Dr Hudak featured in Wall Street Journal article, “Here’s When Family Therapy Can Help”

I am so grateful to have had the opportunity to speak with award winning author, Elizabeth Bernstein, who writes the Bonds column for the Wall Street Journal.

She and I spoke, literally, for hours, about families and family therapy; she really captured the value of this approach to treatment.

Here’s the link to the full article.

For those without access to the WSJ, here’s a bit of the content.  You can also try to find it on Google News.

What is family therapy?

It’s a kind of psychotherapy that is different from individual work, in which the therapist interacts with the patient from a pathology-based model. The family is seen as a system. To understand the individual, I don’t look at a patient and think about what is going wrong inside them; I think about what happened between them and the significant people in their life—their partner, siblings, parents, kids. To me, that is the genesis of so many of their problems.

One of the important characteristics of a system is the perpetual movement toward homeostasis. People like things being the same. The response to change can be a very powerful pushback. In a family there is constant tension because a life cycle is about change. And sometimes the system can’t tolerate it. Some of the changes are expected, such as birth, death, marriage and adolescence. But sometimes life hands us unexpected challenges—people can develop other health issues: psychiatric problems, mood disorders, chronic health problems, addiction.

Think of a family system as a bunch of people dancing together in a particular way. They have been doing this a long time, perhaps generations before they ever got to my office. I have to learn the dance steps of each family member. Then I coach them on new dance steps.

How does family therapy work?

There is no one way. Typically I want to see the parents first. I’ll draw a genogram, or family tree, going back several generations. I want to know who came to this country and when. That elicits stories, maybe of what happened during the war, or persecution or loss, or tragedy or resilience or courage. These begin to tell me some of the things that are important to them. And it helps me understand the context of what they grew up in and how it impacted how they parent.

I think people’s notion of family therapy is you just throw everybody in the room together. That’s not true. I bring in different constellations of the family—sometimes individuals, sometimes pairs, sometimes everyone together.

I say you should give family therapy at least nine months to a year. But I don’t believe in keeping people in therapy. I am pushing people to go out and live their lives and if there are problems to come back.

How do you know when a problem warrants therapy?

Often, whoever is suffering—the symptom bearer, the acting-out child or depressed adolescent—is targeted for treatment. They go to therapy. But sometimes it doesn’t work. When symptoms continue unabated despite other treatments, maybe the family system needs support. You can always come for a consultation, to see if it may work.

Has your therapy style changed over the years?

I have gotten much less attached to a particular theory and way of doing things. And I am much more collaborative with my families, to see them as experts in their own story. I am more interested in how they see it, as opposed to how I see it. I am really interested in getting people to be researchers into their own lives.

Can a person go to family therapy alone?

Absolutely. A lot of individual, family-oriented work is around coaching that person to change how they behave in difficult relationships with their family members. Because one person’s change does impact the system. Think of the mobile that hangs over a crib: When you touch one piece, it moves the entire mobile. Such is the case with a family system. Even happy events—going off to college, the birth of a child—can throw a system into a state of disequilibrium. And one person going to therapy and making changes in their role in the family is going to impact that system and effect change.

How can you get someone in the family to go if they refuse?

It is almost like the laws of physics: If you are pushing, you are giving someone the opportunity to resist. So I say invite the person and if they don’t come, tell them you are going anyway. This is very powerful, because it is threatening for that person to be left out. Imagine that shift in energy. I coach clients to say: “We really like working with this doctor and we are going back. And I don’t know what is going to happen but I think we are going to start changing.” The person who has been resisting will probably show up because he wants to know what is happening. And even if he doesn’t, this approach will effect change.

Do you share information from each family member with the others?

The question is not if we share but when and for what purpose. I tell young adults that everything you tell me is confidential unless you’re going to hurt yourself or someone else. But I am going to tell you when you need to talk to your parents. It’s really about selling the idea of family members having a conversation, not me sharing the information. I am the least important person in the room.

Do you take sides?

No, unless there is a case of interpersonal violence or emotional abuse. If someone is calling someone a name, I say you need to stop that, it is going to make things worse. But otherwise I practice multi-partiality—the capacity to see everybody’s point of view. I try to understand why people feel so strongly about something.

Do you give homework?

Yes, a lot. One assignment is letter writing. Sometimes I have them write letters for their own edification, sometimes the letters are meant to be shared.

Sometimes I will say: “Here is a great question. I want you to think about it. What will life be like when all of your kids are gone from the house?” Sometimes I ask them to do more research on their own. I might say: “Call up your mother and ask her what happened in the family in 1962. You got really symptomatic then.”

Has being a therapist affected your own family?

I erred on the side of caution. I had a lot of stories in my mind about what could go wrong, especially from a safety point of view. I think I also have high expectations around our capacity to have conversations, and feel connected to each other.

Are there certain dynamics that can’t typically be helped with family therapy?

Yes, when there is a significant amount of emotional abuse or interpersonal violence. People can’t speak freely with someone they are afraid of for fear of retaliation.

