Tuesday, August 26, 2008

History and Strategy

You might find this question and answer interesting.

A reader writes in response to the shame post, The Bistro and the Date (below). First he answers those all important questions* then asks
How can I keep my boundaries tight when my family tries to sabotage what I think should be a moratorium (a.k.a. cut-off ) for the sake of my mental health?
The reader worked for years to distance himself from his verbally abusive father, a man who denies his emotionally violent parenting to this day.

If I were the reader's therapist, I would explain that it is shame that is buried under those layers of denial, that his father and he may not be all that different. The difference is subtle but important. His father's shame is so tragic, so toxic, that it is no longer conscious, he has successfully defended with that most primitive of defenses, denial, unconscious denial, the worst kind. He has to believe himself a good dad. Anything else would destroy him. He hasn't psychic permission, he hasn't given himself permission, to be imperfect.

An identified patient like our reader will sometimes try to cut off communication with people in the family who were "dysfunctional" "toxic" "violent." He may try to hang onto one limb, to save a relationships with a sibling, the seemingly healthiest member of the family.

But this last branch, his only connection, will eventually become angry and resentful, may even threaten to cut him off unless he reconnects when parents become elderly and physically unwell. Siblings needs one another when that happens, when there's family work to share.

We're addressing cut-offs here, obviously. The reason people cut-off their families is not that they don't need them or feel responsible and connected to them, but their families became sources of pain. Families do abuse and shame, betray members. Mis-steps such as these (including addicted siblings who visit and steal the silverware) make us wary. We put up boundaries.

It's the permeability of the boundary that concerns me. Boundaries need to breathe.

Parents who emotionally abuse with words, who shame their children, who fertilize a child's self-doubt, sense of inadequacy, and unworthiness have to be sealed off for a little while. The fence needs some sturdy nails. Not electricity. No, I won't block the metaphor, let's keep it going.

See, you need a fence, because children who grow up with verbal abuse believe it and when it's a steady stream of negativity will join the dissension, believe the words, find someone else who will abuse them, or do the dirty work themselves, continue the lashing, cut, try suicide. Maybe succeed.

This is why therapists will advise conflicted patients to stay away from the source, to protect themselves from further emotionally violent communications with family. Heal.

But we're all human. We will want to cling to the healthiest member of the family, perhaps the one who saw the abuse, who may have also been a victim. And ultimately cut-offs fail. The family guilt and invasiveness is stronger than the average soul can stand. Therapists often get cases like these when they're sinking, shored up by a quick but ineffective hospital stay.

Sometimes during that stay the family has been involved. A family therapist like me will keep that going if I can, at discharge, will contact family members (with the patient's permission and release of information). I work to convince the family to let me take over for awhile, to give the patient less of themselves, not more. But don't worry. We'll be in touch.

And I stay in touch.

It takes time, but if a family therapist can work with the healthiest branches, things can change, really change for the best. Branches only need be a little green to grow. People change late in life, given the chance, given the relabel, the opportunity to be a hero.

But what do we do when it's too late for that, when the cut-off is fragile and not working, and Dad is sick in the hospital and our Identified Patient hasn't the strength to deal?

Not at all uncommon. The sibling, the one care-taking Dad, wielding the chain-saw (help me or you're no longer my brother/sister), is clearly of the tougher child variety. But even the tougher children wear down when they have to care-take sick parents. They look tough. But it's just for show.

Family therapists push for direct communication. First the identified patient has to be straight with his or her sibling(s), the care-taker(s), either by writing (under a therapist's direction and editorial skill) or calling (in the therapist's presence) to communicate something along these lines:
I'm going to call Dad or write to him and tell him what's going on with me. I'm sorry you're stuck with this, but for the time being I probably won't be visiting. I'm not quite healthy enough yet, but I'm working on it. Here's what I'm going to tell our father:
And here is what the identified patient would tell his or her father, either by telephone or in a letter, not face to face, something along these lines
I'm sorry that I'm too sick to reconnect with you right now, that I'm no good to you. Some children, the ones with big issues, get a little funky when parents get sick, and that's what I am right now, laid a little low, too depressed and withdrawn to get out of my shell to help out with you, visit with you.

I know you don't believe in mental illness, but you and I are different like that. You probably see this as a weakness and an excuse. So be it. It's real enough to me to make visiting impossible right now. I just can't do it. I hope that you don't hate me for it. I imagine you do.

One day I'm sure I'll regret this decision, not seeing you, not helping you. It doesn't seem fair to do this to you, especially now. But I don't see life as fair. A parent raises his kids, gives them his all, and just when he needs them, they're gone.

I have bad memories of us, and they haunt me (this is called chipping denial, you're not accusing him of anything). I have to work through things, mostly negative thoughts about myself, nobody else. You did the best you could. You tried to parent the best you could.

I feel like a bad person, a failure, for not meeting your expectations.

I'm in therapy, working on my own set of expectations, and how I'm going to live with myself when you're gone.

