family therapy Archives - Promises Healthcare
ENQUIRY
How To Get The Most Out Of Therapy

How To Get The Most Out Of Therapy

Written by: Andrew da Roza

Deciding to see a therapist is a big step – and staying in therapy requires a commitment to effect real change.   

It is not surprising that many hesitate before starting therapy. 

Some may be wondering how talking to a stranger can change their lives for the better. 

They may not know which therapist they ought to approach – and what they should be looking for in a therapist.

Others may hesitate because they are anxiously thinking ahead: “what happens if I don’t like the therapist?”; “what if the therapist doesn’t understand my struggle?”; “what if I don’t think that enough progress is being made?”.

They may also be wondering if they can change their therapist and if they can have more than one therapist. 

If you are struggling with these questions, thankfully, there may be some answers that put your mind at rest and give you the confidence to seek a therapist and engage in the healing process. 

 

Choosing the Therapist – The Qualifications 

Most clients can articulate why they wish to seek therapy – and have clear ideas about what is causing them distress or difficulty.

Clients with clinically diagnosable mental illnesses may have already sought help from a family member, friend, doctor, psychiatrist or religious leader. They may have even “Googled” their symptoms.  

If specialist help is needed, choosing a therapist with the relevant qualifications and experience will be the first step. 

In addition, you may wish to choose a therapist you are more likely to be comfortable with based on the therapist’s language ability, gender, culture and so on. 

 

What should I look for in a Therapist?

Research has shown that the positive connection a client makes with their therapist accounts for 36%-50% of the changes clients experience as a result of treatment. (1)(2) 

Sometimes called the “therapeutic alliance”, this is experienced by clients as liking and trusting their therapist.  

Some will bond strongly with therapists if they demonstrate empathy, warmth, unconditional regard and respect. They would like their therapist to be open, non-judgmental and curious about the clients’ struggles – to have a strong desire to “walk in the clients’ shoes”. 

Such clients make good progress in therapy when they feel understood and heard – as well as valued. 

Others may seek therapists who are good communicators and are well informed about the issues the clients are facing. They tend to bond with therapists who are able to impart and discuss information; offer practical suggestions; articulate action plans, goals and timelines; and support the clients in their motivation to take action to effect positive change. 

Many also seek insights into themselves, their emotions, the ways they react to people or situations; and their perspectives and intrusive thought patterns. 

By being more present with what arises in themselves, they seek to take more control over their own lives – to respond to people and situations instead of habitually reacting to them – and to accept and let go what they cannot control. 

These clients appreciate therapists who can assist in self-discovery. Therapists who are able to help articulate their “inner worlds,” and to reframe them. Therapists who empower them to navigate this “world” with more ease and confidence by playing to their strengths, rather than dwelling on what they perceive as their weaknesses. 

Interestingly, studies have repeatedly shown that the type of therapy used for individual therapy (such as cognitive behavioral therapy, psychoanalytic or psychodynamic therapy, dialectical behavioral therapy, person centered therapy and so on) has only a marginal effect on the outcomes of therapy (3)(4)(5).     

So, the key to choosing a therapist involves articulating what you expect from therapy and your therapist, and what kind of person you think will best meet your emotional and other needs. 

It would be helpful to articulate what you want the therapist to do (and not do); and what your end goal or “vision” for therapy is. You can do this by first asking yourself the question: “what changes am I seeking that will make a real positive difference in my life?”. 

Many benefit from putting all this in writing and bringing it to the first therapy session to discuss it with the therapist. 

 

Beginning Therapy – And then Changing the Therapist 

On the first meeting with a therapist, some clients – though this may be rare – simply do not like or trust the therapist, or that they do not have the experience or knowledge to assist them.

It also sometimes happens that a client feels that the therapist is not present or really hearing the client’s narrative. 

Worst still, they may see the therapist jumping to conclusions – or solutions. They may feel disrespected and “unheard” – and that they are being left behind, while the therapist is “racing” ahead of them. 

Other clients may feel that the therapist is judging them or telling them what to do, think or feel – and not to do, think or feel. The clients may feel anxious, disempowered, dismissed, angry or offended. 

If this happens to you, let your therapist know. If you don’t see any change in their approach, rest assured that changing therapists is likely to be helpful. 

 

Changing Therapists Along the Way 

One situation that you may wish to avoid though, is changing therapists regularly. This is because continuity in therapy is one of the keys to progress. 

Therapy is very much a journey. 

Whether the goal is self-discovery, empowerment, executing action plans to change behaviour, building confidence, or managing anxiety or depression. The journey has stages, and keeping the same guide on this journey is likely to facilitate progress.

