Dear Dr. Wes & Marissa: I have been researching cutting because my close friend has just shared with me that she cuts. She feels depressed and has an eating disorder, and she doesn’t get along with her parents because she is gay. Her parents don’t accept her for who she is. I don’t know how to help her because she goes to a therapist but won’t talk about the cutting. She says that her therapist won’t care and is just there because she has to be. What can I do to help her get through this rough time? I am scared of what she might do. – Teen Girl

Wes: In the field of therapy, we describe this as “a mess.” It seems that everything that can go wrong for this girl has, leading to a tragic state of affairs. First of all, your friend’s situation points out the common thread between cutting and eating disorders – families who have poor conflict resolution and high expectations. Combined, these tend to generate both behaviors. You suggest that a potential source of family conflict may be your friend’s sexual identity. That alone would consume an entire column, and at some point we will come back to that issue. For this week, we’ll just assume you are correct: The family is unhappy about your friend’s choice of romantic partners.

As if this were not enough, your friend sees a therapist to whom she will not disclose anything. I admit that I was a little incredulous when I first read this. I hope that there are not therapists out there who convey that they “don’t care” and “just have to be there,” and that instead this is just your friend’s misperception. Unfortunately, perception is reality, and your friend has not made a sufficient connection with this therapist to bring up these topics. If that is true for any reason, she needs to either take the risk and share or find a therapist she can talk to.

I don’t know whether the family is going to these sessions. As I’ve said before, if this girl is being seen primarily in individual therapy for the problems you’ve listed, then something is wrong. None of the problems – coming out, cutting, an eating disorder – can be addressed in a teenager without a significant involvement of her parents. I find that people often get frustrated with therapy because they are not involved in the correct therapy, and then their whole idea of therapy suffers.

I’ll let Marissa address other things you can do to help your friend. For my part, I strongly encourage you to see whether you can attend therapy with her. She may not like this, but someone has to be honest with the therapist about how things are really going. I don’t know about other therapists, but we always welcome friends of the client for exactly this reason. I’ve learned a lot over the years from friends and romantic partners, and I can’t think of a time that it was not helpful. Talk with your friend about your concerns and tell her you’d like to go. If she refuses, you should write the therapist an little note and explain your concerns. She can’t admit whether she knows your friend due to confidentiality, but you are free to express your concerns to her.

Good luck, and thanks for being a caring friend.

Marissa: You have a lot to deal with, and I understand that you are probably feeling panicked as to how you can help your friend. Before I go any further, I think it’s extremely important to help you understand that your friend’s issues are not yours. That may sound harsh but you’re only a teen yourself, and even though you want to help your friend, you need to be sure that you separate yourself from her problems. It’s easy to become so involved in the situations of the people that you care for that you become depressed and overly stressed.

You also need to remember that you are not her therapist. There are elements of her problems that nobody but an educated and experienced therapist can understand. I hope that in time she will open up to her therapist, but in the meanwhile, you cannot shoulder that responsibility.

That being said, there are a few things you could do to help her. First, see whether she has some type of outlet other than cutting. Does she write, draw, have a hobby or even just someone to talk to? It sounds like her two main outlets are the cutting and the eating disorder, and I think if you could encourage her to do something positive instead, it would help her. Keeping a journal is my favorite idea because you can combine writing, poetry and art all in one, and it’s easily shared with a close friend.

If she does not like any of those ideas, it does wonders to simply reassure her time and again that you are there for her. She may act annoyed at the time, but if there is anything she truly needs right now, it is a good friend.

Discussion group: Join Wes and Marissa at the Lawrence Parents Network discussion group to discuss the wonders of adolescent brain science. The meeting will be from 10 a.m. to noon Saturday at the Lawrence Public Library gallery, 707 Vt.

Next week: Can teenagers really become addicted to video games?