We evaluate. That’s what we do. We ask question after question after question, and when we’re not asking questions, we’re noting answers to questions we haven’t asked. We’re so curious, professionally curious. It’s a trained curiosity, and if we’re not careful, a habitual curiosity, a distractive curiosity, a harmful curiosity.

Psychologist James Hillman (1967) warned: “Curiosity awakens curiosity in the other. He then begins to look at himself as an object, to judge himself good or bad, to find faults and place blame for these faults, to develop more superego and ego at the expense of simple awareness, to see himself as a case with a label from the textbook, to consider himself as a problem rather than to feel himself as a soul.”

There is often a contradiction between my image of a person in therapy through their self-assessment of their issue and my actual experience of the person. There is also a vast gulf between the diagnosable issues as seen through the lens of psychological expertise and the essence, identity, strengths, and hopes of the person before me.

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Therefore, I must cultivate space to come to know the whole person. This begs the question of what “knowing the whole person” entails. But let’s be clear: trained curiosity and assessment are not the soul of psychological change. Therapists mean well, but I know at times even I have strayed outside the bounds of helpfulness. Here are seven ways therapists sometimes irritate people in therapy and get in the way of therapy:

1. Interrogating

When people come into session in the midst of an emotional storm, the last thing they need is to be inundated with endless questions on the basis of an agenda that is likely intended more to fulfill organizational protocols than to promote a foundation of therapeutic empathy and rapport.

Questioning always runs the risk of interrogation. The details learned about people’s lives ever tempt helping professionals toward distraction. There is a distinct difference between a personality and a person, a diagnosis and a destiny. It is our responsibility to stir hope and catalyze strengths rather than to stew history and analyze at length.

2. Pathologizing

The concept of “mental disorder” is rigid and misleading. In short, diagnosis is description, and by and large, mental health diagnosis provides description of “software” issues rather than “hardware,” so to speak. It’s a language of understanding what type of struggle a person is experiencing. When therapists refer to people by these diagnostic labels, we overgeneralize a person’s experience and distance ourselves from a critical resource: the powerful, complex, and fluid process of therapeutic understanding, the power center of effective therapy.

It is our responsibility to stir hope and catalyze strengths rather than to stew history and analyze at length.

One of my professors, Bill Collins, taught me “pathology” is a dangerous categorization of a person’s experience. He contrasted “providing treatment to people” with “puzzling through a process with someone.” He told of one friend whose father, growing up, would never let him finish anything without taking over. His friend would, as his father asked, begin to screw in a nail with a screwdriver, and before he could finish, his father would grab it from him and say, “Oh, just give me that.” Those kinds of experiences, he noted, leave long-lasting impressions on a person in regard to self-worth and competencies. Bill said we are to “help others to unpack their conclusions about who they are.”

3. Shaming

We ever risk a false sense of expertise about people’s lives against the backdrop of anxiety about our own. If we’re not careful, we may find ourselves reinforcing the tyranny of the perceived should. Should is shame’s accomplice, and therapists must take care not to aid and abet them.

4. Sympathizing

Researcher Brené Brown (2010) rightfully proclaimed, “Empathy fuels connection, while sympathy drives disconnection.” Saying you understand is unhelpful and probably not true. And let’s be honest—it’s usually a ploy to rush people out of their emotionalism, which sends the message, “I really don’t care enough to walk with you through your suffering.”

5. Lecturing

Psychologist and psychotherapy researcher Les Greenberg (2002) wrote, “Darwin, on jumping back from the strike of a glassed-in snake, having approached it with determination not to start back, noted that his will and reason were powerless against even the imagination of a danger that he had never even experienced. Reason is seldom sufficient to change automatic emergency-based emotional responses.”

With a surge in cognitive therapies, there has been a surge in their wrongful implementation, with many therapists engaging in power struggles to convince people of faulty beliefs in order for new, more positive truths to simply work some magic ripple effect into their lives.

As an emotion-focused therapist, I have been prone to, for instance, encourage couples to engage in safer, softer, and more emotionally responsive interactions, yet when I have stood on my own soapbox, encouraging them to do so out of pace with their own readiness, I have violated my own guidance. Miller (1986) observed that people will “persist in an action when they perceive that they have personally chosen to do so.”

6. Babbling

Silence can provoke anxiety, even for therapists, who think they should surely be redirecting, conjecturing, advising. I find myself observing people in therapy watch me watch them watching me watch them. And I have found a power in it. Like a Rorschach ink blot, presence has power in and of itself to nudge a person’s anxiety so it presents and speaks up for itself.

Another of my mentors, Blanche Douglas (2015), wrote: “There was a method in Freud’s madness when he prescribed the analyst be as undefined as possible, not disclosing details about his life and sitting behind the patient out of sight, saying little. This forced the patient to make meaning out of an ambiguous situation, and the only way he could do this was by recourse to his own experiences.”

7. Methodologizing

If a psychotherapist is lifeless or their technique too technical, their efforts to help may be worthless. Therapy, in this case, is not a relationship but a poor excuse for scientific experimentation. The mechanisms of some psychotherapies undermine their therapeutic value. When we fixate on therapeutic modality, we run great risk of missing prime opportunities to interject the most valuable therapeutic tool we have to offer—ourselves.

Additional reading: The Elements of Good Therapy.

References:

1. Brown, B. (Speaker). (2010). Brené Brown: The power of vulnerability [Video file]. Retrieved from https://www.ted.com/talks/brene_brown_on_vulnerability?language=en
2. Douglas, B.D. (2015). Therapeutic space and the creation of meaning. Context. Warrington, England, United Kingdom: Association for Family Therapy and Systemic Practice. [Edited by Edwards, B.G.]
3. Greenberg, L.S. (2002). Emotion-focused therapy: Coaching clients to work through their feelings. Washington, DC: American Psychological Association.
4. Hillman, J. (1967). Insearch: Psychology and religion. New York, NY: Charles Scribner’s Sons.
5. Miller, W.R. (1986). Increasing motivation for change. In W.R. Miller & N.H. Heather (Eds.), Addictive behaviors: Processes of change. New York, NY: Plenum.

Some people differentiate “counseling” from “therapy.” I have practiced in Washington and Texas and have found no clear differentiation in state law, the language of credentialing regulation, or the definitions provided by major national accrediting bodies for the respective professional licenses.

I am currently in Washington state, so I speak from a perspective within these borders. Here, there is no legal protection for the use of the terms “counselor”/”counseling” or “therapist”/”therapy” in and of themselves. Meanwhile, terms such as “social work”/”social worker” (see RCW 18.320), “psychologist,” and related titles and terms are protected by law (see RCW 18.83.020). Because of this, no explicit distinction has been made in law or regulation, that I am aware of, distinguishing “counseling” or “therapy.”

Rather, the scope of practice for particular credentials is deferred by states to the national bodies that accredit graduate counseling programs and provide guidance for standards of professional practice for mental health professionals with specific credentials (LCSW, LPC, LMHC, LMFT, LCPC, etc.). Examples of these accrediting entities include CACREP, COAMFTE, and the APA. Examples of organizations providing guidance for standards of professional practice include NBCC, NASW, AAMFT, AMHCA, and, again, the APA.

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Beyond that, states treat these varying master’s-level clinical practitioners with legal parity, or equivalence, in scope of practice and legal protection.

