Introduction

Adverse and traumatic experiences in childhood predispose these children to parentification, a situation in which a child is forced to relinquish age-appropriate psychological needs to accommodate and care for the logistical or emotional needs of the parent (Haxhe, 2016; Hooper et al., 2011; Hooper & Wallace, 2010). Researchers differentiate between adaptive (or moderate) parentification and destructive (or pathological) parentification. Whereas the former is considered culturally fair, the latter is characterized by neglect of the child's psychological needs, which creates intense anxiety and chronic feelings of helplessness in the child (Hooper, 2007; Saha, 2016). Numerous quantitative studies have reported significant associations between childhood pathological parentification and an increased risk of psychopathology in adulthood (see the meta-analysis by Hooper et al., 2011). The most frequently documented pathologies are mood disorders, including depression (Schier et al., 2015; Shifren & Kachorek, 2003); personality impairments such as self-defeating characteristics; narcissistic personality characteristics (Jones & Wells, 1996); and substance use disorders (Godsall et al., 2004; Pasternak & Schier, 2012). Data have shown that increased engagement in parentification is associated with a variety of adverse outcomes to the self in adolescents, including self-harm (Bifulco et al., 2014), difficulties in separation–individuation, greater self-silencing (Goldner et al., 2021), and a low sense of self-esteem (Oznobishin & Kurman, 2009). Despite these disturbing findings, little is known about the lived experiences of children who have undergone destructive pathological parentification.

Background

Adequate parent–child psychological boundaries in which the parent(s) provides most of the caring for the child is considered a cornerstone of child development (Kerig, 2005; Macfie et al., 2015). Nevertheless, in some families and circumstances, severe disruption of the psychological boundaries between parents and children, known as parentification, takes place where parents turn to their children for concrete instrumental help with housekeeping chores or for emotional nurturance, support, comfort, and closeness.

Studies often distinguish between adaptive and destructive or pathological parentification (Byng-Hall, 2008; Saha, 2016). The adaptive form is relatively temporary and moderate in intensity and aligns with the family's cultural norms and the child's developmental stage. In this situation, the child is validated for her or his efforts in public. Thus, the child's caregiving efforts are perceived as fair and rewarding (Byng-Hall, 2008; Saha, 2016). This type of relationship, which is more often experienced by girls, may have positive outcomes for the child such as acquiring empathy, interpersonal competence (Champion et al., 2009), adaptive coping skills (Stein et al., 2007), a sense of self-worth (Titzmann, 2012), maturation, and motivation to excel (Byng-Hall, 2008).

By contrast, destructive or pathological parentification relationships are characterized by poor parental care, which is manifested by placing exaggerated, overburdening, long-lasting emotional responsibility, and instrumental caregiving on the child, which the child perceives as an intolerably heavy burden and unfair (Jankowski et al., 2013). These relational responsibilities do not coincide with these children's development stage and tend to generate anxiety and depressive feelings when they realize that they are not up to the challenge (Haxhe, 2016) and force children to abandon their own needs for self-assurance, recognition, support, and security to satisfy their parents' self-absorbed needs (Earley & Cushway, 2002; Walsh et al., 2006). In addition, they involve the violation and distortion of the psychological boundaries between parent and child accompanied by the parent's failure to acknowledge the psychological distinctiveness of the child (Nuttall et al., 2019). In some cases, adultification can emerge, where the child is expected to function as the caregiver's partner by taking an active role in decision-making and problem-solving while also serving as a friend and confidant (Garber, 2011). As a result, the child's developmental processes, including individuation, may be impaired (Goldner et al., 2021; Macfie et al., 2015).

Data indicate that this kind of relationship can arise from a variety of situations or intrapersonal factors such as the absence of a parent, parental dysfunction caused by parental mental illness or disability, substance use, immigration, parental conflict or divorce, domestic violence, parental insecure attachment style, maternal depression, neglectful parenting, or poor parental competence (e.g., Bifulco et al., 2014; Ponizovsky et al., 2012).

Conceptually, the negative consequences of parentification have been dealt with in several psychoanalytic theories, including attachment theory (Bowlby, 1980), object relations (Winnicott, 1965), self-psychology (Kohut, 1971), and family systems theories (Minuchin, 1974). All underscore the need for clear, distinct boundaries between parents and children in which the parents provide most of the scaffolding and support for child development that enable their emotional needs to be fulfilled. According to these theories, inappropriate parental demands instill a sense of inferiority, which hampers children's ability to form an autonomous, robust sense of self (Goldner et al., 2019; Goldner et al., 2021).

For instance, according to attachment theory, there are consistent positive associations between parental warmth, sensitivity, responsiveness, and healthy socioemotional adjustment (Kerns & Brumariu, 2016). In contrast, in situations of poor attachment, when children are forced to act as caretakers for their parents and siblings in order to respond to their attachment needs, parentified children may internalize negative representations of the self and others that may contribute to the multigenerational transmission of parentification (Hooper, 2007). Even though individuals who were parentified as children often maintain their positions as caregivers in adult relationships, these individuals are inclined to compensate for their childhood losses by turning to their children for their own nurturance, narcissistic, and relational needs (for a review, see Engelhardt, 2012).

Object relations theories (Winnicott, 1965, 1974) posit that parentification can instill a mental “fear of breakdown,” which describes an unthinkable state of mind rooted in the mother's failure to adequately care for her baby, impeding the development of the baby's primeval integrative self-sense. This fear creates self-organization defenses, including true/false self-split, in which the child internalizes the parent's ego ideal and is forced to relinquish his or her true wishes, needs, and goals to satisfy unfilled parental needs. Similarly, self-psychology theories consider that the development of a cohesive self-structure involves satisfying the child's selfobject needs for grandiosity, idealization, and twinship on the part of the parents. However, when parents fail to satisfy these needs, a pathological disorder of the self may appear, characterized by an underlying lack of self-cohesion, severe doubts about one's sense of esteem and continuity, and narcissistic pathology (Kohut, 1971).

