But it did make me wonder about how therapists deal with adult patients who have toxic parents.

The topic gets little, if any, attention in standard textbooks or in the psychiatric literature, perhaps reflecting the common and mistaken notion that adults, unlike children and the elderly, are not vulnerable to such emotional abuse.

All too often, I think, therapists have a bias to salvage relationships, even those that might be harmful to a patient. Instead, it is crucial to be open-minded and to consider whether maintaining the relationship is really healthy and desirable.

Likewise, the assumption that parents are predisposed to love their children unconditionally and protect them from harm is not universally true. I remember one patient, a man in his mid-20s, who came to me for depression and rock-bottom self-esteem.

It didn’t take long to find out why. He had recently come out as gay to his devoutly religious parents, who responded by disowning him. It gets worse: at a subsequent family dinner, his father took him aside and told him it would have been better if he, rather than his younger brother, had died in a car accident several years earlier.

Though terribly hurt and angry, this young man still hoped he could get his parents to accept his sexuality and asked me to meet with the three of them.

Image Credit... Craig Frazier

The session did not go well. The parents insisted that his “lifestyle” was a grave sin, incompatible with their deeply held religious beliefs. When I tried to explain that the scientific consensus was that he had no more choice about his sexual orientation than the color of his eyes, they were unmoved. They simply could not accept him as he was.