Tag Archives: Family

Challenging the inevitability of inherited mental illness

By Lindsey Phillips August 29, 2019

With a family history that famously includes depression, addiction, eating disorders and seven suicides — including her grandfather Ernest Hemingway and her sister Margaux — actress and writer Mariel Hemingway doesn’t try to deny that mental health issues run in her family. She repeatedly shares her family history to advocate for mental health and to help others affected by mental illness feel less alone.

And, of course, they aren’t alone. Mental health issues are prevalent in many families, making it natural for some individuals to wonder or worry about the inherited risks of developing mental health problems. Take the common mental health issue of depression, for example. The Stanford University School of Medicine estimates that about 10% of people in the United States will experience major depression at some point during their lifetime. People with a family history of depression have a two to three times greater risk of developing depression than does the average person, however.

A 2014 meta-analysis of 33 studies (all published by December 2012) examined the familial health risk of severe mental illness. The results, published in the journal Schizophrenia Bulletin, found that offspring of parents with schizophrenia, bipolar disorder or major depressive disorder had a 1 in 3 chance of developing one of those illnesses by adulthood — more than twice the risk for the control offspring of parents without severe mental illness.

Jennifer Behm, a licensed professional counselor (LPC) at MindSpring Counseling and Consultation in Virginia, finds that clients who are worried about family mental health history often come to counseling already feeling defeated. These clients tend to think there is little or nothing they can do about it because it “runs in the family,” she says.

Theresa Shuck is an LPC at Baeten Counseling and Consultation Team and part of the genetics team at a community hospital in Wisconsin. She says family mental health history can be a touchy subject for many clients because of the stigma and shame associated with it. In her practice, she has noticed that individuals often do not disclose family history out of their own fear. “Then, when a younger generation person develops the illness and the family history comes out, there’s a lot of blame and anger about why the family didn’t tell them, how they would have wanted to know that, and how they could have done something about it,” she notes.

Sarra Everett, an LPC in private practice in Georgia, says she has clients whose families have kept their history of mental illness a secret to protect the family image. “So much of what feeds mental illness and takes it to an extreme is shame. Feeling like there’s something wrong with you or not knowing what is wrong with you, feeling alone and isolated,” Everett says. Talking openly and honestly about family mental health history with a counselor can serve to destigmatize mental health problems and help people stop feeling ashamed about that history, she emphasizes.

Is mental illness hereditary?

Some diseases such as cystic fibrosis and Huntington’s disease are caused by a single defective gene and are thus easily predicted by a genetic test. Mental illness, however, is not so cut and dry. A combination of genetic changes and environmental factors determines if someone will develop a disorder.

In her 2012 VISTAS article “Rogers Revisited: The Genetic Impact of the Counseling Relationship,” Behm notes that research in cellular biology has shown that about 5% of diseases are genetically determined, whereas the remaining 95% are environmentally based.

The history of the so-called “depression gene” perfectly illustrates the complexity of psychiatric genetics. In the 1990s, researchers showed that people with shorter alleles of the 5-HTTLPR (a serotonin transporter gene) had a higher chance of developing depression. However, in 2003, another study found that the effects of this gene were moderated by a gene-by-environment interaction, which means the genotype would result in depression if people were subjected to specific environmental conditions (i.e., stressful life events). More recently, two studies have disproved the statistical evidence for a relation between this genotype and depression and a gene-by-environment interaction with this genotype.

Even so, researchers keeps searching for disorders that are more likely to “run in the family.” A 2013 study by the Cross-Disorder Group of the Psychiatric Genomic Consortium found that five major mental disorders — autism, attention deficit/hyperactivity disorder (ADHD), bipolar disorder, major depressive disorder and schizophrenia — appear to share some common genetic risk factors.

In 2018, a Bustle article listed 10 mental health issues “that are more likely to run in families”: schizophrenia, anxiety disorders, depression, bipolar disorder, obsessive-compulsive disorder (OCD), ADHD, eating disorders, postpartum depression, addictions and phobias.

Adding to the complexity, Kathryn Douthit, a professor in the counseling and human development program at the University of Rochester, points out that studies on mental disorders are done on categories such as major depression and anxiety that are often based on descriptive terms, not biological markers. The cluster of symptoms produces a “disorder” that may have multiple causes — ones not caused by the same particular genes, she explains.

Thus, thinking about mental health as being purely genetic is problematic, she says. In other words, people don’t simply “inherit” mental illness. A number of biological and environmental factors are at play in gene expression.

Regardless of the genetic link, family history does serve as an indicator of possible risk for certain mental health issues, so counselors need to ask about it. As a genetic counselor, Shuck, a member of the American Counseling Association, admits that she may handle family history intake differently. Genetic counseling, as defined by the National Society of Genetic Counselors, is “the process of helping people understand and adapt to the medical, psychological and familial implications of genetic contributions to disease.” It blends education and counseling, including discussing one’s emotional reactions (e.g., guilt, shame) to the cause of an illness and strategies to improve and protect one’s mental health.

Thus, Shuck’s own interests often lead her to ask follow-up questions about family history rather than sticking to a general question about whether anyone in a client’s family struggles with a certain disorder. If, for example, she learns a client has a family history of depression, she may ask, “Who has depression, or who do you think has depression?” After the client names the family members, Shuck might say, “Tell me about your experiences with those family members. How much has their mental health gotten in the way? How aware were you of their mental health?”

These questions serve as a natural segue to discussing how some disorders have a stronger predisposition in families, so it is good to be aware and mindful of them, she explains. Discussing family history in this way helps to normalize it, she adds.   

Everett, who specializes in psychotherapy for adults who were raised by parents with mental illness, initially avoids asking too many questions. Instead, she lets the conversation unfold, and if a client mentions alcohol use, she’ll ask if any of the client’s family members drink alcohol. Inserting those questions into the discussion often opens up a productive conversation about family mental health history, she says.

Environmental factors

Mental disorders are “really not at all about genetic testing where you’re testing genes or blood samples because there are no specific genetic tests that can predict or rule out whether someone may develop mental illness,” Shuck notes. “That’s not how mental illness works.”

Shuck says that having a family history of mental illness can be thought of along the same lines as having a family history of high blood pressure or diabetes. Yes, having a family history does increase one’s risk for a particular health issue, but it is not destiny, she stresses.

For that reason, when someone with a family history of mental disorders walks into counseling, it is important to educate them that mental health is more than just biology and genetics, Shuck says. In fact, genetics, environment, lifestyle and self-care (or lack thereof) all work together to determine if someone will develop a mental disorder, she explains.

One of Shuck’s favorite visual tools to help illustrate this for clients is the mental illness jar analogy (from Holly Peay and Jehannine Austin’s How to Talk With Families About Genetics and Psychiatric Illness). Shuck tells clients to imagine a glass jar with marbles in it. The marbles represent the genes (genetic factors) they receive from both sides of their family. The marbles also represent one’s susceptibility to mental illness; some people have two marbles in their jar, while others have a few handfuls of marbles.

Next, Shuck explains how one’s lifestyle and environment also fill the jar. To illustrate this point, she has clients imagine adding leaves, grass, pebbles and twigs (representing environmental factors) until the jar is at capacity. “We only develop mental illness if the jar overflows,” she says.

Behm, an ACA member, also uses a simple analogy (from developmental biologist Bruce Lipton) to help explain this complex issue to clients. She tells clients to think of a gene as an overhead light in a room. When they walk into the room, that light (or gene) is present but inactive. They have to change their environment by walking over and flipping on a switch to activate the light.

As Everett points out, “Our experiences, drug use, traumas, these things can turn genes on, especially at a young age.” On the other hand, if someone with a pervasive family history of mental disorders had caregivers who were aware and sought help, the child could grow up to be relatively well-adjusted and healthy in terms of mental health, she says.