Similarly, studies within the self-psychology framework consider that the need to fulfill the caregivers' narcissistic, self-absorbed needs while complying with their hostile and manipulative control increase the odds of developing a masochistic narcissistic vulnerability (Nehrig et al., 2019; Van Buren & Meehan, 2015) or narcissistic grandiosity and narcissistic personality disorder (Taillieu et al., 2016) in adulthood. Finally, family systems theory and research (Saha, 2016) suggest that parentification can be evaluated in terms of the perceived fairness of the tasks and responsibilities placed on children (Jurkovic, 1997).

Recently, to obtain a richer perspective on childhood experiences in parentification, several qualitative studies have examined how young adults make sense of their childhood experiences of substance-abusing or depressed parents and associated processes of parentification. These studies describe the fear, threats, lack of support and trust, and the absence of love and validation they felt as the victims of emotional abuse (Van Parys et al., 2015). Although the participants rarely reflected on their childhood experiences during their childhood and focused mainly on preserving their family's well-being, many recalled attempting in adolescence to achieve some form of psychological or physical distance and separate identity formation (Van Parys et al., 2015).

Comparable findings were found in a recent qualitative meta-analysis of 19 studies that investigated the experiences of young adults having a parent with a serious mental illness. The review found that the participants experienced their childhood as dysfunctional, neglectful, frightening, deviant, and uncomprehending. It involved a tremendous role-reversed relationship of caring for parents and siblings and was also accompanied by feelings of guilt, shame, loneliness, and relationship difficulties during childhood and later adult life (Källquist & Salzmann-Erikson, 2019).

The current study

Drawing on this literature, and to achieve a better understanding of the emotional experience, consequences to the self, and coping strategies related to parentification from children's perspectives, this study explored the retrospective perspectives of adult females who experienced parentification throughout their childhood and adolescence. Because parentification is considered a gendered phenomenon that appears to be more frequent in girls than in boys, especially in cases of divorce, neglect, and illness (Katz et al., 2009; Titzmann, 2012), it focused on the experiences of women.

METHOD

Participants and procedure

This work is a follow-up qualitative study to a quantitative study that investigated the adverse influences of mother–daughter parentification on these daughters' self-system (Goldner et al., 2021). We recruited participants through convenience sampling using advertisements on social media. The inclusion criteria were women who believed that they had taken on parental roles during their childhood and adolescence. Theoretical sampling (Glaser & Strauss, 1967) generated a diverse sample of women who experienced a range of types of parentification and situations leading up to it. This diversity was designed to shed light on the psychological experiences of the relationship, its profound implications, and the women's adaptive and maladaptive strategies. Data collection stopped after 19 interviews because the analysis reached theoretical saturation; that is, the interviews yielded no added information or insights. The final sample comprised 19 Israeli Jewish women aged 30–68. Most of the participants were born in Israel (n = 16) and had a college degree (n = 18). About half were the eldest daughters (n = 10) or daughters of divorced parents (n = 9). More than half were married and mothers (n = 11). After receiving approval from the Ethics Committee of the Faculty of Welfare and Health Sciences at the University of Haifa (Approval No. 295/19), the women were contacted by phone by the researchers, who explained the study's objectives and the procedure.

In-depth semistructured interviews

After signing consent forms that explained the aims of the study, face-to-face individual semistructured interviews were conducted. Semistructured interviews are more appropriate for a grounded theory study where the researcher has identified, albeit tentatively, numerous domains that have already situated the inquiry, which interviewing can then begin to expand upon (Foley et al., 2021). As a follow-up to our initial quantitative findings that concentrated on the influences of parentification on female adolescents' self-system, the current study delved deeper into the psychological effects of parentification and the coping strategies women employ.

During the interview, the participants described their experiences of parentification throughout their childhood and adolescence. We asked participants to describe the factors they felt were associated with parentification, how it unfolded, the impact of parentification, and their coping strategies.

The first author interviewed the participants and transcribed the interviews in Hebrew. Later, the second author and a language editor translated the transcripts into English. The transcribed interviews were initially analyzed separately by the two authors using the constructivist grounded theory approach advocated by Charmaz (2006, 2011). First, an initial line-by-line analysis of half of the interview transcriptions was conducted to assess their match with the research objectives (Charmaz, 2011). This line-by-line analysis is typical of open coding in classical grounded theory (Strauss & Corbin, 1990). These initial codes (akin to the axial coding phase in the original classical grounded theory literature), were used to identify recurring themes, which were then relabeled and categorized (Glaser & Strauss, 1967; Gordon-Finlayson, 2010). Throughout the analytical process, both researchers constantly compared data sets, discussed notes and codes, and discussed their interpretations of the meanings underlying the codes and themes. New themes emerged to saturation, which became increasingly conspicuous as the analyses unfolded. The progressive abstraction of the codes evolved into conceptual broader themes (initially referred to as selective or theoretical coding; see Strauss & Corbin, 1990) that were reconnected and combined into causal and consequential relationships. The researchers continued to write notes throughout the analysis on their interpretations and the relationships of and between the codes and the evolving themes. These notes continued to develop abstractly and conceptually and became a significant part of the model (Chun Tie et al., 2019). Disagreement in terms of the identification of the codes, the themes, or the interrelations between them were resolved through a series of conversations and discussions while rereviewing the participants' texts.

