Inside the Consulting Room. Episode 2. When Helping Everyone Becomes A Hidden Cry

Emily is the kid everyone leans on. She helps classmates, comforts younger students, and props up her family at home. From the outside, she looks unusually mature and “fine.” From the inside, she is carrying an unmanageably large life, using control to manage anxiety, isolation, and feelings she does not yet have words for.

I walk you through Emily’s story from the consulting room and the turning points that reveal what her politeness has been protecting. We explore emotional parentification, what it looks like when a child becomes the family stabilizer, and why extreme compliance can be less about empathy and more about fear. Along the way, I share the clinical questions that matter: what happens to anger that cannot be shown, where hard feelings go when they are never spoken, and how a young person can build an identity beyond being needed.

You’ll also hear how self-harm, restrictive eating, and excessive exercise can function as attempts at self-regulation rather than “bad behavior,” and why parents often miss the signs when they are navigating their own overwhelm or grief. The takeaway is simple and hard-won: caring for others should never require a child to abandon themselves.

If this resonated, subscribe, share it with someone who always plays the caretaker, and leave a review so more families can find it. What role did you learn to play to keep things “together”?

Transcript

Welcome To The Consulting Room

SPEAKER_00 0:00

Hello and welcome. I'm Kim Lee, child and adolescent psychotherapist, and I'm inviting you back into the consulting room to understand and to learn about the things that can happen within it. This is the story of Emily, the girl who felt responsible for everything. She sat upright in the chair. Her posture was composed, almost adult-like in its steadiness. And she spoke easily about others at her school, those who were struggling. And then she says, I just like to help people. Emily was thirteen. Teachers and to some extent her parents had noticed that she constantly worried about the well-being of others. She organized classmates, always was first to offer help for the teacher. She comforted younger pupils. And at home she spent much of her time supporting her parents and caring for her younger brother. Her parents described her as the one who keeps everything together. What they didn't realize, however, was that Emily's method of keeping everything together was rooted in her own need to try not to fall apart herself. She developed a number of methods. Cutting the insides of her arms had become the latest, drawing rather disturbing pictures of figures hanging from a tree, restricting her food intake and excessive exercising. Now, although it had been noted that she was looking a little leaner than she had been, nothing had been said. So the difficulty that presented itself was one in which a protective kind of collusion had formed. Some people will call it the elephant in the room. For me, it raised some very important but unasked questions. Why was this girl needing to be so compliant? How did she become so concerned with the needs of others? This was beyond the realms of empathy. Could it be that her own needs had had to be abandoned, and if so, why? To me it seemed that a driving powerful force of anxiety underpinned her preoccupation with the well being of others. At the time of the referral I wasn't aware of the self-harming behaviors, and neither were her parents. But I was concerned to note the weight loss and on inquiry learned that her parents believed it was a passing phase. Needless to say, such phases tend not to pass, and they tend to be things that young people grow into. When I interviewed her parents and took a case history, I was alerted to a number of indicators which in my mind possibly stood out signalling something worthy of further investigation. This is true with all case history sessions. Now I want to make it clear this isn't a criticism of parents because after all they haven't had the benefit of training. But I suppose one of my abiding concerns is that young people are at much greater risk of self-harm when they are in carrying impossible conflict which has nowhere to go, combined with all of the pressures of adolescence. From a clinical point of view, at first sight, I thought that Emily's behavior suggested something called emotional parentification. And this occurs when a child assumes responsibility that normally belongs to adults. And there are lots of reasons why this can arise. But in emotional parentification, the child becomes the stabilizer within the family. And this finds expression almost always beyond the home. We see it being enacted in other situations. And this pattern often develops when parents are struggling with separation, distress, or psychological overwhelm or dramatic events that have taken place within the family. It's a consequence rather than a criticism. And although such children may appear unusually mature, the role can restrict normal emotional development. The child learns to prioritize the emotional needs of others while suppressing their own. And the consequences of this can be very far reaching and progress through into adulthood. You know, people who talk about being a person or people pleaser, well, where'd that come from? So emotional projectation is not a standalone state, it's a position from which other difficulties may very well occur. Now inside the consulting room. In her first session, I was struck by Emily's preoccupation with presenting herself as a well mannered and polite, compliant young girl. She inquired as to my well being and even asked about my work, but then stated that she wasn't really sure why she was coming to see me. Yes, everything was fine and she was really very happy. She didn't understand why her parents had come to see me and why they thought she needed help from someone like me. So I said, Well, what do you think you need? And she said with what looked like a very forced smile, just to be left alone and not have people worry about me. Now I regarded this as something of a dynamite moment. This one comment pointed towards something potentially explosive within her, and it needed to be handled with great care. And I remember thinking to myself, You are so angry, but you just can't show it. Instead I said I understand. I didn't understand, but what I could see and hear was something that wasn't ready to be revealed or explored, and also it wasn't far from the surface. In another session she described in very great detail how concerned she was about a friend whose younger sister was being treated very badly at school. She was animated and determined to do everything she could to help the child. I listened, but then asked had she thought about telling her parents who might be able to have contact with this friend's sister's parents, and perhaps that might make things easier. That would be a waste of time, she said. And I said, Because her answer was brief. They're too busy. The picture was now becoming clearer. Emily had organized her worth and her identity around being alert to the needs of others and responding to them, but at the cost of her own. She had developed a kind of chameleon-like veneer, which gave a very functional impression of the fact that she was okay, but it had to do with a disproportionate concern about others and concealed something much more fragile underneath. During one session, I told her that I'd noticed that she was someone who seemed so very willing to try and look after others, and I knew how demanding that could be. I also said that sometimes it can be really hard work when we come into contact with other people who are struggling and upset. And I asked her what she did when she felt upset, and she listened and then replied, I don't really think about that. And so I said, No, I rather thought you didn't. And it makes me wonder where all those feelings must go. Somehow the quiet recognition that hard feelings existed even though they might not be acknowledged made it possible for Emily to be seen, be seen beneath her apparent capability, and the little Emily, who was struggling and hiding underneath, was taking care of herself in the absence of emotional availability in adults, was seen. As the weeks passed, Emily was able to describe how she controlled her sense of isolation and anxiety through restricting her food intake, her excessive exercise, and eventually the self-harming behavior. From a therapeutic framework, children who stabilize family dynamics often feel responsible for preventing emotional collapse. If tension arises they intervene. If someone's distressed, well they attempt to fix it. And Emily had learned to become a caretaker within the family. And it wasn't due to negligence on the part of the adults, it was due to painful events that were out of everybody's control within the family. And her parents weren't able to see what had happened because they were locked inside unimaginable grief. But eventually it became possible to help them, and they became people who were unlocked. Therapy allows the child to rediscover something that had been quietly lost, their own emotional life. Emily didn't stop caring for her family, but she began to recognize, as did her family, something new. That was that her feelings mattered too. Emily was a small person living in an unmanageably large life. She did very well. There are lots like Emily. Thank you for listening.