It’s OK being close to your Dad, but you want to be close to your Mum as well.
Dana, the 14-year-old daughter of a married couple, in response to her father reminding her that she can talk to him if she’s troubled by anything. Dana’s response had followed her parents’ account of difficulty in mother-daughter communication, which had been contrasted with her father’s view of his with Dana (Dana can talk to me, giving examples e.g. counselling Dana after her overdue late-arrivals home).
Dana had been referred by her GP because of her behaviour: arguments with her mother, persistently returning home late from evenings with friends, and occasionally skipping school (once brought home by the police after being caught shop-lifting with a friend, and on another because she and her friend had been observed glue-sniffing in a park).
In addition to the presence in the consultation room of her parents, her elder brother Tony (21 years old, a half-brother from their mother’s first marriage) came, during his return home from university; Tony too was worried about her. Their parents had not brought her younger brother (age 8 years old) because they considered “too little” to understand what’s happening, and who also needed to be protected from their worries.
Sitting next to his mother, Tony listened sympathetically to the accounts Dana’s parents gave of their mostly futile attempts to discipline her, her mother rather weary and her husband evidently exasperated. Dana’s father down-played his wife’s concerns about the glue-sniffing (that’s just teenage stuff) but agreed with her that until her behaviour improves she perhaps should be stopped her part-time Saturday job in a toy shop. Her mother nodded in agreement to his aside that perhaps their daughter was getting too close to the owner (the mother of another of her friends).
From any theoretical perspective, the context of Dana’s response was plainly significant, including her complaint of her mother’s unavailability. Equally, so was the manner in which Dana said it, and the impact of that upon each parent.
It’s OK being close to your Dad was said somewhat dismissively, as if to close down her father’s insistent communication, whilst but you want to be close to your Mum as well was addressed to the therapist.
It prompted her mother to look down at her lap, seemingly preoccupied and shaking her head, before agreeing with the therapist that she felt under their daughter’s attack. Tony looked unconvinced, but her remark precipitated her husband’s re-entry. Recovering his evident discomfort at Dana’s remark, he sought to defend his wife from criticism about her availability, with a vigour that suggested to the therapist that in doing so he was perhaps also defending his own position.
These moments from an initial family session will now be briefly explored from each of the five perspectives being brought together in our integrated model. In each case, what each perspective might have already established, what sense might then be made of these few moments, and how each might have followed them up.
McMaster: would explore whether the issue Dana had raised was one that others had recognised was a problem for her, were in agreement with its significance, what discussion had taken place, what if anything had been decided, curious about what family roles were involved, whether and how the issue was linked in to the problems for which they had been referred, before finally using the findings for an enquiry about more general aspects of each (curious about who spots what type of problem in the family, how things get talked about, family roles, and emotional involvement, etc.).
This might be followed on by enquiries about limit setting, adolescent and life cycle issues, and what each parent had brought into the family from their experience of being parented themselves. Some of this could be undertaken by exploring what Dana and Tony knew about their parents’ history, and as the session proceeded the therapist might frequently switch how their curiosity was exercised, both by prompting different family members to respond to what was emerging, and by switching between a searching enquiry (‘can you tell me more about that’ ‘did other people know?’ ‘ what do you think about what you’ve just heard’) and a scan mode of enquiry (‘can we talk about whether that happens in other places/times’ ’are there times when Dana and mum get on/do things together/solve a problem together?’).
Structural: arising within the first twenty minutes, where the unusual family alliances would have become apparent and openly labelled, Dana’s statement would have been regarded as breaking out of her position, perhaps testing the relationship between her parents.
Their response would have been considered an indication that she had touched a raw nerve – Dana evidently fulfilling some triangulated function in her relation with them, where Tony’s acquiescence perhaps constituted unspoken support of his sister. He might then be co-opted to help Dana stick to her message, but perhaps as much to strengthen the weak boundary separating parental and sibling subsystems as any immediate intention to learn more about underlying issues. As underlying issues gradually emerge, the therapist would be watchful to ensure renewed cross-boundary functioning did not occur, if necessary by re-directing questions, blocking manoeuvres, or getting some members to change seats (e.g. moving Tony to sit with Dana, rather than beside his mother).
Once established, being openly curious about how their parents were feeling by directly enquiring of each would be considered to risk weakening their relationship as marital partners (prompting further cross-boundary functioning e.g. by Dana interrupting, etc.). If for various reasons it were important to know how they were feeling, the therapist might undertake this by encouraging them to talk to each-other, which again would strengthen their relationship within the room.
The relative unimportance of assessment might result in this first session being concluded without any detailed knowledge of just how different were the childhood experiences of Linda and Alan. It would be highly unlikely that the circumstances of Linda’s first marriage would have been explored. The short time between Linda’s pregnancy with Dana and the earlier loss of those who brought her up (and why her mother hadn’t) might not have been spoken about – unless family members led the session in that direction.
