It’s an unfortunate scenario I’ve seen time and time again:

* Parent goes to prison.
* Child, who already felt neglected by parent, becomes more upset when parent ends up behind bars. Child either blames the parent for misbehavior that results in parent being taken away from child and/or blames him or herself (as children often do).
* Parent tries to have contact with child via phone calls, letters, or visits.
* Child decides that he or she wants nothing to do with parent
* Parent, often with poor parenting and poor coping skills, feels like a failure and simultaneously is upset about being rejected.
* Parent needs to decide how to handle situation and often chooses to withdraw and not attempt further contact with child.
* Ultimately child ends up at greater risk for never having a good relationship with incarcerated parent and ultimately other negative long-term psychological consequences.

The advantage to having heard a story such as this many times is that one develops a much clearer understanding of the dynamics typically involved. This ultimately can aid the psychiatrist in having a more therapeutic interaction with the patient.

I had the opportunity to hear this story again recently. I saw a patient for follow-up. He was very upset. He had been talking to his young daughter on the phone a few days earlier, and midway through the conversation she handed the phone to someone else and said she didn’t want to talk to daddy anymore. Daddy had been “naughty,” and it was his fault that she was not going to see him for a long time. In fact, she would be in her mid teens after he is released from prison in another 7 or 8 years.

I asked him how this made him feel. He told me that he felt awful. He felt like a failure. He wasn’t sure how he was going to handle the situation.

Before I say more about the situation, I want to mention a couple of the challenges that prison psychiatrists face.

First, there are significant time constraints. I do not have time to conduct traditional psychotherapy sessions with patients. However, I have learned to incorporate psychotherapeutic techniques into medication management sessions. And, when there is an opportunity for an important intervention, I will take whatever time I need with a patient to do what needs to be done.

Second, when I see an inmate, there is no guarantee that I will ever see him again. He may be transferred to a different prison or be released before the next scheduled appointment.

Because of these limitations, there are times when I feel that the best intervention is to be more directive than a psychotherapist would normally be with a patient.

In the rejected parent scenario, I feel very strongly that I must take an active role in intervening. A child’s future is at stake!

So, how did I handle this situation?

I told my patient the following:

This is a very common situation that many inmates and their children face. This is a time for you to make a critical decision about the future of your relationship with your daughter and possibly about your daughter’s future well-being as well.

How you handle this over the next few years will likely make a huge difference. It all depends on what you want. If in your heart you really care about her and want to be a dad to her, then by all means do not give up on her.

Do not expect your daughter to be rational with you the way you’d expect an adult to be. She probably has justified reasons for being angry. In fact, she’s probably unknowingly testing you right now.

You’ll need to be like the shining sun, shining its bright light and warmth on the earth every day regardless of the earth’s opinion about it. In other words, you’ll have to show her through your actions and not just your words that you really care about her. Don’t harass her, but do send her brief notes regularly letting her know that you’re thinking about her and that you love her. Be sure to send her birthday cards. And keep doing it even if she does not respond.

On the other hand, if your relationship with her is not that important to you, then I guess you could decide not to have contact with her.

A lot of the inmates I’ve met in your situation have felt like they’ve been real screw-ups in life, like no matter what they do and how hard they try, nothing seems to work out. They feel bad about themselves and feel guilty about not being the type of parent that they believe they should be. And, then they get rejected by their child. A lot of inmates in your situation just want to say forget it, and cut off all contact with everyone else. It’s tempting because it’s easier that way. And you don’t feel like you’re gonna get hurt either.

He looked up at me and said, “Yeah, that’s what I was thinking.”

I asked him to imagine what he would want if the tables were turned. He had some trouble imagining this since he had never known his father, but I asked him to imagine that he had known his father and that his father had spent a few years in prison when the patient was a child.

How would he have wanted his own father to handle this situation?

He admitted that he would not have wanted his father to give up on him.

Mostly he just listened, though. He definitely seemed to be giving it some serious thought.

I don’t know if I’ll see my patient again. Regardless of whether I do, I can only hope that my small effort has some positive impact on how he handles his relationship with his daughter. A lot in her life is at stake.

When I can make a positive difference in situations like this, I am thankful that I have the opportunity to do what I do for a living.

The details of this case have been significantly altered to protect the confidentiality of the patient.

Jeffrey Knuppel is a psychiatrist who blogs at Lockup Doc.

Submit a guest post and be heard.