553313 research-article2014
APY0010.1177/1039856214553313Australasian PsychiatryLittle
Australasian
Psychiatry
Psychotherapy
Rescuing – a universal phenomenon John Little Consultant Psychiatrist, Capital and Coast DHB, Kapiti Community
Australasian Psychiatry 2014, Vol 22(6) 533–535 © The Royal Australian and New Zealand College of Psychiatrists 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1039856214553313 apy.sagepub.com
Mental HealthTeam, Paraparaumu, New Zealand
Abstract Objective: Rescuing, where the person is delivered from the immediacy of their conundrum by another, complicates management. The object of this paper is to understand the difficulty in relinquishing the rescuing role. Conclusion: Rescuing is a universal phenomenon in parenting, teaching and therapy that has developed over time through a variety of interwoven social, economic, psychological and clinical variables. Keywords: rescuing, helicopter parents, responsibility
“I
t’s not his fault, it’s his bipolar.” Tom’s mother wanted to explain why her son repeatedly missed appointments but did want treatment. Mel’s mother attempted to dictate the treatment plan, claiming that only she understood her 23-year-old daughter who sat silently in the background. Rescuing, where the person is delivered from the immediacy of their conundrum but where parties find themselves occupying not dissimilar roles, complicates management. The aim of this paper is to understand why this is difficult to change and suggests that the phenomenon is not unique to clinical practice.
Developmental aspects The two year old child must be allowed to toddle and wobble and fall, but if there is someone to help him up.1 Humans are unique in the percentage of total life spent in emotional and physical dependency, with individuation and differentiation being a phase-specific developmental process continuing into adulthood.2 As the child grows, opportunities arise for gradually developing independence at a rate commensurate with biological and psychological capability. Too little and the person may despise dependency, seeking refuge in the illusion of self-sufficiency; too much and the child will be deprived of important opportunities to master their environment. Rescuing is the extension of the latter, whereby the parent not only seeks to protect the child but actively intervenes
to solve problems in order that they do not suffer as they themselves may have; that is, appropriate parenting characteristics taken to an inappropriate degree. Rejecting and neglectful parenting styles in particular were harmful, contributing to low resilience, a sense of entitlement and the increasing use of antidepressants and recreational analgesics.3-6 Changing this process is difficult and involves taking risks. Curiously, there is little in the literature that describes the young person’s role and responsibility. Instead, this has been abdicated to the parents who have had difficulty in letting go of their own unresolved conflicts.5 Informed by an intense wish to foster a secure attachment and sense of well-being in their children, the parent, whose own self-esteem is crucially dependent on their children’s success, rescues. As a result, “… rather than struggling with the subtleties of creating the conditions for the child’s mind to develop, parents seek to remove the realities of the external world from their children’s experience. In so doing they collude with the distorted thought processes of a maturing mind and create an inner world that can not tolerate disappointment and rejection”.5 The child, so diminished, is unable to think or feel for themselves. This parental difficulty is exacerbated by depressive and anxious states, by narcissistic injuries and by marital and family stressors, all of
Corresponding author: John Little (Consultant Psychiatrist), Capital and Coast DHB, Kapiti Community Mental HealthTeam, Warrimoo Street, Paraparaumu, 5032, New Zealand. Email: [email protected]
533 Downloaded from apy.sagepub.com at University of Bath - The Library on June 7, 2015
Australasian Psychiatry 22(6)
which inhibit reflective capacity. Relinquishing the rescue role is further complicated should the child’s age approach that when the parent themselves had similar difficulties in individuation,6 or when the interaction style mimics historical and unhelpful family patterns.2
Educational aspects …we must remind staff that solving problems for students robs them of the opportunity to learn.7: 31 The same dilemma, where to tread between protection and guidance, is described in the early childhood8 and university education7,9 literatures with at least four major surveys involving over 19,000 students. As the child progresses, parental support has been important. However, parental involvement has also been detrimental to development with the emergence of ‘helicopter parents’, referring to parents who anxiously hover over their children. Extensions are requested by parents who are writing their children’s assignments in an attempt to promote their self-esteem. Schools have responded by developing parent programmes and by providing counselling services for students with adjustment disorders, low self-esteem and feelings of emptiness and confusion rather than requiring them to meet course requirements. Changing this process is difficult and again involves risk taking. Modern parenting has changed, with fewer children spending longer in emerging adulthood with more emphasis on self-actualisation. The shift to the information age has led to an assumption that post-secondary education is mandatory for any young person who wants stability and permanence in the changing labour market. Education has become a commodity, with parents and students becoming consumers who monitor quality and performance electronically and by what has been called the world’s longest umbilical cord, the mobile phone.9 With pressures for academic success, threats on safety, waning natural resources and economic recessions, over-parenting has become an understandable but unhelpful response.6 The role of the individual is again curiously absent.
