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Stage 1: Reflecting on Current Solutions

As Jake became a little more talkative, we spent time reflecting together on all the past and present coping strategies that he’d used to organize his life when the adults in his life didn’t do what he’d expected them to do. In these discussions, we looked for coping strategies that others in Jake’s family and community had found helpful for solving similar problems, like protecting someone who was drinking too much by helping them get into treatment. We also talked about how the world was perceiving him—that his mother worried that he was just as depressed as his father, and that his teachers and school administrators viewed him as a traumatized boy in need of therapy.

During one such discussion, he said: “Nobody in my family is good at looking after anyone else. Everybody does things for themselves. But I’m not like that.”

“So who are you more like?” I asked.

“I dunno. Maybe like some superhero?” he smiled, embarrassed. “Not like I’m great or anything, but if I didn’t stay home, Dad wouldn’t be doing too good.”

“I get the superhero thing,” I said. “But that means you have to have superhuman powers. Is there anyone you know who helps others without being quite so different from you and me?” Jake shrugged and went quiet for a minute.

When I reflect with clients on these patterns of coping, I often use a large piece of flipchart paper on which I list possible problem-solving strategies, returning to the same sheet of paper during each session as we add more and more ideas. There are other techniques I use as well, like genograms that plot solutions across generations and detailed family history, and eco-maps that help plot the reactions clients have received from the solutions they’ve tried. The point is to focus the conversation on a range of different, more socially acceptable, patterns of coping. I try to draw new solutions from coping patterns that clients have seen in movies and TV shows or learned from teachers, mentors, parents, grandparents, or other relatives.

With Jake, the first glimmer of hope that he’d be able to develop less troubling patterns of coping than being a “superhero” came when he told me about his support worker from the Diabetes Association. “I like her because she stood up for me. She’s told the school that I’m different from other kids and that my diabetes makes it difficult to go to school every day.” Jake appreciated her taking up his cause and, in general, he admired people advocating for the needs of others. When I asked him whether his support worker sacrificed herself when she advocated for him, he laughed, “Of course not. My problems are mine. Not hers.”

I was both surprised and pleased to hear that he understood the difference between advocacy and self-sacrifice. Could he learn to become his father’s advocate rather than remain the parentified child who risked his own future to keep his father alive? Could being an advocate become a pattern of interaction between Jake, his father, and his father’s professional caregivers that would help Jake retain a sense of control over his world, while demanding less self-sacrifice?

Stages 2 and 3: Challenge and Perform

When I find a pattern of coping that’s perceived by a young person as just as powerful as the one others label “dysfunctional,” I know we’re ready for part two of the treatment process: challenge. However, to be a viable challenge, the new solution must be just as effective as the previous maladaptive behavior. In Jake’s case, we needed to find a way to prove to him that he could still protect his father and exercise some say over his father’s care. Any solution that would infantilize Jake and leave his father adrift—like simply making him go to school—wasn’t going to work. In addition, the new pattern must be capable of being defended discursively. By this, I mean Jake and I needed to be able to get others to appreciate his new solution and accept it, even if it sounded unconventional.

At this point, we began to move from the challenge part of the intervention to the third part: the performance. Any good solution needs eventually to be performed for others to see. In Jake’s case, rather than remaining the self-sacrificing child, we explored how he could become his father’s advocate.

It was January when we finally met to discuss this strategy. After we settled in and swapped holiday stories, I asked him, “What would be the one place where you think you could be the most helpful to your dad?”

“At home,” Jake answered quickly, reverting back to his old, comfortable solution.

“Sorry, I meant, as your father’s advocate,” I said, emphasizing the new solution we’d begun to explore.

Jake paused for a moment, and then sat up straight in his chair. “I should be able to meet with my dad’s treatment team at the hospital. They don’t get what he’s all about. I should be there when dad goes for his appointments.”

It seemed like a reasonable request and, within an hour, we had a contract. Jake agreed to attend school more regularly and to accept support from his teachers and guidance counselor, if he could have a role in advocating for his father’s care. My job—and it wasn’t easy—was to position a 13-year-old boy on his father’s care team. At first, my proposal brought small chuckles from my colleagues at the hospital, but when I fully explained to them the background of Jake’s proposal, they agreed to let him attend his father’s case conferences.

Two weeks later, I asked Jake how the first conference had gone. “I talked more than my dad,” he said proudly. He’d told the team about how his dad slept in late every day and didn’t seem to have any friends. Jake wondered whether his dad was lonely because his mother had left him. “They all thought I was right,” Jake told me, clearly basking in the recognition he was receiving in his new role.

As he became a regular participant in these case conferences, Jake found a new way to take care of his father without sacrificing himself. His school attendance was never perfect, but it improved enough to get his CPS file closed. Our work continued, though, and finally, in early February, we began talking about Jake’s experience of his father’s attempted suicide and his frustration with his mother. It was at this point that we managed to get his mother, and later his father, to individually join us in therapy, encouraging each parent to acknowledge Jake for the role he played in the family. Like the psychiatric team, Jake’s parents, too, became an audience for his performance as the responsible, and resilient, young advocate he’d become.

Jake continued to live with his father, but as a better case plan was put in place, the two of them were provided with a home-support worker once a week to make sure their basic needs were met. While not ideal, it was a cheaper solution than institutionalizing Jake’s father and avoided the rebellion everyone anticipated if Jake was forced to live with his mother. Of course, Jake remained at some risk, but he’d returned to school and begun to see his mother more often. Though no one was quite sure what would happen next for him and his father, I ended my work with Jake at his insistence. “I’m going to school. I don’t need a therapist,” was how he’d phrased it. I had to agree. He’d found a way to both play his role as his father’s advocate and look after himself. To my mind, that was resilience.

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