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An Open Letter & Plea to Therapists & Treatment Programs: Stop Having Parents Write ‘Impact Letters’

[Editorial Note: An open letter is “n.: a published letter of protest or appeal usually addressed to an individual but intended for the general public” ( Merriam-Webster).  

This open letter is meant to begin discussion on a topic, an opinion piece. Wilderness Therapy programs began to market to professionals and directly to consumers in the early 1980’s. There have been needed and evolutionary changes — like licensing by the state, having licensed therapists working with the clients, whole foods, meal planning and treatment planning. The changes are vast. Is this the next evolution?

Feel free to email me at jw@allkindsoftherapy.com if you have any comments. This is an ongoing discussion, not a conclusion. I look forward to seeing this topic at conferences in the next year. Full disclosure, the author is an advertiser on AllKindsofTherapy.com.]

girl writing journal camping

For years, I sensed that something was wrong with the ‘Impact Letter assignment’, an integral part of many wilderness therapy programs. In response to this feeling, I simply taught around the assignment in my own program for years. I discouraged shame and guilt, encouraging parents to instead offer clear, assertive, and compassionate feedback to their struggling children. While I asked parents to talk about their feelings, or the “impact” of the child’s behavior on the parent, I advised that it not be a principal element of the letter. I would explain, “Yes, it is important for them to know how you feel but we don’t want them to change so you feel better—we want them to change so they feel better.” I justified the means because of the value of the end and rationalized that the parent’s concern and fear could be useful as the initial impetus and later be replaced with something more intrinsic to the child.

As years passed I became fed up with enabling this assignment and its implications. A few years ago, while sitting in an ‘Impact Letter’ group, a young woman finished reading impact letters from three of her family members where details of life-threatening drug abuse, stealing and prostitution were chronicled. As she concluded, she was sobbing, heaving amidst a circle of her peers and staff in the Utah desert. As she sat covering her face, one of her peers looked to her and asked, “What are you feeling?”

“I can’t believe what I put my parents through,” she said. That was the moment I realized something needed to change. This young woman had just shared a litany of life-threatening behaviors and her first thought was what her parents went through. The point is that this child is suffering and of course, when a child is hurt and struggling, loving parents and family members are going to hurt for them, but that is not the point of this intervention/letter. The point is that without help, her life is at stake. Yet, with the impact letter, the professionals have allowed the focus to become … the parents. We tell ourselves that the parents are loving, that their intentions are only for the well-being of their child. While this may be true, how is a child supposed to learn right from wrong, a sense of self, or develop if they are taught that how their parent feels is clear evidence of the child’s rightness or wrongness?

The crux of the problem is this: if children are conditioned to believe that what their parents feel and think about them is evidence of right and wrong, they will become neurobiologically wired to believe that what anyone thinks or feels about them is about them. They become wired for peer-pressure. They are wired to depend upon others for their sense of self. They have no reference point to determine who they are and what they want. This is the essence of codependence. This is the essence of what people who go to therapy and Al-anon spend years trying to unlearn.

A principle problem with this assignment is its title. ‘Impact Letter’ suggests that parents or family members are charged with sharing the impact of the child’s behavior on their lives: emotions, lost sleep, lost time at work, stress, financial accommodations, and the many accommodations one makes when living with a child suffering with a mental health issue or a substance abuse problem.

While to the layperson, this list of consequences or impact on loved ones might seem like a logical and rational consequence to be shared with the child, it flies in the face of what we know about child development, moral development, healthy motivation, and the psychology of relationships.

The thinking goes something like this: “If the child understands his or her impact on loving, well-meaning family and friends — if they can just recognize that — they will wake up and change their course.” But this reasoning does not line-up with what we, the professionals, know about motivation, children, and sustained change in one’s mental health trajectory.

While it may not be appropriate to share with the child, there may be some value in the parent writing an Impact Letter and reviewing the feelings, incidents, and accommodations that led to an intervention. With this perspective in mind, it is critical that we distinguish between what a parent needs and what the child needs — the Impact Letter may be helpful and cathartic for a parent, but the child may not yet be able to bear it.

