Tuesday, June 4, 2013

Strategies for Initiating Discussions of Family Dysfunction, Part II

In Part I of this post, I discussed two possible initial strategies for beginning discussions about highly charged, difficult family relationship patterns with the goal of putting a stop to them (metacommunication). Here in Part II I will discuss three more.

In trying to figure out the best possible strategy for a given family member, I mentioned the process I use with my psychotherapy patients: 

In doing psychotherapy with patients, when I start to help them shape an initial approach, I usually try one or another of the five potential strategies in a role playing exercise to see what my patient is up against. I generally stick with a given strategy even if the target’s initial response is a negative one - such as evasive maneuver or a verbal invalidation of the patient. Such maneuvers can often be countered with specific responses that are employed as the conversation progresses.

However, if I seem to get in trouble with escalating negativity from the patient playing the targeted other even while employing the usual countermeasures, I know that I should stop, and try a different initial approach.

Of course, all the usual approaches may not work, so ingenuity is required. Every time I am foolish enough to think that I have heard every possible negative response, I am surprised. But where there is a will, there is definitely a way.

Here are the remaining three strategies for getting the ball rolling:

3. Initiation strategy #3 is used in cases in which someone has been sacrificing his or her idiosyncratic ambitions in order to overtly or covertly “look after” parents. Such individuals may have been “on call” to help mediate the parents’ disputes, take care of various chores or duties for one parent or the other, or to provide missing companionship for one of them. 

Alternatively in families with gender role problems, an adult may live with a widowed mother so that either the mother appears to be dependent on her adult child or vice versa. The latter situation is created by the dyad in order to avoid the violation of any family proscriptions against women being powerful enough to make it on their own. In this situation, the adult child also appears to be in some way dysfunctional, so that the mother partially discharges her repressed ambition by running the adult child’s life. In such cases, it is very difficult indeed to tell exactly who is taking care of whom.

"Who is Taking Care of Whom?" is a shell game

Metacomunicators begin strategy number three with a statement that they are worried about the parent’s well being in some way. They might say, “I’ve been really worried about you, Mom, you’ve looked so lonely and depressed.”  The patient brings this up without any suggestions or advice about how Mom should take care of this problem. The reason for doing so is that the parent will usually argue with any particular advice offered - which is usually something fairly obvious anyway - in order to avoid dealing with his or her underlying loneliness and depression. 

Any such behavioral prescriptions that are offered by the metacommunciator can be dissected and debated ad infinitum, and the conversation invariably deteriorates into a game of “why don’t you - yes but” ("Well try this."  "Yes, I could do that, but [here's why that won't work]").

The initial response of the parent to this recommended opening statement is usually something like, “You don’t have to worry about me, I’m doing fine.” Such statements are an invalidation of the metacommunicator’s worries, since in most of these cases the parent really is depressed or lonely - or may be drinking too much or behaving self-destructively in some other way as the case may be. 

The statement is also an invalidation of the metacommunicator’s caring and concern. The best response here is for the individual to reply, “I appreciate the fact that you don’t want me to trouble myself with your problems, but I really am concerned.” 

Predictably, the parent will then respond with a distancing remark such as, “No you don’t. You don’t care about anyone but yourself.”  The metacommunciator can answer this type of statement by saying: “I wish I knew of a way to convince you that I really do.” No point arguing about it, since there is really no way to prove it one way or the other.

In the case of a mother and, say, an adult son playing the game of “who is taking care of whom” as described above, the son might begin strategy number three with a statement such as, “I know that you are perfectly capable of taking care of yourself, but sometimes you seem to be afraid to for some reason.” With this opening gambit, the mother has an obvious comeback that she can use in order to avoid facing the dilemma that has been brought up - usually for the first time - by the metacommunicator.

She can point out that it is really the son who is the dependent one. After all, such individuals often have, up to that point, exhibited some apparent defect that has prevented them from going out and making their own life separate from Mom. In many of these cases Mom has bailed the adult child out of one financial bind after another. Who is he to be talking about the mother’s dependency problem? In this situation, the adult child should confess that he has not striven for independence thus far, but that one of the reasons for his not having done so is his continued worry about how the mother might feel if left alone and on her own.

