Dr. Barry Dworkin

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Stuck in the middle

Originally published in The Medical Post, VOLUME 39, NO. 4, January 28, 2003

Before she can improve relations with her divorced and feuding parents, a young woman must get to know her true self

As adolescents progress through their teenage years we bear witness to their emotional and cognitive development. Some sprout early and surprise us with their clarity of thought and insight. Others remain stuck in neutral for long stretches of time. This is one of the challenges of providing adolescent care.

Fifteen-year-old Caitlin falls into the former category. The reason she came to the high school clinic was her concern about the risk of an eating disorder relapse. About a year ago, she cut breakfast and lunch out of her diet. She did not binge or purge her meals. She did not have a distorted sense of body image or depressive illness. Her behaviour continued for several months then abruptly stopped.

She now remains stable and of normal weight. Her goal was to find out how she could prevent future recurrence.

Adolescent behaviours do not come vacuum-packed. When they seek help, an earnest empathetic approach creates an atmosphere of trust. Let them know you may be asking potentially charged or pointed questions. They need to understand that its intention is to help, not harm or anger them but to draw a clear understanding of their problem. For Caitlin, it turned out her eating disorder arose due to her parents’ post-marital strife.

Caitlin’s parents divorced when she was nine years old. Her father suddenly left the family to marry another woman. Her mother did not establish any new relationship and remains bitter and angry with her father. Many unresolved issues remain between them.

Both parents use Caitlin as a sounding board to snipe and criticize one another. They reveal marital details that she does not want to hear. Caught in the middle, she resents both for their actions.

She is angry with her father for breaking up her family yet still tries to maintain a father-daughter relationship. She tries to support her mother but is uncomfortable with being her mom’s confidant. This stress and worry consumes her. She bears the burden of being the intermediary for a situation she cannot resolve; her frustration grows. She has no control over her parents’ behaviour.

Further, her mother perceives that she is in competition for Caitlin’s love and attention. Tearfully, Caitlin recounted how her mother made it clear that she will not attend her graduation (two years hence) if her father brings his wife.

Instead of looking forward to one of the milestone days in her life, she faces two years of its use as a weapon to control her actions. Her mother, unwilling to resolve the issue herself, transfers the responsibility onto her daughter’s shoulders.

This is a fork-in-the-road life moment. How she handles these relationships and their inherent difficulties can affect the rest of her life and future relationships.

Already seeking solace from within her peer group she takes on the role of therapist solving their personal problems. Yet when she needs their support, they beg off with excuses that they have homework or are busy. Her response is to redouble her efforts, further ensnaring her in an unequal relationship situation: a response akin to her family dynamics.

The goal for Caitlin is to develop the tools to counter the guilt and manipulation on the part of both parents. Given her insight, it is necessary to provide a plan and establish short- and long-term goals.

Clearly, she desires a normal adolescence without the aforementioned burdens. She wants her father to treat her with respect and to spend time with her. Her love for her mother, cognizant that she is alone and now increasingly dependent upon her, hinders her ability to act. She needs a method to approach her parents to discuss these issues. She also needs someone in her corner to support her efforts.

Introducing the concept of true and false self, respectively listening to or ignoring one’s inner voice or conscience, adds another dimension to cognitive therapy. The true-self usually can discern right from wrong. It is akin to an inner voice trying to keep us true to our morals and beliefs. People who follow this inner voice tend to respect themselves and their motives. They become more self-confident and self-reliant. They are not afraid to say “no.”

The false-self follows a path or decision contrary to doing the right thing. The person knows their actions or decisions are wrong but they follow through with them anyway.

Sometimes others try to draw a person away from their true-self using guilt and manipulation, as in Caitlin’s situation. Other times it is the person himself or herself listening to an addictive or self-deprecating thought. The result is anger, frustration and loss of self-respect.

One approach is for Caitlin to write down and organize her thoughts. She has to define what friendships and relationships mean to her. She needs to identify and explore her good and bad qualities and her likes and dislikes. Helping her define these concepts gives her the initial foundation to confront present and future issues that will challenge her sense of self. Once this process is under way, she can focus on her parents.

Caitlin has difficulty discussing her concerns with her father. He consistently interrupts her train of thought. He will twist her words to suit his argument: an irritating and frustrating situation. Her goal is to get him to listen to her.

She is afraid of telling her mother it would be best if she talked about her issues with a friend instead of her. Caitlin needs to grow and develop her own sense of self. She cannot accomplish this goal if her mother becomes increasingly dependent on her for her emotional stability. Yet, she does not want her mother to feel rejected or abandoned.

The beginning of dysfunctional patterns between her mother and herself has grave implication for the future. Caitlin is aware that her future relationships and friendships will naturally move her away from her mother. Requiring more attention, her mother has already shown she is insecure with Caitlin’s foray into adulthood. Caitlin does not want to face the choice of moving away in the future to avoid her mother’s intrusions into her life.

The emotional challenge is overwhelming from Caitlin’s standpoint to talk to her parents face-to-face without some preparation. Caitlin can write letters to her mother and father in a non-confrontational manner explaining how their behaviour affects her. Writing it down reduces the argumentation inherent in parental discussions fraught with emotion.

One way is to look at her relationships as a series of contracts. Every relationship has a contract of needs, expectations and consequences. She should define her needs and wants and ask her parents to define theirs. They should meet to clarify and honour them. Enlisting the support of a counsellor as mediator could support Caitlin’s efforts.

Early to mid-adolescence is fraught with healthy and damaging events that define a person’s future interactions. Offering them the basic tools and support to use in these instances, combined with appropriate followup, can serve them well.

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