Murray Bowen is one of the most respected family theorists in the field of family therapy. Bowen views the family unit as complex and believes it is important to understand the interactions among the

The Petrakis Family

Helen Petrakis is a 52 -year -old heterosexual married female of Greek descent who says that she feels

overwhelmed and “blue.” She came to our agency at the suggestion of a close friend who thought Helen

would benefit from having a person who could listen. A lthough she is uncomfortable talking about her

life with a stranger, Helen said that she decided to come for therapy because she worries about

burdening friends with her troubles.

Helen and I have met four times, twice per month, for individual therapy in 50 -minute sessions. Helen

consistently appears well -groomed. She speaks clearly and in moderate tones and seems to have linear

thought progression; her memory seems intact. She claims no history of drug or alcohol abuse, and she

does not identify a history of trauma.

Helen says that other than chronic back pain from an old injury, which she manages with

acetaminophen as needed, she is in good health. Helen has worked full time at a hospital in the billing

department since graduating from high school.

Her hu sband, John (60), works full time managing a grocery store and earns the larger portion of the

family income. She and John live with their three adult children in a 4 -bedroom house. Helen voices a

great deal of pride in the children. Alec, 27, is currently unemployed, which Helen attributes to the poor

economy. Dmitra, 23, whom Helen describes as smart, beautiful, and hardworking, works as a sales

consultant for a local department store. Athina, 18, is an honors student at a local college and earns

spending money as a hostess in a family friend’s restaurant; Helen describes her as adorable and

reliable.

In our first session, I explained to Helen that I was an advanced year intern completing my second field

placement at the agency. I told her I worked closely with my field supervisor to provide the best care

possible. She said that was fine, congratulated me on advancing my career, and then began talking. I

listened for the reasons Helen came to speak with me.

I asked Helen about her community, which, she expl ained, centered on the activities of the Greek

Orthodox Church. She and John were married in that church and attend services weekly. She expects

that her children will also eventually wed there. Her children, she explained, are religious but do not

regular ly go to church because they are very busy. She believes that the children are too busy to be

expected to help around the house.

Helen shops, cooks, and cleans for the family, and John sees to yard care and maintains the family’s

cars. When I asked whether the children contributed to the finances of the home, Helen looked shocked

and said that John would find it deeply insulting to take money from his children. As Helen described her

life, I surmised that the Petrakis family holds strong family bonds within a large and supportive

community.

Helen is responsible for the care of John’s 81 -year -old widowed mother, Magda, who lives in an

apartment 30 minutes away. Until recently, Magda was self -sufficient, coming for weekly family dinners

and driving herself sho pping and to church. But 6 months ago, she fell and broke her hip and was also

recently diagnosed with early signs of dementia. Through their church, Helen and John hired a reliable

and trusted woman to check in on Magda a couple of days each week. Helen g oes to see Magda on the

other days, sometimes twice in one day, depending on Magda’s needs. She buys her food, cleans her home, pays her bills, and keeps track of her medications. Helen says she would like to have the helper

come in more often, but she can not afford it. The money to pay for help is coming out of the couple’s

vacations savings. Caring for Magda makes Helen feel as if she is failing as a wife and mother because

she no longer has time to spend with her husband and children.

Helen sounded angry as she described the amount of time she gave toward Magda’s care. She has

stopped going shopping and out to eat with friends because she can no longer find the time. Lately, John

has expressed displeasure with meals at home, as Helen has been cooking less often and brings home

takeout. She sounded defeated when she described an incident in which her son, Alec, expressed

disappointment in her because she could not provide him with clean laundry.

When she cried in response, he offered to help care for his gr andmother. Alec proposed moving in with

Magda. Helen wondered if asking Alec to stay with his grandmother might be good for all of them. John

and Alec had been arguing lately, and Alec and his grandmother had always been very fond of each

other. Helen thou ght she could offer Alec the money she gave Magda’s helper. I responded that I

thought Helen and Alec were using creative problem solving and utilizing their resources well in crafting

a plan. I said that Helen seemed to find good solutions within her fami ly and culture.

Helen appeared concerned as I said this, and I surmised that she was reluctant to impose on her son

because she and her husband seemed to value providing for their children’s needs rather th an expecting

them to contribute resources. Helen ended the session agreeing to consider the solution we discussed

to ease the stress of caring for Magda.

The Petrakis Family Magda Petrakis: mother of John Petrakis, 81 John Petrakis: father, 60 Helen Petrak is:

mother, 52 Alec Petrakis: son, 27 Dmitra Petrakis: daughter, 23 Athina Petrakis: daughter, 18

In our second session, Helen said that her son again mentioned that he saw how overwhelmed she was

and wanted to help care for Magda. While Helen was not sure this was the best idea, she saw how it

might be helpful for a short time. Nonetheless, her instincts were still telling her that this could be a bad

plan.

