6. Parent - RonaldMah

Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
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6. Parent

Therapist Resources > Therapy Books > Therapy! What's Therapy?

The therapist-client relationship can be conceptualized as a process of re-parenting.  Parents hold many roles that differentiate over time and development of their children.  Applied to therapy, sometimes the therapist become like a parent managing a growing child or the squabbling of siblings.  While a child may get stuck in some dilemma or siblings may recognize that they cannot reach agreement on their own, or are calling for intervention on one's behalf, parents often abhor the judge role it invokes.  How the parental model is manifested for the therapist may depend on theoretical orientations, or perhaps on his or her family-of-origin experiences, or both.  A key parental task is to create an environment to hold all the energy, needs, exploration, and exploration activities of children.  The physical home and the nurturing, loving, and educative developmental context is set to ensue healthy relationships and growth.  Most theories of therapy advise the therapist about the importance of creating appropriate therapeutic contexts with clients.  Much advice revolves around the therapist developing rapport with clients and setting up appropriate roles and expectations.  The individual client comes to therapy with anxiety and/or depression.  In addition, couples and families often arrive in therapy highly polarized, blaming each other, and deeply wounded from fighting.  They may be increasingly disconnected from each other or almost ready to break up.  Something traumatic may have happened, including possibly affairs or other acts of betrayal having been discovered.  With raw feelings, they may be highly vulnerable and feel and act defensively.  Therapy may become about creating a holding place where clients can calm down, sit and talk, and reasonably expect to be heard.  And, the session becomes a situation where clients are confident that the therapist can control the process for the individual, couple, or family to be safe enough from excessive harm from intrapsychic turmoil, and in the couple or family from each other and their own poor communication and relational skills.  This is often the first goal in couple therapy. Scheinkman (2008) has the following recommendations for creating a holding environment.

1. The therapist positions herself in a balanced way, giving each partner equal time, empathy, and consideration.  She must hold both perspectives, no matter how polarized the couple is.  Couples usually do not come back if the therapist is partial.

2. The therapist may need to actively lead… reassuring the couple that their situation is one she often sees, and that there are ways to resolve it.  She reminds them that the process of change is incremental; it occurs step by step.

3. The therapist may suggest a time-limited period in which the couple will suspend making decisions about their future and instead will review when and how they got off track, and how they might try possible solutions.  This ''review process'' grants the couple time to become less reactive and more reflective.  A 6-week period is helpful, if possible.

4. The therapist may instruct the couple on how to interact in the sessions, as well as between sessions, vis a vis their problems.  In the sessions the therapist may work as ''traffic controller,'' not allowing one partner to interrupt the other or respond automatically in defensive ways.  Outside the sessions she may recommend that they avoid problem-saturated conversations and save them for the therapy instead.  To this end she may ask them to write down their feelings and bring them to the sessions.

5. The therapist needs to acknowledge the strengths of the relationship, celebrating and amplifying the positive steps each partner takes.  This is essential as it invites the couple to consider positive narratives and stimulates them to enter a virtuous cycle…

6. The person of the therapist is a crucial factor in the process of therapy, as our feelings, vulnerabilities, and family of origin dynamics inform the ways that we engage, intervene, and get blocked.  Sometimes it is necessary to obtain personal consultation in order to deal with the interface between our personal issues and those of the couple… (page 200).

While other theories or therapies may have variations, subtractions, or additions from her recommendations, the basic themes of the holding therapeutic environment are similar: for each client and for the couple or family, fairness and respect, reassurance, boundaries, guidance, attention and availability to clients, and from the therapist, wisdom, honesty, responsibility, dedication, and integrity.  The humanistic oriented therapist may emphasize demonstrating care for clients and sharing the humanity of the therapist.  Different therapies may offer clients more fully and deeply interpersonal relationships with the therapist, while others stay in more circumcised roles.   Intense intimacy however can be challenging to therapeutic boundaries.  "Therapists who become overly responsible and pleasing are most likely to experience burnout… therapists at risk for burnout are too emotionally involved with their clients… It is important that therapists take the time to center themselves, become aware of themselves, and to set clear boundaries between themselves and their clients" (Lum, 2002, page 185).  Whether the therapist takes more limited roles versus personal relationships with clients, the therapist's problematic personal experiences may lead them to becoming problematic- perhaps, taking problematic parent roles in therapy.

