Pages

Tuesday, January 29, 2019

Guest Post: My Experiences with Family Dysfunction and Therapists - Anonymous





Editor’s note: This guest post came in response to my request for stories from those on my Facebook  fan page who had a bad experience with therapists who seemed to think that all of their problems were in their heads (for example, poor distress tolerance, irrational thoughts, or anger issues) and had little to do with other people who were stressing them out or pissing them off.


When I was 6 or 7, a neighbor (age 17 or 18), took me into his house "to play a game." He blindfolded me, made me kneel, and took his penis out for me to suck. The blindfold wasn't properly attached so I was able to figure out what he was doing. Afterwards - and after the mandatory "don't tell anyone" - I told my grandma, who then informed my parents.

Now, my mom certainly has her own issues. She hates being touched, always tends to think only about herself, is obsessed with TV shows, tends to be depressed and spends most of her free time in her room, and has a very high fear of going to the doctor - even though she is one! My Dad was certainly narcissistic (as you'll see it in a minute), so they both decided it was best to sweep it under the rug.

Years later, when I was 12, I had my dad's brother pull me close while dancing in order to rub his large stomach against my budding breasts.  Thinking back, I later realized that my Dad never ever let me stay with my cousins. My mom then confirmed that his brother is a pedophile. His poor, poor stepdaughter from my aunt's previous relationship! My dad must've known this, yet when I was raped, his answer was...to become my rapist's godfather!!!

My dad - and mom - made me go to my rapist's Confirmation (a Catholic ritual for teens) a year after my rape. We remained neighbors, and my Dad had weekly breakfasts with that family. No, I am not kidding. When I was 8 or 9, my mom bought a house two doors down from my grandparents...but only she and my dad moved out. I was told to stay with my grandparents "because I would be more comfortable there, and we need money to build a second floor." They never did.

My Dad was never steadily employed. I caught him kissing the maid when I was almost 13. So my mom, who at that time was working in a different region, came back home and told him to get out. He then blamed me for the "breakup of our family." I was also sexually harassed several times as a teen, but I never told my mom or grandma because my grandma told me I was "dirty" because I was still talking and playing with that neighbor. Why would I stop? NO ONE bothered to explain that what had happened to me was sexual abuse.

My uncle on my mom’s side slapped me when I was 13 for defending his teen housekeeper, and my aunt and mom (after I had come back home) wept but said nothing. Again, no one talked to me about what had happened. My dad got cancer when I was 17 and I asked him to come home. His siblings were robbing him and not taking care of him. He initially rejected our offer. Only when he knew for certain that his siblings were taking important property deeds (he owned a house in the mountains. I am Peruvian), did he finally agreed to come back to be looked after by us. He was bitter and scared, but was still a bad parent. I had barely seen him during the 5 years that he was not living with me - his choice, of course. I again saw him flirting with the maid during his remission. He died when I was 22.

Although I've barely ever been beaten, and no one in the family did drugs or alcohol, I nonetheless had a highly traumatic childhood. I'm a Psychology student. I am a 4-time college dropout from 3 universities. I am married now and living in Europe. I have been subjected to verbal abuse at home, but he's getting treatment. I’ve been diagnosed with ADHD, but I’m wondering if it's the right diagnosis. I do acknowledge that a trial of Concerta did show me I can do more, although I stopped after 14 days because the side effects on my mood were too much for me.

With all of this, I have also been subjected to racism and homophobia in society. I'm not a lesbian, but I "look like one,” apparently because of my very short hair and baggy pants. Once,  when I had messy hair and not-fancy clothes, I had to leave a store because of a screaming security guard who was asking me what the hell was I doing at that store (I lived in a "well-to-do" neighborhood). Where I am, racism is expressed with frowning faces and rude attitudes from clerks. But when they see me with my White husband, I am "graciously welcomed" anywhere. I guess those two (racism and sexism) can never be escaped, but I am DAMNED sure happy I am far away from my family's dysfunction now.

At 22 I started psychoanalysis, and my therapist wanted me to focus on forgiving my parents.

Later, I did CBT, and that psychologist wanted me to focus on my goals, when all I could think of was how damaging the sexual abuse had been, and how troubled I felt about being neighbors with the rapist.