If you are in the middle of your therapeutic journey, and you wish to change therapists, it would be helpful to articulate clearly why you want to do this. 

Is the therapeutic bond broken – and cannot be fixed? Is there little or no progress in your clearly articulated goals? Have you changed the goals and discussed them with your therapist – and it is clear that the therapist will not be able to assist? 

Some clients simply feel that therapy has become “stale”; or they feel as though they are attending therapy to “tick the box” and to show others that they are willing and able to change. 

Whatever the reasons, write them down. Discussing them openly and honestly with your therapist is likely to help. 

If you wish to make a change, ask the therapist for a referral to another therapist, and give permission to the current therapist to brief the new therapist. You may wish to join in this discussion.  

This is more likely to ensure that your therapeutic journey continues without disruption. 

One situation you may wish to be conscious of, is changing therapists solely because the therapeutic work has become difficult. “Jumping ship” may not be the answer. 

There is no doubt that therapy can be very challenging – perhaps the most challenging thing you have ever done. 

The challenge could arise because the insights are uncomfortable (or even painful); the changes in behaviour require a lot of motivation to sustain; a change in perspective seems counterintuitive; or because the anxiety, intrusive rumination or low mood seem relentless.  

Changing therapists may not be the answer – and may simply delay or disrupt the difficult therapeutic work ahead of you.

It is likely to be more helpful to articulate these challenges, write them down and discuss them with your therapist.    

 

Having more than one therapist

Some clients may need more than one therapist. 

A client may have an individual therapist who assists the client on their own personal journey. 

They may also have a couples’ therapist to address their relationship with their partner. In that event, the therapist treats the couplehood as “the client” – and provides equal support to both parties and works towards their joint goals.  

Other clients may also have a family therapist to address the relationships within the family. Again, the therapist will see the family as “the client” and assist with the family goals.

Couples and family therapists tend to provide specific modes of therapy, which have proved effective for couples and families.  

In the case of individual, couple and family therapy, in most cases, it is generally considered unethical and a conflict of interest for one therapist to play all three roles. 

The therapist cannot best serve the client’s, couples’, and family’s interests while wearing all three “hats”. 

Once a therapist tries to do this, they may (for example) feel obliged to keep secrets from one person in the couplehood or others in the family. This may reinforce the unhealthy dynamics of secrets and deceit that brought the clients to therapy in the first place.

Conflicts of interest create confusion, anxiety, anger and disappointment for clients. 

Keeping to ethical boundaries is more likely to ensure that the therapeutic journey is not sabotaged. 

Unethical conflicts of interest also arise if a client is seeing two different individual therapists.

Broadly, therapists are obliged to decline to see a client if they already have an individual therapist they are actively working with. 

Having two therapists engaged in the same work exposes clients to confusion, anxiety and conflict, and is likely to disrupt a client’s progress in their therapeutic journey. 

If you are considering seeing two therapists for individual therapy, it would be helpful to clearly articulate why you think this will assist – and to discuss this openly with the therapists.

Some clients may change therapists to “find the right answer”; the “best answer”; or the answer that fits their “view of the world”. That “view” may be the same “view” that has been causing them the trouble – and motivated them to seek therapy in the first place. 

All this is worthy of open and honest discussion and exploration. 

Another situation in which other therapists may be involved occurs when a client has an individual therapist and also attends group therapy. Group therapy can be a very effective way to continue the therapeutic journey, once progress has been made in individual therapy. 

Again, therapists commonly use specific modes of therapy for groups. 

 

Working with Multiple Therapists 

If you are working with multiple therapists, it is helpful to let them know who else you are working with, and what goals you (e.g. as an individual, couple or a family member) have agreed to pursue with the other therapists.

From time to time, it will assist to share with your therapists what you took away from the other therapy sessions, how the sessions are progressing and what plans you have agreed with the therapists.

It is always open to you to ask the therapists to communicate with each other and to coordinate treatment. 

It is also your right to maintain confidentiality and not to coordinate treatment – but “dovetailing” these different therapy sessions is more likely to help optimize your outcomes.

The Promises Healthcare website provides assistance to clients to identify their issues and provides photographs, names, languages, qualifications and experience of the specialists who can assist: https://promises.com.sg/about-us/our-team/

We hope that you will be able to find the right help from us.

