Parentification: A License to Kill Childhood

Photo: Jadelui

Parentification is when children under age eighteen assume care-taking responsibilities for parents, or other family members at the expense of their own developmental needs and pursuits (Earley & Cushway, 2002). First conceptualised by Boszormenyi-Nagy and Spark in 1973, parentification can also be viewed more broadly as a “construct”. That is, outlining behaviours within a range of contexts that fit into “ever-widening systems of influence and meaning involving individual, interpersonal, family, institutional, cultural and historical issues” (Chase, 1999, p.xi). This means it occurs in various scenarios, at different times, and under a range of circumstances. Examples include divorce (Jurkovic, et al., 2001); family unpredictability and parental alcoholism (Burnett, et al., 2006); chronically unavailable parents due to parental AIDS-related illness or drug use (Stein,et al., 1999); and children who care for siblings with a disability or chronic disease (Lamorey, 1999). It also occurs as a result of the historical process of deinstitutionalisation, where parents with a mental illness were sent home from mental institutions without adequate support to parent their (often mentally intact) children. Instead, their children parented them, i.e., via parentification processes (Misrachi, 2012).

Parentification is different from teaching children responsibility (Hollingsworth, et al., 2003). Although there is a cultural component to parentification, with different societies viewing parentification differently (L’Abate, 1998), effectively it is ‘bad news’.This is because parentification is a hidden form of abuse and exploitation, as it represents “role corruption” (Garber, 2011) and can therefore be traumatic. When a parentified child’s care-giving efforts are not acknowledged or supported, it is more deeply understood as “destructive parentification” (Jurkovic, 1998, p.237). Parentification carries serious physical, psychological, and later occupational and economic status implications (e.g., Vitaliano, et al., 2003) which can also occur in high income countries (Gilbert, et al., 2009). Parentified children often find themselves taking on adult tasks ranging from repetitive physical labour to emotional ones like being their parent’s confidant (Jurkovic, 1997). It is therefore an exploitative phenomenon not unlike ‘modern slavery’ where a person is “coerced and controlled and forced to work… and not free to leave” (Swan, 2017). The ‘slave’ in this case, is a needful child trapped in the landscape of perhaps the most potent of all institutions: the family.

What are the features of parentification in the child and emerging adult? Points to watch out for are:

Parent ‘missing in action’: A parent might be unaware, unavailable, uninterested or otherwise too preoccupied to attend to their child’s needs. A parent might be physically present, perhaps even mouthing seemingly correct words, but mentally and emotionally ‘missing in action’. For example, parents with a mental illness can and often do parentify their children (e.g., Jeffreys, et al., 2011). They do this act by informally and persuasively recruiting them as a “need satisfying object” (Mudaly & Goddard, 2001, p.228) to fulfil their own perceived needs for care (Valleau, et al., 1995).

Unmet needs: Research since the 1970s reveals that unmet needs make caregiving at any age an emotionally challenging and at times impossible task (e.g., Bleuler, 1978). Parentification compromises needs. For instance, children of parents with a serious mental illness forced to grow up too early often learn to ignore and neglect their own needs (Sivec, et al., 2007).When parentified individuals assume excessive responsibility for their family it often involves inappropriate, high-level, adult responsibilities coupled with unrealistic expectations by younger children looking to older siblings (not their parents) for their needs to be met (e.g., Jeffreys, et al., 2011). Despite the lack of empirical research (McMahon & Luthar, 2007), the weight of evidence appears to lean towards general agreement that as a result of parentification, parentified individuals as children neglected their own needs (e.g., Burdekin, et al., 1993; Sivec, Waehler, Materson, & Pearson, 2007). The threat parentification poses goes beyond a child’s school life (Barnardo’s, 2017). It threatens psychological health and development throughout life, including identity development, personality, interpersonal relationships, and relationships with an individual’s own children affected (Earley & Cushway, 2002).

