Parenting Styles and ADHD Symptoms

 

In my continued effort to beat a dead horse, this post concerns yet another not-so-science-based characteristic of authors of the literature on ADHD: their refusal to consider any alternate interpretations of their data other than that they are studying some sort of brain disease. In this case, they do not consider the possibility that the symptoms of their subjects come as a result of environmental issues, such as a chaotic home environment and/or sleep deprivation.

One well-publicized study (Variable Patterns of Remission From ADHD in the Multimodal Treatment Study of ADHD | American Journal of Psychiatry (psychiatryonline.org) purports to show that up to 90% of children who have attention-deficit/hyperactivity disorder (ADHD) may continue to experience residual symptoms of the disorder into young adulthood. Amazingly, the authors add that they may also have periods of remission along the way. In other words, ADHD is a disease with waxing and waning symptoms. Could it not be that other, environmental issues that create their symptoms are what is doing the waxing and waning???

In another publication, Greg Mattingly, MD, of the Midwest Research Group, tells us that, “Instead of resorting to positive parenting, many of them [parents of kids diagnosed with ADHD] have fallen back on what we call negative parenting: scolding, discipline, getting frustrated. As we shift into next year, we need to shift into how we shift into a positive parenting model. I want you to talk to your kids with encouragement about the school year. Share something each day that was something cool they learned in a positive way, and then complement them for sharing that fact back with you."

So the symptoms get better with positive changes in parenting style? The author doesn’t seem to consider the possibility that negative parenting styles were perhaps a big cause of the so-called disease in the first place. 

This reminds me of TARA, a support group for parents of people with BPD (at least those that weren’t physically or sexually abusive, since those relatively common parents-of-kids-with-the-disorder would never join a parent support group —other than perhaps the False Memory Syndrome Foundation). They teach parents how not to invalidate their kids but somehow don’t mention the DBT theory that an invalidating environment is a major cause of the disorder in the first place. In TARA's case, this isn’t a bad thing because if they did that, a lot of these parents wouldn’t attend their seminars. But researchers in the field ignores this issue as well.

Spoiling Behavior is All an Act, But a Deadly Serious One

Relationships between people are formed through interactions that are two-way and simultaneous. People learn and become different over time as this occurs, and can push one another away.

I recently received an angry letter from a mother whose child apparently has been diagnosed with borderline personality disorder (BPD). She told me that I must have no idea what it is like to raise a child with the disorder, or I would never say what I do about it. She added that kids with the disorder do not respond to the most positive of upbringings, so don’t blame parents!

Having been the direct recipient of the spoiling behavior of adult patients with the disorder when I started out as a therapist - and did not know then how to deal with their in-session behavior effectively - I can say that I have a really good idea about what that is like. And it ain't no picnic. And I agree that unrestrained positivity does not change it. It can even make it worse!

It is also true that not all families that produce kids with the disorder are overtly abusive either physically, sexually, or verbally, although a large and significant majority of them are in fact abusive in those ways – according to every study ever done. Even DBT therapists believe they come from an “invalidating environment,” even though they seem to scrupulously avoid identifying that specific environment as the family of origin.

I would like to suggest that the reader take a look at what the letter writer said in a different way than would be a typical interpretation. (Of course, I can’t know for sure even if her child has even been correctly diagnosed or exactly how positive the family environment is). In just a couple of sentences, she could be understood to be saying that her parenting has nothing to do with how her child turned out. In a phrase, it is only the child who is (completely) screwed up.

           

If I’m hearing this in a short letter, you can bet that the child has heard it. And guess what? If children hear this point of view a lot, they will begin to act in ways that give the parent an easy justification for making the statement so the parents don’t have to feel bad about blaming everything on the kid. But doing this is all an act to placate and stabilize the parents.

I can predict relatively confidently that if the mother continues to exhibit this same attitude much of the time, the child will continue to give her grief, and will not get better.

