Sunday, June 19, 2011

How To Land Your Kid In Therapy

By Lori Gottlieb, The Atlantic

If there’s one thing I learned in graduate school, it’s that the poet Philip Larkin was right. (“They fuck you up, your mum and dad, / They may not mean to, but they do.”) At the time, I was a new mom with an infant son, and I’d decided to go back to school for a degree in clinical psychology. With baby on the brain and term papers to write, I couldn’t ignore the barrage of research showing how easy it is to screw up your kids. Of course, everyone knows that growing up with “Mommy Dearest” produces a very different child from one raised by, say, a loving PTA president who has milk and homemade cookies waiting after school. But in that space between Joan Crawford and June Cleaver, where most of us fall, it seemed like a lot could go wrong in the kid-raising department.

As a parent, I wanted to do things right. But what did “right” mean? One look in Barnes & Noble’s parenting section and I was dizzy: child-centered, collaborative, or RIE? Brazelton, Spock, or Sears?

The good news, at least according to Donald Winnicott, the influential English pediatrician and child psychiatrist, was that you didn’t have to be a perfect mother to raise a well-adjusted kid. You just had to be, to use the term Winnicott coined, a “good-enough mother.” I was also relieved to learn that we’d moved beyond the concept of the “schizophrenogenic mother,” who’s solely responsible for making her kid crazy. (The modern literature acknowledges that genetics—not to mention fathers—play a role in determining mental health.) Still, in everything we studied—from John Bowlby’s “attachment theory” to Harry Harlow’s monkeys, who clung desperately to cloth dummies when separated from their mothers—the research was clear: fail to “mirror” your children, or miss their “cues,” or lavish too little affection on them, and a few decades later, if they had the funds and a referral, they would likely end up in one of our psychotherapy offices, on the couch next to a box of tissues, recounting the time Mom did this and Dad didn’t do that, for 50 minutes weekly, sometimes for years.

Our main job as psychotherapists, in fact, was to “re-parent” our patients, to provide a “corrective emotional experience” in which they would unconsciously transfer their early feelings of injury onto us, so we could offer a different response, a more attuned and empathic one than they got in childhood.

At least, that was the theory. Then I started seeing patients.

My first several patients were what you might call textbook. As they shared their histories, I had no trouble making connections between their grievances and their upbringings. But soon I met a patient I’ll call Lizzie. Imagine a bright, attractive 20-something woman with strong friendships, a close family, and a deep sense of emptiness. She had come in, she told me, because she was “just not happy.” And what was so upsetting, she continued, was that she felt she had nothing to be unhappy about. She reported that she had “awesome” parents, two fabulous siblings, supportive friends, an excellent education, a cool job, good health, and a nice apartment. She had no family history of depression or anxiety. So why did she have trouble sleeping at night? Why was she so indecisive, afraid of making a mistake, unable to trust her instincts and stick to her choices? Why did she feel “less amazing” than her parents had always told her she was? Why did she feel “like there’s this hole inside” her? Why did she describe herself as feeling “adrift”?

I was stumped. Where was the distracted father? The critical mother? Where were the abandoning, devaluing, or chaotic caregivers in her life?

As I tried to make sense of this, something surprising began happening: I started getting more patients like her. Sitting on my couch were other adults in their 20s or early 30s who reported that they, too, suffered from depression and anxiety, had difficulty choosing or committing to a satisfying career path, struggled with relationships, and just generally felt a sense of emptiness or lack of purpose—yet they had little to quibble with about Mom or Dad.

Instead, these patients talked about how much they “adored” their parents. Many called their parents their “best friends in the whole world,” and they’d say things like “My parents are always there for me.” Sometimes these same parents would even be funding their psychotherapy (not to mention their rent and car insurance), which left my patients feeling both guilty and utterly confused. After all, their biggest complaint was that they had nothing to complain about!

At first, I’ll admit, I was skeptical of their reports. Childhoods generally aren’t perfect—and if theirs had been, why would these people feel so lost and unsure of themselves? It went against everything I’d learned in my training.

But after working with these patients over time, I came to believe that no florid denial or distortion was going on. They truly did seem to have caring and loving parents, parents who gave them the freedom to “find themselves” and the encouragement to do anything they wanted in life. Parents who had driven carpools, and helped with homework each night, and intervened when there was a bully at school or a birthday invitation not received, and had gotten them tutors when they struggled in math, and music lessons when they expressed an interest in guitar (but let them quit when they lost that interest), and talked through their feelings when they broke the rules, instead of punishing them (“logical consequences” always stood in for punishment). In short, these were parents who had always been “attuned,” as we therapists like to say, and had made sure to guide my patients through any and all trials and tribulations of childhood. As an overwhelmed parent myself, I’d sit in session and secretly wonder how these fabulous parents had done it all.

Until, one day, another question occurred to me: Was it possible these parents had done too much?

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