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Blog 2017-12-07T22:30:59+00:00

CHARLIE’S DBT BLOG

7. Love and Family

His Holiness the Dalai Lama gave a public lecture in our little town, Northampton, Massachusetts. When he invited questions from the audience, he was asked if he had any advice for raising children.

“Raise children? Me? I’m afraid I have no experience.”

He laughed his sweet Dalai Lama laugh at the thought of being considered an expert on raising children, reminding the audience of his celibacy vows.

“Maybe I will go away from here and have children and raise them so that I can answer your question.”

He went on after a pause:

“But I do know something about raising children, because I was a child and I was raised by my parents. And I learned that the most important thing is to love the child no matter what. The child needs to feel loved.”

We might expand on this to say that everyone needs love.

But what do we do if the love in our family, or in the families with which we work as therapists, has for all practical purposes been extinguished, replaced by acrimony, disengagement, mutual disrespect and invalidation? Given how important it is, how do we access or catalyze love among them? We can think of it as the glue that holds things together through thick and thin. Without it things deteriorate, things fly apart, things can become quite ugly. I once worked with a single father and his two sons, ages 13 and 15. During the previous year, the mother had died at the end of a prolonged illness. The father wanted to have family therapy to address the level of tension and conflict among the three of them. Both boys had essentially retreated since their mother died, staying in their rooms, playing videogames, using social media to stay in touch with friends, decisively objecting to any efforts the father made to engage with them or to bring them together with each other. The only way the father got them to family therapy was through blackmail—he threatened to stop giving the rides to their friends’ houses if they refused, not a great way to begin but from his point of view, the only way.

In sessions the boys were silent to the extreme, resisting my efforts to converse with them, attacking the father if he tried to get them to talk. The only words they uttered at the start were in response to something the father said, in which case they would attack his credibility and intentions.

“He acts that way here, but if you saw him at home all you would see is that he yells at us, and goes out to meet girl friends. He doesn’t care about us!”

If one of the boys were to paint himself in a positive light the other one would accuse him of being a liar, or worse than that a goody-goody. Mutual invalidation was the default position, and invalidation flew in every direction including at me. If I validated any one of them, one or both of the others would invalidate my validation. It was bleak.

I met individually with each of them to establish some rapport and to get some history. The picture that emerged was of a family in which there was a good deal of love, affection, activity, laughter, and mutual engagement, all of which died as the mother became terribly sick, until her death. She had been the connector in the center between the three males, and now the connection was gone. The father was searching for a way to rekindle the connections and the love among them. His failures in doing were burning him out, which showed in his frustration toward the boys.

Within my family of origin I had three brothers and a sister. I had personal experiences with the male-male connection, and a lot of pained feeling about it. And my wife and I had two sons and no daughters. In our family, disconnection between the boys, and between the boys and myself, often caused me distress. So the distance, the hurt, and the disappointment among the males in this family in therapy, obscured by acrimony and accusations, was painful to see. Any effort to define and solve a problem was immediately shot down. Any hint of validation, in any direction, was immediately shot down. What was left was tension, heartache, and paralysis. To say that I felt ineffective would be the understatement of the century. In my heart of hearts I was hoping they would quit, as the sessions evoked such hopelessness, helplessness, and eventually irritation in me. In my individual meeting with each of them, I found them to be courteous, interesting, willing to reflect life past, present, and future, and able to accept validation and support. But it all vanished in the group context. It was clear to me that there was hunger for normal exchanges, desires to be understood, but not manifest in the family sessions. Still I could find no way to break through in the sessions by addressing these matters. I couldn’t bring them out.

I shifted my focus away from them, disclosing some of my own pain and disappointment. I explained that when I was 12 years old, and one of my best friends was killed in a freak accident, electrocuted in the presence of his father, I withdrew from life, became bitter, and questioned the point of living. The boys asked detailed questions about him and what happened. It would not have worked if they perceived my personal story as a gimmick to get them to open up. As I recalled the story, I was definitely, emotionally, into it. When I said how much I had missed my friend, day after day, the 13 year old said that he missed his mother every day. The others were silent, as if he had touched a dangerous live wire. Little by little the boys and their father alternated between small but potent doses of talking about her death, and then focusing on conflicts in the house such as curfew, chores, and the use of cell phones after bedtime. Movement was slow but obvious. I wish I could say the outcome was positive. Maybe it was helpful in the long run, but sadly, the therapy ground to halt when the 15 year old suddenly refused to attend any more sessions, and the father insisted that we not continue without his older son. I haven’t heard from them again.

Love in a family takes direct forms: physical and verbal expressions of affection, tuning in to the other’s distress, jumping in to help when help is needed, protecting one another and so on. And it takes indirect forms when things are difficult: biting your tongue when you are dying to scream at someone, taking distance when closeness breeds judgment and contempt, maintaining the mundane details of family life when relationships are fragile, basically holding things together when they are coming apart. Love manifests as concern, more as compassion than passion. Love starts with understanding where the other family member is coming from, and acting accordingly. It is hardest, of course, when other family members are behaving in ways that repel us, alienate or hurt us, and drive us away. Most broadly, love is the life force that motivates us to hang in there, to move toward one another, to work things out, ultimately creating safety and bonds of concern.

