Years ago, I was referred a 15-year-old because of my willingness to work with high-conflict families. The family had spent more than a decade working with mental health professionals, and his behaviour had become so explosive that no one involved was willing to meet with the son and his parents together.
From the outset, it was clear that escalation worked. He had been born two months premature, and his mother had lived with the fear of losing him. That sense of his fragility was still present in their relationship. When he became highly distressed, she would soothe, accommodate, or back away from limits. His father was more authoritarian, and a psychologist had advised the father and son to avoid each other, which had increasingly pushed him out of the picture.
My work required me to hold two goals at the same time. I had to help the parents change what was happening around the behaviour. His mother had to stop rescuing him from the distress that followed limits, his father had to regain a legitimate parental role, and both parents had to learn to set and hold limits through the inevitable behavioural escalation. His escalation had to stop working.
At the same time, I had to maintain a strong enough relationship with him to help him understand why those limits were necessary, and help him learn to tolerate the feelings that came with them: disappointment, anger, grief, and fear of abandonment.
The therapist has to manage both carrots and sticks. Individual therapy can be insufficient when the environment is reinforcing the behaviour. Working with an adolescent in a family means working with both: helping the family change what reinforces the behaviour and set and hold limits, while helping the young person understand, tolerate, and eventually respect those limits.
The cycle repeated almost daily: the kid would blow up, his father would become angry and threaten to kick him out of the house, and his mother would move in to soothe him, intensifying the conflict between his parents. His siblings resented both him and their parents as so much of the family’s attention and energy became organized around his crises.
The change in this kid was profound. His relationship with both parents improved dramatically, and he went on to do well at school, in a summer job, and later in college. More importantly, he had developed a different understanding of relationships. He learned that frustration has to be tolerated, entitlement has to be examined, reciprocity matters, and other people are allowed to have boundaries.
He came to understand that if you want something from someone, they have to want to give it to you.
In one of my last conversations with him, we were talking about what had changed that made it so much easier for him to accept no without escalating. His answer captured the shift perfectly:
“I’m not entitled to their yes.”
That is the change I am looking for.
