A colleague of mine who rents an office in my suite is trying to get a young adult into treatment, but was venting to me about how frustrating it is to be dealing with this young personās mother more than they are with the potential client.
This young adult missed their consultation call, which was set up on their website, so the therapist called and emailed but got no response. A few days later, there was a very angry email from this personās mother, whoād painted this picture to their mother that therapists are awful people who donāt reply to calls and that no one wants to help them. At the time, I grimaced and sympathized with the therapist and didnāt think much of it, exceptā¦ thereās a part two.
It turns out that the therapist and this young adult did actually speak, and the person asked about seeing the client at 6 pm on a Tuesday, which wasn't available. The therapist said they could put the person on a waitlist or consider other times and days that might work; they also put this in an email.
Guess who called over the weekend?
Yup, Mom called asking if she could facilitate getting her child, who, by the way, is closer to their mid-twenties, into treatment because their kidās āexecutive functioning and adhdā make it very hard for them to organize things like this.
The kicker is that the young adult hadnāt replied to the email to confirm whether they wanted to be put on the wait list, or if they had other times or availability to come into treatment.
Of course Iām not saying that this person doesnāt have ADHD or Executive Functioning difficulties; that could all be in the mix, but thereās something very systemic going on too.
- I canāt recall a time in my decade of doing this when a mother has been this involved in a young adultās ability to schedule a session or, more simply, reply to an email.
- Thereās a pattern of this young adult calling Mom, complaining, and then Mom doing something about it on the child's behalf.
Both factors indicate some enabling patterns and likely some elements of parental accommodation.
Housekeeping!
- There's a podcast onl this topic - if you work with parents and need some help -you'll like this one.
What family or parental accommodation really is
Family or parental accommodation is any change a caregiver makes to routines or behaviors to help their child avoid distress. That might be:
- Doing things for them - this is more apparent in younger children - speaking for a shy child in social situations. But in the case above, it seems that this mother is hell-bent on booking a session for her child.
- Providing things - if the child is afraid of nightmares, it might look like sleeping in their room all night. If this young adult was
- Participating with them, not going out in the evenings to keep them company. If this mother lived in the same city, it would look like her picking the IP up and taking them to therapy.
- Or avoiding things - not inviting guests over if social anxiety was a problem, keeping them homeschooled if they said they were afraid of going to school.
Part of the problem we face as clinicians is helping parents differentiate a totally natural and healthy instinct to protect our kids from threats and danger, and protecting them from having feelings. Feelings arenāt dangerous, obviously, and we need to face them to understand how to regulate them. Nearly all parents do some form of accommodation, but it comes with a cost and a risk if we do it too often.
The long-term problem is quite apparent in this case my colleague is dealing with. Over time, too much accommodation sends the message that the parents don't believe their child can handle things. And the child starts believing they canāt handle certain things, too; part of my hypothesis is that this young adult, who by all means seems somewhat self-sufficient, now believes they canāt do something as straightforward as reply to an email or set up a therapy session.
Accommodation itself reinforces the anxiety and dependency, and over the years can prevent a child from developing the skills to manage hard feelings or deal with situations just like this.
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What To Do About It
I encouraged the therapist whoās dealing with this to start with some family sessions if at all possible; at this point sheās spoken to the mother more than the young adult, so itās basically family therapy anyway!
- Name The Sequence
Iād start off by mapping the sequence. Iām only hearing this second-hand, obviously, but to me it sounds like the IP (the young adult) faces a setback; they miss a consultation call; Tuesdays at 6 pm arenāt available, or something else. They then call their mother to vent about the setback. The mother then picks up the phone and tries to change things for the child.
2. Distinguish accommodation from choice
Sometimes it helps to be clear on whether something is accommodation or just the parent being a parent. So Iād ask something along the lines of whether itās normal for this mother to make appointments or take action on behalf of their child like this. When weāre working with younger children, this is a little more black and white, but for a young adult, who weāll assume is perfectly capable of doing this themselves, Iām going to lean towards accommodation.
3. Normalize and validate.
We risk shaming and embarrassing this parent if we rush in too fast and point out this loving, generous tendency to fix or take action as a problem, so take a moment to validate her concern and normalize the instinct to help.
Iād probably slip in a comment like: āAnd yet, what Iām noticing is that when your child calls you with some form of setbackā¦ā
4. Point Out The Family Map
Before I rush into talking about accommodation, itās always helpful to get a broader view of the family. Iād want to understand who else is in the mix. I would want to know if things have always been like this, or when things started to change.
5. Individual Therapy
As much as I love family therapy, sometimes parents have their own work to do, so I wouldn't be afraid to lightly and politely get the parent into their own treatment. The parent needs to understand what's going on for them with regards to setting boundaries or limits or pushing back on requests for help.
Reframes to try
- You're doing this because you love your child. The problem is that your love is now preventing them from discovering what they can actually do without you.
- Every time you take action on your childās behalf, you're voting with your actions that your child can't handle it. What if instead you voted that they can?
- Right now, your child is learning to depend on you to get through a challenging but not overwhelmingly impossible setback. What if he learned to depend on himself instead of you?
- Helping your child like this made a lot of sense when they were younger, but now Iām wondering if continuing to help is keeping them feeling younger and less capable?
Responses