I don't know what kind of treatment I received from a third therapist I took on, but he said I should focus on why I went into the neighbor's house in the first place. That was said to mean that I was starving for male attention, and I was told I should work on that.

There was that psychiatrist too, when I was 26, who I told about my anxiety and possible ADHD, He said I should just take it easy, that no one is supposed to demand too much of themselves and that is okay not to accomplish everything I want. He added that it's all about "finding contentment." I felt that that one was sexist AND racist.

My parents and I went to ONE session of family therapy when I was 16, but as soon as the therapist pointed out to my parents their troublesome, inattentive behavior towards me, we stopped going.

So from my experience, what I learned is that even people with the best intentions (or at least who are supposed to have them) will try to redirect you to what they think it's best for you, instead of actually listening to you. Validate your own feelings, and after that, inform yourself  both about what psychology says about your own experiences AND about how to pick a good therapist. Work from there. Too many uninformed people will spout their opinions, whether they are family or professionals.

Wednesday, January 2, 2019

Book Review: The Kevin Show by Mary Pilon





In this impressively well written book – I may have to steal a few of her cool phrases, like when she discusses situations in which people walking on eggshells start to feel more like they are walking on landmines – Mary Pilon tells the story of Kevin Hall and his family. Kevin Hall was a championship sailor who on one occasion made the Olympic Team, although he did not win a medal. At the same time, he struggled with Bipolar Disorder. The real illness, not what passes for bipolar disorder these days.

The author’s discussions of what went on inside of Hall’s head during a manic episode are some of the best I’ve ever seen. After reading them, readers will know that this has absolutely nothing in common with normal human thinking. After coming down off of a manic high, a sufferer knows that. Although they may question themselves about the “reality” of what they had experienced during an episode, it still seems to them to be bizarre and alien.

The book also does a great job of describing the traumatic effects on parents, spouses, and siblings in having to deal with a family member with a major mental illness – especially one who is not always cooperative with treatment but doesn’t let them know when he goes off his meds.

Hall’s delusion when manic was that he was some part of a larger “Show,” run by some all-knowing “Director”  - sort of like the movie “Truman Show,’ which indeed is mentioned several times in the book -  in which he is meant to save the world by interpreting various “signs” in the environment. The signs could be things he happened to see in the environment, unusual coincidences like his having been a college classmate of one of the doctors who treated him, song lyrics, or passages in various books he liked to read.

Unfortunately the author, who seems only to have a limited  familiarity with mental illness and, in particular, the treatment of manic-depressive illness, falls a bit into the trap of starting to wonder if it may just be some variation of normal. After all, with the rise of Instagram, selfies, and social media, everyone is seemingly thinking of themselves as in some sort of show and as having an almost national presence in the minds of others.

Mary Pilon


Not only that, but the author adds that certain delusions are more common in certain cultures than others, and some only seem to exist in a single culture.

In fact, the difference between psychotic delusions and false beliefs that are due to groupthink, everyday human foibles, wishful thinking, and just plain kidding oneself is colossal and not in the least bit subtle. Of note is that the author spends almost no time describing Hall’s thinking during periods of bipolar depression. She only mentions one episode in which he maintained that he was depressed but not delusional - but we do not know if he ever experienced a psychotic depression.

Either way, when depressed, it is mentioned almost in passing, he believed the exact opposite of what he felt while manic – that he was a born loser, loony-bin screw-up who was worth absolutely nothing despite his fairly spectacular accomplishments in love and work while euthymic (neither manic or depressed – in other words, normal).

Hall kept going off his medication because he felt that it was drugging the real him, which is why he kept having recurrences. While I obviously can’t say for certain anything about his reasons for stopping his treatment, the frequent reason bipolar patients discontinue their meds is that mania feels so good in so many ways that normal feels like down to many sufferers, and they want the high back.

Another possibility is that he was taken off lithium -  which generally does not make people taking it feel drugged – not because it was ineffective but because the doctors thought it was ineffective when in actuality he had stopped taking it or his blood level was too low. Good doctors monitor lithium blood levels.

