“How Should I Handle this Paradox?”

Posted on May 20, 2016 by Robert

Question from a colleague in upstate New York —

I encountered an odd dilemma. I have a private practice in New York, and it is close enough that sometimes, not always, I bike to the office, instead of drive.

Last week I had a light morning schedule, just one family at 0930. It is a family with a history of shame and blame, based in their intergenerational transmission of many struggles and disappointments. Now the father brings his young adult son, and things are going well. They are on their way to new-found resolution and stability.

On that particular morning I arrived at 0900 (checked the time) and parked my bicycle in back of the office building. The waiting room was already open for other offices, so I opened my office, turned on the lights, read my mail, penned some thoughts for today’s session and waited.

Unlike some, this family usually arrives a few minutes early, so at 0925 I stepped into the waiting room to greet them when they arrived. But for whatever reason, they no-showed, and at 0945 I closed up my office and headed off on the next part of my morning. (When clients no-show, I usually wait a few hours to contact them without the pressure of immediacy.)

A half hour later I received an email from the father asking me to call the son about today. He wrote that they had arrived on time at 0930, and the son had gone in and reported back that the office was locked and dark. If an email can have a tone of voice, this one would have been accusatory.

I called the son and he said that they had not seen my car so they assumed I had not arrived. He added that his father had looked in and reported that the office was locked and dark. (In the interests of time, I did not point out the discrepancy in their stories.) I apologized for any confusion and rebooked for next time.

When do you recommend I confront these folks about their discrepant stories? When should I try to get to the bottom of the truth?

Thoughts from Vermont —

Thanks for a good question – New Yorkers have a knack for them!

You could certainly take the inquisitive or direct confrontational route – many therapists would. My suspicion is that focusing on their obvious discrepancy is premature. Here’s are a few possible reasons….

(Assuming that there were no simple explanations such as daylight saving time, or broken digital clocks.)

1
You report that “they are on their way to new-found resolution and stability.” With many families with long traditions of conflict, starting to change things for the better will trigger unconscious pushback – the system is trying to maintain equilibrium, as they say. Trying to make that the next focus of therapy may be premature to repairing the relationships and co-regulating whatever affect comes up about their memories. THEN you might be in a position to discuss actual events without defenses, if it still seems relevant. Relationship connection first.

2
In families such as you describe – steeped in blame and shame — any crisis will require finger-pointing and assigning some failure and/or negative motives to others, if only to avoid being on the hot seat oneself. The goal of each member becomes, ‘it wasn’t MY fault’. Suggesting that you are the one who must be lying or mistaken helps expose the family’s dilemma like an x-ray. No need to waste this vulnerable moment trying to rush everyone into cognitive realities. They are ripe for empathy for their fears of vulnerability to each other. Spend your opportunity wisely.


3
Having made what sounds like lovely progress on the surface, you may be being tested before being allowed in to a deeper level of worries and fears of this family. To pass this test, you must show them a different way to handle the shame/blame cycle – and you have to do it under the spotlight of a crisis. ‘How can you maintain you were there when we say you weren’t?’ Can we get you to argue with us about our clumsy different stories? (As we do all the time…)
Or will you continue to deliver empathy for our accusatory defenses, continue to value our stuckness as an honor to work with, and avoid our surface invitation to divert your care for us into a search for ‘the facts’?

My guess is that ‘the facts’ – or anything else — can be discussed after re-affirming your deep empathy for this family and their need for safety and co-regulation of their big feelings.

Here are the priorities in order: 1) a sense of safety for the family, 2) help regulating their traditional big feelings, 3) then, lastly, if you get there, reflecting with empathy on the cognitive meanings of this situation, after no one is any longer fearful (as you are not) of being in the crosshairs of family blame. After all, sometimes all things are true at once.

All the best from Vermont —

Bedtime Success with an Oppositional Child

Posted on August 31, 2014 by Robert

A parent used to try to help his child, age eight, understand and agree with the parent’s decisions. This father had had a painful childhood himself, and he kindly did not wish the same for his son. The boy would go along with decisions he liked, but learned to rage violently against the others until father gave in. He typically refused to cooperate with bedtime. He would say, “I don’t want to go to bed,” and then he would ignore or fight with father.