           

Likewise, if a parent is constantly invalidating a child, the child will begin to act in ways that practically invite invalidation. One leader of a parents of BPD kids' support group once told me that her daughter said bizarre things, such as that she had grown up poor. The family was in fact quite well off financially. The daughter was not psychotic. Her mother is quite bright, so I would have to assume that the daughter is not actually stupid enough to somehow not know that the family was affluent. If she were my patient, I would ask her specifically what she thought the family was poor in. Validating responses, perhaps? Warmth?

           

When I speak of this stuff being an act, I always have to clarify that it is specifically the spoiling behavior which is the act. The way they generally feel, their sense of a poor identity, the impulsiveness and such are all real – but all adaptive or reactive to the family dynamics that produce BPD.

Mental and Interpersonal Mechanisms of Groupthink Maintenance

                                                                                          PatientSafe Network

This post is a shortened version of one of my chapters in the upcoming multi-author book, Groupthink in Science.

One of the defining characteristics of groupthink is something called “willful blindness.” People often know things but choose to pretend that they do not, in order to fit in with larger social groups. They lie to everyone including themselves They refuse to look at any sources of information that might call into question any beliefs that help them to “convey and conform to” the needs of the various groups to which they belong. The paradox of such willful ignorance is that in cases in which you are motivated to avoid looking at something, you have to know where not to look! In other words, you had to have seen it.

The reason that we all do this has to do with a significant characteristic of natural selection during biological evolution. Conforming to the values and requirements of our kin group or tribe has high adaptive value. Genes that contribute to the survival of the tribe or clan to which we belong, as opposed to those that only benefit individuals, are highly likely to be passed on. This process is known as kin selection.

While sacrificing oneself for a group – such as the widespread willingness to die for one’s country in a war – is not beneficial for individual survival, it does contribute significantly to group survival. Nonetheless, it can sometimes actually harm a group’s interests in the long run. The term pathological altruism has been used to describe situations in which this tendency to self-sacrifice backfires and harms not only the individual making the sacrifice but his or her group as well.

Many mental mechanisms and tricks have evolved to help us lie to ourselves to achieve these purposes. Interestingly, we also tend to assist our fellow group members in using these tricks on themselves. Groups as a whole also have a variety of mechanisms for keeping certain information censored. The mechanisms are the subject of this post.

They appear at the level of the individual, where they include the defense mechanisms described by psychoanalytically-oriented psychotherapists, and the irrational beliefs enumerated by cognitive behavioral psychotherapists. They also appear at the level of the family or kin group, where they are called family myths. They also exist at the level of cultural groups, where they are called mythology.

Defense mechanisms were originally defined as mental processes, typically subconscious, employed by individuals to avoid ideas or impulses that are unacceptable to their own personal value system, and to avoid the anxiety that those ideas or impulses therefore created. Notice, however, that these mechanisms do not just serve an internal purpose within our mind, but an interpersonal one as well. We may, for example, compulsively try to act in the opposite way that an impulse that is unacceptable to our group would dictate (reaction formation), or displace our anger at one person within our kin group onto another outside, safer person to avoid tension within our group.

Irrational Beliefs are often automatic in that they come to us without any conscious effort in response to an environmental event, and they quickly lead to specific behavior patterns. They are often said to be subliminal, which is a similar concept to subconscious. If you, for example, catastrophize (imagining every single thing that could possible go wrong if you did something, no matter how unlikely) about your engaging in a course of action not condoned by your group, you will indeed scare yourself away from engaging in it. Group norms are often internally policed by unquestioned thoughts that start with “I should or must” do or think this or that. If you had contrary thoughts in the past that turned out to be wrong, you might overgeneralize by thinking that all the thoughts related to the earlier ones are always going to be wrong as well.