In utero epigenetics is another area that illustrates how environment affects our genes and mental health, Douthit notes. The Dutch Hongerwinter (hunger winter) offers an example. In 1944-1945, people living in a Nazi-occupied part of the Netherlands endured starvation and brutal cold because they were cut off from food and fuel supplies. Scientists followed a group who were in utero during this period and found that the harsh environment caused changes in gene expression that resulted in their developing physical and mental health problems across the life span. In particular, they experienced higher rates of depression, anxiety disorders, schizophrenia, schizotypal disorder and various dementias.

Why is this important to the work of counselors? If, Douthit says, counselors are aware of an environmental risk to young children, such as the altered gene expression coming from the chronic stress and trauma associated with poverty, then they can work with parents and use appropriate therapeutic techniques such as touch therapy interventions in young infants and child-parent psychotherapy to reverse the impact of the harmful
gene expression.

Behm uses the Rogerian approach of unconditional positive regard and “prizing” the client (showing clients they are worth striving for) to create a different environment for clients — one that is ripe for change.

Counseling interventions that change clients’ behaviors and thoughts long term have the potential to also change brain structure and help clients learn new ways of doing and being, Behm continues. “It’s the external factors that are making people anxious or depressed,” she says. “If you get yourself out of that situation, your experience can be different. If you can’t get yourself out of it, the way you perceive it — how you make meaning of it — makes it different in your brain.”

The hope of epigenetics

Historically, genes have been considered sovereign, but genetics don’t tell the entire story, Behm points out. For her, epigenetics is a hopeful way to approach the issue of familial mental illness.

Epigenetics contains the Greek prefix epi, which means “on top of,” “above” or “outside of.” Thus, epigenetics includes the factors outside of the genes. This term can describe a wide range of biological mechanisms that switch genes on and off (evoking the prior analogy of the overhead light). Epigenetics focuses on the expression of one’s genes — what is shaped by environmental influences and life experiences such as chronic
stress or trauma.

Douthit has written and presented on the relationship between counseling and psychiatric genetics, including her 2006 article “The Convergence of Counseling and Psychiatric Genetics: An Essential Role for Counselors” in the Journal of Counseling & Development and a 2015 article on epigenetics for the “Neurocounseling: Bridging Brain and Behavior” column in Counseling Today. In her chapter on the biology of marginality in the 2017 ACA book Neurocounseling: Brain-Based Clinical Approaches, she explains epigenetics as the way that aspects of the environment control how genes are expressed. Epigenetic changes can help people adapt to new and challenging environments, she adds.

This is where counseling comes in. Clients often come to counseling after they have struggled on their own for a while, Behm notes. The repetition of their reactions to their external environment has resulted in a certain neuropathway being created, she explains.

Clients are inundated with messages of diseases being genetic or heritable, but they rarely hear the counternarrative that they can make changes in their lives that will provide relief from their struggle, Behm notes. “Through consistent application of these changes, [clients] can change the structure and function of [their] brain,” she adds. This process is known as neuroplasticity.

Behm explains neuroplasticity to her clients by literally connecting the dots for them. She puts a bunch of dots on a blank piece of paper to represent neurons in the brain. Then, for simplicity, she connects two dots with a line to represent the neuropathway that develops when someone acts or thinks the same way repeatedly. She then asks, “What do you think will happen if I continue to connect these two dots over and over?” Clients acknowledge that this action will wear a hole in the paper. To which she responds, “When I create a hole, then I don’t have to look at the paper to connect the dots. I can do it automatically without looking because I have created a groove. That’s a neuropathway. That’s a habit.”

Even though clients often come in to counseling with unhealthy or undesirable habits (such as responding to an event in an anxious way), Behm provides them with hope. She explains how counseling can help them create new neuropathways, which she illustrates by connecting the original dot on the paper with a new dot.

Of course, the real process is not as simple as connecting one dot to another, but the illustration helps clients grasp that they can choose another path and establish a new way of being and doing, Behm says. The realization of this choice provides clients — including those with family histories of mental illness — a sense of freedom, hope and empowerment, she adds.

At the same time, Behm reminds clients of the power exerted by previously well-worn neuropathways and reassures them that continuing down an old pathway is normal. If that happens, she advises clients to journal about the experience, recording their thoughts and feelings about making the undesirable choice and what they wish they had done or thought differently.

“The very act of writing that out strengthens the [new] neuropathway,” she explains. “Not only did you pause and think about it … you wrote about it. That strengthened it as well.”

In addition, professional clinical counselors can help bring clients’ subconscious thoughts to consciousness. By doing this, clients can process harmful thoughts, make meaning out of the situation, and create a new narrative, Behm explains. The healthy thoughts from the new narrative can positively affect genes, she says.

Protective factors

When patients are confronted with a physical health risk such as diabetes or high blood pressure, they are typically encouraged by health professionals to adjust their behavior in response. Shuck, a member of the National Society of Genetic Counselors and its psychiatric disorders special interest group, approaches her clients’ increased risk of mental health problems in a similar fashion: by helping them change their behaviors.

Returning to the mental illness jar analogy, Shuck informs clients that they can increase the size of their jars by adding rings to the top so that the “contents” (the genetic and environmental factors) don’t spill over. These “rings” are protective factors that help improve one’s mental health, Shuck explains. “Sleep, exercise, social connection, psychotherapy, physical health maintenance — all of those protective factors that we have control of and we can do something about — [are] what make the jar have more capacity,” she says. “And so, it doesn’t really matter how many marbles we’re born with; it’s also important what else gets put in the jar and how many protective factors we add to it to increase the capacity.”

Techniques that involve a calming sympathetic-parasympathetic shift (as proposed by Herbert Benson, a pioneer of mind-body medicine) may also be effective, Douthit asserts. Activities such as meditation, knitting, therapeutic massage, creative arts, being in nature, and breathwork help cause this shift and calm the nervous system, she explains. Some of these techniques can involve basic behavioral changes that help clients “become aware of when [they’re] becoming agitated and to be able to recognize that and pull back from it and get engaged in things that are going to help [them] feel more baseline calm,”
she explains.

In addition, counseling can help clients relearn a better response or coping strategy for their respective environmental situations, Behm says. For example, a client might have grown up watching a parent respond to external events in an anxious way and subconsciously learned this was an appropriate response. In the safe setting of counseling, this client can learn new, healthy coping methods and, through repetition (which is one way that change happens), create new neuropathways.

At the same time, Shuck and Douthit caution counselors against implying that as long as clients do all the rights things — get appropriate sleep, maintain good hygiene, eat healthy foods, exercise, reduce stress, see a therapist, maintain a medicine regime — that they won’t struggle, won’t develop a mental disorder, or can ignore symptoms of psychosis.

“You can do all of the right things and still develop depression. It doesn’t mean that somebody’s doing something wrong. … It just means there happened to have been more marbles in the jar in the first place,” Shuck says. “It’s [about] giving people the idea that there’s some mastery over some of these factors, that they’re not just sitting helplessly waiting for their destiny to occur.”

Shuck often translates this message to other areas of health care. For example, someone with a family history of diabetes may or may not develop it eventually, but the person can engage in protective factors such as maintaining a healthy body weight and diet, going to the doctor, and getting screened to help minimize the risk. “If we normalize [mental health] and make it very much a part of what we do with our physical health, it’s really not so different,” she says.

Bridging the gap

Shuck started off her career strictly as a genetic counselor. As she made referrals for her genetics clients and those dealing with perinatal loss to see mental health therapists, however, several clients came back to her saying the psychotherapist wasn’t a good fit. Over time, this happened consistently.

This experience opened Shuck’s eyes to the existing gap between the medical and therapeutic professions for people who have chronic medical or genetic conditions. Medical training isn’t typically part of the counseling curriculum, often because there isn’t room or a need for such specialized training, she points out.

Shuck decided to become part of the solution by obtaining another master’s degree, this time in professional counseling. She now works as a genetic counselor and as a psychotherapist at separate agencies. She says some clients are drawn to her because of her science background and her knowledge of the health care setting.