“So I used to think, ‘Oh, his body knows what it needs better than I do,’ and leave him alone.”

“But now when he gets oppositional and combative I move in closer and give empathy but also bring in limits, allow fewer choices and less freedom.”

How’s that working?

“His rages are shorter and less frequent.”

I notice that formerly ‘fun’ father also seems calmer, less reactive, more confident, more serious, and makes fewer crisis calls between sessions.

How’s that feel?

He looks at me seriously. “It’s hard work.”

This father who previously worked hard to avoid his son’s frightened and frightening feelings, has stepped up to the plate, taken charge and given his son the parental attention, limits and guidance the child has been both demanding AND rejecting at the same time [classic example of children’s Ambivalent attachment style.]

It was as if by sharing so much inner confusion and chaos the son was saying, “I feel too much in charge of myself and need help. But I also will reject help, so you should expect to feel as confused as I do. Help me please!!” Parents and caretakers must then rise above the child’s helpless logic, see the big picture, take over, and free them both from the old stuck pattern.

DOUBLE-BIND — when families are stuck in paradox

Posted on July 20, 2014 by Robert

Sometimes a parent will bring in a child – natal, adopted, foster, etc. — who functions well enough in school and in public, but who has recurrent rages toward the parent at home. Rages only at home, and only at this parent.

The parent is typically a very nice and kind parent – undeserving of any violent treatment (assuming anyone anywhere is deserving of violent treatment.) So the parent is mystified. “What’s going on? She needs help!”

A case example walked into my office in Ontario soon after I finished graduate school. A single father complained about his nine year-old daughter. “Sometimes she is fine, but suddenly she’ll be frustrated or upset by some little thing, and she starts attacking me or trying to break something precious to me! I feel so helpless. Why does she do that!?”

Does she say anything? I asked.

“Mostly just screaming. Sometimes she’ll say odd things like, “I don’t deserve to be in this family!” or “You hate me!” or “I hate you!” or “You don’t love me!” What should I do!?

This question, “What should I do!?” is a red flag for most psychodynamic therapists. We know so well that our goal is not to give advice but to help reflect, help with process. However “What should I do?!” is one of my professional weaknesses.

Too often I head off into advices:

Try to not reassure, but give Empathy for how she must be feeling….“I tried that.”

…and be in charge of yourself so there are not TWO dysregulated people in the room…

“I did that.”

….and remember that the more you want to get away from her, the more she needs you nearby….

“I remembered that.”

…..

Finally I heard myself rattling off ‘advice’ to an emotionally exhausted parent who needed my empathy for himself – my empathy for how he was feeling, my empathy for how hard he was trying, and my empathy for his own unresolved past traumas.

I apologized.

Beginning with the last item, this father’s own traumatic past left him determined to keep things positive for his own child. He dealt with his despair by disallowing any ambivalent feelings of his own such as resentment, until it burst and he would lash out verbally, after which he felt horrible.

Thus when he felt frustrated at his child’s blind, out-of-control behavior, he would bury his frustration so that it came out sideways – tearful pleadings with his daughter to “Tell me what’s wrong so I can help you!!” and “What is it you want!?”

And when she of course could not explain herself on a conscious level, but kept expressing her sense of shame and worthlessness preverbally and violently, he would eventually blow up in exasperation, desperately wanting to help.

This explosion would leave him burdened with shame and fear that he had wounded his child. However it sometimes had the paradoxical effect of calming his child. At last she could finally see in this repressed father some real feelings she could trust.

I now had a helpful map of their double-bind. In a double-bind, people are stuck in a dilemma: feeling bad if they act, and equally bad if they do nothing. Lose-lose, what do you choose?

Father could try to be direct about his own anger and resentment, but then would beat himself up for expressing negative feelings to a child, his suffering daughter no less. Or he could keep repressing his own resentments and continue to feel unable to connect to her in her own struggles.

