Family Estrangement

When I started working in healthcare I never expected to see the number of people who are estranged from family members as I have encountered. It’s honestly more common for me to meet clients who are estranged from at least one family member than to meet clients who have completely intact familial relationships.

In my own clinical experience I’ve heard countless reasons for family estrangement: “They are toxic,” “It’s better for us to be apart,” “They only bring drama…” There can be emotional abuse, physical abuse, sexual abuse, or problems that arise over time like finances, inheritances, deaths, properties, custody, stepparents or stepchildren, etc. I wouldn’t say I’ve heard it all, because I haven’t, but I have heard a lot.

As a naive twenty year old in nursing school I remember introductory psychiatry and discussions around reparation and healing relationships. What I’ve learned over a decade in practice is that some relationships cannot be mended and that some individuals heal more fully with the absence of certain family members.

Possibly the most painful separations for clients to experience and recount are the loss of parent-child relationships. As the parent or the child. None of these estrangements happen quickly, and none happen easily. It is a long, painful process that starts often before either person is aware the distancing is happening. There is usually a final argument around something that has been continuously an issue or statement for years. But underneath there can be years of invalidation.

Clinically I often see the old adage “Hope springs eternal” come into play. Individuals chronically hope for change in relatives that often never comes to fruition leading to cut-off’s.

The opposite of estrangement is healthy family relationships in a tight knit family unit. Healthy relationships provide support, empathy, communication and love. Study after study finds that healthy families spend quality time together, which explains the chronic push for “family dinners” or “game nights” and put the phones away. These are tried and true methods to have daily or weekly quality time together. If there have been years of damage done then family dinners or outings likely will not fix it and the best medicine for estrangement is prevention.

But when estrangement is inevitable and you feel it is best for you in that moment then be at peace knowing you are doing what is right for you. When you think of that family member or members it may cause a feeling of pain or hurt because it is a loss. But if life is better for you, easier, emotionally more stable, if you feel a sense of relief living with estrangement then feel safe embracing it. Feel safe and comforted in the knowledge that you are not alone. There are many people and families with estranged family members.

Fill your life with love and laughter and feel justified to put up boundaries against pain and emotional turmoil.

I often share the following list with clients who suffer from feeling invalidated and not heard by family members or friends. This is taken from Dialectical Behavior Therapy Skills Workbook, by Mckay et al. and adapted from McKay et al. 1983.


  1. You have a right to need things from others. 
  2. You have a right to put yourself first sometimes.
  3. You have a right to feel and express you emotions or your pain. 
  4. You have the right to be the final judge of your beliefs. 
  5. You have the right to your convictions and beliefs. 
  6. You have the right to your experience- even if it’s different from other people’s.
  7. You have a right to protest any treatment or criticism that feels bad to you.
  8. You have a right to negotiate for change. 
  9. You have a right to ask for help, emotional support, or anything else you need.
  10. You have a right say no; saying no doesn’t make you bad or selfish. 
  11. You have a right not to justify yourself to others. 
  12. You have a right not to take responsibility for some else’s problem. 
  13. You have a right to choose not to respond to a situation. 
  14. You have a right, sometimes, to inconvenience  or disappoint others. 

You have a right to disentangle and disengage from people who are toxic to your life. You also have a right to try and re-engage at any time if that feels positive for you and your family.

Psychiatry is meant to be healing work. Sometimes to heal distance is required.

“If we begin to understand that relationships are not cages, that family is not a cage, we could release, and be released without suffering so deeply and profoundly.” Fiona McCall

This is not meant to rationalize irrational behavior. And is not meant to be substituted for putting work in to mend relationships if they can be mended. It is meant to bring peace in a moment when you may feel turmoil.

Seeking therapy and objective feedback is a great first step in exploring your own family dynamics and individual boundaries. Find someone you can connect with and who will validate your experience. And may you find peace.




Ten Signs You May Benefit From an Anti-depressant (for adults)

Many clients call for a medication evaluation after months or years of struggling with the decision to try psychiatric medication. You may have thought “I just need to suck it up,” “So many people have it worse” “I can just power through”. You may have been told by therapists over the years that you could benefit from psychiatric medication, “But I work, I have a family, I’m functioning. I’m fine. I don’t have time. etc.” The following are ten common reasons patient’s present for medication assessments.

  1. You have been told by a therapist or multiple, by another healthcare provider, by a family member of friend that you could benefit from trying medication for your mood.
  2. You have thought about this decision for weeks, months, or years, with many times being able to talk yourself out of it.
  3. In the past six months there have been changes in your sleep and eating patterns either increasing in sleep and food consumption or decreasing in sleep and food consumption (weight loss or gain).
  4. You don’t feel like yourself. Something’s off. You’re more sad, more irritable, more anxious, more tearful, less motivated, less sexual drive, less able to concentrate, having difficulty at work, and your significant other and/or children notice a change in you.
  5. Hormonal changes can cause increase in depressive and anxiety symptoms- are you menopausal? Are you postpartum? Did you recently stop breast-feeding? Did you start or stop birth control? All of these changes can lead to changes in mood.
  6. Some one in your immediate family with whom you are genetically linked takes anti-depressants and feels a benefit from them.
  7. Season changes cause changes in mood. Is Winter always particularly difficult? Is Spring? Are you having more trouble this year “bouncing back”?
  8. Acute and chronic stress lead to changes in brain chemistry which can lead to depression and anxiety symptoms. Death of a loved one, sudden change in financial situation, divorce, job loss, job stress, traumatic relationships emotionally or physically or sexually. Traumatic childhood abuse over the course of years can lead to depression and anxiety symptoms in adulthood especially if particular memories are triggered.
  9. New diagnosis of a terminal or chronic medical illness can trigger depressive episodes that present with fatigue and pain in addition to other classic depressive symptoms.
  10. Anxiety and panic symptoms can be treated effectively with certain anti-depressants. If you have no depressive symptoms but suffer from high anxiety symptoms, social anxiety, panic symptoms more than three times a week, then you may benefit from an anti-depressant.

All of the above reasons generally impact a person’s level of functioning as an individual, as a spouse, parent, and employee or employer. Not everyone needs medication, but if you are suffering and your life is being impacted do not hesitate to call and seek an assessment. Maybe it’s time to not “power through” but to enjoy the journey.