He was apparently put on the antipsychotic Haldol at one point, which definitely does make people feel drugged. Antipsychotics, while they do prevent mania, should only be give in acute mania (because it takes time for lithium or depakote to kick in) – and then discontinued after the other drugs start working. Or used indefinitely only if all other options fail or are not tolerated. The author does not really tell us any details about Hall's treatment.

And what about the cultural aspects of delusions? Well of course delusions concern things that people with the disorder are familiar with. You can’t think the CIA is following you around with ray guns if you have never heard of the CIA or ray guns. And just like with Alzheimer’s disease, in which underlying personality traits affect the expression of impaired memory issues and cognitive confusion, they affect the content of delusions as well. 

Pointing out the cultural differences as a possible reason that bipolar is not a real brain disease is a bit like doing the same by pointing out that the delusions of Japanese people are expressed and thought about in the Japanese language, while the delusions of Spanish people are expressed and thought about in Spanish.

Wednesday, December 5, 2018

Self Actualization, Mirroring, and Individuality




Self Actualization is a somewhat vague term that is used in slightly different ways by psychologists. Originally used by Kurt Goldstein, it is loosely defined as “the realization or fulfillment of one's talents and potentialities.” He thought we all had a drive to achieve this throughout history, and that it was of singular importance, but that is not quite correct. 

The term was then picked up by Abraham Maslow and incorporated into his hierarchy of needs, and later used by the “humanistic” schools of psychotherapy (now referred to as emotion-focused therapies) championed by Fritz Perls (gestalt therapy) and Carl Rogers (client-centered therapy).

The way that I define it is, I hope, more clear cut: It is the process by which you learn to live your life as you see fit, and not merely blindly follow your herd and going along with all of their mandates, desires for you, and beliefs irregardless of whether you, deep down, believe them or endorse them.

Another way of looking at this is that it is our ability to focus on our individualistic strivings as opposed to collectivist needs. Of course, we all need other people to one extent or another, and we cannot always follow our own “druthers” and allow our family members and tribespeople to sort of go to hell. We all have roles and functions to maintain within our groups or we’d never survive. In fact, we are all literally biologically programmed to learn “who we are” from our primary attachment figures.

We all come into the world completely helpless and with absolutely no knowledge of how the world even works, so our survival literally depends on our parents or parent-substitutes. Their survival, in turn, is dependent on other people within their tribe or kin group, who do those things of which they are incapable as well as protect them from potentially dangerous outsiders. This is why our brains develop through our interactions with them. A so-called call-and-response process with the brains of young children as this interaction progresses leads to the formation of vast numbers of new connections between brain cells.

In his classic book from the 1940’s, Escape From Freedom, Erich Fromm pointed out that our degree of inter-dependence has slowly decreased over history as culture and technology evolved. In the middle ages, as an example, you were not Joe Blow who happened to be a knight, a serf, or an artisan. Being those things was all you were, in total. There were no “individuals” to speak of!

With the industrial revolution and the Renaissance, people suddenly had time to think about other things beside basic survival needs. For the first time, they could think about their own likes and dislikes. They could think about their place in society and whether or not it really made sense. The whole culture was evolving, allowing this development.

So how could their brains do this when they were literally designed to go along with the group and think exactly what everyone else seemed to think (groupthink)? Well, that’s the nice part of having brains that are malleable. So exactly what process bridges the brain development described earlier with these new cultural developments?

One of the mechanisms by which the call-and-response process of brain formation works is called mirroring or, in a slightly different sense, validation. When we emit various behaviors spontaneously, some of them are reflected back to us, or positively reinforced, by our parents. Seeing ourselves in the eyes of our parents makes our behavior and feelings seem real to us, while if our behavior or thoughts are not mirrored, they feel unreal. The latter induces in us a highly noxious feeling called groundlessness.

In most families, some individualistic, non-conformist thoughts and behavior are mirrored. In others, being “selfish” in this way is attacked. Dysfunctional families are full of ambivalence and conflict over individualist strivings. They give off double messages, leading to confusion. Often the individualist strivings of the children are not only discouraged or disagreed with but completely invalidated as something completely insane. Even the child’s own emotions. 

