By Letticia Banton
Photo by Marianna Smiley

“It’s starting to get dark early.” After several years of working together, I knew this was my client’s code for ‘Christmas is coming’, which for him meant a reminder of his family’s estrangement and the prospect of spending another festive season alone, with intense feelings of loneliness, grief and shame resurfacing.

‘Family estrangement’ is a term used to describe the breakdown of a relationship between family members. In the UK, it is estimated that 1 in 5 people are estranged from their family, with numbers on the rise (Stand Alone, 2015). Yet it is an area of relationships that has received little attention by psychotherapeutic theory, research and training. To help address this gap, the Inner Citadel Institute welcomed Dr Samantha Barcham for a two-part CPD on family estrangement. Dr Barcham (2021) has conducted doctoral research into this area, and it is her specialism in clinical practice.

While every person’s experience is unique, Dr Barcham emphasised that “family estrangement often comes with incredible sadness and heartache for all those involved, and it is not something done on a ‘whim.’” Her research describes estrangement as a ‘relational injury’ or trauma (Barcham, 2021). As relational beings, a person’s sense of self-confidence and self-worth may be significantly impacted by family estrangement. Exploring a person’s lived experience of family estrangement and its impact on their sense of self in psychotherapy is nuanced work. In this post, we share six takeaways from the CPD sessions on working therapeutically with people who are estranged from/by their families:

1. Reflect on your own assumptions towards family estrangement

Family estrangement is an area that may not have been explored during core psychotherapy trainings. Drawing on Blake’s (2020) research, Dr Barcham highlighted several common biases that people carry toward those who are estranged from their families:

• Reconciliation bias: Are you encouraging reconciliation, pushing the client to reconnect and make amends? Why might you hold this agenda?
• Estrangement bias: Do you believe the client should ‘just walk away’ without exploring this fully and the consequences? Why might you be holding this position?
• Perspective bias: Do you hold one side at fault? Why? How much does being human and always thinking one person is ultimately to blame factor in your perspective?
• Forgiveness bias: Are you pushing your client to forgive to move on? Or encouraging them to make an apology, even if they don’t mean it? Why might this be the case?

2. Recognising and holding the complexity of family estrangement is important

Pathways to estrangement can be multifaceted and complex. These can include harsh or poor parenting, divorce, a problematic child-in-law, mental illness or addiction. It can also include divergence in values and lifestyles, such as gender, sexuality, religious and political beliefs. For some people estrangement might mean no contact, while for others it could be infrequent communication.

For others still, there could be physical proximity but an emotional distance. As a therapist it is important to demonstrate insight into this complexity. During therapy, collaborative and phenomenological inquiry can help to build a picture of what is known/unknown about a client’s family and their idiographic experience of estrangement.

3. The therapeutic relationship may play a reparative role

While the therapeutic relationship lies at the heart of any effective therapy, for people experiencing family estrangement, an attuned and trusting relationship carries reparative potential. While the client’s family relationships and attachment-bonds may have broken down the expression of intense feelings and conflicts, a good-enough therapeutic relationship can withstand this.

The therapeutic relationship may play a pivotal role in offering a relational experience that was missing in the client’s family-of-origin and self-development. It can offer warmth and compassion when the family environment may have been harsh and cold. Or flexibility when the family may have been rule-based and rigid. A safe and trusting therapeutic relationship can also help a client to face disavowed or shadow parts, which may be painful to revisit. For example, their role in the estrangement, or the experience of ambiguous loss of grieving for someone who still lives.

4. Left-brain and right-brain interventions are important

Using therapy as a space to dialogue about a client’s experience can help them to process complex emotions about estrangement, including shame, guilt and anger. As well as left-brain dialogue can enhance insight, right-brain interventions can expand a person’s capacity to ‘be in relationship’ so they can face the relational ‘other’. For example, a therapist offering affective co-regulation through grounding and breathing exercises could be important developmentally for people who may not have had emotional co-regulation modelled in their family of origin.

5. Working towards a form of acceptance

Fully accepting and moving beyond the immense pain of an estrangement may never be possible in a person’s heart. However, when someone learns to live with the estrangement, they can often feel a sense of relief and reduced suffering. Accepting the lived reality of the estrangement can help someone regain a better sense of control. They begin to grieve the ambiguous loss they may feel around being estranged from a family member.

