Many years ago I had the good fortune of studying with one of the pioneers of family therapy, Dr. Carl Whitaker, and one of his disciples, Dr. David Keith, a child/family psychiatrist who shared with me an unpublished article in which he drew a parallel between his work both as a child/family therapist and an air force flight surgeon where his job was to keep the jet pilots flying despite the high degree of stress they encountered. Now, Dr. Keith was not suggesting that helping pilots deal with the emotional sequelae of dodging surface-to-air missiles was exactly the same as treating child patients and their families. However, the goal of the flight surgeon and the child/family therapist had one striking commonality: the need to keep ‘em flying.
How does this apply? First, during this period of covid, the many uncertainties we all experience and the departures from our normal routines continues to be very challenging. Second, there are a number of chronic, intractable problems (i.e. ADHD; Aspergers; Learning Disabilities) that families must navigate during non-covid time that may be exacerbated by our current situation. For example, ADHD, with its’ wide constellation of symptoms, presents parents, teachers, and therapists with many exasperating and treatment resistant issues. Procrastination, for instance, is common amongst ADHD kids. It is a problem that drives parents mad as their attempts to apply simple logic and reasonable strategies either fail outright or work for only a short period of time. For example, parents, teachers, and therapists often attempt to utilize a schedule to address procrastination. Sounds good, right? Well, schedules only work when they are followed. Many procrastinators are expert at their jobs and, if you ask them, they will tell you exactly how they defeat the most well-established strategies. Remote instruction just adds to the task of combating procrastination, low motivation, and poor task completion.
Therapy directed only toward the creation of strategies is likely to fail. This is because most kids know what it they need to do. Yet, they do not do what they know. Understanding and finding creative (i.e. out-of-the-box) ways to address the procrastinators’ resistance to doing what they already know has a greater likelihood of yielding positive results than generating more and more strategies in the absence of addressing the obstacles that interfere with their implementation. Failed attempts to stem the procrastination evoke increased frustration and hostility which only exacerbates matters. ADHD may be particularly resistant to treatment even when medication is used because it only addresses the biological component of the problem. However, failed strategies do not signal failure if something is learned from the attempt.
Removal of parent-child impasses requires a transfusion of emotion and play into the system. This involves recognizing that impasses are bilateral. That is, each party is contributing to the stalemate. In fact, impasses develop as a result of a deterioration in the state of the relationship we have with the other party. This worsening of relationships comes from or starts with a withdrawal of emotion or connection. This is why parents, teachers, and kids engage in repetitive behavioral patterns that each knows has not worked in the past. Fixing the relationship connection requires that we find ways to rekindle the good feelings we have had in the past by infusing new emotions and a sense of play.
Diluting an impasse requires time, patience, and an acceptance of the idea of being “good enough.”
When adults and kids are stuck, getting unstuck means rebuilding the reservoir of good will. It does not happen overnight, but baby steps can be signal a fresh start. The adults and the kids need to regulate their emotional responsiveness to one another and drain off toxic feelings emanating from the frustration of one party not acting in ways acceptable to the other. Making baby steps involves accepting the idea of each needing to only be good enough with each other-i.e. relating constructively more often than not. Tolerating slips, regression, and emotional meltdowns is part of the repair process. This is a major operation. However, the choice is to make changes or remain mired in the emotionally deadening state of the status quo.
This is why the idea of keep ‘em flying is so important. The use of adjuncts like medication and behavioral techniques needs to be augmented by talk therapy that supports the family members while it also addresses the removal of the obstacles to successfully implement the simple, logical strategies that always seem to fail. Talking keeps parents and kids flying because it induces hope and over time permits the unsaid or nonverbal components of the problem that fuel its’ continued existence to evolve and be translated into words. Language is the vehicle for change to occur while unspoken/nonverbal resistances just impede progress and reinforce the status quo.