Journal of Family Psychotherapy

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Parentification and Related Processes: Distinction

and Implications for Clinical Practice

Stéphanie Haxhe

To cite this article: Stéphanie Haxhe (2016) Parentification and Related Processes: Distinction
and Implications for Clinical Practice, Journal of Family Psychotherapy, 27:3, 185-199, DOI:
10.1080/08975353.2016.1199768

To link to this article: http://dx.doi.org/10.1080/08975353.2016.1199768

Published online: 02 Aug 2016.

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JOURNAL OF FAMILY PSYCHOTHERAPY
2016, VOL. 27, NO. 3, 185–199
http://dx.doi.org/10.1080/08975353.2016.1199768

Parentification and Related Processes: Distinction and

Implications for Clinical Practice
Stéphanie Haxhe
Department of Psychology, University of Liège, Liège, Belgium

ABSTRACT KEYWORDS
With the emergence of what can be called “new families,” the Adultization; delegation;
emotional responsibility;
place and the role of the child are increasingly questioned. If a family process;
child helps a parent or takes care of them, the terms “parentified parentalization;
child,” “parental child,” or “adult child” are used equally. However, parentification
these concepts hide different processes that have different
impacts on the child’s development. In the present article,
based on the current doctoral research and clinical practice
experience, the author will try to make the distinction between
these concepts and to illustrate them. By a better identification of
each process the author is convinced that therapists and social
workers can be helped in their interventions with children and
their families.

Although the parentification concept has existed since the early 1970s, it is
often misused and/or confused with other concepts. Most of the time, it is
confused with the “parental child” as Minuchin et al. (1967) described it.
According to Minuchin, the parental child joins the parental sub-system for
defined tasks and periods of time. In this position the child assists with family
and parental tasks rather than being a carer for his parents. The two situations
are different and have different impacts on a child’s development, as will be
shown in this article.
The primary concern of this confusion is the diagnosis. Several parentification
scales and questionnaires exist (Mika, Bergner, & Baum, 1987; Hooper, 2011;
Sessions & Jurkovic, 1986). These tools combine emotional and instrumental
responsibilities endorsed by the child, as they evaluate two types of parentifica-
tion: instrumental and emotional. Some items refer to instrumental tasks such as
doing the laundry or the dishes, while others refer to emotional tasks like
supporting a parent or being a confidant. The problem lies in mixing these
items. Chase (2004) reviewed the instruments contributing directly or indirectly
to the evaluation of the parentification process, and outlined that none of these
measures specifically differentiates instrumental and expressive dimensions of
the parentified role.

CONTACT Stéphanie Haxhe shaxhe@ulg.ac.be Department of Psychology, University of Liège, Rue

Frédéric Nyst 64, Liège 4020, Belgium.
© 2016 Taylor & Francis Group, LLC
186 S. HAXHE

If one returns to the texts of Boszormenyi-Nagy and Spark (1973);

Boszormenyi-Nagy and Krasner (1986); Bowlby (1977); Minuchin et al. (1967)
or Stierlin (1979), parentification implies an emotional responsibility which is the
core of the process. This differentiates it from other processes in terms of impact
on the child’s emotional development (attachment, security, trust in adults and
self-esteem). Instrumental responsibilities without emotional burden don’t lead to
parentification. These differences will be explored and some psychopathological
consequences for the parentified child will be presented in this article.
The concept of “constructive parentification” (Jurkovic, 1997; Le Goff, 1999) is
also likely to generate some confusion. According to Le Goff, parentification is
constructive when the following elements are present: recognition by parents of
the child’s contributions, non-overwhelming responsibilities, the temporariness of
the situation, and a harmonious relationship between child and parent(s). In the
presence of these elements, the child experiences beneficial responsibilities for
development and maturity, says Le Goff. Yet, this does not match the previously
quoted texts (Boszormenyi-Nagy & Krasner, 1986; Boszormenyi-Nagy & Spark,
1973; Bowlby, 1977; Minuchin, 1967; Stierlin, 1979), or the clinical practice reality.
Certainly, the degree of parentification may vary and all parentified children are
not affected in the same way. But applying this label to dynamic family contexts in
which the child is rewarded for his gifts, has harmonious relationships with his
parent(s) and is not burdened with emotional responsibilities, gives a distorted
definition of parentification and should perhaps be categorized another way. For
example, depending on the type of responsibility endorsed by the child, a
“parentalization,” an “adultization” or a “delegation” could be used.
By clarifying the parentification process and comparing it to other pro-
cesses, the purpose of this article is to help therapists and social workers,
especially those who work with children and their families on a front-line.
Child protective services, schools, and counseling services have to made quick
decisions in short periods of time. Therefore, it is crucial to correctly assess the
needs of the child and the family before selecting an approach to treatment.

