Systemic assessment of the Atreides family

A fun and personally gratifying look at how Paul, Chani, Irulan, and the rest of the Atreides clan would look to a systemic therapist.

As a final assignment in my preclinical class on Systemic Evaluation, I was asked to write a Systemic Assessment report of a fictional family. As a congenital geek, I of course selected the Atreides family from Dune. What started out as a fun take on the subject turned out to be a really interesting in-depth look at cultural and religious considerations, trauma, substance use and abuse, and potential therapist bias with respect to nontraditional relationships. What we're left with is a systemic therapist dropped into an unfamiliar and literally alien context. How will we do?

---

The following Systemic Assessment Report (SAR) was written for the Atreides family from Frank Herbert’s Dune saga. I chose this family because it was an interesting exploration of several concepts presented in classes on the fundamentals of MFT theory: namely, (1) the therapist’s obligation to manage their personal bias and respect values and traditions outside their own experience, and (2) the application and limitations of conventional assessment tools and therapeutic approaches in the context of a non-Western/indigenous belief system and a (nominally) open marriage between the spouses. Although I have taken some liberties with this fictional family, as described below, the SAR refers to the Atreides family at a point in the second novel, Dune Messiah. Briefly, Paul Atreides has usurped the Emperor of the known universe and is revered as messiah to the indigenous people of the planet Arrakis, the Fremen, thereby unleashing a universal jihad which has killed 61 billion people. He is nominally married to the previous Emperor’s daughter, Irulan, but is not sexually involved with her and instead maintains the marriage as a link to the imperial position. Instead, he and his Fremen “concubine,” Chani, are trying to produce an heir, which has thus far been unsuccessful as Irulan has been adding contraceptives to Chani’s food. (Chani, who is suspicious of Irulan, has switched to a traditional Fremen fertility diet, which prevents the contanimation.) Paul is fully aware of this intringue, but allows it to continue due to prescient visions that Chani will die in childbirth. I have elected to focus on this fear as the family’s presenting problem, and have assumed that, as the SAR was written in a therapy session soon after the intake interview, the therapist is unaware of the various character’s machinations. For the purposes of this SAR, I have included Paul, Chani, and Irulan, as well as Paul’s mother Jessica and sister Alia, as clients. In-universe, Jessica and Alia share Paul’s prescience, albeit to a lesser degree, and do not co-habitate with the three spouses, but are closely involved in their affairs.

It was difficult to decide how to integrate Herbert’s science-fiction plot and characterizations with a reality amenable to family therapy. Doing so involved some trade-offs: I have retained the positions and personalities of these characters but de-emphasized the sci-fi aspects, including the off-world setting and prescience. I felt that it was interesting to take a skeptical position with respect to the latter, treating the prescient abilities of Paul, Jessica, and Alia as possibly indicative of schizophrenia, and casting them in the context of their religio-cultural beliefs. I have also included Paul’s blindness – which occurs after Chani’s death in the novel – as an important detail, since this enables me to address it as part of the Needs Assessment. It is my hope that the reader – particularly one who is familiar with the Dune saga – will overlook these compromises and view the SAR as an interesting hypothetical scenario.

---

Family demographics

The “identified patient” (IP) is Paul, 43, a religious and political leader and head of mélange trading for a large mercantile organization. Paul’s immediate family members include his official (aristocratic) spouse, Irulan, 39, and his “concubine” or unofficial spouse, Chani, 41. These clients cohabitate in a large palatial complex. All clients have adopted Chani’s indigenous Fremen culture, and all observe the traditional Fremen religion to varying degrees. Non-cohabitating family members include the IP’s mother, Jessica, 64, and sister, Alia, 31. Chani, Jessica, and Alia hold various roles in the Fremen clergy. Jessica and Alia are also clergy in the Bene Gesserit religion; all clients cite their religion and culture as predominant influences on their activities and values. Chani, Irulan, and Alia are also employed as administrators for the Atreides government, and Irulan additionally serves as an annalist for the Atreides theocratic regime, including writing and teaching on Fremen mythology and acting as Paul’s hagiographer.

