I greet you in the waiting room, and ask if you need to let me know anything before I bring your child back to my office.
You usually say “no,” and likely wonder what is going on behind that therapy wall for the next 50 minutes.
Yes, parent of my patient, it is my job to keep you involved while still maintaining your child’s confidentiality. Achieving that balance often requires me to offer you general suggestions on the basis of my experience and research as opposed to explaining to you what your child has revealed in therapy.
- Don’t make every marital or family interaction and concern about your child’s mental health. Sometimes families establish a “homeostasis” or comfort zone in which the focus becomes the child being mentally ill (i.e. the child’s mental health gives disconnected parents something to talk about, and siblings a target for their anger). This makes the child’s stability incredibly difficult to achieve and maintain. Maintain regular family outings, traditions, or interactions that have nothing to do with doctors’ appointments or mental health.
- From a young age, require your child to participate in at least one extracurricular activity or organized hobby outside of the house. Allow him or her to choose what it is based on his or her interests, personality and comfort level. It could be anything from a one-on-one art class to a team sport. By the time he or she is a teenager, the idea is that he or she will have cultivated an interest and skill that contributes to self-esteem and quality of life.
- Sleep, exercise, and nutrition are important. Also, eventually, talk openly about the risks for alcoholism and substance abuse for the purposes of numbing or self-medicating.
- Just listen (if he or she talks) or be still (if he or she doesn’t talk.) Don’t try to fix him or her or get him or her to talk. And don’t fake knowing what it feels like if you don’t. The more you relinquish control but remain involved, the more the child opens up.
- Pay close attention to any anxieties or fears that you may inadvertently be passing onto your child. I have worked with many children who say that they fear something based on something they heard their parents say or based on a reaction they observed in their parents. Also, pay attention to the unspoken messages you are giving your child about the world. If you never let him or her out of your sight, for example, you are letting them know that the world is a dangerous place.
- Accept all they say at face value. Their feelings may not make sense to you, but that doesn’t make them any less real. And sure, kids say and do things for attention, but they often are seeking attention because they are legitimately hurting. Believe them when they cry for help, but at the same time encourage them to ask directly for what they need or want.
- Know the risk factors for suicide and have a system of “checking in” with your child that works for him or her. It is sometimes difficult for a child to explain in words how he or she feels. Alternatives include using a scale of one to 10, a visual thermometer, or pictures depicting various moods.
- Have very clear and matter-of-fact behavioral expectations, routines, and communication. Be clear and collaborative with your limits and expectations, and consequences. Discuss with your child and his or her therapist what reasonable goals and expectations are. Write down behavioral contracts, chores, and schedules whenever possible. Stability and knowing what to expect minimizes anxiety and minimizes the likelihood that a child will personalize and catastrophize when he or she requires discipline.
- Meet your child where he’s at, but maintain reasonable expectations. If a child lacks motivation and energy, lessen his chore load accordingly, but make sure he does at least some small task. If your child is agoraphobic and fears leaving the house, recognize his limitation, but still hold him accountable for at least riding along in the car with you to the grocery store.
- Don’t walk on eggshells, be overly permissive, or overly indulgent because you fear that your child will become depressed or volatile if you set limits.
- Abandon your need to understand, fix, or control. You did not cause your child’s depression or anxiety and you cannot fix or cure it. Biology, various stressors, and your child’s ways of thinking and behaving all contribute to the presentation of these complex mental health disorders. Management of your child’s illness depends on all of these factors.
- Provide access to therapy regularly. Treatment is significantly compromised when kids and teens (especially with anxiety) attend therapy only sporadically. Consult with a psychiatrist to learn about your options and weigh the pros and cons of medication management in children and teens.
- Validate your child’s anger, sadness, selfishness, frustration, or other unpleasant feelings and behaviors. Dig deep to be able to see your child’s feelings and behaviors as understandable. If your child’s behaviors were inappropriate, and punishment is called-for, always offer validation before the consequence. “It makes sense that you would rather play video games than do homework. And I get why you would be tempted to lie and say you did your homework, but those were poor choices, and it is my job to teach you to make better choices.”
- Don’t underestimate the impact of peer influence and importance, especially in older kids and teens. Stable home life will still be important, but less so than peer influence as your child grows older. Observe what is going on with your child socially, and not just at school and in person. If you suspect that social media is not a healthy social outlet, investigate and discuss this further with your child.
- Take care of yourself by prioritizing your own sleep, exercise, and nutrition. Intentionally make time for your marriage or relationship, and cultivate friendships. Oftentimes, support groups for parents with your unique challenges are extremely helpful.