Dr. Lynn Margolies
Disclaimer: The characters from these vignettes are fictitious. They were derived from a composite of people and events for the purpose of representing real-life situations and psychological dilemmas which occur in families.
Ashley was 19. She had been away at college her freshman and sophomore years when her life unraveled again. In high school, she had struggled for several years with escalating depression, drinking, and marijuana use, and the painful feeling that her mother was ashamed of her. Her parents did not recognize the seriousness of the situation until she began to scratch and then cut her arms with sharp objects, at which point her mom got scared and sought help. During senior year of high school, her mom forced her into treatment, and with intensive individual, family and group therapies she became sober and psychologically stable.
Before leaving for college, Ashley was much better. She felt strong, proud of herself, and grateful to her parents for the ways they changed and learned to support her. Ashley even seemed to rise above her past - becoming an informal spokesperson for treatment and sobriety and seeking out ways to help friends and others in trouble.
At college Ashley initially participated in the support system set up for her, but then her attendance at therapy became sporadic. She became absorbed with campus life and seemed to revel in her independence. Ashley told her parents she felt “fine,” and announced that she no longer needed any anti-depressants and had gone off them.
Towards the end of first semester, Ashley tried to avoid her parents’ calls. When they did speak, she was short with them, refusing to talk about school or therapy. When Ashley came home during winter break, she spent much of her time sleeping and staying in her room on Facebook. Though having agreed and intending to get a job, she became too anxious to follow through with the process. When her grades arrived, she could no longer hide that she had failed a course and was on probation. Ashley felt ashamed but promised her parents she would do better next term and go to her therapy appointments.
Unfortunately, the same cycle occurred the following year, culminating in a mounting emotional crisis towards the end of spring semester which she attempted to hide from her parents. When they questioned her over the phone about how she was doing, she told them she didn’t want to talk about it and wanted space. Her parents complied and backed off. When she was home over the summer, however, the signs that she was sinking became harder for her parents to ignore. (The warning signs of her depression included poor grades/failure at school, avoidance, inertia, withdrawal, staying in bed too much, weight gain, lack of motivation, irritability, depressed mood.) Though her words stated otherwise, Ashley had again fallen into the danger zone.
Ashley’s mom, Laura, was a successful surgeon. She struggled with tremendous guilt over her role in her daughter’s emotional problems and failure to heed warning signs that Ashley was in trouble until things were so bad that Ashley started cutting herself.
Laura recognized that, due to her own upbringing, she had been unable to be available emotionally to Ashley and, on top of that, was perpetually disappointed with her. She came to understand that she had tried to mold her daughter into someone more conventional and ambitious, pressuring Ashley to be more like her, thereby giving her the message that she was not good enough.
Ashley’s dad, Tom, was an easygoing guy who generally aimed to please. He loved Ashley very much and gave her whatever she wanted, but did not comprehend what was going on with her psychologically. Tom did not like conflict and feared Ashley’s anger. When she went to college and pulled away, he worried that if they upset her, they could lose her and she might no longer want to come home or no longer want a relationship with them.
Ashley’s mom made remarkable progress in her own therapy during Ashley’s senior year of high school, propelled by motivation and willingness to be honest with herself. This progress was noticeable and quite important to Ashley. By taking explicit responsibility for her own mistakes as a mom, learning to accept and appreciate her daughter as she was, and acting as a supportive presence and guide, Laura played an important role in her daughter’s recovery and helped mend their relationship. Before Ashley went off to college Laura felt good about herself as a mom for the first time, and her relationship with her daughter became more solid than ever.
Once Ashley went off to school, however, Laura began to feel pushed away and their relationship changed. She sacrificed so much to help her and it now seemed to have been wasted effort. As she became aware of Ashley’s failures at school, she wondered whether her daughter was just a slacker, capable of doing better but manipulating the situation to get away with whatever she could. Feeling angry, defeated, and unappreciated, Laura commented that being a mom was a thankless and hopeless job. She wanted to give up and, pulling away in anger, she decided she would stand back and not do anything.
Laura took it personally when she felt her daughter pull away, becoming consumed by an emotional reaction which obstructed perspective on what was really happening. For all of us, executive functions go “off line” when we are triggered into dysregulated emotional states and over-reaction. When this happens, our capacity to respond flexibly, think clearly, and react with good judgment is compromised. When the part of our brain that allows for reflection is deactivated by intense emotion (often originating from unprocessed experiences from our own childhood), instead of being thoughtful about how to respond to children’s needs, we are driven to react automatically and reflexively, as Laura did in her hurt and anger.
When a child’s distress is not taken seriously, and responded to appropriately by the parent, it can fuel an increasingly dangerous situation in which the child feels unconsciously compelled to continue “upping the ante” until the parent shows that they feel something empathically on the child’s behalf. Laura’s failure to recognize Ashley’s state of mind and step in to help led to her daughter’s continued escalation and deterioration, just like in high school when Ashley’s experience of not being “seen” in her pain perpetuated her self-destructiveness. During family therapy in high school, Ashley told her mom that she had felt out of control and driven to cut herself to produce physical evidence of her suffering - desperately hoping her mom would “get it.”