Confusion over care-giving vs. care-receiving: According to Bowlby (1977), care-giving constantly directed away from child to parent has the child growing up and inevitably associating care-giving (not care-receiving) with what a child-parent relationship is meant to feel like. It thus primes children for compulsive care-giving patterns of relating in adulthood. Bowlby states:

“the person showing [these patterns] may engage in many close relationships but always in the role of giving care, never that of receiving it [and] the person who develops in this way has found that the only affectional bond available is one in which he [or she] must always be the care-giver” (p. 207).

Such confusion can render the parentified individual unassertive. They may feel trapped in an impenetrable situation from which they see little chance of escape. This can bring on a pervasive sense of inchoate sadness (Massie & Szajnberg, 2006). As a consequence of exploitation or maltreatment, such sadness is often mixed in with (irrational) guilt while inhibiting authentic self-expression (Lanius, Vermetten & Pain, 2010). Even for those able to physically ‘escape’, psychological escape from this type of confusion remains illusive in even competent and successful individuals with a history of parentification, unless trauma-informed treatment is received (Misrachi, 2012).

Voicelessness: Children must sacrifice and respond in socially desirable ways if they are to receive social approval from important adults (Sahoo & Suar, 2010). A parentified individual risks losing “any ability to express need or ask for care, yet retains a pervasive, unsatisfied neediness and longing for care” (West & Keller, 1991, p.431). Therefore, children (irrespective of age) trapped in a parentification vortex often have no choice and therefore no voice but to ultimately comply to the demands of their primary attachment figure — usually this is a parent. For survival, the parentified child relies on whatever internal resources and stamina they may have to not give up, to try harder.

Empty hopes: Children who grow up with non-disordered parents and who are not parentified take for granted that they will receive attention from and have an emotional connection to their parents (Lewis, et al., 2011; van der Kolk, 2015). A parentified child, however, cannot take such things for granted. They can only maintain hope of such attention from and connection to their parents (Jurkovic, Jessee, & Goglia, 1991), which sadly often does not eventuate (Donald & Jureidini, 2004; Jeffreys, et al., 2011). Being stuck in a spiral of parental expectations has consequences. It can lead to a wretched pattern of further neglect and a hopeless never-ending cycle of suffering.

Martyrdom: Parentified individuals often become ‘martyred’, for instance, to their parents’ poor mental health while being raised by them (Foster, 2006; Cousins, 2004). After a lifetime of taking responsibility for what is not theirs, the parentified individual has learnt to “react by sacrificing his or her own needs for comfort and guidance and care for logistical, emotional, and self-esteem needs of parent[al figures]” (Chase, et al., 1998, p.105). Already care-worn, and because of the over-familiarity of putting their own needs aside, parentified individuals might have great difficulty viewing themselves as “a person” (Shengold, 1999, p.110) when they are children and then as adults. This is because “as children, they felt they must be ‘good’, healthy and strong because the family already had many problems” (Sivec, et al., 2007, p.579).

Typically, the outside world is blinded by a parentified child’s ‘cuteness’, ‘kindness’ or ‘goodness’ but such admiration is based on ignorance. This may inadvertently reinforce parentification at the expense of that child’s true gifts and talents, leaving them also prone to irrational shame (Wells & Jones, 2000). Individuals who grow up burdened with adult emotional tasks before they are developmentally ready experience martyrdom (Brown, 1989). One individual articulates this premature pressure as: “I grew up long before ‘childhood’ ended” (Camden-Pratt, 2002, p.94). Children have to take the best strategy available to them during their childhood. However, parentified individuals feeling it’s OK to care without limit might be at risk of becoming pleasers, with some ending up with abusive partners. Being too busy caring for their parents and others to process their own trauma prevents children from doing what trauma research strongly recommends — “stop[ping] the self-sacrifice” (Courtois, 2010, p.256).

Distracting and blurring parentification issues: Parentification is euphemistically termed “role adaptation” and falsely viewed as a natural consequence since it “undoubtedly occurs when children care” (Aldridge, 2006, p.82). Misinformed views of parentification are often found in the literature, such as Aldridge and Becker’s (1993) “Children Who Care”. Implicitly this may send a powerful guilt-inducing message that children who are not carers for their parent do not care, and by association are uncaring people. It also obscures their own legitimate need for receiving care themselves while overlooking them as “burdened children” (Chase, 1999). In the context of parental mental illness, such euphemisms don’t stop at children. For adults, “Partnership” programs (Mental Health Council of Australia & Carers Association of Australia, 2000) have entered the matrix. These are perennial yet of dubious efficacy, recruitment-efforts that overlook parentified populations (Misrachi, 2012; 2017). Such efforts delay much-needed therapeutic attention for parentified individuals, who are ultimately the ones paying the price for blurred parentification issues.