When this happens, the children become trapped in behavior meant to stabilize their unstable parents – the dysfunctional family roles described in this blog. Unfortunately, the wider culture at large still has some power to mirror more individualistic behavior in them, and the conflict over rules and roles within the parents is transferred to the children.

The way out so that self actualization becomes possible is to be able is for parents and adult children to discuss this whole process constructively – a process fraught with potentially horrific dangers and difficulties. I describe that process and how to do it successfully, in my new book, Coping with Controlling, Demanding, and Dysfunctional Parents.


Thursday, November 1, 2018

My New Self Help Book is Out Today!





Are your parents constantly trying to control what you do or making incessant demands? Do they sometimes act in hateful ways that make you want to run for the hills? Do they invalidate you by questioning your intelligence, opinions, observations, or feelings?

In this new book, Dr. David Allen—an academic psychiatrist who has studied family dysfunction for over forty years—describes strategies for putting a stop to these repetitive problematic interactions.

You will learn:

1.      How to construct a family history of emotional issues (a genogram) that will help you to finally make sense of your parents’ confusing and seemingly bizarre behavior.
2.      How to use this understanding to plan strategies and counter-strategies for disarming your parents’ often formidable defenses in order to engage them in real problem solving.
3.      Effective methods for countering the ways your parents play with logic to confuse you.
4.      Effective counter-strategies for 17 different tricks they use on you to get you to shut up.
5.      How to block other relatives like siblings from getting in the way of your efforts.
6.      How your spouse or partner is embroiled in your family dysfunction, and strategies for turning him or her from a roadblock into an ally in your efforts to confront it.


Available now at:

Many brick-and-mortar Barnes and Noble bookstores.





Tuesday, October 23, 2018

Book Review: The Coddling of the American Mind by Greg Lukianoff and Jonathan Haidt





This highly recommended book addresses an extremely important issue: why the current climate we have in the States is characterized by increased and pathological polarization between various groups and subgroups, with each group vilifying the others. The authors also focus on a cultural shift on college campuses that has often led to an environment characterized by political correctness rather than free and open debate between opposing viewpoints. Groups can even turn on their own members for deviating ever so slightly from a “party line.”

The book is almost a textbook about certain processes that are characteristic of groupthink. Groupthink is when a group of people, in an effort to demonstrate harmony and unity, fail to consider alternative perspectives and ultimately adopts a shared narrative about the world which actively tries to keep out opposing viewpoints. 

Haidt, in a previous work reviewed here, pointed out that when groups of people who know each other share goals and values, this enhances “our ability to work together, divide labor, help each other, and function as a team is so all-pervasive we don’t even notice it.” He adds that “Words are inadequate to describe the emotion aroused by prolonged movement in unison that drilling involves.” 

However, sometimes groupthink goes way too far. Even supposedly objective scientists are not immune from overdoing it, which will be the subject of an upcoming book on groupthink in science I am co-editing for Springer.

Group process, in human psychology, is often at odds with our own brain’s ability to be selfish and think about what we want and believe instead of what others want us to want and believe. There is a war between individualist and collectivist tendencies within all of us. This idea is at the heart of my own therapy model, unified therapy. Its roots, in turn, are found in the model of family systems therapy formulated by Murray Bowen. 

His was the first, and is still seemingly the only other, therapy model that recognizes this basic conflict, which is found everywhere in nature. We are biologically programmed to, under certain environmental circumstances, sacrifice our own needs and beliefs – and even our very lives – for our kin or ethnic group.

The book discussed here looks at not only political correctness as an impediment for finding truth in the universe, but what they see as a related issue: why the rates of depression, anxiety, drug abuse and suicide have been rapidly increasing in college aged kids and others over the last few years. He attributes this to the adoption by large numbers of people in the Western world, particularly in the States, of what he calls “three great untruths:”

1.      The untruth of fragility: what doesn’t kill you makes you weaker.
2.      The untruth of emotional reasoning: always trust your feelings.
3.      The untruth of Us versus Them: life is a battle between good people and evil people.