 


  1. Horvath, A.O., Del Re, A.C., Fluckiger, C., and Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48, 9-16. Doi:10.1037/a0022186
  2. Duncan, B. (2014). On becoming a better therapist – evidence-based practice one client at a time. (2nd Ed.) Chapter 1, pp.23-24. The American Psychological Association, Washington DC. 
  3. Stiles, W.B., Barkham, M., Mellor-Clark, J., & Connel, J. (2008). Effectiveness of cognative-behavuoural, person-centred and psychodynamic therapies in the UK primary-care routine practice. Psychological Medicine, 38, pp 677-688. Doi:10.1017/S0033291707001511
  4. Benish, S.G., Imel, Z.E., & Wampold, B.E. (2008). The relative efficacy of bona fide psychotherapies for treating post-traumatic stress disorder: A meta-analysis of direct comparisons. Clinical Psychological Review, 28, 746-758. Doi:10.1016/j.cpr.2007.10.005. 
  5. Duncan, B. (2014). On becoming a better therapist – evidence-based practice one client at a time. (2nd Ed.) Chapter 1, pp.9-12. The American Psychological Association, Washington DC. 
Benefits of Family Therapy in the Caregiving Process

Benefits of Family Therapy in the Caregiving Process

When one has to live with debilitating chronic conditions or even degenerative disorders, it is natural that we place emphasis on seeing that the afflicted recover and receive the appropriate management. As our society rapidly ages, the number of elderly living with medical conditions or dementia is also increasing exponentially. However, the care should extend beyond the patients themselves. More often than not, there are other individuals involved, including family members and friends dedicated to supporting their recovery. Is it time we acknowledge their efforts and ensure they are coping well? 

 

Caregiving can be exceptionally draining – both physically and emotionally – when a family member becomes a patient at home. Needless to say, we are unable to predict such unfortunate circumstances, and caregivers are often thrown into their roles without prior knowledge and preparation. This leaves them with no choice but to adapt and pick up new skills in order to commit to their caregiving responsibilities. However, this can take a toll on the primary caregiver as well as family relationships. 

 

With a large part of their time allocated to caring for another person, caregivers are much more susceptible to fatigue and prolonged stress, with little or no time for self-care. It can be a big problem if the caregiver feels that there’s no support – family and social relationships can be compromised, thereby further reducing any support network that a caregiver can receive. This can lead to burnout and immense feelings of helplessness. 

 

A survey by the Singapore Management University (SMU) with the support of Caregivers Alliance Limited (CAL), Enable Asia and the Singapore Association for Mental Health (SAMH), reveals that 3 in 4 caregivers are tired and exhausted caring for a person with mental health issues. Furthermore, the Family Caregiver Alliance estimates that close to 20 percent of family caregivers suffer from some form of depression. In addition, mental health disorders are even more common among dementia caregivers. A study conducted on mental health issues in those caring for Alzheimer’s patients found that the prevalence of depression was an alarming 34 percent, anxiety was 43.6 percent, and the use of psychotropic drugs was 27.2 percent.

 

Some other common problems that caregivers face include (but are not limited to):

 

Mental health concerns Physical health concerns  Secondary Stressors
  • Depression
  • Anxiety
  • High rates of negative affect including guilt, sadness, dread, irritation and worry
  • Ambivalence about care
  • Witnessing the suffering of relatives
  • Feeling isolated or abandoned by others
  • Anticipatory grief
  • Fatigue
  • Sleep problems
  • Risk of illness, injury, mortality
  • Adverse changes in health status
  • Dysregulation of stress hormones

 

 

  • Work/employment (e.g., reduction in work hours, family to work spillover, and work to family spillover)
  • Financial strains
  • Relationship stress
  • Loss of time for self-care
  • Reduced quality of life

 

 

 

This is where family therapy comes in. Families might find therapy useful when they are adapting to a major change in the family such as dealing with a chronic illness or death in the family, or conflicts between family members in the caregiving process. Family therapy is a method to engage family caregivers in active and focused problem-solving approaches related to family caregiving to improve the quality of care, reduce burden and improve family functioning. Family therapy for caregivers, in particular, encompasses six core processes – naming the problem, structuring care, role structuring, role reverberations, caregiver self-care and widening the lens. Therapy is conducted in a way that is tailored to each household. Depending on the needs that caregivers and their families must address, the aspects that are challenging them will become the focus of intervention. Not covering all six areas doesn’t mean that the therapist isn’t taking a comprehensive approach – the core processes simply act as a guideline, and do not imply a rigid prescription of intervention work. 