I would like to lay out what we know about children and change, drawing from several fields of study: child development and attachment; moral development and shame; Motivational Interviewing (MI)1; and transference/countertransference.

First, child-development tells us how children grow and how this development has critical and lasting impact on the life of the individual. Healthy attachment requires connection, which is measured by a parent’s ability to provide an adequate container by taking-in the feelings, thoughts, and behaviors of the child and metabolizing them with greater resources than that child has at their disposal. The process is then to reflect back to the child the sense that his or her experience is meaningful.

…the response of the container is to empathically accept the contained and subtly modify it by use of the greater resources of the container, i.e., “metabolize” the contained…In this situation, the contained is more or less “fully” felt and understood by the container. At the same time the container can rely on additional resources to feed back to the contained a wider sense of the contained experience.2

Too rigid or fragile of a container will lead to rejecting the child and their experiences with the child experiencing a kind of dread or what may be called the “unthinkable.” This fragility may be revealed on one hand as unresponsive, or on the other as panic, extreme anxiety, or worry. In an episode of NPR’s Invisibilia3, researchers explore how individuals suffering from severe mental illness are cared for in Belgium. In the episode, the audioguide explores differences between how the villagers in a small-town treat strangers with mental illness versus how they treat their own children. They discover how a parent’s “overconnected” language triggers the same kind of fight-or-flight response that shapes critical or shaming messages. Communication that many of us might find nurturing or connected stifles the child’s ability to think and reason or accept guidance and direction from loving parents,

“It breaks my heart to see him suffering. I’d do anything for him if it would help. There’s nothing I wouldn’t do for that boy.”

The researchers explain, “This kind of comment or even just that yearning, that hope for him to get better as expressed through tone…That desire to fix the problem, it oozes out of a person, they have found, and works to trigger relapse in the person they’re thinking about. Which is odd and noteworthy because that kind of response sounds so supportive compared to hostility and criticism, it sounds like you’re just being a champion of that family member. The reason that we believe it is associated with relapse is because from the part of the patient, they’re just feeling too monitored. They’re feeling too cosseted. They can’t breathe. They feel stifled.” Parental anxiety and worry are natural and well-deserved, but the child is not capable of “holding” this energy. It is the parent’s job to deal with and manage their anxiety, perhaps in therapy or in an Al-anon group setting, so that when they approach the child they can be there for the child’s needs rather than vice-versa.

Pair of Hands Writing in NotebookOne young woman, who was a client described her parents’ encouragement and praise as needy, pressuring and overwhelming. If the child had the capacity to overtly name the experience, it would sound something like this: “I am struggling and afraid. When you come to me with your worry and anxiety about me, it is all-the-more overwhelming. I may need some space from you. I need to talk to someone who is not triggered — someone who doesn’t need me to take care of them or their anxiety.” However, children can rarely name it due to the shame it causes. The subsequent response is either to try to take care of the parent by changing behavior or to sink further into the pathology because of this overwhelmed sense. In either case, the child and her needs are eclipsed and the development of the child’s authentic self is compromised.

It is not the job of the child to contain the parent. In fact, this reversal of roles is not indicative of a healthy attachment. Many assume that this is how empathy is created and developed — that a child’s understanding and creating space for the parent’s internal world creates empathy. This is precisely the problem I have with the Impact Letter in therapy— it redirects the child away from the difficult journey of self-discovery and instead forces them into the Container role

The process where children provide such service to their parents is the subject of the landmark book by Alice Miller, The Drama of the Gifted Child. Miller states.  Miller states

Many people struggle all their lives from this oppressive feeling of guilt, the sense of not having lived up to their parents’ expectations. This feeling is stronger than any intellectual insight they might have, that it is not a child’s task or duty to satisfy his parents’ needs. No argument can overcome these guilt feelings, for they have their beginning in life’s earliest period, and from that they derive their intensity and obduracy [intractable or hardened]. They can be resolved only slowly, with the help of a revealing therapy.

