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When Therapists Encourage Family Cutoffs...Are We Helping or Harming?

by Dr Joshua Coleman

Jeremy’s parents divorced when he was three. For the first two years after the divorce, Jeremy saw his father every Tuesday and every other weekend, but this decreased dramatically when his father remarried and moved to Nevada, where his new wife’s family lived. At that point, the custody arrangement switched to one week during the holidays and one month over the summer. His mother, Sherry, didn’t remarry because she didn’t want to introduce more men into Jeremy’s life. Her mother had done that when she divorced Sherry’s father, and she’d vowed never to repeat that behavior with any child of her own.

Sherry had struggled with depression much of her life, and suddenly being a single mother with a small child and little spousal support didn’t help matters. She couldn’t afford therapy to ease her depression, so she worked hard, read parenting books, and paid attention to the advice offered on shows like Dr. Phil, Dr. Laura,and Oprah. Plus, Jeremy was a quiet kid who kept his head down, did his studies, and didn’t give her any trouble, even as a teen. And because he was a good student, he was able to get a full scholarship to a decent liberal arts college in the Midwest.

But their relationship started to change when he went to college. When he first arrived, Jeremy called or texted his mother once a week to let her know that he was doing okay and making friends, since he knew that she was a worrier. However, that very quickly tapered off to once a month, as he became involved in his schoolwork and new social life. He eventually stopped responding to his mother’s calls and found himself feeling burdened by her complaining and personalizing his distance. The more that she complained about his unavailability, the less he wanted to talk to her.

His father had been reaching out to him again after years of little contact, and he found himself excited about the possibility of reestablishing their relationship. After a difficult breakup with a girl in his dorm, he started seeing a young psychologist, referred to him by the counseling center. As part of their work together, the psychologist told him that his mother suffered from narcissistic personality disorder. He also recommended that Jeremy take a break from his relationship with her and focus on himself.

By the time that Sherry contacted me, Jeremy hadn’t spoken or written to her in almost two years. I emailed Jeremy to see if he’d be open to talking with me about his mother.

He responded right away, and we spent a session talking about his mother on the phone.

I liked talking to him. He seemed thoughtful, insightful, interested in his own psychology. While he was critical of his mother, it was clear that he also cared about her and didn’t want her to suffer. I also discovered that his therapist was a bigger obstacle than were the criticisms of his mother.

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Therapists can do a lot of damage. We can encourage a divorce from a spouse who’s more amenable to change than we realize, harming the lives of the client and her children. We can encourage someone to stay in a marriage that creates ongoing depression for him or his kids. We can support a parent who cuts an adult child out of a will, without confronting how much he has contributed to the child’s negative behavior. We can support an adult child’s decision to end a relationship with a parent without being sensitive to how that decision may affect the client, his children, and the parent who’s being cut off.

Perhaps a more important problem than blind spots resulting from our inexperience, unexamined prejudices, or limited orientations, is that therapists’ perspectives often uncritically reflect the biases, vogues, and fads of the culture in which we live. If you were a therapist in the 1950s and a woman showed up at your office claiming she was unfulfilled in her role as a mother and housewife, most likely your goal would not be to propel her into a career or into more meaningful activities outside of the house. Instead, you would investigate what prevented her from being happy with what made other women, ostensibly, so contented. Her boredom or lack of fulfillment with domesticity, an ideal at odds with the culture at the time, would be viewed as a neurosis to be treated with medication and psychoanalysis.

This example is just one in a long history where psychotherapy and the medical community labeled perfectly natural discontents with or reactions to prevailing social arrangements as “diseases” that must be treated, rather than issues that must be addressed. Here’s another: In 1850, Dr. Samuel Cartwright reported in The New Orleans Medical and Surgical Journal the discovery of a new disease, which he called drapetomania. Drapetomania was a condition that caused sulkiness, dissatisfaction, and a desire to avoid service. It was used to describe slaves who sought to run away from their servitude: drapetes, the ancient Greek word for “runaway slave,” and mania for “excessive energy or activity.”