 

Conflicts and resentment often arise for anyone in the role of family caregiver, and these are exacerbated when trying to share tasks with siblings or other members of the family. Many a time, caregivers tend to bottle up their feelings and put up a positive front so as to avoid passing on any negative feelings to their care recipients. However, this can be extremely detrimental to their own mental and physical health in the long run. The main part of family therapy for caregivers, therefore, involves helping the caregiver and family members sort through challenging emotions and reach resolutions. Speaking about your feelings can help you find comfort, and allows you to gain further insight and through the guidance of the therapists, various emotional-coping strategies. Implementing them will certainly take some weight off your shoulders, and perhaps give you some enlightenment with regards to discovering new problem-solving strategies. 

 

Undeniably, caregivers will benefit tremendously from any assistance in their caregiving responsibilities from family members. Family therapy is extremely beneficial in helping to improve the interactions and support network among family members, especially in providing new perspectives on problems that are seemingly unmanageable (part of which involves building trust, mutual respect and openness). This hence reduces the level of stress within the family and the level of caregiver burden, on top of enhancing communication skills and boosting a positive sense of empowerment. 

 

Family therapy is focused on achieving precisely what is best for the whole family and its cohesiveness, and sorting out obstacles or issues challenging the family dynamics. It is important that you take the important step toward seeking help from professionals in order to achieve a better quality of life for yourself and your family. 

 

While face-to-face consultations are the norm, we understand that as caregivers, you may be faced with time constraints or other concerns. Thankfully, with technological advancement, virtual consultations are also becoming increasingly popular. They are equally effective and allow for more individuals to connect with their family therapists with greater ease. Of course, the decision is entirely yours to make. If you find yourself struggling, or simply feel that you need a trustworthy individual to speak to, feel free to get in contact with us

 


References:

  1. https://news.smu.edu.sg/news/2020/12/09/3-4-caregivers-persons-mental-health-issues-highlight-need-temporary-separation#:~:text=This%20survey%20by%20the%20Singapore,person%20with%20mental%20health%20issues. (Accessed 16/03/2022)
  2. https://au.lifestyle.yahoo.com/caregivers-take-care-of-person-with-mental-health-condition-help-wellness-031845657.html (Accessed 18/03/2022)
  3. https://www.apa.org/pi/about/publications/caregivers/practice-settings/common-problems (Accessed 18/03/2022)
  4. https://www.apa.org/pi/about/publications/caregivers/practice-settings/intervention/family-therapy (Accessed 18/03/2022)
  5. https://www.agingcare.com/articles/counseling-for-caregiver-burnout-126208.htm (Accessed 18/03/2022)
Family Therapy 101 in the context of the pandemic.

Family Therapy 101 in the context of the pandemic.

The year 2020 saw a rise in uncertainties. Many have experienced anxiety, job loss, a strain on finances and family relationships due to the impact of the pandemic. By default, couples need to adjust to working from homes, with blurred boundaries between work and family, lesser personal space and challenges in new routines. They may not have readily communicated effectively about their roles, given the constant changes in adjusting to tightening and lifting measures.  Coupled with the labour crunch, families may find it increasingly formidable or costly to hire a helper to care for children, who are required to stay home for home-based learning or the care of elderly parents who may be weak and frail.  This may inevitably lead to unresolved conflicts between the couple due to the stress and demands of constant transition and change. In 2020, a survey for mums showed that 60% of the participants rated their stress level at a 7 out of 10. In addition, 3 out of 10 of the participants felt sad most of the time.   

Children and young people are not spared from the raging wave of anxiety. According to a survey conducted by Focus on the Family, kids are more anxious about exams than Covid 19 (The Straits Times, 18 Sep 2020). However, in an international study of 72 countries (including Singapore), only 6% of teens share their problems with their families (Impact of the Pandemic on Family Life Across Cultures 2020, Namad Bin Kalifa University). No wonder the CEO of the Institute of Mental Health says that “Gen Z faces different forms of stress, maybe more anxious, depressed than others before them (Today, updated on 1 Mar 2021).” President Halimah also urged Singapore to step up efforts to protect children’s mental health early (The Straits Times, 2 Dec 2020).    

Given the tremendous stress that kids and adults are facing, families are stretched very thinly. Therefore, they ought to rise above their concern of seeking a mental health facility to deal with their issues early, so that family members can get the professional help they need.   

It is timely for the family to consider attending family therapy to address and deal with the mental well-being issues, be it stress or anxiety collectively.   

You may have some questions about family therapy, and here are some FAQs that seek to answer your questions. 

 

Why Family Therapy? 

