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Tuesday, December 2, 2014

Intrapsychic Conflict and Dysfunctional Family Patterns



There have not been a lot of studies done looking at how personality problems affect individuals over three generations within a family, and how they may be passed down from one generation to the next. Today’s emphasis is studying mostly biogenetic factors.

However, the few studies that have been done generally show the same types of things. Although there is never a one to one correlation (because people’s development is affected by the chaotic interactions of thousands of different variables – genetic, biological, interpersonal, and sociological), certain issues are highly likely to be passed down.

Earlier studies have shown what is known as intergenerational transfer of certain types of dysfunction for, as examples:

  • Boundary disturbances such as maternal overprotection and relationships characterized by lack of affection, enmeshment, and/or parent/child role-reversals (Jacobvitz et. al., Development and Psychopathology, 3, 513-527, 1991).
  • Emotional dysregulation with poor disciplining skills with children (Kim et. al., Journal of Family Psychology, 23(4), 585-595, 2009).
  • Substance abuse with parental substance abuse combined with abuse and/or neglect and low levels of family competence (Sheridan, Child Abuse and Neglect, 19 (5), 519-530, 1995).

In understanding this process, I try to incorporate concepts from different "schools" of psychotherapy. The most important task in integrating different psychotherapy models is to pose the question of how concepts from different therapies might relate to one another, and how slight modifications to specific aspects of these concepts may make relationships between them more clear.

In this post, I will focus on the relationship between several such concepts. We have the concept of intragenerational transfer of dysfunctional behavior from Bowen family systems therapy. Then we have a primary concept from psychodynamic therapy, intrapsychic conflict. People have conflicts between their innate desires and the values they have internalized as they grew up within their family and culture. 

To see how these two concepts can both be valid and also when combined explain certain human behavior, we can take a closer look at the intergenerational transfer question.

The attachment theorist Bowlby first suggested that these transfers occur, not through specific observable behaviors like “abusiveness” or psychiatric diagnoses per se, but through the generation of mental models of interpersonal behavior in the affected children. These working mental models are now called schemas by both psychodynamic and cognitive-behavioral therapists. They are also subsumed under the rubrics theory of mind or mentalization by another set of psychodynamic therapists. We need to look at the subjective experiences of the involved children throughout their development.

Zeanah and Zeanah (Psychiatry, 52, 177-196, 1989) discuss the concept of organizing themes. They mention that studies show that abusing mothers tend to attribute more malevolent motives to their own children compared to other people’s children. More generally, they react with more annoyance and less sympathy to videotapes of crying infants than do non-abusive mothers. To think that these patterns would not be noticed or sensed by children through their daily interactions with their parents, and would not affect the development of their schemas, would be extremely naïve.

In turn, abusive mothers reported more threats of abandonment and role reversals with their own mothers than did control mothers.

These findings are probably the tip of the iceberg in terms of subtle characteristics of repetitive parent-child interactions, and as the Zeanahs say, “Patterns of relating are considered to have more far-reaching consequences than specific traumatic events” (p.182).

When Bowen therapists started doing the genograms of their patients, which describe family interactional patterns over at least three generations, they noticed something that has not really be described much in empirical studies. While some children of dysfunctional parents had problems that were similar to their parents -  such as substance abuse - other children seemed to have developed behavior patterns that were exactly the opposite – they became teetotalers!

I have seen this sort of thing many times in taking genogram-related family histories from my own patients. One son of a workaholic will also be a workaholic, while his brother becomes a complete slacker who can’t seem to hang on to a job, or who does not even bother to look for one and goes on disability of some sort. Or who is enabled by the workaholic father.

In fact, in some families one generation has a lot of alcoholics, the next generation a lot of teetotalers, and the third generation goes back to having a lot of alcoholics. Or impressive successes in one generation are followed by remarkable failures in the next. McGoldrick and Gerson, in their book Genograms in Family Assessment, traced the genograms of some famous people like Eugene O’Neill and Elizabeth Blackwell and readily found such patterns.

If these sorts of issues were entirely genetic, it would be difficult to explain how progeny of the same parents could be so completely opposite from one another, as well as completely opposite from their own parents. So what might be going on psychologically within people that might lead to interpersonal behavior with their own children that generates such bizarre patterns?

This is where intrapsychic conflict may come in. Say a father was a young adult during the Great Depression of the 1930’s. He had grown up feeling that work defined him, and that he was obligated to keep his nose to the grindstone in order to support his family. He was lucky enough to have a job, but his boss made his life miserable. He could not quit because he would not be able to get another job, and therefore he began to subconsciously resent the very values with which he has defined himself.

