So you want your teen to see a psychologist...

I've seen many an adolescent who doesn't want to be on my couch but for some (good) reason their parents do. Maybe the adolescent is telling everyone she's miserable but in the next breath says therapy can't help her because her depression is "chemical", or perhaps she identifies as a "tortured soul". Regardless of the severity of an adolescent's symptoms, if they're unwilling to be in therapy, it's probably going to take more than the 10 sessions available under Australia's Medicare Better Access Scheme to get them to actively participate in the process, if at all.

In these cases, my preferred approach is to focus on what can be changed. Typically this means working with parents, and the school if relevant - looking for what triggers the adolescent's symptoms, where and when problem behaviours arise, and identifying what the adolescent gains from continuing to suffer from, for instance, depression (this is called secondary gain and may include having an unusually close relationship with a parent, or school avoidance). Most importantly, this approach aims to help parents understand the emotional system that exists in their family, and how interactions between family members may lead to an escalation in symptoms, or help to maintain them. Parents then have the opportunity to understand what changes they have the power to make irrespective of their adolescent's desire to keep the status quo. Obviously this runs counter to the commonly held assumption that the problem is "in" the individual, and that it's only a matter of time before the therapist "fixes" the teen - but this assumption is often not reflected by reality; we are significantly affected by our closest relationships, and at no time is this greater than during childhood and adolescence. While working on understanding our role in unhelpful family dynamics can be confronting, it is almost always worthwhile if we have the courage to do it. But more importantly, it creates a much better chance for change than dragging an unwilling adolescent to therapy hoping an hour a week will "fix" them.

Teenage brats: A psychologist's response

Yesterday an article featured in the Sydney Morning Herald about entitled teens and their parents. It basically described teens having temper-tantrums, and quoted the hapless parents saying they gave their children everything and so it's all their fault. From there, some psychologists are quoted on how this generation of parents "can't say no", and that some tough love is needed. But I'm not sure how helpful this is for parents finding themselves in analogous circumstances, so I thought I'd outline some areas I'd look at if this family were clients of mine.

Most importantly though, let's acknowledge that everyone, including parents, are doing the best they can with what they have. Blaming and shaming makes people defensive at best, and depressed at worst, but what's needed here is courage to change. If we're desperate for someone to blame, chances are we'd end up going back generations, because generally speaking we inherit parenting practices (and coping styles) from our parents, who inherited it from theirs, and so on (unless we work on changing - read on). 

Based on the information in the article I refer to above, the beliefs parents hold that make them feel responsible for their children's happiness are critical. Giving their children everything they want may be driven by some of their own pain in the form of childhood memories - memories of neglect, feeling unloved, suffering from an alcoholic parent, or living in relative poverty, for example. Fear of "damaging" their kids, or just discomfort on enforcing rules and boundaries, is increasingly common (if we need our kids to be friends, setting rules is going to be a major issue). Looking at the drivers for low discipline, material indulgence, and the need to be friends with one's kids is essential. 

A child's (or teen's) emotional functioning is limited by their parents; generally children cannot function better emotionally than their parents. Identifying where the parent's emotionality is coming from (assuming it's high) is important. How parents manage their emotions, and then how their emotionality may feed into their teen's (elevated) emotions will in turn affect all members of the family; in a family unit or system, everyone's emotion levels affect the emotions of the others, directly (e.g. yelling at mum), or indirectly (e.g. mum then phones dad, and sibling feels the need to defend mum, which then leads to sibling conflict, which makes the parents more stressed, which leads dad to drink at night, which makes mum feel alone, and so on). Identifying the emotion feedback loops in the family will help the parents identify where they may be able to break the loop (e.g. Mum walks away when teen is yelling at her, then herself follows up with the teen later when both are calm). The parents themselves may be limited in responding effectively to their teen, for instance, by becoming passive-aggressive, so teaching assertive skills (often referred to as tough love) may be needed. Reducing emotionality in the household can only start with the parents.

Beyond this, setting enforceable consequences with the teen when you're all calm (e.g. removal of driving privileges or practise hours, or allowances) and carrying them out calmly may be necessary. The older the teen gets, the more negotiation will need to take place in setting consequences everyone is agreeable to.

The above approach is informed by Bowen family systems theory, cognitive-behaviour theory, and social learning theory, to name a few. The above post is not meant to be a substitute for therapy, and if you need help with the above issues, please consult a qualified professional.

The importance of fathers

I recently attended a seminar on fathers that discussed the impact fathers have on their children. Many fathers may not be aware of the important role they play in their child’s life, both in childhood and beyond. For instance, research suggests fathers serve as a template for their child’s relationships to authority figures, and for girls, close relationships with men. In addition, a good relationship between father and daughter has been shown to help guard his daughter against premature sexualisation. In other words, adolescent girls who are close to their dads generally engage later in sexualised behaviours (e.g. wearing revealing clothing and heavy make-up, or becoming sexually active) than girls who aren’t close to their dads.

Emotional closeness with fathers (i.e. children being able to share their emotions with their father, and receiving validation from them) is incredibly important to a child’s wellbeing. Research suggests that enabling children to talk about their emotions with their fathers is much more important for separated families than fathers providing a fun time for the kids each visit. 

As well as having the capacity to do great good in their children’s lives, fathers also have the capacity to do ill. Children in regular contact with fathers who display anti-social behaviour are at high risk of emulating that behaviour. And if fathers are abusive towards their child’s mother, sons will learn this behaviour, and daughters are more likely to accept this behaviour towards themselves from men.

So, if I could summarise what I learned from this seminar to take away it would be, Fathers, take a little bit of time regularly (20 minutes a week) just to talk with, and listen to, your child so that they can tell you what’s happening in their lives, and receive your support and understanding.