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A family had a 10-year-old daughter with severe chronic asthma. She spent about four to seven days each month in hospital, where her condition would settle rapidly and respond to treatment, but once home her symptoms would return and be unresponsive to nebuliser and corticosteroid treatment.

The parents, the patient and her two younger brothers came for an assessment. The father closed the office window in case their daughter might "be in a draught" (overprotection). All questions directed at any of the children about school or interests were answered by the parents, usually the mother (enmeshment). The father repeatedly involved himself in correcting and adding to the free drawings his sons were quietly engaged in. On several occasions minor disagreements occurred between the parents -- for example, when and where they might go on holiday. Attempts by the therapist to get the parents to elaborate and solve these disagreements led to the "patient" asking for her puffer, with a move in focus on to her and the suggestion that she might need to go back to the ward (detouring of conflict).

Throughout the meeting the girl sat attentively on the edge of a swivel chair that she had raised to maximum height between her parents.

Subsequent family, then parent, therapy revealed a longstanding marital conflict between the parents regarding their sexual relationship and desire for children, with both parents having anxiety and low self-esteem. At follow-up two years later the girl's asthma had stabilised on regular prophylactic inhaled medication and she had had only one hospital admission (for an episode of bronchitis).

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