Although efforts were made to avoid applying theoretical concepts to the data (especially at the beginning of the analysis), clearly, the literature (mainly from psychoanalytic, developmental, and system family theory) and therapeutic personal perspectives impacted these interpretations. Thus, we tried to moderate these effects by returning to the quotes. In the results section below, to be as transparent as possible, the number of participants who addressed each topic is indicated, and citations are provided to illustrate and validate the findings.

RESULTS

The 19 participants described parentification as an ongoing, painful, threatening life experience that has left its mark to this day. The analyses evolved into a conceptual model comprising four central themes, with explanatory subcategories for each theme. The first theme corresponds to descriptions of the causes of the reversed relationships. The second describes the manifestations and patterns of parent–daughter relationships, which were identified as immanent to the experience of parentification and were characterized by distortions and violations of the psychological boundaries between parents and daughters. The third theme covers the emotional experience of the relationship, and the fourth theme describes the strategies used to deal with it. All of these were associated to develop the core theoretical model that emerged from the constructivist grounded theory analysis.

First theme: “My mother is still five years old”: Causes of parentification

The interviews revealed numerous factors that led to parentification. These factors could be divided into two main categories. The first deals with factors that originated in the participants' external reality, and the second relates to internal factors.

External factors

In all the interviews, external factors were identified. These were related to diverse types of parental incompetence and vulnerabilities such as mental disability (n = 13), parental physical and cognitive impairment (n = 6), early parenting (n = 6), and parental loneliness and lack of social support (n = 14). Thirteen participants described parentification with their mothers, and five with their fathers. Five participants experienced parentification simultaneously with both parents and 14 participants also described parentification with siblings or other family members. For example: “She was very post-traumatic, my mother is still five years old, and this is how I have experienced her all these years, as a child in need of protection” (Shelly¹); “My mother was 21 when I was born and my father was a few years older, but they were very childish, unstable […] Even then I felt that there was no responsible adult in the room” (Nina).

Ongoing exposure to parental conflicts and domestic violence was also identified as a factor influencing the formation of the reversed relationship, which undermined the entire family unit (n = 13). For example: “He threatened to murder her, he - it was scary. We slept with the doors locked. All of us” (Hagar); “They closed our bedroom door so we would not hear them shouting and fighting in the living room, but obviously we heard. My mother always found my sister, brother and me clinging to each other in the bed” (Dana). Nine participants felt that their parents' divorce was a factor that aggravated the existing parentified relationships, and that they had to adapt to new living conditions alone with their mothers, who often experienced emotional and financial difficulties and were absent for most of the day. As a result, the participants were forced to act as the sole source of emotional and instrumental support for their mothers (not their fathers), their siblings, and even themselves, and quickly acquired instrumental, emotional, educational, and therapeutic capabilities. For example: “As soon as my parents divorced, I found myself in charge of my siblings. Between the ages of 8 and 10, I ran the household, took care of the dinners, showers, babysitting, paying bills” (Dana); “I felt I had to be strong for my mother, I had to help and support her, I did not feel she knew how to manage things, I felt she needed me, that I would be the stable one, and that she could lean on me” (Rose).

Eight participants indicated that one of their nuclear or extended family members had physical disabilities and stated that from an early age they had to care for disabled family members as well as deal with the ramifications of this reality. For example: “I had to sleep with my grandmother, and especially when she had her seizures - cirrhosis of the liver - she vomited a lot of blood, I had to shower her and see the blood” (Michal); “When I was nine, I was alone with my eleven-year-old sister. She took a huge knife from the kitchen and started to cut herself. She said she would stab herself and kill me. I was terrified” (Gili).

Finally, different contextual factors were also considered to have instigated or prolonged the reversed relationships. These included economic hardships related to the death of a parent, parental mental illness, or physical disabilities (n = 8); immigration (n = 5); and the birth of younger siblings (n = 5). In the case of immigration, they were forced to act as mediators or translators between their parents and society. Sharon, who lost her father, recalled, “There was an atmosphere of financial anxiety. My mother talked about it a lot, she was distraught, and it made me very anxious. It was very scary.”

Internal factors

The participants also cited a range of self-attributions, such as their birth order (n = 19) and innate traits (n = 10). In all the interviews, the participants referred to their rank in the birth order in the family as the eldest or the youngest as a factor shaping their parents' expectations and their responsibilities to provide support and alleviate their mother's loneliness: “My sister was no longer at home, and I needed to support my mother. I was her backbone and her good friend” (Rose). Some participants referred to their innate trait for caregiving and nurturing others as a direct factor instigating their parental role: “I feel like I was born to be this kind of parent” (Orna).

Theme 2: Distortions of the psychological boundaries between parents and daughters

The participants described six types of parent–daughter relationship patterns characterized by parental distortions and violations of psychological and hierarchical boundaries with their daughters, which in most cases was experienced concurrently in different combinations.

Parentification

A relationship pattern characterized by a premature caregiving role emulating parenting was identified in all the interviews. This pattern included taking instrumental and emotional roles, providing support, comfort, nurturing, care, and relief to their parents, family members, and the self: “I was always very attentive to my mother, she could collapse, fall apart, get into bouts of hysteria with crying and shouting, anger, and sadness. I had to make sure she was stable” (Aya); “I was someone who raised and cared for them [brothers], not exactly their sister. I sat with them while they did their homework, I made sure they prepared their school bag or took showers in the evening” (Nina).

Adultification

Another pattern experienced by most participants was the pressure to act prematurely as adults to satisfy the parental need for relatedness, friendship, and companionship. They mentioned explicit restrictions and prohibitions on engaging in play or imaginary activities, and not being allowed to go on school trips, join youth movements, or take part in social gatherings. The participants were forced to use adult language while effacing their childish selves: “I always talked in a mature manner; I was always told that I was very mature. It was clear to me that I understood adult language. I thought I was a woman” (Sara); “From a very, very young age, I was treated like an adult. My father saw me as his business partner, and he kept telling me that when I turned 18, he would transfer the newspaper to me” (Shelly).

