Daniel Sokal dissertation

Institute for Clinical Social Work

THE EXPERIENCE OF THE PARENT-AS-PEER DYNAMIC AMONG ADOLESCENTS IN PSYCHOTHERAPEUTIC TREATMENT

A Dissertation Submitted to the Faculty of the Institute for Clinical Social Work in Partial Fulfillment for the Degree of Doctor of Philosophy

By DANIEL SOKAL

Chicago, Illinois January 2024

Abstract This study used interpretive phenomenological analysis methodology to explore the phenomenon of the experience of the parent-as-peer (PAP) dynamic. The dynamic is defined as a primary symptom related to a peer-like relationship with a parent. This study examined adolescents in psychotherapeutic treatment who described their relationship with their parent as a best friend, peer, confidante, or good buddy. These types of statements revealed a conflicted, exploitive, and inconsistent parent–child relational dynamic. Insight into the experiences of adolescents in psychotherapeutic treatment with an identified PAP dynamic, how this dynamic relates to their relationship with their parents, and how this dynamic relates to their presenting symptomatology was conveyed.

Table of Contents ABSTRACT .................................................................................................................................... 2 DEDICATION ................................................................................................................................ 9 ACKNOWLEDGEMENTS .......................................................................................................... 10 CHAPTER 1 INTRODUCTION .................................................................................................. 11 General Statement of Purpose.............................................................................................. 11 Significance of the Study for Clinical Social Work ............................................................. 11 Why Study the PAP Dynamic? ............................................................................................ 12 Statement of the Problem..................................................................................................... 12 Literature and Gaps in Literature ......................................................................................... 13 Specific Objectives and Potential Benefits of This Study ................................................... 15 Research Questions .............................................................................................................. 16 Theoretical and Operational Definitions of Major Concepts............................................... 16 Statement of Assumptions ................................................................................................... 17 Epistemological Foundation ................................................................................................ 17 Foregrounding...................................................................................................................... 20 CHAPTER 2 LITERATURE REVIEW........................................................................................ 22 Freud .................................................................................................................................... 24 The Case of the Rat Man ...................................................................................... 24 The Case of Dora .................................................................................................. 26 PAP Dynamic Specifiers ...................................................................................................... 28 PAP........................................................................................................................ 29 Child as Parent’s Confidante................................................................................. 30

Role Reversal ........................................................................................................ 31 Role Conflict in the Adolescent Period of Development ...................................... 32 Summary of Specifiers .......................................................................................... 33 Primary Symptoms .............................................................................................................. 33 Depression............................................................................................................. 34 Impulsivity ............................................................................................................ 34 Summary of Primary Symptoms........................................................................... 34 Familial Factors ................................................................................................................... 35 Single Parent ......................................................................................................... 35 Marital Conflict..................................................................................................... 35 Narcissistic Parent................................................................................................. 37 Intergenerational Boundary Violation ................................................................... 38 Summary of Familial Factors................................................................................ 38 PAP Dynamic Concurrent Factors ....................................................................................... 38 Enmeshment.......................................................................................................... 39 Suicide Attempt in Response to Parental Relationship Conflict ........................... 39 Parentification ....................................................................................................... 39 Spousification ....................................................................................................... 42 Adultification ........................................................................................................ 43 Role Function Discrepancy ................................................................................... 43 Summary of PAP Dynamic Concurrent Factors ................................................... 44 Theoretical Framework ........................................................................................................ 44 Conclusion ........................................................................................................................... 46

CHAPTER 3 METHODS ............................................................................................................. 48 Introduction.......................................................................................................................... 48 The Rationale for Qualitative and Phenomenological Research Design ............................. 48 Rationale for a Specific Methodology ................................................................................. 49 Research Sample .................................................................................................................. 50 Information Needed ............................................................................................................. 51 Research Plan or Process ..................................................................................................... 51 Changes in How Sample Was Obtained .............................................................................. 54 Data Collection .................................................................................................................... 55 AAPI-2 .................................................................................................................. 55 Interview Guide .................................................................................................... 56 Field Notes ............................................................................................................ 56 Data Analysis ....................................................................................................................... 57 Ethical Considerations ......................................................................................................... 58 Issues of Trustworthiness ..................................................................................................... 59 Limitations and Delimitations ............................................................................................. 60 My Role and Background .................................................................................................... 60 Theme One: Symptoms and Their Relation to the PAP Dynamic ....................................... 61 Theme Two: Parental Conflict Impacting the Adolescent ................................................... 61 Theme Three: The Ideal Parent/Parental Failures ............................................................... 62 Theme Four: Parentification ................................................................................................ 62 Summary .............................................................................................................................. 63 CHAPTER 4 INTRODUCTION TO RESULTS .......................................................................... 64

Overview of Methods .......................................................................................................... 64 Reintroduction of Purpose Statement .................................................................................. 64 Reintroduction of Research Questions ................................................................................ 65 Changes in How Sample Was Obtained .............................................................................. 65 Participant Summaries ......................................................................................................... 67 Allana .................................................................................................................... 68 Emilee ................................................................................................................... 68 Anya ...................................................................................................................... 69 Mark ...................................................................................................................... 69 Ron ........................................................................................................................ 70 Allie....................................................................................................................... 71 Results.................................................................................................................................. 71 Research Questions and the Emerged Themes .................................................................... 72 Master Theme 1: The Lived Experience of the PAP Dynamic ............................. 72 Superordinate Theme 2: Intrusion or Expectation of Access to External Relationships ......................................................................................................... 79 Superordinate Theme 3: PAP Evolved Tension in the Dynamic........................... 80 Superordinate Theme 4: PAP Dynamic Declarative Experiences ........................ 83 Superordinate Theme 5: Child as Caregiver ......................................................... 84 Superordinate Theme 6: Child as Confidante ....................................................... 87 Superordinate Theme 7: Ideal Best Friend Identification ..................................... 88 Superordinate Theme 8: Ideal Parent Identification ............................................. 89 Superordinate Theme 9: Child’s Experienced Role in Their Family .................... 93

Superordinate Theme 10: Healthy Identifications of Relationship with PAP Parent .................................................................................................................... 98 Master Theme 11: Reason for Therapy ............................................................... 100 Superordinate Theme 12: Narcissistic Need of PAP-Identified Parent .............. 103 Summary ............................................................................................................................ 106 CHAPTER 5 FINDINGS ............................................................................................................ 107 Introduction........................................................................................................................ 107 Interpretation of Themes .................................................................................................... 108 Master Theme 1: The Lived Experience of the PAP Dynamic ........................... 108 Superordinate Theme 2: The Intrusion or Expectation of Access to External Relationships ....................................................................................................... 110 Superordinate Theme 3: The PAP Evolved Tension in the Dynamic .................. 111 Superordinate Theme 4: PAP Dynamic Declarative Experiences ...................... 113 Superordinate Theme 5: Child as Caregiver ....................................................... 114 Superordinate Theme 6: Child as Confidante ..................................................... 116 Superordinate Theme 7: Ideal Best Friend Identification ................................... 117 Superordinate Theme 8: Ideal Parent Identification ........................................... 118 Superordinate Theme 9: Child’s Experienced Role in Their Family .................. 121 Superordinate Theme 10: Healthy Identifications of the PAP Dynamic ............ 125 Master Theme 11: Reason for Therapy ............................................................... 126 Superordinate Theme 12: Narcissism in the Soothing Response Need of the PAP-Identified Parent ......................................................................................... 132 Conclusion Statement ........................................................................................................ 135

CHAPTER 6 CONSIDERATIONS AND RECOMMENDATIONS ......................................... 137 Clinical Considerations ...................................................................................................... 137 Clinical Recommendations ................................................................................................ 137 General Summary ............................................................................................... 137 Clinical Recommendations When Working with PAP-Dynamic Patients .......... 138 Revisiting Original Assumptions ....................................................................................... 139 Strengths and Limitations .................................................................................................. 139 Future Recommendations .................................................................................................. 140 Personal Reflection ............................................................................................................ 141 REFERENCES ........................................................................................................................... 142 APPENDIX A INDIVIDUAL CONSENT FOR PARTICIPATION IN RESEARCH................ 147 APPENDIX B INTERVIEW GUIDE ......................................................................................... 150 APPENDIX C INITIAL PHONE CONTACT WITH PARTICIPANTS .................................... 152 APPENDIX D SAMPLE OF EMAIL AND FACEBOOK AND LINKEDIN POST TO RECRUIT PARTICIPANTS .............................................................................................. 155 APPENDIX E SAMPLE POST TO SOCIAL MEDIA, FACEBOOK AND LINKEDIN ......... 156

Dedication This research is primarily dedicated to my wife for her unwavering patience and tolerance of the endeavor towards my PhD. To my children for the reminders of the permissibility and mandate of play in the midst of seriousness.

Posthumously, I would also like to dedicate this to my deceased grandfather, Ernest, who instilled in me his love of psychoanalytic theory, and my recently deceased father, Yonatan, an empathic Psychiatrist whose love for his work shone deeply.

Acknowledgements I want to thank the members of my dissertation committee. Thank you especially to Madelyn Greenberger for her deep warmth, empathy, and keen clinical eye that helped me get through my primary years at ICSW. Thank you to my chair John Ridings for his direction and feedback during this process. Thank you to Greg Rizzolo for his brilliant and hilarious integration of theory and historical context to help provide a dynamic conceptualization of the foundations of our field. Thank you as well to my other committee members Denise Tsioles and Andrea Harris Alpert for their feedback and guidance in preparing and strengthening this study. I would also like to broadly express my deep gratitude to the numerous staff at ICSW (a list too long to write) who assisted in expanding my clinical skills, sense of the world, and search for healing and truth through curiosity for the human condition.

Chapter 1 Introduction General Statement of Purpose The purpose of this phenomenological study was to understand the experience of the parent-as-peer (PAP) dynamic for adolescents with psychotherapy experience. At this stage in the research, the PAP dynamic is defined as a primary symptom related to a peer-like relationship with a parent. This study examined adolescents currently in or who have completed psychotherapeutic treatment who describe their relationship with their parent as a best friend, peer, confidante, or good buddy. These types of statements often reveal a conflicted, exploitive, and inconsistent parent–child relational dynamic. The intent of this study was to gain insight into the experiences of adolescents in psychotherapeutic treatment with an identified PAP dynamic, how this dynamic relates to their relationship with their parents, and how this dynamic relates to their presenting symptomatology.

Significance of the Study for Clinical Social Work Research into the PAP dynamic provides future knowledge of important factors for clinicians regarding the etiology of symptoms, courses of focus in family therapy interventions, and future therapeutic interventions for those experiencing the PAP dynamic and having related presenting symptoms to the parent and child relational dynamic. This research can help clinicians provide better service to help their adolescent patients who struggle with these parent–child dynamics. This study also provides expanded knowledge to an identified factor in abusive parenting, parental role-reversal.

This study aimed to gather knowledge into how the PAP dynamic influences the parent– child relationship and how this dynamic relates to the adolescents presenting symptoms in

psychotherapeutic treatment. This study also hoped to clarify whether the PAP dynamic is an influencing and or primary factor leading to an adolescent receiving psychotherapeutic treatment.

This research also aimed to gain insight into how adolescent patients experience the PAP dynamic.

Why Study the PAP Dynamic?

In my clinical experiences of the PAP dynamic, I have felt the parent–child relationship was often exploitative on the parent's end. I firmly believe that in these cases, the PAP dynamic led to the patient’s presenting symptoms and was the most integral explanation of the patient’s etiology of symptoms. The possible unconscious exploitation of the adolescent for a parent's personal needs in the PAP dynamic is essential to understand from a clinical viewpoint. If a parent acts like a friend, peer, or confidante, mental health symptoms can develop in the adolescent (Glickauf-Hughes & Mehlman, 1998). The insight gained in this study can assist the psychotherapists working with these types of adolescents in conceptualizing and identifying when the parent–child relationship is skewed and if the adolescent is at risk for increased development of negative attachment behaviors. The negative attachment behaviors exemplified might include promiscuousness, self-injurious behavior, and engaging with peers with drugs and alcohol abuse tendencies, leading to mental health symptoms such as depression, anxiety, and personality disorders (A. Harris, 2009; Bernstein, 1999; Haule, 1999; Howard, 2013; T. Harris, 2007; Wurmser, 1979; Wurmser & Zients, 1982).

Statement of the Problem Adolescence is a developmental stage when youth are exploring the roles and expectations of adulthood and experimenting with becoming independent from their parents (Bowlby, 1969). At the same time, adolescents are seeking guidance, direction, rules, and

oversight from a parental figure (Erikson, 1968; Waterman, 1982). If a parent acts like a friend, peer, or confidante, mental health symptoms can develop in the adolescent (Glickauf-Hughes & Mehlman, 1998). Adolescents who present to my psychotherapy practice with anxiety, depression, and adjustment disorders often report an exploitative (feeling used, taken advantage of, one-sided) peer-like relationship with a parent. This peer-like relationship exists when the adolescent identifies a parent as a best friend, good buddy, and or confidante. This type of connection is called a PAP dynamic.

When a familial dynamic is reversed, skewed, or imbalanced, the adolescent can experience mental health symptoms concerning the disturbance to the expected developmental framework of parent and child roles. This dynamic is most clearly identified in research about parentification impacting a patient’s symptomatology and is discussed in numerous articles (Boszormenyi-Nagy, 1965; Boszormenyi-Nagy & Spark, 1984; Diamond et al., 1999; GlickaufHughes & Mehlman, 1998; O’Connor, 2007). The collective meaning of parentification is when a child acts in a role similar to a parent towards their parent (Bernstein, 1999).

Literature and Gaps in Literature The PAP dynamic is not a widely studied phenomenon. Minimal research has focused on this dynamic in a way that identified it as a clinical issue. The PAP dynamic is often only presented in the literature as an aspect of narrative information in a case, as opposed to relating directly to the patient's presenting symptoms. The idea of the PAP dynamic was discussed as early as the 1900s when Sigmund Freud mentioned it in the cases of the Rat Man (Freud, 1909) and Dora (Freud, 1905). In the above cases, Freud described a peer-like relationship with a parent as solely part of the narrative and did not notably relate the peer-like dynamic to the patient’s pathology or etiology of symptoms. Freud mentioned the concepts of the father as “best

friend” (Freud, 1909, p. 182) in the case of the Rat Man and the daughter as her father’s "confidante" (Freud, 1905, p. 57) in the case of Dora.

The PAP dynamic does not appear as more clearly defined in the literature until the late 1970s. Hetherington (1979) described that when the parent forgoes their maternal role and relies on the child to confide in, and as solely present for the parent’s emotional support, the child ends up fulfilling the parental role and function of the parent who is not present. Hetherington discussed the dynamic as an aspect of a patient’s pathology as opposed to a key and central component in their pathology. This study intended to explore the way in which the PAP dynamic becomes a central component of the presenting patient’s etiology of symptoms and their presenting pathology.

The closest discussion of a PAP dynamic as a clinically problematized focus appears in literature in the language of when a parent becomes peer (PBP; Glenwick & Mowrey, 1986).

Glenwick and Mowrey (1986) described the PBP dynamic as when a parent becomes a peer, and the loss of intergenerational boundaries occurs in single-parent families, mostly by maternal figures. Glenwick and Mowrey discussed that children with a PAP dynamic are unable to express their fears and concerns to the parent due to needing to be present for the parent's emotional needs. They discuss that this leads to symptomatic behaviors including truancy, sexual and aggressive acting out, withdrawal, running away, sleeping and eating problems, over compliance with parental requests, and drug use. Glenwick and Mowrey also described the child's symptoms as related to the parent’s crossing of generational boundaries in an exploitative or selfish and nonreciprocal way, thus damaging the expected developmental roles of the parent as a parent and child as a child. After this article in 1986, the PBP dynamic does not seem to appear again in any literature.

Parentification, spousification, role-reversal, and the violation of intergenerational boundaries are all specific, related subcategories that are minimally researched as well. The previously mentioned categories describe aspects of the exploitative shift in expected parent– child roles, and they serve as descriptors of observed phenomena that relate to relational clinical data but are not mentioned directly by patients. The previous categories are used to describe the observed phenomenon from a clinical perspective. None of the aforementioned terms appear in research as a dynamic disclosed as a primary presenting problem by the patient, whereas the PAP dynamic arises in my clinical experiences as a core experience discussed in a patient's initial presenting-problem session.

The terms parentification, spousification, role-reversal, and the violation of intergenerational boundaries are also solely used by clinicians and researchers as explanatory terms for encapsulated experiences, not core aspects of symptom presentation and magnification.

The PAP dynamic that I discuss in this research differs from these categories in that it represents a broader thematic issue that has been directly verbalized by patients since the beginnings of psychotherapy and I intended to explore its direct relation to presenting symptoms. The PAP dynamic encapsulates the possible concurrent experiences that may include parentification-like phenomenon, but it also encapsulates boundary issues, attachment needs, and primary treatmentrelated pathologies that stem from the PAP dynamic. The PAP dynamic has been largely ignored as a clinical issue that directly relates to symptomatology, and this research intended to explore that connection.

Specific Objectives and Potential Benefits of This Study The mental health symptoms of an adolescent and their relation to the phenomenon of the PAP dynamic is understudied. Potential benefits of this study are the development of further

insight directly from the adolescent perspective into how the PAP dynamic is experienced amongst the dyad of the parent and adolescent child. Such insight could highlight the etiology of symptoms, psychosocial data needs, and future therapeutic interventions for the adolescent who experiences this dynamic.

Research Questions The experiences of adolescents who experience a PAP dynamic in their relationships with a parent were the primary focus of this study. This phenomenological study intended to report their narrative of this experience and gain insight into the commonalities, themes, and significant patterns that arose. Specifically, I explored two primary research questions: 1. How do adolescent psychotherapy patients who identify as having a PAP dynamic relationship with their biological parent describe their experiences with that parent?

2. How does the PAP dynamic relate to the adolescent in psychotherapy and their presenting symptoms?

Theoretical and Operational Definitions of Major Concepts This dissertation endeavor was an exploratory phenomenological qualitative study. The phenomenon under study was the experience of the PAP relationship among late-phase adolescent psychotherapy patients who were evaluated in this study. The sample of central importance in this study was adolescent patients aged 18–21 who have attended psychotherapy and identified a PAP dynamic.

A significant concept of the sample of this study was adolescents who have parents whom the adolescent patients defined as a best friend, peer, confidante, or good buddy. The PAP phrasing is used to relay this dynamic. Below are definitions of two terms:

•

Loss of Intergenerational Boundaries: Fish et al. (1991) and Glewick and Mowrey (1986) discussed the concept of an intergenerational boundary violation. They discussed this concept as relating to a situation or role of the caregiver in which a parent violates a fundamental tenet of their specified role and the child experiences losing their parent.

•

PAP Dynamic: This dynamic can present amongst adolescent psychotherapy patients who describe their relationship with their parent as a best friend, peer, confidante, or good buddy. These types of statements are related to a conflicted, exploitive, and inconsistent parent–child relational dynamic.

Statement of Assumptions The PAP dynamic directly relates to and impacts an adolescent psychotherapy patient's pathology. The adolescents presenting symptoms likely ebb and flow with the patterns of their parental relationship style. If the parent has a substantial role as an authoritative (Bowlby, 1969) adult, the adolescent feels secure in their development and exemplifies less pathology. A parent who exploits their adolescent as a peer, best friend, and or confidante influences a lack of stable growth, anxiety, and magnified symptomatology in the adolescent. If a PAP dynamic exists with a patient, it is a crucial factor and influence in the foreground of the etiology of symptoms as opposed to background information that is only a component of the etiology of symptoms.

Epistemological Foundation Bloomberg and Volpe (2018) described the qualitative research approach as promoting a deep understanding of a social experience as viewed from the research participants’ perspectives.

The scholars also discussed that the qualitative approach implies an emphasis on exploration, discovery, and description, while describing current conditions, investigating relationships, and studying cause-and-effect phenomenon. A transformative worldview phenomenological based

approach was the central theoretical grounding of this research. The transformative component of the study was its focus on a vulnerable population, children who experience abuse. Bavolek (1984) developed an assessment to identify risks of abusive parenting called the AdultAdolescent Parenting Inventory (AAPI). The AAPI inventory consists of five developed theoretical constructs that are categorized as aspects of measuring common abusive parenting behaviors. The fourth construct of the assessment, Construct D, evaluates parent–child role reversal and describes it as a primary component of parental behaviors that may lead to abuse and neglect. A few examples of role reversal that are included in the questions from Construct D—in which a parent would be assessed on their answer to their strength of agreement to the statement—are: children should be their parent’s best friends, children should be responsible for their parent’s well-being, parents should be able to confide in their children, and children should know when their parents are tired (Bavolek, 1984). Thus, role reversal can be considered a related factor or specifier to the PAP dynamic.

The intended outcome of this study was to learn new knowledge of and insight into the PAP dynamic, which often directly correlates to an aspect of identified child abuse, parent–child role reversal. This study intended to highlight this aspect of child abuse related to this population so it may be more easily identified and treated. If clinicians know more about the PAP dynamic, they can better recognize it. Children of abusive parents are a marginalized and vulnerable population; therefore, this study intended to highlight them and gain an understanding of their experience and perspective while empowering them to own their narrative and not have it done for them, as most prior research surrounding the nuances of this topic has done from a clinician’s and external adult’s perspective. The worldview was a phenomenological qualitative study. The phenomenon of the lived experience of adolescent patients who have been involved in

psychotherapeutic treatment and who have identified in the therapeutic milieu a PAP relationship were evaluated in this study. A phenomenological and psychodynamic theory-based approach was the primary theoretical grounding of this qualitative research.

Creswell and Creswell (2017) noted that the transformative worldview assumes that the inquirer proceeds collaboratively, avoids marginalizing the participant, and provides a voice for participants, thus raising their consciousness and advancing an agenda for change in their lives.

Creswell went on to discuss that the transformative worldview places central importance on the study of the lives and experiences of diverse groups that have been traditionally marginalized and how their lives have been constrained by oppressors and the strategies they have developed to resist, challenge, and subvert the constraints they have experienced in these asymmetric power relationships. Romm (2015) discussed that the transformative approach bears a sense of social justice issues in mind so that the inquiries become intertwined with a political action-oriented agenda towards generating increased fairness in the social fabric.

Creswell and Creswell (2017) discussed phenomenological research as a design of inquiry rooted in philosophy and psychology where the researcher is describing the lived experiences of a phenomenon described by the participant, culminating in the essence of several individuals who have all experienced this phenomenon. Van Manen (1990) described phenomenological research as the study of the lifeworld that aims to gain a deeper understanding of the nature or meaning of our everyday experiences by asking what the recollection of the lived experience is like for individuals. Psychodynamic theory and its bond to a transformative worldview phenomenological approach can best be described by Cushman’s (1995) description of the psychodynamic process as taking place within a broader cultural space or terrain than the therapeutic milieu. He described the ground as one that emerges out of the parameters of the

shared philosophical and moral understandings, language, gender roles and identities, customs, rituals, and political and economic structures of the specific historical era in which the psychoanalysis takes place.

Foregrounding The theoretical sensitivities I bring to this study are the values and experiences of a psychodynamically oriented therapist who works with both parents and children and direct observation on how the identified parenting role or PAP dynamic presents symptomatically for adolescent clients in psychotherapy. I have seen the PAP dynamic most frequently in two scenarios: in adolescent males presenting with aggression and depressed female adolescents. I have had numerous male juvenile clients with anger issues who identify their parents as peers.

These parents often side with their child after impulsive and aggressive incidents and stand up for them as opposed to stressing upon their children the growth from learning from mistakes. The parents of these males tend to defend their sons as a friend would support a peer as opposed to clarifying their role as a parent and holding their children accountable for adverse behavioral outcomes.

