by Nannette Thomas, LMFT
We are all aware of the concerning increase in depression, anxiety and general mental health issues in the adolescent and young adult population. In my practice, I see teens, young adults and their families and, of course, I see teens and young adults with anxiety and depression. I also see many of the side effects of rising mental health problems. For example, parents in general have become more anxious. They become anxious when they hear of suicides within their school or community. They also become anxious hearing stories of seemingly well-adjusted teens who appear to suddenly refuse to come to school or get out of bed. The adolescent mental health system has also become overwhelmed, so when parents are worried about their child or teen and start looking for services, they encounter long wait times, full practices and very expensive options, which leads them to feel even more anxiety. This parental anxiety alone has many implications.
In addition, when parents call their child’s school, they frequently find more reason to be anxious. The schools are often overwhelmed by calls from concerned parents. Many parents have told me stories of teachers and administrators not returning their calls or not having useful suggestions for how to handle problems. Schools and the training programs that educate teachers have traditionally focused on educating children. The sudden need to manage children’s mental health is a new and unexpected challenge for schools and their staff. A call to a teacher or principal used to calm many parents as they shared the wisdom of their extensive educational experience. Today, this calming experience seems less common as the issues extend beyond education and as the school staff themselves are often more anxious.
In my practice, I also see the challenges of families trying to adjust and work with teens returning from treatment. Whether this treatment was a few days in residential care, an IOP program or a year at a wilderness program followed by a therapeutic boarding school, trying to figure out how to return to a new, healthier normal is difficult.
In all of these scenarios, anxiety is high. The parents’ anxiety is high, creating more anxiety within the family. The teachers and administrators are anxious trying to handle the safety of kids in an environment where suicide is not uncommon. In Bowen family systems theory, one of the goals of working with families is to reduce the family’s overall anxiety. Bowen also talks about the many ways that anxiety can contribute to unhealthy family functioning such as triangulation and emotional cutoffs (Sharf, 2016). Family anxiety is both a cause and an effect of the increase in adolescent mental health issues.
In working with families today, my goal is to contain and reduce the anxiety. Regardless of the situation, we need to listen carefully to each other and work slowly to effectively respond to the issue at hand. I use the metaphor of a container when working with parents. We want to create a safe container for children and teens to grow. The first and primary aspect of this container is the container itself, which is the limits that parents (and schools and the community) set to keep the child safe and on track. The second aspect is the space inside the container, which allows the child or teen the room they need to figure things out. In this space, all of their feelings are acceptable and they can determine their strengths, their weaknesses and their preferences. They can experiment to see how life works and who they are, who they want to be. We cannot do this work for a child.
In setting limits, parents often need help. My first focus is on safety. If there are safety issues with the child, these need to be addressed first. Depending on the safety issue, I often work very behaviorally with the parents to make sure we take action to keep everyone safe. There is a common misconception that the way to handle a depressed or anxious child is to be supportive and not ask too much. While at times we may need to do this for an afternoon or a few days, I believe that generally children and teens feel better when they are contained and have appropriate limits. Often parents have tried to be supportive and not ask much until they hit a crisis and suddenly they must take action and the child encounters strict limits. An example would be a child with disordered eating who has lost more and more weight. The parent finally becomes concerned enough that they take the child to the pediatrician and the child is hospitalized. The hospital is extremely structured and sets limits on all aspects of the child’s functioning. If the family had been able to find a way to set limits before this crisis, the child might have avoided the shock of going from overly permissive parents to a completely restrictive hospital regime.
Setting limits is difficult, especially with the internet and devices, and can bring out anger and conflict that parents have been avoiding. I work closely with parents to understand them, their child and their family and see how we can gradually and effectively set limits and create a safe container. For example, parents often say, “I don’t care about my child’s grades” and I reply that “I do care.” In general, children and teens do not feel good about getting Cs, Ds and Fs and if they are getting these kind of grades, I want to know what is going on. Limits are not about punishment. They are about knowing when to be concerned and to take action. If a child is getting grades that do not seem to reflect their abilities and we say that is acceptable, the child may hear the message that they are not very capable or that they do not matter very much. When working with grades and school work, I often recommend a book called The Learning Habit (Donaldson-Pressman et al., 2014). This book details a common sense approach to a homework routine. Structure and routine are a type of limit that can be very helpful for many busy families.
In working with parents on the space within the container, I teach them to listen and empathize, to reflect and summarize, to name emotions, and then to allow their child space to figure it out. Part of this work is skills training with parents, but part is helping them to manage their own anxiety so that they can become a “nonanxious presence” (Friedman, 2007). A parent who can provide a nonanxious presence can listen and connect without becoming too involved in the child’s emotions. Another of my favorite parenting books to provide to clients is The Self-Driven Child (Stixrud and Johnson, 2019). This book contains a chapter on becoming a nonanxious presence by first managing your own emotions.
In all of this work, I am creating a container for the family. In my practice, it is critical that I manage my own anxiety as a therapist. I rely on my own therapy and effective consultation to make sure I have the support that I need. Schools and communities used to provide a container for families. Today, though, the whole system seems to be straining under the pressure of increasing demand. Therapeutic work with families requires good containment for the therapist under these circumstances. The therapist can then both provide and teach containment for the families, children and teens that are their clients.
Nannette Thomas is a licensed marriage and family therapist practicing in downtown Los Altos. She sees adults, couples, older teens and families. She previously worked as an engineer and manager in the tech industry and has volunteered for many years as a lead on the Mountain View Los Altos (MVLA) K-12 Parent Education Speaker Series.
References
Donaldson-Pressman, S., et al. (2014): The learning habit: A groundbreaking approach to homework and parenting that helps our children succeed in school and life. New York, NY: Penguin Group.
Friedman, E.H. (2007): A failure of nerve: Leadership in the age of the quick fix. New York, NY: Seabury Books.
Sharf, R. S. (2016): Theories of psychotherapy and counseling: Concept and cases. Boston, MA: Cengage Learning.
Stixrid, W., & Johnson, N. (2019): The self-driven child: The science and sense of giving your kids more control over their lives. New York, NY: Penguin Random House.