The concept of parentification

Boszormenyi-Nagy, in Invisible Loyalties, gives a primary definition of par-
entification: “By definition, parentification implies the subjective distortion
of a relationship as if one’s partner or even children were his parent. Such
distortion can be done in a wishful fantasy or, more dramatically, through
dependent behaviour.” This definition is based on the central element of
relationship “distortion.” The author introduces at the outset two fundamen-
tal nuances, form and degree. Indeed, to put a partner in a parental position
is not the same as placing a child in such a position. There are different
 JOURNAL OF FAMILY PSYCHOTHERAPY 187

degrees of parentification, ranging from a simple fantasy of being wrapped

and treated as a child to the demanding addictive behavior that others are
forced to support. According to Boszormenyi-Nagy, each adult has at times
regressive needs but if the adult parentifies a child, the distortion progresses
one step further because the generational difference is denied.
Bowlby (1977) underlines this configuration as a source of anxious
attachment for the child:
An additional set of conditions to which some such individuals have been, and may
still be, exposed is that a parent, usually mother, exerting pressure on them to act as an
attachment figure to her, thus inverting the normal relationship. Means of exerting
such pressure vary from the unconscious encouragement of a premature sense of
responsability for others to the deliberate use of threats or induction of guilt. (p. 207)

Bowlby didn’t precisely name it as “parentification,” whereas his successor

Byng-Hall (2002, 2008) identifies a “parentification script” in which the child
is expected to fulfill a parental role and take care of the adults (West & Keller,
1991). For Byng-Hall and for Boszormenyi-Nagy, parentification emerges in
an insecure family context, rooted in the insecure attachments of previous
generations.

Parentification roles
(1) The caregiver. Boszormenyi-Nagy distinguished roles of obvious care
and those exercised in a more hidden way. The author took the
example of a child who had to call the police because his mother
was lying on the ground following the blows issued by his father.
However, a child may also act in a way that will be less noticed and
yet equally intense as a binding agent of the parental couple to avoid
separation.

Bowlby (1977) wrote about the caregiver’s experience:

Thus, from early childhood, the person who develops in this way has found that
the only affectional bond available is one in which he must always be the caregiver
and that the only care he can ever receive is the care he gives himself. (p. 207)

(2) The sacrifice or scapegoat role. Boszormenyi-Nagy described the

scapegoat role in several texts without synthesising it, and this
makes it somewhat difficult to apprehend. The scapegoat individually
handles a collective responsibility. He is unfairly forced to assume the
responsibility for someone else’s mistakes. Most of the time, parents
of the “scapegoat child” have experienced trust, reliability, and secur-
ity issues as a child (they were abused, mistreated, abandoned, or
188 S. HAXHE

neglected). Once they become parents, they want to be better parents

than their parents and give their children all they lacked. They
also unconsciously expect their child to repair what others have
damaged and to restore their faith in human nature. Having such
high expectations unintentionally puts the child in a position of
assured failure. Faced with this “impossible mission,” the only thing
that the child can do is disappoint. As the parents do not perceive
the weight of their expectations, the child is seen as aggressive,
rejecting, ungrateful, and unwilling to give them love. This behavior
forces parents to confront their difficult past and early experiences
and the child is, therefore, side-lined and blamed even if he tries
hard to satisfy them.
(3) The neutral/perfect role. Boszormenyi-Nagy described the silent
role that a parentified child can endorse. It is the “good child” or
the “perfect child” who never worries the parents and brings them
satisfaction. Parents describe this child as “a model of health and
performance.” However, according to Boszormenyi-Nagy, one rea-
lises that this child’s health is a “myth:” “Behind his well-preserved
facade he may be struggling with feelings of emptiness, emotional
depletion, or depression.” Indeed, as the child realizes at an early
age that his parent(s) is (are) highly vulnerable, his contribution is
to keep all his feelings and thoughts hidden (anger, fear, doubts,
anxiety). By claiming nothing and keeping his requests to himself,
the child tries to protect the parent, at the cost of an intense
loneliness.
(4) The infantilization. This factor is an unexpected form of parentifica-
tion that makes it barely identifiable. How can someone so young, so
immature and without responsibility be parentified? If one under-
stands that the responsibility in question is emotional, the perspective
is different; as described by Boszormenyi-Nagy, the dependence of the
child actually hides the dependence of the parent(s). The constant
need of the child for his parents gives them a sense of value, helps
them feel useful and fills gaps left by their childhood (sense of self-
worth, recognition, self-esteem).

