Family Therapy - Mom & Son's Lost Weekend

Many of u.s.a. have experienced the complexity of a kid therapy case in which the parents are not amenable to modify. If the parents are resistant, the pathological parent-child relationship is highly unlikely to improve. In my own practise, I have constitute this to be an issue particularly with children who have been neglected and abused, but it arises in many of my child and adolescent cases, regardless of the presenting problem.

Certainly, when dealing with a child's confusing beliefs and a parent'south feelings of frustration or fifty-fifty clear hostility toward the child, the most successful intervention is ordinarily some form of family intervention. Family unit therapy has long been our chief approach to behavioral problems with children and adolescents, with stiff show of its efficacy. And the integration of family therapy and individual treatment has been standard exercise for years, as information technology is not uncommon for individual members of the family unit to require separate but parallel help.

But I have establish over the years that such parallel help is not always successful. In some cases, parental problems pose such serious difficulties for the child or boyish that a drastically different approach is necessary. Consider the angry eleven-year-old who has begun acting out, and who volition soon enter the wider, more demanding world of boyhood, where his difficulties with authority could hands escalate. If his parents are likewise hostile and uncooperative in therapy, it oftentimes becomes a question of fourth dimension; there may be some adventure that the parents would benefit from an intervention endeavor, merely not without the passage of more than time than the kid can afford.

The result becomes, and so:

When do we shift from trying to work inside the parent-child relationship to seeing the child equally a separate entity needing to find a way to protect him- or herself from the negative touch of a destructive parent?

When do we shift from trying to piece of work within the parent-child relationship to seeing the kid as a dissever entity needing to observe a way to protect him- or herself from the negative bear upon of a destructive parent?

3 Contrasting Cases

The following three cases exemplify how major differences in parent-kid relationships bear upon the treatment process with families, and how the child'due south perception of acceptance versus rejection is a central factor in this. Jane, the beginning case, has a female parent able to work separately on her own problems in a way that aids the family unit therapy procedure. The second case, Mike, is at the other end of the continuum with a totally destructive parent. The third example, Roberta, falls in the middle, where the parents are trying to be office of the family therapy attempt, but the adults' personal difficulties cake the therapeutic process. The parents of Jane and Roberta contacted me at my private office seeking help for their girls, while the mother of Mike came to a community clinic where the local courts often sent youngsters and their parents for assistance.

Jane

Jane's mother and father were in a abiding battle with nine-twelvemonth-sometime Jane as she fought every rule and requirement they imposed. She had become increasingly uncooperative in school, and her peers were rejecting her. Equally family treatment progressed with the use of behavioral contingencies, Jane's mother reported that she was unable to follow through on negative consequences: she had a bang-up deal of difficulty saying "no" to Jane. During an private session she explained that she wanted Jane to grow up to be her friend. She feared that being firm with her at present would make Jane "detest" her afterwards on. Jane'southward mother had had a very traumatic relationship with her own mother. Jane'due south maternal grandmother had a serious substance abuse problem and Jane'south female parent went through years of feeling aroused with her. The grandmother died without having reconciled with her girl. Jane's female parent'south painful past relationship with her own mother was controlling her perception of her girl ("she will larn to hate me"); in turn, this perception was interfering with her ability to be a parent to Jane.

This mother, although angry and frustrated, was bonded with her child and desired a better relationship; she was certainly not a hostile and rejecting parent. She was amenable to handling and learned in private piece of work how her past feel was interfering with her relationship with Jane beyond just the result of saying "no." She learned that changing Jane's current behavior required that she make some changes equally well. As Jane's mother worked on her own issues, the family unit work progressed quickly.

Mike

In contrast to Jane'due south story, Mike's mother followed a courtroom order to seek therapy for her 14-year-old male child who avoided school, stayed out as late as he wished, affiliated himself with a gang, and was finally arrested for stealing bikes from neighborhood children. The court placed him on probation with clear instructions that if he did non go to school, was non in his domicile by a specific fourth dimension in the evening, and/or connected any contact with the gang members, his probation would be revoked and he would be incarcerated in a juvenile facility. Mike felt that his mother hated him and wanted him "put away." His female parent refused to attend family unit or individual sessions herself, stating that merely Mike needed help. She frequently called the probation officer to mutter about Mike'south behavior and avoided contact with me. Many of her complaints nearly Mike were issues that could have been handled by working straight with her and Mike together, with the help of his probation officeholder. I explained my professional person opinion to his mother, just she refused to be involved. She stated that she did not take the time and believed that Mike was just "evil."