Logical fallacies can also be used to either explain away or justify ideas that might contradict group norms or beliefs. For instance, post hoc reasoning assumes wrongly that if event A is quickly followed by event B, then it is probably true that A caused B. Therefore, you opt to avoid A in order to avoid B. An example: "Looking at pornography will lead to sex addiction." This is fallacious because the pairing is often due to another variable common to both A and B - in this case the internal conflict over one's sexuality - or because the pairing is just a coincidence.

Group Mythology. In order to operate as an integrated unit, groups with a common purpose also have mechanisms that they use to enforce conformity of thought within their numbers. Members employ various strategies to invalidate any competing ideas with which they might be challenged. Once again, group cohesion has its advantages; it often maximizes the group’s chances of success, but these mechanisms can also backfire severely and lead to failure.

Family therapists have studied groupthink phenomena within families, but similar ones are used by other groups as well. An individual's family often acts as if they all share a set of beliefs, and they all seem to live by them almost compulsively. While some of these beliefs are applied only to certain individuals, others apply to the whole group. The latter ideas are referred to as family myths. They justify and support a set of rules which dictate how each family member should behave and why, and what family roles each must fully and habitually play. This allows the family to function in a predictable way (family homeostasis).  

The myths function as a belief system which the family uses, often defensively, to explain or justify its behavior and beliefs. They are sometimes verbalized explicitly, but can also be expressed implicitly. Sometimes they take the form of oft-verbalized adages or slogans. One good example of this was seen in a family that strongly believed in fatalism—the idea that people are powerless to change their world so one should make the best of that which already exists. They all spouted three different proverbs on numerous occasions that expressed and reinforced within the group a warning about what happens to anyone who tries to take charge of their lives: "The grass is always greener on the other side of the hill;" "The devil you know is better than the devil you don't know;" and "You've made your bed so now you have to lie in it." 

Within-group Mechanisms for Enforcing Groupthink: Disqualification and Invalidation.

Individuals can, when necessary, use two related mechanisms to obfuscate their own real beliefs to themselves or others. This is done so that if later said beliefs are rejected, the persons can deny they had meant what they had in fact said. These tactics are called disqualification and invalidation. Disqualification is a strategy used to make one’s own position on an issue ambiguous. When someone does this, other members of the group cannot say for certain what it is that the person actually believes. When other people ask for clarification, they are basically told that they are misperceiving in some way the person they are asking. Doing this to them is an example of invalidation. 

Personality Disorders: Researchers Continue to Make Misleading Assumptions

In this blog I have discussed several instances of researchers making unwarranted assumptions about both their study populations and in interpreting their results in a variety of ways. In this post, I’d like to focus on three recent articles about personality disorder research. The first is a possible refutation of a common presumption, while the second two assume facts not in evidence.

The difference between “cannot” and “do not:” Confusion based on lack of attention to subject motivation, and ignorance of the concept of “false self.”

Shane MS; Groat LL. “Capacity for upregulation of emotional processing in psychopathy: all you have to do is ask.” Social Cognitive & Affective Neuroscience. 13(11):1163-1176, 2018 11 08.

Could it be that a psychopath’s apparent lack of ability to be empathic stem from differences in motivation rather than ability? This article is certainly possible evidence that this is the case. Perhaps people who routinely engage in anti-social acts suppress empathic responses because that is their role in their family. That what has been observed results from subjects’ false selves? 

This study of course does not address that latter issue, but thinking about it certainly suggests something which could explain the results. (Of course, it would help in that endeavor if we could read minds, because the thing about a false self is that it is based on someone lying to themselves in order to fulfill a social function, so they are highly unlikely to tell experimenters the truth during a short interview).

In any event, in this study, high-psychopathy participants showed typical, significantly reduced neural responses in the brain on an fMRI to negatively-toned pictures under passive viewing conditions. However, this effect seemed to disappear when the subjects were instructed to try to maximize their naturally occurring emotional reactions to these same pictures!

The locations of these increased neural responses included several brain regions involved in the generation of basic emotional responses and which have often been shown to be reduced in psychopathic populations. Thus, despite baseline differences from non-psychopaths,  high-psychopathy participants appeared capable of deliberately manifesting emotional responses to the negatively toned pictures within several brain regions believed to underlie emotional processing. 