Sometime in the early 90’s, when his son Jakob Dylan, lead singer of the band The Wallflowers, had a hit album, Bob Dylan was asked what he thought of his son’s success. Was he proud of him and the accolades he was receiving from fans and critics alike? Dylan responded flatly with the statement, “It’s irrelevant.” At first hearing this story I thought it was just Dylan being Dylan — he has always held some contempt for the press and critics. But, as I began to work with children and families, I realized Bob Dylan was powerfully right—it is irrelevant.

Children often say “I want to make my parents proud.” My reply is the same, “That is not your job.” In Al-Anon, there is the slogan, “What you think about me is none of my business.” This slogan is a mantra that seeks to liberate individuals from the shame and the shackles parents put on their children in the service of trying raise them up in the “right” way. Yet, raising children with the notion that the parent and their opinions of the child ought to be the guiding star in the child’s life will ensure their failure in the world. I try to share with my young clients the mindset that I am not inclined to be proud or disappointed with my children, regardless of their successes or failures, “If my child got into Harvard, I wouldn’t be proud of her… I might be happy for her if that were her goal, but I would not be inclined to be proud of her. If that was the case, then I would also be inclined to episodes of disappointment.”

They will often respond incredulously, “Nobody thinks like that. That is not normal.” Such a response is indicative of a context where the parent occupies a space in the child’s mind that reduces safety and erodes the ability of the child to develop a strong sense of self.

Perhaps what is worse than a parent’s mistake in trying to raise a child in this way, is that many therapists take up this crusade for them when a child is placed in their care. Therapists have many blind spots and a common error is their willingness to deliver exactly what a parent wants — this is a very common countertransference error. It is the job of a therapist to provide a container where a family can discover what they do not know about themselves. This discovery can only be provided, however, if the therapist has done battle with their own inner-darkness – their need to be accepted and approved One has to make friends with and be on speaking terms with their own insecurity in order to provide clients with what they need. Gill (2016)4 offers the following as a model for understanding the mistake that many make in the name of therapy:

The therapist or guide we choose must not duplicate the wounds of the past. Thus, if the therapist or guide knows what is right for us and manipulates us to achieve these “treatment goals,” it is abuse plain and simple. It is hard to see how good abuse ever cures bad abuse.

D.W. Winnicott once stated that it is the “false self that brings the real self into therapy.” In other words, what we think or expect of therapy is not what it will eventually become. We must treat children and parents within the unique lens of therapy. Too often, tools and skills are merely channeled through common sense thinking. Therapy is a different sensibility and context where this new context offers the client a profoundly different experience. I often tell the staff I work with, stop trying to fix the child and start seeing the child — the result will be healing.

Even if we can come to understand the value in learning to see and hear our children beyond their symptoms, their struggles… The resulting anxiety and anger we feel creates a fracture in attachment—in a real sense we are triggered and we lose connection with them. Their choices make it difficult for any loving parent to stay psychologically present in order to hear and understand them. This is why we need more resources than those parents whose children are not struggling. We need therapists, books, support groups and mentors to hear us out and prop us up. And the result is worth the effort as Carl Rogers beautifully taught,

When a person realizes he has been deeply heard, his eyes moisten. I think in some real sense he is weeping for joy. It is as though he were saying, “Thank God, somebody heard me. Someone knows what it is like to be me.”5

Even if your biases or orientation cause you to rebuff the ideas outlined above, pragmatically we therapists know that change is best initiated and maintained through a process that invites the individual to look at themselves without the overlay of shame and confrontation. What we know about motivation and change comes through connection and curiosity. Supported by a plethora of outcome studies, Miller and Rollnick<sup>6</sup> describe their Motivational Interviewing [MI] “not as a ‘technique,’ but as an easily learned gimmick to tuck away in one’s toolbox. We describe MI as a style of being with people… Your purpose is to understand the life before you, to see the world through this person’s eyes rather than superimposing your own vision.” So, while you may think your views are right and it is your obligation to teach (or even impose them on) your child, the research shows that it just doesn’t work.

In the context of my urge for therapists and parents to see children, and that through that connection, healing will occur, I am often asked by families, “But how will my child learn morals?” My answer comes from my experience working for years with men convicted of domestic violence and sexual abuse. It is self-evident that these men lack the quality of empathy to a great degree. They are prone to turn others into objects and in many cases demonstrate very little remorse or empathy. Common sense would suggest that it is then the job of the therapist to show them how they have affected their victims.