Nosotros had started family handling past working out an agreement regarding what was expected of Mike (e.grand., getting himself to school on fourth dimension, when to be dwelling, the kids he had to avoid, the kids he could spend fourth dimension with) and what his mother should do to reward his cooperation (increasing his allowance and TV game time were the "rewards" he wanted). Mike's mother, unfortunately, failed to cooperate with this agreement; this, combined with her emotional rejection of him, led to Mike seeing the agreement as a farce.

His mother'south view of him had determined Mike's view of himself, which factored significantly into his destructive behaviors. He felt rejected by his female parent and struggled with feelings of worthlessness as a result. On ane level, he appeared to blame his female parent, and fabricated aroused statements about how wrong he felt she was. At a 2nd level, however, he blamed himself and had to deal with feelings of low. At times he entertained cocky-destructive thoughts, but denied whatsoever actual plans to impairment himself.

Unfortunately, Mike'due south justified acrimony at his mother'due south rejection left him eager to maintain a relationship with his gang friends. Eventually his mother spotted him talking to one of them and reported information technology to the probation officer, who revoked his probation and sent him to a juvenile facility, thus catastrophe treatment.

Roberta

In a 3rd example, Roberta, a thirteen-twelvemonth-old girl, was living with her begetter and stepmother. She was trying to maintain contact with her mother, only her mother lived with a young man who had been establish guilty of sexually abusing Roberta. He had been incarcerated for a few months, and was again living with Roberta's female parent, only now was not permitted to be habitation when Roberta visited. The mother admitted that she did not believe the corruption had occurred, and blamed Roberta for all the personal and legal difficulties she and her boyfriend had gone through as a result of the accusations.

Roberta'due south father, on the other manus, had married a younger adult female who related to Roberta as a sibling rather than an adult. Roberta'south father greatly enjoyed and depended upon the devotion of his young bride. He thought that the only mode his life could proceed happily was if his daughter would cater to his wife'due south demands. He perceived his daughter'south adolescent struggle for independence, forth with her competition with his wife for his attention, every bit serious threats to his personal happiness.

Roberta was in an almost continuous rage as she struggled to deal with how "unfair" she said her mother and male parent were, how "disgusting" she said her stepmother was, and how "dangerous" she reported her mother's swain to be. She continuously fought whatever expression of authority by all the adults in her family. She was increasingly defiant in school, and had likewise become sexually agile with several neighborhood boys.

All of the intra- and interpersonal issues in this family were potentially amenable to treatment. Still,

the parents were each involved in complex, competing relationships that resulted in therapy moving frontwards at glacial speed, while the child continued to struggle and deed out.

the parents were each involved in complex, competing relationships that resulted in therapy moving forward at glacial speed, while the child connected to struggle and act out.

In this case, Roberta'due south perception of rejection was based on the negative communication from her mother and father that represented their own frustrations. The long-term disharmonize between Roberta and her parents served for her as testify of rejection. The young girl was not in a position to recognize that her parents' behaviors were reactions to other complex issues in their lives, and non indicative of their honey for her or lack thereof.

In addition to anger at the adults in her life, Roberta expressed strong feelings of sadness, including self-subversive thoughts, which were difficult for her to share with me. Fortunately, these stayed at the occasional "idea" level and never progressed to self-destructive plans or actions.

A Therapy Model

These types of cases are serious in terms of the potential for both hating acting out and cocky-destructive behaviors. And many of these cases practice not answer at all, or much as well slowly, to the usual attempts at family therapy. By "usual" I am referring to interventions that aim for the maintenance of an improved family unit. Such therapy facilitates changes in the child's beliefs partly through internal changes the child makes, and partly equally a result of positive intra-family changes. Just what about the cases where intra-family unit changes may not occur at all, or only after information technology is also belatedly for the kid developmentally?