But, in general, I think most problems can be mastered, which is different than being solved. Mastered means you understand what this is and recognize it and can tolerate it. Not everything is resolvable. You can’t always change the circumstances. But you can master the situation.

Grow your Family’s Relationship Superpowers

I’m so pleased to share this recently published book by my friend and colleague, Dr. Saliha Bava, and her partner, Mark Greene.

Although we might agree in theory that parenting is indeed a relational endeavor, our language belies this perspective. For example, we describe the child as “oppositional defiant” as though she existed in a relational vacuum, without that ‘other’ person she must oppose.

Diagnostic criteria focuses on the individual and obscures the parts of the relational system that promote imbalance and ill health.  This extends beyond the family system to the school, community and environment in which families are situated.  But responses to poverty or racism are not part of our diagnostic nomenclature.  We focus instead on the interiorized pathology of the individual, as if divorced from her community and relational world.

Bava and Green eloquently describe what happens in the relationship between parent and child:

“As we are shaping them, they are shaping us”

Indeed, we are changed as we parent,  uncovering parts of ourselves as we are buffeted from one intense emotion to the next.

Green talks about the opportunities in this process:

“for me to discover that I have some agency in those relationships, in those spaces, that there are ways I can operate that help me not fall prey to my own doubts, fears or concerns. “

The doubts, fears and concerns we harbor as parents are openings for change:

“If we have more flexibility, if we can look at problems from more angles, if we can hold our fears and concerns more lightly, if we can be more playful and collaborative,

If we can wait and see what’s emerging before we name and define our responses, all of these things are possible .”

 

I invite you and yours to hone your “family relationship superpowers” by engaging with this brilliant and captivating guide.  The Relational Book for Parenting: Raising Children to Connect, Collaborate, and Innovate by Growing our Families’ Relationship Superpowers is now available.

Enjoy this video by the authors https://player.vimeo.com/video/267271358“>video by the authors and you and your family can grow your relationship superpowers!

Happy Valentines Day

Family historian,  Stephanie Coontz, is admittedly one of my favorites.

Former President of The Council on Contemporary Families, Dr. Coontz brings a much needed perspective to our cultural discourses about marriage and family life.  Her capacity to mine enormous bodies of data and expose trends about the current state of relationships is remarkable – and very much needed.  The landscape of marriage and family is not easy to navigate, and I’m grateful for her clarity and perspective.

In that spirit (and because tomorrow is Valentines Day), I wanted to share her New York Times piece, For a Better Marriage, Act Like a Single Person.

Couple and family therapists are well aware of the hazards when two people believe they can be ‘everything’ to each other.  From a historical perspective, this “soul mate,” “one and only,” “romantic love” narrative is a fairly recent phenomenon.  In the not too distant past, one’s marital partner was not expected to fulfill so many needs; rather, marriage was more of an economic arrangement, with less expectation of emotional fulfillment from that one person. (For a full discussion, check out Dr. Coontz’s 2006 book: Marriage, A History: How Love Conquered Marriage). 

I’ve said before that one of the more exciting things about being a Couple and Family Therapist today is the research that shows the significance of relationship in one’s life.  In a shift from the traditional, individual paradigm that has dominated psychological theory, the new “science of relationship” and data from a wide variety of studies shows what we family therapists have intuited for so long: that the quality of one’s relationships matters to health and well being.

In her Times article, Coontz shifts her lens to the impact of community on marriage.  She finds that social networks of friends and family are enormously helpful to the couple:

“having supportive friendships is associated with more satisfying marriages, even among couples already content with the support they get from each other.”

And, the benefits go beyond the psychological health of the marriage:

“…..health researchers report that maintaining high levels of social integration provides as much protection against early mortality as quitting smoking. In fact, having weak social networks is a greater risk factor for dying early than being obese or sedentary. One analysis of 148 separate health studies found that people who cultivated a wide network of friends and other social relationships had a mortality risk 50 percent lower than those with weak ties.”

Therapists typically attempt to shift the dynamics between the members of the couple they see for treatment.  Coontz warns against using such a narrow lens:

“Many marriage counselors focus narrowly on improving partners’ couple skills without taking into account how the marital relationship is affected by interactions with other people. Yet a 2017 study found that when people socialize more frequently with good friends, they not only report fewer depressive symptoms themselves, but so do their partners.”

So, Happy Valentines Day.  Here’s to celebrating the many relationships that edify our lives, and contribute to our health and well being.

Read Dr Coontz’s full article here

Observing Traditional Holidays in Updated Ways, New Expressions

For nontraditional families, including same-sex couples, single parents, and people raising their grandkids, the ways in which holidays like Father’s Day are celebrated continue to evolve. Jacqueline Hudak, PhD, clinical director of the Penn Center for Couples and Adult Families, explains how these family dynamics grow and change.

Communications placement

WHYY NewsWorks

Family and friends can be powerful tools in improving health

David Asch MD and Roy Rosin, MBA of The Center for Healthcare Innovation at Penn Medicine have published an article  in The New England Journal of Medicine that supports the involvement of family and friends in improving health and health care outcomes.

