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Your family screwed you up.

That's what most therapists attribute their patients' problems to -- either a quirk in a specific relationship, or the family system as a whole.

But most of these dysfunctional patterns are cyclical in nature, sometimes dating back generations. Children are so impressionable that what they learn from their parents, their environment, is deeply ingrained in their daily thoughts and behaviors. Overcoming learned behavior -- essentially reprogramming people to recognize that those closest to them, like a father, mother, siblings may have set them up for failure -- is a monstrous task for most patients.

Biology does have its place. Disorders and addictions may be hereditary. Chemical imbalances can have a direct effect on mood. But according to most therapists, someone in serious emotional, cognitive distress doesn't just happen by chance.

There is a theory called "goodness of fit" which dictates that problems may arise when ones temperament does not gel with the temperament fostered by ones environment. And sometimes that environment is an ugly, ugly place.

BT: Have you ever had a dramatic case in which the family background played a major role in developing the patterns of a patient?

I currently see a 13-year-old male on probation for making terrorist threats at his school. This happened when he was 11. He threatened to kill his teacher and blow up the school. He has severe anxiety and anger problems, is legitimately ADHD, and is not on medication because his mother does not believe in it.

He can be extremely violent and has access to many weapons as his father is an avid hunter and keeps the weapons unlocked and in plain sight. He was recently transferred to an alternative school for attempting to harm another student with a clay tool in art class.

I also see his 16-year-old sister, who used to be on probation for fighting in school. She's also very explosive and aggressive. She just became pregnant by her boyfriend, a Neo-Nazi, and chose to keep the child. Her boyfriend has serious objections to her seeing me for therapy because I am Jewish. She is an overly sexualized patient. This most likely stems from being molested by her biological father, who hanged himself in prison around 1988.

I used to see their older brother, age 19, who was on probation for possession of a controlled substance and grand theft. He almost died two weeks ago after "huffing" computer keyboard cleaner.

BT: That's the whole family?

Sadly, it gets worse.

The oldest brother, 23, used to be a cocaine addict and had a history of cross-dressing. Their 20-year-old sister ran away when she was 16, and is currently a drug addict and in an abusive relationship with a 36-year- old man with two kids.

The youngest brother, 10, manifests the least severe of the problems and has only minor hyperactivity.

Their mother has been living with a boyfriend for the last 15 years -- the last two boys are his -- and she has four other children fathered by three different men.

The mother and the boyfriend use marijuana daily, sometimes with their children. She used to be a crystal meth addict and used cocaine during five of the six pregnancies. Both the mother and boyfriend were members of a motorcycle gang in the 80s. The mother was sexually abused as a child. Three of the four fathers have a history of drug dependency and anti-social behavior.

The current boyfriend is an over-controlling parent and is hypocritical with his discipline. Do as I say, absolutely, and not as I do, essentially. The boyfriend has an extensive police record and a warrant for nine outstanding DUIs. The entire family was homeless at several times in between the mother's relationships.

All the siblings abuse each other, too. Not one person in the family, or either extended family, has graduated from high school or obtained their GED. As you can see, drugs played a role with the biological composition and temperament of the children and their environment made sure it would be nearly impossible to succeed.

Families like these have their own culture, and it is difficult to ask a child to take the risk of not conforming to the norms of the family. The harassment of non-conformity would, in itself, be a gateway to other psychological issues.

BT: Well, is it dangerous to have these patients recognize their family history as cause for their problems? Doesn't that in a way give them almost an excuse for their behavior?

Yes and no. It is integral for kids to recognize other family members' dysfunctional patterns, their own patterns of behavior, and how it evolved into what it is today. It is great for a child to realize how his behavior was formed and molded. The problem is that once they recognize their own problems, they view it as a license to continue the cycle -- that their environment excuses their behavior.

This is dangerous, because it is the element of change that is critical to therapy. If they don't change their life, future generations may feel the repercussions. We often times admire the elders in our family, but if they are fucking up, it is a poor modeling schema.

BT: What does it take to change somebody with a family background that's that messed up?

First, is understanding. Evaluating the ineffective behavioral patterns and the understanding that what they are doing is counterproductive to their own well being.

Second, there has to be some desire to change, that there is an alternative to the emotional distress they are incurring and more effective ways of handling situations.

Third is engaging in the therapeutic process, developing skills and using trial and error to determine what will improve the patient's level of functioning.

I am not a touchy-feely type of therapist. While feelings are important, I am not feelings-oriented. I subscribe to two main theoretical approaches: One is a cognitive-behavioral approach. In short, an activating event elicits a feeling or belief about that event, which elicits a specific behavior. The behavior is what is overtly dysfunctional, but it is the individual's dysfunctional belief about the event, which causes the emotional reaction. If you can change the belief -- the thought -- you, in essence, change the behavior.

The other approach has its basis in one's control, or perceived control. The object is to get people to control what they can, not try to control what they cannot. Problems arise when one tries to control what is out of control -- like depression, anxiety -- or when one does not control what he can, losing a sense of their own efficacy.

BT: But given the extreme case that you outlined before, it appears there's absolutely no hope for any of those kids. They all seemed destined to fail, right?

I disagree, mainly because I have seen people change their lives firsthand.

You need a competent therapist, but the will to change on the part of the patient is the impetus of change. I find it to be analogous to a person with the flu. If the person wants to get better and takes an antibiotic, the process will be facilitated and the person will recover. If they do not take an antibiotic, they may improve, or the symptoms may worsen and something more severe may develop. Therapy is the antibiotic. Change is not overnight, so patience is necessary. Years of learned behavior and being engrossed in dysfunctional patterns will not be extinguished overnight or by some magic pill.

BT: Are there times where the cycle just cannot be broken?

Sad to say: Yes. I once treated a kid who was a sexual perpetrator. His caseworker went to investigate the house and found his three-year-old sister in the corner of a room shoving a carrot in her vagina. There were just too many generations of an offender/victim cycle. In those environments there is little chance for success and most of them are so secretive they go undetected.

If everyone was capable of change, there would be no need for policemen and the prisons would be shut down. Sometimes people do not want to change or their negative behavior gives them too many rewards to see the effects of what they do.

BT: Can you get these kids removed from their environment?

Yes, in extreme circumstances. I can recommend removal from the home, but only a state agency may remove someone from his or her home.

Advocates for Children and Youth -- or as I call them, "Children and Useless" -- is the agency that we contact. They're terrible. If a kid pisses on the toilet seat they take him from the home, but when a kid is getting his ass rammed by his brother, they need more proof.

They rarely make the right call. I saw a girl once who had no food in her home, no soap or shampoo, and trust me, she smelled terrible. The mother, who did not work, spent the money on beer and cigarettes.

Well, Children and Youth, after I harassed them to take action, told me that the evidence of neglect was insufficient after a home investigation. Eventually the girl got arrested and sent away, so they did not have to do their job anyway.

I usually err on the side of patience, giving the family every opportunity to stay intact. But some situations are too volatile and unavoidable. The only problem with removal from the home is that while the kid improves, home stays the same and the child regresses when they return, whether it is violence, neglect or something else.

Want more "Confessions of a Therapist?" Read Part One.



The Black Table's therapist is licensed in Pennsylvania, has a private practice working with children and adults, and provides therapy to adjudicated youth.