Maybe I'll get it together soon. Who knows? I don't expect you to forgive me for this or to really understand me. But despite your take on mental illness, I think everyone gets depressed sometimes. Maybe even you.
And then the identified patient stops talking or signs off (he doesn't have to write "Love" that's up to him) and hopes his father begins to talk about his own feelings, his own depression, his own childhood abuse, knowing he probably won't.

But he might. They sometimes do.

This is a strategic intervention, full of lies. The identified patient is not remorseful, probably doesn't even believe his father did the best that he could. The identified patient may never regret not talking to his father, cutting him off.

With good therapy, he will live with himself just fine once his father has passed on. He probably won't care. Some celebrate. It is survival we're talking about here. And you can't always sleep with a person you perceive as the enemy. You can't always go home just because they're ringing the dinner bell.

The therapy, surely, is about changing that perception, the one that identifies the parent as the enemy. If that's possible.

To do that, you need history. You need the extent to which the parent suffered abuse during childhood. If the identified patient doesn't know the history or denies transgenerational abuse, I make finding out a therapeutic objective. It's there.

He was criticized, abused, shamed. Not loved. Abandoned. The child who cuts him off finishes the job. It's the unkindest cut.

In family therapy you want to get to a point with an abusive parent that you can admit you're not so tough. You don't know how he survived his childhood. How did he do it?

Families can toughen us up or wear us down. The resilience variable is having a healthy adult around who counters the abuse, one who puts a hand on the abused child's shoulder and says, "You're a good kid, a wonderful kid. You'll grow up. You'll get out. Talk to me any time. Tell me everything."

We can get into calling authorities about child abuse another day. In a word, Yes. Call.


*Those questions include:
Did (your father/mother/guardian) call (you) lazy?
A loser?
A fool?
With gusto? With sarcasm? With hate? Disgust?
Were there tirades directed at making people feel badly about themselves?


Carolyn R. said...

Thanks - C. Rau

porcini66 said...

Tough one for me to read. But, as always, thank you for writing.

Syd said...

No, my parents never called me any of those things. But my father did criticize in a different way--through a lot of parental messages. So somehow I felt less than. I think that it was a subtle form of child abuse. It became ingrained in my psyche. This was a great article and brought up a lot of things for me. Thanks for writing it.

Isle Dance said...

Excellent post. Thanks for writing and sharing it.

Anonymous said...

what about the trangen abuse ? what if the phrase retarded echos in your brain or I can't do it because...and yet in present day life everyone can't say enough about how smart you are ....what if you want to help someone and you are too afraid to tell them that you are concerned about it as they the other person may yell and scream at you for it...

therapydoc said...

Believe everyone else when they say positive things, Anon. Always give the positive a chance.

Oh, boy. We have to talk about the last part.

"what if you want to help someone and you are too afraid to tell them that you are concerned about it as they the other person may yell and scream at you for it"

The fear that people will yell and scream. It's so subtle and yet not subtle at all.

Yeah. I'll write on that one. So smart :)

jp said...

Wow, TD. I very rarely disagree with you, but twice in one post? Unheard of. I must be wrong, but I'm in a risk-taking mood:

Lies - aren't lies inherently violent? Especially to the one doing the lying? And if the ends can be used to justify the means, all manner of horror is possible (your recent post on Simon Wiesenthal comes to mind).

"You need the extent to which the parent suffered abuse during childhood. If the identified patient doesn't know the history or denies transgenerational abuse, I make finding out a therapeutic objective. It's there."

It's not clear from your post whether this is stated as a universal truth or a generalization. If it's stated as a universal truth, I'm not buying it. Mental illness is more contagious than the common cold. I think it's entirely possible for a parent with a perfectly adequate childhood to abuse their child(ren) in an effort to control the illness of the other parent. No?

cardiogirl said...

Wow, therapydoc. This post hit home in a big bad way. So many similarities it actually made me cry.

Like Anonymous I am working on attempting to erase the echos in my brain. Some days are better than others.

I, too, have validation now from other people in my life about just that -- how smart I am. And yet all I hear is how lazy I am and how if I applied myself and worked *just* that much harder I really would be smart.

And yes, I frequently keep quiet because I would rather not be yelled and screamed at.

I think I'm going to have to print out this post and attempt to use it as a primer.

Thank you very much for sharing this.

Anonymous said...


Thanxfor the post
I was critisized as a kid(and even today) called names( Idiot, worthless, ect..)I dont realy call it abuse (or verbal abuse).
locked in the bathroom as punishment (kind of time out)when I was overly cheeky (chutzpa)

Its just parents who dont know better. They did not go to "parentschool" they tried as best they can.

Alice said...

Wow, yes - this really struck home with me, too.

Only trouble is, I'm an only child of a single parent. There IS no healthy one in my tiny family, there IS no sibling (or anyone else) to share taking care of her, there never was any hope of ever being able to cut her off and I still believe she'd probably kill herself if I tried. One of the healthiest decisions I ever made was the decision that it will be her death that ends our relationship, not mine - but I don't want to actually be responsible for it!

