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Parentification and Boundaries: Helping Patients Navigate Role Reversal

October 22, 2013

By Leslie Durr, PhD, RN, PMHCNS-BC
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The opinions expressed by Psychiatry & Behavioral Health Learning Network bloggers and those providing comments are theirs alone and are not meant to reflect the opinions of the publication.

A young woman, I’ll call her Julie, nearing 30, came to therapy saying that she felt that she was not meeting the life milestones that she expected of herself and that her friends were making. She had a job with significant responsibility, although she still felt like an imposter, a not-too-uncommon feeling during the early years of a career, I’ve found.

She had friends but didn’t do much to stay in touch with them. And then she said, “My mother is my best friend,” and proceeded to describe texting back and forth with her mother several times a day and talking by phone a couple more.  While she said she liked being in touch with her mother, she said she was beginning to find it burdensome since her mother called and texted about her problems, and Julie was often in meetings or with a client. Julie felt both put upon and distressed because her mother lived more than 100 miles away and Julie could not be available to assist.

Since her father’s death when Julie was a young teen, she had become Mom’s confidant, and even felt like a parent to her. Here was a case of a parental child if there ever was one. In this case, Julie was growing uncomfortable with the role and sought a way to make changes. Rather than mother and daughter grieving the loss of husband and father together, with the mother continuing to offer support to Julie and getting her support from another adult, Mom had made Julie into her parent or even spouse. She confided her problems and looked to her for emotional support, a clear situation of a parentified child.

Parentification—a term used by therapists such as Salvador Minuchin, Murray Bowen, and Virginia Satir—is a form of role reversal in which a child of a personality-disordered parent is inappropriately given the role of meeting the emotional or physical needs of the parent or of the other children.

The effects of this on adult children often are one of two things. Lacking a clear sense of what they want for themselves, people who have been parentified are needy for the approval of others in everything. They have had their boundaries violated and look to others for what they should feel or do.

Or they keep others at an emotional arm’s length because they can’t risk anyone getting close or accepting help or advice from people since they have become rigidly bound to the caretaking, rescuing role. And then they are sad that no one seems to care about them.

Julie came to therapy at a point of readiness for learning how to set healthy boundaries with her mother. She needed guidance on how to do that without rupturing the entire relationship because she did, after all, love her mother. She did the consistent work, while the therapist helped with both support and some suggested wording that Julie made her own. In addition, Mom showed herself resourceful by getting back into therapy.

As therapists with backgrounds in child development, we often can see the monstrousness of parental behavior and could be tempted to give the green light to a patient/client to act in monstrous ways themselves, but it is our duty to assist those we help to handle themselves in ways that add to their health development.

Oh, and Julie’s boundary-setting got some extra practice when she met a nice man of whom Mom didn’t approve. A year later, Mom even attended their wedding and Julie keeps setting those boundaries.

As a clinician, how do you help parentified children to learn to set boundaries?


Leslie Durr, PhD, RN, PMHCNS-BC is an advanced practice psychiatric-mental health nurse with a private psychotherapy practice in Charlottesville, Virginia.

The views expressed on this blog are solely those of the blog post author and do not necessarily reflect the views of Psych Congress Network or other Psych Congress Network authors.


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