I also work with many depressed female patients who define their parents as peers. These parents often utilize their children as a confidante to disclose and vent about their troubles. I have also experienced that these parents tend to be narcissistic and are often unable to view their children as children. They instead react to them more as a narcissistic extension of themselves.

The children are expected to be available and on-call for the parent to serve their own narcissistic needs as opposed to being viewed as children needing care and consequences.

A significant PAP example of a case that I worked with was a female adolescent patient whom I treated for 4 years. She was in a PAP relationship with her mother, and her second

suicide attempt was intended to induce her mother’s parental role. She recalled the maternal warmth she experienced while waiting to be evaluated in the emergency room, having her hair caressed and hands held after her first suicide attempt. She reported she attempted suicide a second time to try and shift the way that she and her mother were relating. She stated that she wanted, "to make mom act like a mom again; I really missed it, craved it, really, really wanted it again. Trying to kill myself was the only way I knew how to get that back.”

In my clinical experiences of the PAP dynamic, I have felt the parent–child relationship was often exploitative on the parent's end. I firmly believe that in these cases, the PAP dynamic led to the patient’s presenting symptoms and was the most integral explanation of the patient’s etiology of symptoms. I also bring my own cultural and religious experiences, as well as my perceptions of how my parents raised me and how my grandparents interacted with their children and grandchildren. As a parent of five, I am also conscious of the ongoing struggle to be an ideal parent and the need for being supportive, connected, and caring while maintaining appropriate and realistic boundaries.

Chapter 2 Literature Review The literature most related to this qualitative study includes research on language similar to the PAP dynamic and the child who is a confidante to their parent from a psychodynamic perspective. The literature is limited in scope; articles obtained mostly convey components, but not the breadth of scope of the PAP dynamic that I sought to understand. Most literature obtained maintains the Freudian perspective that the PAP-dynamic-like occurrences are important aspects to convey in narrative summary but are not the core aspect of pathology and symptom magnification.

Additional articles were obtained on the adolescent period and the adolescent period's relationship with suicide when parental boundaries fluctuate, mental health symptoms, adolescent developmental tasks, parentification (and parallel term to this subject), and the symptoms of depression and impulsivity. Numerous articles on the factors that contribute to the PAP dynamic, including divorce, a single-parent household, marital conflict amongst parents, narcissistic parents and suicide's relationship to the adolescent and parent relationship, and parentification, are later discussed. The concept of enmeshment amongst adolescents and their parents and the idea of an intergenerational boundary violation from a parent to a child were also topics of relation to the PAP dynamic.

Mitchell (2013) proposed a theory that places an addendum to Freud’s theory of a parental vertical axis that represents parenting experiences and their impact on pathology.

Mitchell proposed adding a horizontal axis that discusses a sibling impact called a fraternal horizontal, which represents how sibling relationships relate to significant patient dynamics and pathology development. She suggested the importance of sibling trauma appearing on a

horizontal axis to conceptualize familial typifications of trauma. I intended to expand on Mitchell’s proposed axis and bridge the crossing of these two axes (see Figure 1).

Mitchell (2013) did not discuss when the two axes collide or cross; she saw them as separate entities. When a parent acts like a sibling, it induces confusion to the child regarding the role they expect (i.e., a parental role and all the expectations and boundaries that would align with the expectations of that role). I also explore how the parent in the sibling axis subjugates the boundary in which they were placed as a parent and how they delve into a different and unexpected realm. In his commentary on the sibling society, Bly (1996) wrote that he believes the American culture has regressed. He discussed his worry that the vertical plane of the superego formed by Freud now stretches along a horizontal plane. Bly discussed that the move from a parental vertical realm to a horizontal sibling realm has fostered creating a role modeled around greed and desirousness amongst both parents and their adolescents that changes the parent–child role into something Freud never anticipated, a much more narcissitically rolemodeled coexistence without parenting.

The criterion for research selection was broad due to the lack of specific study on this topic. Literature was obtained via crucial word searches such as "parent as peer," "parent + best friend," "child + confidant," "parent + role," "parent + best friend," "parentification," "spousification," and "adultification" via the Psych Info database and PEP Web database.

Empirical case studies and meta-analysis articles were obtained, as well as more narrative and theoretical articles. Literature was obtained dating back to original works by Freud in 1909 to present-day literature.

The subheadings for the literature review are as follows: Freud (with subheadings of the case of the Rat Man and the case of Dora), PAP dynamic specifiers (with the subheadings of

PAP, child as parent's confidante, role reversal, and the role conflict in the adolescent period of development), primary symptoms (with subheadings of depression and impulsivity), familial factors (with subheadings of single parent, marital conflict, narcissistic parent, and intergenerational boundary violation), and PAP dynamic concurrent factors (with subheadings of enmeshment, suicide attempt in response to parental relationship conflict, parentification, spousification, adultification, and role function discrepancy).

Freud Freud discussed the idea of the PAP dynamic in the cases of the Rat Man and Dora as solely part of the narrative. Freud mentioned the concepts of the father as "best friend" (Freud, 1909, p. 182) in the case of the Rat Man and the daughter as her father's "confidante" (Freud, 1905, p. 57) in the case of Dora. Freud failed to problematize the shift in intergenerational boundary expectations as a significant factor in the etiology of their symptoms. In conveying this dynamic as only a part of the narrative, Freud failed to connect the father figure’s role shift to a PAP dynamic as the likely linchpin of the symptomology presenting in these two cases. In Freud’s failure to create a sense of the significance of the etiology of the symptoms stemming from the PAP dynamic, and by considering the PAP dynamic an element that was solely part of a narrative, a significant trend might have begun in which this dynamic has been largely ignored in the psychotherapeutic literature.

The Case of the Rat Man The PAP concept was discussed in passing in the Rat Man case as a random addition to the description of the father–son relationship presented by the Rat Man during a session. The father-as-best-friend dynamic did not further develop as a concept to Freud past the identification of this dynamic by the analysand. Freud (1909) discussed the moment in treatment when the Rat

Man expressed his relationship with his father as something that came up “somewhat disconnectedly” and the Rat Man told Freud that, he had been his father’s best friend, and that his father had been his. Except on a few subjects, upon which fathers and sons hold aloof from one another… there had been a greater intimacy between them than there now was between him and his best friend. As regards the lady for whose sake he had sacrificed his father in that idea of his…The source from which the hostility to his father derived its indestructibility was evidently something in the nature of sensual desires, and in that connection he must have felt his father in some way or other an interference. (p. 182) Freud discussed the importance of this "disconnectedly" discussed moment when the father became a peer in the narrative and went so far as to consider the father an "interference" in connection to this dyad shift of a best friend peer relationship from a father and son relationship.

The fact that this peer relationship was "disconnectedly" discussed holds a significant meaning in regard to it being an essential element of an unconscious thought emerging. It seemed to have come out of nowhere but was reported by the Rat Man with a conviction of significance. The fact that this conveyance of the Rat Man's relationship with his father leading to Freud's thoughts of the father as an "interference" seems to be more significant than solely a fact in the narrative.

Freud's presentation of the root of Rat Man's hostility was still maintained in the narrative, though as thematically around the guilt of defying a father's wishes and wishing death upon his father. This disclosure of the PAP dynamic seemed to fade into the narrative after it so strikingly arose as such an important fact by the Rat Man. Freud missed a key focus on the idea that a father acting in the role of a best friend could lead to a child's reactivity and hostility towards the failure of a father to meet the child's

assumptions of the father role. The father becoming a peer to the Rat Man could have been less about the guilt of defying a father and possibly about intense competitiveness amongst peers, or even mourning the loss of an idealized father figure who remains as a buddy in his death and not a father.

The Case of Dora In Freud's case of Dora, she was described as her father's confidante. Freud discussed the relationship that existed between Dora and her father as skewed from an early age. Freud himself conveyed a peer dynamic that was never problematized and only presented as an element of the narrative. He described a vital component of the narrative of the case that was a significant example of the suppression of a father’s expected role as, The nature of her disposition had always drawn her towards her father, and his numerous illnesses were bound to have increased her affection for him. In some of these illnesses, he would allow no one but her to discharge the lighter duties of his nursing. He had been so proud of the early growth of her intelligence that he had made her his confidante while she was still a child. It was she and not her mother, whom Frau K.'s appearance had driven out of more than one position. (p. 57) Dora's father utilized his daughter as a confidante; the father–daughter roles were skewed since she was young. The idea that her instinct was to become the one nursing her father insinuates her task was not to be taken care of but to be his caretaker. The concept of a confidante dynamic existing between the two conveys a significant flaw in the assumptions of how a father should act with a daughter but is parallel to how one would perceive a similarly aged friend or peer. Dora being drawn out of more than one position could be interpreted as the

confidante role’s rupture, but also the rupture of daughter role to an idealized father and the suppression of the father’s role as a father.

Dora was distraught due to a man of a father-like status who had replaced her father while her father was off having an affair with his wife, making a sexual pass at her. Freud discussed her feelings and reactions to Herr K.'s pass and its arousal of anger at Herr K. (likely displaced anger for her absent father) as, ...for unknown reasons since the scene by the lake her love had aroused in her violent feelings of opposition, and that the girl had brought forward and reinforced her old affection for her father in order to avoid any further necessity for paying conscious attention to the love which she had felt in the first years of her girlhood and which now had become distressing to her. (p. 58) Could this anger and its relation to her girlhood relationship with her father be a residual fury directed at a man in the father role, suppressing that role, and treating her as an adult while she is seeking a father figure, not a peer? Was the pass symbolic to her in the sense that she is a pawn to the men in her life, to serve them and their needs? She did not have the opportunity to be a child enjoying the company of a role model who would not take advantage of the closeness that existed between the two. Her father utilized her to vent his stressors and as a free nursing service, and she became his confidante; Herr K. wanted her as his sex object.

Freud also discussed Dora's jealousy of Frau K., the woman with whom her father was having an affair. Freud identified the envy numerous times in the case in the passage to follow.

Freud described it as follows:

…her father's relations with Frau K. there lay a concealed feeling of jealousy which had that lady as its object- a feeling, that is, which could only be based upon an affection on Dora's part for one of her sex. (p. 60) The jealousy towards Frau K. was also likely displacement of an emotional response to being replaced by her father with someone else as his close confidante. Dora's father also made an unspoken gentleman's agreement in which Dora was an object of barter for Herr K. while her father was off seducing the man’s wife (p. 60). Both Herr K. and Dora’s father became sexually selfish and suppressed their roles as adult role models. Herr K.’s seduction likely led to Dora’s sadness over another father figure turning into a peer, suppressing the ideal father role. In the case of Herr K., it was the suppression towards a romantic realm, in her father's case, the suppression towards a confidante who was also expecting a caretaker to his medical needs.

To further expand on this concept of adults in Dora’s life acting as friends, Freud discussed that Frau K. had also utilized Dora as a peer: “She had been the wife’s (Frau K.) confidante and adviser in all the difficulties in her married life” (p. 61). She was further dragged into the dynamic of the adults in her life, taking advantage of her by being utilized by yet another adult as a venting ear. Freud did not problematize this, just another aspect of the narrative to exemplify the libidinal aspect of Dora’s relations with her father and this couple, without seeing that the etiology of her symptoms might lie in this skewed playing out of generational roles and constant disappointment in being close to an adult figure only to be utilized in one self-serving way or another by them.

PAP Dynamic Specifiers A specifier is intended to be an extension of a diagnosis to clarify the diagnosis further.

Specifiers are used in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

extensively to allow for more specificity in a diagnosis. I am using the term specifier with the following categories to represent what I believe to be integral characteristics for identifying and conceptualizing the PAP dynamic. The PAP dynamic specifiers are grouped into the PAP, the child as parent’s confidante, and role conflict in the adolescent phase of development. The PAP specifier is a descriptor of when the child can verbalize a subjugation or shift from a parental role to a more peer-like role. I believe this ability by a patient to verbalize this role shift is a primary factor that gives credibility that the PAP dynamic exists as a core function of the pathology presenting in a case. The child as a parent’s confidante serves as a specifier because it often exposes a utilization of the child for a parent’s narcissistic needs and encapsulates a shift from parental experiencing to confusing boundary fluctuations that seem to commonly arise in my experiences of the PAP dynamic. Role conflict in the adolescent phase of development serves as a specifier to the PAP dynamic because the adolescent phase of development occurs during an important part of emerging adulthood, role identification and role conceptualization formation.

Conflict surrounding a parent’s lack of or confusion in fulfilling and representing their parental role and adolescent role expectations of a parent can serve as a significant symptom magnifier when looking at pathology and its relationship to adolescent needs from an authoritative and supportive parent figure who is capable of meeting a child’s needs and not relating as a peer or colleague would to their child.

PAP A similar explanation to my discussion of a PAP dynamic does not appear in literature until 1986 when Glenwick and Mowrey described a similar dynamic, when a parent becomes a peer (PBP). Their theory discusses the PBP experience occurring specifically when the loss of intergenerational boundaries occurs in single-parent families, mostly in the maternal role. They

go on to discuss the PBP dynamic by quoting Hetherington's 1979 article, which describes when the parent abdicates their maternal role and relies on the child to confide in and solely be there for the parent’s emotional support and the child ends up fulfilling the role and function of the parent who is not present.

Glenwick and Mowrey (1986) were the first to discuss the connection between the crossing of parental boundaries into a peer realm being directly connected to symptoms. They discussed that children’s fears and concerns in PBP situations are unable to be expressed to the parent and reveal themselves in symptomatic behaviors including truancy, sexual and aggressive acting out, withdrawal, running away, sleeping and eating problems, over compliance with parental requests, and drug use. They described the child’s symptoms in the crossing of generational boundaries as related to the child experiencing two losses, including the physical loss of the parent who is no longer present and the loss of the parental role of the current parent.

Child as Parent’s Confidante The concept of a child serving a parent as a confidante appears in numerous psychodynamically oriented articles (Bowlby, 1973; Cohen, 1992; Grand, 1982; Mayes & Cohen, 1993; Renik, 1990; Steinberger, 1989; Stolorow, 1979). All of these works identify the mother utilizing the child as a confidante, and only Cohen (1992) and Mayes and Cohen (1993) described the utilization of the child as confidante to both parents. Stolorow (1979) described a case in which the child served as his mother's admiring little confidante, her little gentleman, and a narcissistic extension of herself. Bowlby (1973) described the dynamic as the child becoming a companion to the parent and discussed that the parent is anxious about the availability of their attachment figures and unconsciously inverts the parent–child role, creating a situation where the child is expected to comfort and care for the parent-as-child. Renik (1990) described a case in

which the mother utilized her son as a confidante and discussed dissatisfaction with her husband and caused tension in the father–son relationship. Steinberger (1989) similarly explained the conflict relayed onto the child through being used as a confidante and ally during periods of marital discord as placing additional strain on the child's already present issues with separation.

The above cases exemplify the shift in experience and impact to the child when they become utilized as an object for parental needs, as opposed to experiencing being a child with needs expressed to a parental object.

Role Reversal Bowlby (1980) discussed role reversal as an inverted relationship as the symptom producing experience in which a parent’s insecurity about their own attachment figures leads to an insecure attachment with their child, who they then seek and expect to be comforting to them.

Zeanah and Klitzke (1991) explained that role reversal is a disordered relationship between parent and child, rooted in a dysfunctional interdependence that causes symptoms of mutual anger, disappointment, and anxiety. Bavolek (1984) developed an assessment to identify risks of abusive parenting called the AAPI. The AAPI inventory consists of five developed theoretical constructs that are categorized as aspects of measuring common abusive parenting behaviors.

The fourth construct of the assessment, Construct D, evaluates parent–child role reversal and describes it as a primary component of parental behaviors that may lead to abuse and neglect. A few examples of role reversal that are included in the questions from Construct D, in which a parent would be assessed on their answer to their strength of agreement to the statement, are as follows: children should be their parents’ best friends, children should be responsible for their parents’ well-being, parents should be able to confide in their children, and children should know when their parents are tired (Bavolek, 1984).

Mayseless et al. (2004) discussed that the concept of role reversal is very broad, encompassing aspects of enmeshment, spousification, different parental pathology, and physical and emotional abuse. Thus, it serves as a broad symptom descriptor for a largely broad categorical way of explaining the phenomenon of role reversal. I believe role reversal can be considered a common specifier to the occurrence of the PAP dynamic and that its broad definition serves as an extension of narrative data to assist with the diagnostic sense of clarifying the PAP dynamic’s occurrence in the way it is described by the presenting patient’s experience.

Role Conflict in the Adolescent Period of Development Erikson (1968) discussed the adolescent period as the stage of development of inner identity in part based on successive identifications of the earlier years when the child wanted to be and was forced to become like the people the child relied on. Waterman (1982) built on Erikson's concept by hypothesizing that parental behavior contributes to identity formation.

From a developmental perspective, the function of the parent towards the child is a highly influential factor in an adolescent's healthy identity development.

Spirito et al. (1992) discussed the adolescent period and its linkage to risk for reattempted suicide. They explained that adolescents who attempted suicide were at a 10–16% increased likelihood of reattempting from 3 months to a year after the initial attempt. Graber et al. (2002) discussed that adolescents are at higher risk for negative affect compared to preadolescents due to the increased association with stress and depression as the child develops.

Fuligni and Eccles (1993) examined the links between parents’ adjustments to adolescents during early adolescence and early adolescence orientation toward parents and peers.

They discussed that the child’s increased orientation towards peers is at the expense of their closeness to their parents and that children "trade" a dependence on parents for reliance on peers.

For a parent who craves dependence or yearns for the past dependence that once was a mainstay of the parent–child relationship, this might be an avenue of explanation for the peer shift a parent might make in their relationship with their adolescent child.

Meeus et al. (2002) evaluated parental and peer attachment and identity development in adolescence. Meeus et al. found evidence that parental attachment identifiers were related to school identity and peer influence was related to relational identity. Meeus et al. evaluated whether parental and peer communication and trust were differently associated with the process of identity formation, commitment, and exploration. One could postulate that if the roles are skewed, and a parent represents both a peer and the parent, then it is likely attachment and relational identity could be negatively impacted.

Summary of Specifiers Specifiers are intended to be an extension of a diagnosis to further clarify the diagnosis.

In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, they are used extensively to allow for more specificity in a diagnosis. I grouped these specifiers to represent what I believe to be integral characteristics for identifying and conceptualizing the PAP dynamic.

Primary Symptoms Symptoms are indicators of a diagnosis as presented by the patient. This section specifically discusses depression and impulsivity in the context of specific cases mentioned in literature whereas the primary presenting symptom was later exemplified through narrative means as relating directly to dynamics similar to the PAP dynamic. The symptoms mentioned in the case literature were primarily described as experienced symptoms presented as the reason for treatment prior to a fuller narrative being conveyed to the clinician.

Often primary identified symptoms are expanded on in mental health diagnosis by narrative data. These narrative data then give clinicians a sense of magnifying factors to experienced pathology. In these discussed cases, the symptoms of depression and impulsivity are discussed as primary reasons for treatment. As more information is gained from the patient, PAPlike experiences are expressed narratively, thus expanding the relating aspects of what magnifies and impacts those symptoms.

Depression Steinberger (1989) discussed a case of a teenager with depression whose mother would utilize her as a confidante and ally in periods of parental discord. Steinberger went on to say that this caused additional strain on the teenager’s conflict with separation, especially when the conflict subsided and the teenager felt rejection and betrayal when the mother submitted to the previously vilified spouse. The conflict experienced in this case exemplifies the objectification of a child for a parent’s needs, and when the subjugation of intergenerational boundaries occurs, the child has a directly correlated magnification of depressive symptom presentation.

Impulsivity Widener (1998) discussed an attention-deficit/hyperactivity disorder, impulsive-type case of a 7-year-old boy whose mother would fluctuate between perceiving and interacting with him as if he was her mother on some occasions and as if he was her husband in others. This situation caused many conflicts for the boy and was directly followed by significant increased behavioral problems. Symptom presentations were a direct outcome of this role confusion.

Summary of Primary Symptoms Symptoms serve as indicators of a diagnosis as initially presented by the patient as a reason for seeking treatment. Depression and impulsivity appear in literature as specific cases

mentioned whereas the primary presenting symptom later was exemplified through narrative means as relating directly to dynamics similar to the PAP dynamic.

Familial Factors Familial factors, including familial experiences, function or dysfunction, parental and familial mental health history, and relationship experiences, are a significant aspect of mental health diagnosis and risk factor conceptualizations in the development of mental health disorders. The familial factors found in literature that have a direct relation and provide explanatory support to the experience of the PAP dynamic developing are single parents, marital conflict, narcissistic parents, and intergenerational boundary violation.

Single Parent As mentioned earlier, Glenwick and Mowrey (1986) discussed the PBP dynamic in the mother-run single-parent family. They found in their study that the theme of marital conflict, relational issues amongst a parent, and their desire to fulfill the void of a missing adult romantic partner are possible influences on the PAP dynamic taking a form that could lead to depressive and aggressive symptoms, sometimes even with an outcome of a suicide attempt.

Marital Conflict Laurent et al. (2008) discussed the effects of interparental conflict on child attachment and the moderating role of a parent's romantic affection. They identified numerous factors of parental relationship conflict concerning a child's attachment to each parent. Pedro et al. (2012) discussed the impact on children via parenting practices about marital satisfaction and the mediating role of coparenting behaviors.

Erel and Burman (1995) completed a meta-analytic review of the interrelatedness of marital relations and parent–child relations. Their research found validation in a spillover

hypothesis that refers to the direct transfer of mood, affect, or behavior from one setting to another and in this case from the marriage dyad to the parent–child relationship.

Buehler and Welsh (2009) examined adolescents’ emotional reactivity to their parents’ marital conflict as a mediator of the association between triangulation and adolescents internalizing problems. Buehler and Welsh found that triangulation was associated with increases in adolescents internalizing problems. Emotional reactivity and increased internalizing problems characterized youth with lower levels of hopefulness and attachment to parents. They utilized input from both parents and adolescents, which gave a more abundant source of data to evaluate.

The conflicts of being "caught in the middle" (Buehler & Welsh, 2009, p. 167) for an adolescent could lead to significant internalizing symptoms that could be broken down to specific symptoms that would include aggression and depression symptoms in adolescent clients. This study also highlighted a dynamic in which the child can be utilized as a balancing and peer factor in parental conflict, which can lead a parent to seek out a person familiar with the person in their related conflict, and they might seek a venting ear or advice from the child present in the home, thus skewing the parent role and insinuating a peer relationship to the child.

The above examples describe the ways in which marital conflict can expose risks for a PAP dynamic to evolve, specifically when there is a traumatic experience in the separation or distance from an age-appropriate confidante, the ex-intimate partner. This fosters a perfect storm for a child to be utilized in a way in which parental needs trump awareness to the conflicted parent of a child's developmental needs. Further, the conflict’s stressors serve as a blinder to that parent maintaining the role expectations of a parent.

Narcissistic Parent In his article on psychosexuality, Stolorow (1979) discussed a case in which a mother viewed her son as her confidante and labeled him a little gentleman and narcissistic extension of herself. The behaviors of the narcissistic parent using her son as a confidante and seeing him like a small adult led to disturbances of his self-esteem, which led him to seek treatment. Chase (1999) discussed the narcissistically parentified child as giving up their self-actualization for the narcissistic parent's ego ideal. Chase viewed the child's role as the parent's object who is used to living out the attempted repair of the parent's low self-esteem, deficiencies, and losses undifferentiated from the child's self.