Behm also notes a disconnect between genetics and counseling. “I see these two distinct pillars: One is the pillar of genetic determinism, and the other is the pillar of epigenetics. And with respect to case conceptualization and treatment, there aren’t many places where the two are communicating,” she says.

Douthit, a former biologist and immunologist, acknowledges that some genetic questions such as the life decisions related to psychiatric genetics are outside the scope of practice for professional clinical counselors. However, helping clients to change their unhealthy behaviors and though patterns, deal with family discord or their own reactions (e.g., grief, loss, anxiety) to genetically mediated diseases, and create a sympathetic-parasympathetic shift are all areas within counselors’ realm of expertise, she points out.

An interprofessional approach is also beneficial when addressing familial mental health disorders. If Behm finds herself “stuck” with a client, she will conduct motivational interviewing and then often include a referral to a medical doctor or other medical professional. For example, she points out, depression can be related to a vitamin D deficiency. She has had clients whose vitamin D levels were dangerously low, and after she referred them to a medical doctor to fix the vitamin deficiency, their therapeutic work improved as well.

Another example is the association between addiction and an amino acid deficiency. Behm notes that consulting with a physician who can test and treat this type of deficiency has been shown to reduce clients’ desires to use substances. Even though counselors are not physicians, knowing when to make physicians a part of the treatment team can help improve client outcomes,
she says. 

Another way to bridge the gap between psychotherapy and the science of genetics is to make mental health a natural part of the dialogue about one’s overall health. “Mental illness lives in the organ of the brain, but we somehow don’t equate the brain as an organ that’s of equality with our kidneys, heart or liver,” Shuck says. When there is a dysfunction in the brain, clients deserve the opportunity to make their brains work better because that is important for their overall well-being,
she asserts.

Facing one’s fears

Having a family history of mental illness may result in fear — fear of developing a disorder, fear of passing a disorder on to a child, fear of being a bad parent or spouse because of a disorder.

“Fear is paralyzing,” Shuck notes. “When people are fearful of something … they don’t talk about it and they don’t do anything about it.” The aim in counseling is to help clients move away from feeling afraid — like they’re waiting for the disorder to “happen” — to feeling more in control, she explains.

Some clients have confessed to Everett that they have doubts about whether they want or should have children for several reasons. For instance, they fear passing on a mental health disorder, had a negative childhood themselves because of a parent who suffered from an untreated disorder, or currently struggle with their own mental health. For these clients, Everett explains that having a mental health issue or a family history of mental illness doesn’t mean that they will go on to neglect or abuse their children. “With parents who have the support and are willing to be open and ask for help … [mental illness] can be a part of their life but doesn’t have to completely devastate their children or family,” she says.

Shuck reminds clients who fear that their children could inherit a mental illness that most of the factors that determine whether people develop a mental disorder are nongenetic. In addition, she tells clients their experience with their own mental health is the best tool to help their child if concerns arise because they already know what signs to look for and how to get help.

Even if a child comes from a family with a history of mental illness, the child’s environment will be different from the previous generations, so the manifestations of mental illness could be less or more severe or might not appear at all, Douthit adds.

The potential risk of mental illness may also produce anger in some clients, but as Shuck points out, this can sometimes serve as motivation. One of her clients has a family history that includes substance abuse, addiction, hoarding, anxiety, bipolar disorder, OCD, depression and suicide. The client also experienced mental health problems and had a genetic disorder, but unlike her family, she advocated for herself. When Shuck asked her why she was different from the rest of her family, the client confessed she was angry that she had grown up with family members who wouldn’t admit that they had a mental illness and instead used unhealthy behaviors such as drinking to cope. She knew she wanted a different life for herself and her future children.

Defining their own destiny

Everett doesn’t focus too heavily on client genetics because she can’t do anything about them. Instead, her goal is to encourage clients to believe that they can change and get better themselves. She wants clients to move past their defeated positions and realize that a family history of mental illness doesn’t have to define them.

Likewise, Behm thinks counselors should instill hope and optimism into sessions and carry those things for clients until they are able to carry them for themselves. To do this, counselors should be well-versed in the science of epigenetics and unafraid of clients’ family histories, she says. Practitioners must believe that counseling can truly make a difference and should attempt to grow in their understanding of how the process can alter a client’s genes, she adds.

From the first session, Behm is building hope. She has found that activities that connect the mind and body can calm clients quickly and make them optimistic about future sessions. For example, she may have clients engage in diaphragmatic breathing and ask them what they want to take into their bodies. If their answer is a calming feeling, she tells them to imagine calm traveling into every single cell of their bodies when they breath in. Alternately, clients can imagine inhaling a color that represents calm. Next, Behm asks clients what they want to let go of — stress or anxiety, for example — and has them imagine that leaving the body as they exhale.

Hope and optimism played a large role in how Mariel Hemingway approached her family’s history of mental illness. She recognized that her history made her more vulnerable. Determined not to become another tragic story, Hemingway exerted control over her environment, thoughts and behaviors. Today, she continues to eat well, exercise, meditate and practice stress reduction.

Hemingway’s story illustrates the complexity of familial history and serves as a good model for counselors and clients, Douthit says. “Whether it’s genetic or not, it’s being passed along from generation to generation,” Douthit says. “And that could be through behaviors. It could be through other environmental issues. It could be any number of modifications that occur when genes are expressed.”

Shuck says she often hears other mental health professionals place too great an emphasis on the inheritance of mental illness. A family history of mental illness alone does not determine one’s destiny, she says. Instead, counselors and clients should focus on the things they do have control over, such as environmental factors and lifestyle.

“We have to emphasize wellness [and protective factors] much more than the idea that ‘it’s in my family, so it’s going to happen to me,’” she says. “We have to look at those things we can do as an individual to enhance those aspects of our well-being to make [the capacity of the mental illness] jar bigger.”

 

****

 

Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist living in Northern Virginia. Contact her at hello@lindseynphillips.com or through her website at lindseynphillips.com.

Letters to the editor: ct@counseling.org

 

****

 

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Stepping up to the challenge

By Lindsey Phillips May 29, 2019

Stepfamilies are complex and feature unique differences, yet on the surface, there may be little to distinguish them from “traditional” families. In fact, as Joshua Gold, a professor in the counseling education program at the University of South Carolina, points out, some counselors don’t necessarily think to ask if they are working with a stepfamily or blended family.

But perhaps they should. According to a 2010 Pew Research Center report, more than 40% of American adults have at least one step relative — a stepparent, a step- or half-sibling or a stepchild — in their family. Gold points out that of the eight most recent U.S. presidents, four (Obama, Clinton, Reagan and Ford) were part of stepfamilies.

“Often for counselors, it gets overwhelming to think about working with stepfamilies because it does look like so many moving parts,” says Jayna Haney, a licensed professional counselor (LPC) in private practice at the Wellness Collective and at Red Dun Ranch in Texas. “But what is also true is that stepfamilies [tend to] have similar problems.”

According to Institute for Stepfamily Education Director Patricia Papernow in her 2017 Family Process article “Clinical Guidelines for Working With Stepfamilies,” stepfamilies face five
major challenges:

1) Insider/outsider positions

2) Children struggling with losses, loyalty binds and change

3) Parenting issues and discipline

4) Building a new family culture while navigating previously established family cultures

5) Dealing with ex-spouses and other parents outside the household

Normalizing stepfamily dynamics

Stepfamilies often assume that something is wrong with them if the family isn’t working well, so counselors should reassure these clients that crisis and change are normal in stepfamily life, says Haney, the founder of the Bridge Across for Single Parents and Stepfamilies. She will often tell clients, “It’s not you. It’s your situation.”