In Washington state’s new credentialing law, passed in 2008 and rolled out in 2009, “psychotherapist” and “psychotherapy” were more clearly defined, but let’s be clear that the kind of regulatory accountability provided by these defined uses in the law does not apply to the terms “therapy” or “therapists.” I should note that the law also restricts the use of the term “private practice counseling” to sole use by two new categories of unlicensed providers, certified advisors (CA) and certified counselors (CC) (see RCW 18.19.020 and WAC 246-810-010). Can you imagine a law reserving such a term for unlicensed practitioners and placing licensed practitioners in legal limbo for using it?

Further, that 2009 law in and of itself did not explicitly regulate beyond providing new credentialing categories. It did result in executive recommendations in 2011 for scopes of practice, disclosure statements to be provided to people receiving services, and continuing education standards, but these recommendations still have not been translated into regulation (or even a great deal of clarity).

For instance, agency-affiliated counselors (AAC) are credentialed to provide counseling (see RCW 18.19, WAC 246-810), but Washington State Department of Health regulation does not require any academic degree as a minimum educational requirement for this particular credential, so the term “counseling” remains loosely defined and diluted (though not nearly as much as it was in the era of the state’s “registered counselor” credential).

And, whereas some regulatory bodies and insurance companies associate “counseling” with such services as skill-building, coaching, and varying forms of behavioral modification, all I have seen in the language of regulatory code and most insurance coding language are terms such as “skills training,” “psychoeducation,” “rehabilitation,” and the like, and a steering clear of the word “counseling” by itself whenever possible, due to its multitude of uses rendering it nearly descriptively meaningless.

One might think it best, then, to limit the words “counseling” and “counselor” to referring to non-degreed or bachelor’s-level mental health practitioners. Keep in mind, though, that the nature and scope of clinical practice for those credentialed as LPCs (licensed professional counselors), LMHCs (licensed mental health counselors), and LCPCs (licensed clinical professional counselors) has legal parity with master’s-level professions that prefer the terms “therapy” and “therapist” (such as LMFTs, or licensed marriage and family therapists). So while I think it’s fair to say the use of the term “therapy” is more limited, I’d bet LPC, LMHC, and LCPC boards would contend it is unfair to elevate it to a higher educational or professional plane in usage, which may result in viewing such clinicians as less qualified or as providing a less specialized treatment service than, for instance, LMFTs.

While it’s true that there are not, similarly, examples of bachelor’s-level clinicians who are credentialed under the terms “therapy” or “therapist,” it seems to me the terms are used so interchangeably as to be nearly synonymous from a regulatory perspective. Ultimately, I think calling a treatment service “psychotherapy” or “therapy” versus “counseling” has less to do with the methodology used or, in most cases, diagnoses rendered and more to do with permissions related to an as-yet-insufficiently defined scope of practice.

The terms “therapist” and “counselor” are often used interchangeably but are also sometimes used to highlight level of education or credentialing. A credentialed therapist may have had more extensive training and be more broadly credentialed. A counselor may not be credentialed, and may have a bachelor’s degree but no master’s. Of course, a counselor may indeed have a graduate degree and independent license yet simply prefer the words “counselor” and “counseling” to “therapist” and “therapy.”

For these reasons, I do not think there is a necessary distinction between “counseling” and “therapy” unless clear direction is provided for their usage by a local governing entity or other regulatory body that makes it so. Still, some are adamant that “therapy” is the realm of clinicians with a master’s-level education and above, while “counseling” is the realm of clinicians with a bachelor’s or below.

In many places, authorization to diagnose sets apart master’s- and doctoral-level clinicians from bachelor’s-level clinicians, although within the community mental health system in Washington, a master’s degree alone is insufficient for diagnosis. According to Washington state’s Access to Care Standards (2015) for Medicaid enrollees, one must also meet the state’s legal definition of MHP, or mental health professional (WAC 388-865-0150). Nearly every linguistic distinction and practice limitation has been forged into regulation in order to provide consumer protections requiring that practitioners practice reasonably within their scope of education and training.

The terms “therapist” and “counselor” are often used interchangeably but are also sometimes used to highlight level of education or credentialing. A credentialed therapist may have had more extensive training and be more broadly credentialed. A counselor may not be credentialed, and may have a bachelor’s degree but no master’s. Of course, a counselor may indeed have a graduate degree and independent license yet simply prefer the words “counselor” and “counseling” to “therapist” and “therapy.”

If you have any questions about a practitioner’s level of education, credentials, or experience, ask them. When I was in private practice, I periodically received phone calls to consult about the nature of the services I provided as well as to inquire about my background and qualifications. I was grateful for these opportunities to provide people with helpful information ensuring that if they did choose to see me, for counseling or for therapy, they would do so with eyes wide open.

A few questions: Do you differentiate between “counseling” and “therapy”? Does your state? Especially if you’re a master’s-level practitioner, do you value one term over the other? Please share your thoughts below.

References:

1. Revised Code of Washington 18.19.
2. Revised Code of Washington 18.83.
3. Revised Code of Washington 18.320.
4. Second Substitute House Bill 2674, 2008. 60^th Legislature, State of Washington.
5. State of Washington (January 2015, revised September 2015). State of Washington access to care standards for regional support networks/behavioral health organizations.
6. Washington Administrative Code 246-810.
7. Washington Administrative Code 388-865.

A colleague of mine, a psychiatric nurse, was working alongside a psychiatrist who would often be insistent about his intention to change a patient’s medication regimen before they even had an opportunity to see the patient together. She recalled that on one such occasion, she boldly interrupted the psychiatrist as he reported his clinical perspective and intentions. “No, doctor,” she urged. “Just because he’s had an increase in psychotic symptoms does not mean we need to increase his risperidone. He’s been on meth all week. We need to prioritize getting him off of the drugs he’s been using before we start changing his meds!”

The psychiatrist hadn’t seen the bigger picture, had been operating with a kind of clinical tunnel vision out of habit, and her boldness to voice her perspective broadened his, ultimately increasing the quality of the care for the patient. The doctor, for his part, was responsive and did not change the patient’s medication regimen as he had intended.

What Does It Look Like to Promote a Collaborative Care Environment?

Collaborative care involves the sharing of perspective, not necessarily an agreement of perspective. While collaboration in treatment between a nurse and a psychiatrist may in some ways look different than that between a psychotherapist and a psychiatrist, the spirit of the collaboration is necessarily the same—that in our work with people, we naturally and inevitably bring with us our own toolbox of experience, perspective, knowledge, and skills. And to the extent we resign ourselves to treatment in a vacuum, we neglect the person’s treatment, as collaboration is essential, not elective. We each naturally and necessarily engage in our work with people from different angles.

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When the therapist shares the angle of the therapist, the psychiatrist’s perspective widens. When the psychiatrist shares the angle of the psychiatrist, the therapist’s perspective widens.

Think of perspective as standing in a place and looking out over a horizon. As we move about, so changes our available horizon and, thus, our perspective, and yet we are able to take the previously seen horizons with us, aren’t we? In our mind’s eye, in our understanding, we integrate them into our inner map. To acquire a horizon means that one learns to look beyond what is close at hand—not in order to look away from it, but to see it better within a larger whole and in truer proportion.

Therapists, therapeutic case managers, psychologists, psychiatrists, and other mental health clinicians best serve people when they share perspective and responsibility in meeting people’s needs and ensuring therapeutic progress toward established treatment goals.

