Unfinished Business: Adult Children and Parents

Dear Dr. Neimeyer,

I’m a clinical psychologist.  I work with many adults who have very difficult relationships with their parents.  Some say they anticipate they will feel relief when their parents die.  Then they feel guilty for feeling that way.  Do you have any advice/thought for people whose grief or anticipated grief is complicated in this way?  These adults also say they feel isolated because these feelings are not socially acceptable; so they can’t share them with others.

Sonya K., PsyD

Dear Sonya,

Yes, our research on unfinished business in bereavement confirms what our clinical experience has long suggested:  That those clients who have unresolved relational issues with family members and intimate others do indeed tend to experience more struggles with complicated and protracted grief.  What may be more surprising is that over 40% of bereaved adults acknowledge some form of unfinished business, especially in their closest family relationships, and their distress about this is a significant predictor of complications following the death of the relevant person, and very probably of complex anticipatory grief as well.

Recently, in developing the first valid measure of this construct, the Unfinished Business In Bereavement Scale or UBBS, our research group spearheaded by Jason Holland has determined that this form of complication can be conceptualized and assessed as two distinct dimensions.  On the one hand, many people struggle with Unfulfilled Wishes, in the form of not having expressed their love for the other, not having had a chance to say goodbye, having had too little time together, and anticipating the person’s absence in significant future events.  On the other hand, people can be tormented by Unresolved Conflict, in the form of abiding disappointments, guilt, deep and corrosive anger, troubling secrets, relational breaches, and lack of forgiveness over some form of wrong committed by one or both parties.  Across different samples of bereaved adults, unfinished business is associated with more intense symptoms of prolonged grief disorder, greater attachment insecurity, and less meaning made of the loss.  In fact, the potency of this effect is clear when one considers that just two factors–UB and meaning made of the loss—together account for 50-60% of symptom severity of prolonged grief, a debilitating response to bereavement now recognized by the World Health Organization.

So what might be done clinically when we find ourselves working with adults who have very difficult relations with their parents, as you describe?  Here are a few ideas.

Don’t leave the business unfinished.  If issues can be addressed when both parties are living, they needn’t weigh as heavily with the survivor when the other party dies.  In some sense, this is the fundamental premise of family therapy:  that imperfect, disappointing or even conflicted relationships can be reviewed and repaired when the relevant parties come to recognize that it is in their mutual interest to do so.  Of course, this often requires skillful facilitation by a therapist who resists triangulation and alignment with one party against the other, and who is capable of “joining” with each empathically to elicit the vulnerability, fear or defensiveness that led to their sub-optimal treatment of the other to begin with.  For example, in the presence of such conflict I will often request the permission of the conflicted parties to have a deep-going one-on-one conversation with me in the presence of the other, who I request to remain silent and attentive until we have finished a 10-15 minute interview.  In that interview—say, with the angry or hurt adult child—I will try to empathically delve beneath the anger or distancing to the source of the pain, often experienced initially early in life, or at a point of earlier loss (as in the unavailability of a parent, or being caught in the middle of a parental divorce).  As we deepen into this, tears often flow, the empathy of the witnessing other is engaged, and genuine dialogue becomes more possible.  I then solicit the reactions of the witness, and invite him or her into a similar dialogue in the presence of the adult child.  This commonly opens doors to rapprochement.

Talk to the absent other.  When the parent is geographically absent, ill, suffering dementia, or simply unwilling to participate in therapy, invite them anyway… symbolically.  Ask the client to imagine them present, healed psychologically and physically from whatever they had suffered in life, accepting the invitation to meet with their child for a heart-to-heart conversation.  Develop this in a sensory way for a few minutes, as the client closes his or her eyes:  How would your father be dressed?  How would he be seated in the chair opposite you?  What expression would you see in his eyes, as he prepares himself to hear the truth about your relation to him?  What might he be feeling as he did so?  Then, instruct the client to open her eyes and state how she is feeling at this point in their relationship, as the parent’s life grows short, or after it has ended.  Reflecting and deepening the client’s disclosures (Tell him more about that.  What more can you say about what you feel?), work toward what the client needs from the parent, and would like to see happen.  How would he like to feel 5 years from now about their relationship?  Keep all of this in direct I-you language, not in the form of third-person commentary—have the client speak it while looking directly to the chair, to the parent.  Then, at a moment that calls for a response, ask the client to rise, take the chair of the parent, “channel” his or her voice, and respond from the heart to what the child has just said.  Again, deepen this toward emotional truth with brief restatement and empathic reflection.  Rotate the client to the alternate chair as needed to allow the dialogue to move toward greater resolution.  Then de-role from what is commonly an emotionally evocative encounter, take a few deep breaths together to clear the screen, and reflect on what the client learned and observed, considering what action steps might now be taken to move the process forward.  This might well lead to real world conversations with the parents or relevant others, such as siblings, that nurture transformation.

When in doubt, write it out.  Some clients might decline the chair work format of dialogue with a problematic parent, and might feel “safer” writing their feelings and responses to the parent than speaking them.  This can be done in the form of an “unsent letter” that cuts to the source of the hurt, the goal of which is to be vulnerable and truthful about the suffering of the child, rather than merely judgmental and accusatory toward the parent.  Sometimes the therapist might offer sentence stems to “jump start” this process (What you never understood was… What I need you to know is… The one question I have wanted to ask you was… I feel ready to change our relationship by…).  AfterTalk’s convenient format for writing, archiving, and sharing such letters with the therapist can facilitate this work.  Then, after a session talking through and perhaps reading aloud the letter, consider asking the client to write a letter back to himself, as if from the standpoint of the parent.  As with the spoken dialogue, this written dialogue often opens the doorway to change.

Rebalance the power.  In some parent-child relations, great damage has been done—perhaps a father physically or sexually abused a child, or a mother tormented or abandoned a son or daughter.  When the offense feels beyond forgiveness or redress, much can still be accomplished using the above techniques—but without allowing the powerful and injurious parent to “speak” or “write” back.  Instead, like someone accused of a high crime, the parent is called into court as required to sit silently as the “witness” or “plaintiff” speaks to the wrong that has been committed, in effect giving the client a voice and authority he or she previously lacked.  However, I find that this one-way interaction is required in no more than 5-10% of difficult cases, as much can often be done in a more dialogical format…

…ideally, when the parent is still living.

Dr. Neimeyer

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