Lily’s first step is simply to validate Sandy’s feelings. It’s a reasonable guess that she both misses her dad and is angry with him; that she is glad her mother got her out of the situation, but feels guilty that she is glad. She both loves her mother and is angry with her for not only taking her away from her father but for taking her away from her home, her school, and her friends. It probably makes no sense to her that she is feeling all those feelings at once. Complicating things further is that she was raised by her dad to think that her sensitivities are somehow wrong.
Lily needs to let her daughter know that she understands how overwhelming and confusing the move has probably been for her and that there are ways to handle her feelings that don’t put her at risk of giving herself a serious wound or leave her with permanent scars. Yes, Lily needs to be the mom. But she can also let Sandy know that the reason she can be understanding is that sometimes she also feels mad and glad and sad about the move and wishes there had been another way to make things better.
Once Sandy feels supported and heard by her mom, I’m hopeful that she will come to the next appointment. If not, Lily can still be coached to help her daughter learn new ways to discharge the emotional buildup that happens when she keeps suppressing her feelings. We can teach her that physical exercise (dancing, running, going to the gym) can release the same relieving endorphins into her system that cutting does. We can teach her other ways to relax like taking a warm bath, listening to music or making art. And we can give her some coping skills. Deep breathing or washing her hands or or getting a cold drink of water can calm her while she works to get the urge to hurt herself under control. Most important, we can help her learn to value her feelings by keeping a journal and talking to her mom or a friend or even to me.
While all this is going on, Sandy also may need a little help fitting in with her new school and making friends. Lily had lost sight of how hard it is for a kid to move in the eighth grade. She agreed that she could be more encouraging about having other kids hang out at her place and be a little less focused on grades for now.
I’m certain that before we’re finished, we’ll also need to at least attempt to involve Sandy’s dad. She doesn’t miss his rages but there is more to him than a walking ball of anger. There were good times too. She loves the dad who shot hoops with her in the backyard and who joked around with her when he was feeling good. My guess is that he’s a guy who can’t tolerate his own feelings and who hated feeling out of control when his daughter cried. Perhaps if he feels understood, he’ll be open to working on himself and his relationship with his daughter. Lily is okay with the idea as long as she has assurance that we’ll prepare Sandy to deal with disappointment if her dad doesn’t respond.
Coaching Sandy’s mom like this may work. Not all “therapy” happens in an office. A loving mother who can listen, stay calm, and offer some practical advice can also give a young person exactly what she needs. Learning some concrete ways to be helpful and having some support gives Lily hope and focus. She’s highly motivated to do the best she can for her daughter.
If this method doesn’t work – or doesn’t work enough – my hope is that Lily’s efforts will help Sandy eventually feel okay about getting some additional support. She might come to see me, alone or with her mom, or she might be more comfortable joining a support group with other teens who are struggling to learn how to manage strong and sometimes contradictory feelings. Whatever path therapy takes, she’ll know her mom is there to help.
For more information about self-harming, go to Psych Central’s list of links to resources.