In this episode, Neil, responds to a mother who is very worried about her anxious and depressed 15-year-old daughter. She doesn't want to add to her daughter's stress, but is concerned that her daughter is not moving forward. Mom has had anxiety all her life and wants her daughter to learn the coping skills she has. Neil explores the synergistic impact of mother and daughter's anxiety and what it will take to get unstuck and moving forward.

Welcome to Healthy Family Connections, the podcast for families wanting out-of-the-box solutions to parenting and relationship challenges, with your host, psychotherapist and author of Ending the Parent Teen Control Battle, Neil D Brown.

Elizabeth's Question

Today we are hearing from Elizabeth of Los Gatos, California.

Dear Neil,

My 15-year-old daughter has depression and extreme anxiety. Unfortunately, I think she got her anxiety from me, since I've always been an anxious person. I deal with it by staying busy and having goals, but our daughter doesn't operate that way. Her psychiatrist says we shouldn't put pressure on her because she puts too much pressure on herself. The psychiatrist referred our daughter to a therapist, but our daughter says she only wants to see the psychiatrist because she says the psychiatrist is the only one who understands her well. The psychiatrist is expensive and doesn't have that much time for my daughter.

I make sure I don't pressure my daughter. I tell her how great she is, and I encourage her to do positive things for herself. She doesn't eat right and mostly stays in her room watching YouTube videos and chatting with friends. She used to take piano lessons and dance lessons, but she says she doesn't want to anymore because girls in her dance studio were mean. My daughter has always been a good student, but towards the end of last year, she said she was too anxious to go to school and started missing days. Her psychiatrist wanted to get her medically excused and have a home teacher come to the house, but we didn't want to do that.

We're hoping things will be more normal when she goes back to school, but we're anxious that she'll start missing school again. We don't want to get into any control battles, but we don't know how to get her to do anything without a battle, and we don't want to make her anxiety worse. Is home teaching a good idea? Are there any alternatives we can consider?

~ Elizabeth

Neil's Response

What Elizabeth is describing is a real dilemma. What we as parents have running around inside of us affects our kids, and what's running around in our kids affects us. There is clearly a dynamic at play here — but what exactly is happening, and how can things get better?

This daughter perceives that her psychiatrist understands her, which is meaningful. But she doesn't appear committed to getting better. She seems stuck: "I'm anxious and I'm depressed, and that's what I've got. I'm not necessarily going to do anything about it — I just want someone to understand me." She needs parental structure, therapeutic input, and she needs to start moving. But right now, her anxiety and depression are in control. She's not managing them — they're managing her. And meanwhile, mom is anxious but not empowered.

Here's the core dynamic: we have a girl with an anxious temperament, and her mom has a similar anxious temperament. Mom has anxiety about her daughter's anxiety — and that is a message to the daughter that something is very wrong with her. It becomes a negative synergy: mom's anxiety begets daughter's anxiety, and daughter's anxiety increases mom's anxiety. They are on the anxious train to no place.

This is a form of enmeshment — being so over-involved and too close that it undermines development.

What Needs to Change

Mom needs to appeal to her daughter's strengths, not to her anxiety and depression. When she tells her daughter how great she is, she also needs to follow through with: "You have real strengths, and right now you're going to need to start using them."

Change is stressful, and mom has to be willing to face the stress of moving a resistant teenager. There has to be accountability in every family — in our work lives, our home lives, our relationships. Being a teenager means being accountable to parental structure, standards, and expectations. Mom can't say, "Since you're anxious, we'll do nothing." Instead, the message should be: "If you're anxious, let's talk about what your needs are" — and then create structure around that.

Therapeutic Options to Consider

There are several layers of support that could help here.

Family therapy would give mom and daughter a space to talk about their shared anxiety, the synergy between them, and how they can both access health together. Dad has a role here too — his voice may be getting drowned out because he doesn't want to step into the middle of the anxiety dynamic.

Individual therapy gives a teenager a confidential space to unpack feelings she may not feel comfortable sharing with her parents — whether that's issues with family, possible trauma, or things she simply needs to process with an objective, non-judgmental professional. We don't know whether this girl has experienced trauma, but trauma is often a secret that needs to be carefully unpacked and addressed.

Group therapy can be powerful for teens because very often kids think they're the only ones having a certain kind of feeling or problem. When they're in a group, they realize other kids have similar issues. Kids helping kids — collaborating and supporting each other in health and recovery — can be a wonderful thing.

When More Intensive Support Is Needed

If a child or teenager is absolutely stuck and not moving, or becomes out of control or suicidal when you try to move them, there is a full range of more intensive options available.

Most local hospitals with a mental health component have both an inpatient program and an Intensive Outpatient Program (IOP). A child can receive full assessment and stabilization inpatient, then step down to an IOP, and from there to regular counseling.

For more serious behavioral health issues — whether psychiatric or substance-abuse related — there are also residential treatment programs and wilderness programs. And for kids who need a structured therapeutic environment over a longer stretch, therapeutic or emotional growth boarding schools offer a strong therapeutic component, typically designed for a year or part of a year rather than a full four-year stay.

I'm not suggesting any of these for Elizabeth's daughter at this point. But it's important for parents to know the full range of options when the negatives are winning the day and nothing is moving forward.

For Elizabeth Specifically

Elizabeth needs to feel like she can be a parent. She doesn't have to be paralyzed by anxiety. She can have confidence in her daughter and in herself. If she can't find her way to that on her own, then she needs some therapy for herself so she can become a more empowered parent. Right now, mom's anxiety and paralysis and daughter's anxiety and paralysis are bringing out the worst in each other. That's exactly why family therapy is so important — and why I end every podcast with that encouragement. I'm not just whistling in the wind. I'm trying to help parents understand how critical their own mental health is to everyone else's mental health in the family.

Parental anxiety creates youth anxiety, and youth anxiety and poor performance create more parental anxiety. Kids need parents to be confident and to use their benevolent parental authority to create healthy structure and accountability.

On the Home Schooling Question

Home teaching needs to be temporary. It is designed to keep kids from losing academic ground during an intensive medical issue — not as a long-term solution. If Elizabeth's daughter simply isn't going to school and a support plan hasn't yet been put in place, home teaching could make a short-term sense, but only as part of a clear plan to get her back on her feet quickly.

When a child isn't in school, they fall behind in their classes, feel like something is wrong with them, and things get worse — not better. The school district is required to support forward progress educationally, but it cannot be open-ended. It must be part of a plan to get the child back.

Closing Thoughts

Thank you, Elizabeth, for sending in your question. And thank you to everyone tuning in. I want to remind you to take a breath, go inward — go for a walk, sit down with a favorite book, do something for yourself. Self-care is essential. This parenting business is not easy, and you deserve to take care of yourself.