Assessments administered

Client assessments were selected based on Structural and Bowen family therapy models and included evaluation of intergenerational patterns via genogram; family structure, organization, and functioning via the Family Assessment Device (FAD); satisfaction and consensus among the three members of the spousal subsystem via the Revised Dyadic Adjustment Scale (RDAS); and individual risk for suicide, depression, and anxiety via the Culturally-Sensitive Assessment of Suicide Risk (CARS), and Beck Depression (BDI-II) and Anxiety (BAI) Inventories. The genogram is a diagram of intergenerational relational, cultural, and biological patterns which originates in Bowen family systems theory but has since been adopted by practitioners using a variety of therapeutic models. The present genogram was completed for three generations based on input from all five clients during the second intake session, using a standardized family genogram interview format. All clients also individually completed the FAD, a widely used 60-item self-report questionnaire based on the McMaster Model. It assesses perceived family functioning with respect to familial problem solving, communication, roles, affective responsiveness and involvement, behavioral control, and overall (general) family functioning, and can be used to identify at-risk families based on established cutoff scores. The FAD was selected for this case on the basis of its strong history of implementation, research support, and cross-cultural validity, the latter of which was a principal consideration in regard to the current clients.

The three members of the spousal subsystem also completed the RDAS, a brief assessment which examines relational patterns of spousal interaction including evaluation of spousal consensus, affection, sexual relations, and spousal confidence, and can indicate subjective estimates of marital satisfaction or distress. As with the FAD, cutoff scores for identification of potentially dysfunctional spousal systems have been established for the RDAS via rigorous quantitative research and meta-analysis, and, like the FAD, the validity of the RDAS has been established across several cultures and contexts. Both considerations suggested its selection for administration in the current case.

Additionally, given the affective nature of the client-identified presenting problem, and the possibility of substance (mélange) abuse by several family members, all clients individually completed assessments for risk of depression, anxiety, and suicide using the BDI-II, BAI, and CARS, respectively. The BDI-II is a 21-item self-report questionnaire which assesses depressive symptoms in individuals, with an emphasis on negative cognitive distortions as well as somatic symptoms such as agitation, changes in appetite, and fatigue. The BAI also consists of 21 self-report items and is intended to discriminate anxiety symptoms from those of depression, given the comorbidity and high degrees of symptom overlap between those mood disorders. The BDI-II and BAI exhibit high degrees of construct and content validity and have been validated across cultures, with the caveat that some ethnic groups exhibit greater somatization of affective symptoms. The CARS inventory is a 52-item self-report questionnaire to assess individuals for suicidal ideation and risk; it was designed for consistency and applicability across cultural and ethnic populations and has been shown to exhibit high convergent validity with the BDI-II and other suicide risk assessments.

Finally, a Needs Assessment was conducted to identify need gaps with respect to medical treatment, sustenance, and concurrent therapies. This interview followed an agency-standard protocol and included assessment within the domains of anger and substance abuse management and other counseling; employment, burial, medical, clothing, transportation, housing/shelter, and food needs; citizenship and legal assistance; and parent education and peer guidance. All clients participated in the Needs Assessment interview.

Purpose for Referral

The clients presented to therapy due to Paul’s “ongoing visions and nightmares” of Chani’s death in childbirth. Paul endorses wanting to “move past” these fears, but sees “[his] path [as] set and inevitable.” Jessica also notes tension between Irulan, Chani, and Alia, and Paul and Alia’s perceived abuse of mélange (“spice”), as secondary concerns. Alia states that coming to therapy was her “mother’s idea”; however, all family members state that they are dedicated to “making the family work” and are willing to attend therapy, as well as “tending to” any matters which achieve this end.

Background Information

An intake interview with the clients revealed several patterns of intense trauma, grief, guilt, and resentment among all family members which contribute to latent discord among the family members, and which are responsible for anxiety within and among the familial subsystems. This anxiety may contribute to Paul’s fears of losing Chani in childbirth (the client-identified presenting problem).