These examples demonstrate how the failure of therapists to challenge the social, economic, racial, and gender norms of their time led them to translate adaptive behaviors, or at least understandable discontents, into illnesses. Today’s therapists continue this tradition by failing to critically examine new cultural and societal trends that often serve to lessen wellbeing and increase family conflict and division.

One of the more profound ways that our culture has changed in the past century is in its embrace of the individual as separate from the family and the community at large. Today’s culture of therapy both reflects and contributes to our nation’s ever-growing embrace of individualism. While prior to the 1960s, the aims of psychotherapy were generally to encourage people to conform to the institutional dictates of the time, today’s therapists and self-help authors want to help their clients become more resistant to the forces of guilt, shame, and worry about others that stand in the way of their developing their talents and pursuing their dreams. To that end, family members have increasingly come to be viewed as facilitators of (or obstacles to) a fully realized life, rather than necessary and forgivable features in an imperfect existence. While the family was once where individuals located themselves in a chronological or social order, it now comprises the institution from which they must be liberated.

With the exception of parenting small children, encouraging individuals to feel some sense of obligation or care for family members is not typically on most therapists’ agendas. As a result, an adult child’s psycho­therapy can sometimes increase family conflict and distance. Unless a client requests help in having a better relationship with the parent, sibling, grandparent, or in-laws, most therapists worry that too much emphasis on the needs or feelings of the person outside of the room will be antithetical to helping their client focus on their own needs—which is, after all, the point of much therapy today.

As therapists, we hold up the ideal parent or family experience as a way to shine a light on what an adult’s life might have been if she’d had better parenting. This serves the purpose of helping our client to not blame herself for self-limiting and self-hating voices, and to allow her distance from parents and others whose contact tends to amplify that voice, rather than diminish it. It also allows a creative space to imagine what she might feel or accomplish without the critical voices, that may have brought her into therapy in the first place, whatever the origin.

Helping adult children see what they didn’t get and what they should’ve ideally gotten from parents is one of the biggest tools in a therapist’s tool chest, and one that I go to on a daily basis. An analysis of a client’s childhood is useful because parents and siblings can powerfully shape identity, self-esteem, feelings of trust or safety in the world, and later, one’s ability to parent. Psychotherapists can be efficacious teachers about the relationship between the adult child’s functioning as an adult and the family’s contribution to those inadequacies, deficits, or conflicts.

But there’s a downside to that. In so doing, therapists tempt adult children to feel contempt or even hatred for their parents. They may encourage their anger because anger is powerful: it can carry anger away from the self. In blaming others we’re relieved of the self-blame, the shame, and the guilt we feel about our defects and our failures. Anger is active: it can cause us to feel like we’re pushing back, rather than feeling victimized by the outcomes of our lives. But in the same way that hating the sin and not the sinner still involves hate, supporting anger or contempt for a parent doesn’t necessarily free the adult child from that from which they hope to be freed.

Family Therapy with Jeremy and His Mom

After speaking with me on the phone, Jeremy agreed to do a few sessions with his mother and me. Sherry was right that Jeremy was a kind, quiet person. But a kind nature can sometimes be a burden; it may overly weigh you down with feelings of guilt and responsibility for those you love. In my experience, sometimes the nicest kids have to become the most aggressive to reassure themselves they’re not responsible for another’s wellbeing.

I had counseled Sherry before our first family therapy session, attempting to prepare her for what was to come. I’d advised: Listen in a non-defensive way to whatever Jeremy has to say. Try to find the kernel of truth in his assertions, however hurtful they may be. Even if his words are at odds with your memory and self-reflections, try to hear it as his perspective and not a matter of right or wrong.

In my solo session with him, I recommended that he directly tell his mother what bothered him. Jeremy didn’t hold back. He didn’t dilute his perceptions or try to shield her from being hurt. It seemed as though he was waiting for this moment to get all of this off his chest, which I supported because I wanted him to get as much on the table as soon as possible.

