The following is an email that I sent to my LIU 1st year field students last December.  Thought I'd share it:

From Professor Steele:

The following is an observation that I want to share with you all that was prompted by a process recording. 

A frequent presentation in clinics or other mental health settings serving the frum community is one where a mother brings a latency age (8-13) son for treatment to address behavior.  A common feature of this presentation is that the mother will portray the father in any number of negative lights, from fairly benign descriptions, such as “he’s too busy at work to come to sessions or spend much time with him,” to far more damming portrayals, such as “he’s in denial/useless/the same way/doesn’t believe in therapy/has an anger problem,” etc.

As clinicians, it can be very tempting to accept this presentation at face value.  After all, we’ve all met frum men in the community who seem to comport with this negative portrayal, so it’s not much of a stretch to believe that the presentation is valid.  It can often be, however, a very serious mistake to fall into this trap.  The trap is also often attractive because it may feed into our fantasies about who we are.  We are the sensitive, aware, verbal males that can help struggling boys, in contrast to the emotionally clueless fathers.

When we fall into this trap, we run the risk of unwittingly entering the dynamics of the family in a very unhealthy way.  As clinicians, we learn that the family is a psychological entity/system unto itself, and our task is to help heal the family.  We should be thinking not in terms of helping this child individually, but in terms of helping the family become more functional.

When we accept the mother’s critique of the father at face value, we collude with one side in the conflict.  This is not helpful to the family. A marital relationship that lacks respect, especially from the wife toward the husband, is highly problematic.   Indeed, not to get too psychoanalytic or Freudian, but we can end up taking on the role of the idealized, sensitive, intelligent male that the mother longs for.  We become the respected male in the family, while the father is left to feel disrespected by the mother, and, by extension, the therapist.  Given this, is it any wonder that, when we initially accept this presentation, fathers are often reluctant to participate in treatment?  Imagine that the father feels disrespected by the mother, and gets to hear about how much the mother respects the wise therapist.  Imagine what that must feel like.  Mothers will sometimes even say things like “he needs a male role model;” however HE ALREADY HAS A FATHER. 

Let’s speculate, for example, that the father and child share some mental challenge.  Let’s say, for example, that they both have anger issues.  Instead of accepting her husband and son as the flawed people they are, maybe she is utterly intolerant and rejecting of their anger.  She drags the son to a therapist because anger is “bad,” and she rejects the father for it.  However, if she were more accepting and tolerant, maybe she could actually HELP them with their anger.  She could set limits, but also find ways to be of help to them with this problem.  So what sounds perfectly reasonable to the clinician (boy is coming to therapy for anger problem and has angry father) may, in fact, be more a problem with the mother than the son or the husband.  In fact, maybe, instead of treating the father as of little use for therapy, he could be the key.  Maybe talking about his own struggles with anger, how he has learned to deal with it, and what he wants for his son is vitally important. 

This leads to another potentially problematic aspect of this presentation.  Mothers often bring boys for treatment with the hope that they will talk out their issues.  They will say things like “he’s so angry.  He must be angry about something that he’s not saying.”  The logic is understandable and it reflects a normal female bias about how to cope with psychological distress.  Said simply, females cope by talking.  They express themselves verbally and it’s helpful, so the natural assumption is that the men in their lives should also talk more.  What this misses, however, is that men often cope in different ways.  They do not always talk.  I certainly do not mean here to suggest that verbal expression of feelings is in any way bad; however, it is not the only way to cope with stress and it is not the only path to healing.  It is best applied when there is a clear, identifiable stressor, i.e. a divorce or some event that invariably gives rise to thoughts and feelings.  Mere bad behavior, however, is not always the result of unspoken angst that needs to be verbalized.  When men or boys are nagged into talking about their feelings by the women in their lives, it can be counterproductive.  I sometimes want to say to mothers: “News flash.  10 year boys don’t talk about their feelings very much.”

When you put the family dynamics issue together with the above, then the process of therapy itself can easily become a furtherance of the mother’s agenda and dominance in the household.  Again, given this, it should not be surprising that fathers resist participation in the therapeutic process.

Of course, it certainly could be true.  The father really could be out to lunch.  He could even be mean or borderline abusive (if he is actually abusive, then that calls for a different set of interventions).  The point is to be careful and skeptical.  Sometimes, the doctor has to perform dangerous, radical surgery.  Disrupting a family is radical surgery.  It’s sometimes necessary, but you don’t jump into it until you’ve exhausted all other options.

So what do you do in this situation?  It starts with a skeptical mindset, and then moves to including the father in the therapeutic process, which doesn’t just mean inviting him to a session.  You want to be empathetic and supportive toward the mother, but you don’t want to suggest to her in any way that you accept the presentation at face value.  Here are some examples:

His father is in denial.  He doesn’t believe in therapy.  It sounds like the two of you have talked about this.  Tell me more about that He thinks I’m overreacting and nagging our son, and he’s against therapy.  OK.  It sounds like he he’s skeptical about therapy.  Any idea why?  He says he just needs firm discipline.  OK, and what do you think about that?  He’s too strict and doesn’t see that Moshe needs to talk about his feelings.  Ok, so it sounds like the two of you have some very different ideas about how best to help Moshe.  Seems like we’re going to need to address that disagreement.  I don’t want my son to turn out like him.  And what way did he turn out?  He always loses jobs and he’s an embarrassment.  Wow.  That sounds hard.  Yes, but we’re here to talk about my son, not my marriage.  Yes, but my professional experience tells me that it’s pretty hard to separate the two.  If you want things to be better for your son, we’re probably going to have to address these issues.

When do you think his father can come to a session.  Oh, he’ll never come.  Don’t even bother.  He wouldn’t be much help anyway.  If you want, I can tell him to come to the next session (could be she’ll nag him to come and he’ll resent the whole process before it begins).  No, I think I’d rather call him myself.    Hello, Mr. Schwartz, this is Evan Steele, your son Moshe’s therapist.  I’m calling because I really need your help.  You are such an important figure in Moshe’s life that I can’t really help him without your participation.  I don’t believe in therapy.  OK, you know what, I don’t either.  I only believe in G-d, everything else I’m skeptical of.  It sounds like you have some real concerns and reservations about therapy.  That’s fine.  I’d love to hear them.  How about you come to a session and we can talk about this.  I’d really like to hear what you have to say.

Lastly, just to even things out and put them in a family systems context, our job as therapists is always to support, empower, and build up parents.  Many times parents come to us feeling weak, defeated, and lacking confidence.  They’ll say “what do I do when…”  The temptation can be to answer the question, but the real problem here is not how to handle Moshe when he gets angry.  The problem is the parent’s lack of confidence in his or her parenting.  So the bottom line is that if one or both parents present or are portrayed by the other as weak, our job is to build them up.  Helping parents and families be strong is the best way to help children.