Psychodynamic: as in all emotionally-focused family work, exploration of feeling would be the predominant approach. For example, asking family members to indicate how one-another were feeling, cross-checking between members as this happened, and from time to time using a particular observation to make a more general enquiry (‘does X ever/always get …?’ ‘whenever Y happens/doesn’t happen/feels lost’, etc.).
The emphasis would be on communication (‘what happens when mum’s feeling down?’ ‘ how people know/do you think other people realise /’ … etc.), with determined attempts to generalise from the concrete examples offered by the family – in terms of not only how much is shared, and how this corresponds to the internal world of particular family members, but also what inter-personal situations of the past are perhaps being re-enacted now.
For example Linda: that feeling of being lost, overwhelmed, which you’re feeling right now, I’m wondering if that also goes back a long way; is that something you recognise from the past, perhaps even before you had Tony or met Alan? Rather than this necessarily arising from an attachment focus, the therapist might be curious having observed something more in the person’s demeanour, or because they had picked up on something they themselves were feeling, recognising its possible salience to the family (because even if its salience was uncertain, family members’ responses could be expected to clarify that).
Social Constructionist: the very different responses, to what the therapist thought had been a wish rather than a complaint, provided an opening to explore the different family stories might be present around closeness and talking.
Can we take a look at what happened back then, when Dana – you said – “It’s OK being close to your Dad, but you want to be close to your Mum as well”. There seemed to be very different ideas about what that meant.
Turning first to Tony, both because had not expressed what he thought, and also because he might be least defended in his response Tony, I’m curious to know what you thought …
As this had occurred within the first twenty minutes, it is likely that issues related to intimacy attachment and trust – which had not emerged before – would begin to be talked about. The therapist would be watchful to ensure their individual stories were allowed to be expressed uncontested, which would be likely to require the therapist to be just as active as a structural family therapist because of the presence of dominant and subordinated discourses.
Stories about closeness (Linda to her grandmother, and to Tony, and Alan to Dana) would be the first to emerge. However, far from simply listening, the approach would require re-focusing and re-directing questions to allow the story of each to be told and explored, finding different ways to model respectful listening and to quietly block interruptions.
Depending upon how active the therapist is, how directive their questions were, and how much time had been allotted for this first meeting, the session might conclude with a shared understanding of what each family member brought from their past, and what in the light of that was important to each now.
The relative unimportance of assessment (in comparison to shared meaning-making) would result in the absence of any other systematic approach to curiosity, so it would be possible for this first session to be concluded without any detailed knowledge of just how different were the childhood experiences of Linda and Alan. It would be unlikely that the circumstances of Linda’s first marriage would have been explored. The short time between Linda’s pregnancy with Dana and the earlier loss of those who brought her up (and why her mother hadn’t) might not have been told – unless family members led the session in that direction.
Constructivist: seeking to explore and build upon positive experiences of closeness within the family, using questions, to construct a new reality of personal competence for each of the family members.
Constructing questions in sequence to build one upon another constructs mental images and associated positive emotional experience to link with individual and family competence. What (asking Dad) pleased you when Dana was close to her mum that time? What difference did this make to you? And what difference did that make to you? What difference did this make to Dana? And what difference did this make to her mum?
Further constructive questions might include asking individuals in the family in detail about their preferred future and building on what they have done so far that works, implicit in each communication from the therapist being the expectation that there is a possibility of a hopeful future and that the family have already achieved some positive outcomes. The more detail, the more the focus is on what a family wants and the more perspectives from which this is explored, the greater the mental imagery of change constructed. One might ask Alan to describe in detail, including his emotional responses, what a preferred future might look like and how this would be experienced by each member of the family, then other significant people outside of the immediate family. More specifically thinking about what the family have done so far that works might include what Alan has noticed Linda doing that has helped the mother-daughter relationship moved a bit closer together and then follow this up with what difference this made? Then linking this with steps achieved already toward their preferred future empowers the family to believe change is within their control and activates and consolidates feelings as well as thoughts of hope.
Constructing best hopes for the therapeutic intervention might also be used here. For example to Dana, how will your friends know that coming to family therapy has not been a waste of time? How would they get to know? What else would they notice? Then moving towards exploring each family member as others see it when at their best consolidates hope and competence further. The therapist’s implicit message, consistently provided throughout communication from this theoretical position is therefore: the family and individual members within the family do have strengths and change toward a hopeful future is possible.
Epigenetics and Neuroscience: arising within the first twenty minutes, a therapist familiar with hypotheses arising from these disciplines would have recognised a possible pattern across three generations of women (a mum with PND whose own mother had left her in her infancy because of unknown factors, and who was now in difficulty with her own teenage daughter’s worrying behaviour, very different it seemed to her relationship with her sons).
The reported difficulties would not be considered congruent with low mood, as Linda evidently regarded herself as no longer depressed (Alan’s attitude toward her was protective – viewing her as vulnerable, not depressed), whilst Dana seemed thoughtful and composed. Nevertheless, that therapist would not discount the possibility of a heritable disposition toward emotional vulnerability, as the mental health and well-being of each maternal grandparent (neither of whom had continued to provide care for Linda and Alan) was uncertain rather than completely unknown.
