Category: families

Gendered: “girl culture”

One of the recurring themes in my therapy room for my female clients has been the reluctance and even fear of emotional conflict.

We are raised in contemporary social norms to maintain pleasant relationships. Taught as children to “get along” rather than assert ourselves physically or verbally when encountering trouble (as most boys are), we become evermore sensitive to emotional energy in the people around us. While this can become what I call a female superpower, it is an emotional preference with a great shadow side: we are often paralyzed by bullying in our families, at the neighborhood bus stop, on the playground, at sleepovers, anywhere someone with an urgent need to assert their dominance lurks. We easily become victims of other people’s inappropriate power.

Does this feel familiar? it is completely familiar to me. By the time we are deep into dating or full time jobs as young adult women, we have reinforced this emotional bias so many times we can struggle to know what appropriate personal power looks like. A large majority of women never fully heal from this expectation and gendered socialization: they become adept at sending their anger inward at themselves, sideways to those who don’t deserve it, and passively with those who do.

Bad romantic partners, bad family members, bad neighbors and bad bosses all cause enormous stress to those of us raised to not kick up a fuss when we are slighted, injured or even abused. At the far edge of this impulse to be forever pleasing is the extreme automatic adult responses of freeze and dissociation when threatened, enduring trauma or physical or emotional assaults. We have simply never given our bodies and minds the chance to push or fight back when threatened.

To become whole, happier, less anxious and perfectionistic people, we need to grow our toleration of social awkwardness, conflict, distain and stand up for ourselves when we need to do so. The need to be the people who are forever soothing others comes at such an enormous cost to us and to our relationships. No wonder women have such high rates of depression, anxiety, insomnia, body image issues, food addictions and eating disorders, emotional dysregulation and suicide attempts.

Any kind of emotional conflict is the kyrptonite of people pleasers and perfectionists. Time to see that superpower as an incomplete strategy, turn it into wonderful intuition that is BALANCED by the strength of your strong voice, confidence and skills at problem solving. But we must first become unafraid of wading into those turbulent waters. I promise you already know how to ride out that rip tide: speak up, hold on and ride it out.

Does Birth Order Matter?

For generations, family members have noted the differences that naturally arise in children raised in the same family. How is it that John, the first born and only boy, seems to have such different personality characteristics than his younger brother, raised in the same house by the same parents just two years apart? Good question!


Theories of personality abound. You may be familiar with some of the more popular models, often used in work or educational settings. The Myers-Briggs Type Indicator (MBTI), based on the four major personality styles described by Swiss psychoanalyst Carl Jung, is a favorite. The Enneagram, a model developed in religious communities and often used in spiritual direction, and other forms of personal discovery, is another. These are models that seek to describe common types of personalities. Other models, such as the Big Five theory, attempt to describe personalities using the idea of common traits shared by human beings across the world, such as extraversion or neuroticism.


Whichever way makes more sense to you to describe human beings, by types or common traits, we have a collective curiosity about how people become who they are, and how much we can or should adapt ourselves to others and our environment.


How did I get to be the way I am? When my clients ask me this question, I answer this way: our personality is constituted like a recipe, with three primary ingredients. The first main ingredient is our individual nature. We are born with a particular style of personality, inherited from our parents and our larger family system. It’s part of our genetic code, and forms the basis of who we become. Our general sense of the world, our innate optimism or pessimism, our sense of humor; this basic personality is another thing we have inherited.


The second main ingredient of our personality is formed by the way we are cared for by our parents; it’s the nurture part of the recipe. Was our mother well nourished, healthy, and ready to become pregnant? Were our parents free from addiction, major illness or injury? Was our birth relatively normal? Were we welcomed into the world with joy and cared for with love? The way our parents meet our vulnerability, suffering and growing sense of self makes up the great majority of our personality relationship style.


If our parents or primary caregivers have enough sense of self that they can sacrifice and respond to our needs consistently, we learn to trust that others will meet our needs, and that others are trustworthy. We offer ourselves to them, and get care and love in return. In the research done on this concept of emotional attachment, about half of us get just what we need to feel secure. The rest of us learn some combination of security, anxiety and withdrawal to cope with inconsistent parenting.