The horizon of the present is being continually formed, in that, as the philosopher Hans-George Gadamer contended, “we have continually to test our prejudices, and in so doing, adjust our understanding.” This sort of humility is fundamental to good psychotherapeutic and medical treatment.

The purpose of clinical staffing is to aid in service planning, consult on issues of safety and risk, discuss developmental concerns, collaborate on behavior and mental health assessment, address concerning family and social dynamics, consider referral options, and share critical case updates.

Each case presented will typically either qualify as a “consultation” or an “update.” Clinicians usually have only about 15 minutes to staff cases. Here’s how I encourage clinicians to approach clinical staffing and, essentially, all forms of collaborative care:

1. Tell the story (brief): Just as the case record documentation should provide a narrative of services rendered, the introduction of a person in a clinical staffing should similarly provide context. Facilitate talk about engagement in services, home and social dynamics, relevant historical considerations, psychological profile, academic, vocational, and/or behavioral functioning, and recent events that may be relevant to any concern.
2. Identify concerns (robust): Share clear and present concerns. Use clarifying statements, such as, “I am concerned because __________.” Express particular observations, such as, “I have noticed __________.” Ask specific questions, such as, “Why do you think __________?” Strike a tension between curiosity and clarity. If you fail to bring clarity and direction to a consult, time will waste away.
3. Tie services together (summary): It is your responsibility to end discussion about a person by providing specific feedback. Try to summarize any recommendations and clarify the who and what of any follow-up to result from the staffing.

A Caution to All Clinical Professionals

Psychological knowledge and jargon are dangerous, often standing between well-intentioned clinicians and effective mental health treatment. Curiosity always runs the risk of gossip. Clinical case consult groups scattered across our fair land meet frequently and are filled with far too much clutter, too often driven by curiosity rather than care. Jargon and gossip increase tone deafness in clinicians.

We all have our blind spots, and we all get stuck in ruts of routine and habit. And details learned about people’s lives ever tempt therapists, psychiatrists, and the like toward distraction. There is a distinct difference between a personality and a person, a diagnosis and a destiny. It is our responsibility to stir hope and catalyze strengths rather than to stew history and analyze at length.

Effective mental health treatment should always aim to treat the person—the whole person. A collaborative mental health treatment approach should enhance communication of relevant evaluative and ongoing therapeutic feedback, increase clinicians’ adherence to a person’s treatment plan, and reduce risk, frequency of crises, and unnecessary emergency room visits and inpatient stays.

It is important for all mental health providers to be well connected to and collaboratively engaged with multidisciplinary networks to ensure the most effective and integrated treatment that can occur does occur. Therapists, therapeutic case managers, psychologists, psychiatrists, and other mental health clinicians best serve people when they share perspective and responsibility in meeting people’s needs and ensuring therapeutic progress toward established treatment goals.

During healthy development, children learn that the people around them are mostly safe and trustworthy. Even when they do not get what they want, they eventually learn to self-soothe in many ways as they grow. They may try persuasion or defiance to get what they want or avoid what they do not want, but ultimately they learn that being respectful and cooperative maintains stability. Because the average child’s brain is not easily triggered to extremes, they typically find ways to self-soothe, delay gratification, and self-regulate their emotions.

Either due to traumatic experiences—including abuse or extreme neglect—or developmental anomalies, some kids have intense fight, flight, or freeze responses and little ability to self-soothe. Chronic volatility in family relationships can also set this pattern into motion. Developmental neurobiologist Daniel Siegel (2003) wrote, “The mind develops as the brain responds to ongoing experience.” Problem behavior is a manifestation of well-worn neural and cognitive pathways that translate into reflexive emotional, cognitive, and behavior patterns.

We must learn to detour kids’ domino-effect reactions, which so frequently emanate from underlying fear or shame. Matthew Selekman (1993) wrote that change arises “out of the breaking of patterns, both of thought and action, the interruption of repeating sequences.” Many adults perpetuate volatile cycles of emotion, thought, and behavior unintentionally by interacting with children in ways that trigger further volatility.

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Navigating out of these ruts requires self-control, empathy, and creativity. Explosive and withdrawn behaviors are typically adaptive responses, arising out of needs to be liked, valued, and respected, needs to have some sense of predictability and control, needs to heighten or lessen sensory stimulation, or all of the above. When behaviors are confronted through criticism or control, a defensive neurophysiological response perpetuates the vicious cycle through an emotional display on the outside of feelings being felt on the inside.

Development is a train choo-choo-ing along. When the Polar Express slid out of control on a lake of ice, it took courage, creativity, and collaboration to aim it back onto its tracks. It is important to maintain firm guidance alongside unconditional acceptance, as well as to discern that fine line between what is vital and what is negotiable. Consequently, the need to become defensive and act out may diminish over time if the child finds that it is not needed anymore to be heard or to feel loved.

I describe therapeutic connection in the acronym ATM, in which “A” stands for accommodation, “T” for tracking, and “M” for mirroring. We maximize opportunities for connection when we accommodate our use of words to those used by another, track and intentionally relate with the stories they tell, and mirror body language to the extent that it sends the message, “There is no need for defense. I’m here with you, and I care about you. I’m trying the best I can to know you.” This is part of the way we invest into the relationship account, and when the time comes for withdrawal, those who have done so won’t go for broke.

It is important to maintain firm guidance alongside unconditional acceptance, as well as to discern that fine line between what is vital and what is negotiable.

Children who are withdrawn often need greater affirmation of their strengths and efforts. Mark Twain once wrote, “I can live for two months on a good compliment.” When someone approves of some part of who we are, it is as if that part of us becomes illumined. The need for approval can be compulsive, but just about anything can be. The truth is that we benefit from that sort of love in our lives. We grow better in the light.

Discipline should aim to teach and to train a child. We must not fail to teach facts and skills, for they are pixels in the resolution of a bigger picture. Yet, insight also has its limitations. I believe that there are few better ways to teach or train a child than to immerse him or her in the best experiences that life has to offer: fun, silliness, art, creativity, exercise, work, rest, food, adventure, and relationship—not necessarily in that order. I call these the parenting disciplines. Shared moments equal shared lives.

Children who are explosive may engage easily in power struggles. Before getting hooked in, learn the patterns and try to better anticipate them. Proactively communicate about expectations, limits, and consequences so that they are clear, measurable, and enforceable. When a power struggle is beginning, verbalize guidance authoritatively, then stop talking, and maybe even walk away. Become a broken record, if need be, in reinforcing limits. Play good cop/bad cop, and let established rules and limits do the dirty work.

If you accidentally get stuck in a power struggle, catch yourself, confess it, and end it: “Ah, you hooked me, and I just realized it.” It’s OK to change your mind. It’s also OK to be honest about your own internal ambivalence about a decision, yet to be firm in it. We need not hide these tricks up our sleeves.

Also, be sure that you understand the difference between perpetual tugs-of-war and constructive complaints or requests from your child. Be open to negotiating or changing your mind when there is opportunity to be flexible. Diplomacy and adaptability are fundamental life skills for all of us, skills that are gained via modeling and experience, and we would do well to pass them along to our children.

More than anything, it is important to remain calm and cool-headed when facing difficult behavior. The best strategy is to “seek first to understand and then to be understood.” When people are angry, resistant, and anxious, feeling that someone is attempting to hear and understand them can be calming and helpful.