Triangulation

All the participants described being involved in their parents' relationship, to prevent a catastrophic disintegration of the family unit (n = 19). Their involvement manifested in three main ways: as a mediator (n = 5), as a confidant for one of the parents (n = 11), and as the spouse (n = 2). For example: “There was a huge disconnect between my parents. I only dared to tell them ‘Stop treating me like your ping-pong ball! If you have something to say - tell each other!’ when I got to be 14” (Dana); “I think that maybe for my father, I was a substitute for my mother and that was expressed in this psychic triangle” (Laura).

Psychological control

Thirteen participants described themselves as being manipulated psychologically by one or both parents. This control was manifested in covert and overt ways. The covert tactics included binding the participants emotionally by favoring them over their siblings, inducing shame and guilt, positioning them as incapable, overprotection by calling them weak and ill, using alienating strategies, and conditioning love on excelling or satisfying the parents' needs for self-worth and relatedness. The overt tactics included aggressive, punitive, and hostile behavior toward the participants and their siblings, including emotional, physical, and sexual abuse, which forced them into an aggressor–victim relationship with the abusive parent: “I was told that nothing good would come of me! That I'd be a prostitute! That I would be the one to clean the school's toilets when my friends were studying there! My mother called me: ‘a lump of flesh’” (Tamar); “She was afraid I would be exhausted, so she would not let me take ballet lessons, go to the movies because it was dangerous, or go on annual school trips because it was dangerous” (Ruth).

Neglect and abandonment

A threatening, disruptive, and deceptive relationship pattern was identified in 15 of the interviews characterized by a sense of collapse, dropout, or being jettisoned into an abyss or a catastrophic situation: “Really, the experience of falling, as if you suddenly have nothing […] it was a pure experience of a very sudden abysmal abyss” (Gili); “Wherever I turned, there was no one to hold onto. It was a genuinely physical lack, in the most physical ways” (Laura).

This pattern included a range of passive, indifferent, neglecting behaviors, as well as alienation, rejecting, distancing, and denial of love, which instilled a feeling of abandonment, orphanhood, and inexistence: “She was a terribly fragile, disappearing parent. Like, no intimacy, no emotional world. My mother went out of her room at seven in the evening, made us an omelet and salad, and went back to her room” (Aya); “My father suddenly stopped seeing me, I had no influence over him, as if I were nothing, as if I were air” (Yana).

Merging and enmeshment

The last relational pattern was defined as the merging and enmeshment of the self in the parent's feelings, thoughts, and desires (n = 7). The participants described this experience as a parental expropriation of the self as of an early age. As a result, they experienced self-alienation, nonexistence, feelings of confusion, and difficulty feeling and recognizing themselves as separate beings: “It's simple, the inner experience was not mine. I did not exist from age zero, totally, there was nothing” (Laura); “There was no separate me, I was not counted as a person, or as a child, or as a body. I could not decide anything by myself. If I said I wanted something, it would immediately be negated” (Anne).

Theme 3: “Like stepping on glass”: The emotional experience of the relationship

The major goal of this study was to better understand the complexity of the participants' experiences. Five emotional foci were identified in the interviews as underlying this experience: (a) fear and threat, (b) endless intrusion and aggression, (c) nothingness and nullification, (d) extreme emotional swings, and (e) anchors of salvation, meaning, and hope.

Fear and threat

The emotions of fear and threat emerged as being rooted in a volatile and fragile existential experience characterized by the fear of breaking down, falling apart, and the intense anxiety of catastrophic annihilation (n = 19). The participants expressed their stress and concern over their responsibility for the survival of their family members and themselves. This stress was also enhanced when participants experienced parentification for their mothers and their siblings or both simultaneously: “It's like being on a surfboard, you need to know where the wave is going, where the water is, so that you can stay stable on the surfboard” (Tamar); “I think all my life I have felt a responsibility. That something will fall apart if I do not take responsibility […] it could be Mom, it could be the house, and it could be me” (Hagar).

In the absence of an emotional anchor and safety, all the participants described constant concerns about survival, vigilance, and worries as to the well-being of their family members and themselves: “It's an experience of survival. All the time, you're surviving, you are alert. All the time. All the time. You can never rest for one moment because you don't know what will happen the next moment” (Tamar); “Being frantic, agitated, what will happen? Being constantly on the alert” (Laura).

The threat rooted in the participants' relationship with their parents became a dominant experience in their lives and generalized to other relationships. Most of the participants experienced themselves as threatened by others who were not members of their family. This was reflected in feelings of ongoing anxiety of abandonment and rejection (n = 15), and existential fears of invasion, kidnapping, or aggression as a real threat that could have materialized at any moment (n = 5): “I was afraid to sit with my back to the door if I could not see what was happening behind me. I always turned on all the lights in the house. I was afraid to walk on the streets after dark” (Sara); “My parents would always say that the foster care workers would come to take me from them” (Tamar).

Simultaneously, the participants also experienced their inner world as threatening (n = 19). The participants all expressed the sense that their feelings, needs, and desires had a destructive potential, which might destroy their household's stability. As a result, they restrained themselves: “It was impossible to express any type of problem, it was impossible, you could not be sad, if you were sad the whole house would collapse” (Sharon); “As a young girl you understand that you have to be very careful about how you express your excitement and enthusiasm since they could make my mother sad or hurt” (Dana); “‘I' was an obscene word. Taking care of myself sounded selfish” (Sara). In addition, most of the participants perceived their emotions as potentially leading to depression (n = 15): “I had a daily fear of my negative emotions” (Tamar); “I was afraid to sink into my loneliness, my sadness. I felt that if I sank into my sadness, I would not know how to get out of it” (Gili).

