daughter, Emma (16). Over time, John’s escalating alcohol use has caused significant strain on the family. Mary has taken on most household responsibilities, often covering for John when he misses work or family events due to his drinking. Meanwhile, Emma, once close to her father, has grown distant and resentful. She avoids being home, choosing instead to spend time with friends or participate in school activities. Recently, Emma confided in her mother, expressing that she feels “invisible” and believes the family is avoiding the real issue—her father’s drinking.

At Mary’s request, the family began counseling. Exhausted and considering separation, Mary hopes therapy might help repair their relationship. John agreed to participate but denied his drinking was a problem, instead blaming Mary’s “nagging” and Emma’s “attitude” for the family’s issues. Emma reluctantly agreed to attend a few sessions but expressed skepticism that counseling would lead to meaningful change.

During the second session, John privately disclosed to the counselor that he has been drinking heavily in secret and has driven under the influence. He admitted feeling out of control but pleaded with the counselor not to share this information with Mary or Emma, fearing it would worsen tensions at home. Meanwhile, Emma shared a recent incident where John, while drinking, became verbally aggressive and punched a wall near her. She expressed that she no longer feels safe when her father is drinking, prompting her to avoid being home. John downplayed the event, but Emma’s fear raised significant safety concerns.

Separately, Mary confided her growing worry about John’s drinking and revealed her intention to separate if things do not improve. She shared that she feels financially trapped, as John controls their bank accounts, but requested that the counselor keep this information private. Despite these revelations, John’s denial about his alcohol use remained evident, continuing to contribute to the family’s dysfunction.

Counseling further revealed that Mary has been enabling John’s drinking by covering for him at work, making excuses to friends and family, and taking on additional household responsibilities. At the same time, Emma has been emotionally neglected, leading her to withdraw from her family and engage in risky behaviors with her peers. The family’s challenges underscore the deep impact of John’s substance use on their relational dynamics and highlight the complex interplay of enabling behaviors, denial, and avoidance within the family system.

Discussion Questions

1. How should the counselor address John’s private disclosure about his drinking and driving under the influence? Should this information remain confidential, or should the counselor consider sharing it with Mary or Emma to ensure their safety?
2. Given Emma’s account of feeling unsafe and the incident involving John’s aggression while drinking, what steps should the counselor take to address potential safety concerns? Does this situation warrant mandatory reporting, and how can the counselor navigate this while maintaining trust with the family?
3. How can the counselor ethically and effectively address Mary’s enabling behaviors and Emma’s emotional neglect without placing undue blame on them for John’s substance use? What strategies can the counselor use to foster healthier family dynamics?
4. Given the counselor’s expertise in family systems counseling but lack of specialization in addiction treatment, is it ethical for the counselor to continue working with the family if John refuses specialized help? How should the counselor approach referrals while maintaining the family’s engagement in counseling?
5. How can the counselor navigate the conflicting requests for confidentiality from John and Mary while working toward the family’s collective goals? What ethical considerations should guide the counselor in managing these private disclosures in the context of family therapy?