Miller (2008) discussed the gifted child who becomes gifted as a burden of a parent's narcissistic needs, growing so profoundly attuned to meeting the parental needs and expectations that they become heightened in their intelligence of sensitivity, attunement, and awareness in another’s emotional needs. She discussed that certain aspects and developmental needs of the gifted child cease because the child cannot differentiate their true self; therefore, the child feels emotionally isolated. This type of narcissistic dynamic leads the child to develop into an adult always seeking unfulfilling validation from others. She described the lifelong risk of trauma triggers in which abandonment gets continuously aroused due to the child not receiving the needed respect, echoing, understanding, and mirroring in childhood. This dynamic is due to the need for the child to repress their childhood needs for the parental requirements of sole presence for them.

The above literature exemplifies when the narcissistic parent forms a bond of objectification and expectation fulfillment of their own self-oriented needs as opposed to the

empathic realm of reading nonverbal cues, such as gauging, relating, and connecting to the child as an independent individual with child-like needs.

Intergenerational Boundary Violation Fish et al. (1991) and Glewick and Mowrey (1986) discussed the concept of an intergenerational boundary violation or loss in family systems theory. They discussed this concept in connection to a situation in which a parent violates a fundamental tenet of their specified role. Fish et al. described the role shift as a boundary violation/enmeshment behavior that is dysfunctional. Glenwick and Mowrey discussed the intergenerational boundary loss as a blurred boundary where role expectations are ill-defined. Glenwick and Mowrey further discussed the characteristics that are included in the boundary loss as occurring in the late latency stage of the child's development, including the abdication of the mother in her parental role, and a parent–child relationship in which the mother functions as a peer/partner. McCloskey (2013) expanded the idea of intergenerational boundary violation to the intergenerational transmission of intergenerational boundary violation. They discussed the intergenerational transfer of mother–daughter risk for gender-based abuse might derive from women's compulsive caregiving and parentification during their own childhood carried forward to the next generation.

Summary of Familial Factors Familial factors serve as a significant factor in diagnosis and risk factor identification to mental health disorder development. The familial factors discussed above have a direct relation and provide explanatory support to the experience of the PAP dynamic developing.

PAP Dynamic Concurrent Factors Concurrent factors to the PAP dynamic are factors that would exist in unison to the PAP dynamic. The concurrent factors discussed below serve as a singular explanatory factor to the

parental dynamic conflicts that lie within the experienced PAP dynamic. The following factors often appear in literature, occur concurrently, and are a component of the PAP dynamic: enmeshment, suicide attempt in response to a parental relationship conflict, parentification, spousification, adultification, and role function discrepancy.

Enmeshment Enmeshment is a concept that appears in much of the literature searched concerning the PAP dynamic (Davies, 2005; Gardner, 2004; Widener, 1998; Wrye, 2007). Enmeshment relates to the crossing on the precise boundary of the parent and child dyad to the PAP dynamic.

Suicide Attempt in Response to Parental Relationship Conflict Calhoun et al. (1980), Gardner (2004), and Spirito et al. (1992) discussed the concept of suicide concerning the parent–child dyad. Calhoun et al. surveyed parents of children who completed suicide; a pertinent statistic was that 47% of the suicide cases reviewed were children from either a single parent or divorced household. Gardner discussed suicide concerning a child adapting to narcissistic parents’ needs for compliance, resulting in their enmeshment to the parent, the child repressing anger for respect to the parents’ emotional needs, and the child abdicating the child role. Gardner discussed this as possibly leading to the metaphorical or literal sacrifice of dying by the child.

Parentification Parentification’s impact on a patient’s symptomatology is discussed in numerous articles (A. Harris, 2009; Bernstein, 1999; Boszormenyi-Nagy, 1985; Boszormenyi-Nagy & Spark, 1984; Brown, 1989; Byng-Hall, 2008; Chase, 1999; Diamond et al., 1999; Friedman, 1975; GlickaufHughes & Mehlman, 1998; Goldfarb, 1956; Hanna, 1992; Haule, 1999; Howard, 2013; Jones & Wells, 1996; O’Connor, 2007; O’Loughlin, Merchant, 2012; Rendon, 1974; Robinson, 1974;

Stechler, 2003; Steele et al., 2009; T. Harris, 2007; Wurmser, 1979; Wurmser & Zients, 1982).

The common meaning of parentification and the terms of spousification, adultification, and role function discrepancy is when a child is acting in a role similar to that of a parent towards their parents. O'Connor (2007) defined parentification for the child as a role in which the child has much more power and responsibility than developmentally appropriate. A. Harris (2009) called parentification one of the most destructive aspects of flawed attachments. Rendon (1974) described parentification as role inversion within the family system; it is a lower grade mystification and exploitation of the child by the parent.

Boszormenyi-Nagy (1985) is considered an early theorist of family systems therapy, though he was trained psychodynamically. He discussed parentification as if the child is, in a sense, responsible for healing their parents and is in a position of marrying their parents. Per Boszormenyi-Nagy, the burden of the parent role falls on the child (Friedman, 1975). The therapeutic task of family therapy in the parentified situation is to free the child from their adult role of needing to heal their parents and allowing them to be kids again (Boszormenyi-Nagy, 1985). Brown (1989) discussed the struggle of the parentified child as grappling with the roles of caretaker and care-receiver, in all relationships, due to the loss of typical reciprocity evolving in the give and take that is normalized in most relations but runs on a deficit in a parentified rolemodeled childhood.

Byng-Hall (2008) postulated the parentified child evolves from inadequate or absent parenting, developing a "little parent." The experience may also become destructive to children in several ways. The destructive experiences include the loss of childhood. As the children are unable to fulfill the parental role adequately, they can develop low self-esteem, depression, and other symptoms.

Diamond et al. (1999) discussed a case example describing symptoms concerning the patient's relationship with his father. The father was described as distant, inadequate, cruel, and more like a peer. The patient worried about the parent more like a parent would worry about their child. In the case discussion, this was characterized as role-reversal, or caretaking of the impaired erratic parents (Diamond et al., 1999). Glickauf-Hughes and Mehlman (1998) discussed parentification in situations when adolescents are assigned roles and responsibilities typical in the province of adults in a given culture that has been abdicated by their parents, leading to a higher level of maturity in the adolescent, more control of their lives, and meeting dependency needs vicariously. Glickauf-Hughes et al. further discussed the symptomology related to parentification in adolescents with borderline parents as relating to anxious attachment and fear of emulating the borderline mother’s negative characteristics.

Hanna (1992) discussed a patient whose father's parentification took the form of abusing her sexually. This abuse created a patient who presented with a false self and had to dissociate from her own needs to comply with her parent's requirements (Hanna, 1992). The patient experienced hopelessness, despair, and disillusionment at not having her primary needs met by her parents (Hanna, 1992). The patient discussed how she shut down internally to cope with the overstimulation associated with her father’s sexual attacks; she also closed herself off to bury the overwhelming rage she experienced in realizing her father was using her to tend to his own needs without any regard for the impact on his daughter (Hanna, 1992).

Jones and Wells (1996) posited that parentification can predict three sets of negative personality characteristics: masochistic or self-defeating, overt narcissistic features, and compulsivity. They stressed the importance in therapy of working with the whole family along with individual treatment to put the parent back in charge of caretaking and limit setting

functions (Jones & Wells, 1996). Mayseless and Scharf (2009) studied a sample of parentified Israeli adolescent females and discussed the shift that becomes symptomatic when a parent subjugates their role from the expected role of protector, comfort provider, and as a guide to a child’s separateness. Symptoms that can arise in these parentified adolescents were shown as transitional issues including panic and rumination, emotional regulatory dysfunction, overdependent personality type, lower levels of identified self-esteem, and lower levels of exemplification of self-efficacy.

Wurmser and Zients (1982) discussed one of four types of families that fall into patterns of drug abuse as having externalization and intrusiveness defenses as their prominent feature.

These families see a false identity and pervasive shame in their children. The children are abused for the parent's grandiose expectations and disregard for the child's age-appropriate needs (Wurmser & Zients, 1982). The pattern of relating in these families includes the crossing of intergenerational boundaries, the parentification of the child, and the sexualization of the parent– child relationship (Wurmser & Zients, 1982).

Spousification Spousification is a more infrequently used term that relates to parentification. It was discussed concerning role confusion issues by Fisher et al. (2011) and in regard to incest and confiding in a child by Cortina (1999). Cortina discussed incest situations specifically with a stepfather, when the stepfather tells their daughter stories of sexual liaisons, or when the stepfather seeks comfort in the daughter after having argued with their wives as situations of spousification.

Adultification Adultification is a lesser-used term similar to parentification and spousification that was discussed by Burton (2007) and Miller (1994). Miller (1994) discussed adultification as a symptom of a narcissistic parent.

Role Function Discrepancy Satir (1983), a founding therapist of the family systems theory of practice, discussed role function discrepancy as to when a son becomes the head of the family or when the daughter assumes the mother role. She stated that the child in this condition usually ends up with all of the responsibilities and none of the privileges of the new position, and in taking on this role, the child leaves behind the old position. She described the impact on the child as a very lonely and unsure place for the child to be (Satir, 1983).

Bavolek (1984) developed an assessment for abusive parenting called the AAPI. The AAPI inventory consists of five developed constructs that are categorized as aspects of measuring common abusive parenting behaviors. The fourth construct of the assessment, Construct D, evaluates parent–child role reversal. The child's role in the cases of role reversal is described as the expectation that the child is sensitive to the parent's needs as opposed to the normalized reverse; parents become the helpless, needy child in the dynamic; the parent is incapable of empathically meeting the child's needs; and the parent gives the decisive role of major familial decisions to the child. This fosters a failure for the child to reach developmental tasks, reinforces feelings of inadequacy in the child, negatively impacts the child's sense of self, and develops in the child a sense of purpose to solely meet their parent’s needs (Bavolek, 1984).

Summary of PAP Dynamic Concurrent Factors The concurrent factors discussed above are factors that would exist in unison to the PAP dynamic and serve as a singular explanatory factor to the parental dynamic conflicts that lie within the experienced PAP dynamic.

Theoretical Framework In the beginnings of psychoanalysis, Freud (1905, 1909) addressed the core issues of the PAP dynamic in passing, leaving a possible core component of the etiology of symptoms as a passing thought that he felt needed to be mentioned, but not as a core tenet of his aforementioned cases. In much of the later literature, this theme continued and ceased when Glenwick and Mowrey (1986) identified a similar theme to the PAP dynamic of parents becoming peer-like.

Mitchell’s (2013) proposed theory places an addendum to Freud’s theory of a parental vertical axis that represents parenting experiences and their impact on pathology by adding a horizontal axis that discusses a sibling impact. Mitchell called this a fraternal horizontal that represents how sibling relationships relate to significant patient dynamics and pathology development. She suggested the importance of sibling trauma appearing on this horizontal axis to conceptualize familial typifications of trauma. I intended to expand on Mitchell’s proposed axis and bridge the crossing of these two axes (see Figure 1).

Figure 1 Title

Mitchell’s Horizontal

Freud’s Vertical

Sokal- where the parental vertical and sibling horizontal cross.

The primary theoretical literature obtained was found in past and present-day psychoanalytic literature, nonlinear dynamic systems theory literature, and family systems theory literature where many of the authors were primarily influenced and trained psychodynamically including the authors Boszormenyi-Nagy (1985) and Satir (1983). The identification of the headings began with early roots of theoretical grounding for the PAP dynamic in Freud’s cases, which then led me to identify and categorize the literature further into the framework of PAP dynamic specifiers, symptoms, familial factors, and concurrent PAP dynamic factors.

The literature was evaluated via numerous search terms that relate to the PAP dynamic.

The synthesis of the categorical headings was in direct correlation to answering what is known in

the literature in regard to my specific research questions. The following research questions guided this study: 1. How do adolescent psychotherapy patients who identify as having a PAP dynamic relationship with their biological parent describe their experiences with that parent?

2. How does the PAP dynamic relate to the adolescent in psychotherapy and their presenting symptoms?

Conclusion The PAP dynamic leads to role confusion for the adolescent. The literature addresses significant themes, similarities, and patterns that arise related to the PAP dynamic and related conflicted dynamics that influence mental health symptoms. The idea of a parent as a peer goes back to early cases of Freud. The PAP concept is built on by looking at how the parental role can shift to fulfill a single mother’s or other parental figure’s need for an adult partner, thus transforming the parent–child roles to peer-to-peer or adult-to-adult roles. Numerous psychodynamic pieces of literature exemplified the PAP dynamic as the parent utilizing the child as a confidante. Parallels were found relating the period of adolescence to increased risk for a suicide attempt and the parent–child risk for role blurring to occur. The symptoms of depression and impulsivity were discussed in connection to the adolescent at risk for suicide and with a PAP dynamic occurring. Factors of parental function and couple relational discord were evaluated as motivating influences for a parent–child relationship role shift to occur in the dyad of a parent and child. Enmeshment, as a common theme and secondary descriptor to the concept of confidante, was presented concerning the PAP dynamic. Parentification, spousification, adultification, and role function discrepancy were discussed in relation to the confusion that a

shift in a parental role causes an adolescent, as well as how this type of parental role can influence and develop symptomology in an adolescent.

Gaps in the literature include a specific evaluation of the PAP dynamic in parallel to symptomatology. Further integration and relational understanding of the themes of the child as a confidante, PBP, and parental conflict could lead to more knowledge about how adolescents experience their PAP relationships and how this dynamic might relate to their etiology of symptoms. Further understanding of these connections could influence future therapeutic interventions and family therapy interventions with adolescent patients who identify the PAP dynamic.

Chapter 3 Methods Introduction The purpose of this phenomenological study was to understand the experience of the PAP dynamic for adolescents who have attended psychotherapy. The PAP dynamic is defined as a symptom-related peer-like relationship with a parent. This phenomenological study examined adolescents in psychotherapeutic treatment who describe their relationship with their parent as a best friend, peer, confidante, or good buddy. These types of statements often reveal a conflicted, exploitive, and inconsistent parent–child relational dynamic. This study intended to gain insight into the experience of adolescents in psychotherapeutic treatment with an identified PAP dynamic, how this dynamic relates to their relationship with their parents, and how this dynamic relates to their presenting symptomatology.

The experiences of adolescents who experience a PAP dynamic in their relationships with a parent were the primary focus of this study. This phenomenological study intended to report their narrative of this experience and gain insight into the commonalities, themes, and significant patterns that arose. The following two primary research questions guided this study: 1. How do adolescent psychotherapy patients who identify as having a PAP dynamic relationship with their biological parent describe their experiences with that parent?

2. How does the PAP dynamic relate to the adolescent in psychotherapy and their presenting symptoms?

The Rationale for Qualitative and Phenomenological Research Design Van Manen (1990) discussed phenomenology as aimed at gaining a deeper understanding of the nature or meaning of our daily experiences. It also seeks to answer the question of

another's experience. Van Manen further discussed phenomenology in how it differs from other sciences in that its purpose is to gain insightful descriptions of the way people experience the world prereflectively, without taxonomizing, classifying, or abstracting the information. It is not meant to offer the possibility of useful theory, but rather the chance of plausible insights that bring us in more direct contact with the world (Van Manen, 1990). Gergen (1999) discussed phenomenological research as placing the client's experience center-most. Gergen further explained that the study involves a deep valuing of the knowledge of the other.

This research used Smith et al.’s (2009) interpretative phenomenological analysis (IPA) method of data conceptualization and interpretation. Smith et al. discussed IPA as a qualitative research approach committed to the examination of how people make sense of their significant life experiences and that it is phenomenological in that it is concerned with exploring expertise in its terms. IPA attempts to understand other people's relationship to the world as necessarily interpretive and focuses on the person's attempt to make meanings out of their activities and the things happening to them (Smith et al., 2009).

Rationale for a Specific Methodology The IPA, as developed by Smith et al. (2009), was used for this research due to the comprehensive guidance it provides in the collecting, interpreting, and analysis of data. The IPA method (Smith et al., 2009) provides structure and insight into the step-by-step process of developing an interview and choosing questions that refrain from being over-empathic, manipulative, leading, and closed whilst focusing on the types of items that are descriptive, narrative, structural, contrasting, evaluative, circular, and comparative, with prompting and probing questions, to increase the narrative descriptions.

IPA (Smith et al., 2009) also provides guidance on how in-depth interviews can be structured to tie in with one's research question, how to schedule a series of in-depth interviews, language use in interview question development, as well as support in the preparation of conducting the interviews, the rhythm of the interviews, and contextualizing the extra data in the interviews. IPA (Smith et al., 2009) also provides a comprehensive step-by-step process of data analysis that is further discussed later in the data analysis section of this chapter. The IPA process of data analysis includes six steps: reading and rereading (to immerse the researcher in the data), initial noting (examining semantic content and language to use on an exploratory level), the development of emergent themes (utilizing the transcript and initial notes), searching for connections across the emergent themes (via one or more of the methods, which include abstraction, subsumption, polarization, contextualization, numeration, and function), moving to the next case (repeating the previous steps for the rest of the cases), and looking for patterns amongst the cases (Smith et al., 2009).

Research Sample The criteria for participation in this study were adolescent patients who have had or are currently in psychotherapeutic treatment who also define having biological parents whom the adolescent patients described as a best friend, peer, confidante, or good buddy. These criteria were determined via a referring therapist's clinical experience of the patient shown by their referral of the current or former patient to the study or by the participant themselves. The PAP phrasing was used to relay this dynamic. The age of adolescence in this study was defined as ages 18–22. The age range was chosen as a section of adolescence in which participants can consent to participation on their own accord. The parent is a biologically related parent to the adolescent. Psychotherapeutic treatment must have occurred at least weekly in a mental health

therapy clinic or private practice setting for a period of over 6 months under the care of a licensed mental health therapist (e.g., psychiatrists, psychologists, doctorates, licensed professional counselors, marriage and family therapists, and master's-level social workers). The adolescent must have discussed the PAP dynamic to their therapist in psychotherapeutic treatment.

The planned sample size aimed to total five participants (N = 5) with a mix of male and female participants with different ethnic and cultural identifiers. The balance between male and female as well as ethnic and cultural identifiers depended on available participants. The sample size was chosen due to the need for a strong narrative of the PAP dynamic with adolescents with a stratification representative of the general population (race, gender, class, cultural, and ethnic identifiers). The sample size also accounted for attrition of possible participants who decide not to complete the full interview process.

Information Needed The participants in this research had their basic demographics obtained before participation. They were required to be between the ages of 18–22. The parent must be a biologically related parent to the adolescent. Psychotherapeutic treatment must have occurred at least weekly in a mental health therapy clinic or private practice setting under the care of a licensed mental health therapist (e.g., psychiatrists, psychologists, doctorates, licensed professional counselors, marriage and family therapists, and master's-level social workers).

Research Plan or Process These interviews were conducted over the 2020–2021 academic year. Implementation of the research plan included the following steps:

1. An email was sent to colleagues and numerous listservs of psychotherapists about this study requesting participants who fit the study criteria. A message was also posted in psychotherapy Facebook groups and Linkedin to advertise a request for participants for the study. The message included the title, purpose of the study, and sample criteria (parent reverses family roles; tends to use children to meet self-needs. Children perceived as objects for adult gratification tends to treat children as confidantes and peers, expects children to make life better by providing love, assurance, and comfort tends to exhibit low self-esteem, poor self-awareness, and miserable social life (Bavolek, 1984).

2. Information about the study was passed along to other psychotherapists or individuals who fit the study criteria. The message also included my contact information and a deadline for expressing interest in the study. Refer to Appendix D for a sample email and Facebook post.

3. The first point of contact was participants contacting me directly via email or phone.

Potential subjects who expressed interest in participating in the study received a response from me using the same mode of communication initiated by the likely subject (via telephone or email) to schedule an initial phone consultation to discuss the research and to vet possible subjects. The potential subject received a response from me within 48 hours upon receipt of notification that the subject was interested in participating in the study. My response followed the phone script to discuss the research and vetting questions (see Appendix C).

4. Upon receipt of the subjects' availability and preferred location/media, I confirmed the individual interviews. I offered an alternate date and time if there was a scheduling conflict.

5. The initial interview contained the questions in the interview guide (refer to Appendix A).

6. I met the subject on the confirmed dates and times for the interviews on the Health Insurance Portability and Accountability Act-compliant online telemedicine platform called Doxy.me, or via an interviewee-preferred method, including in-person, facetime, or Skype. I waited for no longer than 15 minutes at the preferred meeting location/media on the confirmed date. If the subject did not arrive, one telephone attempt was made to reach the subject before I left the preferred location or signed off of the preferred media used for contact. If the attempt was unsuccessful, no further efforts were made as I assumed the subject was no longer interested in the study. The preferred or ideal method of interviewing occurred via Health Insurance Portability and Accountability Actcompliant Doxy.me due to its encryption and favorite media by the participant will be considered including face to face, skype, phone, & Facetime.

7. As the principal investigator, I conducted the interviews. Participants were asked to provide a pseudonym for me to use in the study at the beginning of the first interview.

The responses were summarized to ensure accuracy, and participants were provided an opportunity to ask any questions or provide clarification of their responses. I conducted two to three interviews. The purpose of more than one interview was to provide extra time if needed to answer all questions thoroughly.

8. After each interview, I entered research notes into a journal and audio-recorded any reflections about the interview. I used my notes and observations to modify interview guides or improve the interview process.

9. After each interview, the audio recording was transcribed. The transcribed interview data were not analyzed until all interviews were conducted, transcribed, and reviewed.

10. After the final interview for each participant, the transcribed series of interviews was analyzed via the IPA method (Smith et al., 2009). Transcripts were read and reread numerous times to immerse myself in the data, and my ongoing reactions were also notated throughout this process. After the rereading process, the initial notation occurred.

This notation entailed notating descriptive comments and summarizing the interviews’ content. Linguistic comments were then notated, including specific descriptive and experiential language usage by the participants. Conceptual comments were then notated that focused on evaluating the transcriptions from a conceptual level.

11. Further analysis included notating via computer spreadsheets the developing emergent themes that began to arise in each interview as well as possible connections across those emergent themes. Patterns amongst emergent themes were evaluated via abstraction, subsumption, polarization, contextualization, numeration, and function. Patterns were then sought across all participants’ interview series.

Changes in How Sample Was Obtained The sample had numerous changes that were made in collaboration with my dissertation chair. The two primary changes were that two participants were above the age of 21 (they were newly aged 22). For the sake of obtaining more data, the decision was made to include their interviews in the study. The second change was in how participants were obtained. Email listservs did not culminate in any participant referrals, so LinkedIn and an academic vetting research participant site were utilized to obtain participants. The sample was obtained via two means. The first three participants were obtained via a LinkedIn flyer that was shared by fellow

clinicians. The remaining three participants were obtained via a research support site called User Interviews. The LinkedIn participants were screened via phone and email to determine that they met the criteria. The participants obtained via User Interviews met the criteria via a screening tool on the site. Two participants had recently turned 22 by the time of the interviews but I was granted permission by my dissertation chair to include them in the study to expand the data set and due to their being in close range to the age requirement.

Data Collection AAPI-2 The PAP cases were identified by the referring psychotherapists using specific questions from the subscale (Construct D, role reversal) from a valid and reliable assessment called the AAPI-2. The language from the AAPI-2 questions was only used to help practitioners identify role reversal. The assessment was not performed, but its specific questions served as a guide map for the identification of possible participants to be interviewed in the study. The AAPI-2 was developed to assist professionals in assessing parent child-rearing attitudes of adolescents and adults. The results of the assessment indicate degrees of agreement and disagreement of maladaptive parental behaviors, including parent–child role reversal that is identified in the assessment as a factor found in abusive parenting. The results also provide an index of risk of abusive and neglectful parenting (high, medium, low). The subscale Construct D was found to be valid and reliable individually from the other constructs of the assessment, thus maintaining its validity and reliability separate from the rest of the constructs in the assessment (Bavolek & Keene, 2010). The questions from Construct D were integrated into emails, postings, and calls seeking referring providers and the possible participants.