Trauma/Abuse History (recent and past): Paul states that he was trained in military tactics and combat from an early age and reveals that he was subjected to painful and emotionally-traumatic tests by his mother’s Bene Gesserit superior. Soon after relocating to Arrakis from Caladan, Paul and his parents were betrayed by the family physician to a rival family, the Harkonnens, and the resulting war resulted in Paul’s father being captured and killed. Paul and Jessica were able to escape into the surrounding desert and were taken in by an indigenous tribe, the Fremen. Due to Fremen custom, Paul was forced to prove his manhood and gain acceptance into the tribe by fighting and killing a Fremen warrior, an event which Paul still views with remorse, since, despite his military training, he “had never killed a man.” Over the ensuing years, Paul felt pressured to assume the highest leadership position among the Fremen by (1) engaging in guerrilla offensives against Harkonnen and imperial units and (2) consuming large amounts of highly-addictive mélange, which Fremen and Bene Gesserit culture holds to enhance supernatural abilities. These experiences ultimately led to Paul’s victory in warfare, culminating in a ritualistic knife fight in which Paul was again forced to kill a representative of the Harkonnens in hand-to-hand combat. His sister, Alia, states that she was compelled to murder another Harkonnen representative, in the same offensive, in order to protect herself and the lives of her mother and brother. Alia states that she was perhaps six years old at the time.

Paul also states that a later insurgent attack left him blind, but does not characterize the event as a “trauma.” He denies that his blindness incapacitates him to any significant degree, since he functions using his remaining senses. Paul also denies that the attack or his subsequent blindness increased his anxiety, either in general or specifically with respect to his fears for Chani.

Since assuming the Fremen leadership, the Fremen have continued jihadist warfare in Paul’s name, resulting in massive casualties. Paul and Alia endorse feeling “horrified” by their personal history of violence, and the continued instances of violence conducted by the Fremen, but agree that these past and present offenses were, and are, necessary, to protect the continued existence of their family, life, and culture.

Chani denies any history of trauma or abuse in childhood but describes her life in the desert, among the martial culture of the Fremen, as “arduous.” She cites the continual conservation of, and search for, water, which is somewhat plentiful but nevertheless conserved and even venerated in Fremen villages, as the most consistent stressor in her early years. She states that she and Paul had a miscarriage early in the marriage and endorses continuing guilt and grief over this loss. Paul agrees that he also experiences these feelings, and acknowledges that the experience may contribute to ongoing anxiety over the health of Chani and their future children.

Irulan was trained by the Bene Gesserit but did not attain Reverend Mother grade, and denies any personal history of trauma or abuse. Jessica states that her formative years as a Bene Gesserit dedicant were often difficult but does not believe any particular events were traumatic or abusive. Upon further questioning, however, she revealed that she continues to grieve the death of Paul’s father, with the proviso that, since she did not personally witness his death, she feels that this is more “ongoing grief” than a “trauma.” She and Irulan feel that the violence committed by the Atreides family, and by the Fremen as a whole, are “appalling but necessary” in their cultural contexts, which are characterized by religious (Jessica) and dynastic (Jessica and Irulan) beliefs and codes of ethics.

Substance Use/Abuse (current and past; self, family of origin, significant others): Use of mélange is endemic to both the Fremen and Caladanese cultures and Bene Gesserit religion. Consequently, all family members use “spice” routinely, adding it to their food and implementing it in religious and ethnic ceremonies. Chani and Irulan deny consuming mélange outside of these contexts. However, Alia, Paul, and Jessica admit consuming it in large quantities on a daily basis for religious reasons, and as Jessica uses high doses of mélange as part of her religious duties (both as a Bene Gesserit and a Fremen Reverend Mother), Alia was exposed to its effects in utero. Jessica expresses deep concern for Alia and Paul’s excessive “spice” consumption, and particularly for its effects on Alia, who she believes exhibits early signs of personality disintegration and irrationality known to accompany such doses (in Bene Gesserit parlance, “abomination”).

Related Historical Background: Paul states that his anxiety regarding Chani’s death began soon after he first met her, but increased markedly after the Atreides-Harkonnen truce, perhaps during the early years of the Fremen jihad. He states that he cannot link his fears to any particular precipitating event, and denies any recent life changes or novel stressors. All family members deny seeking previous treatment for any mental health issues, and deny any concomitant medical diagnoses, based on regular appointments with family physicians.

Family Life Cycle Stage: Paul and Chani (and Irulan, by age and association) are childbearing adults. Although they are currently childless due to a prior miscarriage, both Paul and Chani endorse wanting to have more children. Paul does not plan to have children with Irulan, his marriage to whom he regards as “a marriage of convenience.” He denies having any sexual relationship with her.