One tool that Haney uses to educate clients about the challenges of stepfamily dynamics is called the stepfamily triangle. She draws a triangle, and at the top she writes in the name of the biological parent. She adds the name of the stepparent in the bottom right corner of the triangle and the name of the biological children in the bottom left corner. Then she explains how the biological parent and biological children have three bonds — emotional, biological and legal — and each bond is as old as the children are. Haney draws three lines to represent these bonds on the side of the triangle that connects the biological parent and biological children. The biological parent and stepparent have an emotional bond and a legal bond (if they are married), so Haney adds the lines connecting them. The stepparent and stepchildren have only an emotional bond (one that is only as old as their relationship) connecting them, which Haney illustrates with one line at the bottom of the triangle.

“So, when stepfamily couples are confused or frustrated because it feels like the family dynamics aren’t squaring up, it’s because they’re not,” says Haney, a member of the American Counseling Association. To illustrate her point, she’ll often put her hands together in the shape of a triangle and tip it over to the left because all of the weight is with the biological parent and child. She has found this visual helps families understand the dynamics and challenges that stepfamilies often face. 

Gold, author of Stepping In, Stepping Out: Creating Stepfamily Rhythm and editor of the newly released book Intervening for Stepfamily Success: One Case, Multiple Perspectives (both published by ACA), also uses education as a means of normalizing stepfamilies’ experiences. Rather than directly asking stepfamilies whether a specific issue affects them, he provides general information about challenges that stepfamilies often face to see if anything resonates with them. He often starts counseling sessions by drawing two large circles — one for the clients’ lived experiences and the other for common stepfamily issues based on his professional knowledge. For example, in his circle, Gold may write that some stepfamilies deal with gendered expectations, such as assuming the stepmother will automatically be nurturing with the children or expecting the stepfather to be the disciplinarian. If the clients say they have experienced that issue, Gold will add it to their circle. 

Both Gold and Pat Skinner, an LPC in private practice in Denver, agree that the schools offer one effective avenue for easily reaching stepfamilies and helping normalize their experiences. Gold recommends that school counselors hold stepfamily groups. These groups can be promoted in the school handbook given to parents at the beginning of the year.

Skinner, an ACA member who specializes in working with stepfamilies, thinks that holding stepfamily groups or classes at schools helps address some of the time and financial obstacles that these families might otherwise face in getting assistance. She also says that groups allow stepfamilies to hear stories similar to their own, helping them realize that they are not alone in their experiences.

Integrating multiple perspectives 

Working with stepfamilies means having multiple voices and perspectives in each counseling session, which can further complicate the process. “The more complex the situation, the more flexible you need to be,” says Gold, a member of ACA and the International Association of Marriage and Family Counselors (IAMFC), a division of ACA. “If I’m dealing with one client, I’m trying to meet one client’s expectations. If I’m dealing with five, I now have five sets of expectations.”

“It takes more skill and more orientation as a clinician to figure out how to integrate all these different voices,” he continues. “Most conflict is founded in the notion that it’s an either/or situation. Either you’re right or I’m right.”

Gold, a contributing editorial board member of IAMFC’s The Family Journal, advises counselors to help stepfamilies switch to a both/and mindset so that situations won’t become win-or-lose propositions. For example, rather than focusing on how the kids from one family ate yogurt and cereal for breakfast and the other family ate eggs, the new stepfamily could include both breakfast options.

Haney, who specializes in high-conflict situations, parental alienation and stepfamilies, has developed an integrated family protocol in which she spends three to four family sessions discussing how to convert high-conflict tendencies into something productive. High conflict involves rigid thinking, unmanaged emotions, extreme behaviors and blaming others. She advises stepfamilies to do the opposite: engage in flexible thinking, manage their emotions, moderate their behaviors and own their actions.

In the first session, Haney always discusses flexible thinking. She puts eight or nine items with various textures (such as slime, play dough, Kinetic Sand, putty and therapy dough) on trays and passes them around. Each family member plays with the items and discusses how the items feel. Haney then asks what all the materials have in common. Someone typically responds that all the items can be mushed or smashed. Haney points out that no matter what the family members do to the items, the materials remain flexible. To emphasize this point, she asks the stepfamily to consider what would happen if they punched slime versus punching a wooden box. The answer: Only the wooden box would break.

Haney connects this exercise to the importance of being flexible in one’s thinking and explains that all people and situations have some good and some not so good features. With this new perspective, she asks each family member to tell her one thing that they like about their other family members.

Next, they take turns telling Haney one thing that drives them a little crazy about their family. For example, a family member may say that they don’t like it when everyone is yelling or how one of the parents is constantly asking the children how they are doing. Haney purposely uses the phrase “drives you a little crazy” because she finds it helps clients think of small problems, not big ones. She also advises counselors against asking clients what they wish were different because that is often counterproductive, she says.

When a stepfamily walks into Darrick Tovar-Murray’s office, he observes where each family member sits and how they communicate with each other. Take for example a session with Jim (the custodial parent), Jeff (the stepparent) and James (the child). Tovar-Murray will call attention to the way the family is arranged in the room: “James, why did you sit closer to Jim than to Jeff? Help me to understand what you make of the way … the family is sitting in the room right now.”

Tovar-Murray, an associate professor of counseling at DePaul University, also points out subtle verbal and nonverbal communication: “Jim, when you said James is not doing well in school, your voice went up, and at that moment, James turned his back to you. Can you tell me what James may be feeling right now?” Teaching stepfamilies effective communication skills helps them to understand one another’s experiences and emotions, says Tovar-Murray, a member of ACA.

Haney encourages clients to explore the narratives they are telling themselves about certain situations while simultaneously accepting that everyone has their own perspective on those situations. For example, if a stepmother says that her husband is always looking at his phone and waiting for his ex-wife to call, the counselor can say, “I understand that bothers you. What’s the story you are telling yourself?”

The stepmother might say she feels like the ex-wife is still more important to her husband than she is. The husband says he’s simply concerned that he’ll miss a phone call from his children. To which the stepmother responds, “I don’t want you to miss a phone call from your children. I just feel like you’re always looking at your phone when we’re out at dinner.” The couple can then make an agreement for the husband to either put his phone away for an hour or call his children before going out to dinner.

Recently, Haney had a stepmother come in by herself because her 25-year-old stepdaughter was constantly fighting with or upset with her and her husband. Haney worked with the stepmother to help her understand that she could not control the adult child’s behavior — but she could control how she reframed the situation and responded to the stepdaughter. With Haney’s guidance, the stepmother changed her perspective and learned new skills so she would no longer get surprised, upset or disappointed when the stepdaughter turned argumentative.

“The hardest part in relationships is to realize the amount of power you have or don’t have to make change,” Gold says. “You have endless power to make change in self. You have less power to make change in others. And, sometimes, part of being in a relationship means you accept things you don’t really like.”

Establishing stepfamily structure

Haney often begins counseling with the stepcouple first because she believes the partnering piece needs to be in place before other issues can be addressed effectively. “If the stepfamily couple can create the structure within their relationship and they can get on the same page with some of these issues, the kids fall into line,” she says.

Stepcouples often face challenges with establishing and maintaining clear parenting roles. In fact, a primary area of conflict for stepfamilies is the parent–child relationship, Haney notes.

The stepcouple need to agree on what they want to teach their children and what the family rules are in the home, she continues. For instance, if the stepmother thinks the children should stop using their smartphones at night and tries to enforce the rule without the biological father’s support, it will cause problems. In such situations, Haney often finds that the biological parent agrees with the overarching rule; the disagreement is in the details. Perhaps the father thinks that 8 is too early to restrict phone use and that 10 would be a better time.

“The moment that you allow the biology to divide, then the house is really two different houses,” Gold says. “So, there’s got to be a set of rules for the house.”

Haney suggests that stepfamilies establish basic rules about bedtime, homework and family dinners. Every family member should also have his or her own space in the house, she says. For example, one person shouldn’t sleep on the couch while the others have their own bed.

Haney believes that the biological parent needs to parent, and the stepparent needs to let that happen. Gold agrees. The stepcouple should figure out the household rules, and then the biological parent should present those rules to the family, he says. Then, both parents can enforce those rules.