At The Center for Couples and Adult Families, we are thrilled to  share this vision: that the quality of one’s relationships matters and has important and measurable impact on health and well being.

Holiday Tips from a Family Therapist

Fir Branch With Pine Cone And Snow Flakes

 

Each year around this time, conversations with clients turn to the predictable stress of time with family over the holidays.

Like ghosts in the night, old issues, long dormant, reappear at holiday time. How is it that an adult with partner and children can walk into their parents’ home and instantly feel 10 years old again? The anticipation of a holiday encounter can lead any adult to feel slightly unhinged in a way that few other situations do.

Let’s face it, no one can upset you like a family member.

Here are some ideas to try on this holiday season. They are born of basic tenets of family therapy theory and are utterly applicable to a variety of anticipated holiday situations:


1. Plan and be strategic. 

It’s always a good idea to warn someone that you are going to make a change before you actually do:

“I was thinking about the holiday, and this year I might do something a bit different.”

You don’t even have to be sure of what specific change you’re going to make, the point is to warn others first. That way, you can attempt to avoid their shock and surprise when you decide not to follow the family script – you know, ‘the way it’s always been and everyone (but you) wants to continue’.

This can be particularly useful when, for example, you have young children and want to begin to create your own traditions around the holidays. Perhaps you feel the stress of traveling with small children in an effort to please everyone, or because ‘you’ve done it every year, and they’re counting on you.’ So let people know in advance and find allies to support your change.

Which brings me to the next point.

2. Expect a reaction.

It is true that relationships have much in common with physics: for every action there is a reaction. Families attempt to maintain a homeostasis – a state of balance, maintained by familiar patterns and expectations. Think of the tremendous impact it has upon relationships when a family member joins or leaves the system; these points of normative developmental crises, birth, adolescence, marriage, or death, each require a renegotiation of previous roles and rules in the family system. Holiday traditions are valued as markers of continuity, so changes, however minor, can feel disruptive and unsettling.

3. Focus on yourself.  

You can change only your behavior, not the behavior of others.

Admittedly, this is a tough one. It’s the balancing act between giving up the dream of what can be, and accepting what is. There is much integrity in changing one’s own behaviors in a respectful and compassionate way, and it’s sad to realize that, for now, others may just not be who you want them to be.

Developing a curiosity about yourself may help. This might be a good time to entertain the questions:  Why does this person still hold so much power over me?  Why do I still need my mother/father/sibling to compliment or recognize me? How is it that I have come to this place in my life carrying that old wound?

4. There’s always next year.

Your opportunities to practice being different in your family are boundless. Try to think of this as one of many steps toward change. It will most likely take more than one conversation and there can be complicating factors: addiction, trauma, divorce, remarriage. Relationships take time, so keep in mind the long term; families are full of surprises and unpredictability as the family life cycle inevitably moves into the future.

When I hear a person in their 20’s or 30’s say “I’ll never have a relationship with my brother, I respond, “Well, let’s think about this for a moment. If you both live until you’re 80, are you telling me nothing will happen over the next 50 years? Most likely, your parents will predecease you, and you and he will together become the oldest living generation in the family. You may each partner with someone, and perhaps become aunt and uncle to each other’s children.”

There are endless circumstances that create opportunities for us to evolve in our family system.

Lastly, I try to remember at this time of abundance and giving thanks, that to even think about the quality of relationship is, of itself,  both a blessing and a privilege.

With all my best to you and yours during this special season,

Jacqueline Hudak

 

 

CCAF Event 9/28/16 Supporting Transgender Young Adults: Working Collaboratively with Family and Individual Treatment

Join colleagues at Penn Medicine and CHOP for this exciting panel, lead by transgender activist and family therapist, DR. ELIJAH NEALY.  They will address the importance of family therapy in the treatment of transgender young adults.

Dr. Nealy will be joined by Jacqueline HUDAK, PhD., LMFT, The Center for Couples and Adult Families, Perelman School of Medicine, Linda HAWKINS, Ph.D., Gender and Sexuality Development Clinic, CHOP, and Benoit DUBÉ, MD, Perelman School of Medicine.

 Wednesday, September 28th, 2016

6-8PM

16th Fl., 3535 Market Street

Philadelphia, PA 19104

A light dinner will be served

 RSVP sean.smith@uphs.upenn.edu

For the past 25 years, Elijah C. Nealy, PhD, M.Div., LCSW has worked extensively with LGBTQ adolescents and adults in both pastoral and social service capacities. Currently an assistant professor of social work at the University of Saint Joseph, West Hartford, CT, his clinical practice has focused on transgender and gender diverse youth and their families. Ordained with Metropolitan Community Church, Dr. Nealy regularly preaches and provides trainings for clinicians, faith communities, and organizations. An openly identified transgender man, Dr. Nealy lives in West Hartford with his partner and is the proud father of three amazing young people. He is the author of Transgender Children and Youth: Cultivating Pride and Joy with Families in Transition [Norton, February 2017].