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.
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.
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,
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
16th Fl., 3535 Market Street
Philadelphia, PA 19104
A light dinner will be served
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].
CCAF Clinical director, Jacqueline Hudak, will present on a panel about “The Changing Family” during Penn Spectrum Weekend.
Held during alumni weekend, Penn Spectrum “brings together alumni for dialogue centered on issues of cultural identity. We welcome alumni and allies from all backgrounds as well as current Penn undergraduate and graduate students. The conference focuses on issues pertinent to the Black, Latinx, Native, Asian, and LGBTQ alumni and student communities.”
For a full schedule of events, check out the link here.
I had a wonderful time presenting to physicians, nurses, social workers and psychologists at The Reading Hospital this spring.
The audience wanted to understand the meaning of emotional cutoff and the impact of this process on development and family relationships over the course of the life cycle.
Always true to my training as a family therapist, I began with my family genogram, and a story about my father’s cutoff from his family of origin. This happened when I was two years old and shaped the events in our family for many years to come. His alienation from his own family became the landscape of our life; it was always present. At certain times, like holidays, or life cycle events, like death, the impact was more acute. This relational rupture shaped how he was viewed by us, his immediate family members, influenced decisions, and had a grave impact on his health.
Emotional cutoffs are the natural mechanisms people use to counter high anxiety or high emotional fusion, also known as ‘too much closeness.’ A cutoff can look like physical or emotional withdrawal, avoidance of sensitive topics, physically moving away from family members or rarely going home.
Relationships may look “better” if people cutoff to manage them, but the problems remain, and are dormant.
Although people reduce the tensions of family relationships by cutting off, they risk making their new relationships too important. For example, the more a man cuts off from his family of origin, the more he may look to his spouse, children, and friends to meet his needs. This makes him vulnerable to pressuring them to be certain ways for him or accommodating too much to their expectations of him out of fear of jeopardizing the relationship.
Not all cutoffs are unwarranted, however. In some cases they are necessary, or preferred, as in the case of emotional or physical abuse.
There are circumstances when someone may be coached to ‘cut off.’ For example, consider the concept of ‘tough love’ or ‘letting someone hit bottom’ that is often suggested when a loved one is suffering with addiction. Post divorce families also struggle with physical and emotional cutoffs as issues of loyalty are prominent.
The words “cut off” imply a static state – a lack of motion or movement. However, to remain angry or to hold a grudge are in fact, actions.
Consider these verbs: to harbor bitter feelings, resent, brood, or stew.
Indeed, it is possible to become so wrapped up in the wrong that’s been done to you that you can’t enjoy the present. And there are significant health consequences. Anger, frustration and sadness increase the stress hormone, cortisol.
Experiencing these negative emotions instinctually prepares the body to fight. A prolonged state of fight increases levels of protein in the bloodstream which promote cardiovascular disease and stroke. But here’s the good news: Studies have found that the act of forgiveness can reap huge rewards for your health, lowering the risk of heart attack, improving cholesterol levels and sleep, reducing pain, blood pressure, and levels of anxiety, depression and stress. And research points to an increase in the forgiveness-health connection as you age.
Chronic anger puts you into a fight or flight mode, which results in numerous changes in heart rate, blood pressure and immune response. Those changes then increase the risk of depression, heart disease and diabetes, among other conditions. Forgiveness, however, calms stress levels, and leads to improved health.
Perhaps in the next post I’ll write about the work of forgiveness and repair. But for now, a return to my own family story.
About ten years into the cutoff, around the death of my paternal grandparents, my father’s siblings began to contact him. These vaguely familiar men, my uncles, were welcomed into our home, and celebrated.
My father’s expansive capacity for forgiveness has stayed with me, and brought valuable lessons which I apply in clinical work with families: that despite dire circumstances, change can happen, and usually does.
We just need to take the long view – that is, a family life cycle perspective. We are constantly negotiating closeness and distance in our relationships over time; we readjust according to the phase of the life cycle. The warmth and closeness around the time of birth is juxtaposed with the ‘letting go’ required for launching into young adulthood.
The practice of compassion and forgiveness, for ourselves as well as those we love, will enhance our health and nourish our spirits as we face the challenges that will inevitably come.
Join us for the next CPSP
Engaging Family Supports
Learning Objectives – Participants will be better able to:
CME: You can earn 1.25 CME credits
When: Thursday, April 21, 2016
|Course Directors:||Wesley Sowers, MD
Robert Marin, MD
Ellen Berman, MD, Clinical Professor of Psychiatry, Perelman School of Medicine, and Founder and Director of Training, Center for Couples and Adult Families, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
John Sargent, MD, Director, Division of Child and Adolescent Psychiatry, Tufts Medical Center and Professor of Psychiatry and Pediatrics, Tufts University School of Medicine, Boston, MA
*Community Psychiatry Forum: Free online videoconference offered twice each month. Continuing Medical Education credits