Furthermore, whatever Dana’s complaint of her mother, Dana herself seemed a feisty young woman who had turned out well through the love and care her father had provided for her. He, like lots of fathers, was evidently finding it hard to let go of his daughter, and his late-night counselling session unlikely to be helpful. Now that Dana’s elder brother was no longer living at home to provide companionship and guidance, her part-time Saturday job and the pleasure she took in the company of the owner of the toy-shop was understandable. Particularly perhaps in the light of her mother’s depression when she was an infant i.e. her recognition of a need for an older woman’s guidance and support during adolescence, which might be further evidence of her resilience (rather than viewed through the lens of problematic attachment).
Nevertheless, the session would not be completed without exploring Dana’s mental state, whether she was subject to low mood, and – if she was – age of first onset and any possible relationship with her menstrual cycle. Any positive findings would prompt a similar enquiry of her mother. The therapist would recognise the opportunity this would provide to cement some common understanding between the two that had not been possible before.
A Formulation that could integrate these for this family
A fuller account of Formulation is provided elsewhere. The formulation provided below has been constructed in language that a systemic therapist, using the integrated collaborative model, might choose to summarise the final understanding of Dana’s difficulties that the therapist and family have reached between them.
It should be noted, that as we describe elsewhere, the formulation would have become gradually established during the course of the session and the different parts of summarised in an ongoing way.
Well thank you for coming today. It’s been a long session but I think we all feel that we’ve made sense of the problems that took you the GP. Tony: I know you’re about to return to University, do you feel that we’ve done a good-enough job today? that you’ll be able to go back to Uni without worrying about them so much? …
I’d like to summarise what we’ve been talking about, and how it fits together. We couldn’t have done that without all of you feeling you could be open, and sharing important things about your family and yourselves. We’ve got a few minutes left, so after I check out whether what I’ll say represents what we’ve agreed, we could spend a couple of minutes talking about where we should go from here. Would that be alright? …
OK. Well, I know we’ve spoken quite a lot about this already. I suppose to start with, the main thing today is how important what each of you’ve brought from the past and what each of you bring now, at a very different time of your lives. And how openly you’ve been able to talk about all this; without that we couldn’t have got to where we are now.
As parents, will Dana be able to make a success of her teenage years like her elder brother. As a family, will the very different experiences within the family of what it takes to become independent be useful. As Dana’s mum and dad, you’ve had very different experiences of growing up, yet both of you have each experienced a lot of loss and uncertainty. Which you’d hoped to make good in becoming a unit.
Linda, growing up without a mum but being looked after well by your grandmother and her sister, returning to them after your first marriage turned out badly (Tony: you’re obviously turned out very different to your dad!), but losing them both so quickly, and so soon before Dana came along. Tony was there for you as you cared for Auntie Isobel after her stroke, Alan – who’d never had a family of his own – was very understanding. But your pregnancy with Dana came too soon after, it was really hard to connect with her as a baby (you wondered if your own mother had the same problem – perhaps she had been depressed too), but Alan was there for you. And he was there for Dana.
So you thought, well maybe Dana’s got enough – at least she’s got her dad. And Alan, you too were relieved to see that this was a help to Linda. It was difficult for Alan to know how to help you otherwise: Linda’s low mood, her loss of the two who brought her up, that was hard to know what to do, how to get close to her. Linda’s close relationship with Tony seemed to do both of them good, and you got to know Tony and respect him – even if that didn’t involve hugs!
So we talked about how you looking after Dana was much more than a responsibility, it was a “gift” that gave you treasured experience of what family attachments can mean, changing her nappies, picking her up if she woke at night, looking after her when she was ill. We haven’t talked, maybe we don’t really know why neither of your mothers was able to do the same, but neither you, Alan, nor your employer, had problems with time-off. He knew how hard-working and reliable you were, which were qualities Linda recognised when she met you.
We then talked about how that both helps and doesn’t always help when kids grow up. I guess Alan’s respect for Tony will be even greater after what Tony said about that.
Alan – Linda hadn’t seen you cry like that, and you knew that Tony wasn’t judging you when you did. Letting go of the apron strings is very hard, it’s been very muddling for both you and for Linda, who wasn’t sure good she could ever be a good mother to Dana. So Dana, when you said “It’s OK being close to your Dad, but you want to be close to your Mum as well” that went to the heart of your whole family’s history, didn’t it? It wasn’t the complaint of a difficult teenager, or an angry one, was it? … She wanted things to be different, all of you do, her behaviour brought you all here, so even though Dana’s the youngest person in this room, in her own way she’s quite wise! … She’s looking pleased at that! You too Linda! I don’t know which way to look but I sense there’s a hug or two coming up from somewhere!
Is that going to be OK, or a bit frightening? … going too fast? yes. Was that OK, admitting that? … OK: so one step at a time? … Would going back to arguing feel easier? or just more familiar?!
So when you get home, what do you think will happen? How do you want this to continue? … And what will you say to the ‘little one’ who you had worried wouldn’t understand? 8 years old – maybe he would understand …