Having to deal with unhealthy family dynamics constantly puts a toll on one’s mental wellness. Family therapy focuses on improving family communication; it deals with family conflicts, seeks and creates better functioning and environment. It provides family members with an opportunity to talk about how they think and feel, being affected by the issue they face. It enhances skills to facilitate healing. Therefore marriage and family therapy are essential. 

Family therapy shifts the focus from blame, diagnostical lens, linear causality, and looks at circular causality in an issue. For example, a teen who exhibits school refusal may be staying home because of his worry and caregiving role to his mum, who is in chronic health and has a strained marital relationship with her spouse. It helps the family understand the issue confronting them in the family context and the larger contexts, i.e. the pandemic. 

Family Therapy is often used to help treat an individual’s problem that has dire effects on the entire family, i.e. depression, anxiety and behavioural issues. This type of psychotherapy is also helpful in addressing family-centric problems, i.e. conflicts between spouses, siblings, parents and children. 

 

What is Family Therapy? 

Family therapy is psychotherapy designed to identify family patterns that may have contributed to behavioural or mental well-being concerns. The idea is to help family members break those habits as the family therapist involves the family in discussion and problem-solving. 

 

What can I expect when my family and I attend a Family Therapy session? 

During family systems therapy, the family therapist works individually and collaboratively to resolve their issue, which directly affects one or more family members. Each family member has the space to say what they think and how they feel as the issue affects them. For example, when a teen has anxiety issues, a family member gets to talk about how this issue impacts them.  

 

How long is each session and how long is the therapy period? 

1.5 hours per session over a period of 4-8 sessions, subject to review with your family therapist. Family therapy is a specialised counselling process. No one is a miracle worker. It takes time and commitment for the family to work through their issues. 

 

Are family therapists trained? 

Yes, systemic family therapists are trained with a Masters in Family and Systemic Psychotherapy, a specialised skills competency in systemic couple and family work. It draws on systems thinking and views the family as a unit. It evaluates the parts of the system (individual) in relation to the whole (family) and examines how an issue of one or more members of the family affects the whole family. It suggests that a family member’s behaviour or issue may be embedded in the family dynamics and influenced by the family of origin issues. 

Family Therapists would have undergone at least 560 hours of academic instruction and supervised clinical practice, accompanied by years of experience. 

 

When should my family and I attend Family Therapy?

It is always helpful to seek family therapy early before the issue snowballs and becomes more difficult or complicated to manage at the later stage. 

 

Who should attend Family Therapy? 

Immediate Family members in a family nucleus should attend Family Therapy, i.e. couples, parents, children (includes teens and adult children) siblings.

 

Does my whole family need to attend? What happens if I am unable to get all my family members to attend Family Therapy? 

It will be helpful if your family can attend therapy together. However, it is okay if not all family members can turn up for therapy. The family therapist will collaborate with the members who come for therapy sessions. 

 

How do I prepare for Family Therapy? 

Discuss with your family members about attending therapy together. Think and write down what you want to discuss before each session. Then, ask your family therapist how you want to improve the communication in the family. 

 

Is there confidentiality? 

Yes, the session is confidential under the Singapore Data Protection Act 2012 (“Act”). 

 

Where can I attend Family Therapy? 

Promises Healthcare provides family therapy service, so feel free to visit our website or contact us at Tel: 6397 7309 to make an appointment. 

To Forgive Others, Is To Set Myself Free

To Forgive Others, Is To Set Myself Free

Written by: Dr Terence Leong, Senior Consultant Psychiatrist, Promises Healthcare

Translated by: Christian Tan

First published on Wan Bao Fu Kan on 31 May 2020.


 

“I forgive you.” while on the surface seems to be an innocuous word and easy to say. But in reality, it’s one of the most difficult words to express in our human language. A few years ago, a middle-aged man angrily dragged his 13-year-old son to our clinic, it turned out that Mr Zhang (pseudonym) had discovered his son hiding in a corner of his room smoking, and slapped the boy hard in a fit of anger. Even after being scolded the boy was recalcitrant and didn’t even feel remorseful. In her efforts to appease the situation at home, his wife suggested bringing the son to see a counsellor.

On that day, I happened to walk past the therapy room. I could only hear the loud arguments between the father & son, and loud sobbings of the mom. Just as I stepped into my office, my office phone rang. It was an urgent call from my colleague, the therapist, who alerted that the situation was getting a bit out of hand, and asked for my assistance in the therapy room. Upon arriving at the scene, I could hear the son’s angry retort, “You’ve never loved me since young, why are you trying to control me now? All you’ve ever done was scolding me. So what if I behave myself? Would you even notice?”

