By Angelica Shiels Psy.D.

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 fifty minutes.

As you know, courageous parent, it is my job to keep you involved while still maintaining your child’s confidentiality.  And that I do.

Achieving such a 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.

Here are some of those suggestions:

1)  Don’t make every marital/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. Prioritize regular family outings/traditions/ interactions/conversations that have nothing to do with doctor’s appointments or mental health.

2) From a young age, require your child to participate in at least one extra-curricular or organized hobby outside of the house. Allow him/her to choose what it is based on his interests, abilities, and comfort-level. It could be anything from a one-on-one art class or a team sport. By the time he/she is a teenager, the idea is that he/she will have cultivated an interest and skill that contributes to self-esteem and quality of life.

3) Sleep, exercise, and nutrition are incredibly important. Also, eventually, talk openly about the risks for alcoholism and substance abuse for the purposes of numbing/self-medicating.

4) Just listen (if he talks) or be still (if he doesn’t talk.) Don’t try to fix him/her or get him to talk. And don’t fake knowing what it feels like if you don’t. Forcing understanding and conversation with depressed/anxious kids and teens is like playing with one of those Chinese Finger trap toys: the more you relinquish control, but remain involved, the more the child opens up.

5) 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 xyz based on something they heard mom/dad say or based on a reaction they observed in mom/dad. Also, pay attention to the unspoken messages you are giving your child about the world. If you never let him/her out of your sight, for example, you are letting them know that the world is a dangerous place.

6) Accept all they say at face-value. Just because it doesn’t make sense to you why they would feel such a way does not make their feelings and less real. And sure, kids say/do things “for attention,” but they often are seeking attention because they are legitimately hurting/in a place of desperation. Believe them when they “cry for help,” but at the same time ways encourage them to directly ask for what they need/want.

7) Know the risk factors for suicide, and have a system of “checking in” with your child that works for him/her.  It is sometimes difficult for a child to explain in words how he/she feels; Using a scale of one to ten, a visual thermometer, or pictures depicting various moods are some alternatives.

8) 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/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/she requires discipline.

9) 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, preferably in the sweet spot just outside his comfort zone, but still realistically possible.  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.

10) Don’t walk on egg-shells, be overly permissive, or overly indulgent because you fear that your child will become depressed or volatile if you set limits. See #8.

11) 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/behaving all contribute to the presentation of these complex mental health disorders. Management of your child’s illness depends on all of these factors.

12) Provide access to therapy regularly. Treatment is significantly compromised when kids/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/teens.

13) Validate your child’s anger, sadness, selfishness, frustration, or other unpleasant feelings/behavior.  Dig deep to be able to see your child’s feelings/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.”

14) Don’t underestimate the impact of peer influence/ peer importance, especially in older kids/teens. Stable home life will still be important, but less-so than peer influence as your child grows older. Be observant of 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.

15)  Take care of yourself by prioritizing your own sleep, exercise, and nutrition.  Intentionally make time for your marriage/relationship, and cultivate friendships.  Often times, support groups for parents with your unique challenges are extremely helpful.