Delay in trauma awareness and treatment: As we’ve seen, parentified individuals had to cradle their parent (or sibling) to survive, trading off part of their development in the process. Insight, if it arrives at all, does so in adulthood and only with much pain (Misrachi, 2012). This delay in awareness is neither desirable nor inevitable, and young carers can be psycho-educated, in age-appropriate ways, at any point to make their predicament less harmful into their future. But depending on the cultural context, various obstacles to psycho-education as an intervention exists. Perhaps the most obvious one is Australia’s government policy associated with family-focused interventions. This is where the needs of sick parents are given priority over and above the needs of their mentally well but traumatised offspring (Goodwin & Happell, 2007; Misrachi, 2017).

Little soldiers turning into big soldiers. The metaphor of “war” is well suited to the physical imprint trauma has on the brain and body not only for ex-soldiers but also for neglected or abused children and adults (van der Kolk, 2015). Parentified children are not usually soldiers, but are often taught that their identity depends on their ability to keep suppressing their needs, while catering to the convoluted needs of others. That is, rewards can only come if such behaviours continue. This means such individuals believe they should dutifully keep “soldiering on”. Nancy J. is a case in point. She notes that she is seeing a therapist to deal with severely limiting issues emerging as a result of the parentification process and which affected the quality of her life and mental health. Nancy J. wrote the following after reading my comment about a radio segment on the topic of parents with mental illness (30 June, 2017):

“I am 51, successful and functional but was engaged in parentification (new term for me!) since I was about 8 when I became very aware of my parent’s issues… People affected like myself really need advocates and assistance, otherwise it truly feels like you’re a veteran of some war but are ‘fine’”. ( ABC Radio National All in the Mind )

Nancy’s reference to “war” is not uncommon for people raised by parents who were ‘missing in action’ due to, for instance, parental issues associated with a mental illness (Misrachi, 2012).

Creation of a false self hidden within plain sight: We now know, for example, that parental demands for regular support and help from their children come at the cost of that child’s well being and developmental needs. A parentified child grows lopsidedly, taking an out-sized sense of responsibility at the expense of their other developmental needs. Conditioning makes it easier for them to repeat this early dysfunctional pattern later on in their services to others (Bowlby, 1977). This can manifest in choice of professional pursuits that demand similar engagement, power dynamics, close or intimate knowledge, or relationships (e.g., DiCaccavo, 2002). Thus parentified individuals socially morph into false selves in the service of whoever they are made to care for (Jones & Wells, 1996).

A paradox of power relations: Children are not psychologically or emotionally capable of reporting abuse and neglect meted out to them by their parents due to attachment needs. Neither can they prevent maltreatment because they can only identify factors that can cause an event rather than those that prevent it (van der Kolk, 2015). Yet role reversal, i.e., parentification, is “a relationship disturbance in which a parent looks to a child to meet the parent’s need for comfort, parenting, intimacy, or play, and the child attempts to meet these needs” (Macfie, et al., 2005, p.51). Here the child appears to be logically in a position of power. Paradoxically, being parentified by their parent does not reduce their parent’s coercive powers even though it is the child meeting the needs of the parent.

Ethical considerations involving a power differential: Parentification is about exploiting children. It is done by adults for adults. They benefit. Children do not. Ultimately, parents have greater authority and power over their child’s high dependency and attachment needs (Bowlby, 1973). This can continue into adulthood. Yet some claim children (“young carers”) are acting out of choice (e.g., Aldridge & Becker, 2003). Children often cannot decide, not only because of their powerful attachment and dependency needs, but also for developmental reasons (Ward & Glaser, 2010). For instance, because of the way trauma and early attachment operate (van der Kolk, 2015), and without trauma-informed internal work, individuals, for example, raised by sick parents often remain under their control, just as they were as parentified kids (Misrachi, 2012). Research by Wuest and colleagues (2010) illuminates how survivors of child maltreatment can become caregivers for their abusers — this is a type of traumatic bonding. Traumatic bonding contains cognitive distortions and behaviours which serve to maintain and reinforce the dysfunctional bond. Typically one has more power than the other, such as between adult and child (Courtois, 2010). Here, parentification is equated with a license to steal childhood.

