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N.  27,  XIV, December 2016 - January 2017 "Psychoanalysis and Infant Research"

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       Role-Confusion in Parent-Child Relationships




 by Lauriane Vulliez-Coadya, Elisabet Solheimb, Jeremy P. Nahumc, Karlen Lyons-Ruthc

click here  to read this article in Italian


a Child Psychiatry Department, CHRU Besançon, Besançon, France ; b The Center for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Oslo, Norway; c Harvard Medical School, Cambridge, MA, USA

 This article was published originally in "The European Journal of Counselling Psychology", 2016, Vol. 4(2), 205–227.

Abstract in English

The representational world of the mother has long been at the center of clinical discussions regarding the quality of parenting. However, assessing mother’s representation of role-confusion in her relation with her child has yet to be investigated, even if parent-child role-confusion can lead to maladaptive pathways. As part of a larger study we developed the Maternal Role-Confusion Scale (PARC) to assess role-confusion in the way a parent talks about her relationship with the child on the Experience of Caregiving Interview (ECI). The ECI, a semi structured interview probing the mothers’ representations of her relationship with her child (Solomon, J., & George, C. (1996). Defining the caregiving system: Toward a theory of caregiving. Infant Mental Health Journal, 17(3), 183-197), is very clinically relevant and parts of the interview can easily be adapted for use in counselling and psychotherapy settings. Here, we first define role-confusion, its socio-economic and family dynamic aspects, and its impact on child development and adulthood. We then present our Parental Role-Confusion coding Scale (PARC). Next we describe two profiles of role-confused mothers from our sample, as well as evidence validating these maternal responses as predictors of role-confused distortions in observed interactions with the child. We call attention to the dimension of sexualisation in the relationship, a high indicator of Role-Confusion. This emerging body of work points to the importance of being alert to indicators of role-confusion in the clinical setting. The findings can inform and enrich counselling and psychology practice by familiarizing clinicians with how to listen for indicators of role-confusion while talking with parents about their relationship with the child.









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Parent-child role-confusion can lead to maladaptive pathways often linked with dysregulation of affect and others physiological subsystems and is mainly discussed by clinicians. Nevertheless, studies about these relational disturbances have not investigated the mother’s representation of role-confusion in her relation with her child. This important gap, in the measurement literature, needed to be addressed. This work was aimed to describe a measure of parental role-confusion, PARC (Parental Assessment of Role-Confusion), elaborated and validated against other role-confusion measures (AMBIANCE, Bronfman, Madigan, & Lyons-Ruth, 1992-2009; GPACS, Lyons-Ruth, Hennighausen, & Holmes, 2005; CHQ, Solomon & George, 1996) and provide examples of different profiles of role-confused mothers. The validation of this measure has already been published (see Vulliez-Coady, Obsuth, Torreiro-Casal, Ellertsdottir, & Lyons-Ruth, 2013). Here, we are more interested in its clinical and empirical utility and will focus on a more descriptive approach to inform and enrich counselling and psychotherapy practice. The way people talk about themselves and about their relationships is at the heart of counselling and therapy, in the sense that all therapeutic work involves the telling of stories (McLeod, 1997).

Our focus is to address the importance of being alert to indicators of role-confusion in the clinical settings and offers tools for sharpening the eye of the clinician in making such evaluations.

We will first define role-confusion, its socio-economic and family dynamic aspects, and its impact on child development and adulthood. We then present our Parental Role-Confusion Coding Scale to examine how to identify role-confusion in the transcripts of mothers when asked to speak about their relationship with the child. Finally, we provide examples from interview transcripts and examine how the responses of the mother may help us discern these distortions in the relationship with the child.

What is Role-Confusion?

Parent-child role-confusion, also known as role reversal or parentification, refers to a variety of ways in which a child may be pressured to assume functions in the relationship usually assumed by the parent (Boszormenyi-Nagy & Krasner, 1986; Jurkovic, 1997). Our choice of the term role-confusion stems from the notion that parentification and role-reversal suggest completeness of the exchange of roles. Rather, we think that role-confusion more closely captures the wide variations in ways a parent abdicates and the child assumes responsibility (see Macfie, Brumariu, & Lyons-Ruth, 2015 for a critical review).

Authors have often disagreed on how to operationalise this construct. We include in the definition, emotional and instrumental support (help with housework and child care) for the parent, as well as functioning in the role of a spouse (Bifulco, Brown, & Harris, 1994; Earley & Cushway, 2002; Mika, Bergner, & Baum, 1987; Sessions & Jurkovic, 1986), and responsibilities that are inappropriate to the child’s age. This shift in responsibility occurs because of the parent’s difficulties in carrying out appropriate parental tasks. They are unable to function in the protective role of caregiver, or to identify with a child’s subjective and developmental needs. Role-confusion is problematic in that it may interfere with the child’s investment in other appropriate developmental tasks.

Precursors of Role-Confusion and Resilience

While the importance of role-confusion in parent-child relationships was initially described by clinical observers, developmental researchers have also made headway in studying this concept. Using retrospective report measures with young adults, as well as observed interaction with peers or parents, a variety of studies have examined the family contexts related to role-confusion.

