Children of Alcoholism: The Struggle for Self and Intimacy in Adult Life

CHAPTER 6. Clinical Strategies for Use with Adult Children

6 CLINICAL STRATEGIES FOR USE WITH ADULT CHILDREN oNE OF my patients entered therapy in her early twenties in order to work through the suicide of her alcoholic and tranquilizer-dependent mother, who had committed suicide when my patient was 15. This young woman could never adequately mourn her mother's loss, because her father was completely unable to confront his own grief and deep sense of guilt over his wife's addiction and suicide. He blocked every attempt by his daughter to express sadness, rage, or fear about her mother 's death. This patient had received SOine brief psychotherapy for anxiety attacks at her university's counseling center, but she agreed with her therapist there that she needed to tackle some relatively deep issues about her mother that could never be resolved in a short-term therapy. The patient was an extremely intelligent and articulate young woman who worked in a paraprofessional helping capacity herself. Since she was so knowledgeable about mental health work and since she had found her previous psychotherapy so helpful, she was confused and troubled by the considerable anxiety that she experienced before meeting with me each week. Her extreme fearfulness made it difficult for her to share deeper feelings with me or even to look at me very often Clinical Strategies for Use with Adult Children 107 during our sessions. During the early months of this young woman 's therapy, she had a dream that explained this intense fear. In the dream, the patient showed her mother a small and fragile caged bird that was the daughter's pet. The mother reached into the cage, and the patient thought, "She is going to pet the bird." Instead of petting the bird, however, the mother grabbed the bird and crushed it. This simple, but terribly disturbing dream revealed the entire purpose of this patient's psychotherapy as well her terror of embarking upon it. Actually, the most fundamental purpose of psychotherapy with any adult child is to open a hidden, imprisoned , and extremely fragile part of the self, and convince it to allow itself to be touched by another person. But these patients all fear, as this one obviously did, that if they open the door to the heart of the self, it will be crushed by the therapist, just as it was nearly crushed by the insensitivity, abuse, or betrayal of the parent(s). Self Psychology and British Object Relations Theory prescribe a form of psychotherapy that searches out the hidden heart of the self in order to unify the psyche and allow the self to begin a new period of growth. They advocate an explicit clinical focus on the condition of vital psychic structures, especially their incompleteness , fragmentation, divisiveness, and defensiveness. Kohut, ofcourse, believed that psychic structure is selfstructure. He proposed that all psychotherapeutic interventions should address, and aim at increasing, the cohesion, vitality, and harmony of the self. The British theorists, and Kohut, believed that the fundamental condition of the self, as well as transient self states, are largely dependent on the quality of the relationships between the self and its objects. They held that impairments of the self can be significantly reduced, if the therapist responds to the frustrated longings of the self as the parents could not-with understanding, acceptance, and a willingness to work toward their ultimate resolution. 108 Children ofAlcoholism This chapter applies the tenets of British Object Relations Theory and Self Psychology to self disorders in adult children of alcoholics. It advances several general principles of psychotherapy that are designed to address, and redress, the critical failures of the alcoholic home. It should be noted that, while each of these principles describes a relatively discrete aspect of psychotherapy with adult children, they are all ultimately concerned with the provision of the calm, empathic, and strong selfobject environment that was largely unavailable to the patient during childhood. The Healing Environment: A Psychological Safety Net The adult child's feeling of psychological safety in psychotherapy depends on the therapist's capacity to convince the patient that he will not be subjected to the sorts of traumatic disappointments that were commonplace occurrences in the alcoholic home. Therapeutic error, as we have learned, is an unavoidable feature of clinical practice in psychology, and while many adult children are greatly disturbed even by the therapist's relatively small failures, these events can usually be turned to good use in the...