Clinical aspects The aim of treatment of the suicidal patient is to reverse the process by which suicidality has become reinforced and enhanced. The responsibility for ones life must be gradually re accepted. The person with the suicidal character structure has become used to letting himself fall toward death as a means of coercing others into catching him. He must be helped to recognise that the treatment plan will gradually remove some of those catching arms, leaving him with increasing responsibility for not letting himself go.10
The same tension – of whether to guide or protect – is variously described in the clinical literature and includes rescue fantasies and the disavowal of our own aggression and vulnerabilities in a relationship that may be open or distant and removed.11-13 In this sense, parenting and therapy share similarities. By the time the person with borderline personality disorder has arrived at the psychiatrist’s door, a considerable amount of learning has occurred by both parties. The therapist too may hover anxiously, striving to protect the person from further hurt and yet in so doing, do more harm than good by involuntary hospitalisation in the hope of keeping the person safe from themselves. Changing this process is difficult. The risk of suicide and the fear of negligence both hover expectantly. There are, however, less obvious but equally potent impediments to change. The therapist may over-identify with the patient, set unrealistic expectations and unwittingly create a ‘self-assigned impossible task’.14 Secondly, there is the temptation to ‘play it safe’ and so avoid the same dilemma the person is struggling with. However, the contrary choice of not intervening may in practice be no less harmful, and short-circuit further enquiry.15 The third, and perhaps more pernicious, of those factors making it difficult to relinquish rescuing is the curious absence of the individual. Although it is articulated in the early childhood literature under the heading of bidirectionality,16,17 it is only briefly alluded to in adolescence – “the tendency in both the adolescent and his/ her parent to blur the boundaries between them and collude in stimulating and sustaining intrusion and over protective behaviour from one side and provocation and dependent behaviours from the other”6 – before it disappears from view. It is as if the literature has colluded with those parents, teachers and clinicians who rescue the person from their dilemma. Vulnerability does not preclude the possibility of participation and of meaningfully contributing to one’s own health care.18
What to do? Treat people as if they were what they ought to be and you will help them become what they are capable of becoming. van Goethe. What, then, is to be done in the light of a complex and lengthy process that has become rescuing? It is our contention that the principles of good parenting, teaching and therapy overlap; “In the face of the child’s outburst, parental responses of non anxious, firm limit setting in an atmosphere of love and understanding help the toddler to master separation anxieties”.19 At an educational level, we must understand that learning is about questions as much as answers, with a willingness to take risks and to learn from mistakes, frustration and disappointment.6 In a clinical setting, the task is also to hold the paradox between empathic recognition and concerted action, and within a nurturing and respectful relationship, enable a
534 Downloaded from apy.sagepub.com at University of Bath - The Library on June 7, 2015
Little
“generative framework for negotiating new possibilities”.20 ‘What if my daughter runs away from hospital?’ The therapist could respond by saying she will be discharged or could ask the parent what they think they should do. Either runs the risk of solving an immediate problem. Instead, sharing the difficulty provides an opportunity to tolerate strong feelings through which a previously undiscovered solution may declare itself.19 Finally, there needs to be a recognition and acceptance of respective roles and responsibilities. In the therapeutic setting, patient autonomy has become asymmetric with duties falling mainly on the clinician and only exceptionally on the patient themselves – “it tends (incorrectly) to interpret patient autonomy as mere participation in decisions, rather than a willingness to take the consequences”.18 In clinical work, there is a tension between providing appropriate concern for the suffering endured by patients, and according a respect and understanding for choices that people make as to how they cope with their suffering – “To provide love or empathy without this proper respect for the potential freedom of our patients, even the freedom to act in perverse disregard to their own interest, is to convey a pity that only reinforces the patient’s sense of victimisation and passive resignation to an unfortunate fate”.21
Acknowledgements Thanks to Heather Dryburgh for typing. Thanks are extended to Marg and Rosie Little for their insights and to Dr Katie Richardson for alerting us to the concept of ‘helicopter parenting’.