A process
At the end of the author’s doctoral research (Haxhe, 2010), parentification
proves to be a process that develops in the presence of several factors. The
 JOURNAL OF FAMILY PSYCHOTHERAPY 189

identified factors are as follows: the sensitivity of the child; the request of (a)
parent(s); the factual (events), temporal (life cycle), transactional, and trans-
generational context of the family.

Sensitivity of the child

Generally, the parentified child is called “more sensitive” than other children
in relation to parents’ and family needs. Therefore, the process does not
emerge randomly and there is a “match” between a parent’s need and the
sensitivity of the child. This sensitivity has been barely explored. Jurkovic
(1997) questioned the existence in the development of the child’s early
features that increase his vulnerability to parentification. He identified the
following three variables: temperament (shyness, capacity of adaptation),
attachment behavior of the child (the care giver is the child more than the
parent), and his ability to take care of someone.

Sensitivity amongst siblings

Even if parentification is mostly described for one child, the current research
has shown that within a family several children can be parentified at the same
time in different manners. Indeed, siblings take different roles and support
their parents in their own way. In the author’s book (Haxhe, 2013), it is
shown how siblings share responsibilities in an adaptive organization and
how it affects the sibling relationship. Sharing roles, such as “the perfect
child” and “the scapegoat,” in a same sibling subsystem creates a framework
in which, even if each child gives its contribution to the family, mistrust
slowly grows within the relationship. If it is difficult for the scapegoat child to
identify and recognize the huge responsibility of the perfect child, the
opposite is equally true. Therefore, what each sibling experiences is that he
is the only one trapped by parental expectations and needs, whereas the other
is free. If the roles are more similar (like two caregivers), solidarity and
mutual sharing are increasingly possible. The current research and clinical
practice experiences have convinced the author that the sibling relationship is
a large resource and is often underestimated. If parents are unavailable, too
old, or deceased, working with siblings is a highly interesting alternative to
individual and family therapy.

Parental request
According to Michard (2005), parentification is an “essential risk” of the
parent–child relationship. If the parent has unfulfilled needs in his childhood
and outstanding issues with higher-generations, the temptation will be great
to use the gifts of the child to complete the gaps. The unsatisfied needs of the
190 S. HAXHE

parent are mostly emotional needs, such as support and security. The
research also reveals an intense need for recognition among some parents.
This recognition may be the recognition by relatives (i.e., need for attention,
love, the loving gaze of the parent and the need to have its own place in his
heart). However, it may also be a need of social recognition that has been
missing and could be achieved through the child. Therefore, each of these
needs will lead to a particular form of parentification. Nevertheless, the call
for the child to fill the role of “good parent” is characteristic in all forms and
distinguishes parentification from other processes. Therefore, the weight of
the emotional responsibility entrusted to the child, which exceeds its
expertise, is inherent in parentification. To fulfill this responsibility, the
child must silence its own needs to move toward those of its parent.

The context
The early death of a grandparent is a primary factor. Already described by
many authors, the death of a parent leaves a person with unfulfilled needs,
which become a search for satisfaction with their own children. The death
of a spouse also seems to activate the process. Sometimes, a person who is
strongly attached to someone finds in him/her an important emotional
support and may be totally lost after his or her departure. According to
Byng-Hall (2002), by being part of a couple, partners can represent an
essential resource and support each other to provide “good enough”
parenting. Therefore, when the partner is no longer present, the protection
that prevented parentification is removed. Disease is another factor, if
emotional vulnerability is present or perhaps dormant since childhood,
disease can be an activator and strengthens the needs and expectations of
the parent.
Therefore, based on the components of the parent–child relationship
(sensitivity of the child, the parent’s expectations), the author proposes loss
in its various forms is an activating factor. Besides loss caused by death, some
losses are more “ambiguous” (divorce, degenerative disease, immigration) as
described by Boss (1999) or D’Amore (2010).

