Thank you to everyone who responded to our September Clinician's Quandary. Here are some of the top responses! Submit to next month's Clinician's Quandary here.
September Quandary: I have a client who’s been estranged from his mother for 15 years. He’s recently brought up wanting to be in touch with her. I’m not sure how best to support him in this effort, as the mother lives across the country and there is a history of abuse there.
1) Unpacking Creatively
I think it’s important to first do some psychoeducation to normalize the desire for reconnection, even when there’s a history of abuse. This client’s interest in reaching out to his mother makes sense, as it speaks to our ongoing biological imperative for connection and attachment. This will allow the client to explore the issue with self-compassion rather than guilt, confusion, judgment, or shame. I’d invite the client to be curious about the part of him that wants to reach out to his mother, to better understand what prompted the desire to connect, and to gain clarity about what that part is hoping to achieve by reaching out to her.
If the client was ambivalent about reconnecting or doesn't fully understand what was motivating the desire, I’d encourage an exploration through two-handed writing. Dividing a large piece of unlined paper in half, the client could engage in a dialogue between the part that wants to connect by writing on one side of the page with either his dominant or non-dominant hand. On the other side of the page, using his other hand to write, the part that is reluctant or unsure about reconnecting could respond with questions and comments. This reduces inner conflict by honoring both perspectives and giving each part a voice, while allowing the client to gain greater insight about deeper motivation and potential concerns.
Within the safe context of the therapeutic relationship, I would offer the client several different creative ways to unpack and explore the issues that might arise if he reached out to his mother. He could be guided to do a visualization of the encounter, noticing what he would say and what he might anticipate his mother saying in response. Then we could process how the experience lands for him emotionally, cognitively, and somatically: the feelings and thoughts that surface as he watches the encounter unfold in his mind’s eye, and how his body reacts physically. The same experience could also be achieved by doing a role play in session, using either an “empty chair” to represent his mother, or having me take on whatever role he chooses.
Another strategy would involve using a sand tray and choosing a figure or object to represent himself and his mother, then creating sand scenes that depict a variety of potential outcomes. This would include a scene where his mom takes ownership and apologizes, and a scene where she doesn’t. I would also invite the client to choose an object that represents his wisest part and include that in the scene. I would work with this part to process the idea that his continued healing and inner peace is not contingent upon his mother cooperating, apologizing, taking responsibility for the abuse, or making amends. Incorporating that cognition into the work would help the client to not abdicate his power and would reduce the likelihood of him being retraumatized if the reunion didn’t play out the way he hoped.
Lisa Ferentz, LCSW-C, DAPA
2) Between Two Extremes
It’s good that you’re being cautious on your client’s behalf. Those who are healing from abusive or toxic childhoods are in a tricky position, a situation fraught with polarized opinions. My guess is that if the client has disclosed this situation to people in his life, he’s received two kinds responses: one along the lines of, “I can’t believe you haven’t spoken to your mother in 15 years! She’s your mother, after all. Family is family no matter what,” and the other along the lines of, “You were abused? You’re wise to have cut your abusive parent out of your life. Any connection can only be harmful to you.”
Every situation is different. Sometimes cut-off is necessary and appropriate, and other times some kind of relationship can be safely maintained. Keeping an open mind and helping our clients maneuver through the middle ground between these two extremes is the most helpful thing we can do for them. There aren’t many places where a person can safely talk about such complicated family dynamics without being judged or having indiscriminate platitudes applied to their situation without regard for the subtleties and specifics involved. The therapy room (or screen, these days) should be one where only the specific details of the situation and possible ramifications are considered.
Before your client reaches out to his mother, I would advise him to reflect on questions such as these: Why does he want to resume contact, and why now? What does he hope to gain from it? Regarding his mother’s reaction to him reaching out, what are some best- and worst-case scenarios he can anticipate? Is he prepared to manage his emotions if the interactions don’t go as he hopes they will?
Renewed contact with a previously abusive parent can trigger unexpected feelings of vulnerability in an adult child, even if they think they’ve moved beyond such feelings. Who can your client turn to if this happens? Therapy is a critical resource as he takes the first steps toward opening up communication, but it can also be vital for him to have others who are aware that he’s venturing into fragile emotional territory and are prepared to be supportive.
This client should carefully consider what level of contact he wants to begin with. Being in different states can actually be an advantage in this situation. Re-establishing a broken relationship is a delicate process, and it’s easy to plunge into it quickly, especially if things seem to be going well. Geographical distance can build in some appropriate caution that ultimately benefits everyone.
If your client is able to consider all of these factors and acknowledge that there’s risk involved in reaching out, giving this relationship another chance could turn out to be a risk worth taking.
Julie Borden, LCSW
3) What Is (and Isn’t) Your Job
If I was this client’s therapist, I’d want to keep in mind that my job isn’t to make this decision for him, but to help him make the most informed and aware choice available. I want to honor his desire to reconnect while helping him understand where it comes from and what the consequences might be.