Disclosure The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper.
References 1. Mathis JL. People who hate dependency. Med Aspects Hum Sex 1985; 19: 64–74. 2. Anderson SA and Sabatelli RM. Differentiating differentiation and individuation. Am J Fam Ther 1990; 18: 32–50. 3. LeMoyne T and Buchanan T. Does ‘hovering’ matter? Sociol Spectr 2011; 31: 399–418. 4. Baumrind D. The influence of parenting style on adolescent competence and substance use. J Early Adolesc 1991; 11: 56–95. 5. Locke JY, Cambell MA and Kavanaugh D. Can a parent do too much for their child? Aust J Guid Couns 2012; 22: 249–265. 6. Munich RL and Munich MA. Overparenting and the narcissistic pursuit of attachment. Psychiatr Ann 2009; 39: 227–235. 7. Hirsch D and Goldberger E. Hovering practices in and outside the classroom. About Campus 2010; Jan-Feb: 30–32. 8. Manning-Morton J. The personal is professional. Contemp Issues Early Child 2006; 7: 42–52. 9. Somers P and Settle J. The helicopter parent. College Univ 2010; 86: 2–9. 10. Schwartz DA, Flinn DE and Slawson PF. Treatment of the suicidal character. Am J Psychiatry 1979; 28: 194–207.
Concluding remarks Rescuing is a universal phenomenon recognisable in parenting, teaching and therapy that has developed over time through a variety of interwoven social, economic, psychological and clinical variables. Together these contribute to the difficulty in changing this style of interaction. In acknowledging this complexity, expectations of change can be realistically adjusted and principles of care shared. These include an awareness of what the consequences are for those in the care of the anxiously hovering parent, teacher or clinician. Secondly, a reminder that our role is one of engaged neutrality – “the teacher does not love the pupil as such but rather the progress of the pupil and the work they do together”.12 Finally, a recognition that the relationship is bidirectional – “Can we not understand the varying influences…that lead people to do what they do and at the same time hold people responsible for their actions, thus according an all-important respect to their human dignity of having free choice”.21
11. Malawista KL. Rescue fantasies in child therapy. Child Adolesc Social Work J 2004; 21:373–385. 12. Orgel S. Commentaries. J Am Psychoanal Assoc 1997; 45:5861. 13. Nussbaum MC. Analytic love and human vulnerability. J Am Psychoanal Assoc 2005; 53: 377–383. 14. Roberts VZ. The self-assigned impossible task. In: Oblozer A and Roberts VZ (eds). The Unconscious at Work. London: Routledge, 2004; pp.110–120. 15. Anna GJ and Densberger JE. Competence to refuse medical treatment. Toledo Law Rev 1984; 15: 561–596. 16. Loulis S and Kuczynski L. Beyond one hand clapping. J Soc Pers Relat 1997; 14: 441–461. 17. Goldstein LS. The relational zone. Am Educ Res J 1999; 36: 647–673. 18. Draper H and Sorell T. Patient’s responsibilities in medical ethics. Bioethics 2002; 16: 335–352. 19. Shapiro ER. The holding environment and family therapy with acting out adolescents. Int J Psychoanal Psychother 1982; 9: 209–226. 20. Stern S. The conundrum of self-care. Contemp Psychoanal 2007; 43: 605–620. 21. Shabad P. Beyond determinism and self-blame. Contemp Psychoanal 2007; 43: 587–604.