The daughter was also in a double bind: When I get scared that I’m not lovable, my dad doesn’t get it and wants me to explain it and tell him what I need. But I have no idea how to articulate that stuff – I’m just a kid! — so my sense of being not good enough increases….(begin again)….

Finally, as the therapist, I also enter the double bind (though I am the one who can best reflect productively on the experience of being there.) Heck, I offered this father my best ideas and advice, yet was repeatedly dismissed with “I tried that.”

Rather than start arguing with father about whether or not he ‘tried that’ the proper way, my path forward is to recognize my privileged position. I am experiencing what the father AND his daughter experience – frustration, helplessness, hopelessness and the resentment at doing ones best and receiving no results, appreciation or recognition. If my ‘best’ was not good enough for father, perhaps I am not good enough.

When I can reflect on this, perhaps right away or later in clinical consultation, I feel honored to have been allowed to experience their stuck system for myself. I am grateful for an inside view of the emotional challenge which faces father: to find a way to tolerate standing with old intolerable feelings and reflecting from that place until it is safe for his daughter to recognize her own feelings in him, allowing her to sense (over time) that there is less need to maintain the fierce, defensive walls between them.

This is the therapeutic potential of allowing ourselves to sit inside any client’s paralyzing double-bind. Just not for too long.

Maintaining empathy for an aggressive, controlling child client.

Posted on June 3, 2014 by Robert

Increasing control is a common and logical response to rising anxiety. Yet sometimes reducing anxiety by increasing control can get out of hand, hurting relationships through pain and confusion. At a meta-social level, author Alan Johnson points out that men in a patriarchy find the fastest path to control is violence. (“Don’t make me hurt you…” “She threatened to take the kids, and I lost it….”)

Children can also project commands, threats, and other attempts to find safety through control. My first experience with such a child occurred early in my job at a Canadian mental health clinic.

A lovely but angry nine-year-old girl was brought in by her legal guardian. As usual, I asked the safe adult attachment figure – in this case the guardian — to stay in the room with us. [The four major benefits to this will be listed in a future essay.] And as usual, I accepted the child’s symptoms as clues to what she had been through. I knew from her history that she had grown up between divorced parents. She visited one parent who would avoid her strong feelings as much as possible (resembling the “dismissive” adult attachment style). And she lived with the other parent who treated her sometimes warmly and sometimes coldly, depending on her own mood (similar to a “preoccupied” adult attachment style.)

Consequently, the girl’s rude demands and commands in session were accepted as invaluable clues to her own attempts to make sense of her confusing history. The challenge for me was to respond with Acceptance, Curiosity and Empathy — versus either opposition or cooperation. (Note: it is best to avoid Playfulness with an upset child. It can sound a lot like sarcasm.)

With children like this girl, who bullies, my initial hypothesis (to be tested) is usually that she is trying to put her anger and frustration into others, where she can observe it outside herself – giving her a rare moment’s relief from experiencing those feelings within, 24/7. Peter Fonagy in the U.K. explains in a brilliant essay that the bullying person can experience brief relief from their own internalized shame and terror by forcing those feelings onto another person, whom they can then attack, drive away or even kill in an attempt to be rid of the feeling forever. (Note the routine daily news of murdered women in patriarchal societies.)

I did not have long to wait.

“Robert! Sit over in that chair!”

I let my jaw drop and outwardly reflected my experience of HER inner sadness and scaredness which she was trying to relieve by commanding ME. Matching her ‘vitality affect’ (Daniel Stern’s fine term), I used her commanding voice, but my words.

“You want me to change chairs! And if I do, you hope that you feel better! And I so want you to feel better!”

At first she registered only my failure to obey. “Go!! Sit there!!”

I continued to keep my voice loud, like hers, but my words empathic, like mine. “And if I don’t sit there, you’ll get more upset!! Oh dear!! I feel terrible!” I appeared visibly and audibly distressed — loud and vulnerable and without mocking sarcasm. I was reflecting from a stuck place, a spot she had experienced so many times in her short life.

