The third and final time that I met with Mark Birbeck alone was on the 5th November 2021. Meg had, yet again and with extreme short notice, decided that she was too unwell to attend her scheduled therapy appointment and I was close to my wits end. There were just four remaining therapy sessions left before she turned 18 and yet still no discernible alleviation in any of her symptoms. Any opportunity to talk about Meg’s progress in therapy was confined to 'Parent Work' with Sally Mungall but that was limited. Sally and I were heavily engaged in intense psychodynamic work under the umbrella of ‘art therapy’. Sally hadn’t even met Meg until the first ‘review’ meeting on the 23rd December, 2021. As far as I could tell, Sally was appraising Meg’s mental health progress, by proxy, in discussion with Mark Birbeck. Access to medical records later confirmed that Sally was compiling mental health questionnaires and assessments during 2021 without ever talking to Meg. Sally’s assessment of my daughter relied exclusively on the second hand testimony of Mark. I had actually criticised Mark Birbeck’s therapeutic approach in front of Sally Mungall during one of our ‘art therapy’ sessions. Sally’s reaction was overly defensive, vigorously defending a colleague instead of opening up a safe space for dialogue and objective enquiry. Defending Mark Birbeck took priority over my legitimate concerns and I never criticised him in front of Sally again. So, when this new opportunity presented itself I grasped it, firmly, and made the decision to take Meg’s place.

I met Mark in CAMHS reception, explained Meg’s absence and requested that we use the now vacant therapy appointment to review my daughters progress. He was visibly frustrated by my presence but reluctantly agreed, inviting me to join him in the quiet of a therapy room. At first I expressed my deep anxiety at the lack of progress in Meg’s therapy and the looming, inevitable discharge from CAMHS services after her 18th birthday. I asked for his appraisal of the work. He told me that he had been disappointed that he hadn’t had more time to work with Meg. He acknowledged that she had waited far too long to be admitted into CAMHS for therapy and, in a truly bewildering admission, told me that 10 months had been far too short an amount of time to deal with such severely complicated OCD and that, ideally, he would have needed two to three years to properly address Meg’s mental health issues. I was quietly aghast. This man had assured me that he could do ‘good work’ with Meg because he had once worked, successfully, with another patient presenting similar OCD symptoms . I had met him twice before and raised the same concerns about the limited time, had raised the suggestion that Meg needed a different therapeutic approach, quite possibly needed access to more intensive, maybe even part time or full time residential care. All of which he had casually dismissed. And now, here he was, making excuses for his professional miscalculation.

I reminded him of our earlier meetings, my misgivings and his previous confident reassurances. Mark diverted the conversation, telling me that it was inappropriate for me to be taking up the therapeutic space designed for Meg. He went further and suggested that my daughter and I were ‘enmeshed’. I bristled with irritation. Enmeshment is a psychological concept that describes diffused personal boundaries and undifferentiated relationships in family dynamics whereby a child loses capacity for self-direction, distinctness and autonomy due to parental needs. Philosopher, John Bradshaw, uses enmeshment to describe cross-generational family bonding that leads to a child becoming a ‘surrogate spouse’ to their mother or father.

I challenged Mark’s assessment, explaining that I already had insight and had been consciously enforcing healthy boundaries in and around my relationship with my daughter and stridently encouraging her self-autonomy. I had been regularly criticised by welfare and pastoral staff employed at two of Meg’s schools for over-parenting, criticism that I had always vehemently countered. It had long ago been obvious to me that my daughter was either autistic or suffering for some other developmental condition. She was regularly overwhelmed by school environments and struggled dealing with social relationships. I will remind the reader that Meg was finally tested and diagnosed as being neurodivergent in the early autumn of 2021, validating my decade long held suspicion. I had behaved as I believed any responsible and loving parent should. I was attentive and available, supportive and relentlessly devoted to the care of my daughter. Meg had a fractious relationship with her own mother and felt displaced when her mother’s new romantic partner came to live in the family home. My daughter needed stability and I took up the shortfall. I fulfilled my role as a father and filled the space vacated by her mother. It was necessary.

But, enmeshed? NO!

Mark pushed back, telling me that enmeshment was probably inevitable. I pushed back again, perhaps too robustly. I didn’t like where he was going with the line of conversation. There was nothing remotely inappropriate in my relationship with my own daughter. Medical records released over two years later revealed his reaction to this very same conversation. He described me as being ‘wounded’ by his accusation of enmeshment. ( and, yes, I am painfully self-aware that I have just used the word ‘accusation’ ). That description was couched in his earlier and later therapy notes that made similar allusions of unhealthy enmeshment. For the record, I strongly rebuke Mark Birbeck’s enmeshment accusation. I believe he was woefully off the mark on this point and it was he that was potentially wounded by this conversation. Different medical records made reference to his claim that I had ‘strong, angry’ feelings towards him. That was not true. I had resisted his professional opinion at that particular time because I believed him to be wholly wrong. I still believe him to have been wholly wrong. I was highly critical of him professionally but I actually liked him as a person and was otherwise friendly and polite whenever I met him.

Mark took cue from my resistance to his enmeshment hypothesis and called a halt to our impromptu meeting, raising the boundary around his therapeutic relationship with Meg. Mark told me to take my concerns to the ‘Parent Work’ with Sally Mungall and with that, I was out the door. That was my final meeting alone with Mark Birbeck.