Pre-Administration Family consultation
James Riva, Jr.
June 5, 1974

Mr. and Mrs. James Riva, the identified patient James. Jr age
17, and brother Peter, age 15, attended a family meeting at the
recommendation of Dr. Robert Hopkins after father had requested son's
admission to McLean. Originally the patient's therapist.
Dr. Jeffrey Green o the Brockton Drug Center, had referred the
patient to the Beth Israel for an inpatient evaluation. The patient
was supposedly scheduled there for an admission on 6/3/74. However,
when no bed was available, Ms. Judith Tovin social worker at Bet
Israel, contacted Ms. Tikvah Portnoi of the Children's Center, who
referred the case to adult services.

At the beginning of the session, Jim was very sullen and both mother
and Peter were the vocal members of the group. However, towards the
end of the session, Jim began to open up and talk about himself and
his relationship with his mother and at the vey end father became
a very active participant. Bot of the brothers accused mother of
being "crazy" in that she has beaten them for many years as she
experiences "frequent temper tantrums". Mother tends to minimize
these temper outbursts and denies having beaten he children.
Father more less corroborates the boys accusations and admits
that he beat hem using his belt as a strap and only stopped this
practice about a year and a half ago. At that time he was being
used as mother's tool for carrying out her erratic efforts at
discipline.

Jim dates his troubles to the 6th grade although mother says that
even in kindergarten there were complaints about his behavior in
that he couldn't sit still and in the first grade he was sent to
the guidance counselor. Jim admits to having taken a variety of
drugs for the past several years but states that for the past three
weeks he has stopped this practice and became a vegetarian. However,
he has not been able to stop himself from stealing which he has also
been doing for several years and it is because of his inability to
control this impulse that he is seeking help. Jim has stolen a
variety of things. In march, 1974, he stole pills from a doctor's
office in Plymouth and at that time he was expelled from the
Plymouth school system. He had been living with a maternal aunt
there since July, 1973, when he an away rom home. Since return-
ing to the Marshfield schools where he is supposedly in his junior
year, he has taken tape recorders, a watch, etc., all of which are
still at home as he is afraid to return them as he is worried he
would be expelled. In May, 1974, Jim and his bother, Peter, were
both charged with stealing a small boat and breaking and entering
a shed. Then on 6/2/74 Jim was caught stealing smoke bombs from
behind the police station and currently both he and Peter have
court charges pending for July 24, 1974.

Peter minimized his own stealing habits and infers that he just
does this to be one of the boys. Last week he stole some car
speakers from Bradley's and since then has been restricted by the
police from going to the Hanover Mall. He admits to heavy drug
use especially marijuana. He acknowledged that the first two
semesters of school he was "stoned" every day and, therefore,
unable to function in school. However, he recently cut this prac-
tice out although he still smokes grass on weekends. Both boys
have also taken barbiturates and LSD and insinuate that mother has
taken amphetamines in an effort to control her weight problem.

All seemed to agree that Jim's behavior has been very erratic and
he is subject to mood swings.

In 1970 the patient's parents separated for three months when father
moved out of the house. At that time divorce proceedings were in-
stituted and the court recommended marital counseling for the
parents. They went to a court clinic for about six weeks and then
reconciled. Later on, when Jim was seeing Dr. Jeffrey Green, he
referred them to family counseling service but father claims
that the social worker suggested he might like a different therapist
as the sessions were not useful. These were the only two abortive
efforts the couple made for treatment. Both Jim and Peter have
seen Dr. Jeffrey Green at the Brockton Drug center off and on. Jim
terminated with Dr. Green when he ran away to Plymouth. There he
was supposed to see Dr. Keville at Plymouth Mental Health Center but he
never followed through.

During the course of the session, mother reported that Jim was
worried about father being homosexual. This was quite a surprise
to Peter. Peter admitted that he himself had problems communicating
with father but he never thought the father was homosexual. Father
minimizes any sexual problems but Jim did not seem reassured about
this worry. The parents sex life was not explored. Apparently
the routine is that father leaves early in the morning and comes
home about 6 or 7 o'clock. He works as an electrical contractor.
Mother teaches school and when she returns takes a nap in the
afternoon. She then usually sees various girl friends and has
dramatic interests. father says that mother is frequently out
till 3a.m. and, therefor is so tired when she comes home
after school.

PLANS FOR ADMISSION

Although initially quite resistant, Jim seems quite eager to
come to the hospital especially after seeing the Admission ward.
He acknowledged his inability to control his impulse to steal but
denies his other problems mentioned such as his becoming overly
excited, his useless projects, his religion and food kicks, etc.
Peter on his part is uncertain that Jim should come in the hospital
as he is unsure as to just who is crazy in the family and would
like that determined. Both parents want Jim in the hospital
as the situation is out of control at home. All the members of
the family have agreed to follow our recommendations and participate
in Jim's treatment program as recommended here. They were
told that the length of the stay would depend on the initial evaluation
here but that in all likelihood, regardless of how long
Jim stayed in the hospital, the entire family should be involved
in continued treatment.

Golda M. Edinburg, ACSW
GME/jy