“GO!! SIT THERE!!” The only response to non-compliance this girl had ever learned was her parent’s escalation.

Without mocking (practice this), I continued to mirror her affect (her outer expression of her inner feeling) and reflect on how it was affecting me as I cared about her. This ability to reflect is something she should have learned early in life, instead of being made to feel ashamed of her own feelings.

Me: “Now I am stuck!! I want you to be happy, because I like you, but if I don’t do what you want, I’m scared that I’ll disappoint you and then you won’t like ME!!!”

Being one-third my size, she did not try to push me, but she did try the other parent’s response: abandonment. Looking away she announced, “I’m ignoring you.”

I then shared my sadness at feeling ignored by her, whom I liked, and said in a hopeful, lonely voice that I hoped she would talk to me again soon! (This modeled for her how to articulate a complex relationship with feeling. I suspect she had never heard this before.)

She suddenly became vulnerable herself. “You’re scaring me, Robert!…..You know how come I’m afraid of you?”

Me: “How come you’re afraid of me?!” (Repeating her phrase tells her both that I’m listening, and avoids distracting from the huge window she is about to open onto her own thoughts and feelings.)

“Because,” she nearly spit in self-protective anger, “I WAS TREATED LIKE A LITTLE STUPID IDIOT MY WHOLE ENTIRE LIFE!!!”

I quickly reflected my feelings, while matching her vitality affect. “I AM SO SORRY TO HEAR THAT!!!” And I continued to share my own affective response to the thought of a child being treated like a ‘little stupid idiot’ her whole entire life. Almost wailing I said, “Oh! I am sad to think of you being treated that way!!”

Then, I introduced my curiosity: “What did you do?! How did you cope?” (Note: It sometimes requires a cool hand at the tiller to steer away from knee-jerk reassurances such as, “You’re NOT an idiot! How could anybody treat you like that!!?” But reassurance shuts down feelings, while I wanted to articulate her need for a way out – What shall I do? How shall I cope!?)

Now she deepened into her memory but still could not differentiate her inner life (remembering the past) from her outer life (being here now). She could not yet reflect from the safe emotional present, as most adults do. She was still emotionally in the past, stuck in the memories and trying to manage her old feelings by making others change (“instrumental” use of affect) instead of describing her feelings to deepen connection (“signal” use of affect).

Suddenly she glowered fiercely at me. “If you ever hit anybody in my family – I’ll shove that notepad down your throat!!”

That was low-hanging emotional fruit, for which I was extremely grateful. It is important to not waste it with the following abstractions: (‘How do you think that makes ME feel!?’) would demand of her a complex ability to feel empathy for others. (‘I can teach you to relax and let go of those old hurts.’) would go prematurely to cognitive solutions while she is stuck in a state of highly dysregulated emotion; I would be abandoning her in freefall with her scary feelings. Such a response would be congruent with van der Kolk’s theme of The Body Keeps the Score, emphasizing meditation and other pulse-slowing approaches to stored childhood trauma. Yet this path would be premature to where she was in this moment. I still had to establish safety, and co-regulation of her affect.

Accepting the low-hanging emotional fruit (“…I’ll shove that notepad down your throat”) I match her harsh vitality affect again: “(gasp!) Somebody shoved something down your throat!!”

Immediately she is able to reflect on the past, protected by the empathy I am giving her in the present.

“Instead of spanking me every time I was naughty I had to bite into the bar of soap and chew it and swallow it! And I didn’t get any water!”

She is tearing up. And as I imagine being her being made to eat soap, my own eyes fill, I bite my lip, and my mouth turns deeply down in empathy.

She looks at the ceiling. “And if you cry, Robert, I’ll burst out into tears!!!”

For the rest of our session we had trust. I had helped her feel understood beneath all her fierce threats, by responding only to the feelings under the behavior, and responding preverbally (voice, facial expression, mirroring affect) instead of with cognitive insight.

Co-regulated at last, this aggressive child was finally free to reflect on her life from a safe, outside perspective, something parents usually, unconsciously, provide to children from birth onward.