My first question would be why now? What’s changed to make him reconsider his estrangement? Was there an event, memory, anniversary, or a talk with a friend or loved one that led to these feelings? I’d like to explore the motivation to re-engage to see if it’s based on his own beliefs and wishes, or if he’s making an impulsive decision based on a guilt trip or other external pressure, which he may regret later.
Next, I’d want to explore his expectations for this reconnection, and compare that to what we know of his mother and their relationship. Does he simply want to extend an olive branch with no expectations that she’ll accept? Is he hoping for a Hollywood ending where all is forgiven and they establish a great relationship? Does he wish to work on the history of abuse, if she’s willing? What if his attempt is shot down? What possible responses could she have, and how would that sit with him? Could it be re-traumatizing? Finally, what would life look like if he never spoke with her again, and would that be a tolerable outcome?
If he still decides to reach out after we explore these questions, we could discuss the logistics of how and when, and practice or rehearse the meeting if necessary. And of course, I would be there to debrief, whether it goes well or the outcome is regrettable.
Again, I believe our job as therapists is to help people know themselves and engage their life with eyes wide open. This circumstance fits the bill.
Ryan Howes, PhD
4) Self-Care, Not Just Other-Care
What a great opportunity to explore meaning with this client. What is happening in his life that makes him want to reach out now? What feelings arise as he thinks about getting in touch with her? By bringing this into therapy, he may be entrusting you as a surrogate parent figure, someone who can help him try on the experience of a trusted adult who listens deeply and honors the child within him who’s come such a long way.
You mentioned a history of abuse in their relationship. How did he come to be aware of this and name it as abuse? What does he make of it now? How did he first notice that their relationship was not a healthy one? This is a great opportunity to explore boundaries and triggers. What are his “tells” (i.e. feelings, physical sensations, behavior patterns or addictions) that may tell him he’s getting out of balance as he re-engages with his old family system?
Teaching self-care in balance with other-care will be important. How will he know when his boundaries are being crossed? Sometimes parental abuse is overt physical or sexual abuse or yelling and screaming. More often than not, it’s also covert, subtle, and confusing. Teaching this client to notice his body’s signals about when things feel right or not right will help him not get so seduced by the desire for parental acceptance.
What has he learned from his time away from his mother? How has the distance helped him? What skills, knowledge, awareness, or tools might he need to be able to maintain his equilibrium and sense of self as he attempts contact with her?
I’d reiterate that he can’t control the outcome, only his intent and actions. Who knows, maybe his mother has grown over the last 15 years and might be capable of having a healthier relationship. That said, it’s just as likely she could be stuck in old patterns, and that he may continue to be hurt by re-engaging with her. He may also be able to negotiate some sort of relationship with enough distance, boundaries, and realistic expectations that he can maintain contact without being hurt.
Regardless of what happens in his journey with his mother, he has the opportunity to emerge from this process with a deeper sense of self and a greater sense of agency and trust in his own ability to navigate relationships.
Johanna Smith, MSW, LCSW
5) A Dialogue with the Self
As a Gestalt therapist, I’d invite the client to engage in an empty-chair experiment, speaking directly to his mother and sharing his thoughts, feelings, boundaries, and expectations with her. This would provide an opportunity for the client to gain more clarity about his desire for reconnection, as well as a way for me to support his level of acceptance of his mother’s response.
The empty chair experiment would also help me get a fuller sense of their relationship and what reconnecting might look like. Afterwards, I’d begin to explore both present and historical ego-states, as well as what may have changed that’s driving the client’s desire to reconnect. Exploring the dimensionality of the client’s impulse to reconnect with his mother is important for him to gain clarity about the underlying needs, emotions, and context behind his wish to reconnect.
Next, I’d want to examine why the client and mother decided to sever contact in the first place. I’d want to support the client’s ability to reconnect to younger ego-states, and to deepen the experiential and somatic basis of his younger self’s choice to end contact with his mother. My hypothesis is that the client chose to end contact with his mother out of self-protection. Therefore, I’d want to make the themes of safety conscious again in the here-and-now, re-emphasizing the client’s ability to assess, moment to moment, his safety and comfort. I’d also want to support his ability to access anger as a way of letting himself know he can protect himself, should the need arise.
I might then invite the client to speak as his younger self and revisit the time when he decided to end contact with his mother. I might say, “Can you tell your present-day self about your choice to end contact with your mom? Let him know what was important about that choice?” I might then invite the client’s present self to respond to his younger self and share his current hopes, needs, and motivations for reconnection.
Jordan Dann, MFA, LP, CIRT
New York, NY
Next Month’s Quandary: My client has a lot of regret about past decisions he’s made. Although we've talked about them at length, he still can't seem to move on, and I'm not sure what more I can do to help him. What are some effective, creative ways to work with regret in a client's life?
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