535 Downloaded from apy.sagepub.com at University of Bath - The Library on June 7, 2015
APY0010.1177/1039856214553313Australasian PsychiatryLittle
Australasian
Psychiatry
Psychotherapy
Rescuing – a universal phenomenon John Little Consultant Psychiatrist, Capital and Coast DHB, Kapiti Community
Australasian Psychiatry 2014, Vol 22(6) 533–535 © The Royal Australian and New Zealand College of Psychiatrists 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1039856214553313 apy.sagepub.com
Mental HealthTeam, Paraparaumu, New Zealand
Abstract Objective: Rescuing, where the person is delivered from the immediacy of their conundrum by another, complicates management. The object of this paper is to understand the difficulty in relinquishing the rescuing role. Conclusion: Rescuing is a universal phenomenon in parenting, teaching and therapy that has developed over time through a variety of interwoven social, economic, psychological and clinical variables. Keywords: rescuing, helicopter parents, responsibility
“I
t’s not his fault, it’s his bipolar.” Tom’s mother wanted to explain why her son repeatedly missed appointments but did want treatment. Mel’s mother attempted to dictate the treatment plan, claiming that only she understood her 23-year-old daughter who sat silently in the background. Rescuing, where the person is delivered from the immediacy of their conundrum but where parties find themselves occupying not dissimilar roles, complicates management. The aim of this paper is to understand why this is difficult to change and suggests that the phenomenon is not unique to clinical practice.
Developmental aspects The two year old child must be allowed to toddle and wobble and fall, but if there is someone to help him up.1 Humans are unique in the percentage of total life spent in emotional and physical dependency, with individuation and differentiation being a phase-specific developmental process continuing into adulthood.2 As the child grows, opportunities arise for gradually developing independence at a rate commensurate with biological and psychological capability. Too little and the person may despise dependency, seeking refuge in the illusion of self-sufficiency; too much and the child will be deprived of important opportunities to master their environment. Rescuing is the extension of the latter, whereby the parent not only seeks to protect the child but actively intervenes
to solve problems in order that they do not suffer as they themselves may have; that is, appropriate parenting characteristics taken to an inappropriate degree. Rejecting and neglectful parenting styles in particular were harmful, contributing to low resilience, a sense of entitlement and the increasing use of antidepressants and recreational analgesics.3-6 Changing this process is difficult and involves taking risks. Curiously, there is little in the literature that describes the young person’s role and responsibility. Instead, this has been abdicated to the parents who have had difficulty in letting go of their own unresolved conflicts.5 Informed by an intense wish to foster a secure attachment and sense of well-being in their children, the parent, whose own self-esteem is crucially dependent on their children’s success, rescues. As a result, “… rather than struggling with the subtleties of creating the conditions for the child’s mind to develop, parents seek to remove the realities of the external world from their children’s experience. In so doing they collude with the distorted thought processes of a maturing mind and create an inner world that can not tolerate disappointment and rejection”.5 The child, so diminished, is unable to think or feel for themselves. This parental difficulty is exacerbated by depressive and anxious states, by narcissistic injuries and by marital and family stressors, all of
Corresponding author: John Little (Consultant Psychiatrist), Capital and Coast DHB, Kapiti Community Mental HealthTeam, Warrimoo Street, Paraparaumu, 5032, New Zealand. Email: [email protected]
533 Downloaded from apy.sagepub.com at University of Bath - The Library on June 7, 2015
Australasian Psychiatry 22(6)
which inhibit reflective capacity. Relinquishing the rescue role is further complicated should the child’s age approach that when the parent themselves had similar difficulties in individuation,6 or when the interaction style mimics historical and unhelpful family patterns.2
Educational aspects …we must remind staff that solving problems for students robs them of the opportunity to learn.7: 31 The same dilemma, where to tread between protection and guidance, is described in the early childhood8 and university education7,9 literatures with at least four major surveys involving over 19,000 students. As the child progresses, parental support has been important. However, parental involvement has also been detrimental to development with the emergence of ‘helicopter parents’, referring to parents who anxiously hover over their children. Extensions are requested by parents who are writing their children’s assignments in an attempt to promote their self-esteem. Schools have responded by developing parent programmes and by providing counselling services for students with adjustment disorders, low self-esteem and feelings of emptiness and confusion rather than requiring them to meet course requirements. Changing this process is difficult and again involves risk taking. Modern parenting has changed, with fewer children spending longer in emerging adulthood with more emphasis on self-actualisation. The shift to the information age has led to an assumption that post-secondary education is mandatory for any young person who wants stability and permanence in the changing labour market. Education has become a commodity, with parents and students becoming consumers who monitor quality and performance electronically and by what has been called the world’s longest umbilical cord, the mobile phone.9 With pressures for academic success, threats on safety, waning natural resources and economic recessions, over-parenting has become an understandable but unhelpful response.6 The role of the individual is again curiously absent.