Of note was that the magnitude of these deliberately evoked emotional responses was comparable to levels exhibited by low-psychopathy participants’ during passive processing.

A high index of suspicion versus an “inability” to correctly read the mental states of others

Quek et. al., “Mentalization in Adolescents with Borderline Personality Disorder.: a Comparison with Health Controls.” Journal of Personality Disorders, 33 (2):145-165, April 2018.

Mentalization refers to an individual’s capacity to understand and interpret the meaning of one’s own and others’ behavior by considering underlying thoughts, feelings, intentions, and desire. As in other studies, this was “measured” in adolescent subjects with borderline personality disorder (BPD) and normal controls while interpreting the mental states of others shown in pictures, videos, and narrative vignettes of people in various social situations.

The authors of this paper mention almost in passing that the ability to mentalize  is thought to develop within the context of, and is dependent on, the quality of infant- parent interactions. In the experiment, the differences between the performance of the BPD subjects compared to the control group on the various tests became much greater when the material they interpreted suggested attachment-related stress or arousal. 

Additionally, the major differences between BPD subjects and controls seemed to primarily involve what the authors describe as hypermentalization (that is, making much more complex inferences than expected about social cues, signs, and mental states) by the BPD subjects, rather than through a loss of detail.

Despite all this, the authors don’t seem to consider the obvious possibility that attachment figures’ influence on their children’s ideas about the social behaviors of others continues unabated long after they are no longer infants.

So let’s do a mental experiment. How might you evaluate the motives of other people if you were to grow up in an family environment characterized by your being constantly invalidated and given highly confusing double messages about how you are supposed to think and behave, and even being verbally abused— if not physically or sexually abused—if you seem to have guessed wrong about that? Do you think you might have a higher index of suspicion about other people’s intentions than someone who did not grow up in that environment? Do you think you might have more difficulty making sense of other people's behavior? Ya think??

So, do kids with BPD grow up in that environment? Well, in addition to Linehan’s theory of an invalidating environment being part of the etiology of BPD, and my own paper from 2005 (Comprehensive Psychiatry, 46[5] pp. 340-352) which showed that adults with BPD reported about three times the number of double messages from their parents than non-BPD controls, consider the following paper.

Changing parent’s behavior towards BPD children can make those with BPD better—but their behavior apparently had nothing to do with their kids having developed the disorder in the first place

Grenyer et. al., “A Randomized Controlled Trial of Group Psychoeducation for Carers of Persons with Borderline Personality Disorder.” Journal of Personality Disorders 33 (2):214-228, April 2018.

As mentioned in a post on my blog on Psychology Today, researchers into BPD have of late developed an interest in the “burdens” on parents and other caretakers (almost always other relatives) of having a child or adult child with the disorder. Such “carers” are the subject of this particular study, and were recruited through flyers distributed to mental health services, local media, patient advocacy groups, and patient family and support networks. The recruits were put into groups and given a lot of “psychoeducation” about their charges.

The first thing that jumped out at me in this paper was the fact that, even though the carers were evaluated for being critical and over-involved with their BPD children, there was nothing mentioned about seeing if the parents had been guilty of physically or sexually abusing their charges when the fledgling BPD patients were children. This, despite the fact that every empirical study done on this subject in BPD patients finds a high level of significant abuse history. Of course, parents who respond to flyers and volunteer to be research subjects in this sort of study are highly unlikely to have been seriously abusive. So right away, the experiments are selecting for a somewhat atypical sample of parents of children with BPD.

The second thing that jumped out at me was that the psychoeducation provided for the subjects was supposedly based on Bowen family therapy theory, when the researchers mentioned and seem to know absolutely nothing about one of the major tenets of that theory. You know, those that involve intergenerational transfer of dysfunctional family patterns. The researchers mention nothing about the parents being somewhat responsible for the development of the disorder in their kids in the first place!