If a couple disagree on this point, Haney draws the stepfamily triangle so they can visualize the dynamics. This can help the stepparent realize that he or she may have been overstepping. Haney then asks, “What does the family need to do to make the triangle stay upright?”

First, the partners must be on the same page and create a supportive relationship in which they respect each other’s experiences and perspectives, Haney says. Sometimes, stepparents will need to take a step back, she adds. Haney tells stepparents, “When you assert yourself as a biological parent when you are not … you’re putting a target on your chest because you will always be the bad guy. You will never win.” The biological parent’s job is to protect the stepparent by doing the parenting, she stresses.

Second, Haney says, stepparents have to strengthen their relationship with the stepchildren, but they must also accept that it will take time. One activity she uses to help with this is the emotional bank account. When stepparents marry or move in with the biological parent, they assume a parenting role, she explains. Because biological parents already have a strong emotional, legal and biological bond with their children, they can discipline, set boundaries for, and offer advice and make comments to their children, Haney says. However, stepparents don’t have this emotional connection yet, so with every negative action (e.g., punishing, yelling, making comments, rolling eyes), they make a withdrawal from the emotional bank account with the child, she continues. “It’s not one deposit and one withdrawal,” she points out. “It’s one deposit, but for every negative nonverbal or negative interaction, it’s five withdrawals.”

Haney often helps stepparents realize that they are depleting this emotional bank account faster than they recognize. In such cases, they need to stop making withdrawals and start making deposits. Recently, one of Haney’s clients, a stepfather, was having a difficult time with his 14-year-old stepdaughter. He expected a lot of her and often critiqued what she did. For example, he would point out that he often needed to remind her to take out the trash and even made comments about the way she tied the garbage bag rather than thanking her for her efforts. Haney encouraged him to start making deposits in his stepdaughter’s emotional bank account by giving her compliments, texting that he was proud of her, or saying that he noticed how hard she had been working. When he followed through, their relationship took a 180-degree turn within a week’s time, Haney says.   

When a biological parent finds a new partner, the children are often expected to show love and respect for that new partner right away, Skinner says. However, it’s important to remind stepfamilies that neither children nor adults love immediately. It takes time.

In addition, the child’s developmental stage can affect the degree to which the stepfamily bonds. If children are approaching or into adolescence when the stepfamily forms, they may never feel connected to the stepfamily unit because they are focused on forming their
own separate identities at that point, Gold notes.

In her stepfamily, Haney and her husband developed a plan to handle the stresses and problems they faced. She encourages couples to follow a similar plan, which includes:

  • Talking to and reassuring each other that things will be OK
  • Creating daily habits that provide a sense of connection and support
  • Going out on dates
  • Limiting how much time they discuss children, stepchildren and exes

Haney also reminds clients to laugh. She and her husband found watching a daily episode of Seinfeld helpful during the difficult early part of their stepfamily’s life.

“A lot of times with stepfamilies, you’re sacrificing the me for the we,” Haney says. “If the couple … is willing to make these changes for each other, then it can be a really powerful experience.” In addition, the behavior of asking for help, finding solutions and making changes serves as a powerful model for the children, she says.

Focus on the solution, not the problem

“I think the big mistake that counselors make is they try to start with the problem,” Haney says about counseling stepfamilies. Often, stepfamily couples come in experiencing so much angst, frustration and confusion, they don’t know where to begin. If the counselor asks the couple to talk about their problems and feelings, the couple and the counselor all become problem saturated and risk becoming overwhelmed, she says. 

To avoid this, Haney starts sessions with a basic genogram, which provides her with all the names and connections between the family members. She uses colored markers and construction paper, drawing a circle for each woman and a square for each man in the family, including the stepfamily couple, the ex-partners and the children. Haney then asks the stepcouple’s ages and living arrangements, when the couple first met and when they started dating, and she adds that information to the genogram. For those who are married, she will also ask if they lived together before they got married, when they got married and how long they have been married. Finally, she asks about the most serious relationship that each of the partners had before they got involved with each other.

Next, she draws smaller circles and squares for the ex-spouses or ex-partners and asks similar questions such as age, length of time together, when they separated and if they have children together. If they do have children together, Haney connects the ex and adds in the children’s names and ages, as well as how the parents split their time with the children and how involved each one is with the children.

Haney always ends this exercise by asking, “Is there anybody else that we’re going to be talking about today or who is creating challenges in your stepfamily life?” By asking this question, she often discovers other people, such as one of the partner’s siblings, a grandparent or even the ex-spouse’s new partner, who are adding to the stepfamily’s problems.

In addition to serving as a reference tool that counselors can use throughout their work with the stepfamily, the genogram provides structure to the session. “Structure is a big part of doing a successful stepfamily session,” Haney says. “[It’s] knowing what you’re going to do and how you’re going to do it so that you don’t allow [the session] to become problem saturated.”

Tovar-Murray uses a narrative approach to separate the family from the problem. For example, if a child feels divided between family members, he would have the family name the problem and then ask, “When did the sense of divided loyalty enter your family system? How has it caused you to think you are not a family who can be a cohesive unit? What would your future look like if divided loyalty were no longer present and you were operating as a family unit?” This approach encourages the family to fight together against the problem rather than letting it divide them, he explains.

To strengthen stepfamily cohesion, counselors can also ask family members to describe activities that might make them feel more connected and then encourage them to carve out time over the next week to engage in those activities, Tovar-Murray suggests. “We’re always looking for those unique outcomes, and those are the times in which the stepfamilies are not being saturated and influenced by whatever the problem is,” he says.

Separating the family from the problem is also helpful when there is resistance to the new family structure, such as when one of the partners resists embracing or blending two racial or ethnic identities. For example, in a household with a Latinx stepfather and an African American biological father, the biological father might say, “Maintaining my African American identity is extremely important, and I’m not giving that up. I’m going to see this as an African American family.”

“That resistance piece is just showing [the counselor] how important that identity is,” Tovar-Murray says. With this situation, the counselor could attempt to separate the family system from the resistance piece and reframe it. For example, the counselor could respond, “I can see that you have a strong sense of pride in being African American. Now, I also wonder how you can have that same sense of pride in the relationship that you just formed.”

The counselor can help the family reframe this racial pride and create pride in the new structure the family is developing. Otherwise, the stepfather may feel isolated, which makes cohesion and integration almost impossible, Tovar-Murray says.

Take a step forward

Both Gold and Skinner acknowledge that busy schedules and finances can be big issues for many stepfamilies. As a result, these families often are not looking to engage in long-term counseling.

Gold says that any counseling approach that is more “present-focused” works well with stepfamilies. He often relies on a brief therapy model — six to eight sessions — and finds that most clients will make a commitment to therapy if they know how long it will take. This model also works well with family schedules, he adds.

Counselors “need to remember that a stepfamily couple is going to be less likely to come once a week, every week, for six months,” Haney points out. “So, when [counselors] work with stepfamily couples, [they’re] really doing that solution-focused piece.”

In fact, Haney finds that when stepfamilies come to see her, they have already thought and talked a lot among themselves about the issues they are struggling with, so they want to know what to do. “They know where they are and they know where they want to be, but they do not know how to get there,” she says. Haney doesn’t direct stepfamilies on what to do, but she does help them figure out different paths for getting where they want to be.

After Haney finishes the genogram, she asks the stepcouple directly, “How can I help you today?” Some couples may get to the heart of the matter, whereas others may not have an answer. In those cases, Haney provides the stepfamily with information on the importance of partnering together, the stepfamily triangle and the emotional bank account.

Haney also asks the stepfamily, “What are the two or three things you want to accomplish or work on while you are in counseling?” The family’s answers must be something they have control over, she says. “You don’t have any control over the ex or the stepchild,” she explains. “You do have control over how you respond to the ex. … You do have control over how you respond to the stepchild, how you talk to your partner about the child, and what kind of stepparent or parent you want to be.”

