Case Study Therapeutic Double Binds

The techniques used in this family therapy involved: therapeutic double-binds (prescribing the symptoms), externalization, reframing, enactments, cognitive change and behavior change.
The therapeutic double-binds enacted in this therapy were: Either Rachel goes through to therapy and begins feeling/acting more like a woman in various aspects but causing her dad to feel alienation and feeding into a vicious cycle (e.g. the dad turns to the surrogate son, Roy, while her mother feels more alone and turns more to her own family), or Rachel continues starving herself and being the mediator in her parent’s marriage; Rachel was tasked with keeping herself miserable by the therapist even though she clearly wants to be happy.
Regarding the first double-bind,
She was given the task of listening to Rachel complain about her unhappiness by having Rachel call her mother every time she experienced such feelings. The purpose was to have her mother be okay with having unhappy children and not try to fix every problem her children presented and thus not be as overinvolved as before. This worked out wonderfully, with Rachel’s mother becoming bored with Rachel’s complaints and stopped trying to cheer her up and give her advice.
One of the first things done in the therapy was externalize Rachel’s eating disorder in relation to the family. This allowed the family to see the importance of the role they played, how they contributed to it, and how they maintained the symptomatic behaviors that Rachel portrayed. Rachel’s lack of autonomy was shown to be as a result of the familial rigidity exerted upon her and the role of mediator she took with her parents, thus allowing her sisters to live more independent and autonomous lives, which resulted in them seemingly being much happier than
The major contributors to those cognitive changes were the group telling the therapist when to change her stance (e.g. taking a counter stance, encouraging an action). In Stage 6, the therapist stated that she was reprimanded for suggesting too many enjoyable behaviors for Rachel to engage in that would make her happy. This triggered Sandy to understand why the therapist was being asked t hold back because of their parent’s involvements and reactions when Rachel is happy. Rachel’s cognitions were challenged in a major way in Stage 7, with Rachel considering possible outcomes were she to allow herself to feel happy. Another instance in Stage 8 had the therapist contribute to the merriment and enjoyment that was occurring with the sisters but switch her stance to counter it and worry about a regression. This lead to Rachel considered all the possibilities and then Rachel stating she was confident that she could handle those possibilities. Once again, this is a large indicator of cognitive (as well as behavioral