Tuesday, February 16, 2016

Reader's Therapists Disagree With Me

"Letters, we get letters
We get lots and lots of letters"

Yet another interesting letter came to me in response to my posts that make the recommendation to adult victims of abusive families that they find a therapist who can help them confront their abusive parents about the family dynamics in ways that get the parents to stop any ongoing dysfunctional interactions. 

A therapist actually fired the reader from his practice because the patient did not want to divorce her mother!

As I have said repeatedly, I never recommend that patients continue to be abused by their families. However, I do not think that divorcing your family is the only other option, and it is certainly not the best option. This is because, unfortunately, you continue to carry your parents around with you in your head for the rest of your life. 

Fear tracts and other tracts in the brain's limbic system that determine the way we all normally respond to the interpersonal environment - and that are highly resistant to fading away through the normal processes of neural plasticity - come from, and respond more strongly to, one's parents than to anything else in the environment. 

It does not take much parental contact at all to reinforce them - even once every few years might do it. Contact from other family members in which messages about the parents are provided also works quite nicely in this regard. In fact, anyone else who behaves in any way that is even somewhat analagous to the way the parents behave will also trigger and reinforce them - and the pathways are very powerful in shaping our usual behavior.

Even if you stop interacting with parents altogether, you are very likely to pass on repetitive dysfunctional interactions to your own children despite your best efforts. Often people go to the opposite extreme from their parents in the way they interact with their children, yet end up with kids with exactly the same problems, as described here. Other children from abusive or neglectful households decide never to have children themselves for fear that they might turn out acting just like their own parents.

As mentioned, divorcing a family and continuing to be abused are not the only two options. There is a third: the one I mentioned in the first paragraph above. It is certainly not an easy thing to accomplish, or patients would have done it themselves long ago. It takes a lot of patience and persistence. And doing it badly is worse than not doing it at all. Nonetheless, with one's family of origin members, where there is a will, there is a way.

Unfortunately, the majority of therapists these days do not really understand family dynamics at all, are unaware of the above risks involved in recommending a "divorce" from parents, and do not know the techniques for helping their patients overcome multiple resistances and invalidation from family members when the patients attempt to discuss family dynamics with parents in a constructive way.

Interestingly, just after a received the letter from the reader mentioned above and went on to answer it, I got an extremely nasty missive from a psychotherapist on this very subject. Perhaps it was even the reader's prior therapist. I mean, who knows? I won't mention the therapist's name, but she even signed it. The letter read:

As a therapist I can say you are an awful therapist; truly terrible. The best thing a person who has been abused as a child can do is get away from their parents, make peace with it. Suggesting that someone that has been abused, goes back to the abuser and does the work to try and repair damage is abusive and shocking. I am shocked.

This therapist apparently thinks patients who were abused as children are just too weak and damaged to stand up to their family members. How invalidating! That's probably what the abusive parents think of their adult child as well.

Anyway, here is the letter from the reader complaining about a therapist just like her. My answer is written below in amber color.

My parents abused me, physically, sexually and emotionally. As a result I
have a traumatic brain injury. I was put in foster care when I was 13. I am
now 35. I have gotten help. I am getting help still. My last therapist fired
me after I reconnected with my mother.

My mom has apologized and she has changed! It took awhile as in years but we now have a great relationship. I have a new therapist. I am scared because over Christmas I reconnected with my father who has also apologized and changed for the better. I have closure.

I have my family. I am scared that if I tell my therapist she is going to
freak on me, shame me, guilt me and or fire me. I am seeing her for help for
my own bad choices and the resulting trauma. I know she hates my family but I
don't understand how a therapist can tell me that I can change while insisting my family who they have never met can't [right on!]. It doesn't make any sense. I am not sure how to tell her.

I can't comment on your situation specifically without personally evaluating you and your family extensively, and without knowing a lot more about your experiences with your therapist, so the following are general comments that may or may not apply to you:

As you may have guessed from my blog, I am a firm advocate of my patients reconnecting with their families, even if the family had been abusive, as long as the abusive or invalidating behavior has been stopped and has been openly discussed by the involved parties, with the result that everyone has some idea of where the dysfunctional patterns came from and what purpose they had served. Before that goal has been accomplished, I coach my patients on how to get through the family’s often formidable defenses against having such conversations, so that they can get to that point.

Of course, I make sure that my patients have a safety plan for themselves (and their children if any) if this process starts to take a wrong turn, in which case we try to figure out what went wrong and how to get things back on track. I almost never give up. However, if a patient puts their child in danger (like leaving a young one with a grandfather who had sexually abused the patient as a child), we have to work on that issue first.

Unfortunately, there are a lot of therapists who still believe that divorcing one's family is the best course. My recommendation in such a case is to find another therapist. Unfortunately, therapists familiar with dysfunctional family dynamics are getting harder to find.

Also, if someone is afraid to be honest with their therapist, that in general ties the therapist’s hands, so there is almost no point in continuing. A good therapist may certainly question a patient’s decision but should never attack them personally for having made it.


  1. Thank you for all the work you put into your blog. I have read through much of it. It is generous of you to share your experience and clinical findings. Very helpful

  2. Therapists??? It's about the money. People who get bullied oftentimes are financially abused as well. And the "therapists" are in reality just another covert bully.

  3. "I'm rich biatch!"
    --said no therapist ever.

  4. Even if a patient is able to confront or dialogue with their parent to stem the abusive behavior, wouldn't that be just the beginning of the work of patient? Just because Mom and Dad have stopped being the insufferable fools that they are, a) they don't necessarily understand the family dynamics at work and b) their corrected behavior is not going to help the patient with his habitual emotional responses that have hampered his life. Once Mom and Dad have been more or less straightened out, what is the patient's next move?

    1. Hi Anonymous,

      Excellent questions.

      First of all, the dialog with the parents usually does include an empathic discussion of the family dynamics and the reasons for the parents' problematic behavior - without condoning any damaging past behavior.

      That problematic behavior is the most powerful trigger and reinforcer of the patient's dysfunctional role (based on a model in one's head called a "role relationship schema.")

      Once the parents are no longer feeding into the patient's schemas, this starts to free the patient up.

      However, the patient will often then go through something called "post-individuation depression" or "groundlessness" in which they don't know who they are any more. They have to become acquainted with the true self that had been suppressed throughout much of their lives. I explain this and reassure them this horrible feeling will soon pass.

      Many patients will then spontaneously start to experiment with new ways of relating to others. If not, the usual cognitive behavioral interventions - which would have been quickly overcome before by family reactions - suddenly become very effective in moving patients forward.

      Finally, the patient is instructed on how to handle it when they and the parents inevitably fall back into old habits, which as you know are quite hard to break. Once the earlier discussion had taken place, it's fairly straightforward to bring the relapse up with the parents and refer back to what had been decided earlier.

  5. I am the person who wrote you that letter and the therapist I had had the time turned out not to be a therapist at all! but I have since found a new one at a local hospital and she is excellent.
    When me and my mom reconnected it was hard, there were times I didn't think I could do it, we struggled to communicate, I was being triggered too which made things even harder but we stuck with it, we worked together, we took breaks from each other when needed and now we have a great relationship. It helped that my mom had gotten therapy for her own trauma issues in the years that we were apart.
    I have reconnected with most of my family at this point and it's great. I have learned to set boundaries, I am learning to let go and I don't feel lost anymore. I feel connected and loved and it feels amazing. I truly believe that reconnecting with my family saved my life.