In part because stepfamilies may attend only a few counseling sessions, Haney often spends a longer amount of time in the initial session getting to know the family members, figuring out why they came to counseling and making sure they leave with an action plan. In the initial session, which often lasts up to two hours, she spends approximately 15 minutes on the genogram and 15 minutes educating clients about common stepfamily issues. For the remaining time, she helps families determine two or three things that they want to accomplish.

By the time the family leaves, each family member “need[s] to have something that they’re going to do that’s doable and that they can work on,” Haney says. “Then they leave empowered because they know what to do. [They] leave … educated because you’ve shared with them some insights that help them change their perspective and reframe how it’s working. And … it helps them see their story and their family differently.”

 

****

 

Invisible stepfamilies

The concept of stepfamilies can challenge traditional assumptions of the word family, which often evokes an image of a married father and mother with their biological children. But as Darrick Tovar-Murray, an associate professor of counseling at DePaul University, points out, this image doesn’t account for the diversity found within stepfamilies. In fact, because this assumption doesn’t recognize other types of partnerships or unions, it renders them “invisible,” he says. That’s particularly the case when these families include a noncustodial and custodial parent with at least one child from a previous relationship and encompass multiple racial, ethnic and sexual orientation identities — which he refers to as invisible stepfamilies of color.

“When you look at invisible stepfamilies of color, they tend to come from cohabitating relationships where there isn’t a marriage or legal contract,” Tovar-Murray says. “That legal contract should not be what defines a family.”

As society continues to grow more diverse, counselors will encounter more invisible stepfamilies of color and thus may need to challenge their own views of what family means, Tovar-Murray argues. Counselors also shouldn’t assume that a couple is married, he continues. In addition, asking “How long have you been dating?” implies that the couple’s relationship may not be as close or as integrated as a couple who is married, and that may not match the perspective the clients have of their relationship.

Tovar-Murray also advises counselors not to make assumptions such as thinking that a stepcouple’s decision not to hold hands is related to their lack of affection for each other. Based on their experience of racial/ethnic or sexual orientation microaggressions, many of these couples may engage in this or similar displays of affection only in spaces they consider to be safe. “As counselors, we cannot assume that invisible stepfamilies of color are going to be out in all spaces that they walk in,” he says.

For this reason, Tovar-Murray, an ACA member and co-author of a chapter on blended families of color in the book Intervening for Stepfamily Success, advises counselors to be open and direct about microaggressions. He will often tell clients, “I want to talk about something I think is important. We know that racism exists and sexual orientation microaggressions exists, and I’m wondering if you as a couple or if this family has ever experienced those things.” He also suggests saying, “I know biases exist, and some of the things that may affect a family system like this may even be biases within your own cultural groups. Have you experienced any of those? How have you successfully dealt with those things?”

“The assumption that [counselors] make sometimes is that [they’re] not going to bring [these issues] up because the client didn’t bring it up,” Tovar-Murray says. “But sometimes clients, couples and families may not know that [counseling is] the space [where they] can talk about those things.”

— Lindsey Phillips

 

****

 

Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist living in Northern Virginia. Contact her at hello@lindseynphillips.com or through her website at lindseynphillips.com.

Letters to the editor: ct@counseling.org

 

****

 

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Working with foster and adoptive families through the lens of attachment

By Somer George October 4, 2018

“He just got kicked out of his second preschool program! We’re nearing the end of our options here. What do we do?” I could hear the desperation in the mother’s voice as she described the past few months with the 5-year-old she and her family were fostering and would soon be adopting.

“He threw a chair at the teacher and punched a little girl, and nothing we do seems to make it better,” the father explained, describing the detailed behavior plan on which they had collaborated with a well-meaning social worker.

“And it’s not just at school,” the mother continued. “Even when he’s home with us, he often gets out of control. He even peed on his dad’s lap” — her voice lowered to a whisper — “on purpose!”

I nodded my head, empathetic to the immense strain this family had been under for the past several months. The mother and father were friendly and confident, well-educated and sincere. They had wanted to do something good for the world by fostering and adopting children in need. They had so much to offer. And yet here they were, barely surviving each day and feeling the shreds of normalcy slip through their fingers as this little boy pushed every emotional button they had, leaving them exhausted and discouraged.

My years of experience working with the Secure Child In-Home Program and the Virginia Child and Family Attachment Center helped me to frame their experience in terms of attachment. The situation they were in was not unique among parents who had adopted a child or made the decision to provide foster care, the initial good intention and early excitement slowly turning to exhaustion and sometimes regret. Often, these children who need it the most push away every offer of help and comfort that is provided to them.

Where healing happens

So, what do we do when parents who have adopted a child or are providing foster care come to us, asking for advice or counseling for their troubled child? Certainly, there is benefit in providing these children with play therapy, giving them a chance to form a new relationship and to express themselves through their own language of play.

And yet, that strategy speaks to only one side of the coin. Attachment theory tells us that children heal best in the context of secure caregiving relationships. And parents are the ones who provide the day in, day out caregiving, wielding the most influence on the development of new patterns in the child’s relationships and behaviors.

According to attachment theory, a child is biologically wired to turn toward a caregiver in times of distress. When the child’s emotional needs are met, the child develops patterns of soothing and regulation that are essential for healthy development. When these emotional needs are denied or rebuffed, however, or if the child experiences the caregiver as frightening, the child learns dramatically different adaptive strategies. The child may become withdrawn and inhibited or bossy and aggressive. These patterns aren’t quick to change when a new caregiver comes along. Add to this the trauma of abuse and the loss of a biological parent, and you have a situation full of misunderstanding and relational strain.

New caregivers often come into their role with little awareness of the child’s experiences and the patterns necessary for surviving a young life filled with turmoil, anguish and uncertainties. When these coping strategies show up in the new relationship, parents are (understandably) distressed and often seek help to “fix” the child’s confusing and challenging behavior.

What these parents may not realize is that their own ability to read through the confusing signals and meet the child’s emotional need is the place where most of the healing will happen. If the parents can provide both a secure base from which the child can explore the world and a safe haven for the child to return to, the deeply rooted patterns of behavior and interaction will begin to shift. This is not a quick and easy process. It is messy to be sure, often following a pattern of one step forward, two steps back. However, if parents are given the support they need, it is certainly an attainable and worthy goal.

The counselor’s role

So, what is the counselor’s role in helping form new patterns of interaction, leading to more emotional stability and better child behavior? How can we help move these relationships toward greater security, helping each family to become a haven of safety for children who have experienced significant neglect, rejection, fear and loss?

I’d like to offer some suggestions for counselors who desire to help these parents form stronger relationships with their children and experience a reduction in the difficult behaviors that create such chaos.

  • Provide empathy and understanding to parents. Often, by the time parents seek out a counselor, they have already been through a great deal of distress, frustration and turmoil. Yes, they are coming to receive help, but first they need to feel heard and understood without being judged. Parenting is extraordinarily difficult, and parenting a child with extensive emotional needs is even harder. Take the time to empathetically hear these parents’ concerns and welcome their expressions of distress.
  • Educate parents about normal development and the impact of trauma/loss. Sometimes foster and adoptive parents have already successfully raised biological children, so these difficult behaviors on the part of the child they are adopting or fostering don’t make sense to them. What they did with their other kids doesn’t seem to work with this child. Spend time teaching these parents about how their child’s brain may have developed in a dramatically different way due to the impact of neglect, trauma and loss. Talk about the fact that forming new secure relationships takes time and how important their role is in this process.
  • Help parents to practice observation skills. We human beings so naturally take in information and draw conclusions without even realizing we are doing it. Unfortunately, we aren’t always right. Parents who are living in highly stressful situations may have trouble stepping back and paying attention to what is happening in the moment. Help them to slow down and notice their child’s body language, facial expressions and tone of voice before making assumptions about what the behavior means or how to stop it. With foster and adoptive children, parents often say they don’t know what is going on inside the child; this is often the most important place to help them learn. It is essential that they obtain a developmentally accurate view of the child’s inner experience, feelings and thoughts in the context of the child’s earlier experience and relationship patterns.
  • Invite parents to pay attention to their own experience. How does mom feel when the child is screaming that he hates her? What is dad’s experience when his request to come for supper is repeatedly ignored? As parents become better at observing their child, it is important that they also attend to themselves. What are they feeling in these moments, and what is their body language and tone of voice communicating to the child? Help them to consider their own needs and to find ways to regulate their own strong emotions that are activated when the child is pushing them away.
  • Encourage parents to think about what the child is feeling in these difficult moments. So often, the focus of parents is on how to manage the child’s behavior. Traditional strategies that use rewards and punishment are rarely successful with children who have experienced neglect, trauma and loss. Although the child’s behavior doesn’t make sense at first glance, there is often much to be learned if we slow down and pay close attention.