Interview Guide The interview questions (Appendix B) were developed to be semistructured and take place as individual interviews. The questions were developed with the feedback of a doctoratelevel qualitative social work researcher. Data were collected via one to three semistructured interviews between me and individual participants in an audio recorded MPEG digital format.

Participants were given a $10 gift card for their participation. The card was presented at the beginning of the interviews. Data were also collected via field notes of my experience and observations from before, during, and after the interviews.

The interviews were transcribed verbatim by a transcription service and put into Microsoft Word format. Data were analyzed via notetaking and notebook coding. The transcripts were reviewed and coded in a notebook to define themes that arose from the interviews. Themes were then identified. Field notes were also evaluated. Field notes were evaluated concerning the themes that were discovered in the coding process and related to my affective experience of the interview process.

Field Notes Field notes were evaluated in relation to the themes that were discovered in the coding process and were related to my affective experience of the interview process as well as a reflection of my perceptions, conceptions, and procedures as discussed in the IPA method (Smith et al., 1990). The field notes contained my observations and affective experiences before, during, and after the interviews. The field notes were especially helpful in understanding the dynamics of each participant’s transferential aspects of their described lived experience. The observations found in the field notes also added to my affective insight into the PAP experience of the adolescents interviewed.

Data Analysis This section reviews the methods used for data analysis, information obtained from field notes, my approach to data representation, and how the findings were achieved. Interviews were audio recorded in an MPEG digital format. Data were collected via field notes of my experience and observations from before, during, and after the interviews.

The interviews were transcribed verbatim by a transcription service and put into Microsoft Word format. Data were then analyzed via the IPA method (Smith et al., 2009), which comprehensively included the following: (a) the close line-by-line reading of the experiential claims, concerns, and understandings of each participant; (b) the identification of emergent patterns and themes within this experiential material, emphasizing convergence and divergence, commonality, and nuance, first for single cases, then subsequently across multiple instances; (c) the development of dialogue between myself, the coded data, and my psychological knowledge about what it might mean for participants to have these concerns, which led to the development of a more interpretive account; (d) the development of a structure, frame, or gestalt, which illustrated the relationships between themes; (e) the organization of this material, which is in a format that allows for analyzed data to be traced through the process, from initial comments on the transcript, through initial clustering and thematic development, into the final structure of themes; (f) supervision, collaboration, or audit, which was used to help test and develop the coherence and plausibility of the interpretation; (g) the development of a full narrative evidenced by a detailed commentary on data extracts, which takes the reader through this interpretation, usually theme by theme, and is often supported by some form of visual guide (a simple structure, diagram, or table); and (h) a reflection of one's own perceptions, conceptions, and processes (Smith et al., 2009, p. 79–80).

The results include the themes that emerged from the raw data and the supporting quotes.

Findings follow the results section. Findings are broader ideas that emerge from the themes and which are explored from the theoretical perspective. In the discussion section, the implications of the discovered themes are further discussed regarding the clinical aspects of the findings’ contributions to the field of psychotherapy.

Ethical Considerations The Institute for Clinical Social Work evaluated and granted me permission to begin the study and guaranteed that professional and ethical safeguards would be met to protect the human subjects of this study. IRB approval was obtained before the start of this research. Cultural sensitivity was evaluated throughout the entire research process via field note evaluation and patient cultural identifications obtained in the original demographics from the initial consultation with participants. Informed consent (Appendix A) was collected from all participants as well as a discussion of risks and concerns with participating in this study. Participants had permission to withdraw at any time as well as protect their confidentiality and personal information.

Confidential and personal data were protected via password protection, stored in a locked file, and documented via nonidentifiable pseudonyms.

Risks to participants may have consisted of the flooding of memories that may have been stressful and revisiting perceived therapeutically resolved material that might have led to a need for further therapeutic debriefing and insight through continued or visited psychotherapeutic treatment. Benefits to participants may have included adding to the context of data surrounding this topic; a means of celebrating (via normalization and shared experience with others) and discussing development, growth, and insight through their previous psychotherapeutic

experiences; and the ability to share their narrative in a way that influences future theoretical and clinical underpinnings of how the PAP dynamic affects symptomatology.

Issues of Trustworthiness Validity, dependability, transferability, and reliability issues were addressed by developing research questions to derive the obtained data. The interview questions were designed to relate to the research question. Recording the interviews allowed for a verbatim account of the participants answers to the questions. Field notes and recorded observations allowed transferential and affective elements of the interview process to be documented and become part of the data analysis. During the interview process, allowing new questions to arise and time for segues by the participants’ dialogue exposed a more narrative and productive discussion of their experience of the PAP dynamic.

Creswell (2014) discussed numerous techniques of validity. The following techniques were used in this study: using rich/thick description to transport readers into the setting and give the element of shared experience, presenting negative or discrepant information (discussing contrary information obtained in the interviews to add credibility to the numerous accounts of the PAP experience), and using a peer debriefing so that the statement resonates with people other than the researcher. Bloomberg and Volpe (2012) discussed interchanging the credibility and dependability of the term instead of validity and reliability. This study utilized aspects of Bloomberg and Volpe's likelihood via identifying my biases using field notes and journaling to track my bias and reactions during the entirety of the research process, again utilizing a peer debriefing as Creswell discussed, and dependability was exemplified via audit trails (providing detailed and thorough explanations of how data were collected and analyzed).

Limitations and Delimitations Bloomberg and Volpe (2012) discussed the limitations of a study as consisting of conditions that weaken the study. In this study, these limitations may have included the validity and transferability issues that were vulnerable due to the possibility of small sample size, my bias on the topic, and my possible difficulty in taking an interviewer stance versus a therapeutic stance during the process of interviewing. Bloomberg and Volpe discussed examining delimitations as clarifying the boundaries of the study. This was achieved via my significant indications of the focus of the research scope and the problem (PAP dynamic), time, and location of the study (context of interviews and audit trailing).

My Role and Background The theoretical sensitivities I bring to this study are the values and experiences of a psychodynamically oriented therapist who works with both parents and children and direct observation on how the identified parenting role or PAP dynamic plays out for adolescent clients in psychotherapy. I have many male clients with aggression symptoms who identify their parents as peers. These parents often side with their child after impulsive and aggressive incidents and stand up for them as opposed to influencing them to learn from their mistakes. I also work with many depressed female patients who define their parents as peers. These parents often utilize their children as a confidante to disclose and vent about their troubles.

I also bring my own cultural and religious experiences, as well as my perceptions of how my parents raised me and how my grandparents interacted with their children and grandchildren.

As a parent of three, I am also conscious of the ongoing struggle to be an ideal parent and being supportive, connected, and caring while maintaining appropriate and realistic role boundaries in the parent–child dyad. I once had a patient whose second suicide attempt was enacted to induce a

maternal role to shift the present PAP dynamic. She stated that when she verbalized thoughts about suicide after her first attempt, her mother moved from a peer to a parent. She talked about admitting suicidal ideation to her mom, who would then drop everything, take her to the emergency room, and then caress her daughter’s hair and hold her hand for hours while awaiting a psychiatric evaluation. My patient reported that on these occasions, “It was nice to have a mother again.”

The patient experience found above inspired me to run a small two-participant pilot study on the PAP dynamic. The participants were psychotherapy patients referred to me to participate from clinician colleagues aware of my research interest. Four themes emerged from the data analysis in the pilot study regarding repetitive aspects that both participants had in their descriptions of their PAP experience. The themes were symptoms and their relation to the PAP dynamic, parental conflict impacting the adolescent, the ideal parent/parent failures, and parentification.

Theme One: Symptoms and Their Relation to the PAP Dynamic The first theme discussed each participant's experience of how their symptoms related to the PAP dynamic with their biological parent. The 16-year-old female patient began attending therapy for depression after a significant suicide attempt. She discussed her depression in response to the ending of the best-friend-like interactions with her mother. The 17-year-old male participant started attending therapy for social anxiety issues and discussed his father's adolescent and buddy-like interactions with him in parallel to his social anxieties.

Theme Two: Parental Conflict Impacting the Adolescent The second theme discussed each participant’s experience of their PAP parent’s internal and external conflicts impacting their lives and the outcome of negative feeling states of security

and well-being. The first participant discussed that her mother’s anxiety of driving made it so she could not participate in her lacrosse games and that her mother often did not take her to therapy or doctor's appointments unless she could find alternative rides, so she missed important events and appointments. She discussed being discharged from her psychotherapy treatment due to her mother's inability to regularly get her to appointments. The second participant discussed his father's alcoholism and failure to function and maintain his own home due to his money issues.

Theme Three: The Ideal Parent/Parental Failures The third theme discussed related to each participant's answer to a question about their ideal parent. The participants were asked to describe their perfect parent. Once they declared the qualities of an ideal parent, the conversation quickly shifted to the opposite of their perception of an ideal parent. The participants spent more time discussing their parents’ failures impacting the participants’ lives than the ideal attributes that were asked.

Theme Four: Parentification The fourth theme discussed related to each participant’s discussion of their parentified role in their relationship to their identified PAP parent. The first participant described her confusion at the role reversal of her giving relationship advice to her mother as a child who never had a significant romantic relationship. The second participant discussed role-reversal conflicts with his father surrounding grocery shopping and finances. He explained his need to act more parent-like to an adolescent (as opposed to a son-to-father communication) when his father only wanted to go shopping to look at attractive girls and spend money he did not have.

The results of the pilot study offered insight into the implications into how the etiology of symptoms of an adolescent can relate to their psychological perceptions of their caregivers.

Evaluation of the PAP dynamic in the pilot study exposed the importance of the PAP dynamic’s

relation to the way symptoms and behaviors related to how parental relationships are experienced and played out among adolescents. Through the extension of the data in this current study, I expected that new themes and similarities might emerge and that these pilot study themes may possibly be built on with a much greater breadth of other and new themes due to a broader data set of the experiential narratives that were obtained.

Summary The purpose of this phenomenological study was to understand the experience of the PAP dynamic for adolescents who have attended psychotherapy. This study intended to gain insight into the background of adolescents in psychotherapeutic treatment with an identified PAP dynamic, how this dynamic relates to their relationship with their parents, and how this dynamic relates to their presenting symptomatology.

Chapter 4 Introduction to Results The participants of this study were six late adolescents aged 18–22 years old who defined a parent as a best friend, peer, confidante, or good buddy. All participants were Caucasian. Two participants identified familial financial issues. Recruitment was open to volunteers who met the criteria and expressed a desire to share their narrative on the experience of their relationships to the identified parent. All interviewed participants engaged in a screening questionnaire online and virtual video interviews online. There was a total of six participants (N = 6) and twelve interviews. This chapter introduces the six participants in the study and presents the data obtained via the IPA process of data analysis by discussing the emergent themes and connected emergent themes that were discovered during the data analysis process.

Overview of Methods The IPA process of data analysis included six steps: reading and rereading (to immerse myself in the data), initial noting (examining semantic content and language to use on an exploratory level), the development of emergent themes (utilizing the transcript and initial notes), searching for connections across the emergent themes (via one or more of the methods, which include abstraction, subsumption, polarization, contextualization, numeration, and function), moving to the next case (repeating the previous steps for the rest of the cases), and looking for patterns amongst the cases (Smith et al., 2009).

Reintroduction of Purpose Statement The purpose of this phenomenological study was to understand the experience of the PAP dynamic for adolescents who have attended psychotherapy. The PAP dynamic is defined as a child’s symptom-related peer-like relationship with a parent. This phenomenological study

examined adolescents, aged 18–22, in psychotherapeutic treatment who describe their relationship with their parent as a best friend, peer, confidante, or good buddy. These types of descriptions often reveal a conflicted, exploitive, and inconsistent parent–child relational dynamic. This study intended to gain insight into the experience of adolescents in psychotherapeutic treatment with an identified PAP dynamic, how this dynamic relates to their relationship with their parents, and how this dynamic relates to their presenting symptomatology.

Reintroduction of Research Questions The experiences of adolescents who experience a PAP dynamic in their relationships with a parent were the primary focus of this study. This phenomenological study intended to report their narrative of this experience and gain insight into the commonalities, themes, and significant patterns that arose. The two following primary research questions guided this study: 1. How do adolescent psychotherapy patients who identify as having a PAP dynamic relationship with their biological parent describe their experiences with that parent?

2. How does the PAP dynamic relate to the adolescent in psychotherapy and their presenting symptoms?

Changes in How Sample Was Obtained The sample had numerous changes that were made in collaboration with my dissertation chair. The two primary changes were that two participants were above the age of 21 (they were newly aged 22). For the sake of obtaining more data, the decision was made to include their interviews in the study. The second change was in how participants were obtained. Email listservs did not culminate in any participant referrals, so LinkedIn and an academic vetting research participant site were utilized to obtain participants. The sample was obtained via two means. The first three participants were obtained via a LinkedIn flyer that was shared by fellow

clinicians. The remaining three participants were obtained via a research support site called User Interviews. The LinkedIn participants were screened via phone and email to determine that they met the criteria. The participants obtained via User Interviews met the criteria via a screening tool on the site. Two participants had recently turned 22 at the time of the interviews and I was granted permission by my dissertation chair to include them in the study to expand the data set and due to their being in close range to the age requirement. Table 1 presents a summary of the participants.

Table 1 Summary of Participants Pseudonym

Age

Gender

PAP parent identified

Supplemental data

Allana

19

Nonbinary

Father

Parents suffer from alcoholism, frequent home conflict, home during pandemic.

Emilee

21

Female

Mother

Parents separated, mother had separated parents, her mother’s father died when she was a child.

Anya

20

Female

Mother

Parents divorced.

Mark

22

Male

Mother

Parents both recovering alcoholics, parents divorced.

Ron

22

Male

Father

Parents divorced, father has bipolar disorder.

Allie

19

Female

Mother

Healthy examples of PAP dynamic, home during pandemic.

Participant Summaries Participant summaries for all six participants are provided here in order to give a narrative perspective into their individual experiences of the PAP dynamic. Further, the intent of

this set of individual introductions is to establish the complexity of each participant's individual narrative to heighten the sense of each singularly lived experience as they connect in the emergence of the organized themes.

Allana Allana is a 19-year-old nonbinary college student studying journalism primarily living at college and was temporarily at home due to the pandemic. Growing up, their father worked a 9to-5 job and their mother was a stay-at-home mom who homeschooled her children. They are the middle child of three siblings. They described their father as a “puppy,” and he was their best friend growing up. They would hang out, play guitar together, and watch movies for hours when Allana was young and when they visited home. They also described both parents as alcoholics and that they are put in the position of mediating their conflicts late into their frequent nights of drinking. Allana also described common experiences of parental conflict due to their father being “casual” with his kids and their mom feeling disproportionality put in a parental position. They described that their father was primarily in the position of being the peer, whereas their mother acted like the adult.

Emilee Emilee is a 21-year-old female college student studying political science living with roommates near her college campus. Her parents were never married and separated when she was young. She rarely interacts with her father and sees him twice a year. Her mother is a fulltime teacher and the parent she described as her close friend and confidante who she talks with numerous times per day. She has two siblings and is the oldest child in her family. She described parental experiences with her mother that were healthy and supportive and full of healthy role modeling. She also described feeling in between the role of a child and adult when it came to her

familial role. She described that while living at college, she uses her earnings to pay some family bills at her mother’s house and when home, she took on the role of taking care of her siblings more like a parent than a babysitter. One of the examples she gave was that she had to set up the internet and cover the cost of it for her mother and siblings. She expressed that she had to tackle this cost because her mother did not have internet when her siblings needed to do school virtually during the pandemic.

Anya Anya is a 20-year-old female living with a roommate off campus near her undergraduate college. She is studying to become a psychologist, following in her mother’s footsteps. Her parents separated when she was in high school due to her father’s infidelity. She has a younger sibling in high school. She described her mother as her best friend and that sometimes she feels as if she is her mother’s confidante. She discussed that after her parents split up, and through her mom’s future relationships, she became her mother’s shoulder to cry on and must act in the role of her mother’s primary support in times of relational distress. Sometimes this took entire days of Anya being available to focus solely on being present for and soothing her mother. Through the years, she said she had to develop limits on her mom utilizing her to vent about relationship conflict and stress and that at times it felt as if her mother wanted her to take her side against her father, which impacted her closeness to her father soon after her parents’ divorce.

Mark Mark is a 22-year-old male living with two roommates in off-campus housing at his undergraduate school majoring in global studies. His parents separated when he was young and are both recovering alcoholics. He has also struggled with alcoholism and is involved in alcoholics anonymous and has been in inpatient rehab. He described his mother as his confidante

and that he would overshare his personal life with her and her with him, historically. He also described that she was very jealous of her ex-husband’s closeness with him and that he often felt he had to soothe his mother’s anxiety and jealousy to not make her not feel second rate. He also described his mother’s and his own parallel with the guilt and shame of alcoholism impacting their ability to hold their specific roles and that he is currently building on being a good son. He shared that he felt he was historically a degenerate who primarily activated anxiety in his mother.

He also described a peer-like component in his relationship with his mother because they have had parallel recovery timelines and that has, at times, shifted her parental interactions with him to more of a shallow mother-to-son transactional experience based on economic and situational mandates, rather than an emotionally deep connection based on a more ideal mother-to-son relationship.

Ron Ron is a 22-year-old male living alone in an apartment working as a barista. His parents divorced when he was in elementary school. He described his father as his off-and-on best friend and that he suffered from bipolar disorder. He said his father is very much a child and that he often was put in the position of being his caretaker when he was with him. He would clean his father’s house, pay his bills, and get his brother off to school during middle school while his father slept in. He also said his father would spend a lot of time smoking pot, giving him alcohol, jamming with him and his friends, and talking inappropriately about Ron’s girlfriends while he was growing up, way before any of those things were considered age appropriate. Most recently, Ron’s father lived with him. Ron got him a job, paid his father’s bills, and covered his portion of the rent due to his bad financial decision making. Ron also cooked for him, cleaned up after him,

and when he started setting limits on him, his father became physically violent. Ron had to kick him out and call the police on him.

Allie Allie is a 19-year-old who lives at home temporarily with her parents while her school is meeting virtually due to the pandemic. She usually lives in a dorm at her undergraduate college where she is a liberal arts major. She described her mother as her best friend and confidante and that, at the same time, she feels her mother’s maternal role is very strong and consistent. She described their conversations as very close and full of comfortable chats over coffee and the possibility for Allie to feel like she can be her true self around her. There were some experiences of her mother’s anxiety causing her some distress, but those were more bound in Allie not maintaining familiar patterns of interaction when she was at school. Examples include Allie not replying for hours when she received a text from her mother while she was sleeping in, lost in schoolwork, or hanging out with her friends on campus. She also experienced anxiety when her mother had a cold and she had to take on the role of caretaker to her mom. She found it very overwhelming because the roles had shifted; it was a temporary experience of being parentified towards her mother.

Results What follows is a presentation of the themes that evolved from the participant interviews.

The first 10 themes related to Research Question 1 are 1) the lived experience of the PAP dynamic, 2) the intrusion or expectation of access to external relationships, 3) the PAP evolved tension in the dynamic, 4) PAP dynamic declarative experiences, 5) child as caregiver, 6) child as confidante, 7) ideal best friend identification, 8) ideal parent identification, 9) child’s experienced role in their family, and 10) healthy identifications of the PAP dynamic. The final

two themes are related to Research Question 2: 11) the participants' reason for therapy, and 12) the child’s expected soothing response, and narcissism in the soothing response need of the PAPidentified parent. Themes 1 and 11 are titled master themes because they are considered a group experiential theme in IPA. Themes 2 through 10, and theme 12, are titled superordinate themes because they are personal experiential themes in IPA (Smith et al., 2009).

Research Questions and the Emerged Themes Research Question 1: How do adolescent psychotherapy patients who identify as having a PAP dynamic relationship with their biological parent describe their experiences with that parent?

Master Theme 1: The Lived Experience of the PAP Dynamic The following participant quotes explore the lived experiences of the PAP dynamic through the eyes of each subject's personal experiences and their perceptions of their parental experiences. Anya summarized her struggle with the delineation of her sense of self in parallel to her mother and her mother’s attempts at a parental stance versus Anya’s sense of what was communicated and what was felt: My mom, we definitely are very close. I think I struggle sometimes with feeling like I want to be my own person and I think that's a normal stage in life of trying to figure out what parts of your parent you're like and what parts you don't want to be like. And I think since I'm pursuing the same path as her, I sometimes struggle with feeling like I want to be an individual and I want her to see me as an individual because we are really similar.

We look alike, and we believe a lot of similar things and sometimes I think she views me as more of an extension of herself, which we've had conversations about and talked about

and she's definitely reassured me that she sees me as my own human being, my own person.

Anya went on to convey the struggle with the role she took on to create a sense of boundary to push her mother towards a parental stance and away from a confiding one: We talked a lot about her own relationship with her boyfriend and in the past I've had to have conversation with her about... Like when my parents were divorcing, she would tell me too much about what was going on and it was overwhelming for me, and so we've definitely had some boundary conversations about how much I want to know about her life but within certain parameters, since I want to have a relationship with my dad as well that's healthy, but yeah.

Anya expressed a struggle with the trauma of her parents’ separation and her responsive distance towards her father, including the evolved role as being a confidante to her mother and the over exposure to the conflict her mother was struggling with: So, it was in my first year of college. So my parents split up when I was a junior in high school that's when everything went down, and I wasn't very close with my dad for about a year or two years, I guess after that. And so during that time she would definitely tell me a lot about like, "Oh he sent me this text message," there was the whole thing about he was insisting that there was a 50/50 fault even though he had cheated on her, so it didn't make sense to me.

Anya discussed an example from when she was very young and felt she was in a soothing position to her mother’s pain and sadness: A very distinct memory from when I was very young. My mom dated a woman for years and I grew up with this other woman too. They broke up because her girlfriend cheated

on my mom, and my mom I remember distinctly sobbing crying and sitting on the steps of our house. I climbed into her lap which is definitely an act of her taking care of me, but given my small size, it seemed the only viable option and I held her. There was a complete vulnerability on her part. She was completely broken, and I felt I was sad and I was crying too, but I definitely felt more held together and certainly taking care of her.

Anya also discussed her role as the available empathy to her mother in times of loss and struggle: I've been with her through both of her parents' deaths, and she would certainly say that I've been a rock and been incredibly useful and helpful and emotionally available to her through the deaths of her parents, and just by showing up and being present and being helpful.

Mark discussed the bond that existed with him and his mother and the way in which it became bound in shared stressors. He detailed how he had to navigate the boundary setting and struggled with withholding information and appropriate sharing versus oversharing: My mom would drive me to school. In those car rides, her and I would listen to music, I made her laugh all the time, constantly talking about what's going on. She would share with me what she's stressed about, what she struggles with at work, and I felt completely free to talk to her about anything that was going on for a long time, until I started to keep some things to myself that I found inappropriate to share with her, whether that be relationship, stuff, sex-related stuff, or maybe bad behavior on my part, but we were super close, able to talk about anything. I also think our backgrounds are similar.

Allie expressed some role shifts that existed in her parental experiences in a more declarative sense, discussing experiences of rare parental illness and the ease of justification in the role shift due to healthier delineated boundaries in her PAP dynamic with her mother:

I've taken care of them when they were sick… I've made dinner and stuff like that. I've made meals. I've run to the store and shopped for them. I've gotten them whatever they needed. I helped my mom grade tests sometimes if she's really busy with school work.

So, I've helped her with some of her grading. But when she was sick, I made meals, I ran errands, I got her whatever she needed, stuff like that.