Parentification and related processes

To properly discriminate the various processes, one needs to ask themselves
specific questions, including: What type of responsibilities are held by the
child? In what context? What are the parental expectations? Asking these
questions will help us to identify the singularity of each process and complete
the evaluation grid proposed next:
 Parentification Parentalization Adultization Delegation
Child’s needs Forgotten. Taken into account. Autonomy needs taken into Taken into account (even if some
account. Security and protection needs are privileged based on the
needs have less space. mission entrusted to the child).
Repressed in favor of parental May be less of a priority
needs. according to the context
needs.
Parental request/expectation That the child would be a “good That the child would give That the child becomes quickly That the child accomplishes a mission,
parent” for them and care for their their help, as an auxiliary, autonomous and adult. a specific project.
needs. a secondary.
Type of liability Relational. Heavy. Instrumental, mainly Taking care of himself. Conducting a parental project
executive.
Adequacy to the child’s competences No Yes to a particular point. Matures too fast (depending on Yes, to a particular extent
the child’s age).
May be heavy sometimes.
How do parents consider the child? The child is not seen as a child but The child is considered a The child is seen as a child of The child is seen as a child
as a potential “good parent” child. their parents and also as a small
(unconsciously of course). adult.
Recognition of child’s gifts No Most of the time yes Depends on the situation Yes, especially if the child is successful
Context -Trans-generational family story Immediate context Immediate context (poverty, war, Trans-generational family story
(poverty, war, large large family, divorce, etc.)
family, divorce, etc.)
-Factors related to loss
-Parental and conjugal difficulties
JOURNAL OF FAMILY PSYCHOTHERAPY
191
192 S. HAXHE

Parentification
Consideration for the child’s needs is a crucial criterion to identify parenti-
fication. In other processes these needs are taken into consideration more or
less often, parentification; however, requires putting the child’s needs to one
side in order to focus on the parent’s needs.
The expectation of the parent is for the child to be a good parent to him.
Being a good parent to a parent is to satisfy their unfulfilled needs in terms of
attention, support, recognition and affection. The priority given to the parent
is viewed by the child as a matter of life or death when he perceives his
parent to be in emotional and/or physical danger, or when the well-being of
the parent depends on his response. This perception is the core of the
relational responsibility that the child endorses, the importance of which
far exceeds what he is able to give, but that he cannot afford to ignore.
Therefore, relational responsibility is another inherent element of parenti-
fication, because of its heaviness and its incompatibility with the skills and
needs of a child. Moreover, recognition by the parents for what the child does
is seldom received. This lack of recognition from the parent is due to their
difficulty to acknowledge the unspoken demand they put on the children.
This aspect is a therapeutic goal in itself.
What is the impact on a child’s development? The relational responsibility
can be really heavy to bear. If the child considers that happiness or the life of
his parent(s) depends on him, the generated anxiety is likely to be huge. For
example, a parent with suicidal thoughts and/or suffering from depression,
addiction, anorexia or any other symptom putting him in mortal danger, will
conduct the child to focus on his parent’s needs and not to miss a sign.
Moreover, the child will, one day, face his inner emptiness. Because
parentified children have no space to feel their own emotions, the True Self
of the child can’t express itself, inducing loneliness. As an adult, this child
doesn’t know what he likes, as he is not accustomed to take care of his
own needs (Miller, 1983). Depressive feelings, low self-esteem and guilt are
generated by the gap between the Ego Ideal and the reality of their acts.
Then, the suicidal risk must not be ignored.