Many children carry with them legitimate anger, fear, sadness, and shame related to predispositions, situations, and experiences largely out of their control. They need someone to love them in spite of ways they reflexively aggress or distance as they negotiate through ambivalent inclinations. At the end of the day, every child wants to be heard, which is just another way of saying understood, and loved, which is just another way of saying known.

There is a child in your life secretly hoping you will hear and love him or her today. Will you?

References:

1. Selekman, M. (1993). Pathways to change: Brief therapy solutions with difficult adolescents. New York: The Guilford Press.
2. Hartzell, M., & Siegel, D. (2003). Parenting from the inside out. New York, NY: Tarcher/Penguin.

As parents, we frequently focus on learning how best to “discipline” our children. Yet I find the greatest challenge in learning how to be, as a parent, disciplined.

Parents must become savvy in the implementation of effective disciplinary strategies that are clear, reasonable, and enforceable, but—more importantly—parents first must test their own discipline as people. Disciplined parenting calls for heightened self-awareness.

Much of the research on parenting styles has studied the ways in which parents are responsive as well as demanding. Responsiveness is about understanding and meeting needs, while demanding-ness is about establishing and enforcing expectations. Skillful parenting in these ways undergirds two fundamental, equally necessary forces in human development: attachment and autonomy.

To the extent we are securely attached, we experience trust and emotional connection which are critical to enhancing our capacity for relating well to others. To the extent we are responsibly autonomous, we are able to self-soothe and engage in independent tasks which are critical to living well in society.

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Parenting challenges such as attention-seeking behaviors and power struggles are nearly always expressions of underlying and unresolved needs functioning toward a child’s development. As parents, we must recognize in facing such behavior that we stand at a crossroads—externally control our children’s behavior or positively influence their intrinsic development?

The American theologian Reinhold Niebuhr became famous for a prayer he often repeated in one form or another: “Lord, grant me the courage to change the things that I can, peace to accept what I cannot, and the wisdom to know the difference.” In the context of parenting, at least, change is about control.

We must learn there are limits to the effectiveness of external control in cultivating the development of our children’s character and resiliency, yet we can provide a great amount of powerful influence.

When kids misbehave, wise parents respond in ways that guide the development of the person hidden underneath the monstrous mood and the impulsive behavior. In other words, we can change the way we respond to our children’s behavior in positive ways that demonstrate greater insight, courage, and skill.

We must understand, for instance, that we cannot purely control our children’s disobedient behavior, refusal to do chores, sneakiness, shyness, moodiness, tantrums, demands, overreactions, unresponsiveness to affections or praise, or unwillingness to participate or connect.

What we can control, however, are the ways in which we establish rules and set limits, link privileges to responsibility, allow space and privacy, show interest and inquire into their lives, provide regular choices, use a calm yet firm voice, give our affections and praise, and plan and spend quality time together.

When kids misbehave, wise parents respond in ways that guide the development of the person hidden underneath the monstrous mood and the impulsive behavior. In other words, we can change the way we respond to our children’s behavior in positive ways that demonstrate greater insight, courage, and skill.

The Couch Potato

Some parents are disengaged from their children’s lives and tend to be emotionally detached, practically uninvolved, and negligent in establishing expectations and guidance. I call these parents “couch potatoes.” They are characterized by unresponsiveness to needs, few demands, and little communication.

There are several ways to traumatize with neglect. Provide food and shelter, if that, but little else. Remain emotionally distant. Be selfish and uncaring. Do not enforce any standards of any kind. Uninvolved parenting practically ensures that a child will fear and sabotage close relationships, experience heightened anxiety, and have significant deficiencies in his or her capacity for empathy and even ethical decision-making.

The Dictator

Some parents are highly demanding of their children but not responsive to their emotional needs. I call them “dictatorial” parents. These parents are generally characterized as more rigid, harsh, and demanding and tend to engage in provocative and punitive forms of discipline.

There are several ways we can make children behave—force, fear, and punishment. Dictatorial tactics serve to overpower a child. These methods may result in the restoration of order and compliance, yet far from nurturing unmet developmental needs, they simply make a child angry, resentful, fearful, and dependent upon force.

The Peer

Some parents are highly responsive to their children’s perceived emotional needs but not very demanding. They are overly responsive to a child’s wants and seldom establish or enforce consistent rules or limits. I call them “peer” parents. Others may characterize them as soft or pathetic in their approach to discipline.

There are several ways we can get children off our backs—whine, appease, avoid. Permissive parents are warm and nurturing with their children, yet may fail to engage in effective guidance. By overvaluing friendliness and undervaluing other aspects and principles, parents may inadvertently reward or reinforce immature or deviant behavior.

The Disciplined Parent

Parents who are highly attuned and responsive to their children’s needs and are also highly demanding of them in guiding them toward maturity and independence are, by necessity, disciplined in their parenting. Disciplined parents are firm but not rigid; they are willing to make an exception when the situation warrants.

Disciplined parenting engages in responsive and restorative discipline that focuses on instilling key values and skills, including self-soothing, delaying gratification, constructive communication, fairness, and citizenship. Disciplined parenting serves to empower a child, focusing on responding to developmental needs (the responsive aspect) and teaching how to make things right after they’ve gone wrong (the restorative aspect).

How would you describe your own approach to parenting and discipline?

The continuum of exposure to domestic violence ranges from chronic arguing and yelling to controlling behaviors, threats, and intimidation, to physical threats, threats of suicide or murder, to threats involving weapons, to serious injuries and fatal assaults. While domestic violence takes many forms, there is always a destructive undercurrent of power and control, with offenders commonly and compulsively grasping for in a surrogate what is lacking within themselves: control.

Any pattern of behaviors in intimate relationships marked by coercive control can be a signal or foreshadowing of abuses. And when children are involved, they are always significantly affected, remaining at risk not only of direct victimization but long-term effects stemming from exposure itself.

The Centers for Disease Control and Prevention have reported that in homes where violence between partners occurs, there is a 45% to 60% chance of co-occurring child abuse, a rate 15 times higher than the average. Even when they are not physically attacked, children witness 68% to 80% of domestic assaults.

With April marking National Child Abuse Prevention Month, these numbers are a sobering reminder of the toll a violent environment takes on kids.

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The circumstances of domestic violence leave caregivers, emotionally and otherwise, unavailable and unresponsive, activating a primal fear in kids beneath and between a host of other raw, complex, and unresolved emotions. The pioneering psychiatrist and researcher Daniel Siegel has written, “The mind develops as the brain responds to ongoing experience. … The pattern of firing of neurons is what gives rise to attention, emotion, and memory.” And what fires together—in a combination of overtly violent exposures and the child’s underlying neurobiological experience—wires together.

The unavoidable attention given, emotions felt, and memories imprinted onto a child’s brain in moments of stress become inextricably linked together and forever taint—or else filter—feelings, beliefs, and choices in relationships and all of life. These children are not merely innocent bystanders. They are victims.

We must better understand the psychological aftermath, which can include fear of harm or abandonment, excessive worry, sadness, or guilt, inability to experience empathy or guilt, habitual lying, low frustration tolerance, emotional distancing, poor judgment, shame about the past, and fear about the future.

The unavoidable attention given, emotions felt, and memories imprinted onto a child’s brain in moments of stress become inextricably linked together and forever taint—or else filter—feelings, beliefs, and choices in relationships and all of life. These children are not merely innocent bystanders. They are victims.

Although they may be unintended victims, living within a climate of chronic emotional volatility and near acute incidents of aggression has a way of searing a neurophysiological muddle—painful and isolating emotions existing alongside ongoing and frequently unmet needs for affection and attachment.

