Working with Families and the Parentified Child

By Jennifer Golick, PhD, LMFT, Clinical Director, Muir Wood

Parentification is often defined as a type of role reversal, boundary distortion, and inverted hierarchy between parents and other family members in which children or adolescents assume developmentally inappropriate levels of responsibility in the family of origin that go unrecognized, unsupported, and unrewarded. In the parentification phenomenon, the overarching role of the parentified child can be described as that of caregiver—caring for others at the expense of caring for self. It is often clinically observed and empirically examined along two dimensions: instrumental parentification and emotional parentification.

  • Instrumental parentification primarily involves completing physical tasks for the family such as taking care of relatives with serious medical conditions, grocery shopping, paying bills, or ensuring that a younger sibling attends and does well in school.
  • Emotional parentification often involves a child or adolescent taking on the role and responsibilities of confidant, secret keeper, or emotional healer for family members.

Parentification was first coined as a concept by Salvador Minuchin and colleagues (Minuchin, Montalvo, Guerney, Rosman, & Schumer, 1967) in the mid 1960s to refer to children who assume parental responsibility in the home as a result of economic and social conditions. Minuchin et al concluded that in parentification, “the parent(s) relinquishes executive functions by delegation of instrumental roles to a parental child or by total abandonment of the family psychologically and/or physically.” They asserted that children who experience parentification can perform a range of duties including responding to the emotional needs of parent or siblings, acting as peacemaker for the family (i.e., emotional parentification), and performing duties such as preparing meals, doing household chores, and handling financial matters (i.e., instrumental parentification).

In its simplest form, parentification occurs when a child assumes adult-like roles and responsibilities (Boszormenyi-Nagy & Spark, 1973). Typically, parentified children suppress and defer their own needs so that they can meet the needs of another family member (e.g., parent, caregiver, or sibling; Hooper, 2007, 2011).

There are approximately 1.3–1.4 million parentified children aged 8–18 in the United States (Diaz et al, 2007), and parentification is likely to be experienced by many children and adolescents worldwide. Educators, researchers, and mental healthcare providers are likely to encounter parentified adolescents, and the adults they become, with both short- and long-term aftereffects across many domains of functioning, such as interpersonal relationships, independent living and psychiatric stability (Chase, 1999; Cree, 2003; Diaz et al, 2007).

Although people who are parentified as children are not fated to experience negative outcomes such as psychiatric or relational impairment in adulthood. The aftereffects and malignant outcomes often seen in adulthood have been studied empirically and reported extensively in the clinical and research literature base (Chase, 1999; Hooper, Marotta, & Lanthier, 2008). Self-reported parentification in childhood is associated with negative outcomes in overall health and wellness across the lifespan (Chase, 1999).
According to family systems theory, the dynamic of the parent seeking care from their child represents a distortion of normal generational boundaries and leaves the child at risk of parentification. Parents whose own needs for nurturance were not met in childhood may attempt to satisfy their own emotional needs through their child (Boszormenyi-Nagy & Krasner, 1986; Karpel, 1976). Several decades of research have shown that people who experience parentification in childhood are at an increased risk of experiencing psychopathology in adulthood. Parentification, or the experiences and processes where children take on instrumental and emotional roles and responsibilities usually reserved for adults, has long been linked with negative ramifications (Boszormenyi-Nagy & Spark, 1973).

The parentfication discourse has focused largely on associations with pathology, such as the following conditions and disorders:

  • Trauma, distress, and adversity (Alexander, 1992; Boszormenyi-Nagy & Spark, 1973; Hooper, Marotta, & Lanthier, 2008; Karpel, 1976; Lackie, 1999; Minuchin, Montalvo, Guerney, Rosman, & Schumer, 1967)
  • Eating disorders (Rowa, Kerig, & Geller, 2001)
  • Mood disorders (Shifren & Kachorek, 2003)
  • Substance use disorders (Carroll & Robinson, 2000; Chase, Demming, & Wells, 1998; Godsall, Jurkovic, Emshoff, Anderson, & Stanwyck, 2004)
  • Dissociative disorders (Jones & Wells, 1996; Wells & Jones, 1998)
  • Personality disorders (Jones & Wells, 1996)

A considerable body of evidence suggests that the consequences of parentification are often destructive, crippling, traumatic, and negative (Alexander, Teti, & Anderson, 2000; Boszormenyi-Nagy & Spark, 1973; Byng-Hall, 2008; Chase; Hooper, Marotta, & Depuy, 2009; Jurkovic, 1997, 1998; L’Abate, 1998; Lackie, 1999). The negative outcomes have long been discussed and largely accepted as obvious (Byng-Hall, 2008; Chase, 1999; Cree, 2003; Hooper, 2007b; Jurkovic, 1997). Moreover, 40 years after the phenomenon of parentification was first described, the clinical narrative reviews and empirical research on parentification remains primarily focused on pathology (Fitzgerald et al, 2008; Hooper, 2007, Telzer & Fuligni, 2009; Thirkield, 2002).

