Loves Makes A Family - Part III

Prologue

[I got some feed back that I never described Anna and Cari’s physical appearance. So I hope this late addition doesn’t shatter the character your imagination conjured up. When I first met them, Cari was 14, Anna was 15. Cari was 5’ 7”; a pixie-like, green-eyed blonde, with naturally wavy hair that reached her shoulders. Her triangular face was graced with high cheekbones and beautiful peaches and cream complexion. Her slender, girlish figure was rapidly giving way to maturity. Titian haired and statuesque at 5’9”, Anna was a fully developed woman; very curvaceous, with long legs and very graceful carriage. Her oval face with almond shaped brown eyes, aquiline nose, and full lips could only be described as model good looks.]

Part III

Most of the kids who get put into locked, in-patient psychiatric facilities are there not because of pernicious underlying mental illness, but because their behavior has become so out of control their parents can no longer handle them. Whether or not all of these kids with behavior problems really need to be locked up is another subject and I won’t go into that here. What normally happens to a kid who gets admitted for an unsuccessful or inappropriate adjustment to adolescence is they pretty quickly get put on a program that includes separation from their family and friends.

This can be a great diagnostic tool because their reaction to separation from their parents is very telling. The ones who are relieved about the separation for the most part are the healthy ones who just need family therapy and it’s usually their parents who will need to work hard in family therapy and will need to change. This is a generalization that assumes there is no underlying serious mental illness. For the ones that kick and scream and wail about being separated from the family....well, the outlook and the outcome are not as predictable and the treatment is very, very complicated.

Adolescents are in that most difficult and uncomfortable stage of transition from child to adult and their reaction to this unstoppable force can be quite dramatic and varied. Psychologists and psychiatrists will tell you that the most difficult and vitally important part of this transition is separation and individuation. It’s basically where the child has to build a penetrable wall and put some distance between their own psyche and that of their mother.

This isn’t to say the child rejects or wants to divorce themselves from the mother. It’s just time for the baby bird to test their wings. They aren’t near ready to leave the nest. They just need to feel what it’s like to have a separate identity that isn’t all enmeshed with the parent. In normal, everyday households this process takes place naturally and for the most part, unconsciously on the part of both mother and child. It can be relatively effortless for those individuals fortunate enough to have parents who love each other and love them.

Dr. Jerry M. Lewis III at the Timberlawn Institute is Dallas conducted a study where he interviewed kids that had required in-patient psychiatric hospitalization at Timberlawn Hospital. These subjects were all conduct disorders. That is, they were kids who had such a difficult time adjusting to adolescence that their behavior became intolerable to the parent. They had to be hospitalized to protect them from themselves. None of them had thinking disorders like schizophrenia or were predisposed for any serious mental illness. He used a control group comprised of mid to high functioning adolescents who, unlike the study group, never required any kind of psychiatric treatment.

Comparing the two groups’ answers to a questionnaire, he put together behavioral and familial predictors for a child’s successful adjustment to adolescence. He wrote about it in his book, “How’s Your Family?” He wrote that the single most common response given by those teens about what made them feel safe and sound growing up was the affection and devotion their parents showed to each other. It was not how their parents treated them that mattered the most. It was how the parents treated each other.

So, if children who see their parents being affectionate is the most important environmental predictor of a successful separation and individuation process, then what happens to that process when you have less than that? What happens if your parents argue constantly and you never see them resolve that conflict? What about kids who witness parents being physically violent? What about no parents? What about 15 different sets of foster parents? What about 15 sets of foster parents and then you get adopted by a very dark, disturbed individual without the capacity to express honest affection? If having two loving parents sends a powerful message about security and the value of a loving bond of trust and respect, then what hope could there be for Cari and Anna?

Neither of them were having issues with their conduct at this stage of their treatment. Although Anna was not having the breakthrough in therapy that Cari was experiencing, she was a high functioning kid and had earned the trust of the staff and the requisite privileges. Often the two of them would be off to Westwood together because they were the only two kids on the unit with that high privilege level.

