The Dysfunctional Family Role of the Loser

It seems like a lot more adults in the United States are living with their parents than ever before. Some of this is completely reasonable and is in no way indicative of significant family dysfunction, as economic conditions have led many twenty-somethings to require much more time to get their financial ducks in a row so they can move out and be more independent. 

In other cases, however, this phenomenon is due to significantly dysfunctional family dynamics. If the pattern continues into the adult children's thirties, forties, or even later, the odds that dysfunctionality is the culprit skyrocket. 

In  a previous post, I discussed some typical patterns that create this pattern, and pointed out that the adult children remain enmeshed with their parents because, covertly, they are taking care of some of their parents' needs. They may be mediating disputes between bickering parents who for whatever reason will not get a divorce; they may be helping take care of sick, elderly, or just plain lonely parents; they may be providing free cooking and housekeeping services for families that for a variety of reasons are not being done by someone else.

Or in some cases, all of the above!

This is the shell game that I refer to as Who is Taking Care of Whom?

I have seen cases of such patterns that continue throughout the entire lifetime of the adult child. You can find many examples of a sixty-something year old man or woman living with an eighty-something year old mother or father. The adult child's siblings may all be independent, but the "identified screw-up" seems to be the parent's favorite child.

Usually in these instances, the parent is taking care of all of the adult child's financial needs, including for housing, food and spending money, so said adult child does not have to work outside of the home.  The reason they do not work, however, is actually because they already have a full time job: taking care of their parents.

On the surface, it seems to all the world - and even to many peripheral family members - that the adult child is using the parent, and said adult child normally receives allof the blame for the dysfunctional living arrangement. They are accused of using the parents because of less than admirable motives.  Many such folks readily accept this blame, and in fact act in many ways to confirm everyone else's worst fears. They do this to protect the image of their parents, and in the process sacrifice their own reputation.

Another variety of this pattern is when the adult child living with parents pretends to be a failure who always seems to need the help of their parents. That is the version of the shell game that is the subject of today's post. The adult child appears to be a big loser in both love and work. Said adult children will venture out into the real world from time to time, only to return in relatively short order with their tails between their legs.

So how does one go about becoming such a loser?  Let me count the ways.

They may flunk out of school for various and sundry reasons that are not actually the real reasons. Alternatively, they may get a degree in something that qualifies them for a profession that is rapidly disappearing from the current landscape, so they cannot get a permanent job.

They may make impulsive decisions that get them in trouble in way one or another, and subsequently lose any job they do manage to land. They may even develop various medical or mental illnesses, some of which are real and some of which are feigned and some of which are both, but all of which appear to be far more disabling than these particular illnesses should ever be in real life (the role of the defective). Drug or alcohol problems are common.  Some of these folks are massively obese.

They may get themselves fired from a whole series of jobs, again for reasons which may appear legitimate but are masks for the real motivation of the job loser. Or they might take a job knowing that the company they work for is actually planning layoffs.

These people may also or instead play the role of loser in their love lives.  They may look like they are really trying to meet romantic partners by going to singles events or signing up for dating websites, but somehow very little comes of it. Or they choose partners - or a series of partners - who are abusive, have drug or alcohol or commitment problems, or are in other ways dysfunctional, so their parents have to come and rescue them from dangerous or dead-end relationships. Sometimes repeatedly.

Because of these patterns, the parents - who are in reality highly dependent on Mr. or Ms. Loser - often criticize the poor judgment of their offspring unmercifully.  

The more the parents criticize, the more the adult child continues making the same mistakes over and over again. The parent then feels justified in continuing to make the criticisms. On the rare occasions when the adult child expresses anger at the parent's constant harping and verbal abuse, the parent can point to the child's irresponsible behavior as justification for it.

In a very real sense, the adult child is purposely giving the parent this ammunition to use against him or her, although they do not have to think about this consciously while doing so because their behavior is habitual and automatic. This allows the parent to avoid feeling guilty for both their criticisms and for the fact that they are contributing to their own child's impairment. The parents, of course, act in this manner because they themselves are playing their own roles within the family.