I have found that, in these situations, the only way to annul the effects of a child perceiving himself as rejected, and hence unworthy, is for the youngster to perceive the rejecting behavior of his parent as evidence of his parent's deficiencies rather than his own.

The issue is not limited to dealing with the child's anger. In other cases, rejection may not be a major result. For case, a child who has experienced the affection and credence inherent in a normal parent-kid relationship, now an boyish, is struggling with her parents over money, dating, homework, etc., and says things that hurt her parents. In this case, we are not dealing with the same anger issue. This kid's aroused interactions with parents and their inappropriate responses can often be dealt with successfully in therapy. Parents and child learn to deal with their mutual misinterpretations, develop alternate and more than acceptable ways of expressing anger, and establish agreements regarding major conflict areas. Past dissimilarity,

in the cases I am discussing here, the kid's anger, although a problem, is not the major consequence. The real issue is the depressive upshot of emotional rejection.

in the cases I am discussing here, the child'due south acrimony, although a problem, is not the major issue. The existent upshot is the depressive effect of emotional rejection.

Therefore, the issue is non only that of managing anger but likewise of dealing with the subversive effects of parental rejection. The power of that rejection is based on the kid's underlying belief that the rejection ways that the child is an unworthy person. The issue is at present how to confront that underlying conventionalities and aid the child in rejecting it.

One approach is to foster the psychological separation of child and parent by helping the child to recognize the means in which his parent(s) accept failed to meet the child'due south needs. The therapist also helps the kid understand that his needs for attention, age-appropriate independence, etc., are normal. In this way, the therapist is able to assist the child in rejecting his parents' negative perception of him. It is helpful, in this process, to observe examples of ways in which the parents practice things or provide things that only a parent who loves their child would do. The child tin can then recognize the parent's inability to meet his needs, while rejecting the validity of the parent'due south perception. The child finds other means of validating his worthiness.

By this time, the therapeutic procedure has greatly reduced the parents' emotional touch on the child. The kid must now recognize the harmful effects of his own angry or frustrated responses to his parents, then learn to manage those responses in society to foster appropriate parent-kid interactions.

George: Fostering Independence in Older Children

George was a 15-year-old high school pupil. For several years, school personnel had described him as consistently performing below his chapters, ever passing his subjects but never doing more than than was absolutely necessary. He recently started smoking marijuana with some frequency, and his relationship with his divorced parents (both successful professionals with busy careers) was becoming increasingly stormy.

Separately, each parent complained that at that place were no issues so long as George ever got his own style. If either of them objected to his hours, wanted to come across him put more effort into school work, questioned him well-nigh finding drug paraphernalia in his room, or fabricated any other demands on him, George would swear at them, slam doors, break objects, and storm out the door. Sometimes, when that happened, he would go to the other parent's home and but settle in in that location. The "receiving parent" commonly but accustomed his presence and avoided asking any questions so equally to avert another emotional explosion.

George was an but child whose parents separated when he was 5 years former. In therapy, he recalled many fights between his parents in which he was the central figure.

He insisted that the fights between his parents went on for days and could be instigated by almost anything he did. As he explained it, "they got divorced because they hated me."

He insisted that the fights between his parents went on for days and could be instigated by virtually anything he did. As he explained it, "they got divorced because they hated me."

George was unable to think positively nearly his hereafter. The prospect of attending college, which both of his parents encouraged, was acceptable to him as long as he was immune to live far abroad from both parents and was given enough coin to be "comfortable." He was only interested in schools that had a "party – party" reputation. He refused to discuss his ideas about long-term goals or career interests.

I first met with George and both his parents together, then saw each of them for two private sessions apiece to obtain a history and for diagnostic purposes. The showtime treatment approach was family therapy involving all 3 parties. We started by dealing with such issues as George's need for his parents to respect his independence, and his parents' need for him to respect their authority. Nosotros struggled to find compromises that might reduce the conflict betwixt them. The family unit failed to progress, and ultimately information technology became clear that each parent had significant psychological issues of their own that seriously impacted all the possible dyads—mother-father, female parent-son, and begetter-son. The parents could not move abroad from blaming each other for every issue they had with their son. As they persisted in their angry recriminations and constant mistake-finding with each other, George showed increasing disdain for each of them. George interpreted their behavior every bit simply reinforcing his perception that they blamed him for all of the family's bug.