It took more than an hour to calm all parties down. After which, I carefully interviewed both Mr Zhang and his son, and I finally got to the root of why the situation had become so tense between father and son.

It wasn’t the 13-year-old boy who had caused the breakdown in their relationship. The issues stem from painful experiences when Mr Zhang was growing up. Mr Zhang had grown up with an abusive father who was not only alcoholic and chain-smoked, who often vented his anger on his wife and children. As a result, Mr Zhang made a vow from young to never touch alcohol and cigarettes. Unfortunately, his demeanour also became very stern with hardly any smile on his face and had high expectations with his own children. Why did it become like this?  It was because he had never forgiven his own father. The deeply buried hurts had made him prone to irritability, and thus he didn’t know how to praise or encourage his own child, and only knew strict discipline as his way of bringing up his child. Moreover, his biggest worry had been over his child coming into contact with alcohol and tobacco.

Mrs Zhang explained, her husband was a good man, but was a man of few words, and was not good in expressing his feelings. She knew that he really cares about the child, but it was a pity that communication was poor between the father and son. As a result of a craving for his father’s love and experiencing scolding and punishment from young, the boy had grown to become more rebellious in recent years.  

In fact, Mr Zhang’s father had quit smoking and drinking for many years. However, as a result of the poor relationship between Mr Zhang and his father coupled with a break in communications for more than a decade. Mr Zhang couldn’t come to terms with my conclusion initially. But for the sake of his own son, he finally agreed to receive counselling. After several months, he finally understood the root cause. He asked me, “I’ve finally understood that the root cause of my frustrations was the unresolved anger and hatred towards my own father, but what should I do after so many years?”

Fortunately, one day his mother decided to visit their grandson together with his father. Although he felt embarrassed initially, Mr Zhang struck up his courage, squarely faced his dad and said: “I forgive you.” This simple yet miraculous sentence seemed to untie the knots of anger and hurts between Mr Zhang and his father. From that day onwards, Mr Zhang began to smile more frequently face and he could finally express his love fully to his son. As a result, his son stopped being rebellious. Not only did he stop smoking, but also paid more attention to his studies.

As a psychiatrist, I’m truly happy for this family and admire Mr Zhang’s courage in forgiving his own father. They continued with counselling for some time, and finally mended their father and son relationship that was formerly broken.

Therefore, forgiving others is also giving ourselves a chance to receive complete healing.

Coping With Difficult Family Members (Including Parents, Spouses & Siblings)

Coping With Difficult Family Members (Including Parents, Spouses & Siblings)

Written by: Dr Mark Toh, Consultant Clinical Psychologist

 

It is a reality that we can choose our friends. If at times we find them annoying, we can always choose to make adjustments or even terminate the friendship if needed. But unfortunately, we cannot choose our family members. As such, it can be a challenging and sometimes very difficult situation when family members are emotionally unhealthy and they have not sought help to address their own difficulties. 

 

Instead, by having to live with them as members of the same family, they become a regular source of mental distress. This can pose a particular burden for minors, or those still dependent on the difficult member as the financial source of living, or during the current coronavirus lock-down imposed by the government when family members are confined together. In some cases, especially when violence and harm is a possibility, these unhealthy members can become damaging or dangerous and more drastic action may need to be taken to promote safety.

 

For the child, this may be confusing if the source of difficulty from parents are due to attempts to parent or from inappropriate control. Or they may have siblings who like being bossy to their siblings. Here are some signs to consider in trying to differentiate healthy from unhealthy behaviours from difficult family members. 

 

They are always blaming you while not accepting their own responsibilities.

Individuals who engage in unhealthy relational behaviours often have difficulty taking ownership for contributing to the problems that emerge between each other during disagreements or conflict. Their need to blame others is usually a defensive response against accepting their own guilt or responsibility for their fault or wrong in the situation. 

 

They are always critical towards you. 

Unhealthy family members also often present themselves as critical. This goes beyond a simple discussion to point out about errors if or when you or someone else has made them. But it appears more as a pattern or their habit in regarding you as a target of contempt. Words that undermine your character are often expressed. It is also often expressed regardless of the many accomplishments you may have achieved. It is often an expression of projection that reflects deep resentment or the unfulfilled wishes of the parent on a family member. Sometimes it is a resentment shared between both parents and projected on a child who they have identified as the “scapegoat”. The scapegoat in unhealthy families are usually children who are targeted for blame because the parents need to fault the child to avoid taking ownership of a problem.  

 

They are dismissive of your feelings. 