Some are stuck in bad marriages because of family/cultural/religious prohibitions regarding divorce.  Some are females who are stuck in outdated gender roles with a prohibition against women being independent.  Some need their child to act out their own repressed anger because they cannot do so themselves - often due to family rules prohibiting anyone from being "selfish" enough to put their own needs above those of other family members.

There is a very incisive and sophisticated comic strip called Momma by Mell Lazarus that absolutely nails the family dynamics described above. A son named Francis is the identified loser.  He apparently does have his own apartment, which of course Momma is paying for, but he is constantly doing everything in his power to act out the various negative characterizations of him that Momma compulsively throws his way. 

It's kind of sad that a cartoonist understands this dynamic better than many therapists.

Intrapsychic Conflict and Dysfunctional Family Patterns

There have not been a lot of studies done looking at how personality problems affect individuals over three generations within a family, and how they may be passed down from one generation to the next. Today’s emphasis is studying mostly biogenetic factors.

However, the few studies that have been done generally show the same types of things. Although there is never a one to one correlation (because people’s development is affected by the chaotic interactions of thousands of different variables – genetic, biological, interpersonal, and sociological), certain issues are highly likely to be passed down.

Earlier studies have shown what is known as intergenerational transfer of certain types of dysfunction for, as examples:

• Boundary disturbances such as maternal overprotection and relationships characterized by lack of affection, enmeshment, and/or parent/child role-reversals (Jacobvitz et. al., Development and Psychopathology, 3, 513-527, 1991).
• Emotional dysregulation with poor disciplining skills with children (Kim et. al., Journal of Family Psychology, 23(4), 585-595, 2009).
• Substance abuse with parental substance abuse combined with abuse and/or neglect and low levels of family competence (Sheridan, Child Abuse and Neglect, 19 (5), 519-530, 1995).

In understanding this process, I try to incorporate concepts from different "schools" of psychotherapy. The most important task in integrating different psychotherapy models is to pose the question of how concepts from different therapies might relate to one another, and how slight modifications to specific aspects of these concepts may make relationships between them more clear.

In this post, I will focus on the relationship between several such concepts. We have the concept of intragenerational transfer of dysfunctional behavior from Bowen family systems therapy. Then we have a primary concept from psychodynamic therapy, intrapsychic conflict. People have conflicts between their innate desires and the values they have internalized as they grew up within their family and culture. 

To see how these two concepts can both be valid and also when combined explain certain human behavior, we can take a closer look at the intergenerational transfer question.

The attachment theorist Bowlby first suggested that these transfers occur, not through specific observable behaviors like “abusiveness” or psychiatric diagnoses per se, but through the generation of mental models of interpersonal behavior in the affected children. These working mental models are now called schemas by both psychodynamic and cognitive-behavioral therapists. They are also subsumed under the rubrics theory of mind or mentalizationby another set of psychodynamic therapists. We need to look at the subjective experiences of the involved children throughout their development.

Zeanah and Zeanah (Psychiatry, 52, 177-196, 1989) discuss the concept of organizing themes. They mention that studies show that abusing mothers tend to attribute more malevolent motives to their own children compared to other people’s children. More generally, they react with more annoyance and less sympathy to videotapes of crying infants than do non-abusive mothers. To think that these patterns would not be noticed or sensed by children through their daily interactions with their parents, and would not affect the development of their schemas, would be extremely naïve.

In turn, abusive mothers reported more threats of abandonment and role reversals with their own mothers than did control mothers.

These findings are probably the tip of the iceberg in terms of subtle characteristics of repetitive parent-child interactions, and as the Zeanahs say, “Patterns of relating are considered to have more far-reaching consequences than specific traumatic events” (p.182).

When Bowen therapists started doing the genogramsof their patients, which describe family interactional patterns over at least three generations, they noticed something that has not really be described much in empirical studies. While some children of dysfunctional parents had problems that were similar to their parents -  such as substance abuse - other children seemed to have developed behavior patterns that were exactly the opposite – they became teetotalers!

I have seen this sort of thing many times in taking genogram-related family histories from my own patients. One son of a workaholic will also be a workaholic, while his brother becomes a complete slacker who can’t seem to hang on to a job, or who does not even bother to look for one and goes on disability of some sort. Or who is enabled by the workaholic father.