That they seem to make this assumption is even more awe-inspiring when you look at what was being taught to the parents and which apparently led to improvement in the BPD child’s behavior as well as in the parent-child relationship. They were taught to:

1.      Be non-judgmental, validating, attentive and appropriate.

2.      Reduce their reactivity and try to remain calm and “mindful.”

3.      Attend to their own needs through staying connected with friends and family, attending to their own physical and mental health, and taking breaks.

4.      Model appropriate assertiveness and setting appropriate boundaries and ground rules for the relationship.

5.      Get outside help when crises arise and having a crisis plan.

So, if they had to be taught these things, and if doing those things leads to improvements in their children, maybe the fact that they were doing the opposite of those things all the time previous to the experiment was what was creating their child’s problems in the first place. Exactly what you would expect considering the family dynamics of BPD.

Not Taking the Bait in Family Discussions

When adult children complain to their parents about how the parents are repetitively engaging in invalidating, hateful, critical, demanding, and or abusive behavior towards them, the elder family members have almost always developed a number of ways to get them to shut the hell up. Often these ways include dismissing the adult children's complaints by accusing their progeny of being:

A) Little snowflakes (to use the current trendy term) who are overly-sensitive, weak, selfish, unable to take a little good natured teasing, or "high maintenance."

and/or

B) Stupid - reading things into what the parents are saying that are not really there.

and/or

C) Pathological -making things up that did not even happen or twisting the meaning of everything the parents says to unfairly shift the blame for the child's problem onto the poor, put-upon parents.

Unfortunately, in many of today's psychotherapy models, many therapists seems to agree with the parents that the adult child's problems are all in their heads and are not, in fact, due to their having being traumatized or understandably upset by dysfunctional or abusive family relationships.  

And of course, as readers of my blogs know, if parents act as if they expect  their children to act in weak, stupid, or pathological ways, in response the children often do indeed start to act out exactly what they are being accused of doing. When dysfunctional family patterns include that phenomenon in addition to the problematic parental behavior mentioned at the top of the post, the situation is a bit more complicated to talk about and will not be discussed further here.

To solve the problems, the adult children have to find a way to not shut the hell up, but to constructively push the conversation forward in order to put a stop to the problematic patterns. (I'm currently under contract for and working on a self-help book for New Harbinger publishers that discusses in great detail a large number of different strategies for achieving this goal).

This post will discuss one countermove to use when you are being accused of A, B, and/or C above that is often successful in disarming the parents and pushing the conversation onward. Of course, no strategy works with all families, or even all the time within any one family. But this one increases the odds of productive conversations when adult children bring up the complaints mentioned in the first paragraph of the post.

The strategy is based on a premise that was described beautifully and concisely by my colleague Dr. Jami Woods. She said, "You can't be pulled into a game of tug-of-war if you don't pick up the rope."

In this case, the accusations by the parents are bait. They want you to take it. You are being baited into becoming angry or defensive. Once that happens, constructive conversations immediately end in fight, flight, or freeze responses. No problems get solved then. Do not take the bait!

So how to avoid doing so?

Let's say you tell your parents that their demands are getting on your nerves because no matter how much you do, it never seems to be enough for them, and that that they seem to ignore the fact that you have other things to do and cannot just drop everything at a moment's notice to do things for them. Say they respond by telling that you are grossly exaggerating how much they ask of you, and that you ought to be happy to take the time to help them out. They add that you are being ungrateful. Just think of all the sacrifices they had to make for you when you were growing up!

How not to respond:

A) Argue with them about the frequency or reasonableness of their requests, or how much they sacrificed for you as a child.

B) Attack them and tell them they are insensitive, overly-critical clods.

C) Defend yourself by pointing out that your life is busy and of course you cannot always just drop everything to come over and do something for them.

D) Explain in detail your feelings and go on and on about how those feelings are justified.