Helen worried about changing the arrangements as they were and seemed reluctant to step away from

he r integral role in Magda’s care, despite the pain it was causing her. In this session, I helped Helen

begin to explore her feelings and assumptions about her role as a caretaker in the family. Helen did not

seem able to identify her expectations of herself as a caretaker. She did, however, resolve her

ambivalence about Alec’s offer to care for Magda.

By the end of the session, Helen agreed to have Alec live with his grandmother. In our third session,

Helen briskly walked into the room and announced that Ale c had moved in with Magda and it was a

disaster. Since the move, Helen had had to be at the apartment at least once daily to intervene with

emergencies.

Magda called Helen at work the day after Alec moved in to ask Helen to pick up a refill of her

medicati ons at the pharmacy. Helen asked to speak to Alec, and Magda said he had gone out with two

friends the night before and had not come home yet. Helen left work immediately and drove to Magda’s

home. Helen angrily told me that she assumed that Magda misplace d the medications, but then she

began to cry and said that the medications were not misplaced, they were really gone. When she searched the apartment, Helen noticed that the cash box was empty and that Magda’s

checkbook was missing two checks. Helen determ ined that Magda was robbed, but because she did not

want to frighten her, she decided not to report the crime. Instead, Helen phoned the pharmacy and

explained that her mother -in-law, suffering from dementia, had accidently destroyed her medication

and wou ld need refills. She called Magda’s bank and learned that the checks had been cashed.

Helen cooked lunch for her motherin -law and ate it with her. When a tired and disheveled Alec arrived

back in the apartment, Helen quietly told her son about the robbery and reinforced the importance of

remaining in the building with Magda at night. Helen said that the events in Magda’s apartment were

repeated 2 days later.

By this time in the session Helen was furious. With her face red with rage and her hands shaking, sh e

told me that all this was my fault for suggesting that Alec’s presence in the apartment would benefit the

family. Jewelry from Greece, which had been in the family for generations, was now gone. Alec would

never be in this trouble if I had not told Helen he should be permitted to live with his grandmother.

Helen said she should know better than to talk to a stranger about private matters. Helen cried, and as I

sat and listened to her sobs, I was not sure whether to let her cry, give her a tissue, or inter rupt her. As

the session was nearing the end, Helen quickly told me that Alec has struggled with maintaining sobriety

since he was a teen.

He is currently on 2 years’ probation for possession and had recently completed a rehabilitation

program. Helen said she now realized Alec was stealing from his grandmother to support his drug habit.

She could not possibly tell her husband because he would hurt and humiliate Alec, and she would not

consider telling the police. Helen’s solution was to remove the valuables and medications from the

apartment and to visit twice a day to bring supplies and medicine and check on Alec and Magda. After

this session, it was unclear how to proceed with Helen.

I asked my field instructor for help. I explained that I had offered supp ort for a possible solution to

Helen’s difficulties and stress. In rereading the progress notes in Helen’s chart, I realized I had

misinterpreted Helen’s reluctance to ask Alec to move in with his grandmother. I felt terrible about

pushing Helen into actin g outside of her own instincts. My field instructor reminded me that I had not

forced Helen to act as she had and that no one was responsible for the actions of another person.

She told me that beginning social workers do make mistakes and that my errors w ere part of a learning

process and were not irreparable. I was reminded that advising Helen, or any client, is ill -advised. My

field instructor expressed concern about my ethical and legal obligations to protect Magda. She

suggested that I call the county office on aging and adult services to research my duty to report, and to

speak to the agency director about my ethical and legal obligations in this case.

In our fourth session, Helen apologized for missing a previous appointment with me. She said she

awok e the morning of the appointment with tightness in her chest and a feeling that her heart was

racing. John drove Helen to the emergency room at the hospital in which she works. By the time Helen

got to the hospital, she could not catch her breath and thought she might pass out. The hospital ran

tests but found no conclusive organic reason to explain Helen’s symptoms. I asked Helen how she felt

now. She said that since her visit to the hospital, she continues to experience shortness of breath,

usually in the morning when she is getting ready to begin her day. She said she has trouble staying

asleep, waking two to four times each night, and she feels tired during the day. Working is hard because she is more for getful than she has ever been. Her back is giving her trouble, too. Helen said that she

feels like her body is one big tired knot. I suggested that her symptoms could indicate anxiety and she

might want to consider seeing a psychiatrist for an evaluation. I told Helen it would make sense, given

the pressures in her life, that she felt anxiety. I said that she and I could develop a treatment plan to

help her address the anxiety. Helen’s therapy goals include removing Alec from Magda’s apartment and

speaking to John about a safe and supported living arrangement for Magda.