Upstate News

April 25, 2001
Darryl Geddes 315 464-4828

SUNY Upstate psychiatrist examines defiance in the family in new book

Defiance in children or adolescents is likely to occur when they lose faith in the adult world to care for them, suggests psychiatrist David Keith, M.D., in his new book, “Defiance in the Family: Finding Hope in Therapy” (Brunner-Routledge, 2001).

Keith will discuss his book Thursday, May 3 at 7:30 p.m. at Barnes and Noble Booksellers, 3454 Erie Boulevard East, Dewitt.

“Defiance is often an expression of a child or adolescent’s distress about their family,” said Keith, director of child and adolescent psychiatry and professor of psychiatry, family medicine and pediatrics at SUNY Upstate Medical University. “Parents may know intuitively that the child isn’t the only problem, but they may be too anxious to articulate what else is wrong. The child’s defiance is a successful way to divert attention away from other family problems. Punishment as a response has limits: it breeds only bitterness and brings more intense defiance.”

What can change the defiance, Keith suggests, are therapy sessions involving all family members. These sessions should pay attention not only to the defiance, but to other stresses in and around the family, he said.

“The tendency for many therapists is to see the individual who is in the most distress, or the individual who is most available,” he said. “My belief is that when the need for therapy is urgent, it is essential to include more family members at the therapy session.”

But some families balk at the idea of sitting down with the therapist. “A parent who requests to have an adolescent seen alone may be concerned for the child’s well being, while protecting an upsetting relationship,” Keith said. “Other times, a parent may not want to expose nonproblem children to the situation. However, most children are relieved to come to a setting which will provide help for the situation. We can only underestimate how much children worry about their family and its members.”

Keith maintains that therapy will likely fail if not all family members are included. “Clearly, there are so many more issues that cannot be addressed properly if only one parent is available,” he said. “That parent’s absence from the session might be indicative of the tension in the family.”

Keith’s book, co-written with Gary M. and Linda C. Connell, is a 224-page overview and analysis of what defiance is, how it arises in the family setting and what sort of therapeutic interventions are needed to resolve the problem. “Defiance in the Family” is written most specifically for practitioners who do therapy with families. However, it is a very readable book that would be of interest to anyone who deals with defiant children and adolescents, such as teachers, guidance counselors, and primary care practitioners. “Defiance in the Family” might also be helpful for parents as a consumer’s guide on what to expect in a therapy session.

Keith notes that therapy sessions begin with the first phone call, in which the therapist sets the ground rules, such as requesting that all family members be in attendance. “This power diminishes as empathy for the family develops,” he said.

The father, usually the family member who combines high rank and emotional distance, is interviewed first. The mother, who almost always is the expert on emotion and relationships in the family, is interviewed last. “Family members are less influenced by her views if they are kept until the end,” he noted.

The middle stages of therapy, according to Keith, may bring into focus issues simmering under the surface, such as parental depression or marital dysfunction. The therapist’s role is crucial in this stage to avoid the families desire, in some cases, to sabotage the therapist’s effort to help.

Terminating therapy is most often up to the patient and family. In all cases, Keith suggests that the issue of ending therapy be discussed early. “It’s usually the last question of the first session,” he said. “A therapist will ask: ‘Do you want to come back?’”

What should not be done, he said, is for the therapist to offer the false promise of greater progress should the sessions continue. “Families get what they need from therapy: When they are ready to take responsibility for their living it is time to end.”

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