Vee came from a chaotic painful alcoholic family system.  She was the nurturer who placated, appeased, and pleased everyone in the family.  Anger and conflict meant danger and pain and had to be avoided.  She developed great skills to lovingly stuff conflict.  Although, Vee exists in pain in the relationship, she also frustrates the hell out of her partner Carson by being conflict avoidant yet passive-aggressive.  Sick of not having true engagement or honesty, Carson had become overtly aggressive and hurtful.  Vee and her behavior can be the description, rather than about someone from a dysfunctional family system, but about someone from a historically oppressed community or people.  Therapy can be compromised, if Vee and Carson's therapist comes from a chaotic painful alcoholic system and now has become a "professional" American professional nurturer!  And also a major conflict avoidant agent!  Such a therapist would unconsciously collude with Vee at minimizing issues and avoiding confrontation.  The therapist would dismiss or try to distract Carson when he brought up Vee's passive-aggressive behaviors.  The therapist would discourage Carson's anger as inappropriate.  Such a therapist needs to process, in therapy or in consultation personal co-dependent/pleaser issues and cultural bias against male energy, so that he or she can be present as the professional he or she is supposed to be.

Parents and therapists can best serve both their children and their clients by recalling that the word "discipline" and "disciple" have the same root word.  A disciple learns a healthy and productive way of living through a multitude of experiences facilitated by or from parents or mentors.  Searching, seeking, or confused disciples have sought wisdom, guidance, fulfillment, and inspiration, through the ages from wise men and wise women, shamans, gurus, and other traditional mentors.  A child or disciple is disciplined, and gains discipline to become a healthy and productive community member.  Individuals, couples, and families also need to learn healthy and productive ways of living in therapy.  The good therapist needs to flex and shift therapy to the needs of clients, be it knowledge, values clarification, interventions, or whatever else it takes.  In addition, the therapist interacts so intimately with clients that the therapist often become a parental attachment figure.  As with parenting multiple children, the therapist often bonds with both partners of a couple or several or all family member as an important attachment figure.  The therapist may acquire a parental quality comparable to secure attachment that supports managing the behavior of the individual, couple, or family.  This may be particularly appropriate since attachment issues may be core to the relationship issues for clients.  It is significant that the structure of couple therapy includes routine and regular scheduling.  Estrada and Holmes (1999) are among many that found the "importance clients place upon the routine or structure of therapy" (page 153).  Clients know that there will be a regular opportunity, often weekly at a set day and time to go to therapy and have the therapist help process issues and problems that come up.  This often serves to lower levels of reactivity, frustration, and helplessness that take the individual, couple, or family to greater pain.  "I'm going to ask my therapist about this," or "Let's talk about this in therapy" is analogous to "Let's ask mom or dad."  It is also analogous to children knowing that their nurturing parents are available.  While presenting so may replicate and invoke the parent as the problematic judge role, the therapist can shift the request (as would a wise parent) to a deconstruction of the client's process.  The fact of the therapy schedule becomes an effective strategy to interrupt negative cycles of engagement.