As part of their survival experience, all the participants reported feelings of distress, overload, and exhaustion. These were amplified when the participants attempted to simultaneously address the normative developmental, academic, and social tasks relating to adolescence: “I think I felt I had to bear a weight that was far beyond what I could handle. I did my best, but there was always a danger of failing. It was an experience of surviving with the burden” (Nina); “It was very tiring and exhausting. At the same time, you must function, go to kindergarten, school, high school, the army. It is hard to keep it together” (Yael).

Endless intrusion and aggression

The participants viewed their external reality as aggressive. This was primarily related to the dissolution of boundaries and being psychologically controlled by their parents (n = 14). The participants characterized this relationship as intrusive, aggressive, attacking, and painful emotionally. They described their selves as being plundered and swallowed by their parents (n = 11): “I felt that my mother was stealing from me, taking from me what she was supposed to give” (Gili); “No matter what I did, nothing was enough. My efforts were swallowed up in a huge and unsatisfying need” (Nina).

More than half of the participants described their efforts to contain and digest their parents' needs as an experience of bloating and suffocation (n = 11). They described being imprisoned in a trap that forced them to ingurgitate their parents' mental state, as though they were being choked by their own hands: “You have a sensitive girl, and an older person (my mother) feeds on her, it's a fatal combination” (Aya); “Until I suffocate, because I felt like I could not express anything and I could not bear it either, as though I was in conflict, I was absorbing, absorbing, and suffocating” (Gili).

In some cases, the participants described how their parents gradually elicited their mental and physical disgust (n = 5): “I just could not stand my mother's psychotic outbursts. I was disgusted. I was disgusted. I was very disgusted with her. Touching, seeing her, really disgusted” (Tamar); “I was disgusted that I had to do my mother's laundry from the hospital. I did it, but I was still disgusted by it […] I would swallow my disgust” (Gili).

During midadolescence, this aggression was also directed toward the self and was accompanied by feelings of sadness and self-loathing, which included suicidal thoughts and difficulty functioning (n = 8): “I hated my body, I asked myself why I was so big and fat, a lot of self-hatred” (Anne); “I was depressed all the time, I had constant suicidal ideations” (Nina); “I wanted to die in a terrorist attack. I left a farewell letter to my parents: ‘I'm sorry I went; you know I love you’; I was sure I would die in a terrorist attack” (Anne).

Nothingness and nullification

The participants described a sense of absence and worthlessness (n = 19): “And I felt that something was missing, like a butterfly's cocoon. It has to rub against it so that the blood will flow to its wings - I felt that mine were cut off” (Gili); “Something very shaky as though I was rotten” (Yael); “I was in a fog, not at all aware the situation” (Rose). The participants' sense of nothingness impaired their identity formation and created discontinuity, fragmentation, confusion, and decline: “Everyone seemed to be better than me, more beautiful, better, more successful, smarter, more!” (Yana); “Everyone has a certain starting off place and you start from minus” (Sherry).

An extreme expression of this nothingness and worthlessness was identified in seven interviews as an experience of dehumanization that led to degrading the self to the rank of an object or a device. One of the main semantic indicators of this dehumanized experience was the consistent use of vocabulary referring to receptacles or nonhuman entities such as “vessel,” “container,” “ear,” and “lump of flesh,” suggestive of the ways participants felt used: “I am a vessel born to serve the needs of my parents” (Michal); “I'm a lump of flesh!, more than a whore – I think it connected to my tangible fear because I knew I was not a whore but was not at all sure I was not a lump of flesh” (Tamar).

This sense of nothingness was accompanied by feelings of shame and guilt (n = 15). The participants described how feelings of guilt complemented their awareness of their physical and/or psychological needs. These were aggravated by their parents' aggressive and intrusive behavior: “Lots and lots of shame and guilt like a person who suffers from abuse […] I felt worthless, not good, not successful, such a low self-image” (Tamar); “It was the main experience of guilt, of every time I'm not home, every opportunity to meet friends. Like it's at someone's expense” (Nina).

The participants attributed these feelings to their damaged, failing, neglected, or dependent parents, who withheld physical and emotional nourishment, guidance, and validation. A semantic illustration of this absence can be seen in the over 200 repetitions of the verb “to see,” connoting vision: “She does not notice anything […] nothing, no attention, nothing, it is simply an experience of being ignored” (Rose); “My mother would never get up with us in the morning. We set the alarm, got ready. I remember it from first grade” (Orna). Throughout the interviews, the participants reused the images of “abyss,” “pit,” “hole,” and “void” to illustrate the absence and sorrow involved: “A pit full of sorrow and sadness very very very deep, an abyss of sorrow, of sadness” (Tamar); “I had a huge void that I had to fill, I felt I really needed my mother, and she was not there” (Rose).

In parallel, about a quarter of the participants described an experience of orphanhood, abandonment, and neglect associated with their environment, which created feelings of pain, invalidation, and loneliness: “If at least we were orphans, then we would know that we are orphans, the world would recognize that and treat us as orphans” (Tamar).

Extreme emotional swings: A dialectical movement between poles of the self

All the participants described a deceptive dialectical swing related to their split identities and their relationship with their parents as an inherent characteristic of the parentified experience. This volatility reflects the participants' fragility and ambivalence with respect to their self-worth and confidence in themselves and their parents (n = 19). The participants moved from a position in which they felt presence and existence to one where they felt invisible and disappearing. In other cases, they felt wise, happy, mature, and authentic, whereas in the others, they felt worthless, sad, or perceived themselves as childish and phony. They acknowledged their needs but simultaneously evacuated them. Throughout the interviews, there were over 600 repetitions of the phrases “on the one hand […] and on the other,” “but,” “simultaneously,” and “and at the same time.” For example: “I felt brilliant and mature and interesting and at the same time worthless” (Yael); “I have always been happy, a happy person, but there was something very anxious about it” (Sara).