Parents who are themselves batterers are more irritable, less involved in child rearing, more likely to use severe and erratic physical punishment, and less able to distinguish their children’s needs from their own. Both parents, regardless of culpability, risk poor emotional attunement with their children and, consequently, a decreased capacity to recognize stress and danger, protective factors which might increase a child’s resiliency.

Compared with other kids, those who have witnessed domestic violence experience far greater incidence of insomnia, bed wetting, verbal, motor, and cognitive issues, learning difficulties, self-harm, aggressive and antisocial behaviors, depression and anxiety, as well as, most troubling, adult domestic violence, with boys often becoming offenders, victims, or both, and girls more likely to become victims (Brown and Bzostek, 2003).

A growing body of literature has revealed that children who have been exposed to domestic violence are more likely than their peers to experience a wide range of difficulties, from anger, oppositional behavior, and disobedience to fear, low self-worth, and withdrawal to poor sibling, peer, and social relationships. Studies have found evidence of much higher rates of pro-violence attitudes, rigid stereotypical gender beliefs involving male privilege, animal abuse, bullying, assault, property destruction, and substance abuse.

A study by Kilpatrick, Litt, and Williams (1997) concluded that witnessing domestic violence is an experience in and of itself sufficiently intense to precipitate posttraumatic stress in children. The ongoing Adverse Childhood Experiences (ACE) Study led by the CDC has classified exposure to domestic violence as one of several adverse childhood experiences contributing to poor quality of life, premature death, as well as risk factors for many of the most common causes of death in the United States.

In addition to the exposure itself, additional factors influence impact, including the nature of the violence, age of the child, elapsed time since exposure, the child’s gender, and presence of physical or sexual abuse.

Children who witness fewer incidents of violence and experience positive interactions between caregivers may be, for instance, less detrimentally impacted than those exposed to frequent and extreme aggression. Younger children exhibit more concerning levels of psychological distress than older, more developmentally mature, children. Children are typically highly anxious and fearful immediately after witnessing an incident of domestic violence and less observably so as time passes, but of course this should not be assumed to indicate an absence of anxiety or fear. Boys exhibit more externalizing behavior problems such as aggression and acting out, while girls exhibit more internalizing behavior problems such as withdrawal and depression.

It nearly goes without saying that children who are exposed to domestic violence and are also physically or sexually abused are at a higher risk for emotional and psychological problems than those who witness such violence and are not physically or sexually abused.

Thank goodness there are protective factors that reduce the worst impacts, including a child’s literacy and overall intelligence, the extent to which the child is outgoing and socially competent, and whether the child has safe and supportive relationships with at least one influential adult (Carlson, 2000; Edleson, 2011; Hughes, et al., 2001). Those surrounding the most difficult situations have opportunity to inject resiliency through academic, emotional, and social support. We must all grapple with whether there are ways we might more effectively intervene within our families, schools, and communities to instigate help and healing.

References:

1. Brown, B., and Bzostek, S. (2003, August). Violence in the lives of children. Crosscurrents, 1. Bethesda, MD: Child Trends. Retrieved from http://www.childtrends.org/wp-content/uploads/2003/01/2003-15ViolenceChildren.pdf
2. Carlson, B.E. (2000). Children exposed to intimate partner violence: Research findings and implications for intervention. Trauma, Violence, and Abuse, 1 (4), 321-342.
3. Edleson, J. (2011). Emerging responses to children exposed to domestic violence. Harrisburg, PA: VAWnet, a project of the National Resource Center on Domestic Violence/Pennsylvania Coalition Against Domestic Violence. Retrieved from http://www.vawnet.org/Assoc_Files_VAWnet/AR_ChildrensExposure.pdf
4. Hughes, H. M., Graham-Bermann, S. A., and Gruber, G. (2001). Resilience in children exposed to domestic violence. In S. A. Graham-Bermann (Ed.). Domestic violence in the lives of children (pp. 67-90). Washington, DC: American Psychological Association.
5. Kilpatrick, K.L., Litt, M., and Williams, L.M. (1997). Post-traumatic stress disorder in child witness to domestic violence. American Journal of Orthopsychiatry, 67 (4), 639-644.
6. Siegel, D., and Hartzell, M. (2004). Parenting from the inside out: How a deeper self-understanding can help you raise children who thrive. New York, NY: Tarcher.

The absence of fathers in the lives of their children is not uncommon. David Blankenhorn (1995), author of Fatherless America, wrote, “The United States is becoming an increasingly fatherless society. A generation ago, an American child could reasonably expect to grow up with his father. Today, an American child can reasonably expect not to.”

As this phenomenon continued to spiral, the 1990s was a time ripe for hundreds of studies of this trend, which has continued. According to a 2011 U.S. Census Bureau study, 24 million children—about one out of every three—do not live with their biological fathers.

The question as to whether absent can be equated with uninvolved has been posed repeatedly over decades by researchers such as Vicky Phares at the University of South Florida and Valarie King and Paul Amato at Pennsylvania State University. It cannot. And yet a number of studies have indicated that nonresident fathers overwhelmingly tend not to engage in frequent contact with their children.

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A preponderance of studies identify at least nine factors influencing a child’s well-being when they do not live with their father—frequency of contact, age and gender of the child, the father’s economic contribution to the child’s life, the quality of the father’s relationship with the child’s mother, socioeconomic variables, education, the quality of the father’s relationship with the child, and the father’s parenting style. Five additional factors I find to be widely neglected are the presence of an alternative, or surrogate, father figure such as a stepfather, variables related to family history, length of time the father has been absent from the child’s home, and the number and presence of siblings.

Back in the ’90s, Phares found signs of increased self-worth in younger children and boys of any age when visits with fathers were frequent and regular, whereas older children and girls of any age showed signs of lower self-worth when visits were more frequent. In her studies, King (1994a) found little support for the hypothesis that father visitation in and of itself has beneficial effects for child well-being, regardless of age or gender, and expressed concern that in circumstances where there exists abuses in the father-child relationship, visitation may do more harm than good.

Rather, King (1994b) pointed to numerous studies that provided evidence that the payment of child support has beneficial effects on educational achievement as well as behavioral adjustment. Several studies have found a stronger influence from economic contributions than any other factor.

Some have studied the quality of the parental relationship in moderating child behavior. One study hypothesized that a child’s contact with his or her nonresident father would decrease the child’s behavior problems when conflict between the father and mother was low, but increase behavior problems when the interparental conflict was high. Fascinatingly, although the hypothesis was supported among boys from divorced families, no support was found among girls (Amato and Rezac, 1994).

Other studies, however, resulted in positive associations of the quality of the parental relationship and child well-being with both boys and girls. For instance, Amato and Gilbreth (1999) noted “several studies have shown that contact with nonresident fathers following divorce is associated with positive outcomes among children when parents have a cooperative relationship but is associated with negative outcomes when parents have a conflicted relationship.”

Upon examining 63 studies of nonresident fathers and their children’s well-being, Amato and Gilbreth (1999) offered this critique: “Without knowing about the behaviors that transpire between fathers and children during visits, how children feel about these visits, or the context in which these visits occur, it is difficult to make predictions about the effects of contact on specific child outcomes.”

They asserted that healthy father-child relationships enhance resilience: “When children feel loved and cared for by parents, their sense of emotional security is strengthened. Emotional security, in turn, helps children cope with stress and makes them less vulnerable to anxiety and depression.”