The third part of our personality is made up of all the unique, individual experience we have in life and what we do with it. It’s the fall you took in second grade from school jungle gym, the trip to the hospital, and the cast that you had to wear through the summer. How did that fall affect you? How did it shape the way you think, feel and respond to the world? What happens, and how you chose to respond, makes up a large part of your personality.


What about birth order? I think it fits in this third “what happens to us” category of personality development. While research is still battling it out whether first born children actually are more independent than their second born siblings, therapists and other social scientists have found a common pattern in family position that seems to fit many families, at least in Western cultures. In general, first born and only children are commonly more self determined and disciplined, having been born into an adult system and most closely associated to adults, even as infants. The second born child is less connected to the adults in the family, and if followed by a third child, may feel a bit lost in their parents’ strong relationship to the first born and emotional focus on the baby of the family. The farther away from the parent system, the more independent and even rebellious that child may become. (Sulloway, 1997) Additionally, the more older siblings a child has, the more accustomed they often become to letting other people lead, and can more easily go “with the flow” than those born first.


Family therapists differ in the amount of importance they place in this theory of birth order, but most will inquire about how a client’s family is constituted, and where in the family their client “fits.” Why it matters at all is that it may help people better understand some of their unconscious preferences for friendships, marriage partners, relationship styles, and even how they may connect to or discipline their own children. It’s all just part of our individual personality recipes.

Sulloway, F. J. (1997) Born to Rebel: Birth Order, Family Dynamics, and Creative Lives. New York: Vintage.

(Originally written for GoodTherapy.org profile/topic expert page)

Reader Response: Dividing Family Loyalties

Many thanks to M who took the time to write me about his experience with family loyalty. Here is his letter, in part:

“I am writing because I have been on the wrong end of this issue. That is, my wife has put the needs of her parents ahead of me and our marriage. We married in 1987. In 1995 we made the fateful decision to move in next door to her parents. Problems stared within a few months of moving in.

When a spouse puts parents (or really, anyone else) as a higher priority ahead of the needs of the marriage and their spouse this is the biggest domino that falls causing a cavalcade of other bad actions and decisions…The anger that is festered, self-doubt, damage to self-esteem causes so many poor decisions from how your money is spent, time and priorities are allocaated, how the children are engaged, infidelities and job effectiveness.

Unlike if this happens with friends or worse, a spouse has an affair, in these cases the offending spouse can make those people disappear from the relationship and the relationship has a chance to heal via distance, deeds and time.

When it is a parent or family member, in my wife’s case she was unwilling to stand up to her parents (mostly her mother) and say my husband comes first. When a spouse does not stand up …the family member takes full advantage of this weakness and manipulates the entire engagement. In my case, this continues to damage the marriage. The relationship with the in-laws only worsens and cannot heal or improve. The constant conflict is beyond exhausting.

You may ask why did I not see this before we got married. We met and married and started our life together 2000 miles away from her hometown. Consequently, I did not have the opportunity to witness this enmeshed relationship prior to 1995.

My wife in 2017 moved in with her mother. And I am now at 60 years old alone, trying to put the pieces of my life together.”

Dividing Family Loyalties When You Marry

There is nothing like bringing home a close friend or partner to shine a spotlight on the unspoken rules by which every family, your family, lived and lives.

Every family that lives with one another for some time develops a set of patterns for emotional engagement that soon feels like the “family rules.” These expectations for behavior may start within a marriage and strengthen their grip as children are brought into the home. Once the children catch on to these patterns, they begin to live by them. Only family members know how that family works, even though no one may have ever spoken these powerful expectations out loud.

Many of these rules are quite helpful, and create a kind of emotional shorthand that members count on. Some rules families frequently live by are: this family lets one another know our whereabouts; this family goes to church/synagogue/mosque; this family values education; this family values friendship, and this family works hard. Others might be less helpful. They might be expressed as: this family avoids conflict; this family never questions mother/father; this family relies on men for money, women for support; this family doesn’t live outside our region; this family keeps secrets, and this family doesn’t trust anyone outside the family.

With these internal rules, members keep the connections of their family relationships, even unhealthy ones, intact. Once we bring another person into close relationship with this family system through marriage, the rules become more obvious; our new partner has no way of knowing or observing these internal rules except by bumping into them. Because they don’t have the years of unconscious training in working within the boundaries of these family expectations, newcomers invariably stir up distress and even conflict by disregarding these rules or even openly disagreeing with them. This is one way newcomers remain permanently on the outside of their partners’ family systems.

