The Talking Cure (Jacket image supplied by Pan Macmillan South Africa) 
I was re-reading the referral letter for my next patient, Meredith, when I heard a tentative knock at my consulting room door. The rather scant doctor’s note suggested that Meredith was highly distressed because of “behavioural issues” with her 10-year-old daughter, Jade.
I opened the door to greet a well-groomed brunette in her late thirties, dressed in a designer outfit of subtle blue hues. But what struck me more than her appearance was my immediate sense of Meredith’s underlying fragility. Despite her impressive sartorial efforts, she had a bird-like appearance which spoke to me of anxiety and agitation. I invited her to take a seat across from me in one of the black leather recliners that form the core of my consulting room.
Usually, I begin by making a few introductory comments, but Meredith immediately launched into a detailed description of her worries. She spoke forcefully, but with a quiver in her voice, as she related her struggle to understand and manage her “wonderful but difficult” second daughter, Jade. As I noticed the urgency in Meredith’s demeanour, I also noticed that I was tensing my shoulders and leaning forwards. Knowing that this was likely going to be relevant to my understanding of Meredith, I made a mental note of this initial response: I experienced my own body language to be mirroring hers, tensed for action rather than listening. I made a conscious effort to settle back into my chair, and to focus on listening carefully, tuning into the narrative of maternal anguish that was unfolding.
“I’m at the end of my tether with this child! She’s so nasty to me and her siblings, and neither Derek nor I can do anything to calm her down when she has one of her outbursts. When I asked her to set the table the other night she refused, saying it was not her job. Then, when my older daughter Bianca challenged her, Jade kicked her and called her a ‘stupid slut’. Derek tried to reprimand her, but this just made things worse.”
Meredith spoke of her despair; she could not understand how this situation had developed in their loving, well-off family. She emphasised their respectability and community standing: she was an interior designer and Derek a financier. Derek was involved with the day-to-day life of the family and Meredith had organised her own work life so that she could be available to their three children. She had a largely happy marriage and a supportive circle of friends. To the outside world, the family was a success story, and it felt to Meredith like their problems with Jade were a dirty secret that they tried to hide from their friends and family.
Mothers frequently come to therapy seeking help with “difficult children”. As a mother myself, I have great sympathy with them. I know how difficult it is to get parenting “right” and how judgmental those around us can be of mothers who appear to have got it wrong. What mother hasn’t noticed the smug look of another as her own child throws himself to the floor of the supermarket demanding a lolly? Or, worse, the disapproving gaze when she finally capitulates?
While we try to get parenting right, we should accept that, despite our best intentions, it’s inevitable we will often get it wrong. The mothers of more pervasively difficult children have it tougher than others and are often given bad press.
But it has become clear to me over many years of practice that even well-meaning parents are prisoners of their own histories, and this history inevitably influences their approach to parenting. In some cases, this may result in “difficult children”.
As twenty-first-century parents, we are constantly told by the media that we are rearing a generation of self-important narcissists because we fail to set limits for our children. However, apart from the attitude of entitlement created by social factors in affluent societies, there are also complex psychological factors which make it hard for certain parents to set appropriate limits.
Few mothers willfully create difficulties in their children. They are generally pained by and worried about their problem children, frequently unaware of the way in which their own histories and behaviours are creating and maintaining the child’s “issues”.
What unfolded as Meredith told her story is only one possible scenario illustrating how the road to hell is so often paved with good intentions.
Meredith: I gave up work to be with each of my kids for the first two years of their lives. And I really enjoy being a mum. I just can’t understand why Jade has turned into this monster! Derek can’t understand it either. Jade’s tantrums need to be experienced to be believed. We love her dearly and try so hard to make her happy but she’s just so demanding!
Meredith related how, on her last birthday, Jade had thrown her new iPhone to the floor, calling it “a piece of junk” because she had been expecting a later model. Derek was furious, calling Jade a spoilt brat. He threatened to take the iPhone away and give it to someone who would be grateful for it.
Meredith found Derek’s angry response unbearable. She was filled with anxiety and a dread that she couldn’t understand. She felt an overwhelming need to protect Jade, fearing that Jade would be damaged by Derek’s words. She admitted that, despite her bad behaviour, she regarded Jade as “a miracle baby” because she had been told that she wouldn’t be able to have any more children after complications with the birth of her first daughter.
Jade was relatively small at birth, and though there was no indication of any difficulties, Meredith had always considered her to be delicate. She constantly comforted her and attended to her every need, even as Jade reached an age where she could potentially do more things for herself. It seemed clear to me that Meredith had unknowingly fallen into a pattern of over-functioning in her relationship with Jade, and when we over-function we inevitably and unwittingly encourage the other person to under-function in response. However, now was not the time to point this out to Meredith, as she would have experienced my reflection as critical and unempathetic.
In initial sessions, I usually focus on getting a sense of the patient and their difficulties and on establishing a relationship of trust that that will underpin the therapeutic work to come. In my first session with Meredith, I noted, the therapy time had been filled up with thoughts and feelings about Jade. On the one hand, it seemed as if there was little room left over for Meredith herself, yet on the other hand she was filling both the consulting room and me with her anxiety and pain. I felt an intense pressure to alleviate her distress, but she left me no room to speak. Each time I opened my mouth to make a soothing comment, she would launch into another account of Jade’s deplorable conduct.
I found myself intrigued by Meredith’s exclusion of me given that she had come to me for help. Was she afraid to let me in? I was also aware that, despite my being rendered silent, Meredith appeared to have found the session useful. She was feeling lighter, she said, and was looking forward to seeing me the following week. It seemed to me, at that point at least, that she had come not to hear what I had to say, but to hear what she herself had to say.
I sensed that the real difficulty for Meredith might not be understanding Jade but understanding herself in relation to Jade. Hearing herself speak without too much interruption was a start. I hoped that this style of communication was itself a clue to the issues at stake and might yield the secrets of the story that had shaped it. ML
The Talking Cure: Normal people, their hidden struggles and the life-changing power of therapy is published by Pan Macmillan (R330). Visit The Reading List for South African book news – including excerpts! – daily.