This could lead him to develop an intrapsychic conflict over hard work which starts to tear him apart. He may relate to each of his sons in a manner that – very subtly - suggests to one son that he too should be just like him, while the other son is subtly rewarded for acting out the father’s hidden resentment towards hard work and self-sacrifice.

Likewise, a patient might come from overly-strict religious parents who had rejected any and all hedonistic pursuits, but who had preached to their child about the evils of alcohol in a highly ambivalent manner. Such ambivalence usually arises in them because of their having received mixed messages from their own parents. Their son may feel pushed to rebel, and therefore lead a licentious, alcohol-drenched lifestyle. Such a person often destroys himself in the process, because if his parents observe him being successful in spite of drinking, this would exacertate the conflict in his parents and destabilize them. This would frighten him. So he becomes a self-destructive alcoholic.

His behavior would be sort of compromise. He would be following the repressed urges of his parents and allowing some expression of them, while at the very same time showing his parents that repressing the urge was indeed the way to go.

In the next generation, his children may “rebel” just like he did, but the only way they can do so is by going to the opposite extreme themselves. They become teetotalers. Their children, in turn, “rebel” by becoming alcoholics.

I’m tremendously over-simplifying this process so the basic outline is clear to the reader, but I see these types of patterns – with many fascinating twists and turns - every day in my practice.

5 comments:

  1. Dr. Allen,
    In your examples of subsequent generations flipping their excessive behaviors, does therapy, any therapy, allow the patient to return to a baseline where the root of the behavior is corrected? Or is it always going to be more of a behavioral management process, that is to say, the patient would, for instance, perpetually manage their impetus to teetotaling, rather than eradicating the urge toward teetotaling fundamentally?

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    1. Hi anonymous,

      Good question.

      Different schools of psychotherapy would answer that differently.

      In my view, it's the need to act out one side of the family conflict that is the issue, and the behavior of the family of origin members reinforces it in the individual. I always found that a patient's parents were far more powerful than a therapist could ever be in influencing my patients. The solution is for the patient to get the parents to alter their problematic behavior within the relationship with the patient (the patient cannot "change the parents" but they can change their own relationship with them. If you change your own responses consistently, it forces other family members to change their responses to you). This is a complex task which includes tracing the family history in regards to the issue over three generations (creating a genogram); coming to a preliminary hypothesis regarding the reasons for the conflict and why the parents behave as they do, and then designing a strategy, tailored to each individual in the family, for overcoming their defenses and denial regarding the issue so that the parties can discuss the dysfunctional patterns empathically with one another and agree on what to do about it..

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    2. Altering one's parents' reactions is only an option if a) the parents are not dead or b) they aren't completely incapable of facing the reality of their horrendous parenting. Narcissists who aren't even aware of the concept are going to be a tough, tough sell.

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  2. In the 1960s, one of my great uncles, after receiving an Imperial Service Order from the Queen, began to trace the family tree. No doubt looking for illustrious ancestors related to Royalty. I am the third generation to 'tend' the tree and with my background in psychotherapy methodology, I began to notice recurring patterns, repeating themes that united discrete family groups, yet there was/is an abruptio placentae motif which means the groups don't receive support or solidarity from each other. Distinct styles of self-isolation and self-imposed exile pop up like groundhogs.

    Embedded in the Australian psyche are the experiences of the wave of colonists who came out in the 19th century, leaving England as the Mother-land: they chose to come and entered a period of indentured servitude to work off the cost of passage. All my maternal ancestors were wage slaves.

    The quest for social role valorization has been lethal in some of the family groups. There has been a strong addiction to spectacle and I can see truth in the observation, 'the female is the deadliest of the species'.

    My earlier understanding of patriarchal power, which was informed by second wave feminism, has been turned on its head.

    The defense mechanisms and denial at my parent's generation were formidable. My generation is skilled at
    disocciating and hiding the knives.

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  3. A song getting a lot of airplay in my part of the world, is 'Take me to the Church' by Hozier, an Irish native.

    Powerful lyrics. It seems that the problematic factors of intergenerational and intra-psychic issues are entering mainstream popular culture.

    "Coming from Ireland, obviously, there's a bit of a cultural hangover from the influence of the church," he told the magazine. "You've got a lot of people walking around with a heavy weight in their hearts and a disappointment, and that shit carries from generation to generation.

    "So the song is just about that — it's an assertion of self, reclaiming humanity back for something that is the most natural and worthwhile. Electing, in this case a female, to choose a love who is worth loving."

    Quote sourced from independent.ie
    Interview with Caitlin McBride
    Meet the Bray Singer Cracking America
    13/March/2014

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