Emilee explained her sense of her fluctuating role of kid versus oldest child and the parental duties she felt responsible for in her mother’s absence, including some parental needs her siblings experienced: I mean physically, no, she's never been sick or anything, but in another way I do pay some of the bills at home. So I pay for my mom and my siblings, my sister's internet access since our internet was really bad. And then once everybody got sent home, no one could really sign on to school or sign on to work. So I just bought a router and set it up in my house and everything. So I think that's really the only way that I take care of my mom, but I'm also taking care of my siblings as well. And it does kind of feel like, I feel like I've graduated a level from sort of if there's something between being a sibling slash a child and being a mom, I feel like that's kind of where I'm at right now, since I'm not only taking care of myself, but I'm also sort of taking care of my family in a very small way.

Emilee further discussed her parental instinct towards her mother and siblings in making decisions and spending her own financial resources to problem solve for her family while she was away at college: I think it is mostly just a matter of initiative, because my mom is the type of person where she'll sort of put up with something, even though it's really difficult to put up with just at

the expense of not using more resources. So even though she was getting kicked off of her Zoom calls and my siblings couldn't join, it was more of a matter of, "Oh, we'll just wait until the library opens or once Starbucks is letting people back in, we'll just go there." And I was just kind of like, "Well, this is pretty inconvenient." And I also had to finish my sophomore year of university online. So I just felt like, I guess no one else was really going to do it, so I sort of just did.

Emilee also explained her parent-like feelings of worry for her younger siblings and that most communications with a younger sister were less a touching conversational framework of dialogue but more bound in a caretaking stance: Yeah, I mean, I think that was also a big source of anxiety for me. Because even now I wonder about how she's doing and I'll call her every few days just to make sure she's getting enough to eat and going to school and having fun and also talking to her friends now that everything's virtual, I would always make sure that she's calling her friends at least once a week so she has someone to talk to, and she's getting that socialness too. So, I mean, I think going from seeing my family every day, and being able to talk to them whenever I want to, to only being able to talk to them over the phone or over FaceTime, I definitely had to be more active in pursuing those interactions.

Allana expressed her experience of their parents’ substance abuse and the way in which patterned conflict would evolve, which would activate their mediating their conflicts: My parents are both alcoholics. Recently, they've stopped drinking and said they're going to try to stop that permanently, which is awesome because it's been a staple all of my life.

So normally what would happen is at night, if my siblings and I, when we watch a movie or watch some TV shows with my parents and throughout that, they would drink. So then

by the time that the media was over, then they would be a little bit tipsy and then my mom would often be offended by something that my father does and that'll start a fight.

And then just because we're physically there, sometimes the fight is started because of something like, "Oh, you did this to this kid or you said that." So either we're involved because we're part of the fights topic or we're just involved because we're physically close. With my younger siblings, sometimes they're off doing their own thing if we're watching maybe a more mature movie. Then my older brother, he's on the autism spectrum. So his reaction to conflict is he'll go to his room, be very quiet and just kind of cut himself off, do what he needs to do, so I'm kind of the one that has to mediate with my parents.

Ron expressed that he took on the role as a therapist to his father: I typically find that because he is the parent that is a buddy to me, I would say he's the focal point in this study. If I give myself a little too much time with him, I find that I'll turn into a therapist.

Ron further went on to express his role in taking care of his home and the struggle with liking that he could do drugs as he pleased without consequence, but also wished his father had the awareness of his need for a parent who looked out for him, not vice versa: In an attempt to make it (home) as stable a place for me as possible, because I wanted that mix of stability but being able to smoke pot when I want. I didn't want to be the smelly kid in class.

Ron also discussed his caretaking instinct due to his father’s instability and emergent needs trumping his own developmental milestones by paying for his father’s move with his saved tuition funds. He could not attend college that semester because of his father’s moving costs:

I almost felt this obligation to go out there and help him move out of there, and I did that.

I pulled together enough money, and I tend to beat myself up for this a little bit even today... I pulled together enough money to have a down payment for tuition.

Ron explained his role in maintaining his father’s finances: “I took care of all the financial aspects of things and when to pay bills and how to pay bills, and setting money aside for bills.”

Ron went on to discuss his need to take care of his father’s schedule and meal preparation, and the tension he felt at being haunted by having a cooking job, then coming home to cook for his father and being agitated at work to the point of quitting because he felt he could not quit taking care of his father: I cooked a lot of the food, even though I was a chef where I was working at the time, which was absolutely heinous. Just having to cook all day at work and then come home and cook again, it was... oh my god. What else? I had to wake him up and make sure he would get ready for work and make sure he wasn't late, so I was kind of his alarm clock.

Yeah, it was definitely just... I was the dad in that situation, and eventually, at one point, I had quit that job that I was working at because it was another form of abuse in my life.”

Ron discussed frustration with the absence of parental boundaries when his father introduced him to marijuana and provided him with his first drug use experience: “(Substance use) That started at the age of 13. He actually provided my first hit of marijuana for me.” Ron exemplified his adolescent ID’s validation in experiences in his father’s absence of acting like a parent and being a buddy. He also evaluated the irrational grandiosity and poor boundaries of his father’s advice and reflections on normal adolescent experiences. Ron stressed a wish of receiving feedback of how one can be soundly reflective and reasonably self-critical of one’s

sense of self and expressed his ongoing experienced frustration with broad grandiose unrealistic validations and the delusional amplified sense of self confidence that his father exuded: At the time, I mean the majority of middle teenagers are going to want a safe place to go get stoned and drunk and hang out and talk and be able to bring their friends and party safely, without suffering any consequences. That's like the 16-year-old heaven. A fridge constantly full of beer, a place to smoke weed in the open, and just constantly loud music that you like. He provided that, and he would play along too. So he was just as much a part of it as any of my friends would be sexual advances. Like if I wanted to talk to a girl, he would be the pat on the back and, "Oh yeah, you can lay any girl you want. Look at you, you're the hottest man alive. You're on the cover of TIME magazine, you can have any woman you want." When in all reality that's not the truth, that's not how things work.

Superordinate Theme 2: Intrusion or Expectation of Access to External Relationships This theme was experienced by two participants. The following participant quotes exemplify a version of boundary crossing. There is a very subtle tonality expressed in the way discomfort was exemplified in these descriptions of their PAP parent’s investigative pursuit and prying into peer and family personal information. Allie discussed some ways in which her mother would seek information about others; there was a tone of discomfort in the way she described these experiences: “She's just very interested in what's going on in my life and my friends' lives. She likes to be involved.” Allie further discussed the ways in which her mother pursued information about her own and their mutual connections.

We also have a very big family. So, we talk about them a lot. We talk about what's going on with all of them. We'll talk about my sister and what's going on with her. And she's

very involved, and she wants to know everything that's going on. She knows a lot about my friends and their families.

In a seemingly excuse-making way, Allie tried to justify this pursuit of information in a defensive tone: So, there's a greater connection between me and my mom on a bunch of different levels than there are with me and my friends. We're still connected, but there's just a different dynamic there. So, I keep her more informed, I think.

Ron discussed broadly how his father would spend a lot of time intruding his social circle, smoking marijuana, giving him alcohol, jamming with him and his friends, whilst talking inappropriately about Ron’s girlfriends in front of them. He also conveyed how he obtained his father a job, and that his work social circle was invaded by his father’s intrusion into that experience as well.

Superordinate Theme 3: PAP Evolved Tension in the Dynamic This theme was experienced by three participants. The following quotes convey how the PAP dynamic’s tension started to evolve into an internal conflict for the participants as the normative parental boundaries veered towards a peer-like boundary and a reversal of roles. Allie conveyed feelings from her mother of overprotectiveness and having to settle her mother’s anxieties of a heightened maternal experience, bound with being peer-like in a socially engaged way: It's just in her nature that she's very caring. So, I feel like sometimes she worries a little bit too much about me, just a little bit on the overprotective side, just because she wants what's best. But I realize how much she gives up for me and all the stuff that she does.

So, I'm very appreciative of it. And we do have a good relationship. We always try to do

stuff together, go and get coffee sometimes, and we always check up and see how each other's day went and stuff like that.

Anya discussed having to set limits on her mother’s invasiveness with her relationship with her father when her parents separated. She had to convey boundaries to her mother and described the skewed way in which she felt she was supposed to be in opposition of her father and in alliance with her mother whilst she was expected by her mother to collegially join in a shared hostility towards her ex-husband: I remember her and I were driving together…I remember just telling her, I was like, "I love you and I want to know who you are and what you feel and what you're going through and I want to be close but I also really want a relationship with my dad and I want to figure it out for myself who he is, and what our relationship can look like because I feel like it's difficult for me to have a clear perception of him when you're telling me stuff that he's doing. And I want to be able to navigate my own relationship with him, that's really important to me.” …So I remember for a little bit after that, maybe for a year after that, every time she would bring up my dad in a negative sense I would get a little bit like, "Can you not?”

Ron discussed his perspective of the dysfunction of his father’s need for caretaking and his participation in taking on that role: This isn't exactly a safe place for other younger children to be. He'd get drunk and stoned in front of my little brothers, who were like eight, nine and 10 during this period of time.

Not to mention the house that all of this happened in was a complete byproduct of his bipolar disorder and separation anxiety and, I don't know, maybe ADHD-like tendencies.

It was a total hoarder's haven. There was junk mail all over the place and the trash had

never been taken out, because I wasn't there to take it out during the week. I would only go visit on the weekends. So this place was a total hoarder's haven. Half the electricity in the house was working, the plumbing wasn't fully functional. It was backed up. It really wasn't a stable house, and because he was my buddy and he provided that safe place for me to get stoned or get drunk or do drugs, I would constantly clean that house. That perpetual cycle of constantly cleaning, up-keeping, maintaining, doing everything that I could.

Ron further explained how the skewed boundaries led to a continued reversal of roles that led to severe trauma of emotional and physical violence when he began to set limits on his father as a parent would to a symptomatic adolescent: I cooked a lot of the food, even though I was a chef where I was working at the time, which was absolutely heinous. Just having to cook all day at work and then come home and cook again, it was... oh my god. What else? I had to wake him up and make sure he would get ready for work and make sure he wasn't late, so I was kind of his alarm clock.

Yeah, it was definitely just... I was the dad in that situation, and eventually, at one point, I had quit that job that I was working at because it was another form of abuse in my life.

And I was getting to the point where I couldn't take it, so I quit. I worked about 28 days straight with no time off. All 10 or 12 hour days. Then I quit, and we weren't doing very hot financially, but he was still working there. And when I told him that we should stop spending money on beer and cigarettes, that actually turned into a full-on fight…Threats of death. And I stayed passive through the whole thing, which I actually am kind of proud of that to this day. But yeah, that was a very physical, brutal altercation, and I packed my bags as he was kicking me down the stairs. I packed up everything I could in my hiking

bag, and I went and stayed in a homeless shelter for about a half a week until I found a new apartment. And that was all a product of me trying to, again, be the parent and put down the iron fist and say, "No more beer and cigarettes. Let's do the healthy thing, and let's do what's financially right, and be responsible about this."

Superordinate Theme 4: PAP Dynamic Declarative Experiences This theme was experienced by two participants. The following quotes convey the way in which the participants declaratively stated a thematic experience of their PAP dynamic. Allie conveyed the ways in which there was a parallel communicative and engagement context to her relationship with her mother and close friends: When she comes home from work, that's about the time I'm finishing up classes. So, I'll go downstairs and we'll just talk for a while. And I kind of find that with a lot of my friends the time goes by really quick when I'm talking to them, and it's just effortless conversation and we just talk about a bunch of things, and that's what I find with her.

When I come downstairs at the end of my school day, at the end of her school day, we'll just talk for a while. Hours will pass, and then we really don't even notice it, because we're just enjoying talking to each other and just catching up. So, in terms of just conversation, communication, I definitely see the kind of friend aspect there, because she's very easy to talk to. I'm able to talk to her about a lot of things, a lot of topics.

Allana discussed their thematic recurring role of being the adult and parentified family member intervening, diffusing, and mediating her parents’ conflicts whilst securing their younger siblings: I mean, it's mostly them fighting and then my role is I'll often try to just ask them to go to bed, can we deal with this tomorrow because then sometimes there has been situations if

it's kind of an extreme intoxication where then one of my parents will like threaten to leave and my mom has multiple times before I come up had been like gathering my siblings and being like, "We're leaving." So I'm the one who's like, "No, we're not. Please just let everyone go to bed and deal with your issues by yourself." So I'm either asking them to stop or to take it somewhere away from me or my siblings or sometimes I like to console a parent if during a fight one of them stalks off. Sometimes the other is upset and I'm the one who consoles them.

Superordinate Theme 5: Child as Caregiver This theme was experienced by three participants. The following quotes convey experiences in which the participants discussed their role as a caregiver to their parents, siblings, and peers. Allie conveyed some of the active anxieties that appeared when her mother became ill, and she had to take on some of the responsibilities that existed in their home. She exemplified this in a humanizing way, yet bounced around from a maternal-child and friend-based reference point: Yeah. It's I guess I'd say concerning, just because she's usually just very healthy, very active. So, seeing her not being able to do that kind of worries me. And she does so much around our house. And especially when I come home from school ... I was living away last semester. And if I would come home from school, and then I truly appreciated how much she does on a daily basis and all the stuff that she has to do just to keep our household running and everything that she's responsible for. There's a lot more responsibility that I have to take on when she's unable to do that. And I'm happy to do it.

It's just a different kind of environment when that happens. But in terms of the way that I see her in that situation, it's kind of I want to say humanizing, which I don't know if that

totally makes sense…But as much as I see her as a friend, I also see her as someone who's wise, and I see her as a person who knows everything and has experienced a lot more than I have, so seeing her relying on me and me having to pick up a lot of the work that she normally does, it just reminds me she's just a person and she's got the same kind of thoughts and inner dialogue that I have. And that could very well be me someday.

We're just very similar in that sense. While she has had a lot more experiences, she doesn't know everything. She's not totally perfect, and she doesn't have all the knowledge in the world. So, it just kind of reminds me of that when I see her unable to do the things that she normally can.

Emilee discussed her contention with taking on a parentified role due to her mother’s educational pursuits and how that impeded her capacity to have a normative set of social experiences with her peers: Just having sort of like play dates or just hanging out with people without having to check my phone, to see if my sisters are okay or having to leave early because I have to put my sister to bed or being able to go to a sleepover whenever I want, because I know my mom's not going to... because when she was doing her bachelor's it was in a different city.

So sometimes she'd have to spend the night there if she had classes at night. So I would have to be home with my sisters. So I couldn't go to some sleepovers in middle school, and high school because of that. So I think even when I was older, when I thought about a best friend, it was more about just even kind of being a different person myself and just being able to hang out with someone all day without any other obligations.

Emilee further conveyed how she took on a maternal role in her friend groups and the maternal stances she took based on the perspective of this being a normalized role for her in her family: I think that's a really good question, because I do feel like I am a caretaker in the friend group. Usually people categorize me as the mom of the friend group, just for small reasons. I always bring snacks, and will pay for someone's meal if they don't have money and things like that. But I think more in like, I guess a interpersonal sense. I do prioritize checking in on people, and making sure people are doing okay and listening and really being there for my friend in less of a friendly way. And I guess more of a caretaker or sometimes even, I don't know, I don't want to go so far as to say a therapist, but that's what I've had people tell me before.

Ron discussed having to pursue housing and employment for his father with the role of stabilizing him and bringing opportunities of intervention and normative expectations to his father’s life, but at Ron’s direction and fostering of an employment opportunity and the subsidizing of his housing: ... so my dad ended up living with my aunt, his sister, for a little bit. And I know that my aunt and her immediate family, like her husband and my cousins, my uncle's cousins, they were getting pretty tired of having this old man just play music with the kids and get drunk every night in their house. So I had put quite a bit of money together at the time, and I almost felt this obligation to go out there and help him move out of there, and I did that. I pulled together enough money, and I tend to beat myself up for this a little bit even today... I pulled together enough money to have a down payment for tuition. Towards an apartment. The down payment, the first month's rent, the security deposit, and second

month's rent of an apartment And we both actually managed to get a job at the same establishment. So you've got to think just how potentially poisonous that is. You live in the same place and you work at the same place.

Superordinate Theme 6: Child as Confidante This theme was experienced by two participants. The following quotes discuss the feelings conveyed of a parent confiding in their child in a way that induced discomfort and the child taking on a boundary-setting role due to the discomfort and contention that was evoked in the confiding. Anya conveyed the way in which her mother discussed her contention with her ex, and the way in which she had to limit the permission of these types of conversations: …And so during that time she would definitely tell me a lot about like, "Oh he sent me this text message,” like she felt like she wasn't telling me as much as I was perceiving that she was, that she felt like maybe my memory wasn't accurately perceiving how much she did or didn't share with me. But then as the conversation went on, she recognized that she has definitely shared a bit too much and she reassured me that she really does want me to have a good relationship with my dad and that she will work on not sharing as much while still not having the ability of her and I to be close.

Anya went on to convey how she felt she became the primary confidante to her mother in times of her distress: I definitely felt like I was the shoulder for her to lean on and then I guess more recently her boyfriend and her, they broke up, and there was a big fight and stuff, or not I don't know what it was, but she came to Charlottesville and we spent the whole day talking about it and I definitely felt like I was the support then.

Mark conveyed his experiences in his role as confidante to his mother as well:

She would share with me what she's stressed about, what she struggles with at work, and I felt completely free to talk to her about anything that was going on for a long time, until I started to keep some things to myself that I found inappropriate to share with her, whether that be relationship, stuff, sex-related stuff, or maybe bad behavior on my part, but we were super close, able to talk about anything. I also think our backgrounds are similar.

Superordinate Theme 7: Ideal Best Friend Identification This theme was experienced by three participants. The following quotes convey a reflection on the participants’ ideal best friend, whilst bound with the PAP dynamic imposing upon the culmination of that ideal. Emilee discussed how her version of an ideal best friend was overshadowed and impeded by the parental responsibilities that were placed upon her due to being the oldest child and thus caring for siblings whilst her mother was pursuing a degree: …when I was younger, I definitely wanted someone who would just play all day. This is when I was really young, just because I guess I feel I did have certain obligations at home and that was just something that I wanted, to go outside when the sun was rising and come back when the sun was setting and just play outside or swim or hike or play games or whatever it was. But I guess taking no breaks to do anything, that's more of a responsibility. Just having sort of like play dates or just hanging out with people without having to check my phone, to see if my sisters are okay or having to leave early because I have to put my sister to bed or being able to go to a sleepover whenever I want, because I know my mom's not going to... because when she was doing her bachelor's it was in a different city. So sometimes she'd have to spend the night there if she had classes at night.

So I would have to be home with my sisters. So I couldn't go to some sleepovers in

middle school, and high school because of that. So I think even when I was older, when I thought about a best friend, it was more about just even kind of being a different person myself and just being able to hang out with someone all day without any other obligations.

Mark discussed a best friend ideal that would be a more parental experienced individual who would be a guide and give critical feedback and accountability: That kind of degree of acceptance, love and emotional depth …I don't always like it when it happens, but honesty in a way that is critical and objective and will point you in the right direction, and not just tell you that you're correct because they're your friend, but the seeking for you to be a better than how you are now, so calling you out.

Ron discussed a best friend as one who would have healthier adult-like experiences of social interactions: Quite the opposite of any of my friends that I've ever had actually. Someone who likes to do healthy things, someone who actually likes to go for a run, someone who likes to debate philosophical things or speak about their meditations or go for a long bike ride, or go explore a new area, rather than sit around and mope and focus on negative things, or get stoned or whatever.

Superordinate Theme 8: Ideal Parent Identification This theme was conveyed by all six participants. The following quotes convey the way in which some of the participants discussed the qualities of an ideal parent. Allie discussed a version of an ideal parent identical to her experienced parental relationship primarily with her mother, with whom she had the PAP dynamic. Allie’s conveyance of the experienced ideal had a healthy version in which the PAP dynamic could be experienced:

I would say definitely someone that the child can talk to, definitely a confidante and someone they trust and someone who's going to support them. I personally think for me it's kind of rare that I get along so well with my parents, because just from my friends' parents and their relationships with their kids and from what I've heard from different people about their relationships with their parents, I'm kind of an outlier in that sense.

Because a lot of them trust their parents and go to them with problems and stuff, but they don't really see them as a friend or someone that they talk to for hours or someone that they want to spend a lot of time with.

Allie further discussed, in a reflective way, a clear experienced delineation in her parental experience between confidante, best friend, and being a parental figure: I think that once a parent becomes too much like a high schooler or like a college friend, then I think the kid kind of loses a sense of security and supervision. So, I think my parents did a great job of still being a very friendly, approachable figure but also making sure that I was growing up well and growing up with some rules and not making bad decisions and stuff like that. So, I think there's kind of a balance. I don't think a parent should be like a total best friend, but I think they should have some aspects of it, just in terms of communication and just being like a confidante to them and someone that they feel comfortable approaching and who will be supportive of them. But, yeah, I think acting only as a friend to a child could possibly hurt them in the long run, because they might not have the structure that they need growing up.

Anya discussed a developmental reflection of an ideal parent's role: I guess that depends and what's the age and stage that the child's at, I definitely think that.

Well I think that no matter what, the role of a parent should be to always to be honest and

open with their children and allow for the whys and not the whole like, "Because I told you so." Really answering questions and really trying to explain why there are certain rules in place to keep their children safe. So I guess a parent's role is to keep their children safe and then also to foster imagination and creativity and emotional intelligence…Yeah, and I guess that just looks different at different stages in life, but I guess those core things are keeping your child safe but also encouraging individuality and creativity and self-expression, still are a part of that.

Emilee discussed her belief of child–parent friendship in parallel to an ideal parent having a sense of being an “instructor” to their children: I think parents should be friends, and I think that children should be able to go to their parents with anything that's bothering them. But I also think that parents, when it's needed, need to tell their children what's right. To not talk to strangers, or what to do if someone's stealing their lunch at school, things like that. I think those critical moments are when parents need to step back and not be a friend and be more of an instructor.

Allana discussed an ideal parent triaging safety whilst also being able to know your child with a relational depth: I would like to be a parent so I've thought of it myself. Parents should be supportive of their children to a very large extent, but they also should have the child safety in mind first. It's hard because on one hand, you have this responsibility to take care of this tiny human, help them grow, help them be prepared for the world. And then on the other hand though, I feel like you should also get to know your kid as well. Don't just treat them as your child. Get to know them as a person and try to have a relationship with them besides just an authoritative role. It's a balance, I guess, of both of those things.

Mark discussed an ideal parent from the perspective of an empathetic teaching role model: I think that a parent has an immense responsibility to impart particular behavioral characteristics that allow them to function in society as what we deem as a good human being. The number one thing I would say being empathy. I think that a parent's role is to impart a degree of empathy in their child, so that they can relate better to other human beings. Then alongside that, I think there should be a degree of generosity, work ethic. I guess the role to not go into nuanced something, it would be to impart values, to import values and behavioral characteristics that are lived out within the kids.

