Caught Like a Fish in the Net: Breaking the Dangerous Cycle of Hostile-Dependency
by Foster W. Cline, MD and Lisa C. Greene
We spend a lot of space in the book Parenting Children with Health Issues talking about hostile-dependency because it is so common and so dangerous when dealing with children (or adults) who have serious health issues. Danger is the correct word because, just like an unsuspecting fish who gets caught in a net, it can have life-altering results.
Hostile-dependency is when children (or adults) feel helpless or cheated and always demand more while expecting others to give it to them instead of accepting the responsibility of taking care of their own wants and needs. The common metaphor that describes this is: "He bites the hand that feeds him."
Hostile-dependent children are entitled, demanding, and blaming. A typical example might occur when a parent reminds a child every day to take his medication (or anything else for that matter). Then one day, when the child forgets the medication, he blames the parent: “You forgot to remind me!”
Because of the way they have been cared for, it is not uncommon to see ill children who are more burdened by psychological problems than by their physical illness. And when these children become adolescents and young adults, the psychological problems play a large role in their inability to successfully transition to independence.
Let’s see how this can so easily happen to loving, caring parents who are doing their best to take good care of their child:
Baby Johnny has cystic fibrosis and needs lots of care. When he is little, his parents make sure all of his needs are met- as all good parents do. They do whatever it takes to make him do his breathing treatments, take his medications, and eat properly.
As he gets older, they continue to make sure Johnny stays adherent. But they don't realize that some unhealthy patterns are starting to form. Mom and Dad try to make it easy for Johnny. They do all the work of loading the nebs and remembering the pills. Johnny generally gets to decide what is being served for dinner. And when he doesn’t like what another family member picks, he demands something else. So his mom jumps right to it because she knows he needs those calories.
Extended family members feel sorry for little Johnny so they buy him all kinds of toys and treats. When Johnny wants something, he doesn’t ask for it; he demands it. And, more often than not, he gets it. Johnny is becoming quite the little ruler on the family throne. The family’s life basically revolves around Johnny and meeting his needs (and demands).
So, the years fly by. Johnny hits the teen years and starts slipping in his medical adherence. He’s skipping breathing treatments and isn’t paying much attention to the calories. His weight and pulmonary function starts dropping. Of course, Mom and Dad are right there: nagging him, reminding, begging, pleading, even bribing. Because the parents are “responsible” for Johnny’s care and good health, Johnny blames his parents for his drop in PFT’s and weight. Now, his loving and concerned parents feel guilty that “they aren’t doing enough” to keep Johnny healthy. They believe that it’s still all their responsibility like when he was young. They start to come down hard on Johnny. The CF Team is concerned, too, so he gets it from everyone: "Why aren't you taking care of yourself? You need to do better."
Now he starts developing a bad attitude. He’s not helping around the house and is rude to everyone in the family. “I hate CF” and “Life sucks” are his favorite responses when Mom nags him to do his breathing treatments. She is stuck in a rock and a hard spot. She feels terrible about him having CF and feels guilty about his declining health but she finds that she just can’t make him comply anymore like when he was little. And, she just can’t handle the fights. Keeping him alive is becoming a battle. Everyone is frustrated. She excuses his whiny, negative behavior and actually validates it by apologizing “I’m sorry you have CF” and “I’m sorry you have to do your breathing treatments.” Like it's really her fault...
So Johnny’s self-image drops. All of the important things that go into building a child’s self-concept are not happening which result in escalating poor self-care. Things like:
· Learning to solve problems and taking responsibility
· Contributing to others and making a difference in the world
· A job well done and pride in doing things right; achievement
· Having effective role models
· Being encouraged by others
· Learning how to interpret and manage negative emotions
Since Johnny’s self-image is so low, he thinks, “Why bother? I’ll die anyways.” Depression might even become an issue at this point which further contributes to his downward spiral and continuing lack of self-care. So, of course his parents come down even harder on him and the unhappy cycle continues around and around. This is the cycle of hostile-dependency.
So what can parents do? There are steps that can be taken to deal with the problem:
Step 1: Because hostile-dependent and entitled children generally have “across the board” personality issues, parents can start by focusing on a particular behavior that they would like to see changed. This does not have to be the “worst” problem (like medical adherence), but simply a chronic problem that parents know will reoccur (like doing chores). The mind set, as Jim Fay of Love and Logic® (a popular parenting program on which PCWHI is based) says, is “Decide to experiment with _____.”
Step 2: Parents make an observation: “It makes me feel sad for you when I see you (hear you) ______.
Step 3: Parents calmly, showing as little frustration as possible, let the child know that his or her behavior drains their energy, making no other comment at this time. “It drains my energy when you ______.”
Step 4: Parents wait with patience for a situation within the next few days when their child wants something that would take energy to provide and is medically safe to withhold. This could be either an action (cooking a big dinner or taking the child some place he or she wants to go) or a material offering (something that you would usually pay for or provide).
Step 5: With sorrow for the child, the parents say something along the lines of: “Honey, I have some sad news for you. Ordinarily I would do (or provide) ______, but that would take energy. Remember a couple of days ago when you drained my energy by _______? I understand that you could be unhappy that I am not going to ______, but the good news is now that the energy has been equalized, you don’t have to feel guilty about draining it the other day.”
Saying “unhappy” to describe the child’s reaction at this point is probably an understatement because entitled or spoiled children pitch memorable fits and historically remarkable tantrums when they don’t get their way. The secret to success occurs when parents remain empathetic, calm, (not reassuring, pleading or showing frustration) and stick to their guns. Unwise parents get noisier, show frustration, and finally become angry. Even unwiser parents actually give in to the fit and give the child what he or she wants.
One simple way parents can combat entitlement is to set the expectation for good manners and being treated with respect. The earlier you start, the easier it is. Lisa recalls the times when her children were preschoolers and she would take the kids shopping. Like most kids this age, they’d say things like “I want this! I want that! Buy me this!” Knowing better than to reward such a demanding attitude, she immediately responded with an enforceable statement such as, “Sweetheart, I am happy to do (or buy) _____ for you when you ask nicely.”
Of course the kids would immediately respond (ever so sweetly) with, “May I please have ___?” to which she calmly replied, “Nice try. Next time, ask just like that - the first time.” The kids would say something like, “Awww!” and that was the end of it. After about three of these “manners training sessions” the kids learned to ask nicely- the first time. Of course, that was after Lisa had to remove a tantruming toddler from the store a time or two but that's a different story...
The book and movie The Secret Garden is a wonderful example of the cycle of hostile-dependency and what can happen when someone- even a young girl in this case- has the courage to stand up to such a person and say “No. I am not going to allow you to treat me this way.” Magic can happen. It happens in the movie and it can happen in real life, too. It is absolutely possible, with effective responses, to avoid the dangerous net of hostile-dependency.
Foster W. Cline, MD is a child psychiatrist and co-founder of Love and Logic®. Lisa C. Greene is a parent educator, public speaker, and mom of two children with cystic fibrosis. Together they have written the award-winning book “Parenting Children with Health Issues."Visit www.ParentingChildrenWithHealthIssues.com.
Copyright by Foster Cline, MD and Lisa Greene. All rights reserved.