Crossing Adult with Child Attachment Styles — some thoughts

Posted on February 24, 2012 by Robert

While preparing for an upcoming conference presentation, I created a matrix which crossed the four adult attachment styles (Autonomous, Dismissive, Preoccupied, and Unresolved) with the four childhood attachment styles (Secure, Avoidant, Ambivalent, and Disorganized.) You may recall that each childhood style tends — without intervention — to lead into the corresponding adult style.

From this Vermont therapy practice, I have collected examples to fill each of the matrix blanks — Dismissive style parent seen with Avoidant style child, etcetera. I don’t have much to fill the Securely attached child column, as they rarely have need of services. But the other columns are busy. A brief look at the patterns:

Dismissive style adults seen with Avoidant style children shows a combination in which both adult and child are working hard to avoid relationship and emotional vulnerability. They seem to benefit most not only from acceptance and empathy, but also from my “speaking for” them to each other. “Sorry, Dad, about what happened yesterday — I just didn’t now how to approach you to fix it, so I didn’t say anything…” That makes sense, as all their practice has been at avoiding sharing their own inner awareness with another person. “I’m fine.”

Dismissive style adults seen with Ambivalent style children are another matter. The adult is trying hard to avoid conflict, while the child is busy seeking conflict in a bid to feel safe through control of the people and objects around them. They tend to present with the parent intimidated and the child frequently dysregulated. They benefit most from support for the adult to find their voice, step up to the plate and be in charge again. Kids need parents (safe parents) and they need the parent to be in charge. Because of child development realities, that’s the only way kids are going to be okay.

Preoccupied style adults, on the other hand, are looking for conflict, due to so much difficulty resolving issues from their earlier years. Through no conscious fault of their own, the presenting problem is often one of drama. One parent who daily clashed with his nine year-old asked me in hushed tones whether I thought that his daughter might need an exorcism. (I didn’t.) Unfortunately the dramas are rarely resolved, because they tend to be emotionally founded in unspoken hurts from the past. Only when this is interpreted do the problems in the present lose their power and people become less stuck.

Combine a Preoccupied parent figure with an Avoidant style child, and you have a chase-and-evade dyad, not unlike some unhappy marriages. But a Preoccupied style adult raising an Ambivalent style child will be a dyad often in flames — each person trying aggressively to force recognition and appreciation from the other, while both were denied these things long ago.

Not to paint too bleak a picture, the Autonomous style adult can usually make gradual headway with both Avoidant and Ambivalent style children. Why? They can rely on their own “secure emotional base”, and their own positive “internal working model” to carry them through long periods of the child’s dysregulation — while continuing to project their image of the child as capable and important. That is an important image which children need from adults — a projection of themselves which they can absorb, test, push-against, even reject, but gradually internalize.

The Disorganized style child is usually the most challenging of the childhood styles, due to learning few ways to survive unpredictable maltreatment other than creating immediate chaos in the moment. Parenting this style requires some skill and many outside supports.

What Can We Do About Lying?

Posted on November 6, 2011 by Robert

Q. What can we do about lying?

A. Often a child’s lying, like cheating, shoplifting, stealing, evasion and many other ‘hiding’ behaviors, is rooted in a felt need to hide themselves. From a sense of shame about their own worthiness, a child (or adult) might say if they could, “I’m not good enough to be known for who I really am, and that means my (new) parents would get rid of me if they really, truly knew how worthless I feel. So eventually, when people really see me, then I will have to get my needs met by sneaking. Under the table. On the sly. By hook or by crook.”

With adopted children, this can flow from a nagging fear that what happened once can always happen again — being “given away” because they were “not good enough to keep”. So they are sure they must practice surviving on their own, under the radar, for when the nightmare of abandonment happens again. With incest survivors, the unconscious need to hide ones identity from others can feel like life or death.

One time an adoptive mother with her own horrid childhood lied to me in session. I had suggested some communication exercises for her family. She replied, “Oh we do that all the time at home, let’s just move on.”

You do?

“Yeah, let’s just move on.”

I’m curious. When do you do it?