Ron identified an ideal parent as a role model who can be driven in preparing their child for the way in which they see them as being successful in life, both from a professional perspective but also aligning to a boundary-setting version of a parenting theory: What I would imagine a parent would say is... I would imagine that a parent might try to give advice on how to approach someone the right way, politely, and not like an animal with your genitals already out….I think parents should definitely lead by example, because as a person who learns more so by example, and actually practicing the task myself, to just tell someone bluntly, "This is what you do, and you don't do this," that's not going to teach a kid. I think you need to lead by example, and if you go through life calmly, collected, and your child sees that, to go through life calmly, collected, and to sort of meditate on your response in a very small, brief period of time, before you go muttering out whatever comes to your mind in the moment, life might go the child's way much better…And to just teach children to not be so reactive. Like knee-jerk reactions. I have a couple of friends that are like this, where when they were younger, they would

scream and kick and cry, and mom would buy them the toy. And now they're 24, and they scream and kick and cry and now he has a Mercedes Benz…Oh no. If your child is having a tantrum, some people would call this neglect but just don't pay any attention? Be as stoic as you can as a parent. I don't mean stoicism to the extreme, where you're a cardboard box. I think people take stoicism too far. Just stoicism in the sense of selfcontrol. I think that's a very, very key thing that parents should focus on when raising children. Also, parents should really focus on manifesting what it is that you want to achieve in the world. How to go about achieving your goals. Giving your child the proper tools, the strategic tools, to see something that you know nothing about, but you like. So let's say I like carpentry, but I know nothing about carpentry. Okay, well now I need to utilize social skills and find out who to talk to get an apprenticeship to do this. So how do I do that? And how do I talk to this person the right way? I think it's definitely a parent's job to give their child those tools.

Superordinate Theme 9: Child’s Experienced Role in Their Family This theme was conveyed clearly by five participants. The following quotes discuss the way in which the participants experienced their role in the context of their family. Allie talked about her role as that of being more present and connected to her parents and having her presence in her home and personality leading to a more connected and best-friend status with her mother in parallel to her older sister's role in the family: In my family, I would say I'm more the easygoing one out of the two siblings. My sister is a little more type A, very focused, and she just rolls with the punches a little bit less than I do. I would say that she's still very close with both of my parents. I would say that I would think that I talk to both of my parents a little more than she does, and I can't tell if

that's more of just she was older, she was doing more activities, she had work, she went off to college, stuff like that, and I was still kind of at home. But I think even when we're both at home, I would just naturally just be more talkative, talk to my parents more. I think I have a little more in common with both of them. Yeah. Also, my mom and I, we often just talk about what she's doing and stuff like that. So, when there is something going on with her, I think in the sense that I was kind of always home and I would always just talk to my mom, we'd always go out for coffee or go get breakfast or something like that, so we would kind of be just talking about my sister. My mom would ask my input on what she thinks what would happen or just with some of her friends and her boyfriend and stuff like that. We would just kind of talk about that and what we think is going to happen, what we think would be the best for her. So, I think in that sense, I was just a little closer, and we just were more open and talked about more things together.

Anya saw her role as the one who fostered substantive and deeper connectedness: I think both in my relationship with my mom and in my relationship with my family, my role is to bring about connection and substantial conversation that leads us to getting to know one another more, and challenging one another's ideas, and growing both as individuals and in our relationships with one another.

Emilee discussed her role as a maternal one: I mean physically, no, she's never been sick or anything, but in another way I do pay some of the bills at home. So I pay for my mom and my siblings, my sister's internet access since our internet was really bad. And then once everybody got sent home, no one could really sign on to school or sign on to work. So I just bought a router and set it up in my house and everything. So I think that's really the only way that I take care of my

mom, but I'm also taking care of my siblings as well. And it does kind of feel like, I feel like I've graduated a level from sort of if there's something between being a sibling slash a child and being a mom, I feel like that's kind of where I'm at right now, since I'm not only taking care of myself, but I'm also sort of taking care of my family in a very small way.

Emilee further went on to discuss that monetary supportiveness was a factor in her adopting a maternal stance in her family: Yeah. I mean, now that I think of it, I think there are a lot more and I think a lot of them revolve around money, just because my mom was pretty much a single mom, and is trying to raise us on teacher's salary, which isn't that much. So things like a car, I saw my friends get cars for their Sweet 16, but I saved up for two years so I could buy my own.

And I think that those are things just because of the way that my friends' families are structured, I see them as sort of a parent's responsibility or even if I'm going out with my friends, I'm the one who pays for my food and whatever clothes I buy or whatever I'm doing, versus my friends usually have cash from their parents. So I am not sure which one of those situations is typical. But I think for me, just because the people around me are different, I see myself sort of fulfilling the role of a parent in financial support most of the time.

Emilee further evaluated how her role as oldest sibling played a part as well in the evolution of the PAP dynamic between her and her mother and the way in which her responsibilities evolved in reflection to each sibling and the ways in which they relate: Yeah, I mean, I think, I guess I am kind of a caretaker, I mean, I'm the oldest, and then my other sister is 14, and then my youngest sister is 10. So my mom had my youngest

sister when I was around the same age, 11, and I used to carry her around and people used to think that she was my baby. And I feel like I really internalized that where this was when my mom started to go back to school. So we were at home a lot, and I was the one who was taking care of her. And I really do see her as almost more than a sister right now. I feel like we have a closer bond just because of all the times I put her to sleep, or was feeding her, playing with her, carrying her during different things. So I think with my youngest sister, I'm definitely more of maybe a parent figure, maybe just the caretaker.

And then with my older sister, just because, I mean, I was still a kid when she was born.

So I think that's definitely a sibling relationship there.

Mark evaluated his role in his family alongside his recovery story and his reflections on his sense of ostracization in comparison to his siblings: I definitely feel like I'm always trying to compensate for my years of being degenerate. I guess I have two families really, and so the role is a little... With my father's side, I have a sister and a brother who are both very high achieving. My little brother is intended to … for an elite institution. My sister gets perfect grades, is on a similar track and goes to a good school. For my whole life, I felt like a black sheep there because for a while, I was not on that track and definitely intended more towards homeless shelters and long-term rehab treatment places and…(researcher)”You've come a long way, yeah”…. Yeah, I've made a quick turnaround, but there's a still feeling of being a black sheep, feeling different and feeling like my conduct... I feel like I'm always trying to catch up and I'm a little bit behind, and I can't really rest easy with my family because I'm always making up for how I used to be. With my mom, I don't feel that way as much and I don't know if that's because professionally they, or because it's related to my sense of intellectual

superiority, but I feel like I've achieved my potential and even done better than some of my peers who have not experienced what I've experienced during the setbacks that I've experienced. I definitely feel like not that I owe something to them, but sometimes I feel entitled and feel like they owe something to me on my mom with my mom, which is very interesting and has been discomforting for me to think about recently and something I need to work on.

Mark went on to discuss his feeling of never being able to catch up to his family’s expectations of him: With my dad's family, I'm always trying to seek their approval, and I definitely put a premium on prestige. If I get into Harvard law, then I'll be okay and then I'll get approval, and then I'll get I love you son, I'm proud of you, very stereotypical son wants father's approval. With my mom, it's felt like I act entitled and selfish to things that are really gifts that are being given by them out of the kindness and generosity of their own hearts.

They don't really owe me anything, but I feel entitled to it. I can act dismissive, or not really appreciate what they give me. There's an element of that with my dad too, but with my dad really, if we're talking about the black sheep, yeah, I'll reiterate what I said before. I feel like I'm playing a game of catch up constantly. I'm always 10 feet behind my siblings who are running a little bit faster because they're just themselves. Whereas, I've had the life experience of acting myself and not really processing and self-reflecting.

I'm an absolute mess, and so I have to put on a different way of behavior to be accepted and loved.

Ron discussed his role as caretaker to his father and the way in which his father’s immaturity and parallel age state in his regressive behaviors allowed for his teenage self to dysfunctionally flourish: It really wasn't a stable house, and because he was my buddy and he provided that safe place for me to get stoned or get drunk or do drugs, I would constantly clean that house.

That perpetual cycle of constantly cleaning, up-keeping, maintaining, doing everything that I could.

Superordinate Theme 10: Healthy Identifications of Relationship with PAP Parent This theme was experienced by two participants. The following quotes represent healthy experiences of the PAP dynamic in which the roles of parent and child were clear and support was felt, but aligned with a capacity to confide and be cared for without a subjugated sense of boundary. The below quotes are attributed to Allie and her experience with her mother. She seemed to have the healthiest reflective experience of the PAP dynamic as not stress-magnifying but supportive and caring with a closeness that had reciprocal senses of friendship, with a clear delineation of parent and child. The quotes are listed as they do not all warrant an introduction individually.

So, I think we've had a good relationship, and they've really been able to help me and get me whatever help I needed.

I'm able to talk to her about really whatever I want to. She's very supportive.

She's very caring. She really likes to take care of people. …she'll ask about how I'm doing with my relationships and stuff like that, and I feel like I can talk to her and I can be a true version of myself around her.

She's very caring and very friendly, very talkative. She's just very interested in what's going on in my life and my friends' lives. She likes to be involved. Yeah. She's very caring. She really likes to take care of people. So, she's still very close with her parents.

We go over and see my grandparents all the time. And, yeah, just very, very nice and very talkative, very friendly, very approachable.

I still have all my childhood memories of her being an authoritative, parental adult kind of figure. And still, I think I have a great amount of respect for her as well. I've tried to keep her informed more than I would keep my friends informed, just because I know that she'll worry about me and want to know that I'm safe and I'm doing okay.

I truly appreciated how much she does on a daily basis and all the stuff that she has to do just to keep our household running and everything that she's responsible for.

Anya also conveyed a set of healthy examples of how she experienced her mother: …sees me as my own human being, my own person. …when I am upset or struggling with something and I'm coming to her for advice, especially when I'm sad or just not feeling great or excited about life and if I express that to her, she always really hears me and gives me really good advice. I definitely have felt like more the parent/child relationship.

In the following quote, Anya discusses her mother’s flaws being discussed in a way of sage and imperfect advisor with a clearly set boundary of the conversation being a mother-todaughter framework: (her imperfections) It definitely made her more human to me, I guess it's a typical thing to kind of glorify your parent or put them on this pedestal and think they're perfect. I definitely think seeing her vulnerable and trying to figure out how to navigate these

complicated relationships, I guess made me feel like she's a human being too and she's figuring it out too and she doesn't have all the answers. It's like a good feeling, it's almost like, I'm not alone in, I don't know what I'm doing, or how to navigate certain situations, like both her and I are still learning those things. And even though she's older and wiser, she still has those questions and still struggles to make sense of why things are happening the way they are and stuff like that.

Research Question 2: How does the PAP dynamic relate to the adolescent in psychotherapy and their presenting symptoms?

Master Theme 11: Reason for Therapy The following quotes convey the participants' reasons for starting therapy and their narratives of their experience. The quotes are listed under each participant's pseudonym as each quote is merely a definition of their reason for therapy.

Allie: I was struggling with OCD tendencies, and that was my freshman year of high school.

And at that time, I didn't really know enough about OCD to recognize it as that. I thought I was just really meticulous and I was just overthinking things. And I think the transition into high school was a little bit stressful for me, just meeting a lot of new people and the workload and stuff like that. So, I think that kind of made it worse, because I was kind of struggling with that, but then I was also trying to adjust to high school. Then it kind of lessened. I wasn't seeing any therapist during high school or anything like that. But then, as senior year was ending of high school, I was noticing more anxiety, and the OCD tendencies weren't coming back, but I knew that the transition into high school had made them definitely worse. So, I wanted to kind of get ahead of that. So, I started seeing a

therapist that summer in hopes of just learning some coping strategies and stuff like that just so that they wouldn't get worse if I had additional stress and stuff in the transition to college. So, I met with my therapist that summer, and I lived at school, but I would come home once a week if it was an afternoon that I didn't have class, and I would meet with her then.

Anya: I think I struggle sometimes with feeling like I want to be my own person and I think that's a normal stage in life of trying to figure out what parts of your parent you're like and what parts you don't want to be like. And I think since I'm pursuing the same path as her (my mom), I sometimes struggle with feeling like I want to be an individual and I want her to see me as an individual because we are really similar.…the reason I sought out therapy (initially) in my second year of college was because I was exploring my sexuality and realizing that I was attracted to women and men, or I guess no, that's not even true, I'm attracted to people, and it's not about gender. So, when I was figuring that out I definitely felt more judged than embraced, at least initially, by my parents. My mom was definitely... She would say things like, she thinks I'm rejecting masculinity because of my dad, and I was like, "That's not how it works." …Yeah, I was like, "This is not..." exactly, exactly. And I think she definitely is very protective of the way she raised us, and I definitely will raise my children with more gender inclusive language and probably less religion and stuff like that. When I voice those things to her she takes that as she did something wrong, which it's not like a case of right or wrong. But I guess in those instances or when I was trying to have her understand who I am and being attracted to women…

Allana: Around age 13, I became severely depressed and very anxious. I've always kind of been a nervous person, but it reached an extreme low and then so like … was a very hard year for me and I got through it. Around …, spring of … and then especially fall of …, I found myself in that same kind of very low point. I had attempted before when I was around 15 or 16, try to start therapy, but my mother was like, "You're fine." And also she had this skepticism of therapists where only someone who has a lot of issues will go into that, and you never know….Also, I was molested as a child.

Emilee: So I found myself sleeping in really late, and sort of falling behind in my work. And I was telling my mom about that, because I didn’t really even know what anxiety was, but I guess she struggles with it right now and had struggled with it in the past. So she was just kind of telling me how my the situation sounds pretty similar to what she feels and also what she went through when she was around my age, when her mom died. And that’s when she suggested that I see an on-campus provider just to get a diagnosis and see what services could be helpful.

Mark: I mean being an alcoholic and an addict comes with immense guilt and shame, especially because my family was the closest people to me and they bought witness to my selfdestruction and destruction to the family dynamic. I stole from them, constantly lying and they watched me implode. When I got sober and I started looking at the facts on paper about how I was and what I did, I didn't want to add anything to that list further. I think probably out of guilt and shame and a desire to no longer put those burdens on her, I

stopped. Also, knowing that my mom is incredibly emotional and sensitive, I realized that though I may be getting it probably a degree of relief from her being the maternal figure in my life, which a maternal figure is very essential I think in the formative years to developing emotional empathy and things like that, I realized that rather than with all the relief that it might give me, it brought along some guilt whenever I did divulge things.

Then I also realized I was probably hurting her too, and the calculation there didn't seem to be worth it….I had a complete inability to handle my own emotions, and I would have outbursts of anger, and I was prone to very impulsive behavior. If I thought it, I was like if this is going to make me feel good or get a laugh out of people, I'm doing it. It got me into all sorts of trouble, fights, very hurtful things said to other people, seeking attention.

There's my inability to handle my own emotions made my parents be like, "What is wrong with this kid? We got to send him to someone who can help him."

Ron: It was a full-blown meltdown when I told my dad that I couldn't live with him, when I was younger. Actually, this meltdown scared the hell out of my mom and stepdad, because I was in the basement, on the phone with my dad, screaming, "Please get out of my head, please leave me alone. I don't want you to make my thoughts for me anymore."

And that's what... screaming, "Please get out of my head, leave me alone," was what initiated the start for therapy.

Superordinate Theme 12: Narcissistic Need of PAP-Identified Parent This theme was experienced by four participants. The following quotes convey a primitive narcissistic nuance of a parental need that usurps a normative child–parent dynamic.

Allie discussed two examples of a shared anxiety that was created by her mother’s symptoms to carry the burden of her mother’s anxiety: Just at school last year I noticed there would be times where I was either just studying or visiting someone or just sleeping in, and if I didn't text her back soon enough she would start getting really worried. She didn't really know where I was. And if it were a longer time interval between the last few times I texted her, I think I could see that a little bit more, but it would be shorter time intervals, which I would think normally she would just assume that I was doing something, I was busy, I was sleeping, something like that. But she just got very worried often… She would text me a lot. She would call me. She would ask me, "Are you okay? Where are you? You haven't gotten back to me in a while. You should really keep your phone on you," just stuff like that.

Anya discussed a tension of enmeshment and extension objectification that she feels her mother imposes on her: I think I struggle sometimes with feeling like I want to be my own person and I think that's a normal stage in life of trying to figure out what parts of your parent you're like and what parts you don't want to be like. And I think since I'm pursuing the same path as her, I sometimes struggle with feeling like I want to be an individual and I want her to see me as an individual because we are really similar. We look a like, and we believe a lot of similar things and sometimes I think she views me as more of an extension of herself, Mark discussed feeling like a self-indulging bragging right of his mother in his recovery process, and that he would receive hostile emotional consequences if he confronted his discomfort with it towards his mother:

She often uses me as a poster boy. I go to meetings with her friends, and they all think I'm some shining star because I got sober young when that's not really a healthy way of viewing oneself. I think it's probably a lot more appropriate to just be I'm just like everybody else and I'm on the same path, rather than there's something special about me because I mean I'm unique and human, but there's no added value. It's just because I'm her son, and so that can irritate me at times, but I would rather have a close relationship and connect with her on that level and continue to grow in that area than let my own discomfort with it push her away.

Ron discussed two examples of his father’s entitlement to care: I had to wake him up and make sure he would get ready for work and make sure he wasn't late, so I was kind of his alarm clock. Yeah, it was definitely just... I was the dad in that situation, and eventually, at one point, I had quit that job that I was working at because it was another form of abuse in my life. And I was getting to the point where I couldn't take it, so I quit. I worked about 28 days straight with no time off. All 10 or 12 hour days. Then I quit, and we weren't doing very hot financially, but he was still working there. And when I told him that we should stop spending money on beer and cigarettes, that actually turned into a full-on fight….(his father made) threats of death.

And I stayed passive through the whole thing, which I actually am kind of proud of that to this day. But yeah, that was a very physical, brutal altercation, and I packed my bags as he was kicking me down the stairs. I packed up everything I could in my hiking bag, and I went and stayed in a homeless shelter for about a half a week until I found a new apartment. And that was all a product of me trying to, again, be the parent and put down

the iron fist and say, "No more beer and cigarettes. Let's do the healthy thing, and let's do what's financially right, and be responsible about this.”

Summary This chapter introduced the six participants in the study and presented the data obtained via the IPA process of data analysis. From the data, one sees an expression of the individual adolescent participants' experiences of the PAP dynamic as well as the thematic parallels in their shared experiences of the dynamic. The following chapter evaluates the emerged themes in answering the research questions and revisits some of the prior discussed literature.

Chapter 5 Findings Introduction This study began with my interest in exploring the PAP dynamic between parents and their children in regard to my clinical experiences of the dynamic. In my clinical experiences, I felt that the parent–child relationship was severely exploitative on the parent's end. I strongly believed that in these cases the PAP dynamic played a significant role in the presenting symptoms and etiology of symptoms. I felt that the unconscious exploitation of the adolescent for a parent's narcissistic needs in the PAP dynamic was essential to understand from a clinical perspective. There is data that exemplifies that if a parent acts like a friend, peer, or confidante, mental health symptoms can develop in the adolescent (Glickauf-Hughes & Mehlman, 1998).

My intent in this chapter is to discuss the emergent themes to expand the understanding of the PAP dynamic with heavily supported narrative context due to the richness of the participants’ lived experiences and their own individual conveyance of how their parental experiences have related to the PAP dynamic as well as how their symptoms and pathology relate to their beginning the process of therapy. I hope to represent an evolving narrative to conceptualize the PAP dynamic as opposed to the evolution of a new theory surrounding the dynamic. This chapter evaluates the themes that emerged in answering the research questions and revisits some of the prior discussed literature. The following 12 themes evolved from answering the research questions: Research Question 1: How do adolescent psychotherapy patients who identify as having a PAP dynamic relationship with their biological parent describe their experience with that parent?: (1) the lived experience of the PAP dynamic, (2) the intrusion or expectation of access to external relationships, (3) the PAP evolved tension in the dynamic, (4)

PAP dynamic declarative experiences, (5) child as caregiver, (6) child as confidante, (7) ideal best friend identification, (8) ideal parent identification, (9) child’s experienced role in their family, and (10) healthy identifications of the PAP dynamic; Research Question 2: How does the PAP dynamic relate to the adolescent in psychotherapy and their presenting symptoms?: (11) reason for therapy and (12) narcissism in the soothing response need of the PAP-identified parent. Themes 1 and 11 are titled master themes and are themes that convey a universal experience amongst the participants. Master themes are considered a group experiential theme in IPA. Themes 2 through 10, and theme 12, are titled superordinate themes because they are personal experiential themes in IPA and are considered clusters of experiential statements (Smith et al., 2009).

Interpretation of Themes Research Question 1: How do adolescent psychotherapy patients who identify as having a PAP dynamic relationship with their biological parent describe their experience with that parent?

Master Theme 1: The Lived Experience of the PAP Dynamic During the course of interviewing, I was impressed by the participants’ multitiered and insightful reflections and how they were capable of richly and powerfully conveying their internal worlds, their search for their sense of self, and the confusion of fluctuating and often subjugated parental role experiences. These narratives brought me back to Freud's case of Dora, in which the patient was described as her father's confidante (Freud, 1905). Freud conveyed her paternal relationship that existed between Dora as skewed from an early age. Freud himself conveyed a peer dynamic that was never problematized and was only presented as an element of the narrative, but felt it was pertinent enough to label and be curious about. He described a vital

component of the narrative of the case that was a significant example of the suppression of a father’s expected role as, The nature of her disposition had always drawn her towards her father, and his numerous illnesses were bound to have increased her affection for him. In some of these illnesses, he would allow no one but her to discharge the lighter duties of his nursing. He had been so proud of the early growth of her intelligence that he had made her his confidante while she was still a child. It was she and not her mother, whom Frau K.'s appearance had driven out of more than one position. (p. 57) The significance of the confidante dynamic existing between the two conveys a detrimental flaw in the internalized assumptions of how a father should act with a daughter. It is parallel to how one would perceive a similarly aged friend or peer. Dora experienced the rupture of a daughter role to an idealized father and the suppression of the father’s role as a father.

The PAP dynamic revealed a conflicted, exploitive, and inconsistent parent–child relational dynamic in many of the narrative conveyances. O'Connor (2007) defined parentification for the child as a role in which the child has much more power and responsibility than developmentally appropriate. Brown (1989) discussed the struggle of the parentified child as grappling with the roles of caretaker and care-receiver in all relationships due to the loss of typical reciprocity evolving in the give and take that is normalized in most relations but runs on a deficit in a parentified role-modeled childhood. The PAP dynamic interviews contained material that would often convey these burdens. The participant Emilee similarly discussed that she feel(s) like (she’s) graduated a level from sort of if there's something between being a sibling slash a child and being a mom, I feel like that's kind of where I'm at right now, since I'm not only taking care of myself, but I'm also sort of taking care of my family.

Ron conveyed a similar caretaking dynamic: “I was kind of his alarm clock. Yeah, it was definitely just... I was the dad in that situation (cooking, paying bills, scheduling).”

Steinberger (1989) discussed the utilization of a child as a confidante in that the conflict relayed onto the child through being used as a confidante and ally during periods of marital discord places additional strain on the child's already present issues with instinctive separation anxiety. Allana said, “I'm kind of the one that has to mediate with my parents (when they would fight),” magnifying the separation anxiety burden a child carries in worrying when their parents argue. Stolorow (1979) described a case in which the child served as his mother's admiring little confidante, her little gentleman, and a narcissistic extension of herself. Anya similarly described the following: I sometimes struggle with feeling like I want to be an individual and I want her to see me as an individual because we are really similar. We look alike, and we believe a lot of similar things and sometimes I think she views me as more of an extension of herself.

This statement exposes some declarative narcissistic attributes that played into the experience of her PAP dynamic with her mother.

Superordinate Theme 2: The Intrusion or Expectation of Access to External Relationships The participants conveyed numerous variations of boundary violations to the normative parent–child expectations in a healthy dynamic. One of the examples that occurred with frequency in the interviews was the intrusion into the child’s social life in ways that conveyed an invasiveness and investigatory crossing in dialogue as opposed to a normal curiosity-based conversation that might exist in a healthier parent–child dynamic. Ron discussed how his father would try to play the cool card and hang out and smoke and drink with Ron’s friends as well as giving adolescent-like misogynist romantic advice around girls that were Ron’s age.