“You chose to stay in bed with your depression when I was young instead of deciding to get up and fix yourself,” he began. “And as a result, I’ve had a much harder time knowing how to do basic things in life or prioritize my own needs in relationships. My therapist said that I was parentified by you and that you were emotionally incestuous with me growing up. That’s why I haven’t wanted to talk to you. I need to work on myself.”

I had wanted him to be direct. But I also knew that I would need to translate his words—products of his own therapy—which, undeciphered, sound like the worst kind of character assaults: “emotional incest,” “parentified,” “narcissistic personality disorder.” These, the flora and fauna of the Diagnostic and Statistical Manual, can sound pretty humiliating to those on the receiving end.

Softening the bite of psychiatric diagnoses is especially important, since they are now an active part of mainstream culture. We call someone “borderline” or “a total narcissist” when we used to say “jerks” or “assholes.” We might still call them that, but putting it in the context of a diagnosis sounds so much more authoritative.

While diagnosing is perhaps an unavoidable part of living in a society obsessed with personal growth and development, labels have consequences and can affect the behavior of those doing the labeling as well as those being labeled. In the same way that a diagnosis of cancer or Alzheimer’s may cause family members to increase—or, in some cases, decrease—contact, so too, can a psychiatric diagnosis affect people’s attitudes toward those to whom they’re related.

In this poignant example, Jeremy wasn’t exactly wrong in his assessment about what he didn’t get from his mother or how it may have shaped his life. There’s ample evidence that being raised by a depressed parent (most of the research is on mothers) can have a negative effect on the child. And he very likely did grow up feeling more responsible for his mother’s wellbeing than he might have preferred or than might have been useful to him—though there’s other research that shows that the strengths learned from that role can also be a positive. But he was blaming his mother for behaviors she would’ve done differently if she’d known how, or if she’d had the psychological or economic resources when she was raising him.

Do People Choose to be Bad Parents?

There is often less free will when it comes to parenting than most realize. Parents are as much under the throes of their genetic dictates, partner provocations, childhood traumas, financial threats, and community deprivations as are the children being parented. Sherry’s deficits in parenting stemmed not only from her own parents’ deficits, but also from her financial struggles, her genetic and environmental vulnerability to depression, and her lack of having another parent with whom to share responsibility raising her son.

Our current construction of causality in the family—where therapeutic discourses lead people to believe that choice is the organizing and guiding principle of life—often create more conflict in families than it solves. From Jeremy’s perspective, his depressed mother should have or could have just pulled herself up by her bootstraps, gotten out of bed, and marched herself into a therapist’s office.

Studies show that most adult children explain their estrangements based on the personal traits in the parent that caused their behavior, rather than contextual, economic, or cultural mechanisms. However resonant that causal framework is with American ideals, it fails to describe how depression works, how decision-making works, or even how choice works.

For the child under a therapist’s guidance to later look back and say that the parent should’ve known better or behaved differently—that they now deserve the distance, if not the contempt, they receive—is wrong. It suggests that the parent was handed a map for a geography that wasn’t yet charted when they were raising their children and given resources that were beyond their reach.

This is not to in any way minimize the enormous amount of damage—sometimes permanent—that problematic parenting can cause. Children raised by those who were emotionally or physically abusive, or neglectful due to mental illness or alcohol or drug addiction, know firsthand the pain that can be caused by parents. That pain can radiate out into all aspects of his life. Telling an adult child “I did the best that I could” may be small consolation to someone who suffered for many years as a result of the parent’s behavior. And it provides scarce motivation for the adult child to engage in a process of reconciliation. This is why I encourage parents to do due diligence on their children’s complaints and work hard to repair whatever harm was done.