This dialectical experience was also reflected in the participants' description of confusion regarding the self, their relationship with their parents, and reality (n = 14): “From the outside, I seemed to have a lot of confidence, and I was a happy girl but today I understand that I was not happy, and I did not have confidence inside” (Aya); “There was awfully big confusion and ambiguity which is not something I understood then. Physical abuse or neglect are obvious things, but role reversal is unseen, I did not see it” (Tamar).

Finally, the participants also expressed this dialectical volatility in relating to their relationships with their parents (n = 19) and others (n = 12). The participants moved from longing for an intimate connection to feelings of confusion, anxiety, and fear: “It was clear to me that it was important for me to have a mother and a father, but I did not know why it was good” (Yael); “I was looking for interactions with adults. I felt I needed a lot of attention, also from men. But at the same time, I was terribly afraid to talk to men” (Gili).

Anchors of salvation, meaning, and hope

Along with self-experiences that included nothingness and worthlessness, all the participants also experienced feelings of kindness, competency, and recognition of their value and unique contribution to the well-being of their parents and family members. These feelings were used as a source of rescue and existential meaning. These feelings made it easier for the participants to deal with this responsibility: “I felt that I was a source of good, a source of good influence, a source of calm, a source of logic and stability” (Ruth); “I think I was proud of it as a child. It gave me meaning. That I had something. As a child it gives you a good feeling that you can help, do” (Shelly); “I had a great deal of compassion for my parents” (Dorothy); “There was always constant wish and longing to help my grandmother because she was terribly weak” (Michel).

Theme 4: “Being my own parent”: Strategies for dealing with the experience

The final theme covers the four key strategies used by the participants to deal with their painful experiences. These included (a) maintaining a balance of horror—emotional vigilance, merging, and splitting the self; (b) the formation of the self as an object used by the self; (c) achieving separateness; and (d) correction and compensation in the context of various relationships.

Maintaining a balance of horror—emotional vigilance, merging, and splitting the self

All the participants described their attempts to survive the existential threat and maintain a certain degree of balance between the well-being of their parents and themselves. They described their exclusive ability to hold and protect their family members from catastrophic destruction. These were achieved by continuous vigilance and emotional alertness while monitoring their parents' alternating mental and physical states while merging with them. To do so, the participants had to transcend their young age and acquire sophisticated emotional and instrumental abilities to provide tailored responses to their parents' different needs. These included cooking, house cleaning, and tending to the welfare of the family members: “There is no such thing as forgetting, there is no such thing as sloppy, there is no such thing as half-done work, it had to be perfect! There was no way I could forget my grandmother” (Michal); “I had to mentally hold my mom because she could not have any more pain around her if something bad happened, it was a terrible big drama, it was a terrible pain” (Sharon).

Their efforts to balance the unspeakable horror and fear of the potential catastrophic reality involved the creation of a false self to address their parents' wishes and needs. This process involved disconnecting, splitting, and deleting the authentic, vulnerable, and childlike parts of the self that were inconsistent with parental needs and expectations. They described a dissociated topographic structure dividing the self into two parts. The first was an “inner self,” which was hidden, vulnerable, childish, dependent, and had limited accessibility. By contrast, the second was the “outer self.” This self was accessible, stable, supportive, and aligned with their parents' demands: “Actually, my experience was like I was leaving myself outside, serving others, not thinking my thoughts, not feeling my feelings” (Anne); “I feel as if for many years, I needed to remove myself to achieve greater harmony and stability” (Gili); “Disconnection from emotion, there was no choice, that's what it takes and that's it! And it's really a kind of taming. I knew I had been tamed” (Aya).

Fear that the authentic parts of the self could endanger their relationship with their parents, causing abandonment, rejection, and loss of their parents, prompted the participants to silence authentic self-expression consciously and unconsciously. They described good, pleasing behavior, the self-pursuit of excellence, and internalization of the demand to “be a good girl” to satisfy their parents: “To go to the movies with my mother, to talk to my father the way that he liked and be quiet, to be beautiful and be silent, at some point it became real, it is who I am” (Laura); “I felt that everything that was sad or had unhappy outcomes, I had to hide it, or I had to make my mother very happy so that she would not go” (Yael).

This sensitive approach toward their parents was generalized to other relationships to avoid rejection while eliminating authentic parts of themselves: “I felt I had to be there for others, to satisfy the needs of others, others were more important than me, I was immersed in a very, very big self-silence” (Rose); “I tried to be okay, to be the good girl, and to make sure that everything was running well, I pretty much caused myself to disappear” (Sara).

The formation of the self as an object used by the self

The participants described themselves as being “their own parents,” and engaging in fulfilling instrumental, emotional, and developmental functions. By providing comfort, guidance, and assurance to themselves, they served as a stable object to compensate for their missing parental objects: “I grew up alone mentally, psychologically and emotionally” (Sara); “I took care of myself. If I needed something, if I needed to go to the dentist, if I needed books, I arranged for it myself, everything, I did things alone” (Shelly).

In some cases, the participants described how they validated their self-worth, sometimes in a grandiose and omnipotent manner split from the vulnerable self, to protect themselves from parental aggression and invalidation and calm their anxiety: “I said to myself that I am strong, that I am omnipotent, that I do not need protection, that if there are problems I can solve them alone, that in terms of my abilities, the sky is the limit” (Shelly); “I felt that I could cope, that I could stretch myself to accommodate almost any challenge” (Gili).