It may also enable them to step back and have more insight and perspective into how the estrangement took place. A therapist plays an important role in helping a client to face the complex feelings they may hold around the estrangement so they can move into a place of acceptance. Through acceptance often comes a stronger sense of agency.

6. Reconciliation as a process not an event

Parents with estranged children may often come to therapy with the hope of working toward a reconciliation. Reaching this point requires both parties being able and willing to participate and does not happen overnight. To empathise with the child’s experience and make amends will require for parents to process all the difficult feelings this may entail, including guilt and shame, rather than staying in a defensive position.

There is also the risk that the reconciliation may take more time than anticipated or in some cases it may never be possible. Being able to stay with a client through the uncertainty a reconciliation process needs, rather than reaching for answers, is central to the therapeutic work. 

If you would like to learn more about family estrangement, you can join Dr Barcham’s next CPD course, taking place in September 2024, or you can also visit Dr Barcham’s website, which has lots of helpful resources here: https://familyestrangements.com/

References

Barcham, S. (2021). A mother without a mother: Women’s experiences of maternal estrangement in motherhood [Doctoral dissertation, Metanoia Institute]. https://repository.mdx.ac.uk/download/142bd92b5984ef4bb32647c94063b503fb6449a2ae504a12737f08721084a53c/1767763/SSSBarcham%20thesis.pdf

Blake, L., Bland, B., & Imrie, S. (2020). The counseling experiences of individuals who are estranged from a family member. Family Relations: An Interdisciplinary Journal of Applied Family Studies, 69(4), 820–831. https://doi.org/10.1111/fare.12385

Standalone (2015). Hidden Voices: Family Estrangement in Adulthood. https://www.standalone.org.uk/wp-content/uploads/2015/12/HiddenVoices.FinalReport.pdf

By Dr Ella Davey

What do you think makes a good therapist?

Their depth of experience? Their expertise? How quickly you can see improvements, perhaps through feeling calmer or less conflicted? Or perhaps you conceptualise a good therapist as being someone who makes you feel heard and valued? Or do you rather appreciate the insight a good therapist can help bring about?

The truth is we all have slightly different ways of evaluating the goodness of our therapists. I, for example, once had a therapist who was not only warm, patient, and creative, but also owned an elderly tortoiseshell cat who would sit and purr on my lap during sessions, comforting me to the core and – I’m sure about this – simultaneously regulating my anxious breathing and heartrate.

Such seemingly intangible aspects of what was, for me, an overall positive therapeutic experience can be difficult to quantify, let alone recreate. Yet, the best therapeutic experiences, and the best therapists, are definitely never completely perfect, nor even, necessarily, great. In fact, evidence tells us that the very best therapists are only ever just good enough.

Based on Donald Winnicott’s[1] concept of an infant who requires a ‘good enough caregiver’: one who is fallible and human as opposed to one who is perfectly responsive every time, so it has been said that what clients need most is a therapist who can show them, through their realness and humanity, that faultless care is neither attainable nor necessary when it comes to their healing path­[2]. Instead, a ‘good enough’ therapist should, ideally, embody core qualities such as empathy, authenticity, and competency which the client can then experience within a relationship characterised by safe boundaries and an attitude of mutual curiosity.

The good enough therapist, essentially, is constantly communicating to their client:

“I know I can’t reliably make all your challenges disappear, and sometimes I’ll even get things wrong. But that’s OK, because what’s important is that I’m here now and we’re going to work this through together, as best we can.”

To illustrate this idea further, several schools of therapy, despite their outward differences, have tended to agree that therapists should ideally aim to:

Give a hoot

At the heart of every good enough therapist, lies an ability to care about, attune to, and resonate with another person’s experiences. Of course, some people are naturally more empathic than others, but empathy is also something that can be cultivated and practised. Research has consistently shown it is essential for therapists to be capable of finding ways to authentically connect with their clients and to show them, often without words, that therapy is somewhere they will be listened to and also felt with. Empathy is the thing that, more than anything else, enables the development of a rapport capable of supporting even the most difficult or painful of conversations.