Family structure: The clients’ family structure must be contextualized by their aristocratic class, religio-cultural values and ethics, and the expectations which accompany them. Paul and Irulan state that their marriage was arranged as part of the Atreides-Harkonnen truce, through which the title of Emperor passed to Paul; consequently, Irulan endorses agreeing to the marriage with the (her own, implicit) understanding that she would bear the imperial heir apparent. Irulan states that she soon discovered that Paul is devoted to Chani and denies any relationship, physical or emotional, with Paul, who she states she is “in love with,” and admits to feelings of jealousy and resentment toward Chani. Chani and Paul agree that they are “deeply in love.” Although Chani and Alia both admit suspicion of Irulan, they state that they do not know why, and simultaneously express a reluctant respect for her character and “integrity.” Jessica, for her part, endorses “no strong feelings” toward Irulan, Chani, or the marital arrangement, but confesses that she sees parallels between this relationship and her own relationship to Paul’s father, to whom she was never married. Jessica worries that the jealousy and resentment of Irulan by Chani and Alia may manifest in “strife” within the household.

Results of Evaluations

Overall Observations

Other than the genogram interview, which required a separate session, clients completed the assessments over the span of approximately 50 minutes and had no questions. The clients did not generally answer the questions in sequential order, but approached each questionnaire methodically. Questionnaires were not administered in any particular order. All family members participated in the genogram and needs assessment interviews and completed the FAD, BDI-II, BAI, and CARS, but only Paul, Irulan, and Chani completed the RDAS. All clients denied having previously completed any of the assessments. All family members contributed substantially to discussions during the genogram and Needs Assessment interviews and openly provided thoughtful input during these conversations.

Genogram

The genogram is not a quantitative assessment but a pictorial representation of significant traits, relationships, and interactional patterns within and across generations. The interview followed the standardized format proposed by Platt and Skowron (2013). The genogram for the present clients consisted of three generations. Paul, Chani, Irulan, and Alia comprised the third (youngest) generation; their parents, including Jessica, the second generation; and their grandparents, the first generation. It was difficult for the family to assert any firm details regarding the eldest generation, due primarily to the fact that many females of both Paul and Irulan’s lineage were Bene Gesserit, and thus taken from their families for training at an early age. Additionally, parentage is a closely-guarded secret among the Bene Gesserit priestesshood. For example, Jessica is uncertain of the identity of her parents, although she suspects a Harkonnen father and is certain that her mother was Bene Gesserit, and states that she holds “deep hatred” for the Harkonnen for murdering her husband. Chani relates that her father, who was not Fremen, rarely spoke about her grandparents, and states that she knows little about them; her mother died in childbirth. Likewise, Paul states that he was too young to have a relationship with his paternal grandfather, and his paternal grandmother passed away before he was born. In the absence of a personal connection to these elders, most of the Atreides family articulate that they derive their personal sense of identity from a relationship with the family lineage in an abstract sense (Paul, Alia, and Chani) or with religio-cultural identity, whether Fremen (Chani) or Bene Gesserit (Jessica). Another pattern that emerges from the genogram is the tradition of concubinage in the Atreides line: Paul’s paternal grandmother, mother, and Chani were never officially married to their partners. The exception all the above observations is Irulan, whose mother, a Bene Gesserit, was married to her father (the previous Emperor) and with whom Irulan had a personal relationship. Irulan states that she derives her identity from association with imperial tradition, family lineage, and, she had hoped, as the future mother of the imperial heir-apparent. The use of mélange also recurs transgenerationally throughout the three main lineages, either in low, but life-long, doses in the form of additives to food or in cultural ceremony (Chani, her parents, and presumably her maternal grandparents, being Fremen), as part of Bene Gesserit ritual for those of the Reverend Mother grade or higher (Alia, Jessica, Jessica’s mother, Paul’s paternal grandmother, and Irulan’s mother and younger sister), or for both religious and personal use (Paul, Alia). Finally, transgenerational patterns of violence are evident in the genogram, with Paul’s father, Chani’s father, and Irulan’s paternal grandfather being murdered. Finally, several Bowenian patterns emerge from the genogram, including triangles between Paul and his parents and between Paul, Chani, and Irulan. All triangling linkages are close but not fused, with the exception of the Paul-Chani relationship, which is fused, the Chani-Irulan relationship, which is conflictual, and the Paul-Irulan relationship, which is estranged. Other interesting relational patterns include that between Irulan and her father, which was historically close but is now estranged; between Chani and her father, which was close; and between Jessica and Alia, which is conflictual and borders on estrangement. These findings suggest intergenerational patterns of violence, substance use, and disengagement due to a cultural and classist foundation of absent parentage, concubinage, and theocratic influence which manifest in the current clients in the form of substance abuse (Alia and Paul), spousal (Chani and Irulan) and parent-child conflict (Jessica and Alia), and possibly unexpressed grief for the loss of close relationships (Paul’s father/Jessica’s husband, Chani’s father, Irulan’s father). There is also a theme of a “speculative” kind of self-identity among most, if not all family members, who define themselves solely with respect to their personal and professional roles, and more abstractly with respect to an idea of “bloodline,” “duty,” or “lineage.”

