Navigating Unhealthy Family Dynamics in Therapy: Insights for Clinicians
1. Understanding the Modern Landscape of Family Estrangements
Family estrangements and “cut-offs” are not new phenomena, but the conversation around them has become more public. Clients might feel shame or guilt for stepping back from relationships. It's our role to validate their experiences and help them reframe societal narratives that stigmatize estrangement.Clinical Tip: Avoid minimizing their decisions with statements like “but it’s your mother.” Instead, guide clients toward self-compassion and understanding the impact of these relationships on their mental health.
2. Dealing with Personal Biases as Therapists
Therapists are not immune to biases shaped by personal experiences with family. Acknowledging our own emotional triggers—be it unresolved grief, cultural expectations, or personal values—is crucial to providing nonjudgmental support.Reflection Question: What family narratives or dynamics trigger discomfort for you in sessions? Addressing these within supervision or personal therapy can ensure a more neutral therapeutic stance.
3. Navigating “Toxicity” in Client Language
Clients often label family members as “toxic” based on viral mental health terminology. While this can be a helpful shorthand, it’s important to delve deeper into the specifics of the behavior and its impact.Reframing Opportunity: Shift the focus from labeling individuals as “toxic” to understanding the dynamics as “unhealthy” and exploring why the relationship might still persist.
4. Balancing Boundaries with Empathy
Boundaries are transformative but must be implemented thoughtfully. Clients, especially those new to boundary-setting, may swing from porous to rigid boundaries. Encouraging a gradual approach can preserve relationships and foster long-term change.Pro Tip: Help clients practice language for boundary-setting in sessions and emphasize that boundaries are an ongoing process, not a one-time fix.
5. Validating the Complexity of Staying
Not every client is ready to sever ties with unhealthy family members. Many struggle with the tension between love, cultural expectations, and the fear of loss. Therapy can provide a safe space to explore ways to maintain relationships with minimal emotional harm.Key Insight: “Distance can be healthy.” Encourage clients to redefine relationships on their terms, whether that means less frequent contact or shorter visits.
6. Cultural Sensitivity in Family Dynamics
Cultural norms often play a significant role in family expectations. Clients may struggle with honoring their cultural heritage while asserting personal autonomy. Therapists can help clients navigate this balance by exploring ways to integrate cultural values with their evolving identities.Prompt: “How do you want to engage in this relationship while honoring your values and maintaining your well-being?”
Final Thoughts
As therapists, our role is not to dictate the path but to walk alongside clients as they navigate their family dynamics. Whether clients choose to mend, maintain, or sever ties, therapy should be the place that offers them the tools to align their relationships with their values and mental health needs.
Nedra Glover Tawwab, MSW, LCSW, is a licensed therapist and the author of Set Boundaries, Find Peace: A Guide to Reclaiming Yourself, an instant New York Times bestseller translated into over 35 languages worldwide. In addition, she has authored seven other books, including Drama Free: A Guide to Managing Unhealthy Family Relationships and, most recently, The Balancing Act: Creating Healthy Dependence and Connection Without Losing Yourself. A sought-after relationship expert, she has practiced relationship therapy for almost 20 years. With more than 2.5 million followers across her social media platforms, Tawwab has appeared as an expert on Red Table Talk, The Breakfast Club, Good Morning America, and CBS Mornings, to name a few. Her work has been highlighted in The New York Times, The Guardian, and Vice and has appeared on numerous podcasts including The School of Greatness, We Can Do Hard Things, and 10% Happier.
Speaker Disclosures:
Financial: Nedra Glover Tawwab maintains a private practice and receives royalties as a published author. She receives a speaking honorarium, recording, and book royalties from Psychotherapy Networker and PESI, Inc. She has no relevant financial relationships with ineligible organizations.
Non-financial: Nedra Glover Tawwab has no relevant non-financial relationships.