To summarise, parentification is a very serious problem cutting across generations and cultures, and unscreened can lead to iatrogenic damage (Caplan & Caplan, 2001). Adults instinctively protect children. But if parents are ‘missing in action’, their instincts fade or go missing, and the child struggles with unmet needs while being embroiled in a power differential. Multiple unnavigable consequences ensue which leave a parentified child trapped and confused between care-giving vs. care-receiving. This disorientation renders a child voiceless while holding onto empty hopes. They will then usually try even harder to please, which will, in turn, seductively suck them into martyrdom. Euphemisms and ignorantly driven admiration pose additional obstacles to an already delayed awareness of trauma. Until self-awareness and subsequent trauma-informed treatment arrives, the parentified remain naive, innocent, confused yet soldiering on. ‘Little soldiers’ risk turning into lopsided bigger ‘soldiers’, and within all this, a false self blossoms well-camouflaged within plain sight.

What is to be done? Since the political will power to drive and convert evidence-based ideas into public education appears scarce, we cannot expect a vulnerable person sitting in a counselling room to be aware of their victimisation as a result of parentification. It’s the clinician sitting inside that therapeutic space who’s ultimately in charge and in the best position to assess roles, responsibilities and processes that undergird parentification. In my clinical practice, I ask the individual if they’ve heard of “parentification” and if not would they like to guess what it might mean. I then proceed to raise their self-awareness and psycho-educate. Spreading the word on parentification quickly before more childhoods are killed off, I believe, is an ethical approach. Change begins with one person, and this can smartly be you.

To hear a personal account of parentification, I recommend the following (28 min) podcast: Coping Without Kira (The Untold, 2016).

This article was originally published in Mind Cafe, February, 2018, Issue 37.

REFERENCES

Aldridge, J. (2006). The experiences of children living with and caring for parents with mental illness. Child Abuse Review, 15, 79–88.

Aldridge, J., & Becker, S. (1993). Children who care: Inside the world of young carers. Loughborough: Department of Social Sciences, Loughborough University in association with Nottinghamshire Association of Voluntary Organisations.

Aldridge, J., & Becker, S. (2003). Children caring for parents with mental illness: Perspectives of young carers, parents and professionals. Bristol Policy, c2003.

Barnardo’s (2017). “Schools failing a generation of young carers sacrificing their futures for their loved-ones” Press release: 06 Dec 2017.

Bleuler, M. (1974). The offspring of schizophrenics. Schizophrenia Bulletin, 1(8), 93–107.

Boszormenyi-Nagy, I., & Spark, G., M. (1973). Invisible loyalties: Reciprocity in intergenerational family therapy. Hagerstown, MD: Harper & Row.

Bowlby, J. (1977). The making and breaking of affectional bonds.1: Aetiology and psychopathology in the light of attachment theory. College of Psychiatrists, 19 November 1976 version of the Fiftieth Maudsley Lecture, delivered before the Royal psychopathology in the light of attachment theory. Expanded British Journal of Psychiatry, 130, p.201–210.

Bowlby, J. (1973). Separation: Anxiety & anger. Attachment and loss. London: Hogarth Press.

Brown, E. M. (1989). My parent’s keeper: Adult children of the emotionally disturbed Oakland, CA: New Harbinger Publications.

Burdekin, B., Guilfoyle, M., & Hall, D. (1993). National inquiry into human rights and mental illness. Canberra: Australian Government Publishing Service.

Burnett, G., Jones, R., Bliwise, N.G., Thomson Ross, L. (2006). Family Unpredictability, Parental Alcoholism, and the Development of Parentification. The American Journal of Family Therapy, 34 (3) p.181–189.

