I had been seeing Susan in therapy for a year before she made any real progress.
“Bipolar II and ADHD. Like, the real deal,” was how her past therapist characterized her when she referred Susan to me. Her psychiatrist let it slip that he thought she was “really a mess” during a consult. Her ex husband called me to relay how poorly she had managed structure and discipline with their child. Her parents and brothers emailed me with concerns about how “sick” she was and offered to drive across the country to see her when they heard of her sleeping spells, parenting imperfections, and forgetting appointments (relayed to her family by her ex, not me).
For the first several months, Susan and I talked about symptoms and behavior management. When someone is sleeping all day, avoiding contact with the outside world, and too afraid of her son’s disappointment to tell him not to play with matches, therapy becomes behavioral survival mode.
Eventually I began to notice an important pattern in Susan’s identity and functioning that went something like this: Susan makes a minor mistake; Well-meaning yet codependent/enabling family come in for “the rescue” or “the criticism;” Susan retreats from the life she now believes she is not equipped to handle.
Susan’s problems began with childhood ADHD, during an era when the solution to ADHD was yelling at the kid and telling him he’s an idiot (either that or doing the kid’s schoolwork for him). No one explained to Susan ways that she could finish her homework or gain a friend, even given her neurological difference. No one offered accommodations or modification or small goals or medication (or a model of self-compassion). She had no one telling her “You CAN do it, and here’s how.” Instead she was relegated to black sheep status and forever branded incapable. Over the years of eliciting eye rolls, yelling, and exasperated “rescues,” Susan’s expectation of herself went from complete failure, to utterly annoying, to desperately worthless. Then the avoidance, hopelessness, and depression set in.
What would happen if one person in Susan’s life challenged her on her strongly held identity? If I were to look Susan in the eyes and suggest that she COULD tell her child “no” or she COULD get dressed even though she felt like crawling into a hole or she COULD clean a small part of her apartment? Would she believe me? Would she insist it wasn’t true and come to see me as invalidating and dismissive? Would she rebel out of fear of failure and cling to her comfort zone of incapacitation?
Turns out, Susan is one of the bravest and most willing people I know. After a year of forming a genuine relationship in therapy, she made the terrifyingly uncomfortable choice to consider the fact that I was right. Even though it meant she would be accountable, even though it would be scary, even though she might fail.
I started by matter-of-factly suggesting small goals and offering strategies for accomplishing these goals- Set an alarm to be on time for appointments; Get out of bed by 10:00 am by sleeping with curtains open and just making sure your feet are touching the floor; Aspire to playing a board game with your son for just five minutes at first so it won’t overwhelm you. Each time she accomplished a goal, Susan realized how much more capable she actually was. We dissected social situation and parenting scenarios, and I gave very concrete instructions for improvement, the kind of instruction she would have received in a social-emotional skills group as a child. And she went home and DID it. Susan’s relationship with her son is much improved, and just as importantly, her relationship with herself is actually pretty healthy!
What are the takeaways from Susan’s situation? From my perspective, being a therapist teaches me so much about the fragility of a person’s identity and sense of capability. What would have happened if I went along with the party line of, “Oh Susan, you are so sick. Just lay in bed all day. Of course. Let’s talk about how you’d never be able to get a job.” Susan’s therapeutic progress, identity, and life would have remained in bed nestled alone under her figurative and literal comforter.
As parents, we want to always give our kids the impression that they are capable, and when they struggle, give them the TOOLS to help them as oppose to rescuing and limiting accountability. If we don’t expect our anxious kids to get on the stage, make the phone call, or take the test (after we- or a therapist- compassionately teaches the TOOLS of self-soothing, grounding and visualization exercises), what are we telling our kids? If we don’t expect our disorganized kids to set alarms and utilize systems to keep the balls of their lives up in the air, and instead we complete homework and manage calendars for them, what are we telling our kids? That they can’t do it.
And if we scramble to rescue our kids from ever having the experience of failure or falling on their faces, what are we telling them? That to try and fail would be catastrophic and unthinkable. Let’s give our kids more credit than that.
Instead of telling them they can’t, let’s give our kids tools so that they CAN.
Instead of telling them that failure intolerable and to be avoided, let them they CAN tolerate the times when they fall down.
Just something to think about, says the therapist who never ever wants to underestimate someone just for the sake of avoiding discomfort, but also hopes readers recognize that I’m not talking about telling our kids they can all be Mozart and Einstein, just that they all CAN reasonably engage with life in a meaningful way. You know the difference.
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- Yes, I change all identifying information and some aspects of the story whenever I use an example of a past or present client so that they remain unrecognizable. As Michelle would say, “DUH.”