Definitions of what are positive or negative engagements or dynamics may themselves not be universal.  As much of mainstream child development and parenting philosophy and advice may be oriented towards middle-class families and children, therapy may also have implicit expectations revolving around class assumptions.  Freud's first clients were upper-class women.  Modern psychotherapy may have educated middle-class expectations of normative behavior or relationships, while actually serving a wide range of target populations.  Theoretical orientations and subsequent therapies may have implied fit or misfit for lower-class or underclass, working class, middle and upper class individuals, couples, and families as well as immigrant versus first-generation and multi-generation Americans and individuals with other distinct experiences.  As such, the requirement to have theoretical and therapeutic flexibility- or multi-cultural and cross-cultural conceptualization and practice becomes much like parents adapting to address the needs of children of both genders, at different developmental stages, varied temperaments and personalities, with diverse intellectual and other abilities.  What works marvelously with one child may have marginal effect on another.  Direct instructions with clear expectations, boundaries, and consequences may work well with one child, while suggestions and allowance for exploration and experimentation is best for another child.  At earlier developmental levels, being told what is right or wrong and what specifically to do or not do is comforting to children.  As they near and reach adolescence, children are expected to make choices based on internalized principles of right and wrong acquired through experience over time. Working with clients and couples often requires a therapist with theoretical and clinical agility.  For example, Cline et al (1984) has differential guidance for lower-class versus middle-class therapy.  "It… appears that social class is more significant than the sex variable.  Husbands and wives have less in common with their counterparts of the other class than they do with their own… Generally speaking, directive therapy is not related to positive outcomes for the middle-class couple.  Directive therapy with middle-class couples is correlated with increases in negative social behavior, decreases in positive social behavior, and decreases in expression of personal feelings and is correlated negatively with improvement on self report measures of marital satisfaction at posttherapy, 3-month follow-up and 6-month follow-up" (page 701).

Cline et al are in agreement with some other authors in terms of how increases in expression of personal feelings, therapist reflectiveness, and therapist relationship orientation are related to increases in positive social interaction for middle-class men (but not middle-class women).  Therapist rapport with men, who otherwise may feel like foreigners in the feelings world of therapy, facilitates couples therapy.  When the therapist connect feelings and behavior in a logical relationship, communication improves temporarily for women.  If improvement in communication leads to behavior changes, it leads to increases in marital satisfaction for the wives.  "While facilitation of communication changes may have been most important for middle-class husbands, it may have been facilitation of behavioral changes that were most important for the middle-class wife."  While talk is nice, wives appear to look for behavior change.  While greater expression of personal feeling lead to positive gains for middle-class husbands, it was negatively related to marital happiness for lower-class husbands.  This appears to be related to more nonverbal instrumental marital style for men.  Behavior is the key communication: come home at night, pay the bills, don't hit, is nice to in-laws, and so forth.  Such behaviors communicate care, respect, and fidelity.  Attempting to change men's behavior oriented non-verbal communication style to an unfamiliar emotionally expressive verbal style may be experienced as being too critical of them.  Cline et al recommends "the therapist must walk a fine line with the lower-class husband, in which he helps him understand the workings of his marriage without changing the communication style in the marriage."  Helping the lower-class husbands make sense of how communication and behavior choices affect their wives and marriage enables them to decrease their negative social interactions- the men's behavior.  Although, their nonverbal, instrumental marriages continue, the husbands' better understanding and acceptance of why their wives acts "that way" allows them to not be so reactive.  This therapy strategy allows guys to be guys instead of made to be "wrong," which may have been the unintended effect of communication training therapy (page 702-03).  For lower-class wives, like middle-class wives, communication does not seem to be the issue.  The key issue seems to be more instrumental, or about behavior.  Therapists' directiveness and structuring skills are more effective as that directs behavior changes.  Therapists who act as authority figures and directively resolve role conflict issues and feelings behavior are most highly related to long-term marital satisfaction for lower-class wives (page 703).  There can be various hypotheses about why these class and gender differences or cultural nuances seem to exist, but it is clear that the therapist often need to help individuals understand those differences affect their relationships.

3056 Castro Valley Blvd., #82
Castro Valley, CA 94546
Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist, MFT32136
office: (510) 582-5788
fax: (510) 889-6553
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