I advised each parent that they could do good from individual counseling, merely they both refused, insisting that the trouble was only with George. I terminated the family sessions and changed the therapy plan to weekly private sessions with George and a family unit meeting every v or six weeks to review the current status of their family life.

In the individual sessions, George expressed his anger at his parents and his negative feelings towards himself, referring to himself equally the cause of his parents' divorce and standing conflict. I began to interpret some of George'due south behavioral descriptions of parent-child interaction equally indicators of faults in his parents.

I suggested that some of George's memories, if they were accurate, described parents who certainly loved their child but whose behavior strongly indicated personal weakness or deficiency.

I suggested that some of George's memories, if they were accurate, described parents who certainly loved their child but whose behavior strongly indicated personal weakness or deficiency. I confronted George's thought that he caused the divorce with the argument that George's early childhood beliefs represented a normal range of pestering child behavior that all parents have seen. I suggested to George that his parents' responses to his behavior represented inadequacies in parenting skill.

Equally his descriptions moved to more contempo interactions between his parents, I suggested that it was not surprising that they divorced, as they clearly had significant difficulties dealing with each other. George described a battle going on in which his begetter was screaming at his mother about her spending money. His female parent and so retaliated by blaming him for wasting money on a bike for George that she said George did not use enough. George felt that they were again fighting about him and that information technology was his fault. I strongly suggested that none of these battles between his parents could possibly exist blamed on George, and in this case his mother was only mentioning George and his bike as armament in her fight with his father.

As George began to accept that his parents had real deficiencies, he started to examine his more recent conflicts with each one. At times, he would place total responsibility for an incident on the parent. For example, he expected his mother to ignore his drug utilise and but allow him to fume his marijuana in the living room. She had objected, a screaming match ensued, and George walked out of the house. He complained that she "was old fashioned and didn't sympathize the modern earth." I told George I was surprised that he did non seem to empathise that no responsible parent would ever ignore their son'due south drug use. Fifty-fifty if the son is a legal developed, every person has the right to determine what is and is not allowed in their own dwelling house. He challenged me for my ain views, and I shared with him many examples of my exercising parental say-so with my own sons. The real issue here, I explained, was not that of smoking marijuana, only was actually his impulse to challenge his mother's potency. He was behaving as if his mother was just one of his teenage buddies. I told him that the solution was not for him to stop using marijuana, merely rather for him to end throwing information technology in his parents' faces.

The existent issue here, I explained, was not that of smoking marijuana, simply was actually his impulse to challenge his mother's authority. He was behaving as if his mother was just one of his teenage buddies.Using this type of confrontative approach, we were able to keep a reasonable focus on George's own contribution to many parent-child conflicts. This approach had two goals: developing the skills necessary to manage future interactions with his parents, and improving George's awareness that his power to anger his parents (and others) was based on his beliefs, not their innate hatred of him.

As George explored his memories of his family life, he discovered many experiences that he could easily interpret as each parent demonstrating their love for him. Later on a while, he was able to accept the possibility that activities and experiences similar Fiddling League and family trips to foreign places might take been motivated by their wish to brand him happy, and that such a wish might indicate parental dearest. Slowly, he began to perceive his parents' negative behaviors equally expressions of their own emotional difficulties. He understood their outbursts of anger toward him every bit being reasonable and expected responses to his own obnoxious behavior, instead of bear witness of a bones hatred of him.

We next focused on his learning to care for himself and depend less on his parents. I helped him understand that his happiness—and he had a correct to be happy—could no longer exist adamant and influenced by his parents. He needed to take accuse of his own life. He began to perceive school success, for example, as something he was doing for himself and not for his parents. This process is, in part, congruent with the developmental process of adolescence. In George's instance, it was also a response to the real upshot: that his parents' difficulties prevented them from providing him with emotional back up or practical guidance. Finally, George independently contacted the college and career guidance services available at his school and found the staff more able to respond to his anxieties almost his future than his parents. He began to think critically about what he wanted from a postal service-loftier-schoolhouse education.