The girls had reached that phase of treatment where the family separation could end. Their family members could now start coming for visits. Once the family and their adolescent are re-united, the family therapy phase can take months. In this case it was expected to take at least two months, maybe three.

Usually, there is a family therapist and sometimes the individual therapist at the initial family meeting after the separation phase. The case manager may meet with the family as well, prior to the family therapy session just to let the family know what kind of progress has been made and what to expect when they see their adolescent for the first time in months.

Neither of the girls seemed too thrilled about renewing contact with their family. However, they needed to start family sessions so they could begin the re-integration phase of treatment. For re-integration to even occur, the issue of abuse would have to be raised and dealt with. It was no wonder the girls were nervous about seeing their aunt. They also knew that their great uncle and other aunt who would be there were in for a huge shock when the issue of the bed time panty checking was revealed. There were still some questions about whether or not it would be revealed at all. Both Cari and Anna were getting cold feet as the day for that confrontation approached.

From admission day forward, while the girls were in the hospital working every day on their issues, family members were expected to eventually start coming in once a week to discuss family history and dynamics. The family members in this case had very spotty attendance. Some of it they blamed on the long drive. Santa Barbara is 90 miles from UCLA. The real issue was not the long drive. It became clear that the family view was, “It’s the girls that are broken, just fix them. We were fine till they came along.” This sense of condescension expressed by the elders in the family, was a form of “blaming the victim”, often seen as a by-product in rape and domestic abuse cases. Obviously, there would be a need for ongoing treatment for the girls and the family after discharge because there was so much that had to be addressed.

Finally, family sessions with the girls started. It was chaos from the word “go”. Cari mustered the gumption to lay it all out there. She sat up straight, board stiff, her eyes focused on a spot on the wall. She dared not make direct eye contact. Her delivery was halting and simplistic because she was hyperventilating and crying, but she bandied no words, pulled no punches. Anna, sitting two seats away, had slowly pulled her knees up to her chin and sat in an upright fetal position, trembling, as the allegations of abuse poured out of Cari. It was honest, heartfelt, and direct and a tremor reverberated through the session like a silent bomb had gone off.

The aunt accused of the abuse sat in stony silence refusing to respond while her father and sister defended her. Neither of them believed that these allegations of mental cruelty and sexual abuse could be true. They felt that they had extended a helping hand, offering a home for these orphaned waifs and they had gotten only grief and allegations in return. They threatened to end family therapy then and there, after only one session.

The girls were sent back to the ward and the family therapist spent an additional hour begging the family to hang in there and come back and work through these difficult issues. They reluctantly agreed to try again, but stated that they were not going to let these ungrateful girls destroy their good family name. Their great uncle was not going to risk going to the yacht club and over hearing that there was an allegation of sexual abuse within his family.

The treatment team did their best to suggest alternative ways of re-integrating the girls. The family could certainly afford a private boarding school. There were many available treatment options in Santa Barbara. Remarkably, the girls were willing to forgive their aunt if she would just admit what she did and get help. They were not out to get her thrown in prison. They had experienced the benefits of the best in psychiatric care and knew that she could benefit from it. They were reasonably certain that after this the family would not force them to go back to living with her; and on that score they were correct.

The family did return for the family session the next week, and the next; but that was it. It took only three sessions before the family abruptly made a life changing decision. Did they decide to hire the best professionals to help them; to send the girls to private boarding school for their own protection; to have another family member take them instead of the most disturbed family member? No. They decided they didn’t want them anymore. They abandoned them. They turned them over the county of Santa Barbara and made them wards of the court.

This left the girls with a government entity as the decision maker for their future and for further treatment. Now, for all intents and purposes, they had no family. They were once again orphans; and with no insurance it was up to Santa Barbara County to foot their bill. A Santa Barbara judge ruled that they should get them out of UCLA as soon as possible. Cari and Anna would be discharged within 2 weeks….and they had nowhere to go.