I also have a problem with telling lies. What you suggest writing sounds so much like all the shitty, phoney things she said herself, to maintain the pretence that we lived in some kind of alternative universe in which we were close and we both talked about our feelings and everything was really fine and SHE DIDN’T HURT ME.

"You did the best you could…" is so very far from "you starved me and beat me..." – MY reality is the one that needs reinforcing, not hers - if my therapist asked me to write your letter, I'd fire him.

I enjoy your blog very much, by the way. This one struck a nerve…

Anonymous said...

cardio girl it gets better--- a good therapist is worth many rubies... ;)\

therapydoc said...

About lying. (Sorry, very busy week, off vacation, no time to breathe, can't believe I even got these things out).

But lying as a strategic intervention is sometimes the only way to wiggle into a person's soft side. If we confront, tell people,

Ya' know what? You were an awful son-of-a b and you insulted me, emotionally damaged me, ruined me for life,

the natural temptation is to say, "Wow, touchy, touchy. So sensitive."

Depending upon the person, the context, owning violence is unlikely. Blaming, flipping a situation back onto someone who is already a victim, is the usual response. Protect thyself, says the abuser. Remember, he's likely been abused.

So yes, I suggest lies, only to reinforce boundaries.

These are soft lies. To the person who hears them, they're the honest to G-d's truth.

You gonna' shake someone from his perception of reality? Very unlikely.

And this post-modern world, we're all entitled to our reality, as wacky and "incorrect" as it might be.

aoc gold said...

The Star

Twinkle, twinkle, little star!

How I wonder what you are,

Up above the world so high,

Like a diamond in the sky.


When the blazing sun is gone,

When he nothing shines upon,

Then you show your little light,

Twinkle, twinkle all the night.

The dark blue sky you keep

And often thro' my curtains peep,

For you never shut your eye

Till the sun is in the sky.


'Tis your bright and tiny spark

Lights the traveler in the dark;

Though I know not what you are
Twinkle, twinkle, little star!

-----by aoc power leveling

Fallen said...

Talk about timing.... I was reading this post just prior to meeting my dysfunctional family for dinner and it largely is about keeping up appearances.

There is no one that is healthy in the family. Both my parents deny the abuse and my sister makes excuses for it. I understand the transgenerational aspect of it and have seen how my mother was treated but NOTHING justifies her then turning around and telling her kids they were worthless, among other things.

Every time I try to pull away... to save myself... and put up that fence then I become the scapegoat for their depression or whatnot. Still trying to find the strength to cut them off... to be free.

therapydoc said...

The crazy thing, and I'm not recommending this as much as just commenting that I know it works in some families, is that if you shoot back at an abuser, if you abuse back, they stop.

And it has to be angry, too. This is worth a post in itself, but the idea is that some people only understand anger and abuse. You're not on a level playing field if you're nice, if you're patient.

Much better (for some) to say,
"If you call me worthless, it's because you think YOU'RE worthless, and maybe you are if that's all you know how to do is insult other people, especially your kids. That's a worthless, futile, insulting, demeaning endeavor, insulting me, calling ME, YOU'RE KID, worthless.

It disgusts me."

It's a when in Rome intervention, usually results in things breaking, heads cracking (which is why I can't recommend it unless I know there won't be a violent event).

But when it works, a thing of beauty.

Fallen said...

The problem I had with fighting back is that then my mother turned on my sister instead since she was the easier target. It was a no-win situation.

As an update though my family didn't think it was important to tell me they were going to be late for dinner plans (just in case I might've had something to do) and then just canceled on me and then mom wondered why I reacted. I had spent so much energy just psyching myself up to deal with the family in the first place.

Love my family... love my family... Okay I'm not even convincing myself there.

therapydoc said...

Oh, such a case for double-booking, something I do when a patient is notorious for blowing me off.

Alice said...

Double-booking isn't honest either. What do you do if they do show up?

therapydoc said...

Alice, when patients aren't responsible about keeping appointments I refuse to reschedule them, certainly won't reschedule that week. Other therapists charge, and sometimes I make that agreement. They don't show, they pay anyway.

But I see that as a problem because it still steals my time from other patients. If I've scheduled a No Show, I can't help someone else who needs it as much or more.

As a concession, rather than end treatment, I'll suggest that I schedule the patient for such and such a time, on such and such a day, but if I have an emergency, he or she may get bumped, without warning.

The feeling the patient has, being "bumped" is not much different than the one I have when I open the door to the waiting room, and find no one there.

I'll give the benefit of the doubt. I'll wait to see if someone died, or if the patient was sick (although we now have these things called telephones).

But if it's inexcusable, and it happens more than twice, then I feel the patient has ended our contract for working together.

These rules are set out the day we make our second appointment.

The message is huge and it says, If you're not serious about our time together, then I'm going to give it to someone else who is.

Isle Dance said...

Oh, I do look forward to a future post about this! :o)


...but the idea is that some people only understand anger and abuse. You're not on a level playing field if you're nice, if you're patient.

Better Things-- Seeing Ghosts