Have the parents set aside quick assumptions and, instead, help them to observe carefully, giving consideration to what the child might be feeling. The child might look and sound angry at first glance, but might he or she instead be feeling scared or sad? The child already has emotional and behavioral sequences established that, once activated, run automatically. These unintentional and automatic patterns need to be shaped into healthier ones.

  • Ask parents to think about what the child needs from them. Does the child need to feel heard and validated? Does the child need comfort, protection and co-regulation of automatic well-learned patterns? Does the child need the parent to stay close by and help him calm down because he feels out of control? If the child is anxious, might she need the parent to provide soothing rather than correction?
  • Encourage parents to try new strategies aimed at fostering connection. Instead of putting the child in timeout, try bringing him in close for a cuddle and some conversation. Instead of sending the child to her bedroom to calm down, try going with her and staying close by. Remind parents that new approaches may not work right away, but with persistence and practice, they can begin to make a significant difference.
  • Facilitate parents’ exploration of their own attachment histories and how this influences interaction with the child. We know from research that a foster child’s initial relationship patterns are often a mismatch for a parent’s natural caregiving patterns. We also recognize that parental patterns of attachment have a strong influence on the child’s patterns. Increased reflection on these experiences can help us become better caregivers.

Invite parents to think about how their own experiences with caregivers have influenced the way that they react and respond to their child. What expectations do they hold? What automatic reactions are happening outside of their awareness? What automatic reactions happen outside of the child’s awareness?

  • Celebrate small (and large) victories. The little moments are the big moments. Provide plenty of affirmation and support for parents as they try new approaches and persevere in the day-to-day tasks of parenting. Acknowledging their efforts and celebrating successes, however small, can go a long way toward giving them the courage to continue through the hard times.

Working with these families can be immensely rewarding. They are often highly motivated and desperate for support. As counselors, we need to be aware of our impulse to provide a “quick fix” to try and make things better. We can make concrete suggestions, but we also need to recognize that the process of building stronger relationships and changing behavior takes time.

The type of relationship that we build with the child’s parents can itself be a catalyst for change. We can provide a place where the parents feel safe expressing their distress and their shortcomings, knowing that we will support them in their efforts to help guide their child on the path to healing.

A different path

As I continued working with the family mentioned at the beginning of this article, I could see the changes taking place. They began having more positive interactions with their child and seeing new qualities in him that they hadn’t noticed before; they were thinking about him in a different way. Their own self-reflection helped them to catch themselves before they reacted and think more about what he needed from each of them.

“I noticed that the collar of his shirt was often wet from him chewing on it. I stopped reprimanding him for this and realized that it meant he was feeling really anxious,” the mother told me one day.

“Yeah, and this was a sign that we needed to pick him up and give him some reassurance,” the father quickly added. “It really seems to calm him down.”

The mother continued: “I think that before when he was anxious, his behavior would spiral out of control. And the behavior chart was part of what contributed to his anxiety, which just made things worse instead of better. I don’t think we need it anymore.” As she spoke, she glanced at dad and noted his nodding head.

“They still use one at school,” she said, “but we’ve been talking to his new teacher about how to connect with him and what helps relieve his anxiety. Also, I stuck a picture in his book bag of the three of us together so he can get it out and look at it when he is at school. I think it helps him feel more secure. It’s a way for him to carry us with him.”

As I listened to them share these stories, I couldn’t help but smile. They still had a long road ahead of them, but they were headed down a very different path than the one they were on originally. We celebrated each of these moments together and reflected further on their experiences with their child.

I continued to come alongside them to support them in this journey for a little while longer, serving as a secure base and safe haven for them. Soon, however, they decided that they no longer needed counseling. Through a lens of attachment, they saw that their relationship with their son was much stronger, and although his behavior was still challenging at times, they possessed the confidence that they could handle it, moving forward together as a family. Once again, the experience of a healthy attachment proved itself to be a powerful force, propelling another family toward greater health and healing.

 

***

 

Somer George is an adjunct professor at James Madison University and is currently completing her doctorate in counseling and supervision. She also works for the Virginia Child and Family Attachment Center and the Secure Child In-Home Program, where she helps to provide comprehensive attachment assessments, intensive in-home therapy and research-based parent courses. Contact her at somer@george.net.

 

Letters to the editor: ct@counseling.org

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, go to ct.counseling.org/feedback.

 

****

 

Related reading, from Counseling Today:

Fostering a brighter future

Through the child welfare kaleidoscope

 

****

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

 

The dismissal of divorce advice

By David L. Prucha August 2, 2018

It’s a distressing reality, but advice for the newly divorced might be as common as advice for the newly married. Advice for the newly divorced often centers around protecting any children who might be involved because although parents get divorced from each other, children become divorced from the only life they have ever known.

Parents are advised to keep the child-parent relationship as normal as possible:

  • “Don’t put your child in the middle.”
  • “Encourage your child to have a relationship with their second parent.”
  • “Don’t speak poorly of your former spouse in front of your child.”

Although this guidance seems relatively straightforward, it is difficult for many parents to follow. Why is this? Is it simply unreasonable to hope for wise parenting when anger is running high and hurt is running deep?

To understand how a counselor might help a parent follow divorce advice, let’s first explore the context in which many parents speak poorly about their former spouse with their child.

 

The background for badmouth

One common scenario that leads parents to dismiss divorce advice is when one parent becomes convinced that he or she is on the losing end of the divorce. They have lost friendships and are spending more time alone. The house feels empty.

With this loneliness settling in, eventually the parent is faced with a tempting situation when the child shares feelings of frustration or sadness about the other parent. In many cases, the parent mistakes the child’s complaint as validation for his or her own grievances. In the marriage, they have been on the receiving end of their former spouse’s dysfunctional behavior, and now the parent suspects those same dysfunctional behavior patterns are harming their child. The parent seizes the opportunity to teach the child about how the second parent operates. They convince themselves that they have to share their own experiences to support the child, but in reality, it has become an opening to express their own feelings of hurt. It is catharsis, but camouflaged as compassion for the child.

A second scenario that leads to dismissing divorce advice occurs when a parent suspects that his or her child is aligning against them with the second parent. They start to hear the words of their former spouse spoken through the mouth of the child. The parent believes they are being disparaged and that this is shaping the child’s view regarding who is at fault for the divorce. The parent has tried to take the high road, but the former spouse has taken the low road, and now their relationship with their child is suffering as a result.

This can lead the parent to feeling wronged again by their former partner, and they decide that they need to clear their name in the eyes of their child. They proceed to share their version of the divorce because they think they need to provide a balanced perspective. Unfortunately, this often sets off an escalating arms race between the two parents to compete for the heart and mind of their child.

With these scenarios in mind, how can a counselor help hurting parents to help their hurting child? What new understanding can parents gain that might reduce the likelihood of them oversharing with the child?

 

The child healer

In the first scenario, the parent speaks poorly about their former spouse because they mistake their child’s grievances for their own. In this case, it can be helpful for parents to learn that sometimes children overstate their concern about their second parent in an attempt to help the grieving parent.