Many researchers hypothesized that not only the quality of the relationship but the father’s parenting style held significant influence. Amato and Gilbreth (1999) suggested, “The combination of a high level of support with a moderately high level of noncoercive control reflects authoritative parenting—the parenting style most consistently associated with children’s positive development.”

The extent to which authoritative parenting may positively influence child well-being was illustrated in a study by Young, Miller, Norton, and Hill (1995), who found that “fathers’ intrinsic support—reflected in trust, encouragement, and discussing problems—was positively correlated with children’s life satisfaction, but fathers’ extrinsic support—reflected in going out to dinner, buying things, and seeing movies together—was not related to children’s life satisfaction.”

A substantial body of empirical research has examined implications of a father’s absence on a child’s well-being, indicating evidence to support the following conclusions: (1) contact with a child does not necessarily have positive benefits; (2) economic contributions to a child have positive benefits; (3) interparental cooperation has positive benefits; (4) positive emotional involvement with a child has positive benefits; and (5) an authoritative parenting style has positive benefits.

At the culminating of significant research back in the ’90s, a wonderful national organization took shape, committed to raising awareness of this issue and increasing the number of involved, responsible, and committed fathers in our country. That organization is the National Fatherhood Initiative, which has a host of wonderful resources available on its website.

References:

1. Amato, P.R., and Gilbreth, J.G. (1999, August). Nonresident Fathers and Children’s Well-Being: A Meta-Analysis. Journal of Marriage and the Family, pp. 557-573.
2. Amato, P.R., and Rezac, S. (1994). Contact with nonresident parents, interparental conflict, and children’s behavior. Journal of Family Issues, 15, pp. 191-207.
3. Blankenhorn, D. (1995). Fatherless America: Confronting our most urgent societal problem. New York: Basic Books.
4. King, V. (1994a, March). Nonresident Father Involvement and Child Well-Being: Can Dad’s Make A Difference? Journal of Family Issues, 15 (1), pp. 78-96.
5. King, V. (1994b, November). Variation in the Consequences of Nonresident Father Involvement for Children’s Well-Being. Journal of Marriage and the Family, 56, pp. 963-972.
6. Phares, V. (1993, December). Father Absence, Mother Love, and Other Family Issues That Need to Be Questioned: Comment on Silverstein (1993). Journal of Family Psychology, 7 (3), pp. 293-300.
7. S. Census Bureau (March 2011). Children’s living arrangements and characteristics. Washington D.C.
8. Young, M.H., Miller, B.C., Norton, M.C., and Hill. E.J. (1995). The effect of parental supportive behaviors on life satisfaction of adolescent offspring. Journal of Marriage and the Family, 57, pp. 813-822.

It is the nature of abuse within families to be as behaviorally nuanced and emotionally complex as the individuals involved. Relationship abuses nearly inevitably reveal a life-draining and self-perpetuating dynamic of power and control. It is within this dynamic that abuse is perpetuated.

Abuse may manifest as physical (throwing, shoving, grabbing, blocking pathways, slapping, hitting, scratches, bruises, burns, cuts, wounds, broken bones, fractures, damage to organs, permanent injury, even murder), sexual (suggestive flirtatiousness, propositioning, undesired or inappropriate holding, kissing, fondling of sexual parts, masturbation, oral sex, or any kind of forceful sexual activity), or emotional (neglect, harassment, shaming, threatening, malicious tricks, blackmail, unfair punishments, cruel or degrading tasks, confinement, abandonment).

Abuse may also involve what I call strategic accusation in an attempt to maintain perceived leverage in the context of families and social circles—for instance, communicating to family and friends that the victim has engaged in affairs that have not occurred, or even using the mere threat of spreading such a rumor. There may also be implicit threats, such as, for instance, the open display of weapons. Perpetrators may drive recklessly in order to generate fear and emphasize a position of control.

Financial or what you might call economic abuses may also exist. For instance, many perpetrators maintain individual, or even secret, bank accounts as a way to withhold money. They may also ensure that bills and credit cards be placed under the name of the victim as a measure of self-protection.

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In all of these, the dynamic of abuse commonly takes shape in varying modes of manipulation, intimidation, aggression, and terrorism.

And though we often think of abuse as being inflicted by a perpetrator on a victim, or else between two perpetrators, we must be careful to recognize another disposition, an often secretly performed dynamic of abuse, that is inflicted by an emotionally troubled person onto himself or herself.

Recognizing that those trapped in such dynamics embody varying forms of what psychology has long referred to as sadism and masochism, psychologist David Shapiro (1981) instructed:

Each disposition involves, in its own way, a defensive, usually angry assertion of will; each is driven by a sense of inferiority, shame, or humiliation; each is deeply and self-consciously concerned with relative position, rank, and measure, with superiority and inferiority—but the sadistic person from the superior position, and the masochistic person from the inferior one.

The sadistic impulse occurs when a person dominates others as a way of attempting to gain in a surrogate what they lack within themselves and in life: control. The masochistic impulse occurs when a person grasps for such control through harmful forms of self-soothing.

Eating disorders, cutting, and substance abuse are indicative of a masochistic coping style and often of entrenched emotional dominance or avoidance within a family system.

Child abuse occurs far more commonly than most people realize. The Centers for Disease Control and Prevention began a study in the 1990s that has tracked child abuse and reported that there are more than three million reports made each year involving more than six million children, and that between four and seven children die each day due to abuse or neglect in the United States.

And then there is violence between lovers. Michael Johnson (2006) identified four major types of intimate partner violence—situational couple violence, intimate terrorism, violent resistance, and mutual violent control—and defined them “in terms of the control motives of the violent member[s] of the couple, motives that are identified operationally by patterns of controlling behavior that indicate an attempt to exercise general control over one’s partner.”

Intimate terrorism, which most frequently involves men abusing women, is the most extreme form of domestic violence. Another form of chronic domestic violence is a pattern in which both husband and wife are controlling and physically violent, two intimate terrorists battling for control, what Johnson labeled “mutual violent control.” These types of chronic abuse are products of two quite different evolutionary histories and psychological profiles: “one type broadly sociopathic and violent, the other deeply emotionally dependent on their relationship with their partner” (Skolnick and Skolnick, 2003).

Lipman-Blumen (1984) defined power in relationships as “the process by which individuals gain the ability to impose their will on others.” Abuse is often preceded by a more subtle power dynamic. Newman (1999) noted that early stages of abuse may be primarily emotional and difficult to detect:

For instance, when a husband anticipates his wife’s angry response to his desire for her to do more around the house, he may decide not to voice his concerns in order to avoid conflict. Thus, she has successfully exerted power over him [by preventing him from speaking his mind] without any direct confrontation. Such invisible power is important since it can maintain inequality even in those marriages that appear harmonious and conflict free.

Victims of relationship abuses often enter into therapy in the midst of a dualistic emotional experience—an affectionate emotional bond interlaced with anger, resentment, and fear.

Those who find themselves in therapy are obviously often experiencing painful and isolating feelings and possibly ambiguity of emotions, such as love and anger, which may be felt simultaneously. Unless a therapist is highly empathic, victims may be unwilling to expose themselves. The first tasks in therapy should always be to empathize with the person amid the emotions brought into the therapy room and to ensure an immediate plan for safety should a disclosure of abuse be made.