Jamie: Nurturing Dependency in Younger Children

By virtue of his age, 15-yr-one-time George was at the beginning of a developmental phase that entails building independence, greater self-reliance, and increased separation from parents. Hence, the therapy process was supported by developmental realities.

But what if George had been eight years onetime instead of xv? How could this arroyo possibly work? The phenomenon of pseudo-maturity is well known.

The phenomenon of pseudo-maturity is well known. Young children dealing with fail, for case, often demonstrate role reversal and become the parent.

The phenomenon of pseudo-maturity is well known. Young children dealing with neglect, for instance, often demonstrate role reversal and become the parent. We describe these children as having "lost their childhood." They take difficulty trusting others, are emotionally insecure, and frequently exhibit symptoms of depression. The therapy arroyo described higher up, applied to a kid every bit young as eight, would appear to promote the development of pseudo-maturity, and this is indeed a possibility.

In this type of example, we must respond to the dependency needs of the younger child while dealing with the need to separate from the parents. The case of Jamie provides an excellent example of how this tin be done. Jamie, age eight, was the oldest of two children. Her parents complained that she was resistant, uncooperative, and a discipline problem. They seemed overwhelmed by her insistence on staying up subsequently than her bedtime, arguing almost what they fed her, and refusing to let them to monitor her homework. If they argued about homework too much, she merely refused to do the piece of work. At outset, we worked on behavioral contracts with articulate expectations and rewards that Jamie could earn. But her parents could not stay consistent with the plan; each expressed feeling overwhelmed past having to do such things as reward their kid. They but wanted Jamie to accept intendance of any problems related to school, eating, dressing, bathing, so on, without their involvement. They also continued to express anger whenever a complaint from school, for instance, required their fourth dimension and endeavor.

I looked for what was positive in Jamie'southward life and what made her happy. She expressed a desire to have a closer relationship with a female teacher she admired, and I encouraged that. This changed her relationship to her homework: instead of seeing it as grounds for a power struggle with her parents, Jamie came to recognize the hopelessness of that interaction. Through this new relationship with her teacher, she was finally able enjoy the emotional satisfaction of academic success. As Jamie's grades improved, her emotionally destructive interactions with her parents diminished.

The emotional turmoil in the lives of Jamie'south parents made even the purchase of a bike a serious event for therapy. Questions virtually the type and size of the bike, which accessories to get (if whatever), and where they should purchase it, resulted in major distress for her parents, and certainly for Jamie as she tried to deal with them over an object that was very of import to her.

In handling, Jamie learned that she was incorrect in her perception that her parents wanted to deny her the cycle because they loved her sibling more. She found many memories where her parents had given her things, had fun with her on vacations, and showed pride in her accomplishments. Independently, I learned from the parents that these memories were authentic. I direct stated to Jamie that these were the things that parents who loved their child did for them. I also explicitly interpreted to her that, regarding her parents' more than negative beliefs, they clearly had difficulty making decisions without exhibiting anger and confusion. This was behavior that she had frequently seen. Jamie did not express the demand to know why this happened, merely was comforted by seeing the beliefs as a problem the parents had, and not her responsibleness.

I have found that directly statements to a child, such every bit those above to Jamie, are the best way to bargain with a child's misperceptions. In Jamie's case, they would quickly result in our talking about major bug. And, as with any therapist-offered estimation, Jamie might decline what was offered, then follow up with more of her feelings about the state of affairs.

At that place is always the danger that a younger child will agree with you lot simply because you are the powerful adult

At that place is always the danger that a younger child will hold with you just because you are the powerful adult, merely I have found that my patients, even quite immature ones, are very comfortable in questioning or challenging any of my input. Information technology is a thing of the quality of our relationship during treatment.

