Internalizers Welcome: Share your difficult problems! Winning subscribers will receive free coaching via TIFT. All you have to do is Dare to Share (see below).
We all have difficult cases and doubts. As internalizers we think first of critiquing ourselves. Therapist coaching offers help making sense of what is going on and what choices we might make to deal with challenging problems. Of course you are hesitant to expose the areas where you feel unsure, but I promise full anonymity. We will only publish your description of the problem.
Entries will be chosen for publication on the basis of common interest to the community of therapists. I'm calling it coaching because I can’t ethically tell you what to do, but can discuss universal principles to help you and others decide how to handle difficult problems. Please be sure to disguise any identifying information. Enter by emailing a few descriptive paragraphs to [email protected] with the words "Dare to Share" in the subject line.
Disclaimer: Application of ideas presented here should only be considered in the light of direct examination by qualified clinicians.
Dare to Share
A therapist writes: "The parents referred their 19 year old son, Aidan, because he was put on academic probation in college. He feels the trouble is not him but the parents lack of support. I tried a family meeting to clear the air, but it only got thicker."
Humans are very sensitive to blame, and parents, especially, because they invest so much in their offspring. Blame will quickly obscure the real issue, which is the difficulty both kids and parents encounter as life requires a loosening of child-parent bonds. For the adolescent, there is the additional scariness of building an independent self and life.
Since the real problem is the universal one of growing up, the treatment is different from much of what we do in individual therapy. It is focused on influencing behavior and choices, not so much on untangling unique maladaptive patterns. It is an operation to support a normal, healthy developmental process.
The first job, in general, is to get blame off the table. That is accomplished by helping all parties to be heard, starting with Aiden. It means helping all parties listen to one another without interrupting. The parents will want to “correct” the record, i.e. defend themselves, but that will negate Aiden’s hope of being heard, so it’s best first to establish a space for open communication. Next it helps to have an agreed upon set of facts. Parents who are really insensitive to their child’s needs are also going to be insensitive to seeing how their behavior might have caused trouble. The parents who really try hard will be more open to criticism, even to the point of distracting from the real issue by focusing on their imperfections. After the young person feels thoroughly listened to, it might be useful for the parents also to have a chance to be heard.
Real injury deserves an apology, but often that isn’t possible. On the other hand, there is no way that attempts to repay can make up for past hurt and injury. Trying to do so will only distort the present. The temptation might be to make things easier for the young person, which will more likely undermine readiness to engage with life. The adolescent then becomes passive and waits for parents to somehow fix the situation. Letting go of the desire to make up for the past, there may be things parents can do to provide support or sponsorship, but the main burden (and the reward of having a sense of accomplishment) will need to belong to Aiden.
The real issues
Once blame and compensation are made non-issues, the real problem becomes more visible. At its core, human attachment is very sticky. Detaching is hard for young people and for parents. The Affect Avoidance Framework says that problems arise from avoidance of uncomfortable limbic emotions (the ones we only know about indirectly, and that trigger unhealthy patterns of response). Avoidance doesn’t solve anything. It delays the definitive solution indefinitely and requires a perpetual expenditure of energy. The unnatural, but effective, solution is to face painful emotions, find acceptance, and move forward.
Parents are just as subject to ambivalence about letting go of their precious child. The worst is when their reluctance is unconscious. The result is a confusing mix of overt messages that independence is good, mixed with covert ones discouraging the young person’s drive towards self actualization. Therapists may point out the parents’ ambivalence but need to be aware of the danger that the adolescent’s avoidant side will “throw the therapist under the bus” by sharing our negative comments with parents.
Culture is a big part of the problem. The world has, in recent generations, tried to shield young people from stress. Stress is seen as a villain. It can be when the stress is the kind that arises from problems that have no solution. That leads towards the toxic experience of hopelessness. But maturation is an attainable condition. The stress that is inevitably part of growing is the good kind, leaving a sense of strength and accomplishment. How does one mature? It is simply by behaving in new ways and pushing through the natural fear that accompanies the unknown. When the culture and the family’s ambivalence combine to support avoidance, the wrong side of the young person’s mixed feelings will take on so much strength that we can’t expect much maturation to take place.
Another area where culture interferes with growth is the current overvaluing of diagnosis. Fear of maturation is often manifested as anxiety, OCD, depression, or as a consequence of trauma. Those may be significant factors, but the culture tends to focus on them and make the assumption that they “are the problem.” It’s such a powerful trend that therapists may have to support efforts to address a diagnosis, real or not. Too often the end result is either failure to eliminate symptoms and loss of more time, or success, in which case, the fear then appears in a new form.
