A Psychoanalytically Informed Systemic Approach to Helping Wounded Families Heal

In this episode, I speak with psychologist Kenneth Perlmutter about his work with wounded family systems and how his background shaped his therapeutic approach. Kenneth shared that he originally planned to go to medical school but switched to journalism, then worked in advertising in San Francisco in the 1980s. During that time, he worked with a therapist who made a profound impact on him, which ultimately inspired him to pursue graduate training and become a therapist himself. In 1989 he joined Boyer House as an intern, later becoming the Clinical Milieu Director, and it was there that he was placed on the Family Therapy team and found he really enjoyed working with family dynamics. Kenneth explained that his work is heavily informed by psychodynamic and psychoanalytic thinking, especially the ways people relate to others across different parts of their lives. He shared that his current clinic functions as a full-service mental health center with significant expertise in substance abuse, addiction recovery, and trauma-related disorders, and that many of their referrals involve college-age and young adult clients whose families are struggling to support them. We discussed how he uses a psychoanalytically informed systemic approach, paying close attention to attachment patterns, the family’s stage of development, and even reflections on his own family system. He talked about how wounded family systems often fall into patterns of dependency, such as exaggerated dependency, hostile dependency, or chronic dependency, and how parents may unknowingly reinforce these dynamics. He explained that he looks closely at what he calls the ‘S’ actions,” which include serving, soothing, saving, smoothing, solving, sacrificing, and sobbing, and how these actions often keep families stuck in their roles. He shared that when parents begin to shift their focus toward their own needs and adjust their responses, children often change their behaviors in positive ways. Kenneth also discussed how families tolerate hostility and how interventions often start by looking at the behaviors that enable it. He explained that part of the work is helping families understand how their system functions, what they want more or less of, and what keeps them locked in certain roles. He postulates on what can be considered “right” or “wrong” actions as a result of these pressures and gives the example of sending an adult child money time and time again under tenuous circumstances. He claims that