Camden-Pratt, C. E. (2002). Daughters of Persephone: Legacies of maternal “madness”. University of Western Sydney, Sydney.

Caplan, R., B, & Caplan, G. (2001). Helping the helpers not to harm: Iatrogenic damage and community mental health. New York: Brunner-Routledge.

Chase, N., D (Ed.). (1999). Burdened children: Theory, research and treatment of parentification California: Thousand Oaks.

Chase, N., D, Deming, M., P, & Wells, M., C. (1998). Parentification, parental alcoholism, and academic status among young adults. American Journal of Family Therapy, 26(2), 105–114.

Courtois, C. A. (2010). Healing the incest wound: Adult survivors in therapy (2nd ed.). New York: W.W. Norton & Company.

Cousins, C. (2004). When is it serious enough? The protection of children of parents with a mental health problem, tough decisions and avoiding a ‘martyred’ child. Australian e-Journal for the Advancement of Mental Health (AeJAMH), 3(2), 1–8.

Dent, G. (Presenter) (2016, November, 28). Coping Without Kira. The Untold [Podcast radio programme]. London: BBC.

DiCaccavo, A. (2002). Investigating individuals’ motivations to become counselling psychologists: The influence of early caretaking roles within the family. Psychology and Psychotherapy: Theory, Research and Practice. The British Psychological Society,75(4), 463–472.

Donald, T., & Jureidini, J. (2004). Parenting capacity. Child Abuse Review, 13(1), 5–17.

Earley, L., & Cushway, D. J. (2002). The parentified child. Clinical Child Psychology & Psychiatry, 7(2), 163.

Foster, K. N. (2006). A narrative inquiry into the experiences of adult children of parents with serious mental illness. Unpublished doctoral dissertation. Griffith University, Queensland, Australia.

Garber, B. D. (2011). Parental alienation and the dynamics of the enmeshed parent–child dyad: Adultification, parentification, and infantilization. Family Court Review, 49(2), 322–335.

Gilbert, R., Spatz Widom, C., Browne, K., Fergusson, D., Webb, E., & Janson, J. (2009). Burden and consequences of child maltreatment in high-income countries. Lancet, 373, 68–81.

Goodwin, V., & Happell, B. (2007). Consumer and carer participation in mental health care: The carer’s perspective: Part 1 — the importance of respect and collaboration. Issues in Mental Health Nursing, 28, 607–623.

Hollingsworth, L. A., Didelot, M. J. & Smith, J. O. (2003). REACH Beyond Tolerance: A framework for teaching children empathy and responsibility. The Journal of Humanistic Counseling, Education and Development, 42(2), 139–151.

Jeffreys, H., Rogers, N., & Hirte, C. (2011). Keeping the child in mind: Child protection practice and parental mental health. Adelaide, SA: Department for Families and Communities

Jones, R. A., & Wells, M. (1996). An empirical study of parentification and personality. The American Journal of Family Therapy, 24(2), 145–152.

Jurkovic, G. J. (1997). Lost childhoods: The plight of the parentified child. New York: Brunner-Mazel.

Jurkovic, G.J. (1998). Destructive Parentification in families: Causes and consequences. In, L’Abate, L. (1998). Family psychopathology: The relational roots of dysfunctional behavior, 237–255. The Guilford Press.

Jurkovic, G., Jessee, E. H., & Goglia, L. R. (1991). Treatment of parental children and their families: Conceptual and technical issues. American Journal of Family Therapy, 19(4), 302–314.

Jurkovic, G.J., Thirkield, A., & Morrell, R. (2001). Parentification of Adult Children of Divorce: A Multidimensional Analysis. Journal of Youth and Adolescence, (30)2, 245–257.

L’Abate, L. (1998). Family psychopathology: The relational roots of dysfunctional behavior. The Guilford Press.

Lamorey, S. (1999) Parentification of siblings of children with disability or chronic disease. In, Chase, N., D (Ed.). (1999). Burdened children: Theory, research and treatment of parentification, 75–91.California: Thousand Oaks.

Lanius, R.A., Vermetten, E., & Pain, C. (Eds.) (2010), The impact of early life trauma on health and disease: The hidden epidemic. Cambridge University Press.