The reasoning would suggest that this realization would lead to remorse and course correction in their lives. Yet, this is not how it works. In every case I worked with, the perpetrator himself had suffered significant trauma which they often repeated in their offenses. In their own suffering, they had been treated as objects or turned themselves into non-feeling objects in order to survive their abuse. And since we essentially see others as we see ourselves, they imagine others as non-feeling objects too. Within this dynamic, they are not hurting another person, but it is as if they are doing it to a rock and surely there need be no remorse in that. What is the cure? How does one foster the development of morality? The answer I learned in my training is both profound and simple and is the same answer for our children:

Teach a child how to feel. When they learn how to feel, they will recognize feelings in others. This will lead to empathy, kindness, compassion and goodness.

When adolescents or young adult clients in the wilderness program ask me the question, “What is in it for me?,” rather than shaming them or suggesting that such self-centered thinking is a problem to overcome, I welcome the question. I respond by letting them know that it is the right question. There is nothing in my work that I would suggest or hope for a child or parent that I did not believe benefitted them in some way. It is perfectly okay for a child or client to ask for the benefit of any change. The defense or symptom was in place to serve them, protect them, and we honor it by understanding how it served them. Gill (2016)7 stated, “Both cruel people and inadequate therapists are famous for a desire to destroy defenses without considering the consequences.”

What can we do that is more helpful? We can try to accept, listen, understand and invite change. We can share our love, our hopes, and our intentions with our children. We can ask them to look deeply into themselves that they might discover their authentic selves and the wounds that are tied to the symptoms they present. Ideally, we do this from a place of compassion and not fear. We let our fear and worry inform us, but we don’t hand it to the child and make them responsible for it. We make our serenity our responsibility. If we can do all of this, then in the end, we transform as much as our children. We develop greater capacity and like Gandhi8 explains,

If we really love the Other, as Other, we have heroically taken on the responsibility for our own individuation, our own journey. This heroism may properly be called love.

It is my hope and my plea that we, in the treatment community, stop the use of the ‘Impact Letter’, what it implies, and how it is commonly used. This is not common sense or common thinking. We are not lay people. We must live up to the title of therapists, psychologists, professionals and healers. We must make courageous and uncommon choices and speak for those who cannot yet speak for themselves. What can we do that is more helpful? We can try to accept, listen, understand and invite change. We can write a letter to share our love, our hopes, and our intentions with our children. We can ask them to look deeply into themselves that they might discover their authentic selves and the wounds that are tied to the symptoms they present. Ideally, we do this from a place of compassion and not fear. We let our fear and worry inform us, but we don’t hand it to the child and make them responsible for it. We make our serenity our responsibility. If we can do all of this, then in the end, we transform as much as our children.

About the Author
Brad M. Reedy, Ph.D. is the Co-Founder and Clinical Director of Evoke Therapy Programs (located in UT & OR) and the author of “The Journey of the Heroic Parent: Your Child’s Struggle and the Road Home.” He is the host of the podcast “Evoke Therapy Programs” and has broadcast over 1000 episodes. He speaks throughout North America at schools, conferences, community events, and has been a guest on numerous television and radio shows on the subjects of parenting, child development, and mental health.

1Miller and Rollnick. 2013. Motivational Interviewing: Helping People Change. The Guilford Press. New York, NY.

2Bion, W. R. (1967). Second Thoughts: Selected Papers on Psychoanalysis. Routledge. New York, NY.

3The Problem With the Solution, NPR’s Invisibilia, July 1, 2016

4Gill, J.D. (2016). Seeing in Intimacy and Psychotherapy. Create Space.

5Carl Rogers, (2016). Experiences in Communication. Awaken.

Miller and Rollnick. 2013. Motivational Interviewing: Helping People Change. The Guilford Press. New York, NY.

6Gill, J.D. (2016). The Mexico Papers: Volume One. Create Space.

7as cited in Hollis, J. (1998). The Eden Project, In Search of the Magical Other: A Jungian Perspective on Relationship. Inner City Books. Toronto ON.