Most families are complicated and fragile entities. Prone to outbursts, usually entangled and often blinkered around their own defects, they love, hate and tolerate. “But when families become curious about themselves, they are open to change,” says Lorraine Davies-Smith, a systemic psychotherapist.
“Most of us live on autopilot, caught up in simply coping, but if we can stop and consider more deeply what is going on, amazing progress can happen.”
And with the backdrop of Covid-19, most of us could do with a shift in thinking around our own altered family dynamics. Some families have lived apart while longing for connection; others have been forced together and soured by resentment. Whatever the scenario, there can be big consequences.
Often, when people are in pain, they lash out at loved ones and the impact can be devastating. A family therapist can really help. Highly specialised, they focus on the social systems within families, helping members explore how these structures interlink and influence behaviour, and understand the patterns that may be contributing to conflict.
Ragni Whitlock, a family psychotherapist, says: “While we might be experts in our field, we would never claim to be experts on a family’s individual situation. My role is not to tell them what to do but to help them gain insight for themselves. It’s about having an open dialogue to reveal what might be going on.”
In her podcast series, A Living Loss, psychotherapist Julia Samuel says: “Families can love deeply but there can also be a dislocation in communication.” When a safe space is provided and trust in the therapist established, people can feel more comfortable having those difficult conversations.
“We take a non-blaming approach,” adds Whitlock. “If something negative is going on, I am interested in how each member of the family feels about it. I might ask a mum, why do you think your son is sad? Or I might ask the son, what do you think your mum would say about your sadness? I act as the facilitator, which not only gives each member a chance to speak, but they also get to hear the perspective of others.”
Julia Matthews, a family and systemic psychotherapist, adds: “When one person shares their story, the others take on an audience position and are able to listen deeply. It’s completely different to sitting around the dinner table at home, where someone might be disregarded, or tempers may flare. Often, as therapists, we are dealing with highly emotive issues.
It could be a revelation that someone feels they can’t say or another member can’t bear to hear; families then live in denial or secrecy. It’s important to manage those big emotions and encourage each person to address their situation in a safe and calm manner. It takes real bravery to say something difficult out loud, but simply voicing can create powerful positive change.”
There is no magic wand. Embedded behaviour can be difficult to shift, and most of the hard work needs to be done by the families themselves. Yet Whitlock believes even the smallest changes can have an ongoing positive effect. “I think about Gregory Bateson, an anthropologist who wrote a book in the early 1970s called Steps to an Ecology of Mind. He talked about a ‘difference that makes a difference’.
With my clients, it might be the slightest difference in their conduct, understanding or mindset, but it ends up being hugely significant to the family’s overall happiness. That’s a successful outcome.”
Maybe the difference that happens today is finding the courage to schedule that first appointment at the therapist’s practice. You never know, it could change your family’s future for the better.
"For the first time, we felt understood. There wasn’t any judgment of our situation"
For the past three years, Chris and Louise have been managing a complex situation with their daughter, Lucy, nine.
Lucy was in her second year of primary school when her parents first noticed a distinct change in her behaviour. Evidence of obsessive compulsive disorder and specific copying of her elder sister, Stacey, became a daily occurrence.
“Things like she wouldn’t leave the house without taking a load of her teddies with her,” says Louise. “Certain things had to be in a particular position or she’d have a meltdown, and she’d mirror her sister’s actions constantly – if Stacey brushed her hair or ate her dinner, Lucy would do exactly the same.”
Looking back, the couple now find it hard to believe that for more than a year they existed in this dysfunctional bubble, barely managing through the days when Lucy would scream at the slightest thing and lash out at her parents when they told her what to do. They later discovered that Lucy had been bullied at school by an older girl, and this may have been the catalyst for her behaviour.
Then as Covid hit and the family moved into lockdown, their situation accelerated. “During the worst periods, we were living in a state of high tension. We talked about Lucy every hour of the day, she ruled the house and her tantrums could kick off at any time,” says Chris.
“She particularly picked on Stacey, biting and kicking her; and she seemed to hate Louise. Obviously, Lucy was too young to articulate her feelings, but this only caused us more frustration and anguish. We literally didn’t know what to do. I’d sometimes lose my temper and put her in her bedroom as a punishment, but she’d go crazy, smashing her room to pieces. It was a living hell.”
With Louise on the verge of a breakdown, the local NHS CAMHS asked its family therapist, Ragni Whitlock, to see the couple. “Because Lucy was too young to manage therapy, my focus was on supporting the parents,” says Whitlock.
“I explained that Lucy’s OCD tendencies were telling us that she was highly anxious. If Louise and Chris could work together to stay calm and in control, they modelled to Lucy how to cope better. Plus, if parents are a strong team, it makes it harder for a child to divide and rule.”
Initially, small steps were put in place to keep Lucy’s behaviour in check. Whitlock suggested the parents talk to Lucy about her conduct when she was more relaxed and to set expectations for the future – for example, to “make an announcement” that her dominating approach was not going to happen any more.
“This tells the child that parents are the ones who decide how the situation might play out,” says Whitlock. “Of course, this may not be accepted at first, but therapy helps the parents to feel deeply supported as they instigate change. My aim is to ultimately empower the whole family to work together as a team.”
Chris says the family will be forever indebted to the therapy. “For the first time, we felt understood. There wasn’t any judgment of our situation, and after years of feeling like the worst parents, we have been given hope. Lucy still has her OCD rituals, but she is learning how to manage better, and we have developed coping strategies, too.”
The family have recently cut their therapy sessions down to once a month, and there is a plan for Lucy to start attending now she is older. A successful holiday in Scotland a couple of months ago encouraged Louise to believe that “I have my loving daughter back”.
"With a therapist’s help, we were able to discuss that he was using alcohol to anaesthetise his pain.”