In fact, in some families one generation has a lot of alcoholics, the next generation a lot of teetotalers, and the third generation goes back to having a lot of alcoholics. Or impressive successes in one generation are followed by remarkable failures in the next. McGoldrick and Gerson, in their book Genograms in Family Assessment, traced the genograms of some famous people like Eugene O’Neill and Elizabeth Blackwell and readily found such patterns.

If these sorts of issues were entirely genetic, it would be difficult to explain how progeny of the same parents could be so completely opposite from one another, as well as completely opposite from their own parents. So what might be going on psychologically within people that might lead to interpersonal behavior with their own children that generates such bizarre patterns?

This is where intrapsychic conflict may come in. Say a father was a young adult during the Great Depression of the 1930’s. He had grown up feeling that work defined him, and that he was obligated to keep his nose to the grindstone in order to support his family. He was lucky enough to have a job, but his boss made his life miserable. He could not quit because he would not be able to get another job, and therefore he began to subconsciously resent the very values with which he has defined himself.

This could lead him to develop an intrapsychic conflict over hard work which starts to tear him apart. He may relate to each of his sons in a manner that – very subtly - suggests to one son that he too should be just like him, while the other son is subtly rewarded for acting out the father’s hidden resentment towards hard work and self-sacrifice.

Likewise, a patient might come from overly-strict religious parents who had rejected any and all hedonistic pursuits, but who had preached to their child about the evils of alcohol in a highly ambivalent manner. Such ambivalence usually arises in them because of their having received mixed messages from their own parents. Their son may feel pushed to rebel, and therefore lead a licentious, alcohol-drenched lifestyle. Such a person often destroys himself in the process, because if his parents observe him being successful in spite of drinking, this would exacertate the conflict in his parents and destabilize them. This would frighten him. So he becomes a self-destructive alcoholic.

His behavior would be sort of compromise. He would be following the repressed urges of his parents and allowing some expression of them, while at the very same time showing his parents that repressing the urge was indeed the way to go.

In the next generation, his children may “rebel” just like he did, but the only way they can do so is by going to the opposite extreme themselves. They become teetotalers. Their children, in turn, “rebel” by becoming alcoholics.

I’m tremendously over-simplifying this process so the basic outline is clear to the reader, but I see these types of patterns – with many fascinating twists and turns - every day in my practice.

How Did I Learn About the Family Dynamics I Write About

From Mark Anderson, https://www.andertoons.com/

In my Psychology Today blogpost of 10/14/13, Don't Ask, Don't Tell, I discussed how patients in psychotherapy do not volunteer a lot of information about their family dynamics unless they are asked very specific questions - and often not even then until (and unless) they have formed a trusting relationship with their therapist. I mentioned the case of a patient who was smart enough to have been a Ph.D. candidate, came in complaining of anxiety, and did not think it relevant to tell me until months into therapy about the daily conversations with her mother that literally made her nauseous.

So, therapists who think that what they see and hear in the office is indicative of what is really going on in a patient's life may be sadly mistaken. For example, a woman may complain that her father is "controlling." The therapist should want to invite the father in at some point to see if this is accurate. Most do not. However, even if the therapist does this, both of them may then mislead him or her. 

The father may at first appear to be anything but controlling - telling the therapist about how he gives the adult daughter money to do whatever she wants without obvious restrictions, and never stopping her from doing anything she wants. What neither might mention, however, is that he always calls her incessantly on her cell phone whenever she goes anywhere!

When I was in training as a therapist during my psychiatric residency, psychoanalysis was the king of psychotherapy paradigms, and I was not taught about how to ask my patients about repetitive dysfunctional interactions with family of origin members occurring in the present. A lot of both analysts and CBT therapists seem to think that patients' problems reside entirely within the confines of their own heads, as if we are not social organisms at all.

When I write in my blogs about the types of family dysfunction that I have seen with my patients, a frequent criticism I get is that I am taking patients at their word, and that since patients often distort things, I am surely getting a distorted picture - which by implication must have led me to form distorted ideas about what actually is and has been taking place.

So how do I know that these patterns are real? Well, let me tell y'all how I discovered them. (Hey, I've lived in South now for over twenty years).