When I was growing up in the 1950’s, all of the children I knew were out riding their bicycles in the neighborhood, wandering freely over significant distances, and spending much of their time engaged in free play. Many of them walked or rode their bikes to school, and baby sitters hired by parents at night could be as young as 12. What a difference from today, when someone might call the police or child protective services on you for letting a 9 year old walk home from school without adult supervision! 

Ironically, the rate of child abductions and crimes against kids was no different then than it is today, but partly because of pictures of missing kids on milk cartons and also because of widespread illiteracy about probability, today’s parents are downright paranoid.

The effect is disastrous. Human beings are, in many but of course not always, what the authors term anti-fragile. Of course, if trauma is severe or frequent, children often become more fragile and fall apart emotionally more easily later on. However, as the authors point out, if they are not exposed to a certain amount of stressors and challenges, they do not seem to learn to tolerate adversity, adapt to stressful circumstances, and grow up. They get weaker. Some stress is good for you! 

This is a good illustration of what I call the “principle of opposite behaviors.” Two opposite but extreme approaches to life and parenting lead to the very same problem. In this case, people who act fragile. Parents who over-protect their children end up harming them and driving their emotional problems.

My view about the interpersonal processes involved here differs somewhat from that of the authors. I do not think these folks are usually as fragile as they might appear. I think they act that way because they believe that their parents need them to be that way so the parents can feel good about themselves.

Over-protective parenting has become epidemic in society. The authors go into several revealing reasons for this phenomenon, although they do not mention as one of these reasons what I believe to be a major contributor: Over the period from 1965 to today, the change in gender role expectations and the need for two career families has led parents to feel guilty about not being there as much for their kids. They make up for it by being overly solicitous. These guilty feeling are exacerbated by today's culture wars.

One of the odd things going on in college campuses lately stems directly from the parenting changes: the absurd emphasis on “triggers,” “microaggressions” and the need for “safe spaces.” What this means is that both the kids and the adults running the schools think that a kid can be literally traumatized by hearing someone’s conflicting opinion. Not just upset, annoyed or even angry about it, but literally traumatized. Scarred for life!

The professors who don’t believe this to be the case feel intimidated and fearful for their jobs if they challenge this belief, and so they usually remain silent. This has led to something akin to a “speech police.” Speakers are prevented from coming to campus by occasionally violent protesters, and well-meaning professors and administrators have been fired for using the wrong word in something they wrote. The authors give several truly frightening examples.

This culture is completely the opposite of the culture that led to the “free speech movement” at the University of California in Berkeley in the mid 1960’s. Human knowledge advances by the free exchange of ideas as well as challenges to those ideas. That idea used to be at heart of the philosophy of higher education in the United States, but in many cases it seems to have disappeared.

Particularly enlightening – and frightening – is the book’s chapter on witch hunts. These occur when “A community becomes obsessed with religious or ideological purity, and believes it needs to find and punish enemies within its own ranks in order to hold itself together” (p.99). If someone offers any kind of differing viewpoint, they become the enemy. Everything starts to reek of “Us versus Them,” and the idea that people are either good or evil, and everyone seems to assume the worst about almost everyone else.

Thursday, October 11, 2018

Another Pharma Trick for Overstating the Effectiveness of their Drugs: The Will Rogers Phenomenon



Will Rogers

Big Pharma has a number of ways, many of which have been described in this blog, of making their drugs look a lot better than they actually are. And some psychotherapy researchers use the techniques to push their favored school of thought. I recently came across another one of which I wasn’t aware. 

It is easiest to see with drugs used for cancer chemotherapy, but can be applied in other cases.

It is called the Will Rogers phenomenon (and is also called Stage Migration). It is an apparent epidemiological paradox. The Rogers reference comes from a remark made by the famed humorist Will Rogers about migration during the American economic depression of the 1930's: "When the Okies left Oklahoma and moved to California, they raised the average intelligence level in both states."

With cancer drugs, it comes from changes over time in the way the severity of the disease is assigned to patients - how the various stages of a disease are determined in each case. (Stage I is when the cancer is smallest, has not spread, and is usually the most easily treated. Stage IV is the most advanced with metastases). The issue comes about because the technology for staging a cancer in a given patient has improved significantly. This can produce spurious improvements in stage-specific prognosis, even though the outcome of individual patients has not changed.