Misdiagnosing the Parent

Jeremy’s therapist wasn’t wrong that his mother needed more love, caretaking, and tenderness than he could reasonably be expected to provide. Nor that the incompatibility of their temperaments may have created genuine suffering in him. But in my experience, many therapists misdiagnose a mother’s maternal depression as narcissism. Depressed mothers can be more needy, anxious, and sometimes disparaging. Therapists might interpret this depression as narcissism or some other personality disorder.

Carl Jung wrote that nothing affects children more than the unlived lives of their parents. I sometimes discover, underneath the contempt a client feels for the parent she has rejected, a deep reservoir of sadness for that parent and a longing for them to be happy.”

Did Jeremy’s mother have narcissistic personality disorder, as he and his therapist believed? She did not. More important, that diagnosis foreclosed the possibility that they could together build a bridge of understanding where Jeremy—without guilt or regret—could accept the limitations of what he could or should provide his mother and his mother could accept—without bitterness or complaints to her son—that his care and attention would never be enough to make up for the difficult hand that life had dealt her before and after becoming a parent.

Jeremy’s mother did deserve a better life. It just wasn’t necessarily her son who could provide it. And Jeremy deserved a better life, too. It just wasn’t necessarily his mother’s fault that he lacked it. Giving the mother a psychiatric diagnosis, especially one as outsized and definitive as narcissistic personality disorder, greatly oversimplifies her life and struggles; it devalues her years of love and dedication, however flawed; and it weakens the fabric of connection that could otherwise have existed. She deserved a different narrative, one that was deeper and more compassionate, that saw her less as a freewheeling agent, more as someone responding to what life offered her from what she had to offer in return.

Carl Jung wrote that nothing affects children more than the unlived lives of their parents. I sometimes discover, underneath the contempt a client feels for the parent she has rejected, a deep reservoir of sadness for that parent and a longing for them to be happy. The parent’s sorrows, frustrations, feelings of inadequacy become so burdensome that the child doesn’t know any other way to shed that weight other than to write her off. As author Andrew Solomon wrote in Far from the Tree, “There is no contradiction between loving someone and feeling burdened by that person; indeed, love tends to magnify the burden.”

What some adult children find oppressive about their parent may not be the parent’s personality disorder, as is so commonly highlighted in therapy offices and on forums, but the weight of their own feelings of empathy.

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For the adult child, the decision to estrange the parent, however painful, is nonetheless tied to a narrative of liberation from oppressive forces and the pursuit of happiness. There is no equivalent upside for the parent. It’s all downside: failing at life’s most important task; being denied the valued reflection of oneself as a parent; feeling shame before one’s peers and family; losing not only the adult child, but often a relationship to cherished grandchildren. And for those parents who are all too aware of their parental failures, they also lose the opportunity to do for grandchildren what they couldn’t for their own children.

Jeremy’s mother had a hard time with the first few sessions. Her chronic depression made her less able to hear her son’s complaints as complaints and not as an attack on her fundamental worth. But, as often happens, her ability to just listen, reflect, and find the kernel of truth helped him to see that she was stronger than he had given her credit for. And it also helped when she was able to tell him that while she did miss him and would like to be in more contact, she didn’t need him in the way that he thought she did—to give her life purpose—and that it wasn’t selfish of him to be more focused on his own life and less focused on hers.

They talked about a way to be in contact going forward. It would be less than she wanted, but so much more than she had before.

Reconciliation therapy between parents and adult children is similar to couples therapy where one member is willing to call it quits. For those open to considering a deep examination of the foundational problems in the relationship, a marriage can sometimes be saved and, in many cases, made better than ever. The same can be said for estranged parents and their adult children.


Adapted from Rules Of Estrangement copyright © 2021 by Joshua Coleman. Used by permission of Harmony, an imprint of Random House, a division of Penguin Random House LLC, New York. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

Joshua Coleman, PhD, is a psychologist in private practice and senior fellow with the Council on Contemporary Families. Coeditor with historian Stephanie Coontz on a compendium of research on the contemporary family, he is also a cofounder of Standing Together, a center for advancing awareness of family estrangement.

Illustration © Stephanie Carter


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