When I was a beginner as a therapist, I kept noticing that my patients usually did not respond to various interventions in the ways described in the psychotherapy literature. I would sometimes have some success with these interventions, but the results were often rather inconsequential. So in response I started reading about other paradigms one at a time, and each time, I would have the same experience. Perhaps I was not doing them right, but other therapists would tell me that they noticed the same limitations.

I somehow stumbled on a version of a therapeutic questionthat had, unbeknownst to me, first been proposed by Alfred Adler, one of the three founding fathers of psychodynamic psychotherapy. I had started to ask my patients why they were not employing the obvious solutions to their problems. If I could think of an obvious solution such as "why don't you just leave your abusive husband?" no doubt the patient has already thought of it, and has decided against it for some seemingly strange reason. 

When a therapist asks a question like that, the first answers he or she often gets in response is one described by Eric Berne. It goes something like, “Yes, I could do that but…” followed by some lame excuse for why they cannot do that. This is known as the game of Why Don’t You – Yes But.

I decided I would play my own version of the game that I called Why I Can’t – Yes But. Every time I heard a yes-but answer to my original question, I would counter with, “Yes, but you could handle that obstacle by doing [such and such].” This solution would of course also be yes-butted by the patient with another lame excuse - for which I would provide another obvious solution.

An example from my last book: one adult female could not seem to hold a job and always seemed to end up going back home to live with and depend upon on her abusive father and inadequate mother. I knew other relatives also lived in the home but I had no clue as to their significance. The patient was bright and had made it to the upper echelons of a sport that she liked to play, so I knew she was highly capable of holding a job. 

Every time she offered an excuse such as “I’m no good in school so I can’t learn new skills,” I would counter with my own yes-but. I went through a seemingly endless array of lame excuses in this manner, until finally she said, “If I’m not at the house, my father molests my niece.”

Whaaat??? She never thought to mention this before????  

So, a bit off guard, I said, “Have you thought about reporting him to child protective services?”  She replied, “Of course, but if I did that my mother would end up on the street because she cannot support herself." Her mother would suffer, and it would be all her fault. No doubt she would be blamed by the family.

Well, lessee. She could handle that obstacle to holding a job by…by…by…er, how exactly could she handle that problem? I had no answer. She could write her mother off, I suppose, but since when is caring about the survival of family members or her niece's safety a bad thing? This was a really devilish conundrum. As mentioned, I also wondered why she had not told me about this in the first place. That was the moment that I was first confronted by evidence that family members may be acting for altruistic motives rather than selfish ones, and that family problems might be incredibly difficult to solve.

I then found an easier way to get to this answer than playing a long game of yes-butting: the Adlerian question: What would happen if I could wave a magic wand and you suddenly got better and stayed better?

At first, patients would often answer with such non-answers, "I'd just find some other way to screw things up" or "I cannot even imagine what that would be like." I would not accept those "answers" and pressed on. Then I started getting the real answers. 

But were they really real? Was I just being fooled by my patients with distorted perceptions. Well, just so readers know, I do not just take them at their word.

I began to have conjoint sessions with the patients and their parents. I have had both the mothers of patients with BPD and their daughters with BPD as patients in individual therapy separately, some at the same time, on several occasions. As a psychotherapy supervisor, I have watched videotapes of the mother of a daughter with BPD in a session with one therapist and the daughter with another therapist describing the very same interactions.

Even more revealing, I have had patients who were sick and tired of being accused of distorting everything bring in audiotapes of phone conversations with their parents when the parents did not know they were being recorded. Illegal in some states to record, but not for me to listen to. I heard some of the most unbelievable things come out of their mouths.

In individual sessions, I listen very carefully to what the patients say and ask follow-up questions about anything that seems contradictory - when the patients with BPD are in "spoiler"mode (which is when they are distorting things, but sort of on purpose), they do that all the time. But knowing a few tricks of the trade, it's easy to get them to stop doing that.

One still needs a good theory in order to interpret the behavior that I had been observing. Luckily, as I started to try to make sense of the evidence before me, I came across some relevant ones. For example, there was Sam Slipp, who wrote about the dysfunctional family roles of savior, avenger, and go-between. And then there was family therapy pioneer Murray Bowen, who wrote about family emotional processes and the intergenerational transmission of dysfunctional family patterns.

So no, my ideas about family dynamics do not come just from listening to my patients alone.