Clinical aspects The aim of treatment of the suicidal patient is to reverse the process by which suicidality has become reinforced and enhanced. The responsibility for ones life must be gradually re accepted. The person with the suicidal character structure has become used to letting himself fall toward death as a means of coercing others into catching him. He must be helped to recognise that the treatment plan will gradually remove some of those catching arms, leaving him with increasing responsibility for not letting himself go.10
The same tension – of whether to guide or protect – is variously described in the clinical literature and includes rescue fantasies and the disavowal of our own aggression and vulnerabilities in a relationship that may be open or distant and removed.11-13 In this sense, parenting and therapy share similarities. By the time the person with borderline personality disorder has arrived at the psychiatrist’s door, a considerable amount of learning has occurred by both parties. The therapist too may hover anxiously, striving to protect the person from further hurt and yet in so doing, do more harm than good by involuntary hospitalisation in the hope of keeping the person safe from themselves. Changing this process is difficult. The risk of suicide and the fear of negligence both hover expectantly. There are, however, less obvious but equally potent impediments to change. The therapist may over-identify with the patient, set unrealistic expectations and unwittingly create a ‘self-assigned impossible task’.14 Secondly, there is the temptation to ‘play it safe’ and so avoid the same dilemma the person is struggling with. However, the contrary choice of not intervening may in practice be no less harmful, and short-circuit further enquiry.15 The third, and perhaps more pernicious, of those factors making it difficult to relinquish rescuing is the curious absence of the individual. Although it is articulated in the early childhood literature under the heading of bidirectionality,16,17 it is only briefly alluded to in adolescence – “the tendency in both the adolescent and his/ her parent to blur the boundaries between them and collude in stimulating and sustaining intrusion and over protective behaviour from one side and provocation and dependent behaviours from the other”6 – before it disappears from view. It is as if the literature has colluded with those parents, teachers and clinicians who rescue the person from their dilemma. Vulnerability does not preclude the possibility of participation and of meaningfully contributing to one’s own health care.18
What to do? Treat people as if they were what they ought to be and you will help them become what they are capable of becoming. van Goethe. What, then, is to be done in the light of a complex and lengthy process that has become rescuing? It is our contention that the principles of good parenting, teaching and therapy overlap; “In the face of the child’s outburst, parental responses of non anxious, firm limit setting in an atmosphere of love and understanding help the toddler to master separation anxieties”.19 At an educational level, we must understand that learning is about questions as much as answers, with a willingness to take risks and to learn from mistakes, frustration and disappointment.6 In a clinical setting, the task is also to hold the paradox between empathic recognition and concerted action, and within a nurturing and respectful relationship, enable a
534 Downloaded from apy.sagepub.com at University of Bath - The Library on June 7, 2015
Little
“generative framework for negotiating new possibilities”.20 ‘What if my daughter runs away from hospital?’ The therapist could respond by saying she will be discharged or could ask the parent what they think they should do. Either runs the risk of solving an immediate problem. Instead, sharing the difficulty provides an opportunity to tolerate strong feelings through which a previously undiscovered solution may declare itself.19 Finally, there needs to be a recognition and acceptance of respective roles and responsibilities. In the therapeutic setting, patient autonomy has become asymmetric with duties falling mainly on the clinician and only exceptionally on the patient themselves – “it tends (incorrectly) to interpret patient autonomy as mere participation in decisions, rather than a willingness to take the consequences”.18 In clinical work, there is a tension between providing appropriate concern for the suffering endured by patients, and according a respect and understanding for choices that people make as to how they cope with their suffering – “To provide love or empathy without this proper respect for the potential freedom of our patients, even the freedom to act in perverse disregard to their own interest, is to convey a pity that only reinforces the patient’s sense of victimisation and passive resignation to an unfortunate fate”.21
Acknowledgements Thanks to Heather Dryburgh for typing. Thanks are extended to Marg and Rosie Little for their insights and to Dr Katie Richardson for alerting us to the concept of ‘helicopter parenting’.