FAD

Individual items on the FAD consist of a 4-point Likert scale in response to statements regarding family communication, problem solving, roles, affective responsiveness and involvement, behavioral control, and general family functioning, with 1 meaning “strongly disagree” and 4 “strongly agree.” Scores are averaged for each category and compared to scores typical of “stressed” (clinical) and “non-stressed” (non-clinical) families, in addition to “cut-off” scores which are interpreted as a benchmark at which symptoms may indicate potential family problems. Total FAD scores range from 53-212, and average FAD scores from 1.00-4.00, with higher total scores and averages indicating greater familial dysfunction and relational pathology. The current clients’ total scores and averages ranged from 91-132 of 212 and 1.57-2.49 of 4.00, respectively, with Irulan providing the highest total and average scores (132/2.49) and Jessica the lowest (83/1.57). Both Irulan and Jessica tended to be the maxima and minima, respectively, across FAD subscores. Jessica provided subscores which were below clinical cutoff values for all domains, suggesting that she did not view any domains as extremely concerning. However, all family members, including Jessica, reported Roles (1.13-1.88) and Behavioral Control subscores (1.22-1.67) which were below clinical cutoff values (2.30, 1.90), indicating that all clients assess that the family exhibits organized patterns of behavior with established behavioral expectations and that all members maintain these standards. Family members other than Jessica provided Communication (2.00-3.17), Affective Responsiveness (2.17-3.50), and Affective Involvement subscores (2.14-2.71) which were close to, or exceeded, clinical cutoffs (2.20, 2.20, and 2.10), indicating that these are dimensions of clinical significance. These results suggest that the clients, excluding Jessica, assess that the family is characterized by unclear messaging and a lack of appropriate emotional interest and involvement in each other’s affairs. Finally, Paul, Irulan, and Alia provided General Family Functioning subscores (2.00-2.92) which met or exceeded clinical cutoff thresholds (2.00), indicating overall concerns with familial relational patterns and functionality. Conversely, Chani, who contributed supra-cutoff scores in other domains, rated family functioning at 1.75, indicating an assessment that, from her perspective, the family functions well overall, despite some relational problems.

RDAS

The three cohabitating members of the spousal subsystem (Paul, Irulan, and Chani) each completed the RDAS twice in order to assess the two pairwise relationships of each member. Individual items on the RDAS consist of 5-point Likert scales in response to statements or questions regarding consensus in personal values, displays of affection, and decision making; relational satisfaction in conflict resolution and stability; and cohesion in discussion and activities. RDAS scores range from 0-69, with scores < 47 indicating potential marital or relational distress. Paul and Chani exhibited high total RDAS scores of 56 and 57, respectively, out of 69, indicating general cohesion and satisfaction within their relationship. Conversely, total scores for Paul and Irulan (45 and 43) and Chani and Irulan (33 and 36) indicated moderate to low cohesion in their relationships. RDAS “Consensus” subscores for Decision Making and Values were high (8-10 of 10) for all six pairwise relationships, and moderate to high for all pairwise relationships with respect to “Satisfaction” subscore for Stability (7-10, with the lowest score, 7, provided by Chani with respect to Irulan). Chani and Paul also received high ratings (8-10) with respect to “Consensus” subscores for Displays of Affection, “Satisfaction” subscores for Conflict (8), and “Cohesion” subscores for Discussion (8). Chani and Irulan received moderate to high scores (7-8) for “Satisfaction–Stability” but low to moderate scores for “Satisfaction–Conflict” (5-7). The Paul-Irulan relationship also exhibited low “Consensus–Affection” (0-2) and low to moderate “Satisfaction–Conflict” scores (5-7). Finally, all pairwise relationships exhibited low “Cohesion” subscores with respect to shared Activities (2-4). These results are indicative of relationships which are stable in that members are able to reach a general consensus on daily decisions and generally agree with respect to roles and values; however, these clients appear to share few outside interests and, in the case of Paul and Irulan and Irulan and Chani, are detached/disengaged (both), bordering on conflictual (Irulan/Chani), and lacking in affection (Paul/Irulan).