Wells and Jones asserted that parentified children may not be able to fully separate and individuate themselves from their parents, possibly contributing to the development of self-defeating and narcissistic characteristics, which may, in turn, make those individuals more likely to use defensive splitting (i.e., “an attempt to separate our good and bad experiences” or competing psychological representations of self and others; Wells & Jones, 1998) in adulthood as a way of sheltering themselves from anxiety and emotional injury.

Case Example: Nancy described her son, Nick, as “her rock.” She proudly described how she relied upon him as a stable male in her life and how she “told him everything.” Nick, a dutiful son, was visibly uncomfortable as she described their relationship. He mumbled under his breath that he “didn’t want to know everything,” which Nancy disregarded and continued with her description of how proud she was of her son’s accomplishments and achievements, as well as his failures and faults. During her exalting dialogue of their relationship, Nancy’s husband, Rob, sat silently next to her. A disenfranchised member of his own marital dyad, he sat watching his wife laud her son as “the man” in her life while the man she married was sent out to the proverbial family pasture. Nick described the immense pressure he felt as being the recipient of his mother’s affection and adoration, as well as her emotional turmoil. He frequently turned to drugs and alcohol to cope with feelings of overwhelm and responsibility. His own intimate relationships with girls were infrequent and were often fraught with intrusions from Nancy.

On the surface, it appeared that no girl was good enough for her little boy. But under the surface, a more pathological motive lurked. Nancy needed Nick to remain single, because the idea of competing with another woman for his attention was so threatening to her and her ability to get her emotional needs met that she frequently sabotaged his attempts at forming age-appropriate relationships. Her efforts appeared to be largely unconscious and rooted in her own insecure attachments from her childhood. Thus, the cycle remained intact, with Nancy elevating her son to the level of spouse in the family, Rob being supplanted by his own son, and Nick the victim of parentification.

Case Discussion: A major difference between adult–adult attachment and the parent–child relationship is that the attachment behavior system in adults is reciprocal; in other words, adult partners are not assigned to or set in the role of “attachment figure/caregiver” or “attached individual/care receiver,” although this may be true in any given relationship. Both attachment behavior and serving as an attachment figure should be observable in individuals, and the two roles may shift rapidly between the partners. Other differences are that attachment relationships between adults often serve a wide variety of other functions, including sexual bonds, companionship, sense of competence, and shared purpose or experience (Ainsworth, 1985; Weiss, 1974). The insecurely attached adult in the parent dyad is more susceptible to engaging in emotional parentification with the child because of their inability to engage in a healthy, securely attached adult relationship.

The behavioral elements of attachment in adult life should be similar to those observed in infancy, and, in fact, adults do show a desire for proximity to the attachment figure when stressed, increased comfort in the presence of the attachment figure, and anxiety when the attachment figure is inaccessible (Weiss, 1982). It is reasonable to then expect that an adult who has insecure attachments in childhood may then enter into an adult relationship with the same insecure attachment style. This insecure attachment within the adult–adult relationship leaves the individual more likely to experience the inability to appropriately attach to the spouse, thus leaving the insecurely attached parent at risk of engaging in emotional parentification in the service of the attachment need. This process is largely unconscious and is driven by the need to experience an unconditionally nurturing relationship, which in turn upends the boundaries of healthy attachment as it places the child in the position of nurturing the parent and not the inverse. While some researchers note that parentification may result in the development of desirable attributes such as resourcefulness (Ungar, Theorn & Didkowsky, 2001), much of the literature stresses the adverse effects of childhood parentification.

Parentification as it exhibits itself in the therapeutic setting can allow a clinician to explore multi-generational attachment impairments along with the relational dynamics in the immediate relationship. However, the process of differentiating parentification from enmeshment is somewhat nuanced and requires the clinician to explore not only the impact that it is having on the child but also the intrinsic reward received by the parent. Although much of the research of parentification is focused on adult-onset psychopathology, it seems to reason that if the dynamic is encountered and intervened upon in adolescence, the potential for psychopathology is reduced. Addressing both the healthy emotional differentiation of the adolescent in conjunction with redirecting the parent’s emotional needs to more appropriate relationship.