How to respond to a young person in you care once they return from rehab or a clinic.  The precarious balance between caring and confronting.

Alice

 All parents of growing children have to find a balance between discipline and freedom. These are value-based decisions, and a familiar source of conflict between parents. You do want your children to be able to take care of themselves once they grow up, yet you also want them to feel cared for and free when they are at home. When are you being too harsh, and when are you overindulgent?

An adolescent or a young adult comes home from a rehabilitation centre or a psychiatric clinic, and this question moves to the foreground. It can become a daily – if not an hourly- dilemma.

Must I wake him up if he sleeps late? Can I insist that he does the cooking, or is that asking too much?

At the end of this section there are guidelines for all parents who find themselves in the quagmire of dependency versus independence.

This blog is in the form of a letter to the parent of a 17-year old.

My next blog will contain the letter to the 17-year old.

The letters are about the essentials, which in themselves are quite a lot.

Every single aspect that I write about matters.

Do try to trust me on this one, I write from experience.

Dear Robin

My heart goes out to you as I write this letter. One of the many things that I have learnt over the years is that, when a child breaks, there is at least one parent breaking too. It can happen suddenly, like a glass falling out of your hand, but more usually the suspense has built up over time, with dread having settled in your heart. Inevitably, one day something essential breaks, and the walls come crushing down.

When I first saw Samantha, she had minimal contact with reality. She had been hanging onto a fragile thread for far too long, and it broke at last. In some ways, this was a relief. You had been hoping for a small miracle – a nice boyfriend, something of interest out there that would focus her attention, maybe a different school or just a teenage phase that would pass. And then we were sitting in my room, facing this reality: My child is too badly broken to be fixed by a ‘normal’ intervention. You were on the route that you have been terrified of all this time: Seeing psychiatrists and placing your child in a clinic. Your child being diagnosed with a mental disorder. You face the shame, and the fear, and the guilt.

But here we are, and Samantha, for now, is out of danger. Yet, as you understand so well, out of the clinic does not mean out of danger. The decisions that the two of you take over the next two years are the crucial ones. You get that, and it wakes you up at night: What if you do the wrong thing? Should you have reacted like you did today?

I have written down some home truths – signposts along the tricky path.

  1. By now you probably suffer from burn out. A parent who has been stressed for a lengthy period of time, has depleted resources. Please, please take care of yourself. Physically. Do not let yourself go. It will make you feel worse, I promise. Spend your precious money on your hair, your face, new clothes, a hobby, a course, whatever makes you, singularly, feel that life is worth living and that you are more than your child’s problems.
  2. It is also your fault. Accept that. But it is not only your fault. Accept that too. The part that you can change is the part that was your fault. Do not, whatever happens, repeat that! Overindulgent? Overcritical? Avoidant? Depressed, alienated, aggressive or addicted yourself? And what about your marriage? The atmosphere at home? Somewhere there is an area of your life that is in need of a makeover. Ask your child, s/he will tell you. If you want your child to change, demonstrate that change yourself. So many parents want their child to change; yet do not understand how very difficult this can be for the child, because the parents keep on doing exactly the same. It will also help you to understand how difficult change is.
  1. You can’t do this alone. Talk about it. The more you talk about it, the less ashamed you will feel. Ask your closest friends for their honest opinions and advice. Tell your boss. Ask for help from friends and family. Insist that her father helps you. This is good for her too. Acknowledge that you need help, also to Samantha.
  2. You do have to decide what are the minimum requirements that will enable Samantha to move forward.. Decide on these together with her therapist, the family therapist, the psychiatrist, Samantha’s sister and her father. It is important that we all agree to stick to these conditions. I have learnt over the years that when you face a real battle, you need to deploy a squad.

Minimum conditions that we have already agreed on:

  • Samantha will stay with her father and stepmother every weekend from Saturday afternoon–Sunday afternoon. This is as much for you as for her. For you, so that you can regain some strength, and for her, so that she does not become overly dependent on you again.
  • Samantha will receive pocket money: enough so that she can pay for her own transport, toiletries, phone time and one fashion magazine per month, but not so much that she will be tempted to stay at home forever! She has to be somewhat uncomfortable without being overstressed. Neither you, nor any other family member will provide her with any additional money.
  • Samantha will get up by 10.00 every morning. This means that yes, you wake her up cheerfully, open the curtains, and open the door when it is time. Do insist that she gets up. She has agreed to this and it is in her best interest.
  • She is allowed a maximum of 120 minutes on the Internet or television every day. No more. Please adhere to this limit yourself.