CARS

Individual items on the CARS consist of 6-point Likert scales in response to statements regarding family conflict, social support, sexual, acculturative, and nonspecific minority distress, cultural consequences of suicide, and emotional, somatic, and active ideation of suicide, with higher scores corresponding to a greater risk or suicide or a suicide attempt. Clients completed an abbreviated screening version of the CARS (CARS-S), consisting of 14 self-report items, and all denied current or recent suicidal ideation prior to completing the assessment. All family members endorsed mild to moderate degrees of familial conflict, but held social, religious, and moral objections to suicide. Paul and Alia reported a moderate lack of connection to others and moderate headaches, which may reflect somatization of anxiety, and Alia additionally reported moderate feelings of shame and mild ideation of suicide “in the past.” Irulan and Chani received the highest CARS scores, at 10 and 8, respectively. Irulan cited familial conflict, a lack of familial socialization and support, and feelings that she had disappointed her family as potential issues. However, no family members met the threshold for concern for risk of suicide.

BDI-II

Items on the BDI-II consist of four possible responses with respect to feelings of guilt, sadness, pessimism, failure, and criticism or disappointment in oneself. Clients are instructed to select one response in each category which best reflects their experience over the previous two weeks. Scores on the BDI-II range from 0-63, with scores ≥ 17 considered a threshold for “borderline” clinical depression and scores ≥ 31 or ≥ 40 indicating “severe” or “extreme” clinical depression, respectively. BDI-II scores for Chani and Jessica were within normative range: Chani, with a total score of 6, reported mild feelings of guilt, disappointment, agitation, loss of energy, and decreased appetite, and Jessica, with a total score of 5, noted mild feelings of sadness, loss of pleasure, crying, decreased interest in sex, and a feeling of being punished. Irulan received a total BDI-II score of 11, indicating a “mild mood disturbance,” due to mild episodes of sadness, crying, some increase in sleep duration, decreased pleasure, and a sense of pessimism and of being punished; mild-to-moderate agitation; and complete lack of appetite. Paul received a BDI-II score of 14, indicating a “mild mood disturbance” which does not meet the established threshold for clinical depression, due to mild symptoms of sadness, guilt, self-criticism, restlessness, sleeplessness, irritability, and loss of appetite, and moderate symptoms of pessimism, anhedonia, and disappointment. Alia received a BDI-II score of 27, indicating a “moderate clinical depression,” due to mild symptoms of sadness, pessimism, and anhedonia; moderate symptoms of guilt, expectation of punishment, disappointment and self-criticism, loss of interest, and lack of concentration; and severe symptoms of agitation, sleeplessness, irritability, and loss of appetite. These results thus indicate that Irulan and Paul are experiencing mild anhedonia with some somatization, but which do not meet established criteria for clinical depression, whereas Alia meets the threshold for moderate clinical depression with more severe somatization of symptoms. Other family members fall within the normative affective range for the BDI-II.

BAI

Similar to the BDI-II, items on the BAI consist of four possible responses pertaining to the degree to which symptoms such as nervousness, trembling or shakiness, difficulty breathing, dizziness, and abdominal discomfort have “bothered” a client (ranging from “not at all” to “severely”) over the previous week. BAI scores range from 0-63, with scores ≥ 8, ≥ 16, and ≥ 26 indicating “mild,” “moderate,” or “severe” anxiety, respectively. BAI scores for Jessica, Irulan, and Chani were within normative ranges, at 2, 1, and 1, respectively. These clients reported symptoms of agitation and/or nervousness (Jessica, Irulan) or abdominal discomfort (Chani), which were all rated as “mildly bothersome” and are not specific to a mood disorder. Paul and Alia received scores of 10 and 12, respectively, indicating “mild anxiety.” Paul reported mild symptoms of numbness and unsteadiness and moderate symptoms of dizziness and fear of losing control, dying, and event outcomes. Alia reported mild symptoms of unsteadiness, hands trembling, fear of dying, and inability to relax, and moderate symptoms of numbness, nervousness, and fear of losing control and event outcomes. These findings may suggest a need to address Paul and Alia’s anxiety in therapeutic planning. All other clients were normative for the BAI.