Be a real human being

A good enough therapist knows therapy works best when it’s a collaborative process in which neither party is anything other than themselves. Often, the right therapist for someone isn’t necessarily the person who appears the most polished, or the most qualified. What people often discover is that they tend to benefit most from someone who can provide them with a safe, affirming space where they can explore their thoughts and feelings. People also benefit from someone who is aware that everybody, including them, still has a lot to learn and who is open to receiving feedback in terms of what they’re getting right or what they might need to work on.

Good therapists, ideally, are similarly self-aware enough to know they’re likely trying to do the best they can in a line of work which, on a bad day, can make them feel quite the opposite. The ‘good enough’ bit comes in balancing the endeavour to be a skilled helping professional whilst acknowledging the inevitability of being a perfectly imperfect human being. A sense of humour, too, is useful since sharing laughter with someone in the midst of the occasionally bleak, black comedy of life can sometimes be the best treatment of all.

Not be a know-it-all finger-pointer

Everybody knows how difficult it can be to speak our worst bits out loud: the qualities we don’t like in ourselves or some of the things we’ve done in the past or, perhaps, we still do. Ten times more difficult is to have finally found the courage to tell someone about these who, in their response, inadvertently confirms the certainty that we really are these awful things, except now, instead of them simply festering in our own head, they are being evaluated by the calm-faced, know-it-all therapist who is sitting opposite us, nodding, purse-lipped, and head tilted.

As an antidote to this, Carl Rogers[3], founder of the client-centred approach, encouraged therapists to try hard to embody a non-judgmental warmth and acceptance of their clients, and to view each as cherished and valuable, no matter what. Such humanism can enable a space in which people can feel okay (enough) to explore their deepest worries without fear of censorship, in turn, leading to the fostering of security, empowerment, and a greater willingness to take ‘risks’.

Actively listen using the mind and the body

Some people might be surprised to realise that we not only listen with our ears but also with our bodies[4]. A good enough therapist will be listening carefully to what their client is telling them in words and hopefully then responding sensitively or insightfully. At the same time, good enough therapists will also be listening to what the client is telling them in other ways, including with their tone of voice, facial expressions, posture and even their silences since these modes of communication can, sometimes, tell a rather different story.

Furthermore, there are other therapists, including those who work psychodynamically or relationally, who will also be actively listening to a number of signals which may be coming from their own mind or body. These so-called ‘countertransference’ communications can provide an eerily accurate ‘reading’ of the client’s difficulties and also highlight matters of importance within the therapy itself which can be worth paying attention to, such as when the client feels bored, blocked, or angry but may be struggling to express or even realise this themselves.

Walk the Line

And finally, good enough therapists know how important it is to establish clear, appropriate therapeutic boundaries so that their clients can come to appreciate the extent of the therapeutic relationship and, crucially, the sense of safety and privacy it can provide. Often, therapeutic work around so-called ‘boundary issues’, whilst sometimes highly challenging, also proves transformative for clients through being helped to discover important aspects about themselves or their relationships outside the therapy room.

A good enough therapist will be careful not to introduce confusion by sharing too much about their own lives or by giving the impression they are a friend, rather than a professional. Much has been written on this subject and many debate the exact ‘lines’ therapists should aim to walk, but common standards of conduct exist which all strive to respect clients’ dignity and autonomy and for good reason, since when major boundary issues occur, therapeutic disasters can sometimes be the result[5].

In summary

Being a good enough therapist involves aspects of both doing and being. By cultivating skills such as empathy, active listening, non-judgement and safe therapeutic boundaries, therapists can provide their clients with an open space that promotes curiosity as to what it is to be human whilst embarking on a journey towards healing and personal growth.

[1] Winnicott, D. W. (1971). Playing and Reality. Routledge Classics.

[2] Borg, L. K. (2013). Holding, attaching and relating: A theoretical perspective on good enough therapy through analysis of Winnicott’s good enough mother, using Bowlby’s attachment theory and relational theory: A project based upon an independent investigation [Master’s thesis, Smith College]. https://scholarworks.smith.edu/theses/588/

[3] Rogers, C. R. (1961). On becoming a person: A therapist’s view of psychotherapy. Constable.

[4] Schore, A. N. (2014). The right brain is dominant in psychotherapy. Psychotherapy, 51(3), 388–397.

[5] British Association of Counselling and Psychotherapy (BACP) (2024, May). Boundaries: what complaints tell us. https://www.bacp.co.uk/about-us/protecting-the-public/professional-conduct/what-complaints-tell-us/boundaries/