E). Scold them or lecture them about etiquette and the proper relationship between adult children and their parents.

The basic form of the recommended response:

"Well, maybe so, Dad, but I am finding this situation to be a big problem. Do you think you could help me out by checking with me first about when it would be convenient for me to come over to help you?"

This sort of response is basically a refusal to argue about the merits of your personality characteristics, but trying instead to make a relationship better. In doing this, you are neither agreeing nor disagreeing with their characterization of you. It might be accurate, partially accurate, or complete wrong. Who's to say, really? That isn't the point. The point is how you are reacting to them when they do something, not whether your reactions are justified or not. They should want to know that so that everyone can, to quote Rodney King, just get along.

Surely they'd prefer a pleasant relationships to an unpleasant one. I know that it often looks as if this is not the case, but nonetheless, I advise that you give them the benefit of the doubt. 

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?

Invalidating Therapists Act Like Job's Counselors

Recently I heard a story about a man who made a choice regarding his career that was at odds with family expectations. He was roundly criticized by his father, some of his siblings, as well as an uncle.

Much later, when the man started having financial problems, these relatives told him immediately that this was all his fault. According to them, his financial woes just had to be because of the career decision he had made.

This is an example of what I refer to as clustering - family members ganging up on one of the members for breaking a family rule, and pressuring him or her to tow the party line.

In an analogous fashion, some therapists inadvertently feed into a patient's problems rather than help remedy them, and in the process invalidate their own patients. Before getting to that, however, I wanted to mention that the man in question likened his relatives to "Job's Counselors." I of course had heard the story of Job, but I had never heard about that part.

As most readers will know, the Book of Job in the Bible describes the tale of a pious and righteous man named Job, who had considerable wealth as well as wonderful sons and daughters. In heaven, God asks Satan for his opinion of Job's piety. Satan answers that Job is pious only because God has blessed him; if God were to take away everything that Job had, then he would surely curse God.

God then gives Satan permission to take Job's wealth and kill all of his children and servants. Still, Job continues to praise God. Then, God allows Satan to afflict his body with boils; still he remains pious.

Three of Job's friends became known as "Job's Counselors:"  Eliphaz, Bildad, and Zophar. The friends tell Job that his suffering simply must be a punishment for sin, for God causes no one to suffer innocently. This of course, is the exact opposite of the truth as laid down in the story.

So how does this relate to therapists inadvertently invalidating their patients? Well, many therapists focus on alleged defects in their patients and work on such things as "anger management," "distress tolerance skills," or fixing the patient's defective "mentalization" (the ability to accurately assess the intentions of other people). 

These sorts of interventions presume that if someone is upset, angry, or unhappy with the way the world is treating them, then therefore there must be something wrong with them. Even when they are in fact being abused horribly!

Now, in defense of therapists who received reductionistic training, it is true that patients often act as if there is something wrong with them in these sorts of areas. However, as I have discussed in previous posts, there is a big difference in patients' public performance at a task as opposed to what they are capable of doing.

Often the alleged defects are in reality part of one of the dysfunctional family roles frequently described in this blog. People who are exclusively trained in CBT do not know about —or if they do they do not accept—the concept of a persona or false self. CBT made a name for itself by attacking psychoanalysis, its predecessor as the predominant form of therapy, and rejected all of its concepts regardless of whether they were right or wrong.

Researchers in personality disorders routinely make this same logical error all the time in studies. They look at the subjects' reactions without looking at all at what they are reacting to! It is a bit like watching a movie in which all but one of the characters - both their behavior and their verbalizations - are redacted so that the viewer can only see what one character is doing and saying, apparently in a vacuum. And then asking the viewer to guess why the one remaining character talks and acts the way he does.

An excellent example of precisely this appeared in the February 2016 issue of the Journal of Personality Disorders - a study called "Using Negative Emotions to Trace the Experience of Borderline Personality Pathology" by M. Law and others. Research subjects were asked to record their emotions (especially irritability, anger, shame and guilt) five times a day for two weeks, but not the environmental triggers which seemed to create these feelings. 