Parentalization
Parentalization is an extension of the “parental child” described by Minuchin
in Families of the Slums (1967). The concept refers to the role of a child in
some large and vulnerable families that are defined as “disorganized.” In
these chaotic families living in instability, parents often have a limited
parental role due to particular conditions. Children then sometimes rely on
their parents and sometimes not, because they are sometimes present and
 JOURNAL OF FAMILY PSYCHOTHERAPY 193

available and sometimes overwhelmed. In this context, the “parental child” is

the one to whom authority is attributed by parents or siblings. The role
concerns an instrumental and/or executive function, mainly with regard
to brothers and sisters. Minuchin never mentions a role exercised in the
emotional sphere, particularly in the care of a parent.
The author describes the parental child as a child who has been tempora-
rily delegated a function and a hierarchical position usually assigned to the
parental subsystem. The child joins the parental subsystem for a period of
time with a defined role, and the parental function temporarily entrusted to
him is instrumental because it concerns giving help to his brothers and
sisters. The two points on which Minuchin emphasizes are the following:
clarity of boundaries and the explicit expression of “who has responsibility
and authority.” In the presence of these two elements, Minuchin considers
that the system may operate quite well with a parental child, as well as with
the presence of a very helpful grandmother.
The support brought by the child to the parental subsystem is in this case
contextualised through economic and cultural data. Family status cannot be
considered separate from its cultural, situational (related to a transitional
crisis for example) or temporal context. Minuchin (1998) comments:

The attribution of parental authority to a child is a natural arrangement in large

families, families with a single parent or in families where both parents work. The
system can work well. Young children are well cared for and the parental child
may develop responsibility, competence and autonomy beyond his years. (p. 115)

Therefore, if the role played by the parental child is temporary, defined,

and contextualized, it can be an opportunity to develop an early sense of
responsibility and autonomy.
Minuchin considers that the situation of a family with a parental child can
become problematic if the delegation made to the child is not explicit and if
parents “abdicate, leaving the child to become the main source of advice, authority
and decisions.” In this case, requests that are made of the child may exceed his
competences but also be in conflict with his own requirements and needs.
The addition we make in this paper of the suffix “-tion” to the word
“parental” refers to a movement and suggests that there is a process. The
“parental-iza-tion” refers to the movement toward the “parental,” to what
makes the parental function. This can be a dynamic process, provided that
the child’s age and the weight of what is asked is not too heavy.
Parentalization calls the child, not to be a parent as in parentification, but
rather to assist the parents in their parental function and to be a parental aid.
Parents are then present as parents and consider the child as a child but ask
him to join them to be stronger at particular times for particular things. The
performance of this function can be a source of maturation by learning some
competences.
194 S. HAXHE

Adultization
The word “adultization” encompasses many meanings in the current
language. It is sometimes used to evoke parentification, but it can also refer
to the transition from adolescence to adulthood or the enticing of parents to
turn their child into a “mini-adult.” In the present article, “adultization”
refers to the movement toward what is adulthood. This movement will vary
according to the age of the child. For a teenager, the process is dynamic and
adaptive. For a young child, the process evokes a fast maturation that does
not consider some of the child’s needs such as protection and dependency.
The “adult child” is asked to become quickly autonomous by teaching
himself within a community that is not always available to supervise.
Being an adult is not being a parent and vice versa, and that is why
adultization should not be confused with parentification. The parental
request is not the same in both cases. If the parentified child is expected to
be a parent for his parent(s), the adult child is expected to grow up faster and
be autonomous, within some specific contexts (precarious financial and/or
social situations, single-parenting, parent[s] working hard).

Delegation
“Delegation” is a concept introduced by Stierlin (1979). In its dynamic form,
delegation is a mission entrusted by parents, which somehow gives meaning
and direction to their child’s lives (“I would like you to do university studies,
I would be so proud,” says a workman father to his daughter). Therefore,
delegation is the action to assign a load or mission. Like in other processes,
everything depends on the type of entrusted mission and the adequacy of the
skills of the child. If the mission is too demanding and/or not adjusted to the
child’s ability, it can mutate into parentification. Again, the degree of con-
sideration for the needs of the child is a useful marker to distinguish between
parentification and delegation, as well as the type of parental expectation.
Sometimes, the parental project takes priority over individual needs, and the
only thing that matters is to accomplish the project, whatever the child wants
or experiences. The movie “Black Swan” by Handel and Aronofsky (2010) is
an example of a delegation process crossing the lines and evolving into
parentification. In the movie, the mother is a former dancer who didn’t
achieved the level that she wanted. Narcissistically hurt, she needs to achieve
her project and she will do it through her daughter. Nina, a very promising
dancer, becomes the target of the mother’s projections and hopes and is
forced to accomplish her mother’s project. Aronofsky shows how mother and
daughter are almost the same character and how the mother has a difficult
time letting her daughter live her own life. Being an opera star is so vital that
nothing else matters. Nina does not get the chance to live a normal teenage
 JOURNAL OF FAMILY PSYCHOTHERAPY 195

life, as her mother forbids any contact with people who could distract her
from her project. The film illustrates the mutation from delegation to
parentification, as Nina’s life is oriented toward her mother’s narcissistic
need.