Fuligni and Eccles (1993) examined the links between parents’ adjustments to adolescents during early adolescence and early adolescence orientation toward parents and peers.

They discussed that the child’s increased orientation towards peers is at the expense of their closeness to their parents and that children "trade" a dependence on parents for reliance on peers.

The conflict of this shift going awry can be seen in Allie’s descriptions of her peer/parental fusion in this context. For example, Allie gave some very rich examples of this feeling of intrusion. She seemed uncomfortable and intended to justify the behavior, although it carried a declarative tone of discomfort to her. Allie stated, “she's just very interested in what's going on in my life and my friends' lives. She likes to be involved.” Allie continued to relay, with similar discomfort, “...and she's very involved, and she wants to know everything that's going on. She knows a lot about my friends and their families.” In a seemingly excuse-making way, Allie sought to justify this pursuit of information in a defensive tone: so, there's a greater connection between me and my mom on a bunch of different levels than there are with me and my friends. We're still connected, but there's just a different dynamic there. So, I keep her more informed, I think.

Superordinate Theme 3: The PAP Evolved Tension in the Dynamic The participants conveyed a narrative perspective into how the PAP dynamic started to evolve for them, hinting that the boundaries of parent and child began to fluctuate in confusing ways and that their anxiety and depression in some experiential way was somehow related to these PAP dynamic experiences. In Freud’s case of Dora (Freud, 1905), he mentions that Dora became the confidante and adviser to her father’s mistress in all the difficulties in her married life (p. 61). Dora was continuously, throughout the case, pulled into peer frameworks by the adults in her life, taking advantage of her by being utilized by numerous adults (her father, his

mistress, her spouse) as a venting ear. This exposed Dora’s insight and evolving awareness into her etiology of symptoms as related to constant disappointment in being close to an adult figure only to be utilized in one self-serving way or another.

Allie conveyed a budding awareness of feelings from her mother’s overprotectiveness and having to soothe her mother’s anxieties, aligning the reflection with a peer-like framework in balance of this need to soothe her mother. She stated, I feel like sometimes she worries a little bit too much about me, just a little bit on the overprotective side … We always try to do stuff together, go and get coffee sometimes, and we always check up and see how each other's day went and stuff like that.

Anya discussed having to set limits on her mother’s invasiveness with her relationship with her father. Anya felt she was expected by her mother to collegially join in a shared hostility towards her ex-husband. She explored this insight in describing the experience: I want to be close (with my mom) but I also really want a relationship with my dad and I want to figure it out for myself … I want to be able to navigate my own relationship with him, that's really important to me …so I remember for a little bit after that, maybe for a year after that, every time she would bring up my dad in a negative sense I would get a little bit like, “Can you not?”

Ron discussed the aspects that led to the PAP dynamic formation in his experiences with his father: He'd get drunk and stoned in front of my little brothers… So this place was a total hoarder's haven. Half the electricity in the house was working, the plumbing wasn't fully functional… It really wasn't a stable house, and because he was my buddy and he provided that safe place for me to get stoned or get drunk or do drugs, I would constantly

clean that house. That perpetual cycle of constantly cleaning, up-keeping, maintaining, doing everything that I could.

Superordinate Theme 4: PAP Dynamic Declarative Experiences Glenwick and Mowrey (1986) discussed the concept of an intergenerational boundary violation, including the abdication of the mother in her parental role, and a parent–child relationship in which the mother functions as a peer/partner, creating an ill-defined set of role expectations. Allie and Allana clearly conveyed two pertinent reflections on how the role of their parents was aligned along a peer realm. Allie discussed the ways in which there was a parallel to communications with her relationship with her mother and her closest friends: When she comes home from work, that's about the time I'm finishing up classes. So, I'll go downstairs and we'll just talk for a while. And I kind of find that with a lot of my friends the time goes by really quick when I'm talking to them, and it's just effortless conversation and we just talk about a bunch of things, and that's what I find with her.

When I come downstairs at the end of my school day, at the end of her school day, we'll just talk for a while. Hours will pass, and then we really don't even notice it, because we're just enjoying talking to each other and just catching up. So, in terms of just conversation, communication, I definitely see the kind of friend aspect there, because she's very easy to talk to. I'm able to talk to her about a lot of things, a lot of topics.

Allana discussed a thematic recurring role of diffusing and mediating their parents' conflicts like a friend interjecting themselves into an adolescent conflict: I mean, it's mostly them fighting and then my role is I'll often try to just ask them to go to bed, can we deal with this tomorrow because then sometimes there has been situations if it's kind of an extreme intoxication where then one of my parents will like threaten to

leave and my mom has multiple times before I come up had been like gathering my siblings and being like, "We're leaving." So I'm the one who's like, "No, we're not. Please just let everyone go to bed and deal with your issues by yourself." So I'm either asking them to stop or to take it somewhere away from me or my siblings or sometimes I like to console a parent if during a fight one of them stalks off. Sometimes the other is upset and I'm the one who consoles them.

Superordinate Theme 5: Child as Caregiver Most of the participants often found themselves in a role in which they were providing the maternal or paternal care for their parents. Bowlby (1980) discussed the concept of role reversal as an inverted relationship in which a symptom-producing experience occurs and a parent’s insecurities about their own attachment figures lead to an insecure attachment with their child, who they then seek and expect to be comforting to them. Zeanah and Klitzke (1991) explained that role reversal is a disordered relationship between parent and child, rooted in a dysfunctional interdependence leading to the inducing of the symptoms of mutual anger, disappointment, and anxiety. Emilee and Ron spoke most declaratively of the caregiver experience being a component of their PAP experiences.

Emilee discussed her contention with taking on an obligatory parentified role to her siblings and mother due to her mother’s educational pursuits and how that impeded her capacity to have a normative set of social experiences with her peers. She also exemplified a grandmotherly dynamic with parenting her mother and her siblings as a college student: Just having sort of like play dates or just hanging out with people without having to check my phone, to see if my sisters are okay or having to leave early because I have to put my sister to bed or being able to go to a sleepover whenever I want, because I know my

mom's not going to... because when she was doing her bachelor's it was in a different city.

So sometimes she'd have to spend the night there if she had classes at night. So I would have to be home with my sisters. So I couldn't go to some sleepovers in middle school, and high school because of that. So I think even when I was older, when I thought about a best friend, it was more about just even kind of being a different person myself and just being able to hang out with someone all day without any other obligations.

Ron discussed having to obtain secure housing and employment for his father with the role of stabilizing him. He described the feeling of a caregiving mandate of responsibility: ... so my dad ended up living with my aunt, his sister, for a little bit… they were getting pretty tired of having this old man just play music with the kids and get drunk every night in their house. So I had put quite a bit of money together at the time, and I almost felt this obligation to go out there and help him move out of there, and I did that. I pulled together enough money, and I tend to beat myself up for this a little bit even today... I pulled together enough money to have a down payment for tuition (for myself originally). (Then had to put that money) Towards an apartment. The down payment, the first month's rent, the security deposit, and second month's rent of an apartment And we both actually managed to get a job at the same establishment. So you've got to think just how potentially poisonous that is. You live in the same place and you work at the same place.

Emilee conveyed how she also naturally took on a maternal role in her friend groups and the maternal stances she took based on the perspective of this being a normalized role for her in her family. She experienced a nonreciprocal, adult-like healing mandate that infiltrated her social experiences:

… I do feel like I am a caretaker in the friend group. Usually people categorize me as the mom of the friend group, just for small reasons. I always bring snacks, and will pay for someone's meal if they don't have money and things like that. But I think more in like, I guess a interpersonal sense. I do prioritize checking in on people, and making sure people are doing okay and listening and really being there for my friend in less of a friendly way.

And I guess more of a caretaker or sometimes even, I don't know, I don't want to go so far as to say a therapist, but that's what I've had people tell me before.

Superordinate Theme 6: Child as Confidante The peer experience of confiding in and depending on the other to hold that vulnerability often does not contain a role differential that includes power over another. The act of being utilized as a confidante creates immense confusion for the child in the appearance of the PAP dynamic. Stolorow (1979) described a case in which a child served as his mother's admiring little confidante, her little gentleman, and a narcissistic extension of herself.

Anya discussed how she felt that she became utilized as the primary confidante to her mother, especially in a time of her mother’s distress: I definitely felt like I was the shoulder for her to lean on and then I guess more recently her boyfriend and her, they broke up, and there was a big fight and stuff, or not I don't know what it was, but she came to Charlottesville and we spent the whole day talking about it and I definitely felt like I was the support then.

Mark conveyed his burdened experiences in the role as confidante to his mother as well: “She would share with me what she's stressed about, what she struggles with at work.”

Superordinate Theme 7: Ideal Best Friend Identification The participants were asked about an ideal version of a best friend. These reflections became bound with the PAP dynamic’s imposition upon the culmination of that ideal for them. In Freud’s (1909) case of the Rat man, he discussed the moment in treatment when the Rat Man expressed his relationship with his father as something that came up with importance, but described as “somewhat disconnectedly” (Freud, 1909), and the patient told Freud that, he had been his father’s best friend, and that his father had been his. Except on a few subjects, upon which fathers and sons hold aloof from one another… there had been a greater intimacy between them than there now was between him and his best friend. As regards the lady for whose sake he had sacrificed his father in that idea of his,…The source from which the hostility to his father derived its indestructibility was evidently something in the nature of sensual desires, and in that connection he must have felt his father in some way or other an interference. (p. 182) Freud discussed the importance of this "disconnectedly" discussed moment when the father became a peer in the narrative and went so far as to consider the father an "interference" in connection to this dyad shift of a best friend peer relationship from a father and son relationship.

The fact that this peer relationship was "disconnectedly" discussed holds a significant meaning in regard to it being an essential element of an unconscious thought emerging. Interestingly, in the first session, Rat Man presented that he had been slighted by a friend who “had only taken him up in order to gain admission into [his] house” in the interest of romantically pursuing his sister (Freud, 1909, p. 7). The lead in of boundary violations and skewed peer interactions clouded by friendship bound with a narcissist exemplifies an aspect of peer/parent role confusion and

conditioned skepticism that impeded normal peer relations. The participants exemplified the fantasy, counter imposed by the burden of the PAP dynamic.

Emilee discussed a mournful version of an ideal best friend that was heavily overshadowed by her parental responsibilities: …when I was younger, I definitely wanted someone who would just play all day. This is when I was really young, just because I guess I feel I did have certain obligations at home and that was just something that I wanted, to go outside when the sun was rising and come back when the sun was setting and just play outside or swim or hike or play games or whatever it was. But I guess taking no breaks to do anything, that's more of a responsibility. Just having sort of like play dates or just hanging out with people without having to check my phone, to see if my sisters are okay or having to leave early because I have to put my sister to bed or being able to go to a sleepover whenever I want, because I know my mom's not going to.

Ron discussed an ideal best friend as one who would have healthier and more adult-like experiences of social interactions: Quite the opposite of any of my friends that I've ever had actually. Someone who likes to do healthy things, someone who actually likes to go for a run, someone who likes to debate philosophical things or speak about their meditations or go for a long bike ride, or go explore a new area, rather than sit around and mope and focus on negative things, or get stoned or whatever.

Superordinate Theme 8: Ideal Parent Identification Whilst conveying their ideal version of a parent, the participants’ experiences conveyed often had a context of mourning and reflecting in a parent-like way in how they act towards their

parents. In a pilot study (Sokal, 2015) that I ran prior to beginning this dissertation, four themes emerged that were discussed earlier in this dissertation. One of the themes that emerged from that study was a reflection of the ideal parent and parental failures. In the pilot study, the participants were asked to describe their perfect parent. Once they declared the qualities of an ideal parent, the conversation quickly shifted to the opposite of their perception of an ideal parent. The participants spent more time discussing their parents’ failures impacting the participants’ lives than the ideal attributes that were asked.

The results of the pilot study gave some insight into the implications into how the etiology of symptoms of an adolescent can relate to their psychological perceptions of their caregivers. The participants' conveyances of an ideal parent were bound within a frame of reference of the experiences they desired in which their parents did not practice or where they perceived parental failures. Emilee discussed her belief of child–parent friendship in parallel to an ideal parent performing the role of “instructor” to their children: I think parents should be friends, and I think that children should be able to go to their parents with anything that's bothering them. But I also think that parents, when it's needed, need to tell their children what's right. To not talk to strangers, or what to do if someone's stealing their lunch at school, things like that. I think those critical moments are when parents need to step back and not be a friend and be more of an instructor.

Allana discussed an ideal parent triaging safety and developing relational depth in a nonauthoritative way.

Parents should be supportive of their children to a very large extent, but they also should have the child's safety in mind first. It's hard because on one hand, you have this responsibility to take care of this tiny human, help them grow, help them be prepared for

the world. And then on the other hand though, I feel like you should also get to know your kid as well. Don't just treat them as your child. Get to know them as a person and try to have a relationship with them besides just an authoritative role. It's a balance, I guess, of both of those things.

Mark discussed an ideal parent from the perspective of an empath teaching role model: I think that a parent has an immense responsibility to impart particular behavioral characteristics that allow them to function in society as what we deem as a good human being. The number one thing I would say being empathy. I think that a parent's role is to impart a degree of empathy in their child, so that they can relate better to other human beings. Then alongside that, I think there should be a degree of generosity, work ethic. I guess the role to not go into nuanced something, it would be to impart values, to import values and behavioral characteristics that are lived out within the kids.

Ron identified an ideal parent as a role model whose role is to prepare their child for the way in which they see them living a successful life, both from a professional perspective and an alignment to a more boundried version healthier than he experienced: What I would imagine a parent would say is... I would imagine that a parent might try to give advice on how to approach someone the right way, politely, and not like an animal with your genitals already out….I think parents should definitely lead by example, because as a person who learns more so by example, and actually practicing the task myself, to just tell someone bluntly, "This is what you do, and you don't do this," that's not going to teach a kid. I think you need to lead by example, and if you go through life calmly, collected, and your child sees that, to go through life calmly, collected, and to sort of meditate on your response in a very small, brief period of time, before you go

muttering out whatever comes to your mind in the moment, life might go the child's way much better…And to just teach children to not be so reactive. Like knee-jerk reactions. I have a couple of friends that are like this, where when they were younger, they would scream and kick and cry, and mom would buy them the toy. And now they're 24, and they scream and kick and cry and now he has a Mercedes Benz…Oh no. If your child is having a tantrum, some people would call this neglect but just don't pay any attention? Be as stoic as you can as a parent. I don't mean stoicism to the extreme, where you're a cardboard box. I think people take stoicism too far. Just stoicism in the sense of selfcontrol. I think that's a very, very key thing that parents should focus on when raising children. Also, parents should really focus on manifesting what it is that you want to achieve in the world. How to go about achieving your goals. Giving your child the proper tools, the strategic tools, to see something that you know nothing about, but you like. So let's say I like carpentry, but I know nothing about carpentry. Okay, well now I need to utilize social skills and find out who to talk to get an apprenticeship to do this. So how do I do that? And how do I talk to this person the right way? I think it's definitely a parent's job to give their child those tools.

Superordinate Theme 9: Child’s Experienced Role in Their Family When asked about their perception of their identified role in their family, there was immense variation that carried a common theme of primary parental in nature and, in one instance, more bound in the participant’s addiction pathology. Allie discussed being a best friend to her mother; Anya saw herself as the one who deepened connections and invoked dialogue of relational expansion to her family members, including her sibling; Emillee saw herself as maternal; Ron saw himself as a caretaker; Allana felt they were a mediator; and Ron saw himself

as the ostracized disappointing figure. Erikson (1968) discussed the adolescent period as the stage of development of inner identity in part based from successive identifications of the earlier years when the child wanted to be and was forced to become like the people whom the child was dependent. Waterman (1982) built on Erikson's concept by hypothesizing that parental behavior contributes to identity formation. These skewed roles in the family, with the prevalent experience revolving around the PAP dynamic, has a foreshadowing of the subjugation of the parent–child relationship having a significant likely correlation to symptoms evolving as a byproduct.

Allie talked about her role as that of being more connected and a best-friend figure to her mother, but in a collaborative coparenting frame of dialogue in the context of her sibling: In my family, I would say I'm more the easygoing one out of the two siblings. …I would say that I would think that I talk to both of my parents a little more than she does, …Yeah. Also, my mom and I, we often just talk about what she's doing and stuff like that.

So, when there is something going on with her, I think in the sense that I was kind of always home and I would always just talk to my mom, we'd always go out for coffee or go get breakfast or something like that, so we would kind of be just talking about my sister. My mom would ask my input on what she thinks would happen or just with some of her friends and her boyfriend and stuff like that. We would just kind of talk about that and what we think is going to happen, what we think would be the best for her. So, I think in that sense, I was just a little closer, and we just were more open and talked about more things together.

Anya saw her role as the one who fostered substantive and deeper connectedness: I think both in my relationship with my mom and in my relationship with my family, my role is to bring about connection and substantial conversation that leads us to getting to

know one another more, and challenging one another's ideas, and growing both as individuals and in our relationships with one another.

Emilee discussed her role as a declaratively maternal one: …. So I pay for my mom and my siblings, my sister's internet access since our internet was really bad. And then once everybody got sent home, no one could really sign on to school or sign on to work. So I just bought a router and set it up in my house and everything. So I think that's really the only way that I take care of my mom, but I'm also taking care of my siblings as well. And it does kind of feel like, I feel like I've graduated a level from sort of if there's something between being a sibling slash a child and being a mom, I feel like that's kind of where I'm at right now, since I'm not only taking care of myself, but I'm also sort of taking care of my family in a very small way… I see myself sort of fulfilling the role of a parent in financial support most of the time.

Emilee further discussed how her role as oldest sibling morphed into a maternal framework and played a part as well in the evolution of the PAP dynamic between her and her mother, more specifically in how her responsibilities evolved with each sibling and the ways in which she maternally related to them: … I guess I am kind of a caretaker, I mean, I'm the oldest, and then my other sister is 14, and then my youngest sister is 10. So my mom had my youngest sister when I was around the same age, 11, and I used to carry her around and people used to think that she was my baby. And I feel like I really internalized that where this was when my mom started to go back to school. So we were at home a lot, and I was the one who was taking care of her.

And I really do see her as almost more than a sister right now. I feel like we have a closer bond just because of all the times I put her to sleep, or was feeding her, playing with her,

carrying her during different things. So I think with my youngest sister, I'm definitely more of… a parent figure, maybe just the caretaker.

Mark evaluated his role in his family in parallel to his recovery story and reflections on his sense of ostracization in comparison to his siblings. His recovery story was what evolved into the parallel of his enmeshed and fluctuating boundaries with his mother due to the parallels in her recovery experiences: I definitely feel like I'm always trying to compensate for my years of being degenerate. I guess I have two families really, and so the role is a little... With my father's side, I have a sister and a brother who are both very high achieving. My little brother is intended to … for an elite institution. My sister gets perfect grades, is on a similar track and goes to a good school. For my whole life, I felt like a black sheep there because for a while, I was not on that track and definitely intended more towards homeless shelters and long-term rehab treatment places and……. Yeah, I've made a quick turnaround, but there's a still feeling of being a black sheep, feeling different and feeling like my conduct... I feel like I'm always trying to catch up and I'm a little bit behind, and I can't really rest easy with my family because I'm always making up for how I used to be.

Ron discussed his role as caretaker to his father and the way in which his father’s immaturity and parallel age state in his regressive behaviors allowed for his teenage self to flourish: It really wasn't a stable house, and because he was my buddy and he provided that safe place for me to get stoned or get drunk or do drugs, I would constantly clean that house.

That perpetual cycle of constantly cleaning, up-keeping, maintaining, doing everything that I could.

Superordinate Theme 10: Healthy Identifications of the PAP Dynamic A pertinent theme that arose in response to the first research question was healthy examples of the PAP dynamic. These examples were primarily conveyed by Allie and Anya who had some very declarative parent and child delineated boundaries, experiences of those boundaries, and a clear sense of parental role identifiers. The below quotes are attributed to Allie and her experience of her mother. She seemed to have the healthiest reflective experience of the PAP dynamic as not stress magnifying but supportive and caring with a closeness that had reciprocal senses of friendship, with a clear delineation of parent and child. They are listed again for their clarity as they do not all warrant an introduction individually.

“So, I think we've had a good relationship, and they've really been able to help me and get me whatever help I needed.”

“I'm able to talk to her about really whatever I want to. She's very supportive.”

“She's very caring. She really likes to take care of people.”

I still have all my childhood memories of her being an authoritative, parental adult kind of figure. And still, I think I have a great amount of respect for her as well. I've tried to keep her informed more than I would keep my friends informed, just because I know that she'll worry about me and want to know that I'm safe and I'm doing okay.

“I truly appreciated how much she does on a daily basis and all the stuff that she has to do just to keep our household running and everything that she's responsible for.”

I also list Anya’s declarative examples of a healthy dynamic: “(She)…sees me as my own human being, my own person.” …when I am upset or struggling with something and I'm coming to her for advice, especially when I'm sad or just not feeling great or excited about life and if I express that

to her, she always really hears me and gives me really good advice. I definitely have felt like more the parent/child relationship.

In a more expansive example, Anya discussed her observations of her mother’s flaws being discussed in a way of sage and imperfect advisor, with a clearly set boundary of the conversation being a mother-to-daughter dynamic interaction: (her imperfections) It definitely made her more human to me, I guess it's a typical thing to kind of glorify your parent or put them on this pedestal and think they're perfect. I definitely think seeing her vulnerable and trying to figure out how to navigate these complicated relationships, I guess made me feel like she's a human being too and she's figuring it out too and she doesn't have all the answers. It's like a good feeling, it's almost like, I'm not alone in, I don't know what I'm doing, or how to navigate certain situations, like both her and I are still learning those things. And even though she's older and wiser, she still has those questions and still struggles to make sense of why things are happening the way they are and stuff like that.

Research Question 2: How does the PAP dynamic relate to the adolescent in psychotherapy and their presenting symptoms?

Master Theme 11: Reason for Therapy The stated reason for therapy was varied. Each participant conveyed a symptom reflective reason. Ron was the only participant who blatantly labeled his therapeutic reasoning as directly a byproduct of his PAP dynamic experiences. When the narrative context of someone’s reason for symptoms appearing evolves in the therapeutic process, it is often bound in incremental insights and realizations. I have chosen to convey the data of identifiers in a visual aid (see Table 2) that entails the identified reason, narrative identifiers of reasoning,

supplemental factor data included in the chart in the previous chapter, and the identified PAP dynamic.

Table 2 Title Pseudonym

Identified reason for therapy

Narrative identifiers

Supplemental data

PAP dynamic

Allana

“I became “I found myself in that Parents suffer Mediator to severely same kind of very low from parental depressed and point. I had attempted alcoholism, conflict, very (suicide) before when I frequent peer-like anxious.” was around 15 or 16, try home hanging out to start therapy, but my conflict, with father. mother was like, suicide "You're fine." And also attempts, she had this skepticism home of therapists where only during someone who has a lot pandemic. of issues will go into that, and you never know….Also, I was molested as a child.”

Emilee

“I was sleeping “she (her mother) was just in really late, kind of telling me how and sort of my the situation sounds falling behind pretty similar to what in my work. she feels and also what Anxiety.” she went through when she was around my age, when her mom died.

Parents Maternal to separated, siblings, mother had coparent to separated mother, parents, her parentified, mother’s monetary father died provider to when she household was a needs. child.

Pseudonym

Anya

Identified reason for therapy “I was exploring my sexuality and realizing that I was attracted to women and men, or I guess no, that's not even true, I'm attracted to people, and it's not about gender. So, when I was figuring that out I definitely felt more judged than embraced, at least initially, by my parents.”