“Well…..we really don’t, but I just told you we did so you’d move on to something else,” and she grinned like her teenager whom she complained was compulsively lying.

(From my perspective this was solid gold.)

“You lied to me!” I exclaimed in mock horror, opening my eyes wide.

“No, I didn’t,” she giggled. “I told you the truth in the end.” She was 46.

“You LIED to me! And you ENJOYED it!!” I played this like a hooked sailfish.

“No, come on, I didn’t LIE!” (i.e., Finally someone caught me!)

“And now you’re lying about LYING to me!! Like a TEENAGER!! WHOA!!!” At these words she collapsed into giggles.

This playful incident became part of our therapy history. We referenced it many times as a crucial deepening of our therapeutic relationship: the day she was caught in a lie, but not shamed for it.

"NOW what?"

What would be an equivalent response to a child’s lying?

Dan Hughes once role-played a nice response during a training. In the role-play he neither shamed the “child”, nor accepted the lie — he found a balance: “Hey, you’re giving me baloney! You got any cheese in there? C’mon, hand it over!”

The message: 1. You’re trying to put one over on me….2. I won’t even PRETEND to buy it….3. And I sure like you!

"Baloney!"

This good message offers the child both a challenge to the lie (I’m not stupid) and face-saving through humor (I still like you). We can use this formula with teens and adults as well.

An exception might be when the child is lying from within deep depression. In children this can appear as fierce hostility. “I never took anything! (while hiding stolen item behind back.) I hate you! Get out of here! You’re stupid!!” At those times responding with playfulness will sound to them like sarcasm. I will cover responding to depressive lying in another blog — it can require some reflection on our part to find the voice we (and they) need.

What are the four attachment styles of children? 1978 and 1986

Posted on October 30, 2011 by Robert

The perplexing relational behavior of alienated children was first demystified by the insightful research of Mary Ainsworth. Her brilliant Strange Situation study findings were published in 1978 and remain relevant today. She correctly identified the various responses of different toddlers upon seeing their parent walk out of a room and then return. Additionally a strange woman simply came in, sat, and went out — at two specific times.

Ainsworth identified three childhood attachment styles, eventually called Secure, Avoidant, and Ambivalent. Her explanations were later enhanced by Mary Main (1986), who, with her assistant Judith Solomon, recognized that a leftover, chaotic fourth group (10%) had developed no patterns to make sense of themselves or their world: “Disorganized” style.

Knowing the four attachment styles of children does not guarantee an emotional connection — a quick fix. But it does provide a useful explanation of what may be going on in the child’s head — their inner life of thoughts and feelings. This in turn lets us parents and helpers feel accurate empathy for the struggling child’s difficult inner life. (There is empathy, and there is accurate empathy.) It also allows us to set limits and name our expectations with some degree of confidence that we are doing no harm. We now know how to understand and repair the child’s shame when it becomes triggered. The combination of accurate empathy plus safe limit-setting gradually unlocks emotional doors to trusting. Still, the path to close, intersubjective connection with a child may be easier for some adults than for others.

A dismissive attachment style in an adult

Posted on October 11, 2011 by Robert

An adult client, a professional man who was several years into his new marriage, came into therapy struggling with “Who am I?” After a short time I found he would change the subject each time I got close to focusing on his thoughts and feelings. This is typical of an adult who avoids placing any attention or importance on their own inner life — an adult with “dismissive attachment style”.

In such cases I usually ask whether the client’s partner might join us. It helps get to core issues when I have a second safe person on board. He agreed to ask her. She was a social worker.

Next session the spouse joined us, saying, “I’m not sure why I came today.” My client started chattering about some other topic — his usual response to anything risky.

Suddenly it struck me that he was avoiding his thoughts and feelings because she was a social worker. I shared my thinking: “I wonder if you brought her along so she and I would talk shop and stay safely away from your emotional stuff.”

A home run with that — and it laid the groundwork for future sessions. Before leaving he warned me, “I might go to my grave without dealing with my feelings.” I replied, “Yes, but that could get old for her. Spouses like their partners available to work on issues together.”

Good work followed.