Case study1
Presentation
Lisa is 10-years-old. She lives with her mother, Ms. M., and her younger half-
brother aged 18 months, Jason. Her parents have been separated for 8 years,
and she barely sees her father. Social services send Lisa and her family to a
child protective service because she misses school very often. If she does not
go to school more regularly, she could be placed in a foster family or a home
for children. Lisa’s mother explains that she does not understand why her
daughter does not go to school. She forces her to go but nothing works. Lisa
has some trouble with children in her class, she does not seem to be well-
liked, and these issues could be the reasons why she does not want to go,
according to her mother.
After a few appointments, we learn that Ms. M. has been depressed for
4 years because of the loss of a son. Lisa was 6 at the time. Since then, Ms. M.
describes a huge difficulty to rebuild her life and to go on. Life has been lighter
for a while after the birth of Jason, but now she feels depressed again, some-
times with suicidal thoughts. She would like a new partner but she doesn’t trust
people easily. Her family are seen as a threat more than as a support, as they
have called the social services with their worries for Lisa. Ms. M. feels betrayed
and explains how she always felt rejected by her mother, presumed to favor her
sister. Her father, more affectionate, died when she was 14-years-old.
If her mother does not feel good, Lisa stands by her, trying to entertain
her, proposing activities to make her get out of bed. Most of the time, she
proposes to go to the park or to do some shopping. Even if she doesn’t
understand why Lisa does that, Ms. M. confesses that Lisa is a confident and
a source of reassurance.

Diagnosis
Let’s take a look at this example through the evaluation grid.

● Child’s needs: For Lisa, standing by her mother and trying to animate
her to avoid suicide is the absolute priority; her life as a child with
friends is a minor concern.
1
This is a composite of a number of cases, and does not represent any real individuals or families
196 S. HAXHE

● Parental request: Although Lisa’s mother does not overtly ask for her
presence and care, she confesses that Lisa is a confident and a source of
reassurance. Her relational background is marked by loss, lack of trust,
and feelings of rejection.
● Type of liability: Lisa puts her needs aside and tries to be a good parent
for her mother.
● Adequacy to the child’s competences: Too heavy as it impedes the
child’s development.
● How do parents consider the child? Lisa is seen as a potential “good
parent” (unconsciously of course), providing the attention and care,
which has always been missing or has been lost.
● Recognition of child’s gifts: If the mother acknowledges that Lisa is a
source of reassurance, her relational responsibility is not seen as such by
the mother, who states that she does not understand why Lisa does not
go to school.
● Context: Several losses. Lisa’s mother has lost her father, a child and is single.

All criteria converge in a diagnosis of parentification. The emotional respon-

sibility, the lack of positive social relationships with children of her age, and the
absence of recognition have consequences on Lisa’s development; she’s anxious,
overweight, and tends to blame herself for everything that goes wrong.
It is a bit more difficult to decide on Jason’s parentification, as he is only
18 months. If the author had used an observation instrument like the
Lausanne Trilogue Play created by Fivaz-Depeursinge and Corboz-Warnery
(2001), evaluating interactions between toddlers and parents, there would
certainly be more indications. As a therapist, the author’s feeling is that being
the cute, smiling, funny, and reassuring child could also parentify Jason.

Family sessions
The author worked with the family for 1 and 1/2 years, with various steps. The
first step was the recognition of the mother’s suffering and the investigation of
her childhood experience and unfulfilled needs. At the beginning, Ms. M.
didn’t seem to measure the burden on Lisa’s shoulders. But after the author
explored and recognized her own feelings of loneliness as a child and her lack
of trust in people, she progressively opened herself to the inner world of her
daughter. The temptation is great to push the parent, as soon as possible,
to recognize the child’s contributions toward him. However, doing so
without first connecting to his own experience is not only inefficient but also
moralizing and, therefore, violent for the child who protects his parent.
The second step opened a dialogue between the mother and her children,
through the recognition of the impact of her depression on their relationships,
the recognition of Lisa’s worries and attempts to help her, and the recognition
 JOURNAL OF FAMILY PSYCHOTHERAPY 197