Yet another strategy was to cling to feelings of optimism and hope, because this instilled confidence and made it easier for the participants to deal with the present: “I said soon it will be better, and I just need to bear it, and soon it will be better” (Tamar). The participants also described fantasizing the association to creativity and nature as another strategy to ease the pain and connect to authentic self-parts, by processing the complex reality and transforming it into an alternative psychological reality (n = 15): “The experience of no connection between my inner and the outer worlds was unbearable. I started creating. It was vital for me to understand how I feel […] I wrote in my diary every day until the age of 16-17” (Gili); “All the time my brain was working on creating an alternative reality, I knew it was a fantasy, but it was a pleasant fantasy. It allowed me to bear reality” (Tamar).

Achieving separation

Aside from emotional vigilance, monitoring, and merging with their parents, the participants described how they also established separateness and formed a separate identity during midchildhood and adolescence as a way of coping with parental control and enmeshment (n = 18). At first, this was manifested through physical or tangible separation; however, during adolescence, achieving separation became more sophisticated and involved knowing and defining the self as a separate and unique entity: “In my early childhood, I was very jealous of my time alone and my private space. I always locked the bedroom door, it was a basic way of coping, it was essential to me” (Gili); “I said to myself ‘be special!’ I asked myself, ‘what is special about you?’ ‘What is important to you?’ ‘What do you like?,’ but I couldn't answer these questions” (Michal).

Most participants described how they expressed anger toward one or both of their parents (n = 14) and behaved rebelliously to achieve separation: “I was furious during high school. I was a bad girl. I took out my venom on them, because I was angry with them, they deserved it!” (Yana); “As a teenager, I was endlessly involved in risky situations. I socialized with all sorts of dubious people, even an offender for a time” (Shelly); “Anger helped me mark territory, it was a way to preserve myself” (Gili).

Correction and compensation in the context of various relationships

All the participants described their attempts to establish an alternative familial reality characterized by normality and hope. They repeatedly tried to normalize the family routine and their relationships with their parents while establishing new ideal family traditions or giving their parents repeated opportunities to rectify their behavior, although they encountered repeated disappointments: “I would make breakfast for everyone and wake up my parents and sisters out of longing that everyone would sit around the table. Such a normalizing symbol” (Tamar); “I tried to bring home the normal daily routine as if we were like any other home” (Sharon).

Other compensating and repairing strategies included yearning for missing parents, fantasies about alternative parenting, or idealization of the defective parent (n = 10). These maintained the connection to a benevolent parenting object and instilled feelings of belonging, value, and hope: “I asked myself ‘why isn't Gidi Gov [an Israeli singer] my father? … Why isn't Yoni Rechter [an Israeli musician] my father? or Freddie Mercury?’ … He should have been my father!” (Laura); “My dad was not present at all. But because he was not, I could create an ideal image of him, put it on a pedestal” (Sara).

Some participants described forming supportive and nurturing relationships with alternative adult figures such as grandparents, their parents' acquaintances, educational figures, and social workers. Others described forging an alliance with their siblings. All were aimed at instilling feelings of security, belonging, and comfort (n = 17): “I would get dressed - both me and my sister, and we would ask each other: ‘Do I look neglected? Do I look beautiful?’” (Tamar); “My dad contacted a social worker, and I had a few sessions with her, and I talked to the school counselor, and my grandmother. They helped me get through this period” (Dana).

DISCUSSION

This study was designed to shed light on the experiences and coping strategies implemented to address distress in parent–daughter parentified relationships from the retrospective point of view of a group of Israeli adult women. The findings are summarized in Figure 1 that presents these parentified relationships. As shown, this experience can be framed as a relational trauma in which the contact between the self and the parental object is perceived as a threatened, partial, nullifying, and distorted bond. As in previous studies, the findings here suggest how reversed relationships are rooted in difficult life circumstances characterized by mistreatment and abuse, chronic marital conflict, and contextual factors such as economic hardships (e.g., Bifulco et al., 2014; Ponizovsky et al., 2012).

These difficult life circumstances, which can also be considered adverse childhood experiences (ACEs) and are depicted in the model as “external threats,” chronically hampered parental functioning and directly impacted their children's mental and physical health (Felitti et al., 1998). Although theoretical models typically differentiate between types of boundary dissolution (Kerig, 2005), the current findings suggest that the parentified relationship was experienced as a distorted holistic, threatening, and frail existential experience. These patterns of relationship characterized by a range of dissolutions of psychological boundaries activate the fear system, creating a persistent terror with no way to escape. As a result, the participants described their connection with their failed parents as exhausting and debilitating, and defined by emotional vigilance, fear of annihilation, collapsing, and breakdown. In this sense, parentification can be seen as a mechanism through which these ACEs constitute an immense continuous stressor to the self.

This suggestion is consistent with previous studies indicating that these abusive experiences increase the odds for long-lasting adverse neuronal influences on children's mental and physical health (Herzog & Schmahl, 2018; Hughes et al., 2017) and concords with the literature on attachment (George & Solomon, 2011) and relational trauma (Bailey & Brand, 2017), as well as Winnicott's (Winnicott, 1974) description of this horror as the baby's fear of traumatic mental breakdown. Although the participants related to their childhood and adolescence, they all described the frightening reality, the fear of collapse, sense of falling, and the split of the self as central experiences that characterized their relationships. However, because parental failure did not remain an unrecorded infantile experience but repeatedly occurred in their lives, this fear was experienced as real and could be remembered. In this respect, the participants lived through their relationship with their parents as a form of deceptive helplessness within a paradoxical experience. By being trapped in their parents' demands and needs, and forced to respond to their need for attachment, connection, and bonding, they found themselves nourishing the vicious circle by continuously providing the caregiving role (Winnicott, 1965). Previous studies have indicated that children who are subjected to emotional abuse experience a greater likelihood of developing inadequate strategies related to both emotional and physical well-being such as poor emotion regulation, dissociation, and greater risk-taking behaviors (English et al., 2015; Haferkamp et al., 2015; Oshri et al., 2015).