The authors came to the shocking conclusion that the subject's BPD symptoms and their negative emotions were intricately related. No sh*t, Sherlock.

Wouldn't it have been just a little more informative to have gotten data that would help us understand what sorts of situations were most likely to trigger both the negative emotions and the symptoms of people with borderline traits? Ya think?

How to Fail at Family Problem Solving

In prior posts, I have discussed what I call the principle of opposite behaviors as it applies to repetitive behavior in personality disorders as well as in recurring dysfunctional family behavior. It is related to an idea that I call the net effect of behavior: that if someone always gets the same results from their actions, and they keep doing it anyway, then the result they get is the result they are trying to get.

The principle of opposite behaviors applies in those cases in which someone repeatedly does the exact opposite of what another person is doing, yet repeatedly gets the same results anyway. Or those cases in which a person goes from one extreme to the other, and still always ends up in the same place.  Prior examples discussed in this blog: Parents who let their kids do anything they want versus those who try to control their every move; those who never ask anyone for anything versus those who ask people for the moon.

This post is about how the principle of opposites applies to metacommunication — family members discussing both their mutual interactions and the family dynamics over several generations. As readers of this blog know, I believe that doing so is the most effective way to solve problems and put a stop to ongoing dysfunctional interactions which trigger psychological symptoms and troublesome behavior. It is the "curative" part of my psychotherapy, which I call Unified Therapy.

When I discuss this idea on either this blog or on my blog on Psychology Today, I am usually besieged with comments saying that readers have tried this and it just doesn't work, or that I cannot appreciate that their family members are totally incapable of stopping abusive, distancing, or other provocative behavior.

I always reply that I do not blame anyone for not believing what I say about how metacommunication is both possible and effective in any family in which members are not fragrantly psychotic or a victim of brain damage or Alzheimer's disease. In fact, when I first broach this ideas with my own psychotherapy patients, I frequently get this response. Patients tell me that I couldn't possibly know how impossible their particular family can be.

Oh, but I do. In fact, I've almost always seen families that are far worse. And it is true, I add, that metacommunication done poorly can make a family problem even worse. Then I go on to say that doing it well is extremely difficult and that if it were easy, the patients would have already done it. 

In order to do it well, they have to become aware of things about their family and its members that they could not possibly have known before. Last, every family is different, so I can't just tell them right off how to proceed. Therapy is a complex process by which the right interventions are devised prior to any actual attempts at implementing them.

So why do folks who have tried to talk about family issues get into trouble? Well, again, every family is different, but we can discuss some general issues. It is much easier to talk about what does not work than trying to predict what will work in a given family or with a given relative. 

For this post, I invoke the principle of opposite behaviors: talking too much about something— especially if one always goes about it in the same way—is as futile as not talking about it at all. In either event, nothing gets resolved.

Obviously, trying to ignore an issue might work for a short time, but the issue will continue to hang over the heads of the participants like the proverbial Sword of Damocles, and things will eventually blow up. Or there will be an emotional cutoff in which family members try to divorce one another. But even that does not prevent the issues from continuing to contaminate the participants' other relationships, particularly between them and their lovers and children.

So what "doesn't work?" Here is a short list: blaming, accusing, and saying some variant of "You're bad (or evil, or stupid)," "You hate me," or "You did this to me." Getting angry rather than trying to hear the other person out, and/or becoming defensive rather than being thoughtful about what might be the kernal of truth in what the other person is saying. Not giving the other person the benefit of the doubt no matter what they say.

Another big one is invalidation. There are several variants of this. One of the most obvious is denial of events such as child abuse when both parties to the conversation know very well what happened. 

Telling the other person what they are feeling rather than asking them what they are feeling is another well known example.

