One of the most important decisions a therapist makes is how broadly to define the problem that clients bring into treatment. In an individualistic culture such as ours, it’s common to focus narrowly on whoever is exhibiting problem behavior, without understanding the wider family context shaping the issues of immediate concern. Often the key to working effectively with a family is expanding the therapeutic perspective to include the history of intergenerational trauma underlying the present-day issues, even if that’s not the family’s view of the origins of the presenting problem.
It’s not easy to introduce this perspective to parents. When parents bring their child for therapy, they don’t expect or want to be the focus of the work. That’s why one of the first things I tell parents is that I work from an attachment perspective, and will be working as much with them as with their child, sometimes more. When they’re willing to look into their own childhood history and how it may be contributing to the situation, the real work can begin.
THE BOSS?
John’s entire identity was his family business. He owned a wood-processing plant and a small horse farm, and worked all the time, even on weekends. He never meant to become my client, but when he brought his 11-year-old son, Adam, to see me, I insisted he come too, since I specialize in family therapy. I’d have asked the mom to join us, but she worked the swing shift as a nurse and wasn’t available after school.
Adam had anxiety and executive functioning deficits, and had been diagnosed with attention-deficit disorder and oppositional defiant disorder. When I asked for details, John said, “Adam’s in his own world: he doesn’t listen. He needs to be told three times just to do simple things, like clearing his cereal bowl from the table. Same with going to school, going to bed—whatever we say, he stalls and doesn’t listen.”
When I met Adam, he was on three different psychotropic meds, including a sedative for sleeping. He told me what he thought the problem was: “I can’t think straight sometimes. I forget. When my dad tells me to do something, it sounds far away. Then he gets mad and yells at me.”
I then asked Adam about the anxiety and fears that the psychiatrist was medicating him for. “I can’t sleep at night because I’m scared someone is gonna crawl through the window,” he said. “My dad tells me that’s impossible because we’re so high up, but my sister can climb the tree. Also, I’m scared of Kiko, one of our mares, because she gets scared by critters, and twice she kicked me when she saw a mouse.”
“How do you deal with these fears?”
“I try to tell my dad that I don’t want to muck the stalls. I’ll fill the trough and the water buckets and stuff, but I don’t want to go in behind her because she gets spooked so easily.”
I turned to John and asked, “Is that a fair deal? He’ll take care of the chores outside the stall but won’t go in?”
“That’s fine for now, but it’s not a solution. Adam has to learn that he’s in charge. Horses are social animals. If you’re confident, they’re as calm as can be.”
It turns out, that was John’s entire parenting philosophy. Whenever Adam was scared, John told him he had to put mind over matter and be courageous. This also applied to the bully Adam was contending with on the school bus and when he had fears about going to sleep alone at night.
I tried several different tactics in family therapy to help John understand that this philosophy wasn’t working for his son. I had Adam express how he felt unprotected and judged for his fears. I educated John about the brain and how admonitions and lectures won’t help a frightened child. I recommended John do things with his son, rather than ordering him to do his chores by himself.
John always nodded in seeming accordance. The next week, however, Adam would report the same things happening. John would ask Adam to go to bed but wouldn’t tuck him in; John would tell Adam to muck the stalls, even though we agreed they’d do it together; John yelled at Adam for dawdling before school, even though we talked about his fear of the bullies on the bus. When I asked John why he couldn’t implement our strategies, he said he was tired and couldn’t muster the energy. In exasperation, he said, “Adam is going to have to manage the factory when he’s older. If he can’t stand up to a horse or a kid on the bus, how is he going to be the boss of 35 workers at the factory?”
Sign up with your email to receive news and updates.