If the metacommunicator is successful at getting the parent to talk frankly about his or her expressed areas of concern, the adult child and parent can then go on to discuss how they have been misreading one another’s intentions and about the past family history that has lead to the problem.

4. The fourth opening strategy is employed when mild to moderate distancing behavior by the parents is a primary obstacle to metacommunication. Distancing behavior is manifested when any attempt by an adult child to get close to the parent or to discuss important family issues is met with hostility, verbal abuse, or other provocative behavior. 

The metacommunicator begins strategy #4 by expressing a wish for more closeness with the parent. They say something like, “I really feel bad that we get along so poorly; I really wish that things were better between us.”

This statement often leads to an initial positive reaction by the parent for two reasons. First, many distancing parents do not like to admit that their behavior is purposely designed to drive their children away. In effect, they would have to do so if they were to blatantly reject this overture. Secondly, the statement appeals to the side of the parent’s ambivalence that really does desire a close relationship with their children. The adult child’s expressed desire for closeness in spite of the fact that the parents have been treating her or him horribly communicates such love for the parent that the parent’s hostility often seems to melt away.

Unfortunately, in more severely disturbed families this type of approach may lead to an even nastier rejection of the patient than had been the norm previously. The parent may respond with a statement that communicates the sentiment, "“Well, I do not want to be close to you; I wish you had never been born!”  If this kind of response seems likely, metacommunicators should usually not attempt to employ this strategy. 

I believe that it is highly doubtful that the parent really feels that way even if he or she says it and acts like it, but clearly some other strategy might work better. In rare cases, however, the parent’s nastiness is so transparently feigned that a metacommunicator can break through it by saying, “I don’t believe that for a second.”

If the parent responds to initiation strategy number #4 positively, adult children might then wonder aloud why they and the target are always fighting. This question can once again lead to empathic discussions of the nature and origins of mixed messages and misunderstandings within the relationship, which are in turn used as a basis for requesting concrete behavioral changes from the target.

5. The fifth opening gambit is useful in cases in which an adult child is following in a parent's footsteps in some way. Such individuals usually recreate the parent’s maladaptive behavior in order to shield the parents from feelings of envy. In these cases, the adult child usually tries but fails to achieve some goal that is desperately desired by, but forbidden to, the parent. For example, a daughter might appear to seek out nice men but, just like her mother, end up with a succession of abusive mates. This may happen after Mom has spent years trying to shield the child from this very outcome or warning her about the dangers of it.

The metacommunicator begins strategy number five by asking the target for advice on how to handle a difficulty that the patient is experiencing outside of his or her relationship with the target. The outside difficulty should parallel a difficulty that the target has also experienced within the family. For example, in a family in which a daughter’s father always gives in to the mother's unreasonable demands, the daughter may come to the mother with the following request for help: "Mom, I need your advice. My husband is following me around like a puppy dog. How do you think I should handle it?” 

The goal here is to establish a sense of commonality between the two women that allows for open discussion about how parallels in the family happened to have come about. Once again, this naturally leads to discussions of the nature and origins of mixed messages and misunderstandings within the relationship. 

In dysfunctional interactions, whenever one party brings up such parallels, the other party usually feels unjustly criticized, and therefore reacts negatively. This occurs for one of two reasons. First, the second party may feel that the first party is a hypocrite who is criticizing her for things the other party does herself. Alternately, one or the other party may feel that their situations though similar are not really the same at all.

Strategy #5 changes the valence of the interaction from negative to positive in two ways. First, it puts the daughter in the proper hierarchy with the mother. The patient is asking the mother for advice based on the mother’s experience and intelligence. Second, the mother usually will not feel criticized by the daughter for having the problem, because the daughter is admitting to having the very same or a similar problem herself.

All five initiation strategies, as well as any other creative approaches an individual is able to devise, are meant to soften up the target, so to speak, so that the family dynamics can be discussed and clarified. If an initial approach seems to work, the metacommunicator continues the conversation to the point where the goal of mutual understanding and a request for a concrete change has been achieved.

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