A healthier family is more prone to being encouraging or supportive especially in difficult times. But the unhealthy family member is often unconcerned of your feelings or even your opinion. The extent of their dismissal of you may show up as disagreement with you even if you are right. In severe cases, if you attempted to approach them to resolve a disagreement, they may even resort to convincing you as the problem. In this focus, they could convince you to see that you are the problem rather than to problem-solve in search of a solution that has mutual benefits.

 

They often make threats.

Physical altercations are not the only signs when the relationship or behaviour is unhealthy. Making threats especially when repeated is often employed as a means of control. This is going beyond anger which is a common feeling within long-term relationships. Anger is a sign when someone feels offended, frustrated or hurt. But the use of threats goes beyond anger to become an instrument of intimidation or domination, and a misuse of power. It is a common  behaviour of abusive individuals.

 

They are controlling.

There is a difference between control from healthy parenting and unhealthy parenting. Healthy parenting is focused on what is in the child’s best interests. When discipline is exercised, it is done to facilitate learning for the child. In unhealthy parenting, control is displayed more because it is primarily attentive to the parents’ wishes and not in the best interests of the child. This is often expressed when the parent becomes forceful and induces fear on the child so that the parent can feel powerful or have his or her way. This control can also be applied between couples or siblings. The family member is expected to take the role of submission in their engagement for the controlling person to be pacified. 

 

Additional signs for concern in this area is suggested by (a) prohibition of personal decision-making that is good for the family member, (b) issues of appropriate concern are denied from being raised for discussion, (c) material resources such as money or food are used to manipulate the family member towards submission, (d) there is direct restrictions into personal choices pertaining to clothes, appearances, spending, friendships, or even use of time, and (e) there is an opposition towards the family member becoming independent, to be separated from the unhealthy individual, or for the family member to be individuated (mature to become their own person) over time. Between couples, a controlling spouse is often violating the boundaries of his or her spouse. It is as if the controlled spouse is not allowed to be free to exercise his or her own choices.

 

They confuse punishment with discipline.

Discipline is the means to teach someone to abide by a code of conduct, or correction for a child to learn right from wrong. But for the unhealthy individual, punishment or discipline occurs when there is no lesson to be learned. It shows up usually because the person is unhappy for some reason. Their need to lash out is their attempt to vent out their anger or rage even if it becomes hurtful to others, and they feel justified conducting themselves this way. At other times, this punishment is expressed through passive aggressive behaviours when “silent treatment” is employed instead of yelling or shouting. Or the punishing behaviour is excessive and disproportionate to the action or event.

 

Unhealthy parents take sibling rivalries or ‘misbehaviour’ to the extreme.

This usually occurs when the unhealthy parent is resentful of all his or her children. They may feel that having children (or marriage) have become a personal cost to them because of the responsibilities required for the care of the children. They feel prevented or deprived of their freedom and so the children or family member are to blame. Or this could show up with a parent showing favourites to one child over the others. In the course of sibling rivalry, the unhealthy parents is revealed by (a) blaming one child more severely over the other and consistently, (b) humiliating the scapegoated child, or (c) the unhealthy parent experience the sibling rivalry or conflict as a personal or vindictive act against the parent.

 

Strategies for Coping with Unhealthy Parents or domineering spouses and/or siblings

It may be a sad reality that parents can consider themselves parents simply because the infant is born following his or her physical birth. But beyond the biology, the emotional maturity, readiness or mental health can often be found lacking in parents to create the healthy conditions for the infant to develop or thrive. Controlling family members who are narcissistic in nature are also more interested in their control than the well-being of others. When family members regularly display the above behaviours, there is a need for concern. Given the potential for mental distress, developmental disruption and suffering, the following strategies may be essential to assist in coping.

 

Know that you are your own person.

Although you may share some traits or the same family name with your parents, remember that you are not 100% of the same people who raised you. If you recognise that your parents are emotionally unhealthy, understand that you do not need to follow their same values or behavioural patterns. When you realise that you have been hurt by them repeatedly and their use of authority serves their own interests over your needs to develop in a healthy way, be ready to break away from their self-serving values to work towards a healthy development for yourself. Explore to find healthy models of functioning among others to seek their influence over your lives rather than what is practiced at home.

 

Create space for your own emotions to nurture your own sense of self.

The unhealthy parent, spouse or sibling often do not respect your personal boundaries. They may deny your personal space or your feelings because they are preoccupied with their own. They may not discuss matters out or they may attempt to deny an essential part of who you are. While they deny how you may feel in their relationship with you, this does not mean you cannot acknowledge or express your own feelings by blogging or journalling.

 

Find supportive relationships elsewhere.