Throughout the interviews, the participants described how they implemented several mechanisms to cope with fear and achieve a certain degree of stability and comfort. These were characterized by self-structural changes and intrapsychic splits as well as disconnections in the self, akin to the literature on dissociations and trauma (Schimmenti & Caretti, 2016). These included assuming a false, unauthentic, and pleasing self while disconnecting the vulnerable, dependent, or childlike parts of the self that were inconsistent with parental needs and expectations in favor of an “outer” stable, functional, and supportive self. This defensive façade, which was split from the authentic self (i.e., the sense of being alive, a creative spark that the person experiences as real and powerful), emerged as a reaction to parental impingements, prompted by attempts to accommodate and please the overly dependent and demanding parent and avoid potential rejection (Goldner et al., 2021; Winnicott, 1965). This pleasing stance was generalized to relationships with peers and others (Chiu et al., 2019). Consequently, despite the effort to relate to their parents, no genuine connection was established. Therefore, there was no relief from the fear, reinforcing the dialectical movement and the trauma. The participants appeared to lack a clear sense of self and unobtrusively enacted their existence, while feeling disconnected from their feelings and desires (Norman et al., 2021).

Another disconnection of the self is aligned with Kohut's conceptualization (1971) of the vertical split. To restore their narcissistic equilibrium, the participants reported constructing a specific structural change in which the self was divided into nothingness and worthlessness on the one hand and omnipotence and grandiosity on the other. Whereas in some cases they described themselves as immersed in a continuous state of depression that was hidden from the eyes of others and that aggravated their sense of hopelessness (Maker et al., 2005), in other cases, they exhibited superiority and a sense of uniqueness. Hence, their unfulfilled narcissistic needs lay deeply buried beneath their vociferous assertiveness and superiority, guarded by a wall of shame, guilt, and vulnerability (Kohut & Wolf, 1978). They were thus living within a “narcissistic paradox” (Morf & Rhodewalt, 2001) in which the participants simultaneously longed for external self-affirmation and appreciation from their parents, but also perceived them as frustrating objects and as a threat to their own stable and positive self-esteem (Cain et al., 2008; Pincus & Lukowitsky, 2010). Concurrently, they felt anger and resentment.

The disconnection of the self also relates to the defense mechanism of identifying the aggressor (Ferenczi, 1988). Because they were subjected to the greater power of their parents and experienced overwhelming attacks, emotional abandonment, and isolation, the participants tried to maintain a certain degree of security and connection with their parents. By aiming to fill their attachment and narcissistic needs, they were forced to relinquish and dissociate parts of their subjective, vulnerable, weak experience and to identify with the perpetrating injured parent. Hence, they subordinated themselves to the aggressor (Lahav et al., 2021). In the hope that they would be permitted to survive, they used their strong capacity for empathy and identification to reshape their beliefs and behaviors to fit the ideal image of themselves in the mind of their parents (i.e., the attacker). Thus, their risk-taking, self-harming, and punitive behaviors can be seen as manifestations of identifying with the perpetrator in abuse situations (Lahav et al., 2022) and internalization of the “malignant self-object” (Kohut, 1971) in order to survive. Nevertheless, at the same time, they introjected aspects of external reality and created fantasies that helped them live in the external reality (Frankel, 2002).

Figure 1 schematizes the findings by depicting the experience of the parentified relationship as a closed, circular, trapped system which forms in response to the pressure of grueling life circumstances and is characterized by a horrific, unstable, and Sisyphean experience. While coping with various types of boundary dissolution, abuse, and neglect as described by the participants, the participants were forced to monitor their parents' and families' well-being while experiencing constant hyperarousal. This resulted in inadequate coping mechanisms of enmeshment with their parents and an internalization of their parents' failure, aggression, and depression while experiencing feelings of shame and blame. A disconnected split self-structure with limited integration between its parts was crafted to face the traumatic situation.

Limitations

The current study has several limitations. The first relates to the fact that it was based on the retrospective reports of women who, in some cases, experienced childhood role reversal decades ago. Because memory is fallible and emotions continue to change over the life course, the recollection of events and emotional experiences is likely to be biased by the participants' more recent experiences and interpretations. The second limitation is related to constraints in sampling when applying the principles of theoretical sampling in grounded theory and attempting to achieve saturation with respect to the study questions. The sample consisted of 19 well-educated women. The fact that most of the participants were well-educated probably influenced the findings and may thus not be representative of women from lower socioeconomic backgrounds. Future studies should consider including women from various socioeconomic statuses to validate the results. Furthermore, the analysis was based on a developmental and clinical perspective. Future studies could take a critical feminist point of view to analyze the data. Finally, the sample was composed of Jewish women in Israel, a relatively collective society. Future studies should explore experiences among women from more diverse backgrounds.

Nevertheless, despite these limitations, the current study shows how parentification is perceived as a form of relational trauma that induces pathological defensive mechanisms such as identification with the aggressor and dissociative strategies against constant emotional arousal and the fatiguing frightening reality. The findings emphasize the need to inform clinicians treating individuals who have experienced parentification about the depth of this experience as a form of relational trauma. The findings also call for the development of trauma-focused interventions to respond to an altered personality organization and self-structure, and help clients internalize better object relations. These interventions should focus on the distorted self-structure, and work toward enabling the creation of an integrative coherent self-sense while giving voice, meaning, and validation to the traumatic experience. In addition, attention should be paid to the strengths and resilience of clients who have experienced parentification.