family therapy

Mr. and Mrs. Lahud have come to the clinic to initiate family therapy. The whole family is under stress because their youngest daughter, 10-year-old Elia, loses her temper “almost constantly,” the parents say.
“In fact, she seems to be always seething under the surface, even when she’s laughing and seeming to have a good time, just waiting to explode. She argues about the simplest things you can try to give her choices, like, instead of saying, ‘time to get dressed for school,’ you might say, ‘Elia, do you want your green sweater or your yellow one today?’ She just starts screaming and says, ‘You can’t tell me to get dressed!’ And she’s ten.”
Jaival, their new therapist, asks, “Can you tell me how often, on average, you’d say Elia loses her temper? Can you make an average guess at, say, how many times a week?”
Elia’s mother says, “It would be easier to estimate how many times per day.”
Mr. Lahud nods, “Yes, I’d say about 18 times a day, at least once for every hour that she’s awake.”
“And that’s on a daily basis?” says Jaival.
Both parents nod without hesitation.
“How long has it been like this?”
“Well,” Mrs. Lahud tilts her head. “She was always kind of a fussy baby. She’s never slept much and has just kind of always thrown tantrums and never stopped.”
Jaival takes some notes and then asks, “Is there anything else about her behavior that fits a pattern that’s fairly long-standing?”
Mr. Lahud sighs. “It just feels like she wants a big fight, then blames everyone else for something that she started-even when it’s clear no one else is even participating in the fight. It’s getting to be really hard on the other two kids because she just never lets up from the time she wakes up until late into the night; she tries to annoy us and them pretty equally, and now they’re having trouble with her at school too. She’s not getting along with other kids there either.
“We’ve tried positive reinforcement, like a sticker chart for good behavior—”