But, to get more valuable information from the father, I also ask: How would your parents have handled that when you were growing up? How did that work out? What do you want your relationship with him to be like when he is a man? Expectations that can throw the father-child relationship out of whack usually come from the father’s own past.
How can you tell when it is family dynamics that are causing or interfering with the resolution of child behavior problems? It can help to consider common scenarios. Be open to being totally wrong, but listen to the family’s examples for "syndromes" of what may be happening at home. Some examples:
• Father is pressuring child to succeed, or pressuring the child to be aggressive, and the child rebels.
• Father steps in when mother is having trouble and thereby undermines her authority, making the child sassy.
• Mother steps in when she thinks father is being too tough, undermining him, making the child oppositional.
• Father feels child management is "not his responsibility," but then blocks mother’s efforts when he can’t stand the child’s crying.
How can you interpret these dynamics to help move the family to more adaptive patterns? At the risk of seeming too traditional, draw a family system figure showing the "ideal" of two parents with a close and equal relationship with the child below them (with lower power), but equal relationships with each. Ask each parent how they would draw their own family balance. Then problem solve with them on how they can make their balance more like your figure. This might mean mother deferring to father more, father showing more affection to mother, or both at least not interfering in the other’s management of child behaviors.
We clinicians need to watch out – we are not immune to bias about fathers that can be subtly transmitted and interfere with good care and problem-solving. Maybe we are more inclined to think that men will overuse corporal punishment, be uninvolved, or initiate domestic violence or sexual abuse. We may add this prejudice to race or culture bias. Bias may also make us expect men to be more effective in child management, or more brave or reliable. Our biases can come from general statistics or from our own family experiences. To really engage fathers, we need to step back and be open to each parent for their strengths and weaknesses, regardless of gender.
Dr. Howard is assistant professor of pediatrics at the Johns Hopkins University School of Medicine, Baltimore, and creator of CHADIS. She has no other relevant financial disclosures. E-mail her at pdnews@frontlinemedcom.com.