Needs Assessment

All family members declined assistance with basic life needs including burial, food, shelter, clothing, employment, or citizenship. Jessica noted (somewhat pointedly) that the family was “already well-placed and in need of nothing of that sort.” Alia agreed to a referral for concurrent substance abuse counseling but appeared slightly repulsed by the idea. Likewise, Paul agreed to referral to an external aide agency for assistance with daily tasks due to his blindness, although he insisted that he had no trouble “navigating through life.” He refused a referral to concurrent counseling for substance abuse.

Summary and Recommendations

The clients presented to therapy for assistance with Paul’s fear of losing Chani in childbirth; tension between Irulan, Chani, and Alia; and perceived substance abuse by Paul and Alia. The family history and genogram interview indicate patterns of trauma, violence, familial estrangement, and substance abuse both in the context of the current clients and in their ancestry. All family members, excepting Irulan, have been perpetrators of violence – even in childhood or late adolescence – and all have lost parents or grandparents to assassination and warfare, much of which continues in the jihadist offensives conducted in Paul’s name by the Fremen. This loss of family members to violence is coupled with theocratic, classist, and institutional traditions, including concubinage and sequestration of female children for religious training, meaning that many of the clients can only define their personal identities in the context of abstract concepts such as familial lineage, duty, and ethnicity or origin. In three instances – Chani’s miscarriage, the murder of Chani’s father, and that of Paul’s father, who was also Jessica’s unofficial spouse – the survivors are left with continuing and unaddressed grief, often compounded by guilt. Irulan’s identity seems to be contextualized by her imperial heritage and the prospect of bearing the imperial heir-apparent, a prospect which was frustrated by the absence of a sexual relationship with Paul, her official husband, whom she professes to love. This loss is intensified by her isolation from the other family members, who respect her integrity but do not involve her in family matters, and her forced estrangement from her father, with whom she has no contact due to political banishment. The clients’ responses on the FAD and RDAS appear to confirm a homeostasis characterized by rigid boundaries, roles, expectations, and responsibilities, and although the family is capable of reaching consensus on “family business” issues, there is limited personal or emotional communication and little overlap between members’ interests, even among the closest members (Paul and Chani). The tension and emotional conflict between Irulan, Chani, and Alia, as well as the lack of a medium in which to express their individual grief, reinforce this disengagement and further isolate the family members. It is possible that Paul’s fear of losing Chani, and Paul and Alia’s excessive use of mélange, are manifestations of – and intensify – these issues of identity (lineage and duty), isolation, and a fear of losing control and loved ones (arising from unexpressed grief and past traumas). It should also be noted that Paul, Alia, and Jessica all endorse experiencing presentient visions, reclusiveness, symptoms of depression, and somewhat unusual behavior which may be indicative of a genetic predisposition to mental illness, or, alternatively, symptoms of cultural beliefs or values or the effects of mélange. It is also possible that these symptoms are exacerbated by mélange use; however, it is difficult to extricate their individual beliefs from their religious and cultural influences, although their beliefs are shared, to some degree, among all family members, but only Paul, Alia, and Jessica exhibit symptoms to such extremes.

It is recommended that therapeutic planning for these clients include addressing the above issues of identity, grief, guilt, and emotional isolation from a Structuralist, Bowenian, or Symbolic-Experiential perspective. Attention should also be given to the mild to moderate affective/depressive and anxiety symptoms exhibited by Alia, Irulan, and Paul, using either these models, a Cognitive-Behavioral approach, or concurrent counseling in tandem with family therapy. Referral to a specialist team for evaluation and treatment of Paul, Alia, and Jessica’s possible psychotic symptoms, as noted above, should also be considered. Finally, follow-up with the clients regarding Paul and Alia’s referrals for concurrent substance abuse counseling and medical needs (blindness) is recommended.