Tuesday, October 25, 2016

Discussing Dysfunctional Family Patterns with the Family: More Tricks of the Trade

Offering Theories Better than Asking Questions

As I have discussed in many previous posts, when adult children try to figure out the reasons behind their parents' confusing behavior, they usually conclude that the parents are either mad, bad, blind, or stupid. I mean, how else can you explain the following bizarre parental behavior: denying the obvious, giving double messages that put their child in a damned-if -you-do/don't situation, seeming to want their children around (often in a caretaker role of some sort) while simultaneously seeming to hate their guts, putting up with abusive spouses while making excuses for them, being completely preoccupied with one sibling while acting like another child barely exists—and a host of other unfortunately fairly common dysfunctional behaviors.

I believe, as readers of my blogs know by now, that most parents who act like this are neither mad, bad, blind nor stupid. They are instead acting out roles with their children - in a highly ambivalent fashion - that they themselves had learned in their own families of origin. These roles stabilized the grandparents, who were themselves highly conflicted about certain family and cultural norms and rules of behavior.

Mothers who have gender role conflicts are a really good example of what I am talking about. They often give out mixed messages to their daughters about both having careers and having children. Their daughters are somehow also expected to get some man to take care of them while simultaneously being independent.

Just asking the parents why they are doing what they are doing usually leads to more obfuscation, non-sequiturs, denial, and various other ways of invalidating the person who poses the question and/or disqualifying their own true beliefs. Or even worse, questions sometimes even lead to violence, suicide attempts, and other forms of acting out. 

"Why" questions are also particularly likely to lead to either aggressive or defensive remarks because they can sound accusatory—sorta like asking a child, "Why is your hand in the cookie jar?"

Asking "yes or no" questions is equally problematic. It also often leads to responses that are less than edifying about what the parents are trying to accomplish with their bizarre behavior. The parents can just answer "yes" or "no" with no additional explanation.

One trick in metacommunication is based on the idea that in human interactions, certain verbalizations seem to require certain responses, making it more likely that when they are used, the other person will feel obligated to respond in certain ways. They may say things that are more enlightening or clear. Of course the strategy I am about to describe is not foolproof, but it does increase the odds that a useful exchange may take place.

The trick is for the person to empathically offer some speculation about family interpersonal processes that may be triggering problematic feelings or behavior in the parent. There is something about tentatively offering someone someone a hypothesis that makes it much more difficult for them to merely agree or disagree. Hypotheses seem to demand more than questions; they increase the likelihood that the parent will feel it necessary to explain what is wrong or right with the hypothesis, rather than just giving out an unexplained acceptance or rejection of it.

This is especially true if the adult child overtly labels the intervention as a guess, thereby giving the parents an "out" that allows them to reject the guess if they are just feeling too threatened to respond with more information. This technique makes it difficult for the parent to provoke a power struggle with the adult child over the accuracy of the hypothesis.

The potential metacommunicator can base speculations or hypotheses on any information concerning his or her family that is already available, or on typical patterns that they have seen or read about in my blogs or elsewhere. Having done one's family's genogram often provides a good source of such guesses. Such hypotheses should always be offered in a tentative and non-threatening manner.

Continuing with the gender role conflict situation mentioned above, for example, the adult child might say something to her mother like, "I don't know if this applies to you or not, but in other families where a woman's career choice is an issue, mothers often feel bad because their daughters get to do things the mother always wanted to do but was not free to do. I wonder if this might apply to our situation?

Tuesday, October 11, 2016

Stupid Researcher Tricks

When David Letterman was a late night TV talk show host, he had a recurring segment called "stupid pet tricks." In this vein, this post is titled "stupid researcher tricks." The authors of certain studies in psychiatry employ logical fallacies - either knowingly or in some cases unknowingly - in their discussions of their results. This often results in their drawing totally misleading conclusions from their data.

