This paper is based on a lecture given at a conference held in October 2024 to celebrate the 30 years of operation of the Family Therapy Unit of the Attica Psychiatric Hospital, and a farewell to the founders of the Unit.
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From the very first moment I received the phone call/invitation from Ms. Thanopoulou, a personal journey through time, began. I was invited as a graduate of the Family Therapy Unit, which inevitably made me realize that nearly 24 years had passed since I first encountered Ellanikou Street. I paused and trusted my memory, observing the ‘stations’ that stood out in my mind.
My own story regarding the Family Therapy Unit begins with Autism, which has always been and still remains, my great professional passion. My mind travelled back to 2000, when I had completed my postgraduate studies in autism and was entering the professional field with enthusiasm and energy. However, autism as a scientific field was, and to some extent still is, closely tied to Cognitive-Behavioral techniques and strictly structured approaches. The effectiveness of my intervention had to be measurable, closely linked to checklists and strict protocols, and my collaboration with parents was associated in my mind with their ability to follow the directions I gave them.
Thus, very early on, equipped to support children on the autism spectrum but unable to bridge what I was doing with the child’s daily life, I perceived a gap. Visual programs, lists, and recordings alone were not enough to support the family of the child on the autism spectrum and their family. I tried too hard, I felt anger and I experienced disappointment. I needed to understand what it meant for a family -or better yet, for each family individually- to have a child with developmental differences, so that what I did, and what I asked them to do would have a meaning. I felt the need to deeply understand how each family and each couple functioned so that I could find effective ways to support them in their daily lives.
These concerns marked my encounter with the Family Therapy Unit. Even from the point of my interview and, ultimately, my admission to the course, the integration of autism with the systemic perspective was established, in my professional life. This meeting was the most significant ‘turning point’ in my career because ever since, I have been striving to understand, always keeping in mind a significant ‘and’: the neurodiversity of the individual with a diagnosis and the functioning of the family system, within which, they act and grow.
Since then, many therapeutic tools have been added to my clinical practice, which currently focuses on two main fields: the psychotherapeutic support of autistic adults, and counseling parents of children, adolescents, and young adults on the autism spectrum. In this paper, we will share the introduction of the systemic perspective in counseling the parents of a child on the autism spectrum.
The case involves a young couple that sought me out when their young son, Demos, aged 7, was diagnosed with autism. The child began sessions of occupational therapy and social-emotional development, while the parents engaged in counseling sessions. Their primary concerns were understanding their child's diagnosis and guiding him through daily activities, which were proving to be challenging. Most importantly, they sought practical tools and guidance to better collaborate and communicate with him.
Demos is a smart and capable child, with a keen interest in all the household electrical appliances, and in constructing objects using various materials. At the same time, he experienced daily intense and sudden outbursts of anger and meltdowns, which affected his social life, school attendance, and the overall quality of life of the entire family.
At first, we worked on basic concepts of psychoeducation, focusing on emotional connection with the child through his favorite interests, fostering predictability in space and time, providing visual and clear information, and organizing the family’s daily routines. Gradually, daily life became more manageable, and essential transitions occurred without significant difficulties. However, the quality of interaction and communication within the family remained strained and challenging.
During our sessions, the parents often expressed feelings of despair and frustration. By allowing space for these emotions, they shared their personal anxieties and reflected on all the changes that had reshaped their lives and relationship, since Demos entered their life. The changes had been overwhelming for both, and their relationship -their "first child" that brought them together- had been neglected.
In response to their needs, I proposed a supplementary therapeutic agreement: four sessions focusing solely on their relationship as a couple, this "first child" that required care. The parents agreed immediately, and in our next session, we got to know each other even better.
Our first step was to create a brief genogram for both. Each parent shared their story, their family of origin, and how they connected these experiences to their roles as parents. Their personal narratives began to unfold, and I was deeply moved to observe how attentively they listened to each other's accounts.
Their Personal Stories
Heracles, 38 years old, is the eldest of three brothers. He studied at the National Technical University and became a civil engineer, fulfilling the family’s expectations as the firstborn son. As a parent, however, he feels "betrayed". He explained:
"I expected things to be different, but they’re not".
He admits he prefers things to be done his way and reflects:
"That’s how I was raised, that’s what I inherited, and that’s why I struggle to understand Demos and his reactions".
Chará, on the other hand, is the youngest of three siblings, with two older sisters - one being a doctor and the other a lawyer. Her parents, both civil engineers, are financially well-off and place great importance on academic achievement and social status. Chará describes their upbringing:
"We were all expected to meet expectations, secure good jobs, and avoid shame".
In contrast to Heracles, Chará approaches parenting differently, saying:
"I want to do things differently with Demos".
The Couple's Story
Their narrative shifted to their shared history as a couple. They met during their university years and both described how deeply in love they were. They cherished spending time together, traveling, going on excursions in nature, and socializing with friends. Laughing together, they reminisced about fond and funny moments, relaxing as they reconnected with the nourishing part of their shared past.
When they decided to marry, they found a beautiful apartment in the city center, far from everyone, and decorated it to their liking. They devoted time to their careers, their friends, their individual interests, and to each other. The decision to have a child was mutual, and they planned their professional lives to manage the child’s upbringing independently.
However, already from infancy, Demos proved to be demanding. Chará experienced constant exhaustion from trying to soothe "a baby that cried and was agitated all day". Heracles tried to be supportive, but missed the time he used to have with Chará and "the quiet time to himself". He began experiencing panic attacks and soon decided to change jobs, seeking less pressure for both himself and his family life.
