Today we’re hearing from Joelle from Sacramento, CA and Joelle writes:

Dear Neil,

We’ve been struggling with our daughter (15) for several years.  She’s been diagnosed with anxiety, depression and an eating disorder.  My husband and I have gotten her the best help we could including counseling and psychiatry.  She’s on medication and we’ve done our best to follow guidance from the professionals.  Currently, our daughter is in an intensive outpatient program and part of the program is a weekly parent group with parent education. (An intensive outpatient program is a therapy program that is 4-5 days or partial days a week.)

I really think a big part of the problem is that my husband is too easily manipulated by our daughter. My daughter and I are close, but I expect her to do her work.  When I set a limit and take her phone away, she has a fit and her father gets in the middle and mediates, essentially painting me as too harsh.  In the group, he presents as very loving and positive but it’s not the real him. He works a lot and isn’t involved much at all. When I bring all this up in a group, they emphasize the importance of parents being on the same page but to be on the same page, doesn’t he need to support me?  When I say that, they advise compromise but honestly, I’m very flexible and only take a hard line when she’s pushed me too far.  With all this treatment, I’d think someone would help us deal with this.  Anything you might offer would be appreciated.

Joelle

Now to Joelle’s questions:

Dear Joelle, How frustrating to be undermined in your parenting efforts and not get the help you need from the professionals involved.  Most unfortunately, what you are describing is painfully common.  That is, you and your husband have a common, yet unhealthy dynamic that is undoubtedly related to your daughter’s emotional / behavioral health problems, and yet with years of professional service, nothing is getting to this critical dynamic.  

Let’s look at what is wrong and then how to fix it.

We started using the term, identified patient or IP a good 50 years or so ago to refer to the reality, that the person in the family with presenting symptoms, is reflecting issues that exist in the larger context of the family.  In other words, the patient is really the family. Your daughter’s symptoms are reflecting unhealthy dynamics that exist in the larger context of your family.  So when a youth enters therapy, the idea is that it will create change. And if one part of the family is challenged to change, the other parts need to change as well or the effort will be ineffective. So what I’m saying here Joelle, is you are definitely on target that the dynamic between you and your husband needs to be addressed.  

The IOP you are in is addressing the family issues ineffectually.  Parent education and a support group for parents is not family therapy.  These services can be helpful, but it isn’t family therapy. When therapy programs claim they address the whole family when they provide these services it’s nonsense.  Even if the parent group or the parent educators told your husband to change his behavior, there’s a better than even chance that he won’t. Why?  Because there’s a reason he behaves the way he does.  His behavior is in part related to yours and your relationship with each other and your relationships with your daughter. In other words, his behavior is part of a pattern of behavior within the family. For the treatment with your daughter to be effective, the pattern in the family needs to be identified and changed; changed from a pattern that is part and parcel to the problem, to one that supports healthy growth and development. It doesn’t have to take forever although it might uncover other deeper issues with you and your husband.  Issues from your backgrounds, temperaments, or the history of your own relationship.  And that’s fine, but the destructive pattern needs to be identified and effectively addressed.  Other issues can be worked on while the pattern in the family is a healthy one.

Remember, Family Therapy isn’t who is in the room.  It isn’t sitting together talking about our feelings.  Family therapy is how we think about where problems live and create change in the family dynamics, changing the patterns of interaction within the family.  There is no one way to create that change.  The therapist needs to see how the family dynamics support the problem and work with the family to change those dynamics and create healthy family behaviors.  

Parent groups, parent education and even parent coaching, unless it is focused on changing a specific family dynamic, is not family therapy.  They can be useful and have their place in the world of family mental health, but it isn’t family therapy and it lets the IP languish as the person with the problem.

Joelle, with the little you have shared with me, here are some thoughts.  First of all, in addition to your husband being easily manipulated, you describe yourself as close with your daughter and very flexible.  It sounds like you don’t set what you call a “hard limit” often.

Here is a dynamic often seen with anxious eating disordered youth.  Both parents are emotionally indulgent and neither set clear limits that require their youth to do their best or deal with their feelings.  Often, parents are frustrated with each other and have some chronic stress in their relationship, as you and your husband have. That chronic stress is a factor that is felt in the family and your daughter may well be feeling it, maybe feeling responsible for causing it, and may feel responsible for your feelings and your husband’s feelings and is not learning how to manage her own feelings. 

This is of course conjecture based on other situations that sound like yours and could be way off. But this is the kind of thing family therapy can uncover and address. 

I would add that often, by putting labels or diagnoses on problems such as the one’s your daughter is having, it can make it seem more like a fixed thing and something you need to accept and indulge.  It can be disempowering to parents and encourage indulgence and give a teenager the impression that we see them as ill and not able to learn and grow normally.  Diagnoses can help if we use them to point to solutions. But kids need to be raised by empowered parents; parents who have their youth’s best interests in mind and use their well-intended, benevolent authority to provide the structure and support their adolescent needs.  If diagnosis can help them understand their youth’s needs, great.  If diagnosis intimidates the parent, makes them see their child as disabled and more fragile than they are, then it’s a bad thing. 

So parents, therapists and folks who work with families; with COVID-19 and an increasingly online world that our kids and we live in, behavioral health problems for teenagers aren’t going away anytime soon.  Yes, let’s get our kids the mental health services they need.

Thanks for tuning in today listeners and special thanks to Joelle for sharing her frustrating situation with us. Well here we are in the new year so, let’s resolve to take better care of ourselves.  Let’s do this together. We’ll take a slow deep breath, hold and then exhale very slowly, ready?  Inhale through your nose, 1,2,3,4,5,6,7, good, now hold, 1,2,3,4,5 and exhale very slowly 1,2,3,4,5,6,7,8,9,10.  One more time, inhale, 1,2,3,4,5,6,7, good now hold, 1,2,3,4,5, and now exhale and send your stress away, 1,2,3,4,5,6,7.  Are you remembering to slow down and breathe and do other easy positive things for yourself? They’re important because as I’ve said many times and I’ll say it again, this parenting business ain’t easy so self-care is essential; you need it, you deserve it, you’re worth it.  Bye for now.