Understanding Parentification is an Essential Part of Your Clinical Toolkit

Viewpoints

By Lauren Dennelly, PhD, LCSW

Here’s a typical scenario I see in outpatient practice. The client (they can be any gender identity, though many of the clients I see identify as female) reports on their intake form things like caregiver stress, chronic illness, and/or marital issues. The client arrives visibly exhausted and anxious. When asked what brought her in, she details the issues she referenced on the intake form as well as another important detail. Her real problem, she confides, is this: She has made people too reliant on her and she doesn’t know how to stop.

She feels a sense of responsibility toward others and the sense that she has to take charge in situations or no one else will. She wants to be free of putting other people’s needs before her own and learn how to set appropriate boundaries. She emphasizes that she doesn’t want to hurt anyone’s feelings, feel guilty, or ‘be mean’ in the process. As we drill down deeper, we uncover that the pressing issue is typically rooted in a more complex relational pattern, one that developed as a means of coping with her assigned childhood role as the ‘fixer’ or the ‘responsible one,’ a role that she adopted growing up in a dysfunctional environment in which one or both of her parents struggled to parent. In short, this client has grown up parentified.

Parentification Defined

When a child grows up parentified, it means they were given adult responsibilities that were beyond their developmental scope. These can be emotional responsibilities like acting as an emotional confidant or mediator between parents, or more logistical responsibilities, such as cooking, cleaning and taking care of siblings. The key element here is that these tasks are not rewarded or acknowledged, are exploitative in nature, and/or the child is guilted into taking them on or even punished if they don’t. For example, many of us may have had younger siblings that we helped care for. However, if we were taking care of siblings more often than our parents were parenting us and them, it may be a good idea to look at our experiences through the lens of parentification (as well as consider what may have contributed to our choice to be professional caregivers).

Family Systems Issues

There are certain issues related to the family environment that make parentification more likely to occur. Substance abuse, martial conflict or divorce, physical or mental illness, poverty, immigration/acculturation issues with parents, single parenthood, or the death of a child or partner can all be contributors to a role reversal between parent and child. From a developmental perspective, differentiation between children and family norms is prohibited, and children risk being ostracized, shamed or even abused for going against their family’s unspoken rules. Additionally, children often get caught in a triangle between both parents, as attention is given to the child rather than the dynamic between parents as a means of maintaining order and easing the anxiety of the family system as a whole.

Clinical Presentation and Relational Distress in Adulthood

Parentification as it presents in adulthood can look like the opening scenario that I described, but it can also lurk in relational patterns in more subtle ways, such as overachieving, being chronically overscheduled, or being helpful to a fault. Adults who were parentified as children tend to present as insightful, self-aware, and motivated, though behind a well-organized and polished façade these clients often are highly dysregulated, gripping on to control through staying ‘busy’ or ‘active.’ This never really allows them to sit in the discomfort they feel when they aren’t mired in chaos—as much as they might say they want to avoid it—and it prevents them from exploring their own issues with identity and self-worth.

Experiences of parentification commonly overlap with a variety of diagnoses, including major depression; anxiety disorders, including PTSD and OCD; substance abuse issues; personality disorders; and eating disorders. Clients with this experience often internalize negative core beliefs about themselves as ‘not enough,’ a kind of subconscious mantra that leads them to continue to do more, ignore their own needs, and dismiss their feelings. Taking a detailed family history—including having clients create a genogram of their family relationships going back two or even three generations—is helpful in uncovering the relational patterns and family dynamics that will help clients gain insight into their current relationships.

Social Work Takeaway: Pay Attention to Relational Dynamics from Childhood to Adulthood

The relational patterns clients who were parentified as children carry with them do not simply go away when they move into adulthood and the world of relationships and work. Rather, the patterns typically magnify and become unmanageable, as the client attempts to use survival skills outside of the home environment in which they were necessary. They may not want to let go of the only role they have known, or they may still be acting it out with aging parents or siblings, much to the distress of their partner or children, who often take a backseat to whomever in the client’s family of origin needs them first. Expect hesitancy, use of distraction, and even (polite) resistance to change as they take their time to learn how to be vulnerable with someone who doesn’t require anything from them.

Lauren Dennelly, PhD, LCSW, is a professor, feminist clinician, and author of the forthcoming “Why You Never Got to Be a Kid: How to Heal When Your Parents Didn’t Parent.” She has a special interest in working with adults who grew up with addiction and/or were parentified as children, chronic caregivers, those with co-occurring physical issues, artists and other creatives, and those in eating disorder recovery. She has a blog on Psychology Today titled “The Mental Health of Girls and Women,” and is a sought-after clinical consultant in the field.