of Jason’s attempts to make her smile by his clown attitudes (obvious during
the therapy sessions).
The author has also considered the role of Lisa’s father, barely present in
her life. The father has remarried and has had another child. According to
the mother, he has no time for Lisa. The author invited him but he didn’t
show up. However, the author had phone contacts with him and he got more
and more involved in the family work with time. At the end of the sessions,
Lisa was going to her father’s place every other weekend. Without the family
work with the mother, this would have remained impossible, as the mother
needed Lisa always around her and as Lisa was afraid to leave her alone.
Progressively, as trust was growing between mother and children, they
began to exchange more and more feelings and questions during the sessions.
One day, as Ms. M. was saying that she was feeling better, Lisa stood up, went
toward the blackboard and started a Hangman game. She put the first letter
“W” and asked her mother to play. The mother finally found out the word
“WORRY” and asked Lisa what she was worried about. Lisa responded “I don’t
know how to see if you feel good or not, so I don’t know when I have to worry
or not.” This was a turning point of the therapy because an authentic dialogue
was created. We then asked Lisa if her mother could say or do something
specific, a little thing as much concrete as possible, to let her know how she was
feeling and how she needed help. The objective was to relieve Lisa from
worrying all the time, in order to give some space to her own needs, life and
interests, while respecting her desire to care for her mother. Indeed, the goal of
this kind of therapy is not to make a “care-ectomy” but to help the child to help
his parent, and to be recognized for his it.
Lisa asked her mother to tell her when she felt down. Ms. M. committed to use
the code word “down” and to call someone for help when Lisa was not there.
Another part of the work with the family was to connect Ms. M. to a
network of psychological, relational and material help to support Lisa in her
efforts to help her mother. Helping the parent is helping the child, as the
latter could not benefit from support received by them alone if he/she is still
anxious for the parent. If the parent increases his trust in other people, the
relational responsibility of the child becomes lighter and more suitable. This
also strengthens the trust between the parent and the child and allows both of
them to invest in and outside their relationship. Progressively, Lisa’s mother
felt better, searched for a job and had more activities. Lisa, for her part, went
back to school and was less anxious for her mother.

Conclusion
This article underlines the need for a better distinction between parentification
and some related processes. Parentification is different not only in its form but
also in its call for therapeutic care, as each family member struggles with
198 S. HAXHE

suffering and loneliness. The relational responsibility endorsed by the child,

tends to generate anxiety and depressive feelings when the child realizes that
he/she is not equal to the challenge. The parent for his part fights with various
relational problems, loneliness, lack of self-confidence, trust in others, loss and
more, which can lead to diverse psychological and/or physical symptoms. The
case example illustrates how family therapy, here conducted with the model of
the contextual therapy of Boszormenyi-Nagy proves to be useful. The core of
the therapy is the engagement of the child and parent(s) in an authentic
dialogue about each other’s experience and feelings, but also their commitment
to act in a way that will secure the relationship. If words are important, acts
(even minimal) have way more power to build a more trustworthy, reliable,
and reciprocal relationship. In the case example, the commitment of the
mother to admit and say when she was really down and to call someone,
allowed Lisa not to worry all the time as she used to. She could go back to
school without wondering constantly about what her mother was doing. On
her side, Lisa could stay present for her mother and still caring for her but in a
less burdening way. This type of work strengthens the family bonds here and
now, but also for future generations (having in mind Lisa and Jason becoming
parent at their turn).

Limits and perspectives

The propositions presented in this article are based on the clinical practice
and on case studies from the current doctoral research. Extending the
observations to a larger population would be interesting. For example, the
author would like to create a parentification scale with a discriminative
power regarding the several processes presented here. Also, items covering
less known forms of parentification such as the scapegoat or the perfect child
would be of a great interest. To date, these roles of parentification are not
detectable with a scale. The caregiver and go-between roles being the most
“popular,” the scales seem to be constructed mostly around them.
Chase (2004) also underlined that the current instruments tend to evaluate
parentified role behaviors independently of the sociocultural and ethical
context in which they occur. The author would then like to create a scale
exploring the elements of the context, such as the relational background on
three generations (reciprocal trust and care, quality of attachment, emotional
responsibilities, recognition, fairness, and justice).

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