New imaging tools have allowed detection of cancer metastases before they became evident clinically. As a result, more patients are classified into the more severe metastatic disease stage from the less severe single tumor stage. Such a 'stage migration' resulted in an improved survival of patients in both the less and the more severe disease stages. (Multiple sclerosis is another disease where this sort of thing has taken place).

Some studies compare a new treatment to the treatment of so-called historical controls who had received other treatments. This is usually done because carrying out placebo-controlled studies in potentially dying patients is unethical. The Will Rogers phenomenon is recognized as one of the most important biases limiting the use of historical controls groups in experimental treatment trials. 

Essentially, the use of different diagnostic criteria may generate spurious improvements in the medium-term prognosis which then may be wrongly interpreted as treatment effects.

In psychiatry and psychology, placebo controlled studies can be done ethically, but a variation of the Will Rogers phenomenon can still take place because of how rigorously DSM diagnostic processes are applied to patients. When I first started training, the criteria for major depression and mania were rigorously applied in treatment studies; now they are often applied sloppily – on purpose. 

Chronic unhappiness, which may respond very well to cognitive behavioral psychotherapy, is often now misdiagnosed as the more serious major depressive disorder. If you have a bunch of those folks in your psychotherapy outcome study, CBT can be “shown” to be effective in major depression by including people in your study who really don’t have major depression.

The more serious depressions respond better to antidepressant medications. Since most antidepressants are now generic, drug companies who want doctors to use other, more profitable drugs like Latuda can do the same thing to “show” that antidepressants are actually less effective than they actually are. Placebo response rates in antidepressant studies have gone up about 10% every decade, and this is what I believe to be the reason.

Friday, September 28, 2018

Differences in the Size and Activity levels of Brain Parts: Long-Term Potentiation




One of the ongoing themes of this blog is the nonsensical practice of some researchers in psychiatry of routinely labeling differences in size and activity levels of parts of the brain, as seen on brain scans such as fMRI scans, between various diagnostic groups and control subjects as abnormalities (See the posts http://davidmallenmd.blogspot.com/2010/03/neural-plasticity.html and http://davidmallenmd.blogspot.com/2013/02/neural-plasticity-and-error-management.html).



These researchers seem oblivious to a now well-established process within neurons called long term potentiation (LTP). Briefly, if a synapse – the point between two nerve cells at which a nervous electrical impulse passes from one neuron to the other – is stimulated by individuals’ interactions with the environment that leads to learning, this produces a long-lasting increase in signal transmission between the synapses of those two cells. In other words, the power of the connection starts to increase. Conversely, if such a connection is hardly ever stimulated, its power decreases. This is probably the way memory works. Hearing a fact once in a lecture may not lead to its being remembered for long, whereas if someone keeps studying the fact, the memory of it becomes stronger.


It is important to mention that structural changes in the size and shape of the pre- and post-synapse parts of neurons may mediate permanent or near-permanent changes in synaptic efficacy. Growth may allow for an increase in the size or number of active zones on both sides of the synapse. The “spines” of the cell can increase in volume after LTP induction. While the degree to which structural re-organization of synapses occurs in adult animals is not yet clear, the process seems to involve a neurotransmitter (a chemical substance that is released at the end of a neuron cell by the arrival of a nerve impulse and, by diffusing across the junction, causes the transfer of the impulse to another neuron) called brain-derived neurotrophic factor (BDNF).

If a particular synapse is almost never stimulated, it can disappear altogether. Conversely, LTP is associated with an enhanced recycling of a part of the structure of the synapse, and this process could eventually result in the formation of a new, immature spine.

In other words, the more a part of the brain used for a particular purpose is used, the more likely it is to increase in size due to this process. When many synapses are involved in an individual's interactions with the environment, size differences in those parts of the brain can therefore easily be conditioned responses rather than abnormalities.

Saturday, September 1, 2018

Book Review: Judas by Astrid Holleeder




Imagine what it might be like to grow up in a home in which unpredictable periods of sheer terror and physical abuse were the norm. In this book, the sister of one of the Netherland’s most notorious criminal and crime boss—Willem Holleeder—describes the consequences. In brilliant detail, she sheds light on the bizarre interrelationships between her, her infamous brother, and her sister Sonja, all of whom grew up in such a home.