Another problem here was that when Laura was able to step back from her anger, she felt scared and helpless in the face of her daughter’s fragility. She feared that if she took action to set limits, Ashley would be forced to face the truth about her own limitations and might then want to kill herself. The truth was that Ashley was, of course, already aware - at least unconsciously - of her limitations and forced to be alone in it. She needed her parents or someone to step in and take charge.
Attempting to shield children from what they know intuitively to be true usually backfires, impeding the possibility of growth and causing them to feel shame, confusion, and aloneness. Projecting her own anxiety onto Ashley and colluding in a family-wide denial, Laura in effect reinforced Ashley’s sense of shame - and left her feeling unseen again.
Having the courage to face children’s limitations with them and offer help lends courage, builds coping skills, and is reassuring. Despite fears to the contrary, shame is actually decreased when parents are not afraid to face their children (in a non-judgmental way), and do not feel compelled to pretend or hide what is really going on.
What Ashley wished and protested she could do - and even intended to do - did not match her capacities. She demonstrated that she was unable to function in an environment with unlimited freedom and limited structure. She required a setting where help and supervision were built in, where she could not get lost and hide, and fall so hard. And, most of all, she needed her parents to recognize this and not be afraid to make hard decisions with her.
Ultimately, Laura phoned her daughter’s therapist who was able to help make explicit what the realistic choices were for Ashley and her family. When presented with limited options for what she could do going forward, Ashley not only seemed relieved but, interestingly, selected the plan with the most structured and contained environment (a therapeutic residential environment combined with college). This choice was telling and startled her parents - who had been too caught up in their own emotions to recognize that, behind Ashley’s protests and demands for independence, was a cry for help and limits. As in this example, setting limits involves using adult judgment to protect children, based on what they can safely handle. Limits and consequences are often confused with punishment, but limits are not “reactive” or delivered out of anger, and differ from punishment in that there is no intent to retaliate and “teach a lesson” or cause the child suffering.
Not long after Ashley was accepted and decided to go to this program, she returned home to get ready. Three days prior to her planned departure, however, Ashley began desperately pleading with her mother that she changed her mind and really did not think this was the right plan for her. She no longer wanted to go. Laura could feel tension from her anger building inside her and a voice in her head saying, “Oh my God, not again – I want to run away.” However, having worked on understanding what happened between her and Ashley leading up to then, Laura was able to step back from this reaction. She was prepared and determined not to make the same mistake this time. However tempting it was, she knew it would be a bad idea to insist or close in on any decision with Ashley in this conversation - as she would have in the past out of anger and her own need for reassurance.
Laura calmed herself by reminding herself that things would be better if she could truly listen and not retreat, be reactive, punitive, or authoritarian. With this approach, Laura learned that her daughter was scared about the road ahead, and worried that she would lose all her friends. Laura was able to be empathic, while holding a calm, confident, but unspoken resolve about what her daughter needed, in effect, creating a sense of security for Ashley.
At the end of the conversation, Laura matter-of-factly asked Ashley if she wanted to do some packing for the program together and Ashley nodded in agreement. She thought to herself, “Hmm – clearly she still actually intends to go”. To Laura’s surprise, even though she had not given in to Ashley’s begging, her daughter experienced her as supportive and protective, and eventually calmed and settled down.
Afterwards, Laura invited Ashley to go out for a walk. Ashley complained that she was still in her sweats and was “too fat and ugly” to go out. Laura responded by putting on her sweats too and showing up unobtrusively at the entranceway to Ashley’s room. Ashley looked up at her mom and the two of them headed towards the front door for their walk, quietly in step with one another.
Tips for Parents
• Respond thoughtfully and collaboratively with your teen to signs of trouble including: behavior changes, withdrawal, unhappiness, inertia, self-harm, repetitive cycles of academic or other failure, drug/alcohol abuse, shame/hiding. Seek consultation.
• Listen to teen’s behavior, not just their words. Understand behavior as a communication to you - and think about what the message might be. Try the following: If your teen’s behavior told a story, what would the title be? In this case, for example, the title of Ashley’s story might be, “I’m too ashamed to admit it but I’m out of control. Help!”
• Recognize that often through no fault of their own, teens’ best intentions may not carry over into their actions.
• Notice your own state of mind. Be honest with yourself and your teen about whether you are reacting out of your own needs, fears, anger, helplessness.
• Recognize that anxiety and worry about teens’ reactions (for example, whether they will be mad at you) should not be the primary determinant of what to do, or the gauge of whether you are doing the right thing.
• Differentiate between letting your teen have autonomy and reacting (in kind) to their pulling away.
• Recognize when your teen is unable to make good decisions - and step in.
• Remember the power you have to affect your teen, even if privately you feel powerless or not needed.
• Recognize that, though they will say otherwise (and that’s ok), teens feel protected by limits. No one likes feeling out of control without anyone strong enough to help them.