The value of exploring patterns of relationships

A helper is interested in assisting another to discover what part they play in problem patterns.

When I first met Ahmed he explained the distress of being a father to a young adult daughter with a long history of eating disorders and impulsive behaviours. He and his wife Lina had supported many years of various treatments for their daughter Samira. Their focus had been trying to understand her diagnosis and finding a treatment that would fix her distressing symptoms.  I conveyed to Ahmed that I was willing to meet with him to lend a hand to his efforts to assist his daughter. His wife was also welcome to come to our sessions if she wanted to. It wasn’t necessary for Samira to attend. This was a great surprise and relief to him, particularly as his daughter was resistant to seeing yet another helping professional. His surprise was that I thought that just one family member, who is not the symptomatic person, can utilise help for themselves that can benefit the whole family. Ahmed and Lina started coming to meetings and piecing together patterns of relationships around their daughter. We worked like a research team examining descriptions of interactions and seeing what clues emerged to how interpersonal reactions had contributed to generating and maintaining their daughter’s difficulties. Over time Lina came to see how much she had focussed on assisting her daughter to cope with life challenges throughout her school years. She had been very sensitive to her daughter’s upsets and had taken on the responsibility of smoothing things over for her. Over the years she could see that Samira had become increasingly needy as well as entitled. She also saw that her well-meaning efforts to relieve Samira of any distress had left her daughter with little capacity for managing her own strong emotions. For Ahmed, the exploration of the relationship dance around Samira and Lina revealed that he had become passive and resentful as a parent. He was anxious not to impinge on his wife’s management of Samira and would only assist when Lina was at her wits end. At other times he stayed distant but was silently critical of what he judged as Lina’s overly soft approach. When he stepped up in response to Lina’s requests he would be excessively stern as a corrective to his view of his wife’s parenting. He and Samira would then get caught in conflict and Lina would step in to mediate. This left Samira caught in a confusing triangle with her parents. The pattern that was uncovered revealed that Samira had become accustomed to being rescued by her mother and dismissive towards her father’s reactive attempts at limit setting.

Questions that explore interaction

It took a number of sessions to clarify these repeating patterns between Lina, Ahmed and Samira. Questions were asked each session that focussed on how each person responded to each other. “How did you respond to Samira’s distress? What was her response? Then what happened? Who was involved in these upsets? How? What effect could you observe? How were you affected? What was your response? How did this impact your parenting partnership? How did this play out between you? What differences could you notice in how Samira responded to each of you? What do you notice is different in your response to your son when he’s stressed?” We rarely talked in detail about Samira’s individual symptoms. Rather we reflected on longstanding patterns of relating and how these patterns shed some light on ways Samira was struggling to mature and manage her life without depending on or opposing others. Ahmed and Lina could begin to see that their daughter was so caught in reacting to and leaning on her parents that she had not developed enough capacity to independently manage stress. Her symptoms revealed the overflow of her anxious self in her family.

Questions also focussed on important events in the family’s history and considered how these contributed to more anxious ways of relating. For example: What was going on in the family around Samira’s birth and early years? When did the family immigrate? Where was extended family during the early childrearing years? What were the circumstances of each grandparent’s health issues and the death of both grandfathers? When did Lina lose her job? What changed in family responsibilities with this loss of income? Every significant change in the family over time revealed a parallel of increased sensitivity to Samira and her struggles to cope at school. It was interesting to compare this investment in Samira with her older brother who had not been viewed as so vulnerable. Ahmed and Lina began to see that their son had developed more life coping capacities for himself without his parents trying to be overly helpful.

Broadening the view past individual diagnosis

Unlike previous treatment, which focussed on treating Samira’s symptoms with new medications and individual therapies, this helping process broadened the picture to viewing the family as a single system. If one person can change the way they are interacting, then others will make compensatory changes. Ahmed adjusted his reactionary parenting. He stopped trying to be the tough parent when Lina was struggling and instead worked to have a separate and consistent relationship with his daughter. His efforts were often clumsy and based on ongoing trial and error but he was keen to learn from each interaction about how he could better contribute to the well-being of his family. Lina determined to reduce how much attention she gave Samira during her struggles and to say “no” to her when she became excessively demanding. Every step was a challenge for both parents. They valued the opportunity in our meetings to review what they observed and experienced as they endeavoured to respond differently. Both parents were working on the part they had discovered they were playing in fuelling a regressive pattern with their daughter and each other. Samira had her part in it all as did her brother but the parents were helped to just focus on observing and modifying their part in the dance. A helping relationship that focuses on patterns or process is pivotal to enabling this. If the helper continues to ask about the content of opinions, symptoms and criticisms the parents would have remained blinkered in a narrower view of the problem without discovering pathways to bringing their best to their daughter, their marriage and their other important relationships.

From trying to change others to changing self

Ahmed had commenced counselling thinking that his wife and daughter needed to change. After exploring how each of them affected each other he appreciated that he had a contribution to the family problem. Rather than experience a sense of blame he felt a sense of agency as he had discovered something constructive to work on. It was important to him and Lina that they figured their own way through their problem patterns instead of being instructed to change. Both parents described feeling ‘back in the driving seat’ as parents. They could see gradual improvements in their daughter’s impulsivity which gave them hope that they could make a difference by being less reactive and having clearer positions as parents. Additionally they became interested in the influences of their families of origin and the sensitivities they had brought into their marriage and parenting.

A systems lens guides the helper

The focus on patterns is different to conventional ideas of helping that involve advice giving, interpretations or education about individual’s symptoms. I do need family systems theory as a road map to lead me in this questioning process about relating process. Questions are guided by an ability to identify common patterns of triangles, over and under responsibility and reactive conflict and distance. I have found the shift to asking questions starting with: Who, When, Where, What and How, is liberating as a helper. It reduces my responsibility to solve other’s problems. It keeps me from taking sides around people’s opinions. It prevents me from looking for a singular cause to a complex problem. It allows me to collaborate with others in learning about their particular ways of dealing with tensions in their life and relationships.

Even for the non-professional helper it is worthwhile to ask questions about how the other person is managing their difficulty and how this is played out in their relationships. For example when a friend wants to talk through a problem with a person at work, rather than ask about their view about this other person, ask about how they have been responding to the situation. When does it happen? Who is involved? How do they each get involved? What has been helpful in their efforts to deal with the challenge, what hasn’t been helpful? This can be of greater assistance to another than asking them to vent about their problem and speculate about cause. It can provide a person with an opportunity to think more broadly about their difficulty and gain perspective on how they can address what is within their control.

‘Helping to See the Part a Person Plays in Patterns Around their Problem’ – Jenny Brown