Narrative identifiers

Supplemental data

“I think I struggle Parents sometimes with feeling divorced. like I want to be my own person and I think that's a normal stage in life of trying to figure out what parts of your parent you're like and what parts you don't want to be like. And I think since I'm pursuing the same path as her (my mom), I sometimes struggle with feeling like I want to be an individual and I want her to see me as an individual because we are really similar”

PAP dynamic

Confidante to mother in divorce conflict, enmeshed with mother’s expectations of shared anger at exhusband.

Pseudonym

Mark

Identified reason for therapy

Narrative identifiers

Supplemental data

PAP dynamic

“being an “my family was the Parents both alcoholic and closest people to me and recovering an addict they bore witness to my alcoholics, comes with self-destruction and parents immense guilt destruction to the family divorced. dynamic. I stole from and shame” them, constantly lying “There's my and they watched me inability to implode. When I got handle my sober and I started own emotions looking at the facts on made my paper about how I was parents be and what I did, I didn't like, "What is want to add anything to wrong with that list further. I think this kid? We probably out of guilt got to send and shame and a desire him to to no longer put those someone who burdens on her can help (oversharing negative him." behaviors with mother), I stopped. Also, knowing that my mom is incredibly emotional and sensitive, I realized that though I may be getting it probably a degree of relief from her being the maternal figure in my life, which a maternal figure is very essential I think in the formative years to developing emotional empathy and things like that, I realized that rather than with all the…

Confidante and close friend experience with mother, poor boundaries around recovery, explicit personal life oversharing expectations reciprocally with mother.

Pseudonym

Mark (continued)

Ron

Identified reason for therapy

Narrative identifiers

Supplemental data

PAP dynamic

…relief that it might give me, it brought along some guilt whenever I did divulge things. Then I also realized I was probably hurting her too, and the calculation there didn't seem to be worth it….I had a complete inability to handle my own emotions” “I was in the “At the time, I mean the Parents basement, on majority of middle divorced, the phone teenagers are going to father has with my dad, want a safe place to go bipolar screaming, get stoned and drunk disorder.

"Please get and hang out and talk out of my and be able to bring head, please their friends and party leave me safely, without suffering alone. I don't any consequences. want you to That's like the 16-yearmake my old heaven. A fridge thoughts for constantly full of beer, a me anymore." place to smoke weed in And that's the open, and just what... constantly loud music screaming, that you like. He "Please get provided that, and he out of my would play along too. head, leave So he was just as much me alone," a part of it as any of my was what friends would be sexual initiated the advances… start for therapy.”

Best friend and good buddy with father, parentified towards father, fiscal support to father.

Pseudonym

Ron (continued)

Allie

Identified reason for therapy

Narrative identifiers

Supplemental data

PAP dynamic

“I was “ I was noticing more Healthy struggling anxiety, and the OCD examples with OCD tendencies weren't of PAP tendencies…” coming back, but I dynamic, knew that the transition home into high school had during the made them definitely pandemic. worse. So, I wanted to kind of get ahead of that. So, I started seeing a therapist that summer in hopes of just learning some coping strategies and stuff like that just so that they wouldn't get worse if I had additional stress and stuff in the transition to college.”

Best friend to mother, coparenting examples, anxiety creation by mom in daughters’ independent states.

…Like if I wanted to talk to a girl, he would be the pat on the back and, "Oh yeah, you can lay any girl you want. Look at you, you're the hottest man alive.

You're on the cover of TIME magazine, you can have any woman you want." When in all reality that's not the truth, that's not how things work.”

Note. OCD = Obsessive compulsive disorder; PAP = Parent-as-peer.

Superordinate Theme 12: Narcissism in the Soothing Response Need of the PAP-Identified Parent A commonly recurring theme that arose in the participants’ narratives was a version of narcissism in the parents who had an identified PAP dynamic that required a nonreciprocal version of empathy from the child to soothe their anxieties, placate narcissistic enmeshed emotional needs, and create a mandated reversal of caretaking roles. These narcissistic examples play into the child’s role confusion, symptom activation, and the subjugation of some core developmental experiences that clearly delineate a child in the role of child, cared for and taken care of by a parent.

Stolorow (1979) discussed a case in which a mother viewed her son as her confidante and labeled him a little gentleman and narcissistic extension of herself. The behaviors of the narcissistic parent using her son as a confidante and seeing him like a small adult led to disturbances of his patient’s self-esteem that clearly led to his seeking treatment. Chase (1999) discussed the narcissistically parentified child as giving up their self-actualization for the narcissistic parent's ego ideal. Chase viewed the child's role as the parent's object who is used to live out the attempted repair of the parent's low self-esteem, deficiencies, and losses undifferentiated from the child's self. Miller (2008) discussed the concept of a gifted child who becomes gifted as a burden of a parent's narcissistic needs, growing so profoundly attuned to meeting the parental needs and expectations that they become heightened in their intelligence of sensitivity, attunement, and awareness in another’s emotional needs. The narcissistic parent dynamic’s appearance in literature exemplifies that when the narcissistic parent forms a bond of objectification and expectation fulfillment of their own self-oriented needs, they are in clear opposition to the empathic realm of a child’s needs, no matter the age.

The following quotes convey this narcissistic nuance of a parental need that usurps a normative child–parent dynamic. Allie discussed two clear examples of a shared anxiety that was created by her mother’s symptoms of anxiety needing to be placated at the expense of Allie’s independence and functioning externally from her mother: Just at school last year I noticed there would be times where I was either just studying or visiting someone or just sleeping in, and if I didn't text her back soon enough she would start getting really worried. She didn't really know where I was. And if it were a longer time interval between the last few times I texted her, I think I could see that a little bit more, but it would be shorter time intervals, which I would think normally she would just assume that I was doing something, I was busy, I was sleeping, something like that. But she just got very worried often.

Allie went on to discuss the following: She would text me a lot. She would call me. She would ask me, "Are you okay? Where are you? You haven't gotten back to me in a while. You should really keep your phone on you," just stuff like that.

Anya discussed a tension of enmeshment and serving as an expected extension of her mother’s ego that she feels her mother unjustly and frustratingly imposed upon her: I think I struggle sometimes with feeling like I want to be my own person and I think that's a normal stage in life of trying to figure out what parts of your parent you're like and what parts you don't want to be like. And I think since I'm pursuing the same path as her, I sometimes struggle with feeling like I want to be an individual and I want her to see me as an individual because we are really similar. We look alike, and we believe a lot of similar things and sometimes I think she views me as more of an extension of herself,

Mark discussed feeling like an object to his mother, representing “self-indulging bragging rights” due to his successful recovery process, and that he would receive hostile emotional consequences from her if he confronted his discomfort of her usage of his successes: She often uses me as a poster boy. I go to meetings with her friends, and they all think I'm some shining star because I got sober young when that's not really a healthy way of viewing oneself. I think it's probably a lot more appropriate to just be I'm just like everybody else and I'm on the same path, rather than there's something special about me because I mean I'm unique and human, but there's no added value. It's just because I'm her son, and so that can irritate me at times, but I would rather have a close relationship and connect with her on that level and continue to grow in that area than let my own discomfort with it push her away.

Ron discussed an example of his father’s narcissistic entitlement to care at the hands of his son, which led to a significantly violent episode when Ron started to retreat from being the financial caregiver, job finder, coworker, harder worker, and bill payer: I had to wake him up and make sure he would get ready for work and make sure he wasn't late, so I was kind of his alarm clock. Yeah, it was definitely just... I was the dad in that situation, and eventually, at one point, I had quit that job that I was working at because it was another form of abuse in my life. And I was getting to the point where I couldn't take it, so I quit. I worked about 28 days straight with no time off. All 10 or 12 hour days. Then I quit, and we weren't doing very hot financially, but he was still working there. And when I told him that we should stop spending money on beer and cigarettes, that actually turned into a full-on fight….(his father made) threats of death.

And I stayed passive through the whole thing, which I actually am kind of proud of that

to this day. But yeah, that was a very physical, brutal altercation, and I packed my bags as he was kicking me down the stairs. I packed up everything I could in my hiking bag, and I went and stayed in a homeless shelter for about a half a week until I found a new apartment. And that was all a product of me trying to, again, be the parent and put down the iron fist and say, "No more beer and cigarettes. Let's do the healthy thing, and let's do what's financially right, and be responsible about this.”

Conclusion Statement The purpose of this phenomenological study was to understand the experience of the PAP dynamic for adolescents with psychotherapy experience. This study intended to gain insight into the background of adolescents who had psychotherapeutic treatment with an identified PAP dynamic, how this dynamic related to their relationship with their parents, and how this dynamic related to their presenting symptomatology. The narrative inquiries conveyed that the PAP dynamic played an integral role in the presenting symptoms and etiology of symptoms. The exposure through these rich narratives conveys that, in many cases, a parent's narcissistic needs in the PAP dynamic were essential to the clinical perspective of symptom appearance and activation and served as an integral aspect to confronting and asserting boundaries towards their identified PAP parent. In many cases, some participants declared a self-awareness around the dynamic, which led to a pertinent healing process. All of the narratives conveyed are sometimes subtle but often blatant expressions of Freud’s parental vertical axis and Mitchell’s (2013) horizontal fraternal/sibling axis crossing (Sokal, 2024), creating a confusion of the normative parent and child role delineations (see Figure 1).

The shared narratives exemplify deep rooted expressions of pain, trauma, and emotionally unmet needs in the experiences bound with the PAP dynamic. The participants in

this study also exemplified extreme strength, growth, self-awareness, and insight, which can be attributed to them seeking healing psychotherapeutic experiences, their desire for reparative experiences, their empathy for their family members’ humanity and flaws, as well as the fact that many of the participants conveyed in their post interview debriefings that their wish in participating in this study, and their experience post participation, was to be seen, heard, and reflective about this core and often traumatically confusing context of their lived experience.

Chapter 6 Considerations and Recommendations Clinical Considerations The purpose of this phenomenological study was to broaden understanding of the PAP dynamic, how this dynamic relates to the participants' relationship with their parents, and how this dynamic relates to their presenting symptomatology. Though the narratives conveying the participants' experiences of the PAP dynamic can have a relation to the etiology of presenting symptoms in this albeit small but richly descriptive study sample, it is difficult to address the PAP dynamic as a singular marker for specific appearances of general declared symptoms. The themes discovered in this evaluation of the PAP dynamic phenomenon can serve as markers for areas of strengthening a patient's insight into the nuances of experienced stressors surrounding boundary violations or fluctuations more broadly in many relationships. The negative affects induced by a nonparental relational boundary violation can often relate to family-of-origin dynamics. These family-of-origin dynamics, especially with a PAP dynamic, can be a supplemental point of insight into one’s internal reactions, symptom activations, interpersonal trauma responses, and the sense making to the logical realm from the affective realm that can lead to self-understanding, reparative experiences, and reduced symptomatic activations, which are common byproducts of successful psychotherapeutic treatments.

Clinical Recommendations General Summary In the expression of the PAP dynamic, it was clear that a parent whose internal needs of their adolescent child serving as a peer, best friend, and or confidante to them influenced anxiety and magnified symptomatology in the adolescent. The subjugation of the parental role found in

the PAP dynamic clearly caused a set of internal and relational conflicts appearing in their children. The possible unconscious exploitation of the adolescent for a parent's narcissistic needs in the PAP dynamic is essential to reflect on from a clinical viewpoint. If a parent acts like a friend, peer, or confidante, mental health symptoms can develop in the adolescent (GlickaufHughes & Mehlman, 1998). The insight gained in this study can assist the psychotherapists working with this dynamic in conceptualizing and identifying when the parent–child relationship is skewed and if the adolescent is at risk for increased development of negative attachment behaviors based on the severity of the parental role subjugations. The negative symptoms that might arise include promiscuousness, self-injurious behavior, engaging with peers with drugs and alcohol abuse tendencies, and diagnoses such as depression, anxiety, and personality disorders (A. Harris, 2009; Bernstein, 1999; Haule, 1999; Howard, 2013; T. Harris, 2007; Wurmser, 1979; Wurmser & Zients, 1982).

Clinical Recommendations When Working with PAP-Dynamic Patients 1. Ask about interpersonal dynamics in intake interviews, such as having them discuss their relationships with their parents and how that relationship would be identified.

2. Ask about specific familial roles and their experienced version of that role versus an idealized version of that role.

3. Maintain a sensitivity to experienced boundary violations, perceived roles of others, and how those roles might cause trauma if shifted or if they fluctuate.

4. Note transferential experiences in the clinical work in which role delineation could exist; for example, experiencing the therapist as a peer.

Revisiting Original Assumptions The original assumptions for this study were that the PAP dynamic directly relates to and impacts an adolescent psychotherapy patient's pathology. The adolescents presenting symptoms likely ebb and flow with the patterns of their parental relationship style. If the parent has a substantial role as an authoritative (Bowlby, 1969) adult, the adolescent feels secure in their development and exemplifies less pathology. A parent who exploits their adolescent as a peer, best friend, and or confidante influences a lack of stable growth, anxiety, and magnified symptomatology in the adolescent. If a PAP dynamic exists with a patient, it is a crucial factor and influence in the foreground of the etiology of symptoms as opposed to background information that is only a component of the etiology of symptoms.

My original assumptions hold true in variation of degrees of severity in reflection of the participants’ presented narratives. It was clear that in a PAP dynamic a parent whose internal needs of their adolescent child serving as a peer, best friend, and or confidante influenced, in some cases, a lack of stable growth, anxiety, and magnified symptomatology in the adolescent.

The lack of stable growth can be argued as a weak point in my original assumptions, as it is hard to developmentally identify with definitiveness, but the role shifts found in the PAP dynamic away from a parental experience clearly caused a set of appearing internal and relational conflicts in their children. As represented in the chart relating to Theme 11 (see Table 2), pathology has a clear relationship to the presenting PAP dynamic.

Strengths and Limitations Bloomberg and Volpe (2012) discussed the limitations of a study as consisting of conditions that weaken the study. These may include the validity and transferability issues of this study that are vulnerable due to the small sample size, my bias on the topic, and my possible

difficulty in taking an interviewer stance versus a therapeutic stance during the process of interviewing. Bloomberg and Volpe discussed examining delimitations as clarifying the boundaries of the study. This was achieved via my significant indications of the focus of the research scope and the problem (PAP dynamic), time, and location of the study (context of interviews and audit trailing).

Limitations of this study include the fact that there was a small sample size, that was not racially diverse, and that participants mainly fell on the later end of the adolescent scale. A focus more towards later adolescence and young adulthood experiences of the PAP dynamic might be a more prevalent framework for the title of this study. Strengths of this study include numerous factors. The context of the interviews was based on feedback and development from a team of consulted researchers and therapists. The interview questions were developed in reflection to a small two-participant pilot study, literature reviews, and interview development with a qualitative researcher. Field notes and audit trailing were a consistent practice in the context of the pre- interview, post interview, coding, and writing stage of the research. Interviews were recorded, professionally transcribed, and reviewed numerous times before the extensive process of consistent reevaluation of the coding and later theme emergence and development.

Future Recommendations Future research could include the expansion of the age range of the experienced dynamic in different developmental frameworks, especially in natural role-reversal experiences with an aging parent. Another realm of exploration could be what historical patterns of engagement could be reinvigorated in different developmental stages and how circumstances socially can impact the severity of role-fluctuating dynamics, such as economic crises causing moves back to family-

of-origin homes and pandemic-based experiences of decreased social exposure and home-based mandates impacting the experience of these types of dynamics.

Personal Reflection The participants’ shared narratives exemplified deep rooted expressions of pain, trauma, and emotionally unmet needs in the experiences bound with the PAP dynamic. The participants in this study also exemplified extreme insight and comfort conveying their stories and lived experiences that can likely be attributed to them seeking healing psychotherapeutic experiences.

The fact that many of the participants conveyed in their post interview debriefings that their participation in this study, and their experience post participation, was a fulfilling experience because they felt heard, seen, and valued was a very enriching thing to hear due to the brevity of this dissertation’s meaning to me and my reflection of the importance of acknowledging and valuing the PAP dynamic as a pertinent and primary component of this specifically presenting pathology to be taken seriously, cherished, and more deeply understood.

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Appendix A Individual Consent for Participation in Research INSTITUTE FOR CLINICAL SOCIAL WORK I,______________________________________, acting for myself, agree to take part in the research entitled: The Parent-As-Peer Relationship among Adolescents in Psychotherapeutic Treatment.

This work will be carried out by Daniel Sokal, LCSW (Principal Researcher) under the supervision of John Ridings, PhD (Sponsoring Faculty) This work is conducted under the auspices of the Institute for Clinical Social Work; 401 south State St., Suite 822; Chicago, IL 60601; (312) 935-4232.

Purpose This explorative study intends to report their narrative of this experience and to gain insight into the commonalities, themes, and significant patterns that arise.

1. What is the experience of adolescent psychotherapy patients who identify having a PAP relationship with their biological parent?

PROCEDURES USED IN THE STUDY AND THE DURATION Interviews will be via one to three, semi-structured interviews between the researcher and individual participants in video recorded digital format. The interviews will take no longer than ninety minutes. Participants will be given a ten dollar Amazon gift card for their participation after each interview via email, regardless of whether they complete the interview.

Benefits Benefits will include participation in an exploratory qualitative study that could improve therapeutic interventions in the field of mental health practice.

Costs There are no costs associated with participation.

Possible Risks and/or Side Effects Although risks cannot be predicted, the participant’s will have access to the National Suicide Prevention Hotline at 1-800-273-Talk and the Samaritans of NY Crisis Support Hotline 212-6733000 Privacy and Confidentiality Privacy and the confidentiality of the data will be protected. No identifiable data will be part of the transcription process or recorded interview. The only data that will be used are the participant's first name in the interviews and only the first initial of their first name in the writeup. No last names will be documented or recorded other than in the consent form that will be kept in a locked cabinet with medically compliant HIPAA files.

Subject Assurances By signing this consent form, I agree to take part in this study. I have not given up any of my rights or released this institution from responsibility for carelessness.

I may cancel my consent and refuse to continue in this study at any time without penalty or loss of benefits. My relationship with the staff of the ICSW will not be affected in any way, now or in the future, if I (or my child) refuse to take part, or if I begin the study and then withdraw.

If I have any questions about the research methods, I can contact Daniel Sokal, LCSW, at this phone number: 917-327-0425.

If I have any questions about my rights – or my child’s rights – as a research subject, I may contact John Ridings LCSW, PhD, Chair of Institutional Review Board; ICSW; (773) 263-6225 jridings@icsw.edu Signatures

[All consent forms must be signed and dated. They must be explained to the participants and witnessed by the person who is explaining the procedure.]

I have read this consent form and I agree to take part (or, to have my child take part) in this study as it is explained in this consent form. _________________________________ _____________ Signature of Participant Date Date I certify that I have explained the research to _____________________ (Name of subject or child) and believe that they understand and that they have agreed to participate freely. I agree to answer any additional questions when they arise during the research or afterward. ________________________________ ______________ Signature of Researcher Date

Appendix B Interview Guide Demographics/Identifying Data: Initials: DOB: Age: Race/Cultural identifiers: Psychiatric/Psychotherapy treatment history: Who in present home: Topic Related Questions: Can you tell me a little bit about why you volunteered to participate in my study?

Tell me a little bit about yourself.

Tell me a little bit about your parents.

Tell me about your mother, what is she like?

Tell me about your father, what is he like?

What’s your relationship like with your mother?

What’s your relationship like with your father?

Which of your parents are you closest too?

Describe the relationship you have with the parent you identify as a best friend, or good buddy?

Can you discuss some examples of this best friend or good buddy relationship?

Can you discuss some examples of when the relationship with this parent felt like a parent-child relationship?

How have you ever taken care of your parent? What were the things you did for them?

In what ways did helping your parent change the way you thought about them or the feeling you had for them?

Can you explain to me how you fit in to your family?

How does that make you feel?

How has this impacted your relationship with your parent(s)?

In other areas of your life?

What do you think should be the role of parents in their children’s lives?

Did you ever fantasize about what an ideal best friend would be?

What brought you to treatment with a therapist?

Appendix C Initial Phone Contact with Participants Participants will be vetted via an initial phone call consultation to respondents that verifies the following information: 1. The age of adolescence in this study is defined as age 18-22.

2. The parent is a biologically related parent to the adolescent.

3. Psychotherapeutic treatment must have occurred at least weekly in a mental health therapy clinic or private practice setting under the care of a licensed mental health therapist (Psychiatrists, Psychologists, PhDs, LPC’s, Marriage and Family Therapists, and master’s level Social Workers).

Based on the primary researcher’s evaluation of the possible participants tone and response style, perception of availability, ability to follow through of all requested interviews, and quality of responses to the vetting questions some initial responding participants will be assigned to the final sample of participants.

Phone Script Describing Research to Potential Participants My name is Daniel Sokal. I am a licensed clinical social worker and am completing my doctoral study for the Institute for Clinical Social Work in Chicago. My study will examine the experience of adolescents who have gotten psychotherapeutic treatment and describe their parent as a best friend, peer, confidante, or good buddy.

You will be asked to participate in up to three (90 minute) audio and video recorded interviews using same-time online meeting software (explain how the software works if the subject is

unclear). For online interviews, you will need to have a computer, internet access and a room where you can have privacy. During these interviews I will ask you questions regarding your relationship with your identified parent (the one who is your best friend, peer, pal, etc.). All identifying and personal information about you and your parent will be kept private. You will be asked to choose a fake name for yourself and your parent and I will use these names to identify you and your parent going forward in my study (so your friends and family members will never find out that you are taking part in my study). I will have our discussions transcribed (if the subject does not know what transcription is, then explain). You will also need to sign a consent form in order to participate in my study. A consent form is basically a written agreement between you and me that outlines the information I will collect from you, your rights as a research subject, and any risks and benefits that you might experience. For your participation, you will receive a $25 gift card for each interview you complete. Your participation is voluntary and you can quit at any time without penalty, but you will only be compensated for the interviews you complete.

Do you have any questions for me at this time? So, are you still interested in participating in my study?

If No Well, I appreciate you taking the time to talk to me and enjoy your day. If you end up changing your mind about being in my study, you can call me again at any time.

If Yes

So, what I need to do now is highlight some of the important points of the consent form.

(Important points are covered). Do you have any questions at this time about the consent form?

I’d like a few questions. In your own words: What will you be doing in this research project?

(Being interviewed/Answering questions) Can you refuse to answer interview questions?

(Yes) What will you do if you don’t want to answer a question?

(Don’t answer/Say I don’t want to answer the question/Say skip it) Can you leave or stop the research interviews at any time?

(Yes) Can you drop out of the study at any time?

(Yes) What happens if you drop out of the study?

(Nothing) Who will get to see your responses to the research questions?

(Only you/the researchers) Will I use your name when I discuss or write about this study?

(No) After this call I will email the link to you, and you’ll need to electronically sign it before our first interview. At the start of our first interview, I will re-review the consent form with you again to answer any final questions. Let’s schedule a time and day to conduct our first interview.

Appendix D Sample of Email and Facebook and LinkedIn Post to Recruit Participants My name is Daniel Sokal. I am a licensed clinical social worker and am completing my doctoral study for the Institute for Clinical Social Work in Chicago. I am seeking participants to interview online for a study that will examine the experience of adolescents (aged 18-21) who have received psychotherapeutic treatment and describe their parent as a best friend, peer, confidante, or good buddy. Participants will be compensated for each interview completed.

If you have a patient, friend, contact, or colleague who might fit the criteria or could refer possible participants and would also be interested in furthering the research of this topic please have them contact me via email at danielsokal@gmail.com or phone (917)327-0425.

Appendix E Sample Post to Social Media, Facebook and LinkedIn