This is where the partner, whose family of origin is the one getting stirred up, has to bring his or her best self to the party or he/she will end up offending and damaging the new family and partner. If the rule is “no one can challenge the way Mom behaves,” Mom can run roughshod over the new wife of her son and her son gets caught between his loyalties toward his family of origin and that toward his partner. Because the loyalty to one’s family of origin is older and deeper, chances are that is the one that most easily wins.

In families where emotional connection has never been particularly intense or expected, this kind of division of emotional importance happens automatically. Parents have children, raise them, and expect that once their children marry, the old family changes. The new has come, and everyone has to adjust. In more emotionally intense, enmeshed, or distressed family systems, blending a new spouse and/or grandchildren into the mix may require an our-way-or-the-highway kind of behavior from the newcomer that can make for chronic distress for everyone.

I counsel couples who find themselves in conflict over family rules to think about loyalty as an emotional quality of relationships that can and must be shared unequally. One can be loyal to both one’s family of origin as well as to a new spouse, but the most successful marriages have partners who transfer their primary loyalties to their new partner. Mom or Dad may still be core relationships, but if there is any important conflict, decision, schedule, or issue to decide, the default must move to the spouse and couple.

If you and your partner seem to be in constant conflict over your visits back to visit your parents, your time spent with siblings, or the ever-present sense that you care more about pleasing your parents than you do your spouse, check in with yourself regarding that unequal balance of loyalty. If you feel miserably caught in the middle, it’s time to shift your focus. Unplug some of that urgency from your family of origin and give it to your new partner and children. And, of course, if it’s just not as easy as that for you, consulting with a local marriage and family therapist will help you more easily make that emotional transition.

(Originally written as a post for GoodTherapy.org, April 2013)

What is Structural Family Therapy?

I’m grateful to Sal Minuchin for helping us as family therapists understand, conceptualize and maneuver within the dynamic structures of families: the way that the emotional and legal connections of parents to their children over generations create fluid as well as fixed patterns of hierarchies, loyalties, rules, subsystems, coalitions and boundaries. While we may know these experiences instinctively, his theory gives us a vocabulary, structure and system of talking and thinking about these automatic family features.

I’m particularly glad for the way his ideas give us a way to talk about family power. How are marriages formed? How do parents use their power over children? What does it mean to be a grandparent, a sibling, a twin, a youngest or oldest child? Who creates the family rules? Who breaks them? Of critical importance is the way that this theory helps me to conceptualize children’s emotional dysfunction. I don’t have to think simply in individualistic, intrapersonal terms. I’m free to think, speak and intervene with children’s pain interpersonally by helping their parents better manage their own functioning, power, and relational well-being.

Every time I draw a new genogram, and hear about a conflicted marriage, a stressed child, or cut-off grandparents, and think about rules, power and family structure, I draw upon the core ideas of Minuchin and generations of clinicians after him who have helped us all become students of family structure.

1/2021: Here’s a great detailed look at Structural Family Therapy from a new counseling resource, Choosing Therapy: https://www.choosingtherapy.com/structural-family-therapy/

Sometimes it IS About You

As a family therapist and systems thinker, I view the conflicts and discussions in my therapy office as shared events and problems. We are all connected; what I do effects my spouse, my children and other close relationships, just as what they do effects me.

But there are times when one person’s habits, behaviors, attitudes, or choices are the source of a system’s pain. A problem frequently has a source. And it just might be you.

One of the most pained expressions I hear after couples therapy is the complaint that “therapy is always about me” and never focused on their partner. I hear it most frequently from my male clients. This reflects, I believe, the fact that men don’t often start conflict conversations in their relationships, leaving their women partners to do all that heavy emotional lifting. If their troubled patterns have been going on long enough, and the woman, despite how often she requests help or change, is always doing the complaining, the man is inevitably backed into his corner. Of course he feels that therapy is always about him. Because he has to travel so many emotional miles to catch up to where his partner has been.

