Dear Wes and Jenny: I saw your column on cutting. My cousin is in trouble. She's tried therapy and medication, but she continues to have problems with depression, substance abuse and self-mutilation. Recently, she injured herself at school and the nurse had to call her mom to come get her. I'd like your opinion to help my cousin.
- Teenage girl
Wes: I would like to share a really quick fix for your cousin's problems (and about 50 other kids I've seen in the last year) - one requiring very little dedication on her part or that of her family, no medicine and minimal intervention with the school and community. But I can't, because there isn't one. Your cousin has a classic cluster of problems we've discussed before, and helping her requires a heroic effort on the part of her family.
You note that she has tried therapy and medication management, and neither has worked. This is frustrating because I am a big advocate of that approach. However, mother and daughter need to understand that all treatment is NOT created equally. Success depends on two things: the client and the professional. I strongly suggest that mom and daughter try again (and again) until they get something to work. Here are my therapy-search guidelines for tough situations:
- Find a good match. Kids need therapists who capture their attention and win their hearts. There has to be a connection, and therapy has to be influential. For example, if your cousin is not a big talker, the last thing she needs is a therapist who sits in silence and waits for her to speak (and some do exactly that). A skilled therapist knows how to "feel" his or her way through a session with a quiet kid. If after two or three sessions there is no connection, move on.
- Look for professionals who are trained to work with families and kids. Simply saying you work with teenagers does not mean that you have been trained to do so. It is perfectly appropriate to ask about this before your first session; most therapists will provide you with a resume on request.
- Work with a therapist who has in-house medication management and follows FDA guidelines (see online resources at www.ftimidwest.com on this topic). Medicine management for your cousin needs to be very frequent, not once very 90 days.
- In difficult cases, teens should not routinely be in therapy without ongoing consultation with the parents. This DOES NOT mean the therapist downloads to the parents everything the kid says in therapy. It means the therapist advises the parents on how to work better with their son or daughter.
- Kids and families should leave sessions with specific strategies for dealing with whatever trouble the kid presents - every week. Therapy is not simply a caring ear. It has to be problem-solving, too. A skilled therapist is best thought of as being "kindly blunt."
- Finally, as much as parents and insurance companies hate to hear it, the problems your cousin presents do not go away quickly. When the right therapy is found, the family has to stick with it. The ultimate healing for adolescence is growing up. Our job as caring adults is to help kids get to about 21 with as few scars (real and metaphorical) as possible.
Jenny: The key thing that can help your cousin is support. She may be hurting herself for reasons that you haven't a clue about, so understand it isn't a reflection on you that she is acting in such a manner. Please don't be critical or judgmental of your cousin, which will only push her farther away. Tell her that you care about her and are willing and able to help. Listen to her. Sometimes it may seem like it is hopeless, but if she knows that you care about her and want to listen to her, it may be the best thing you can do. If she spends most of her time at home, encourage her to get out. Get her involved in activities she used to enjoy or that you think she might like. Introduce her to your friends and take her places. By getting her involved in your life and the community, she can develop a stronger net to catch her if she falls.
Sometimes medication isn't the best for everyone, and some teenagers do not feel like opening up to a therapist - either because they are afraid what they say will get back to family members or they don't believe it will help. If either of these is the case with your cousin, I urge you to help her overcome her preconceived notions of therapists and try again. You can even offer to go with her to show your support and be part of the family sessions that Wes suggests.
Finally, when you are talking to your cousin, ask her if she will promise to stop and call you or another person close to her if she feels like hurting herself. The best thing you can do is be there for her and make her aware that people really care about her and that it hurts you to see her hurting.
- Wes Crenshaw is a board-certified family psychologist and director of the Family Therapy Institute Midwest. Jenny Kane is a recent Free State High School graduate. Opinions and advice given here are not meant as a substitute for psychological evaluation or therapy services. Send your questions about adolescent issues to firstname.lastname@example.org.