“My father treated his children the same way he treated his wife. He beat us, no matter how small and defenseless we were. As with my mother, he didn’t need a reason—he made one up on the spot. That was how he justified his actions. It was always “our own fault”—we made him do it” …Our behavior at home was exemplary…We were all compliant good kids who never broke any rules…filled with the smell of booze and my father’s unpredictability, those days seemed endless. Only one thing was certain: there would be shouting and hitting.”

Yet when these children became adults, breaking rules became almost a daily occurrence.

Their father’s attitude toward women was that he was the “boss.” Every day he’d scream “Who’s the boss?” and his wife would answer, “You are the boss.” He believed that “…women were inferior beings, their husband’s property, and whores by nature.” His wife was not allowed to leave the house for fear she might encounter other men, and if he came home and she happened to be home, there was hell to pay afterwards.

Yet Astrid became a lawyer.

Willem started early in criminal activities , and the family was often intimately involved. He first became widely know when he and Sonja’s Husband Cor, along with some others, kidnapped Freddy Heineken—the heir to the Heineken Brewery fortune. Of note was that their father had worked for the brewery for most of his adult life.

The Heineken family ended up paying the ransom; Freddy was released for 35 million Dutch guilders. Most of it was eventually recovered by the authorities, but not all. Questions about what happened to the rest eventually led to a falling out between Willem and Cor. After two previous attempts, Willem eventually had Cor murdered. During the first one, Cor’s car was shot up – with Sonja and their son in it.

Astrid had been more or less pressured by Willem to serve him as a sort of consigliere. She would give him legal advice and helped him keep the rest of the family in line, while he kept her in line with various threats. As far as the attempts on the life of the brother- in-law, he at first acted all innocent and “helpful” to the family. He was an expert at manipulating family members and strangers alike by either turning on the charm or by scaring the hell out of them. 

Gradually Astrid and Sonja figured out that it was Willem who had put the contract out on Cor, and because Willem seemed willing to kill even family members, they eventually turned on him.

Although highly mistrustful of the authorities for a variety of valid reasons (assuming Astrid’s reasons were honestly described) and constantly fearful for their own lives, they began working with the Dutch Justice Department. They eventually testified against their brother and helped put him in prison. He remains there, but the trials of several charges against him drag on. Both Astrid and Sonja are at present in hiding.

The author knew that Willem has put a contract out on her and her sister and that their days are probably numbered. She never forgave him for Cor’s murder. She knows he has put out hits on a significant number of murder victims, many of whom having been his former partners in crime.

Nonetheless, she still felt guilty about putting her own brother away. Such is the power of family-of-origin bonds. The last two sentences of the book say it all:

“The only reason you’re still alive is that you want to take our lives. But despite that certainty, Wim, I still love you.”

Monday, July 30, 2018

The Relationship between Marital Problems and Family of Origin Dysfunction






The essay In Consultation: Becoming a Therapist for Each Other: How to Deepen Couples Therapy by Ellen Wachtel Ph.D. in the Psychotherapy Networker from July/August 2018 answers a therapist’s question about a difficulty the therapist consistently ran into in his work with married couples. The question involved how to deal with the emotional difficulties of one of the members of the couple without derailing the work on the couples’ relationship issues.

Since in my experience both members of couples who seek marital therapy usually come to the relationship with pre-existing emotional issues – which I believe to be highly relevant if not crucial to their marital problem – that problem would come up no matter which member of the couple the therapist focuses on. Dr. Wachtel seems to understand this when she correctly points out that, “It’s common for one person in a couple to believe that the lion’s share of the problems in the relationship arises from the other’s emotional difficulties. As a firm believer that ‘it takes two to tango,’ I try to resist joining with that point of view.”

Unfortunately, she also adds, “But sometimes it’s just too big a stretch to see both partners’ contributions as anywhere near equal.” Nonetheless, she goes on to point out that, no matter how clear that seems to be,  the person “chosen” for individual work invariably reacts with, “’Why me? Shouldn’t she (or he) get therapy too?’ Or ‘I react the way I do because he’s so provocative.’”