If you want Samantha to improve you have to adhere to these fundamentals. There are no exceptions. It is not for ever, it is for six months, thereafter we will reconvene.

Occasionally you may “lose it” That is fine, and it may even be helpful. An occasional melt down is allowed! It is a natural outlet when under severe stress. Definition of occasional: No more than once a month. If you find yourself at the end of your limit more often, talk to a friend and/or get help.

  1. Do not overindulge Samantha’s problem. By this I mean do not focus on her problem and her moods to the exclusion of the rest of her personality. When you can see that she is in great distress, you can hold her and say reassuringly, “I am sorry, “I know you that you are having a rough time, but we will pull through. You have come a long way, and together we will make it.”

Practice listening up to a maximum of 20 minutes, and with the exception of her sharing some new personal information with you, after 20 minutes change the topic gently but firmly. The general guideline is 5-10 minutes of sympathetic listening – do not skip this part- followed by practical rebalancing.

Not speaking about plays an important role in keeping people unbalanced. Some families talk too much about the problem, others too little. You have to take your own measure and create a balance. Both are important: being able to speak about – and be listened to – and being able to not always speak about, and to focus on something else.

We know that a psychological problem is also maintained by a) an overemphasis on the problem b) an overemphasis on “me” and c) an overemphasis on emotions.

And that activities that have nothing to do with a problem are important, as they help us to focus on something outside of ourselves, and gives us something else to talk about. (It can become habitual, and really tedious and unhelpful to talk about personal problems all the time.)

Remember what I said about changing your own habits! Samantha will try out all the habitual responses that the two of you have built up over the years. “But mom, I am too sad to go out today.” Do not fall for old habits my dear!   You don’t have to be harsh, just firm and not indulgent. “I know, but Auntie Sue is expecting you. Go and enjoy, give her my regards.”

Whatever it is that she does, make sure that it gets her out of the house, and gives you a small break.

Do not fretfully enquire on return if she was ok. You have to pretend normal! Ask about auntie Sue.

  1. Loss of reality: If you see that Samantha is losing her footing, and drifting into unreality, interrupt her immediately. In the beginning you will have to be hyper vigilant. In time it will become less. Ask her an ordinary question (“Do you know where my keys are?”) and redirect her towards something ordinary, “ Won’t you please get dog food when you go the shop? I have been wondering if this dog food is causing her to scratch. Maybe we should try something different?” In other words, get her mind engaged with something that is concrete. And firmly based in the world of real.
  2. Stop any ‘weird’ behaviour in its tracks. It is alike to stopping a puppy from chewing your computer chord. She wants to paint her room black? The answer is “No”. Why? “ Because that is what unstable people do. Once you are stable, you can paint your room any colour you like.” She wants to paste strange writings on her wall. “No.” Why not? “Because we do not want the voices in your head to become real. You may think that they are helping you, but actually they keep you trapped, so no, we need to change them to normal. Then, you will see, you will have no desire to write them on your walls where they scare the wits out of me and keep you trapped in despair. So hey, out they go.” (A light humorous touch is always useful). She is drawing strange bloody claws?   “Samantha if you want to draw bloody claws, please do that with Elzan (therapist). In this house, please draw normal stuff. Draw the lounge, or the cat. Or your favourite positive fantasy or dream. In here, we have to do stuff that builds hope and life.”

One of the scariest things that has happened when people lose contact with reality, it that destructive autonomous forces seem to have taken control of their minds. The role of medicine is to keep the hallucinations under control. Our role is to bring her back to reality. To keep her grounded. We have to do this gently, but firmly.  Remember that the voices in her head are dark and seductive. Kindness and love is what she needs now. But also firm boundaries and small concrete daily responsibilities. What will a competent and resilient 17-year old be able to do? That is our end goal. We must be sure that the steps that she is taking every day will be towards that other safer shore.