Studies using retrospective report measures indicate that adverse childhood experiences, specifically maternal mental and physical illness, low socio-economic status, divorce, single-parent family, child gender and birth order during childhood and infancy, are linked to role-confusion (Burkett, 1991; Earley, Cushway, & Cassidy, 2007; Fitzgerald et al., 2008; Mayseless, Bartholomew, Henderson, & Trinke, 2004; McMahon & Luthar, 2007; Tompkins, 2007; Walsh, Shulman, Bar-On, & Tsur, 2006). We propose that role-confusion has detrimental effects on development, only when the demands it places exceed the child’s ability to cope. It may have a positive effect when the demands are developmentally appropriate. When the parent’s difficulty lies in limited domains and does not impair the parent’s ability to act as a source of comfort and authority within the family setting, the effect may enhance rather than distort child development. If the involvement in caretaking activity is time-limited due to a benign, adaptive response to family crises, it is not as detrimental for the child (Godsall, Jurkovic, Emshoff, Anderson, & Stanwyck, 2004). Moreover, cultural expectations may play a part. Different studies suggest that a distinction between instrumental and emotional role-confusion is important to assess. They also include notions of perceived satisfaction, fairness and self-esteem as moderator factors of the impact of role-confusion (McMahon & Luthar, 2007; Telzer & Fuligni, 2009). For example, although more role-confusion (instrumental and emotional) was reported by immigrant German adolescents than by native-born adolescents, more instrumental role-confusion was associated with increased self-efficacy in both groups. However, more instrumental role-confusion, together with less emotional role-confusion, was associated with exhaustion in the immigrant group (Titzmann, 2012). In those specific cultural settings, the child may be the only English speaker and may handle the family’s dealings with the larger world. Such instrumental help in the context of loving and authoritative parents may increase a child’s confidence, especially in collectivist cultures in which children helping parents may be more positively valued than in individualistic cultures (Birman & Taylor-Ritzler, 2007; Jurkovic et al., 2004; Kuperminc, Jurkovic, & Casey, 2009).

Impact of Role-Confusion From Childhood to Adulthood

So far, literature of role-confusion relies mainly on clinician descriptions and developmental research studies.

Nevertheless a few studies have shown that role-confused children are more likely to develop somatic problems (Johnston, 1990) and show adverse physiological consequences, with effects on immune and inflammatory systems (Fuligni et al., 2009). A recent study also found that controlling-caregiving behaviour of the adolescent toward his/her parent was further related to borderline personality features and suicidality in young adulthood (Lyons-Ruth, Bureau, Holmes, Easterbrooks, & Brooks, 2013).

In this paper, we argue that role-confusion is tightly linked with dysregulation of affects, as well as other physiological subsystems. Distortions in the attachment relationship may lead to role-confusion (Lyons-Ruth, Bureau, Easterbrooks, et al., 2013; Obsuth, Hennighausen, Brumariu, & Lyons-Ruth, 2014). Disorganized attachment is one such distortion (Main & Hesse, 1990). Infants with disorganized attachment are thought to experience a paradoxical situation. They naturally look to their attachment figure for comfort and security, but the attachment figure is unable to provide either and may even be a source of fear (Madigan et al., 2006). The parent may see the infant as more powerful and feel helpless to care for him or her (George & Solomon, 2008). Given these parental behaviours, the infant is thought to be in an insoluble conflict between approach and avoidance, and is therefore, unable to use the caregiver as a source of comfort in times of distress. Thus, the attachment system, designed to buffer the infant from stress, breaks down so that the infant remains hypervigilant, fearful, unsoothed, and disorganized (George & Solomon, 2008). As the attachment relationship is geared toward regulating the negative affect of the child, we can speculate that role-confused children experience an absence of regulation of negative affects. In a role-confused dyad, negative affects remain unregulated by the attachment figure. Therefore, a role-confused child would likely experience dysregulated states, where affects (distress, rage, sadness, excitement, etc.) remain unintegrated. To cope with the inadequate soothing responses from their attachment figure, those children develop defensive adaptations that maintain those affects in separate mental “compartments” unintegrated with one another, that Bowlby describes through his theory of defensive exclusion (Bowlby, 1973). The anticipation and expectation of such experiences, which could be experienced as a threat of annihilation, would lead them to try to regulate their environment and their caregiver as a means of regulating their own negative affect (regulating the regulator).

The development of controlling behaviour of either a punitive or a caregiving type toward their parent (Main & Cassidy, 1988; Wartner et al., 1994) can be seen as a strategy, whereby the role-confused child learns to regulate his/her environment, i.e. to meet his/her parent’s needs, in order to have his own needs met. We know that infants have a natural capacity to grasp the state of another (Ham & Tronick, 2009). In capturing the process of role-confusion, beside parental helplessness or neediness, the attunement skills of the infant play an important part.

Growing up, role confused individuals have learned to modify their own behaviour and contain the experience of their own affect in order to protect or regulate the other. Doing so, they have learned important social skills related to nurturance and responsibility (Boszormenyi-Nagy & Krasner, 1986; Jurkovic, 1997). But at what price? Clinicians often describe how difficult it can be for children and adolescents suffering from role-confusion to develop friendships on reciprocal terms. These children often feel that they do not “fit in.” As adolescents they might complain about being “used” but still continue to overextend themselves socially (Jurkovic, 1997). Few other studies have also examined the relations between child or youth self-reports of role-confusion and maladaptive outcomes for the individual, including low academic and professional achievements (Castro, Jones, & Mirsalimi, 2004).

In our clinical experience with adults who function in a caregiving role as children, we often observe the feeling that relationships are burdensome. The role-confused child as an adult has an inclination to take care of others, accompanied by feeling that failing to do so will have terrible consequences. They assume that they are solely responsible for the interaction, with the fear of hurting another if there is conflict. Thus, they vigilantly monitor the environment, checking self-expression, and are hesitant in asserting themselves. Role-confused individuals are also more likely to experience shame, perhaps because of their childhood inability to meet the unrealistic expectations they have assumed (Wells & Jones, 2000). Implicit to their concept of how relationships work, is the idea that one person manages the other (Boszormenyi-Nagy & Krasner, 1986).














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