When your family members have made themselves unapproachable, you can turn to others for support instead. Friends, teachers, counsellors, or colleagues are often available to relate to who engage with a healthier appreciation for you. You do not need to go through difficulties alone. So find a support system from those who appreciate you for who you are and who value you in the person you can become.

 

Understand that your parent, spouse or siblings may have narcissistic tendencies or a self-serving biases so set your expectations low in conversations with them.

Unhealthy parents, spouses or siblings highlight the need to understand mental illness. Having to engage family members who have already discounted you, or hold you in contempt is often more reflective of them than of you. For this reason, understanding if they have a narcissistic or anti-social personality or tendencies is useful to recognise their biases. You may wish to have deep, meaningful or respectful conversations with them. But since this is not possible for those who are narcissistic or anti-social in nature, keeping exchanges brief and light is best to minimise stress or conflict.  

 

Be prepared to employ diversion tactics in conversation.

Being diversionary may not be appreciated in social circles. But if your family member is controlling or looking for conflict, having a mutually respectful conversation may not be possible. As such, their attempts to dominate or argue can be diverted. For example, if they choose to criticise your choice about what you bought, you can note their comment while affirming your choice. Then this can be followed up by you changing the topic. This may allow you to have some control while you may be under attacked.  

 

Recognise the traits that make you an easy prey.

For some, the need to dominate can be influenced by their perception that you have difficulty standing up for yourself. Their view that you are unable to be firm in protecting yourself may appear as an invitation to them to bully or dominate. Learning to stand your ground will help to establish yourself as deserving of respect.  

 

Expect their angry response but do not surrender to it.

Your attempts to hold your ground or establish personal boundaries may be seen as a threat to the controlling parent or spouse. They see it as a challenge to their need to dominate or control. As such, anger can be employed as their weapon. It is important to not be paralysed by the person and to remember that you still have power. This power may not be accepted by them but you have power nevertheless. You can continue to pursue what is clearly in your best interests despite the threats and anger they express. Choosing the right timing to pursue your interests with them may be required. Or being able to refer to the credibility of someone else with authority on the subject may be helpful to borrow these views to help you to hold your position. 

 

Aim to be self-sufficient and independent.

The need to establish your healthy sense of self and personal integrity is important. Your own mental health depends on it. In the face of parents or family members who are clearly focused against your best interests in pursuit of their own interests, you can set goals to be financially independent in order to become autonomous with what is needed to establish your own integrity and identity. Unhealthy parents often employ money as a means of keeping the child dependent. As such, learning to budget and be self-financing will help to establish your independence from them.

 

Do not accept abusive behaviour and the effects of it.

Recognising the signs of mistreatment from abusive parents, spouses or siblings should allow you to feel the anger you have reason to feel. Often these people may also engage in seduction or manipulation to downplay their dysfunction and hide their mistreatment of you. Being able to recognise their self-serving bias and the potential damage that this can create is important to not allow them to justify it. If their mistreatment is justified, it is more likely that you could minimise the damage and practice it yourself.  

 

If the abuse is persistent or violent, be prepared to get help and seek shelter and protection outside the family. 

This is hard to do for children but the sad reality is that some parents are poorly prepared to parent or they are mentally ill when they decided to have children. It is a sad and tragic reality that children have died from neglect, abuse or mistreatment while in the hands of their parents or caregivers. Children have been starved, exploited, tortured in the hands of violent, mentally ill parents. This has also occurred between couples as indicated by one spouse being regularly abused by another. Abuse can be physical, emotional and/or sexual, and they can happen between couples and on children within a marital or family system. If only one parent is aggressive or violent, the other parent has to be prepared to seek shelter to protect themselves or their children. If in the case of one parent being violent and the other parent ignores the child being abused, the children need to be protected from both parents.

 

This article is a call to alert those who may be suffering within families. Tragically, there are hidden dangers that vulnerable family members may be exposed to. They may already be suffering in subtle or obvious ways at the hands of unhealthy, abusive or emotionally damaging family members. Our collective concern for the weak calls out for us to be sensitive to when this danger is present within our community to protect the vulnerable among us.

 

 

 

References:

Faubion, D. (2020, Apr). Toxic family dynamics: the signs and how to cope with them.

Chen, C. (2015, Feb 25). What to do when the toxic people in your life are (unfortunately) your parents. The Huffington Post.

Streep, P. (2016, Dec 14). 8 strategies for dealing with the toxic people in your life. Psychology Today.

Thorpe, J. (2015, Sep 18). 7 tips for dealing with toxic parents. Bustle.