References:

1. Centers for Disease Control. Adverse Childhood Experiences (ACE) Study. Retrieved from http://www.cdc.gov/violenceprevention/acestudy/index.html.
2. Johnson, M.P. (2006). Conflict and control: Gender symmetry and asymmetry in domestic violence. In Violence Against Women (12) 11, 1003-1018. Thousand Oaks, CA: Sage Publications.
3. Lipman-Blumen, J. (1984). Gender roles and power. Englewood Cliffs, NJ: Prentice-Hall.
4. Newman, D.M. (1999). Sociology of families. Pine Forge Press: Thousand Oaks, CA.
5. Shapiro, D. (1981). Autonomy and rigid character. United States: Basic Books.
6. Skolnick, A. S., and Skolnick, J. H. (2003). Family in transition (12th ed.). Boston: A&B.

Humanistic in nature and concerned with the existential qualities of human relationships, Virginia Satir was considered a founder and leading catalyst in the evolution of experiential family therapies.

Satir’s method revolved around two core elements—family life chronology, in which she sought to understand the developmental patterns of relationships in the family as a basis for change; and family reconstruction, in which she attempted to guide families through a process of engaging positive change using experiential interventions from guided fantasy, guided contemplation, hypnosis, psychodrama, family sculpting, parts parties, and role playing (Gross, 1994; Satir, 1988; Winter and Parker, 1991).

One of Satir’s chief concerns was communication within families. Satir (1988) went as far as to write, “Once a human being has arrived on this earth, communication is the largest single factor determining what kinds of relationships she or he makes with others and what happens to each in the world.”

Satir developed within her model five conceptual styles of communication: placating, blaming, computing, distracting, and congruent communication. In Satir’s conception, placaters act as pleasers and are often self-effacing, blamers act self-righteously and often accuse, computers are emotionally detached and often rigidly intellectual, distracters are unfocused and seemingly unable to relate to what is actually being communicated about or going on in the family, and congruent communicators are expressive, responsible, seem genuine, and articulate themselves clearly and in the appropriate context.

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Satir utilized experiential techniques that allowed families to explore, acknowledge, and modify their own communication patterns in-session. Role plays, family sculpting, and guided contemplation were three prevalent forms of experiential communication therapy used by Satir in her work with families.

In observing a family, Satir centered her focus on family interconnectedness, especially triad units, the relationship emotional system between three members of a family. The mother-father-child triad frequently held the center of her attention, as she believed that it is most powerfully in the crucible of this triadic relationship that children begin to learn about and practice intimacy (Baldwin, 1991).

Satir held four assumptions: (1) All people await the potential of growth and are capable of transformation; (2) people carry all the resources they need for positive growth and development; (3) families are systems wherein everyone and everything impacts and is impacted by everyone and everything else; and (4) the beliefs of counselors are more important than their techniques (Satir and Baldwin, 1983).

Satir was concerned with family members’ uniqueness and potentials, and she was always concerned with their spiritual development as well. Satir (1988) wrote, “I believe [spirituality] is our connection to the universe and is basic to our experience, and therefore is essential to our therapeutic context.”

She challenged behavioral and cybernetic epistemologies, criticizing that, in the effort to change behavior, people’s spirits are often crushed, “crippling the body and dulling the mind.” She saw error in equating the value of a person with the nature of his or her behavior. “Remembering that behavior is something we learn,” she wrote, “… we can simultaneously honor the spirit and foster more positive behavior.”

Satir viewed poor communication as a perpetuator of unhealthy relationships, and she championed more open and congruent communication between and within individuals as a key to increasing awareness, compassion, and connection in families and society (Satir, 1983).

Satir (1986) stated, “[People] use their past to contaminate their present, which in turn creates a future that replicates their past, a stuck place, and often a hopeless quagmire” (changed from past to present tense). She added, “It is the learnings from the past that form the approach to the present. To change the perception and the experience of the present so it can become a steppingstone to a healthier future, I need to somehow introduce ways to stimulate new learnings to take place.”

Satir, unlike her contemporary Carl Whitaker, for instance, was concerned with directly identifying and addressing symptoms. Satir held that symptoms of individuals in families express family pain and that children’s symptoms are related to marital difficulties in which they become triangulated (Luepnitz, 2002).

For Satir, the goal of therapy was essentially to increase self-worth and nurturance within families.

Deborah Luepnitz (2002), a prominent feminist voice in the field, criticized Satir’s theoretical simplicity:

Satir’s fallacy is the fallacy of believing that one can change the world by appealing to principles of therapeutic change alone, ignoring the global political changes that must be understood and grappled with. Satir said in our 1984 interview: “If tomorrow morning, every school, every family, every workplace had a transformation in the middle of the night to love and value themselves and treat others likewise, you know we would transform like that!” [snapping her fingers]. This is hardly a theory of social renewal. It cannot help us understand the extraordinarily complex problems of development in the Third World nations, nor the dismantling of weapon systems, nor the bitter mystery of AIDS. There are reasons that people do not decide in the middle of the night—or by the light of day—to love and work as well as they might … Satir, however, has no theory that will help explain violence or the evil that has broken individuals and entire peoples on the wheel of history. Low self-esteem simply cannot account for the eradication of entire nations.

Luepnitz reasoned that Satir’s concept of “self-esteem” is nothing more than a derivation from ego psychology or else just a crude and imprecise conceptual oversimplification.

Satir’s lack of theoretical clarity and precision cost her equal respect alongside other major family therapy pioneers. Alan Gurman and David Kniskern (1981) chose not to represent Satir’s work in their Handbook of Family Therapy because “no discernible school or therapeutic method has evolved from her contribution.”

Nonetheless, many important family therapy trailblazers who have followed after extol Satir’s inspirational genius. Another distinguished family therapy authority, Lynn Hoffman (1981), attested to “the power of her presence with families” and her “extraordinary and unique contribution” to the field.

References:

1. Baldwin, M. (1991). The triadic concept in the work of Virginia Satir. In B.J. Brothers (Ed.), Virginia Satir: Foundational ideas. Binghamton, NY: Haworth.
2. Gross, S. J. (1994). The process of change: Variations on a theme by Virginia Satir. Journal of Humanistic Psychology, 34 (3), 87-110.
3. Gurman, A., and Kniskern, D. (Eds.) (1981). Handbook of family therapy. New York: Brunner/Mazel.
4. Hoffman, L. (1981). Foundations of family therapy. New York: Basic Books.
5. Luepnitz, D. A. (2002). The family interpreted: Psychoanalysis, feminism, and family therapy. United States: Basic Books.
6. Satir, V. (1983). Conjoint family therapy (3^rd ). Palo Alto: Science and Behavior Books.
7. Satir, V. (1986). Foreword. In W. F. Nerin, Family reconstruction: Long days journey into light (pp. v-xii). New York: W.W. Norton & Company.
8. Satir, V. (1988). The new peoplemaking. Mountain View: Science and Behavior Books.
9. Satir, V., and Baldwin, M. (1983). Satir step by step: A guide to creating change in families. Palo Alto: Science and Behavior Books.
10. Winter, J. E., and Parker, L. R. E. (1991). Enhancing the marital relationship: Virginia Satir’s parts party. In B. J. Brothers (Ed.), Virginia Satir: Foundational ideas. Binghamton, NY: Haworth.