When things are coming apart, as was the case with the father and two sons I was treating, so many ordinary strategies don’t work. Identifying a problem, defining it, taking hold of it, and solving it, seems impossible. The trust and willingness isn’t there. Simply listening, reflecting, expressing sympathy and understanding, resonating with distress, seem to go nowhere, and may trigger a downward spiral of invalidation and judgment. As therapists (or as friends to another family), sometimes the best we can do is a holding action, maintaining the status quo for the time being, using trial and error, specifically refraining from doing those things that make things worse. It’s like having arrived deep within a maze, having run into several dead ends, not knowing which way to turn. It is at this point that the DBT therapist turns to the principles and strategies of the dialectical paradigm, the paradigm specializing in patterns of opposition, polarization, isolation and stuckness. It is at this same point, in working with families, that family therapists find ways to contain the conflicts without inflaming them, engage in maneuvers to disrupt the painful family homeostasis without knowing what the outcome will be. The therapist might have people switch places in the room, might use paradox or counterparadox, and might at times come up with off-the-wall interventions. Carl Whitaker, when stuck, used to “fall asleep” in the middle of a session, “wake up with a dream,” share the dream, and move the session in an entirely different direction. It is no accident that DBT’s dialectical paradigm functions in a way similar to these disruptive and creative family therapy strategies, since Linehan admired and studied the work of family therapists when she was working out her ideas about dialectics. Using these ideas with families is different than using them with individuals. We have to center our thinking on the group as a whole rather than as a bunch of disengaged individuals.

More than two decades ago, while attending a course at the Ackerman Family Institute in New York, several of us had the privilege of watching an amazingly skilled family therapist, Olga Silverstein, treat a family from New York’s Orthodox Jewish community. The identified patient was a 15 year-old boy, previously a spirited, ambitious and accomplished student, who had stopped attending school for no obvious reason. He refused to do schoolwork, and at home he was distant and irritated. The parents, having tried every way they could think of to get him to attend school, seemed worn out, defeated by their son’s stubbornness. They brought the son, and his sister, in hopes that Olga could solve the problem and get their son back on track.

From the beginning, she barely even looked at or acknowledged the boy, who looked downward throughout the sessions, or at his rather shy 13 year-old sister. She just spoke with the parents. The tension in the room was high, although Olga’s demeanor was relaxed and open, a stark contrast to their icy stances. As if taking part in a casual conversation, she sympathized with the challenges of parenthood and learned about the parents’ work lives. The father acted as the authority in the family, sitting bolt upright, head up, his arms folded in front of his chest. His wife deferred to him, and he seemed baffled and amazed that he could not get his son back to school, as if his son’s willfulness was a threat to his authority. The mother expressed her worries about her son, but also about her husband since he seemed so distant and angry. Olga wandered her way into an appreciation of each parent, and perhaps of greatest importance, gradually kindled rapport with the father. It seemed that mutual respect grew between them, and even humor at times.

The father’s frustration with the process spilled into the fourth session. Nothing was changing at home, sessions seemed non-productive, the boy was missing school and living mostly in his room. The father insisted that Olga give them advice immediately about how to break the logjam. She caught him by surprise, all of them really, when she responded,

“don’t worry, we’ll get to that, but for now I think we should see what we can do about your depression.”

This was a shock to all of them; they were not accustomed to having someone challenge the father, or even comment on his behavior. The son looked up for the first time, seeming genuinely interested and concerned. The wife looked frightened, anticipating her husband’s response. He seemed insulted:

“what makes you think I’m depressed?”

Olga:

“It’s rather obvious. You never smile, you seem grumpy and irritable, you seem distant and withdrawn from everyone including your wife, and you are filled with pessimism about your highly accomplished son who is taking a little break. You just don’t seem at all happy.”

The father dismissed her comments, saying that to talk about him would be a waste of time.

“I’m fine!”

The session ended on this note.

As the next session began, the mother couldn’t wait to speak. She explained that her husband, for the first time in their marriage, had moved out of the bedroom and into a vacant room in the attic. He was not speaking to her or anyone else. Meanwhile, their son, in a complete reversal, without a word of explanation, had returned to school, was back to doing his homework, and seemed more engaged in his life than he had been in a long time. Olga spoke with the boy, asking him about his studies. His responses were normal and upbeat. She spoke with the shy 13 year-old about her interests. The father sat still, looking down at the floor, emanating tension and disappoval. Olga announced, mid-session, that the kids were no longer needed. She sent them to the waiting room.

Then she inquired into the father’s mood in more detail, and noted that his move to the attic confirmed her impression that he was unhappy with his wife. As his wife quietly wept, he admitted that his love for her had waned many years earlier, maybe beginning around the time the children were born. His wife, as he put it, had abandoned her job as a wife in order to be a mother. He knew that the children needed her, but still he felt he should have come first. He was giving voice to a grudge he had kept to himself since the kids were born. He wondered aloud whether they had had children too soon, indeed whether they should have had children at all. Olga asked them about their relationship with each other before the children were born. The tone became sweeter; it was clear that they both had enjoyed the brief time they had together prior to children. In remembering some of the good times, they seemed more joined. Olga recommended a series of couples sessions to recapture and resume the connection they had in the beginning.

Olga navigated the tensions and the oppositions dialectically—not taking sides but finding wisdom on all sides, letting the process unfold without knowing where it would go, finding balance and freedom by moving in unexpected directions, and keeping things moving even when they seemed to be stuck. It seemed that the locked door between the two parents was unlocked, and for the first time since sessions began they seemed and acted like a couple. There was some kidding and the father smiled now and then.

Per the Dalai Lama, love is at the center; everyone needs it. Per the case examples, love can be extinguished or buried in response to accumulated hurts and disappointment, almost impossible to access. By working with principles and interventions of the dialectical paradigm of DBT to create disequilibrium and movement, new configurations and new elements come into view that open new possibilities. Once the system shifts, the therapist can work with principles and interventions from the more “ordinary” paradigms of acceptance, including mindfulness and validation, and of change, including problem solving. Family members whose lives have been inexplicably interrupted can, if they can get “unhooked” from some paralyzing dynamics, move on with more freedom. Ultimately the family can function as a safe, trustworthy platform for each member, so that he or she can thrive at chosen life goals.

By | January 3rd, 2017|
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