In other situations, it may be that addiction is stealing away all the relationship and family stability. Or infidelity and secrets have damaged the sense of safety and closeness. Or one partner’s failure to care for their health, or work life, or family of origin problems weighs the entire family down. While all of these issues have system impacts, it just might be true that therapy, at least as we begin to unwind the issues, may truly feel like it’s All About You.

When Severe Mental Illness Strikes a Loved One

Book Review: “I Am Not Sick, I Don’t Need Help” by Xavier Amador, PhD.  (Vida Press, 2012)

For the last 20 or so years, brain research has helped doctors and therapists understand that the serious mental illnesses of schizophrenia and bipolar disorder are diseases of brain function. During the century before the “Decade of the Brain (the 1990’s)”, these rare and frightening mental diseases were blamed on bad or inadequate mothering (the “schizophrenogenic mother”), thanks to the early theories of Freud and subsequent generations of psychology, puzzling over the cause and treatments of such life-altering and permanent mental illnesses.

In his wonderfully personal and helpful book “I Am Not Sick,” Dr. Amador explains that the primary feature of these severe mental illnesses is the core belief that the sufferer is “not sick.” In medical terms, this disbelief in their illness is called “anosognosia”  (ã-nõ’sog-nõ’sê-ã). Sufferers may be homeless, talking to voices in their head, unable to sleep or put together a clear sentence, believing that aliens have made inroads to their cells, but to these ill brains, the beliefs and thoughts are as real as sunlight and gravity.

If you have ever been in a relationship with a loved one who has become mentally ill and whose illness has this feature of anosognosia, you know that trying to convince them to get to the hospital for treatment or to take their medication is a futile, frustrating, and relationship damaging exercise. But this is how almost everyone attempts to get their loved one’s the help they need to be safe and recover.

In his best-selling book, Amador explains the model of engagement that he has developed over 30 years of living with his older brother, who was a schizophrenic, and working as a professional forensic psychologist and therapist. He walks the reader through this counter-intuitive but effective model that listens, understands and collaborates with the sufferer, who, in the end, must participate in their care in order to get better.

He calls this program “LEAP,” which stands for Listen, Empathize, Agree and Partner. Utilizing the tools familiar to therapists of Client-Centered/Active Listening, Cognitive-Behavioral, and Motivational Interviewing models, Dr. Amador provides tools, examples, and scripts as examples of learning to use this strategy with loved ones who need help.

I read this book as a way to help one of my clients, whose loved one is beginning to demonstrate marked personality changes, delusions and strange behaviors. As we talked about how to be helpful short of calling 911, this book has become a welcome addition to my library and therapeutic models. If you have someone in your life you are seriously worried about and wonder how to help. I urge you to get this book or log onto his website, LeapInstitute.org.

 

Racism and Trauma

For decades, family therapists and other mental health professionals and researchers have believed that trauma in one generation can be expressed in the genetic code and passed as psychological suffering and vulnerability in following generations. This fact has been demonstrated in animal studies for years, but few human trials have followed.

A research team at Mt. Sinai Hospital in New York City, studying the DNA and mental health of survivors of World War II Nazi atrocities and their children, have newly demonstrated genetic changes in the children of these survivors. The Guardian article of August 21, 2015 describes the changes in a specific gene sequence associated with the regulation of stress hormones. What therapists have seen in their practices has begun to be proven in the laboratory: when emotional and mental trauma happens to us in our early life, it can change our genes, and those changes can be passed down to our children.

It helps to explain the increased mental health issues in children of Holocaust survivors, victims of political terror, accidental trauma, severe poverty, famine and the progeny of African slaves in the United States. This “epigenetic inheritance” can linger for generations and effect the culture, as it has done in the Jewish communities around the world after 1945.

The continuing hurt, vulnerability, anger and rage expressed in Native American tribes and African American communities in the United States against the majority white population can be understood as both cry for justice in the present, and a echo of generational trauma that was endured for nearly 300 years on our nation’s shores.

We have a responsibility as a nation to be struggling to heal the racial injustice and majority privilege that still stains our daily interactions. And therapists need to recognize the layers of trauma that their clients of color may bring to their offices, seeking healing for individual pain that may have been generations in the making.

UPDATE: Here is the link to the mouse study with traumatic epigenetic changes in following generations : Nature Neuroscience, Volume 17, Number 1, January 2014:
https://tinyurl.com/y7zblcwe