A less well-known pattern is when each party is so keen on making their own points that they do not address the points that the other person is making at all. They steamroll any exchange by talking over each other, by completely ignoring what the other person has said in response to something they said, or through other ways of refusing to acknowledge the other person's point of view at all as they continue to make their own additional points.

Interestingly, people talking about a family problem can move on to discuss a related issue without ever having come to any agreement on the initial issue that was broached - so that neither of the issues is addressed fully. Sometimes people make a big circle, bringing up one related or tangential issue after another without achieving any resolution of any one of them, and then at long last returning to the initial issue. And then starting the whole circle all over again from the beginning!

Last is the best illustration of how talking too much leads to the same results as talking too little. After achieving some resolution of an issue, the parties continue to bicker incessantly about it, refusing to drop it even though, if they followed up on their initial plans, the problem would have been solved. In a commonly discussed example, some members of couples are well known for repeatedly bringing up an old grievance even decades after the problematic event took place.

There are a lot of ways to fail.

What Happens if Adults with Borderline Behavior Start to Act Better?

People who have dealt with those who have been diagnosed with borderline personality disorder (BPD) often wonder why those folks persist in their often infuriating as well as self-destructive behavior when it seems so obvious that they are making themselves as well as everyone who cares about them completely miserable. 

When I first started to treat them, I know I did. These patients were not psychotic, nor were they stupid, so why did they persist in dysfunctional behaviors in the face of overwhelming evidence of their consequences. So I started asking the magic, Adlerian question: What would happen if you got better and stayed better?

As I described in that previous post, patients would often answer with the non-answers, "I'd just find some other way to screw things up" or "I cannot even imagine what that would be like." I would not accept those "answers" and pressed on.

When the answers finally started to emerge, I was totally amazed. One thing that might happen was described in my very last post. If a patient with BPD got better, their families would run for the hills. Exile them. Shun them. Abandon them. Anyone wonder why those with BPD have "abandonment issues?" Wonder no more.

But abandonment was far from the worst or the most likely outcome when patients acted beter.

I found that something family therapy pioneer Murray Bowen described was quite real - only that it was the just the first thing that would begin to happen before things got far far worse.

I found that the power of family members to invalidate anything a therapist tries to teach a patient should not be underestimated. As first pointed out by Dr. Bowen, they will literally gang up on a patient with messages that scream, roughly translated, "You're wrong! Change back!"  Previously uninvolved family members may come out of the woodwork, and previously sympathetic family members may suddenly turn on the patient and scream things like, "HOW CAN YOU TREAT YOUR MOTHER LIKE THAT!?!" 

I dubbed this phenomenon "clustering." Try to imagine what it would be like if everyone you know and loved started to come after you like that. If you don't think you would wilt, you are kidding yourself. And that would be true even if you came from a family that was relatively functional to begin with. Imagine having been invalidated like that for your whole life.

As I said earlier, however, that would only be the first thing that would happen if someone with BPD started to act better. The next thing that happens is that the parents start to act out in alarming and frightening ways. I'm talking about things like parents making suicide threats or actual attempts, increasing drug or alcohol abuse to alarming levels, worsening domestic violence, family members getting thrown out on the streets penniless, or any children left in the home starting to be abused, neglected or molested. You know, minor, inconsequential stuff.

Furthermore, as first pointed out by Lorna Smith Benjamin, in "borderline families" all these problems would be blamed on the patient, who would be subtly expected to somehow exert control over them.

Think you'd be able to turn your back on your family if all this happened to you? Very few can. Even if you could, it would only be because your family would, through their own behavior, engineer your dismissive attitude - so that you would continue to not only be their scapegoat, but so they could also label you as an uncaring son of a bitch as well. 

Americans like to think that they don't care what their families think of them. Horse manure!

In response to all of this, individuals with BPD usually start to actively undermine ("spoil") any efforts anyone might make to encourage them to continue with their "good" behavior - without telling anyone (including a therapist if they have one) about any of their family's behavior - and revert right back to the way they had always been.