With my help, Jamie did the necessary research and presented to her parents a firm package of bike type, size, toll, and a local bike store where it was bachelor. Her parents chop-chop bought her the bicycle and not another give-and-take was said. Her Girl Picket leader became the adult who assisted with bicycle maintenance and with whom she shared her biking adventures.

I could meet some of Jamie's dependency needs, just, of form, no therapist should effort to fulfill that office.

I could meet some of Jamie'southward dependency needs, merely, of course, no therapist should try to fulfill that role. The therapy process required helping her find other child-adult relationships to fill this void. At the same fourth dimension, Jamie needed to learn that her Girl Lookout man leaders, teachers, and a grandmother who lived close by could help, but also had their limitations. We addressed her jealousy of the Scout Leader's own children and of the other children in her class that her teacher showed concern for.

Parental Complications

This model calls for recognition that, in some cases, the relationship betwixt parents and kid is a damaged one, and that the principal culprit is the parents' emotional makeup. The cases described here have involved a single-parent home, or two-parent families where both parents are the problem. In other cases, one parent might be acquiescent to change while the other is non. The "amenable" parent's growing awareness of the other parent'south pathology and consistent destructive touch on on the child often results in worsening marital discord, and sometimes separation and divorce. In those cases, my work with the child is assisted past getting the parents to see someone specializing in marital therapy. I establish this assistance to exist essential, and in these cases successful marital therapy allowed me to be successful with the child. Unfortunately, when the disturbed parent refuses marital counseling, that parent usually wants to end the child'south therapy besides.

Considerations to the Approach

Some parents' difficulties are long-term and extremely resistant to whatsoever intervention, but children move along a developmental timeline that waits for no one. In these cases, individual work with the child may have to go the master intervention, and the normal process of a kid's psychological separation from the parent may have to exist accelerated.

There are potential problems with this arroyo that a therapist needs to be aware of. Therapy patients of any age can become dependent on the therapist to a degree that interferes with their progress. I believe that children are even more vulnerable in this regard.

Needy children struggling with hard parents can easily provoke rescue fantasies in the therapist.

Needy children struggling with hard parents can easily provoke rescue fantasies in the therapist. I have seen, for case, young therapists I was supervising jumping in and doing things for the child-patient when they should have been assisting the kid to develop the skills to office independently.

A major potential stumbling block is the parents' response to the increasing independence of the child. Bug can occur if the kid expresses that independence by openly rejecting the parents' authority. For example, if Jamie had appear to her parents that they need not bother to make whatever rules in the house because she would only follow what her watch leader said was appropriate, nosotros would certainly have seen increasing conflict between them. The treatment process includes the child's learning how to disagree with parents in ways that avert such difficulties.

In closing, I wish to stress that this approach is 1 the therapist must choose simply later on family therapy has already been tried energetically without success. What I have described here is a compromise in which we must give up family therapy'southward ability to motility the whole family forward, in a last-resort effort to rescue the child.

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• Identify when and how to shift between individual child therapy and family therapy.
• Assistance child and boyish clients cope with parental rejection when their parents are unable or unwilling to participate in family therapy.
• Support children in learning how to meet their dependency needs without relying on emotionally dysfunctional parents.

Leon Rosenberg is a clinical psychologist, and a Professor Emeritus on the faculty of the Johns Hopkins University School of Medicine. For 38 years he was full-time member of the Sectionalisation of Child and Adolescent Psychiatry and provided individual and family therapy involving children from early babyhood through boyhood. He supervised the child psychiatry residents, psychologists, social workers, and counselors in the Division's community programs. Until he retired in 2000 he was also the Director of their Community Mental Health Plan. Since retiring from his full-time position, he has served as a consultant to the Division of Child Psychiatry's School-Based programme where Hopkins counselors are assigned to Baltimore public schools. In that role he continues to supervise therapists in their piece of work with children and their families.

CE credits: 1

Learning Objectives:

• Identify when and how to shift between individual kid therapy and family therapy.
• Assistance child and boyish clients cope with parental rejection when their parents are unable or unwilling to participate in family therapy.
• Back up children in learning how to meet their dependency needs without relying on emotionally dysfunctional parents.

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Source: https://www.psychotherapy.net/article/family-therapy-resistant-parents

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