I must say I agree with the member of the couple who says that. While one member’s dysfunctional behavior may be far more dramatic or dysfunctional than that of the other, in my opinion both members of the couple have a stake in their relationship continuing in its current dysfunctional form. The way this goes down and the reasons it happens were discussed in my previous posts “I’ll enable you if you enable me” and The Obvious Secret of Interpersonal Influence in Families.”

Briefly, each member of the couple is enabling the other member to maintain a role function that each believes necessary to stabilize their own parents, who are unstable due to an intrapsychic conflict that is shared by the entire family. I call this mutual role function support. Each member of the couple thinks the other member of the couple needs them to play this role because both of them compulsively act out their roles in the face of repeated and obvious drawbacks and negative consequences. Each person would deny this if asked for various reasons, so the other person has to guess why that person continues in their self-defeating or self-destructive habits, and they usually make the guess based on watching their partner interact with the partner’s parents (cross motive reading).

Wachtel comes very close to this formulation by recommending approaching the couple issues by saying, “We’re all stuck with some emotional issues from our childhoods, and even if we work on them in individual therapy, they’re still likely to have a hold on us. In our work together, we’ll try to find ways to keep these issues from affecting the relationship as much as they are now.” She also helps each member of couple construct their genogram to “get a window” into the source of problematic patterns. 

I would add that the emotional issues are not just from childhood but are in fact family emotional issues that are continuous and ongoing.

I have a lot of respect for Dr. Wachtel. She, along with her husband Paul, wrote a book called Family Dynamics in Individual Psychotherapy: A Guide to Clinical Strategies, the first edition of which came out in 1986.  This was one of the first books that attempted to integrate family systems ideas into individual psychotherapy.  (I must also admit I was a little annoyed when it came out because I was still trying to find a publisher for my first book, which attempted to do the same thing, and they beat me to it!)

Unfortunately, in this piece for the magazine, she falls into the exact same trap that Murray Bowen—the family systems therapy theorist who first started tracing dysfunctional relationship patterns through genogram construction—fell into. With his patients, as pointed out by Daniel Wile in his book on couples therapy, Bowen used education, logic, and collaboration to help educate his patients on the reasons for their self-destructive behavior. 

When he sent them back to their families of origin, however, he taught them to use the paradoxical interventions, therapeutic double binds, and strategic maneuvers that are part and parcel of Jay Haley’s alternative type of family systems therapy. In a way, he coaches patients to use this type of therapy on their family members instead of employing Bowen therapy. Wile asked why Bowen did not coach his patients on how to use Bowen therapy on their parents.

Wachtel starts to go down this route. She recommends to each member of this couple to offer support for, rather than merely challenge, the other member’s need to persist in each one's seemingly unproductive habits. In strategic family therapy, this is a paradoxical technique which often seems to have the opposite effect from what it seems to be intended to have: the partner might, in response to being given a green light, start to “be more able to hear his own internal voice that questioned the need to do the task.”

While this might help in couples that come from only mildly dysfunctional families, in my experience with more highly dysfunctional families, any good that comes from a paradoxical prescription will in fairly short order be undone due to the continued  and more powerful influence of the families of origin of each member of the couple. The parents and other family  member, as I often say, will invalidate the efforts of their adult child to step out of their dysfunctional family role with devastating effectiveness.

I find that members of a couple, with the right coaching, can move from the mutual role function support that attracted them to one another in the first place to becoming allies in the efforts of each to deal with his or her primary attachment figures. After constructing the two genograms, the therapist can help devise strategies for each member of the couple to stop dysfunctional interactions with each’s own parents. This can be done with the full understanding of the spouse so the spouse knows why their mate is suddenly trying to change things and understands how the devised strategies might actually work.

In fact, they can practice the strategies with each other. The spouse role plays the role of the other spouse’s targeted parent – and the spouse is usually well acquainted with that in-law and can do so very accurately – while the spouse practices the moves and countermoves planned with the therapist. This practice allows each one to stick with the script more effectively in the face of problematic responses from the parents.

I go into more detail about this process in my upcoming self-help book, due out November 1.