The ongoing demands of parenting and their other responsibilities prompted them to consider moving closer to Chará’s family’s apartment building in the northern suburbs. This move provided relief in terms of caring for Demos, but came at a cost for both of them, as they felt their freedom diminish compared to life in their "small home in the city center".
Gradually, the growing challenges of raising Demos worsened their relationship. Heracles described Chará as aligning with Demos, and often being overly permissive in order to maintain peace, which caused Heracles to feel frustrated. On the other hand, Heracles struggled to find his footing in his role as a father, which was vastly different from what he had envisioned, while also grappling with the loss of balance in his relationship with Chará.
Heracles’s neurodiversity played a significant role, as his rigid thinking impacted his communication with Chará, and their ability to resolve conflicts effectively.
At the time I met them, both Chará and Heracles openly admitted:
"We’re very angry with each other", and "We’re standing against each other, not beside one another".
Chará focused on the communication barriers between them, saying:
"Heracles assumes rules as having been established, without us ever discussing them".
Heracles, feeling defeated and angry, shared:
"We don’t do anything together anymore; we’re constantly fighting about Demos. And of course, Chará always gives in to him. It’s the two of them together against me".
He added: "Yes… I often take out the anger and resentment I feel toward Chará on Demos".
I reflected on how significant these issues are. The autism diagnosis is just one piece of the larger puzzle of their lives. To support them in their parenting roles effectively, it’s crucial to understand the broader system within which they operate.
Chará was accustomed to following, and Heracles to leading. For a long time, this complementary dynamic worked well. However, it broke down when new needs emerged, particularly after their child was born. Chará felt she could no longer defer, and Heracles felt he could no longer be an effective “leader”.
This initial complementary agreement between them ceased to function once Demos entered their lives. Now, they need to reorganize and co-construct a new agreement, transforming their relationship to become more collaborative as equal partners in parenting.
Therapeutic Goals
I shared all the previously mentioned thoughts with them. Using language that resonated with them, I explained to Chará and Heracles everything I thought after listening to them, and together we co-created a common ground for change by establishing the following goals:
• Supporting the couple's communication: We focused significantly on the essential communication skill of clearly and explicitly naming each other's thoughts and needs. Through daily examples of communication misunderstandings, we identified ways for each of them to articulate their needs and to understand the other's needs. Using the Marte Meo method, we employed the "naming" approach to consistently return to a communication style that enables both individuals to, not only name their own needs but also confirm their understanding of the other's needs. This process proved particularly supportive for this couple, as Heracles has a very rigid way of understanding and processing what comes from others, especially from his partner.
• Creating space and time for the couple: Together, we designed a weekly family schedule that included time for the couple to enjoy and connect with each other, which they committed to following.
• Supporting Heracles in finding common interests and spending time with Demos to build a connection: The need for an emotional connection between the father and Demos was a critical area of development for the entire family. This connection gave Herakles the opportunity and the means to understand his son and begin to enjoy their relationship. At the same time, this bond relieved Chará, who was able to take a step back and allow space for the two of them to create their own routines and habits.
• Empowering Chará to positively guide Demos: Chará needed support in finding ways to guide the child through specific processes so that daily life could become more functional and predictable for everyone. This process also relieved Heracles, as he was able to share with Chará the responsibility of working together with Demos.
The Therapeutic Process
The commitment of Chará and Heracles to the process was deeply moving. By giving space to their relationship, both were able to listen and be heard, to alleviate their fears, and thus to embark on a path of resolution by following clear and tailored steps that suited their needs and temperaments.
Toward the end of this brief cycle of sessions focusing on their relationship, Heracles admitted:
“When things are better with Chará, I can be better with Demos too. I recognize that she had in mind for us to find time together, and that is very important to me. I hope this mindset continues. I would like us to keep moving in this direction without leaving out counseling for Demos”.
Chará added:
"Things are getting better and better".
"I recognize that the weight of my anger has shifted. I used to direct constant anger toward Heracles".
"I started seeing him differently, and that anger began to subside".
Follow-Up – The Gift
As the couple's relationship improved and they maintained this new "culture of collaboration" that suited them, our sessions refocused on Demos' developmental needs. The couple's improved communication played a decisive role in reducing family tensions, as they had found ways to better organize themselves, creating a more predictable schedule for everyone and avoiding escalation during moments of stress.
In our final session before the summer, we summarized the journey we had undertaken together. I asked each of them to give a "gift" to the other by naming the most significant change they had observed throughout that year.
Chará commented:
"Heracles confronted his anger, and in doing so, helped regulate my emotions too".
"The discomfort and loneliness I felt have significantly decreased, and the sense of 'togetherness' -both with Heracles and with Demos- has grown substantially".
Regarding his wife in her role as a mother, Heracles affirmed her efforts, saying:
"Even during difficult mornings before school, she tried to remain calm and guide Demos positively, and that made our day start well".
About their relationship, he remarked:
"The most significant shift is that she stopped being 'opposite' me and came to stand beside me".
My Own Gift
The emotion I felt at the closure of that session is a physical experience that I relive every time I recall it. This journey encapsulates, in many ways, my own story in my professional role, as it gave me the opportunity to think "outside the box" and to trust what people bring into the relationship we build with them.
Opportunities for growth are always there before us, present and waiting, provided we have the clarity to see them and the flexibility to make use of them - always keeping in mind that we are not alone. The people we work with have their own active role in our processes and are always the most reliable source of feedback on whether things are evolving in a helpful way.
Moreover, our colleagues, mentors, and supervisors are always there to support our efforts and enrich our work.
The journey of the professional self is in constant evolution, and my encounter with the Unit and its people remains one of the most valuable and nourishing experiences I carry with me.