Problems that make their way to family therapy tend to involve self-reinforcing—or circular—dynamics and, as such, are commonly called “vicious cycles” or even “vicious circles.” When people become “stuck in a rut,” so to speak, a problem has morphed into a cycle of cause, effect, and attempted solutions.

In other words, even legitimate attempts to solve a problem seem to somehow perpetuate it.

By the time a person (or couple, or family) enters therapy, they are often aware on some level of the nature of the cycle they are stuck in, and motivated to try something new.

This is therapy’s opportunity.

People thoroughly entrenched in problems have underlying resiliency. Family therapist Carl Whitaker (1989) wrote, “Psychopathology is proof of psychological health. The individual who is distorted in his thinking is essentially carrying on an open war in himself rather than capitulating …”

Effective therapy need not reinvent a person; rather, systemic therapists wrestle with people in their care to stir their own latent creative energies to free themselves from being stuck in their quagmires. It is ultimately always the people in therapy who become free and responsible over their lives, not the therapist.

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Therapeutic experiencing invokes a kind of psychological immune response. In the best of cases, multiple interdependent systems experience simultaneous positive effect. In the course of therapeutic work, I utilize interventions that turn circular tailspin into dialectical liftoff.

I must credit these ideas, broadly, to the pioneering integrative systems theory of Gregory Bateson, to whom many of the founding mothers and fathers of our field owe their inspiration.

Isomorphism

The use of feedback to engage the parallel emotional process.

At every turn, I believe it is my responsibility to circle back around to mindful reflection of my therapeutic interaction with people. I tell them about my experience of them—what I have felt, wondered, observed, and thought, including my evolving hypotheses.

I sometimes go to great lengths to understand and cajole them to understand some of the basic relational dynamics taking place between us in therapy to stir perspective outside the therapy room.

Isomorphism as intervention is about intentionality as a therapist in cultivating emotional-relational transparency oriented toward therapeutic intimacy.

When built on openness, respect, and curiosity—and while maintaining a practice of accountability with people in therapy—engaging at this level has the potential to infuse transformative power into the therapy process.

Circumnavigation

The use of evaluative assessment to gain contextual perspective.

Recently the Rosetta space probe arrived at its destination after a 10-year journey of more than 600 million miles through our galaxy. When it arrived, it spent months carefully orbiting around comet 67P, aka Churyumov-Gerasimenko, in order to study it from afar. Rosetta first had to get a sense of the shapeliness of the mass, understand a bit of its terrain, and strategize where best to send its lander.

Philae, the landing module that Rosetta had brought along, eventually made its careful descent to the comet. Unfortunately, despite careful planning, the lander bounced at least twice after landing on the surface, and when it landed, it was in a shadow, near the bottom of a towering ridge, unable to absorb the sunlight necessary for its own battery and the continuity of the mission.

After the mishap, scientists reassessed that the unthinkable position of the lander may have a serendipitous upside—as the comet nears the sun, the lander may find itself exposed to the beams of sun necessary to charge itself yet remain shielded enough to carry on for much longer than planned.

As we survey territory, I must be skilled enough to avoid major obstacles, and we must be joined well enough together to traverse through pummeling, disorienting space dust in order, ultimately, for people in therapy to gain an awesome, sometimes catalyzing, perspective of larger processes governing their lives. And we must roll with resistance in the process, reframing stumbles as opportunities.

Oh, and just in case it crossed your mind—yes, assessment is intervention!

Abduction

Analyzing perceptual alongside communicative patterns in order to disentangle them.

Bateson (1979) described how people become stuck in their own rigidity—how, for instance, presupposed ideas are supported by a social system which conversely supports the presupposed ideas because the social system itself is a vast recursion full of individuals with presupposed ideas.

The proverbial “chicken or the egg” really cannot do justice at this level of complexity.

Bateson commonly called abduction “the double description,” and he by this referred to extrapolating patterns of mental processes alongside patterns of adaptive processes. It is fascinating to consider—all forms of communication truly are adaptive; and perception is nearly inextricably tied into it.

We must move far beyond learning as insight-comprehension to a kind of learning-while-learning, with, for instance, communicative shifts occurring simultaneously alongside perceptual shifts and each reinforcing the other—Bateson (1972) called this “deutero-learning” or “Learning II.”

As people in therapy grasp shared aspects of the perceptual and communicative processes within themselves and their families, the possibility increases that as they decode interrelationships, they will learn to disembody the problem transfixed within them. In other words, they may learn increasingly to dissociate themselves in some way from their problem and thereby become disentangled from it.

Bateson (1977) once wrote, “As you become aware that you are doing it, you become in a curious way much closer to the world around you,” and this is its therapeutic power. This, Bateson (1991) argued, is because “meaning is not internal. It is between parts.”

Recapitulation

Practicing the problem in order to demystify and rend it less powerful.

Once people in therapy have come to experience a problem differently in-session, they will come to experience it differently in life. Experience will beget experience, as it nearly always does.

And so I find it of the highest necessity that the people I work with in therapy bring their problem(s) into therapy. This may seem to be stating the obvious. What I mean, though, is that for our therapeutic relationship to affect change in the lives of the people I help, we must somehow experience the problem together in vivo.

When people are tempted to go on recursively explaining problems, I let them know they can choose between carrying on, remaining in the safe position of knowing what they know already, or experientially exploring with me aspects of presence, emotion, or communication to risk gaining what they may have never known.

Summoning the spirit of the problem may necessarily come of its own accord, as its cajoling may constitute an ethical breach for the therapist, depending on the nature of the problem. Nonetheless, nearly inevitably, and often in the midst of a presumed period of improvement, the therapy room becomes proving ground.

Evocation

The spontaneous and creative stirring of images and feelings to energize positive changes.

When the positive end of one magnet is placed against the negative end of another, an invisible force pulls them together. Likewise, when the magnet’s positive end is placed against the positive end of another, they repel one another. Two pieces of uncharged metal neither attract nor repel.

There is magnetism in the emotional systems of families and, to greater or lesser degrees, between every family member. The force between two is skewed by an intervening third, and so on.

The challenge of therapy is of how to work therapeutically with processes that bind and unbind, generating flexibility and instilling resilience. To grow, people must experience freedom within the felt pushes and pulls of powerful self-perpetuating forces in which problems—and families—maintain themselves.

Bateson (1972) himself suggested that painting, poetry, music, dance, and other metaphoric art forms serve as a bridge between the conscious and the unconscious, a way of communicating outwardly what dwells inwardly, abductively and evocatively affording us opportunities to enter into the relationships they express.

Whitaker (1989) taught us that what is therapeutic is not necessarily the experience itself but the meaning the person in therapy attaches to it. Quite so, if the person is to change, then transformative experiencing must occur. Success is quantum leap from one state—or state of meaning—to another.

And who but the therapist must invoke it?

(Incidentally, these modes of intervention spell “I CARE.” You can credit the acronym to me.)

References:

1. Bateson, G. (1972). Steps to an ecology of mind. Chicago: University of Chicago Press.
2. Bateson, G. (1977). Afterword. In J. Brockman (Ed.). About Bateson: Essays on Gregory Bateson (pp. 235-247). New York: E. P. Dutton.
3. Bateson, G. (1979). Mind and nature: A necessary unity. New York: Bantam.
4. Bateson, G. (1991-published posthumously). A sacred unity: Further steps to an ecology of mind. New York: Harper/Collins.
5. Whitaker, C., and Ryan, M. (1989). Midnight musings of a family therapist. New York: Norton.