  1. Have good times together. The more physical and sensorial, the better. Experiment with making your own pasta at home. repaint a room, watch an old-fashioned movie and cry, sort out the garage, take moderately difficult hikes, attend dance classes, music concerts.
  2. One of the reasons what happened, happened, is because something that should have been addressed long ago, has been suppressed for too long. It is the role of the therapist to take care of Samantha’s. Your role is to take care of your own. In my experience this is often something that has been passed on from your parents (who may have got it from their parents. It is the “sins” of the fathers and mothers, being passed on to their children). This may sound corny, but an adolescent in serious trouble, often helps us to see what are the bad habits or secrets that has been passed on from generation to generation. It can also show us what has been in desperate need of change in a marriage.

Three findings to keep in mind for a healthy balance between discipline and freedom

It is useful to remember that longitudinal research findings from all over the world have shown that people who are resilient and who can cope with adversity, have three characteristics in common:

A. A Sense of Belonging

The ability to be connected – to have meaningful relationships and to feel that you belong to a wider community, to feel that you are rooted in a community of which you are a valued member.

With this in mind, it becomes clear that rehabilitation must also include a reality check that addresses this. Often we have to begin by repairing family relationships.

Does your child feel that she is at home in the immediate family? If not, you will have to get help to repair relationships within the family. Family is our first port of call for a rooted sense of “home. It goes without saying that a house is not a home. So if you and s/he has to do a rethink about this, then this is where you begin.

If your house is already a home, then you cast your net wider. What person/ activity /group can your child join out there where s/he would be able to feel that s/he belongs?

Footnote: this obviously goes for you too!

Alienation is at the root of many a psychological problem.

A note on younger children: This is a strong need in young children. They love belonging to a wider family and a small community. This is not a time to be harsh on family members: children love having grandparents and cousins and regular people coming to visit.

 B. Self Determination

Self-determination. This one can be tricky. It is the most common excuse used. “You can’t tell me when to get up”. “Stop telling me what to do.” Is that not self-determination? No, that is subterfuge. It is a way of staying within the problem. Just as you have to change, your child has to, too.

It is clear that the choices that your child has made, has led her/him into trouble. So, you start out small. On what days would they prefer to prepare dinner/walk the dog? What classes would they like to take at the gym? In other words, the ground rules are set, but within the ground rules, they have choices, which will be respected.

Week by week, month by month, you have to make sure that healthy decisions are increasingly made by them, not by you. Some hiccups will occur along the way. Make sure that you address them immediately.

Love them a little bit more for every healthy decision made.

I wrote about self-determination and children, and more extensively on adults, in previous blogs on Emotion Regulation and Will.

 C. Creating and finding Meaning

Let me state this in its opposite: What is not meaningful?

In general: Watching television, playing games on your phone, eating when you are not hungry, cleaning house… anything that is used as a distraction.

Specific to you: Anything that does not make you feel satisfied on completion. Tidying your room can be a form of distraction or a meaningful activity: It depends on how you feel once you have completed the task.

Whatever gives one a deep inner feeling of satisfaction is meaningful.

We can look back on our lives, and pick out the times when we felt truly alive and connected. We can be honest about our inner yearnings, and resuscitate them. Ignoring inner longings is cause to many distractions, and believe me, a significant part of the original problem. So give your longings their due. And no, it will not be easy (bad habits have strong incentives), and it need not be a big enterprise, but at least you won’t be wasting so much of your life anymore.

Explore wider forms of meaning. Religion is experienced as deeply meaningful by many people. So are the arts and nature. A weekend in nature can have you feel as if an inner mechanism has been reset. So can attendance at an art event, whether a book reading, a modern dance concert, a visit to a museum or learning a craft. Whatever it may be, online courses are widely available. Instead of distracting yourself in your free time time, rather enroll and complete and on-line course.

A life that is experienced as meaningful, no matter the circumstances, provides resilience and energy and focus.

In my previous blogs on suicide, I have written more extensively on this.

For younger children: Most young children find shopping and eating in restaurants pretty meaningless. They find great meaning in imaginative play and freedom in the outdoors. Water and sand are their natural elements; combined with pretend play children enter a state of flow.

 

 

 

 

 

 

 

 

Author: elzanfrank

I am a psychologist searching for more natural and enlivening ways to help. After thirty years in the profession, it is time to move on, time to search for new ground, time to venture out.

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