After Fearne’s marriage to Jacob ended, their 18-year-old son, Callum, turned to alcohol.
One Saturday afternoon, Fearne had a phone call from a friend of her son Callum, asking if she could pick them up from a nearby park. The friend told her Callum couldn’t walk. “When I got there, I could see Callum was paralytic,” she recalls. “We piled him into the car; he could barely talk, let alone realise I was even there.”
Fearne knew her son had been drinking heavily for about six months. His moods were dark and although he had a part-time job in a café, he often missed his shifts because he couldn’t get up. The situation had escalated after his father, Jacob, moved out of the family home when the marriage ended.
“Callum was obviously heartbroken about the situation but he just wouldn’t talk to me about it,” says Fearne. “My break-up with Jacob was bitter and aggressive. We argued constantly and the atmosphere at that time was toxic. But Callum adored his dad and was devastated by his absence. His misery turned to anger, and he started blaming us for wrecking his life.”
Because the couple’s relationship was so acrimonious, discussion around how to support Callum became a bitter battle of wills. It wasn’t until Fearne’s best friend suggested a family therapist that something positive seemed possible.
“Jacob and I attended the first couple of sessions without Callum,” says Fearne. “It wasn’t easy. I was still furious with him and had little respect for his opinion. But it soon became apparent that if we wanted to help Callum we had to put our differences aside.
The therapist encouraged us to see the situation from our son’s point of view and understand that every time we tried to hurt each other we were also damaging Callum. She helped us to listen more attentively to each other and without judgement. For the first time in years, we spoke about sensitive subjects without that familiar resentment.”
Fearne says that when Callum was brought into the sessions, the emotional barometer rocketed. At first he sat in silence, then he raged about their selfishness and once stormed out of the therapy room.
“I didn’t think he’d keep coming back, but he did, and then one day he broke down crying. He said that all he wanted was for us to be a family again. And, worse, that it was his fault we weren’t getting on because he’d been so difficult to handle. It was such a sharp wake-up call for me. I realised that whatever happened between me and Jacob, we had to be united as parents for Callum.
“With the therapist’s help, we were able to reassure him his drinking wasn’t to blame and discuss the fact he was using alcohol to anaesthetise his pain.”
The family are still attending therapy sessions together, and although it is clear the marriage is over, communication between the three of them has improved significantly. “We have bonded again as a family,” says Fearne.
“There is a newfound understanding of other’s needs and, even though we may live apart, the importance of being in this together is the key to everyone’s well-being.”
"We can now talk about the situation without fear. That, in itself, is amazing"
Sarah and Dan have four young children. Their eldest son, Elliott, was diagnosed with anorexia when he was 16 years old.
It all started with one comment. When Elliott was 15, he invited a couple of friends home after school. Up to that point, his parents say, he was a happy and intelligent boy, full of life. One of the friends noticed a photo on the wall of Elliott on holiday in Spain and commented that he looked fat. That was the beginning of Elliott’s long relationship with an eating disorder.
“It took us some time to really get to grips with what was going on,” says Sarah. “He was very careful to hide his behaviour, and at first we simply thought he was trying to be healthier by not eating certain foods. But as the months went by, I noticed he was exercising obsessively, his school packed lunch was going untouched and once we went to a restaurant and he asked the waiter which meals had less than 500 calories.
“There was another incident when we said he couldn’t go to the gym and he tried to climb out of his bedroom window, three storeys up.”
Elliott also started to have terrible mood swings. He seemed furious with everyone, but particularly Sarah. He’d get aggressive, purposely picking a fight, punching holes in doors and screaming at her. One day he pushed Sarah hard into a wall.
“We were surviving, rather than living,” she remembers. “The whole family was affected. There was terrible confrontation with his siblings, and Dan was blaming me for the arguments. The pressure on us as a couple grew and there were periods when I thought we’d end up divorcing.”
Eventually, the family’s GP referred them to the Eating Disorder CAMHS (Child and Adolescent Mental Health Service) team. It was the beginning of a year in therapy.
Julia Matthews, a family and systemic psychotherapist, says: “One of the first steps we take is to encourage parents to look after themselves. We aim to strengthen the parental relationship because we believe the greatest resource in any family is the parents. If they are strong, the rest can be supported better.”
In Elliott’s case, he was encouraged to use a technique that separates the patient from the problem. He was asked to give his condition an actual name (from then on, it was referred to as Caesar); the idea is that you are placing the onus on a third party, which helps to alleviate the guilt and shame that people feel. “Caesar” can then be viewed as something that has invaded everyone’s life, a separate force, which can hopefully be tackled and managed.
“For so long we’d felt helpless,” says Dan. “We thought we were terrible parents who had done everything wrong. Slowly those beliefs started to change. The therapy helped us consider how we could work together as a family to confront ‘Caesar’.
“Elliott’s sisters came to some of the sessions, and they really enjoyed the chance to express their feelings and the constructive input they could have. For so long, Elliott’s eating disorder had dominated everything.”
Matthews adds: “Children diagnosed with anorexia often have complicated issues. But strategies to manage Elliott’s situation were put in place, and the parents were supported to take charge of his dietary intake.
Dan had to change his job to give him more time at home, and there was continual management of the heightened emotion in the family. But eventually this helped Elliott to understand how the eating disorder was controlling him.”
Sarah admits she is still reeling from the experience. “The change in our situation is so much more positive, but as parents we have been through a lot of pain. Fortunately, Dan and I have bonded again, and we can be optimistic about our future. Elliott’s relationship with food is healthier now and we can talk about the situation without fear. That, in itself, is amazing.”
For a directory of private therapists, visit Well Doing.
Information is also available at The Association for Family Therapy and Systemic Practise.
*Names have been changed