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Four steps to proactive investment in family mental health and wellbeing

Renowned clinical and consulting psychotherapist Dr. Paul Hokemeyer outlines how families can get started on a path of proactive holistic wellness.
Clinical and consulting psychotherapist Dr. Paul Hokemeyer.

Renowned clinical and consulting psychotherapist Dr. Paul Hokemeyer outlines how families can get started on a path of proactive holistic wellness.

As a licensed marriage and family therapist, I have the privilege of working with families around the globe to enhance their mental health and relational functioning. In this regard, the bulk of my work centres on families who operate family business. Some of these businesses are massive global enterprises. Others are small, privately held operations that have been passed down through several generations. Many are enterprises such as family offices that have been formed to invest and manage the family’s wealth.  

On most days, my mobile only rings in the midst of a crisis. Someone in a family is suffering from a debilitating bout of depression, anxiety or a more severe issue such as bipolar disorder or schizophrenia to the point of chaos or destruction. Other times, I’m retained to help a couple deal with issues that are destroying their marriage such as a recently uncovered infidelity or with a child who ends up in a hospital or jail. Regardless of the situation, I always have the same thought, “It’s a shame we had to get to a state of crisis and see tangible destruction before you reached out for help.”

As an empirically based mental-health professional who has been licensed to work in the field of behavioural health for nearly two decades, I fully understand why this is the case. In my work with families, I constantly observe that when confronted with highly disturbing truths about their own or a family member’s mental health and relational functioning, my patients and clients engage in a number of mental tactics to distort the reality of the situation. In short, they either deny that the problem exists or rationalise it in a way that reduces its severity.

In the world of clinical psychology, these mental tactics are known as “defense mechanisms”. Through the defense mechanism of denial, patients and families block out any evidence that might suggest a mental health issue is budding in their midst. Through the defense of rationalisation, a family explains away the emerging problem by minimising it or blaming it on external or temporary circumstances.

The most recent examples from my clinical practice* illustrating these concepts are as follows.

Denial: A 56-year-old French mother rang me in tears after her 17-year-old son pushed her into their pool during his psychotic break. While the mother subsequently admitted she discovered drug paraphernalia in her son’s rucksack bag 18 months ago and noticed money was missing from her handbag, she believed him when he told her the crack pipe she found belonged to his friend and that she was “crazy” when she confronted him about the money.

Rationalisation: The business manager of a prominent English family rang me for assistance in placing the 22-year-old daughter of his boss, the patriarch of a global family business, into a treatment centre for eating disorders after the daughter fainted during a riding competition. The family was aware of the daughter’s “neurotic” eating habits for years, but attributed them to her social class and competitive drive for excellence.

In each of these two cases, the family had been presented with truths for a period of time that they had either denied existed or rationalised away. It’s important to note that in both cases, neither set of family members were irresponsible or unloving of their children. In fact, both families were well-educated, highly intelligent and exceptionally loving and supportive of their son and daughter. Their failure was not of loving enough, but rather of being blinded by their love to certain truths that no parent would want visited upon their children.

“Highly successful family businesses have begun to be proactive the mental health and relational wellbeing of their family.”


Recently, however, I’ve noticed that innovative and highly successful family businesses have begun to be proactive about issues related to the mental health and relational wellbeing of their family. I attribute this shift to the heightened awareness of the fragile line between health and wellness, order and chaos that emerged from the shadows of the pandemic. I also attribute it to the transition of power and wealth that is happening in families around the globe. These families, typically stewarded by what is known as “next gens”, second, third and fourth-generation family business and wealth holders understand and appreciate the importance of preventive care in their holistic wellness.

Unlike generations that came before them who focused almost exclusively on the family’s financial wellbeing, these subsequent generations see wellbeing as a dynamic construct that incorporates mental health and physical health into their family profit analysis. One of my patients, a 37-year Arab man currently living in Qatar said it brilliantly, “What good is my fortune if I’m paralysed by anxiety and hiding out from the world.” His point is clever and true.

As we emerge from the stresses of the pandemic, however, I’m buoyed with hope that one of the lessons high-performance families have learned is the importance of proactively engaging in their mental health and relational wellbeing. While I’ve certainly seen profound healing occur from problems that arise out of crisis, there are enormous benefits from families assessing and addressing mental and relational problems in advance. To get families started in this path of proactive holistic wellness, I’ve outlined the four steps I use in my practice below:

Information gathering: Because mental health issues in families are often hidden under layers of denial and rationalisation, families will benefit from engaging with an outside professional, a person fully licensed in a mental health discipline, to enter the family system as a journalist, studying the overall family functioning and each family member in it. The benefit of this analysis is an analogue to that of an outside auditor, a neutral person called into a family’s finances to assure there is nothing occurring to diminish the family’s financial wealth.

Risk Identification:Central to the mental health audit described above is the ability of the professional to identify any conditions in the family that places its mental and relational wellness at risk. In this regard, the family will be best served by keeping mental health issues in their proper realm, which is that of science rather than the realm of shame and stigma. Risks that I frequently see in the families with which I work included intergenerational trauma that manifests in subsequent generations as anxiety, depression and substance misuse.

Strategic Planning:Once the existing and potential risks are identified, the family will then be well served by articulating a strategic plan to address the issues identified. To be most effective, the plan should be on family strengths rather than individual weaknesses. For example, families that have identified intergenerational trauma that has manifested through anxiety should create a strategic plan that highlights where the family has utilised its past challenges through positive and reparative constructs, such as resilience and grit.

Risk Mitigation: Strategic plans are only valuable when implemented. As this relates to family’s holistic wellness, family plans should be implemented through psychoeducation and psychotherapeutic exercises. These exercises will objectively educate the family as to the causes, conditions and cures of the risks inherent in it and provide the family with a psychotherapeutic process to address them. In this regard, all family endeavours should be based on best practices. These are empirically based strategies to prevent and treat mental health disorders. As this relates to the example above, families who suffer from anxiety disorders can learn and practice empirically proven therapeutic techniques such as Cognitive Behavioural Therapy (CBT) to identify the thought distortions that lead to their anxiety.

Dance by Henri Matisse - Credit: Ralph Daily (Flickr)

The financial wellbeing of family enterprises is important. This is especially true in our modern world of disruption and uncertainty. But a family’s financial wellbeing is only half of the picture. The full portrait of a family will be revealed in the hues of their mental and relational health. While some families continue to exist in a dark and subdued palate, others are emerging from the pandemic with a vibrancy akin to Matisse’s famous Dance (1910). These clever families are realising they need not wait until darkness has overcome their wellbeing but rather, they can be proactive in painting their family’s future in bright hues and optimal functioning.

* The identifying details of these patient cases have been changed to protect the confidentiality of my patients.

Dr. Paul Hokemeyer is the author of Fragile Power (Hazelden, 2019). In this book, he sets forth a new paradigm for providing culturally competent and clinically effective mental and behavioural health care for ultra-high-net-worth (UHNW) individuals and families.

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