The Healthy Family Connections Podcast

Episode 058 · Duration: 00:13:43

Should I Push My Anxious and Fragile Son To Try Harder?

What’s a parent to do if they give their anxious teenager has all the therapeutic resources they can think of, and nothing changes?

Anna of Sayreville New Jersey writes:

I am not sure what to do with my 17 yr old son; he has Generalized Anxiety Disorder and is falling into a state of depression. We have been seeing different professionals for a few years now. He will not speak in school and has no friends. My question is, do I force him to go to the Adolescent Therapy Group or allow him to see his recent therapist for individual therapy and then maybe go back to adolescent group therapy when he is ready? He is in an emotionally fragile state right now and I certainly don’t want to make it worse. He is definitely receptive to going to individual weekly therapy with his recent therapist. I am not sure if I am making his anxieties worse by forcing the issue. Each time we have to take him for the group therapy he tells us that he only wants to stay for the first hour…..my husband and I keep telling him to try to jump in with both feet…Please advise.

Thanks for your question Anna, because it’s an important one. You’re asking me this question because you are in a bind: do you push your son to challenge himself, worrying that you’re adding to his problem, or back off and watch him stay stuck?

Here’s what I understand you to be saying. Your son has had issues with anxiety that seriously impacts his ability to function socially and emotionally for a long time. You’ve had him with different doctors and therapists and at this point he has no friends and won’t talk in school. Right now, he does have a psychiatrist who is prescribing medication and he’s in weekly therapy with a therapist he likes. And, you want to know if you should require him to go to group therapy and if you do require it, should he be required to stay for the whole time.

Managing Anxiety

What’s wrong with this picture? Anxiety is a manageable if not a curable condition. Using Cognitive Behavioral Therapy (CBT) or Dialectical Behavioral Therapy (DBT), as well as thoughtful medication, anxiety can be successfully treated and managed. So why isn’t this happening for your son?

The glaring issue for me is that your son is not focused on solving his problem. In fact, it isn’t clear whose problem it is, his or yours. I say this because you are the ones who are trying to figure out what to do and your son is focused on staying within his comfort zone. The psychiatrist is trying to help him, his therapist is trying to help him, and he is trying to stay comfortable. If your son is going to get better, it’s because he decides this is his problem to solve and, once he owns the problem, he’ll own the solution and then the professional help he’s getting will actually help.

Right now you’re on a course for him to not be able to function independently after high school and you’ll have the problem you have today only worse, because there won’t be the structure of high school for him to go to. Where is he going to work where he doesn’t need to talk? Or how can he go to a college class if he can’t stay in an adolescent therapy group, or won’t talk in school?

One way to think about this is that your son and his parents are in a control battle, where parents are trying to get their son to push himself to get better, and their son is fighting those parental efforts and is indulging his anxiety and focused on staying comfortable.

There are active control battles where the struggle is obvious– with anger and name calling,–and there are passive control battles where avoidance and passivity are the weapons used to fight the battle. And that’s what your son is using, passivity and avoidance to resist your efforts.

Get Uncomfortable To Change Habits

Anna, as you and I both know, growing and changing is uncomfortable, and your son is going to need to be uncomfortable to challenge his anxiety to get better. In fact, to get anything and anywhere in life, we have to be willing to put ourselves out there, take risks and dig deep. Your son is not learning that. He’s learning to avoid and his anxiety and depression have so much control that they are defining him. Not his athletic ability or his intellect, not his musical or artistic talent, not even his kindness and love for others.

I hear you say that your son is particularly fragile right now, but I’m guessing he goes between somewhat fragile to highly fragile, so if his level of fragility controls you, you’ll go from low standards to no standards.

So what are we going to do? To end your participation in the Control Battle Anna, I would push the alarm button and say, “things need to change right now.”

Here are some things you can do now:

• Tell him, “Yes, of course go to your adolescent therapy group and yes, stay the whole time. That’s been recommended so that’s what you’ll do.” Your son has no friends and a huge part of adolescence is developing relationships outside of your family, so opening up and talking with other teenagers who have emotional problems is an important part of his recovery. If he’s too fragile and he falls apart, whatever form that might take, he can go to an adolescent psychiatric unit of a psychiatric hospital. There will be group therapy in the hospital too and when he’s released, it will be with the recommendation of continued group therapy as well as other therapy.
• Another important thing to do is you and his Dad go with him to a therapy session, and find out what’s being recommended to your son to do; and hold him accountable to following through. For instance, if he’s being guided to do mindful-meditation twice a day, is he doing that? Is he being advised to get exercise or use a workbook on managing teen anxiety? What privileges is he enjoying now? I’m guessing it includes computer and gaming time. How about if he only gets those privileges if he embraces all the therapeutic guidelines? I’m sure he’ll say, “But the video games are the only thing that makes me feel better.” And I’m sure he’s right, but that’s the problem. He needs to find healthy ways to feel better.
• Another consideration is he could enroll in an intensive outpatient therapy program. These are therapy programs that meet several hours a day, for several days a week. They include individual and group therapy and can help a person who is very stuck make progress. After they stabilize and make progress they can graduate to once or twice a week outpatient therapy.
• And finally, there is the option of a residential treatment program. This can include anything from a wilderness program to a therapeutic boarding school. Programs can be short term, medium and longer term; I’m certainly not making a specific recommendation I’m just giving you the broad range of options. If you are going to consider an out of home treatment program, always use a licensed program placement specialist. There are a lot of programs out there and you would want to make sure your son is at the right program for his needs.

The point is Anna, things need to change and they aren’t changing; and they aren’t changing because the family dynamic isn’t changing. Medication doesn’t change the family dynamic and individual therapy doesn’t change the family dynamic. Well-crafted family therapy can change the family dynamic. Your son and his parents are stuck in a relationship pattern that I’ve termed a control battle and your son won’t move forward on his developmental curve unless the family pattern changes.

The dynamic in your family will change if you and his Dad hold your son to much higher standards and expect him to actively address his issues. This has been going on for a long while now, so it won’t be easy. I do recommend that you and his Dad get counseling support for making and maintaining the changes you need to make. But if you as parents are clear and resolved that things need to change, I’m confident that slowly but surely, things will indeed change and your son can recover.

The Importance of Family

So listeners, let’s all remember that mental health problems don’t exist in a vacuum. Of course anxiety, depression and other mental health issues often include a genetic component. But how they manifest and how they’re managed, have everything to do with the family context. If there is a problem with a child or teenager, parents address it with their child or teenager and it gets resolved. If there is a chronic problem, that means one of two things; the problem hasn’t been correctly diagnosed, and/or the way the family is addressing the problem, is now part of the problem and that’s exactly what happened to Anna’s family. So if there is a chronic problem, think: what is the family pattern that is supporting the problem and how can we change that pattern.

Thanks for tuning in today everyone and special thanks Anna from Sayreville, New Jersey.

Is the stress and pressure of helping your teen manage their anxieties starting to take a toll on your effectiveness as a parent? You’re likely experiencing parental burnout. Download my free guide to learn how you can overcome it.

Please remember, take care of yourselves; you need it, you deserve it, you’re worth it. Bye for now.

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