In the child healer dynamic, the child notices that his or her parent is in pain. By exaggerating their complaints about the second parent, the child opens the door to allow the grieving parent to emote. The child creates a conversation to say to the isolated parent, “You’re not alone.” The hurting parent thinks that he or she is healing the wounds of the child by sharing their own experiences about the former spouse, but they have it backward; instead, it is the child who is attempting to heal the wounds of the hurting parent.

By inflating their concerns about their second parent, the child reassures the isolated parent that their bond is special, and this reduces the parent’s fear of losing the child to their former spouse. For the child, this has simply become a strategy to calm the parent’s anxiety and to create stability in the home.

How can counselors help parents interact with their child in moments when the child healer dynamic might be present? When the child is sharing difficult feelings about the other parent, how can parents be helpful without falling into the child’s attempt to help them?

One way to help parents is to teach them how to empathize with the emotions of their child without validating the child’s interpretation of the second parent’s motivations. Although it can be helpful for the parent to tend to the child’s emotional experience, this doesn’t require the parent to explain their own experiences with the former spouse. The parent can learn to validate the difficulty of the child’s feelings without speculating about the intentions of the former spouse. The parent can say, “It’s really hard to feel as angry as you do” without saying, “I experienced that same selfishness, and it made me angry too.”

By attending to the emotions of the child without confirming the child’s interpretation of the second parent’s motivations, the first parent avoids falling into the child healer dynamic. By refraining from sharing his or her own experiences about the former spouse, the parent keeps the focus on the emotions of the child. And in cases in which the child is expressing sincere concerns about the second parent, the first parent is still able to effectively empathize with the child’s feelings.

 

Swinging pendulums

In the second scenario, the parent doesn’t bite their tongue because they think they need to set the record straight. The former spouse is speaking poorly about them, and they think the relationship with their child is suffering as a result. The parent overshares because they want to provide a balanced perspective for the child. Essentially, the parent wants to clear his or her name.

In these circumstances, it can be helpful to remind parents that children of divorce commonly bounce from one parent to the other, and at different times, they will feel closer to one parent than the other. Children of divorce are swinging pendulums: Sometimes they swing toward the first parent, and sometimes they swing toward the second parent. The question then becomes how a parent should respond when the child is swinging away from them so that when the child is ready, he or she feels comfortable to swing back.

It is helpful to remind parents who feel distant from their child that trying to clear their name won’t increase the odds of the child swinging back to them. Parents hope that setting the record straight will return their child back into their arms, but this strategy is rarely effective. Instead, it often backfires because the child thinks that in order to swing back, he or she will have to agree with that parent’s version of the divorce. Or at least the child will have to lie and pretend to agree. This makes swinging back more complicated.

It can also be helpful to remind parents that it is better to think of the relationship with their child as a long-term endeavor and to expect changes in the relationship. Indeed, it’s highly unlikely that their future relationship with their child will exactly mimic their current relationship.

When parents don’t feel that the relationship with their child has to be perfect in the present, they realize that nothing needs to be desperately forced. If normal periods of emotional distance are expected and accepted, this can remove pressure from the interactions that parents have with the child, and this mindset can create more room for calm parenting. As a result, a less complicated relationship with the child can emerge, increasing the child’s comfort in swinging back into the relationship.

Going through a divorce can be one of the greatest challenges of a lifetime, and it’s made even harder when a child is involved. It is not realistic to expect that parents will hold their tongue every time they should, but perhaps teaching parents about the dynamics of divorce will create a moment of hesitation where once there was only the urge to overshare. In this window of hesitation, there might be enough room for parental wisdom to grow. Hopefully this new wisdom will contribute to the healing of divorced parents and the healing of their children.

 

****

David L. Prucha is an adjunct professor of counseling psychology at Johnson and Wales University in Denver. He is also a licensed professional counselor who maintains an independent practice that specializes in depressive disorders, anxiety disorders, and trauma and stressor-related disorders. Contact him at contact@pruchacounseling.com.

 

More from this author, from the Counseling Today archives: The wise support system in domestic violence rescue efforts

****

 

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

The social justice of adoption

By Laurel Shaler June 18, 2018

The adoption journey is not an easy one. After three years and nine months of active pursuit, my husband and I finalized our adoption on Nov. 29, 2017. Through this process, I learned a great deal that has helped me grow as a counselor educator and supervisor. For example, I learned the benefits of being a part of a support group after involvement in several different adoption support groups. Although I have always valued such groups, and facilitated many, the personal experience of being a participant deepened my appreciation of their benefits.

I was also greatly reminded of the beauty and benefit of empathy. When those who supported us during our adoption process were able to put themselves in our place to the point of weeping with us (rather than for us), it was deeply meaningful. We talk and teach empathy as counseling professionals, but when we experience the other side of it, it allows us to more richly understand this critical component of counseling.

But what I learned more than anything is the many aspects of social justice involved in adoption. Merriam-Webster defines this term as meaning “a state or doctrine of egalitarianism.” We wouldn’t accept Wikipedia as a scholarly resource on a research paper, but the way the website expands on the definition of social justice resonates with me: “a concept of fair and just relations between the individual and society.”

So, what does social justice have to do with adoption? Let’s take a brief look at the social justice for the birth parent(s), the adoptive parent(s) and the adopted child(ren).

1) Justice for the birth parent(s). There are at least two categories of birth or biological parents in the adoption process — those who choose to place a child for adoption and those who have their children removed from their care. In both instances, these children should be treated fairly.

For those who have children taken from their home, there is due process that government agencies must abide by. These parents have rights that should be respected.

Likewise, those who are choosing to place a child for adoption have rights. They should be fully informed about the adoption process and should be offered counseling to address the possible short- and long-term impacts. As a matter of social justice, they should be treated as equals — they are still parents who made a plan for their children out of love. This is also the motivation for the adoptive parent(s).

2) Justice for the adoptive parent(s). During the adoption process, adoptive parents should be treated with compassion and empathy. After the adoption is finalized, the adoptive parents should be treated like the parents they are. The word “adoptive” can and should be dropped. The adoption was an action that is now completed.

That certainly doesn’t mean that we should hide or be ashamed of the fact that the child was adopted. Rather, it is something to be celebrated. However, those who are raising children they have adopted should be treated as equal to parents who are raising biological children. Remember, social justice has to do with a fair relationship between individuals and society. This should also be explored for the children who have been adopted.

3) Justice for the adopted child(ren). Children who have been adopted are not adopted by their own choice. Rather, they are adopted because of someone else’s choices. Sometimes those decisions are good (such as the birth mother who recognizes that she is not capable of adequately raising a child, even with significant assistance, and makes an adoption plan). Sometimes those decisions are poor (such as the birth parent who abuses or neglects a child and is not able to meet the requirements to improve his or her parenting skills or meet the needs of the child.)

Regardless, the child who is adopted should be treated like every other child — just as precious and just as wanted. These children should also be provided the opportunity to receive as much information about their backgrounds as is age appropriate, depending on their ability to process and cope with the information.

Additionally, they should be offered counseling if the need should arise. We should not talk about children who have been adopted, but rather to them. Their right to privacy should be respected not only by the helping professionals in their lives, but by everyone who knows about their story. This is a fair relationship between these individuals and society.

 

According to the American Academy of Child and Adolescent Psychiatry, approximately 120,000 children are adopted each year in the United States. Therefore, counselors are sure to encounter individuals who have placed their children for adoption, who have been adopted or who have adopted children in the past. It is important for counselors to understand each of these three components — these human beings — as we work with them. We can learn a lot about social justice by looking at their experiences.

 

****

A national certified counselor and licensed social worker, Laurel Shaler is an associate professor at Liberty University, where she serves as the director of the Master of Arts in professional counseling program. Additionally, she writes and speaks on the intersection of faith, culture and emotional well-being. She is the author of Reclaiming Sanity: Hope and Healing for Trauma, Stress and Overwhelming Life Events. Her next book, Relational Reset: Breaking the Habits that Hold You Back, will be released in 2019. Contact her at drlaurelshaler.com.

 

****

 

Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.