I will discuss two telling examples of such fallacies. The first involves employing a hidden assumption that is not true. I discussed the general issue of hidden assumptions in a previous post. The particular example in this post can actually be thought of as Part II of my post on the heritability fraud. The second example involves a subtle logical fallacy known as the ecological fallacy: making inferences about individuals based on data obtained that characterizes an entire group, using averages on various measures, to which that individual belongs.

In the previous "heritablility" post I wrote about how that term is falsely used as a synonym with "genetic" in studies that purport to sort out genetic versus environmental factors leading to the development of personality traits or behavioral disorders. The statistic is developed from twin studies: identical versus fraternal twins, and/or those identical twins raised together and those raised apart. 

As previously described, these studies - despite frequent claims to the contrary - do almost nothing to sort out genetic versus environmental influences. The reason is because the statistic is based on phenotype (the final interactional product of genes + environment) and not genotype. As such, it includes a mix of purely genetic factors and factors that result from gene-environmental interactions, and there is no way to know how much of each is contained therein.

Another aspect of these studies I mentioned in the previous post: they also divide environmental influences into "shared" (family and home) and "unshared" (peers, media, teachers, and other outside factors). I mentioned that a determination of which parts of an environment are shared by siblings and which are unshared has a lot in common with finding water with a divining rod, because parents do not treat all of their children alike. Nor does each twin have exactly the same interactions with each and every other family member from the moment they are born to the moment they die.

Interestingly, the "shared" environments in these studies usually come out as less important in leading to behavioral issues than the "unshared!" This would mean that family and parental behavior is less of a factor in personality development than outside influences - something that runs counter to logic for a variety of reasons (for example: which peer group someone chooses to hang out with - when there are several different ones to choose from -  is not an accident).  

The researchers almost have to find that family is less important that peers and media because they just ASSUME that each twin is subject to identical influences inside the home. If you make this assumption, and then if the twins turn out differently on some characteristic, of course the home will appear to have no influence!

Maybe these ignoramuses should read the family systems literature on how siblings are treated differently. The more dysfunctional the family, the bigger the differences! 

Example number two, studies that employs the ecological fallacy, involves those that compare two different psychotherapy treatments for the same disorder. These studies are relatively uncommon, as most psychotherapy outcome studies compare a treatment with a "control" condition like a wait list or "treatment as usual" rather than with a second type of treatment. (Those control groups are also invalid, but that is a matter not relevant to this discussion).

In the few studies that compare one school of therapy with another, an interesting statistic is that 85% of the time, the treatment favored by the person designing the experiment "wins" and outperforms the other treatment [Luborsky, L., Diguer, L., Seligman, D. A., et. al. 1999.  "The Researcher’s Own Therapy Allegiances:  A “Wild card” in Comparisons of Treatment Efficacy." Clinical Psychology: Science and Practice, 6, 95-106]. This is due to something called the allegiance effect - the more enthusiastic a therapist in a study is about their own school, the better the patient tends to do.

But even ignoring this clear-cut sign that research conclusions in comparative outcome studies are inherently misleading, let us suppose that with one therapy treatment in the study, 45% of the patients improve significantly, while in the other, only 30% do. The conclusion of the researchers: the first treatment is superior.


This conclusion presupposes that all patients react to treatments somewhat identically, despite the fact that the majority (or at least a significant percentage) of patients in both arms of the study did not improve. It is quite likely that some patients are more comfortable and do much better with one of the therapy treatments than with the other. Of course there is no way to know for certain, but it is quite possible that the 45 percent of people who respond to the allegedly superior treatment are very different in many respects than are the 30% who respond to the allegedly inferior therapy.

A well-designed study, on the other hand, would have to recognize these differences and would look at the characteristics of the four different groups that comprised the study: those who got better with treatment A, those who got better with treatment B, those who responded poorly to treatment A, and those who responded poorly to treatment B. The researchers could then match the patient with the type of therapy they seemed to do best with, and then and only then compare outcomes.

In other words, as I have pointed out elsewhere, no matter what therapy intervention you use, some people will improve with it, while others either will not improve or may even get worse! Different strokes for different folks, people.