Lewis, C., Bornstein, M. H., & Lamb, M. E. (2011). The role of parent-child relationships in child development. In M. H. Bornstein & M. E. Lamb (Eds.), Developmental science: An advanced textbook (6th ed., 469–517). New York: Psychology Press.

Macfie, J., Mcelwain, N. L., Houts, R. M., & Cox, M.J., (2005). Intergenerational transmission of role reversal between parent and child: Dyadic and family systems internal working models. Attachment & Human Development (7)1, 51–65.

Massie, H., & Szajnberg, N. (2006). My life is a longing: Child abuse and its adult sequelae. Results of the Brody longitudinal study from birth to age 30. International Journal of Psychoanalysis, 87, 471–496.

McMahon, T. J., & Luthar, S. S. (2007). Defining characteristics and potential consequences of caretaking burden among children living in urban poverty. American Journal of Orthopsychiatry, 77(2), 267–281.

Mental Health Council of Australia & Carers Association of Australia (MHCA & CAA). (2000). Carers of people with mental illness project: Final report. Canberra: Commonwealth Department of Health and Aged Care.

Misrachi, S. (2017). “Are Dewy-Eyed Policy-Makers Participating in Rather than Preventing Transmission of Trauma?” MindCafe Issue #36, November edition.

Misrachi, S. (2012). Lives Unseen: Unacknowledged Trauma of Non-Disordered, Competent Adult Children of Parents with a Severe Mental Illness (ACOPSMI). Department of Social Work Melbourne School of Health Sciences Faculty of Medicine, Dentistry and Health Sciences.

Mudaly, N., & Goddard, C. (2001). The child abuse victim as a hostage: Scorpion’s story. Child Abuse Review, 10(6), 428–439.

Sahoo, R., & Suar, D. (2010). Influence of social environment on young carers, assistance and consequences of caregiving. Psychological Studies — University of Calicut, 55(4), 323–329.

Shengold, L. (1999). Soul murder revisited: Thoughts about therapy, hate, love, and memory. New Haven, CT: Yale University Press.

Sivec, H., J., Waehler, C., A., Materson, P., J., & Pearson, B., L. (2007). Hearing the silent need: Assessing children who have a parent with a serious mental illness. In S. Smith, R. & L. Handler (Eds.), The clinical assessment of children and adolescents: A practitioners handbook (pp. 575–593). Mahwah, NJ: Lawrence Erlbaum Associates.

Stein, J.A., Riedel, M., Rotheram-Borus, M.J. (1999). Parentification and Its Impact on Adolescent Children of Parents with AIDS. Family Process, 38(2) p. 193–208.

Swan, N. (Presenter) (2017, August, 18). Australia to crack down on modern slavery. RN Breakfast [Podcast radio programme]. ABC Radio National, Australia.

Valleau, P. M., Raymond, M. B., & Horton, C. B. (1995). Parentification and caretaker syndrome: An empirical investigation. Family Therapy, 22, 157–164.

van der Kolk, B. (2015). The body keeps the score: Mind, brain and body in the transformation of trauma. Penguin Books.

Vitaliano, P. P., Zhang, J., & Skanlan, J. M. (2003). Is caregiving hazardous to one’s physical health?: A meta-analysis. Psychological Bulletin, 129(6), 945–972.

Ward, H., & Glaser, D. (2010). The developmental needs of children: Implications for assessment. In J. Horwath (Ed.), The child’s world: The comprehensive guide to assessing children in need (2nd ed.,160–173). London: Jessica Kingsley.

Wells, M., & Jones, R. (2000). Childhood Parentification and Shame-Proneness: A Preliminary Study. The American Journal of Family Therapy. 28(1), 19–27.

West, M. L., & Keller, A. E. (1991). Parentification of the child: A case study of Bowlby’s compulsive care-giving attachment pattern. American Journal Of Psychotherapy, 45(3), 425–431.

Wuest, J., Malcolm, J., & Merritt-Gray, M. (2010). Daughters’ obligation to care in the context of past abuse. Health Care for Women International, 31(12), 1047–1067.