Disclosure The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper.
References 1. Mathis JL. People who hate dependency. Med Aspects Hum Sex 1985; 19: 64–74. 2. Anderson SA and Sabatelli RM. Differentiating differentiation and individuation. Am J Fam Ther 1990; 18: 32–50. 3. LeMoyne T and Buchanan T. Does ‘hovering’ matter? Sociol Spectr 2011; 31: 399–418. 4. Baumrind D. The influence of parenting style on adolescent competence and substance use. J Early Adolesc 1991; 11: 56–95. 5. Locke JY, Cambell MA and Kavanaugh D. Can a parent do too much for their child? Aust J Guid Couns 2012; 22: 249–265. 6. Munich RL and Munich MA. Overparenting and the narcissistic pursuit of attachment. Psychiatr Ann 2009; 39: 227–235. 7. Hirsch D and Goldberger E. Hovering practices in and outside the classroom. About Campus 2010; Jan-Feb: 30–32. 8. Manning-Morton J. The personal is professional. Contemp Issues Early Child 2006; 7: 42–52. 9. Somers P and Settle J. The helicopter parent. College Univ 2010; 86: 2–9. 10. Schwartz DA, Flinn DE and Slawson PF. Treatment of the suicidal character. Am J Psychiatry 1979; 28: 194–207.
Concluding remarks Rescuing is a universal phenomenon recognisable in parenting, teaching and therapy that has developed over time through a variety of interwoven social, economic, psychological and clinical variables. Together these contribute to the difficulty in changing this style of interaction. In acknowledging this complexity, expectations of change can be realistically adjusted and principles of care shared. These include an awareness of what the consequences are for those in the care of the anxiously hovering parent, teacher or clinician. Secondly, a reminder that our role is one of engaged neutrality – “the teacher does not love the pupil as such but rather the progress of the pupil and the work they do together”.12 Finally, a recognition that the relationship is bidirectional – “Can we not understand the varying influences…that lead people to do what they do and at the same time hold people responsible for their actions, thus according an all-important respect to their human dignity of having free choice”.21
11. Malawista KL. Rescue fantasies in child therapy. Child Adolesc Social Work J 2004; 21:373–385. 12. Orgel S. Commentaries. J Am Psychoanal Assoc 1997; 45:5861. 13. Nussbaum MC. Analytic love and human vulnerability. J Am Psychoanal Assoc 2005; 53: 377–383. 14. Roberts VZ. The self-assigned impossible task. In: Oblozer A and Roberts VZ (eds). The Unconscious at Work. London: Routledge, 2004; pp.110–120. 15. Anna GJ and Densberger JE. Competence to refuse medical treatment. Toledo Law Rev 1984; 15: 561–596. 16. Loulis S and Kuczynski L. Beyond one hand clapping. J Soc Pers Relat 1997; 14: 441–461. 17. Goldstein LS. The relational zone. Am Educ Res J 1999; 36: 647–673. 18. Draper H and Sorell T. Patient’s responsibilities in medical ethics. Bioethics 2002; 16: 335–352. 19. Shapiro ER. The holding environment and family therapy with acting out adolescents. Int J Psychoanal Psychother 1982; 9: 209–226. 20. Stern S. The conundrum of self-care. Contemp Psychoanal 2007; 43: 605–620. 21. Shabad P. Beyond determinism and self-blame. Contemp Psychoanal 2007; 43: 587–604.
535 Downloaded from apy.sagepub.com at University of Bath - The Library on June 7, 2015