The therapist needs an ally
Parents often want us to “fix” their child. We can’t do that, but what does give us some power is our lack of power. If we had authority and power over the young person, we would become like the parents. Then, the young adult’s job would be to become independent from us. Without that authority, we have the ability to influence the adolescent’s decisions without owning them. We are able to leave both the hard work and ownership of the results to the young person. In the opposite direction, when parents make decisions or give heavy advice, they become the owners of the results and the young person doesn’t learn or advance.
Our goal is to influence without taking ownership. Given the strength of the parent-child bond and our lack of authority, it helps greatly to ally ourselves with some part of the system. Sometimes, we can recruit one or both parents as true supporters of the adolescent’s growth. That means leaving the young person to face the challenges that are within their reach while giving them the support needed to succeed with those that are beyond their ability. Of course, the hard part is knowing the difference, an art that is never fully perfected. One other tool of importance is acknowledging the advances the young person makes. Simply noticing is more powerful than praise, as it doesn’t carry the baggage of coming from yet another person in authority.
When the young person is older, like Aiden, it is more likely that they will be ready to take charge of the process and become the ally. Then the work looks and feels more like psychotherapy, except that progress comes from behavior change more than from insight. In this context, insight is mainly for motivation, a tool to help the client overcome limbic fear by doing hard things.
How much is conscious?
Much of the time, the adolescent person will not be aware of their limbic emotion. When the emotion is fear, what young person would admit to being afraid to grow up? What comes to consciousness is not fear, but impulses to do things that diminish the limbic fear. Holding back from challenges is a basic strategy the inner mind uses to avoid those limbic emotions. There are an infinite number of plausible reasons to avoid challenges. In my experience, the most potent anti-growth factor in adolescence is marijuana. Both the chemistry and the “laid back” culture favor avoidance of challenges. When the young person is unable to recognize that limbic fear is driving their choices, next best is to look together at the consequences of self-defeating decisions and actions and compare them to a positive narrative of what happens when one seeks out challenges.
Psychotherapeutic exploration of the sources of limbic fear can sometimes help to replace it with more excitement about life, but much of the fear is completely natural and comes from some combination of genes and the pain of loosening strong attachments and entering new territory. Furthermore, psychotherapeutic exploration carries the danger of becoming one more distraction from taking action.
Where is this headed?
The ultimate goal is adulthood, which I define as “a subjective sense of full ownership of one’s own life.” Today that may be delayed even beyond age 25. Not infrequently, adolescents have a sudden awakening, in which they realize that they really do own their future and begin to invest in it. In other cases, that realization doesn’t happen and they keep muddling along with compromises between holding back and moving forward.
As therapists, we do best when we can identify strengths, success, and realistic, but positive narratives. Trying to influence an adolescent to pursue improvement in areas that may be valuable to someone else, but not to the adolescent, is largely futile. In the end, the adult who emerges will inevitably be shaped and sometimes limited, by what is avoided and by challenges accepted.
Popular culture bombards young people with stories of the few people whose “passion” happens to fall in an area where luck has been waiting to propel them to great success. When the two come together, the results can be spectacular. For the most of us, when passion is there, it is definitely worth identifying and acknowledging so it can lead the charge. On the other hand, when early development is focused on survival many young people don’t have a passion. For example, they might simply aim to “get people to leave me alone.” Family ambitions can also be a deterrent when clumsy beginning attempts to learn are taken as failure and lead to shame. When passion is not available to give direction, it may have to come from more or less randomly trying things out, especially low-hanging fruit that promises feelings of success.
A favorite story is that of Meg Jay, recounted in her excellent book about young adults in their 20s, The Defining Decade. There, she recounts her own story in which a job driving a van for an adolescent treatment facility led ultimately to a PhD.
The therapeutic relationship
Working with young people and their families is all about influence. How can you, the therapist, be a positive influence? The kind of relationship we can build depends on the individuals involved. Some clients are lucky enough to be able to make use of a therapist as their own “mentor.” For others, it is more difficult. Being too pushy will kill the relationship, but being passive will, too. Being open about the goal as well as “tuned in” and “real” is a good formula.
Jeffery Smith MD
Photo credit, Ph M Chung, Unsplash
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