Question

Lately I worry that my fourteen-year-old son may be depressed. Some days I think I see the symptoms, and other days he seems fine. I’d really like him to talk to a professional, but he won’t hear of it. What should I do?

Response

Embedded in this question is the realization that adolescents’ functioning changes frequently, and that many teenagers think, feel and actually appear differently from one day to the next.  An important and historic study of adolescents (Csikszentmihalyi & Larson, 1984) demonstrated that the landscape of adolescents’ emotional lives changes even more rapidly than we had thought.  A key finding of this study was that high school students were (are!!) frequently vulnerable to the vicissitudes of their daily schedules, to the various moods and opinions of their teachers, coaches, parents and peers, and to their own ever-changing sense of themselves. In short, this important study clarified that adolescents’ functioning changed as frequently as hour-by-hour, or as often as class period-by-class period.  In addition, for those students who were experiencing additional crises (problems at home, academic problems, feeling left out and/or socially isolated, etc.) the emotional changes within their daily lives were even more rapid.

The parent asking the question above is concerned about his or her fourteen year-old son.  While this boy’s functioning may, indeed, change from day to day, it is also likely that this boy’s parents have a general sense of how their son’s functioning has appeared over time.  As a psychologist, I would want to know more about “the symptoms” the parent has been observing. I recommend that the parents use a structured approach to considering the severity of their son’s condition.  A useful guideline is to examine the frequency (how often do you see these “symptoms” occurring?), the intensity (when the symptoms occur, how disruptive or disabling are they?) and the duration (for how long have you noticed these “symptoms?”) of the symptoms observed.  It may also help the parents to share this information with a trusted friend or colleague, or with a health professional who can help the parents to understand this information more fully.  Since many adolescent depressions are difficult to “read,” and are often characterized, at least initially, by a teenager’s general sense of irritability, the structured guidelines above give parents and other key adults in the teenager’s life a concrete way to gather information that may be useful in deciding whether or not to seek professional help.

Once you have decided to try to get your son to “talk to a professional,” do some preliminary work to increase the likelihood that the “professional” is one that your son AND you can work with, one who can develop a working relationship with your son AND talk with you in support of YOUR efforts to be helpful to your son!!!

Here are some useful ways of getting your son to actually meet with a therapist.

1. Ask your friends for referral names.  Since the most effective counseling is usually based on the quality of the relationship between client and therapist, getting the names of professionals who are known to or by people YOU know can be very helpful.  If possible, call your son’s guidance counselors to ask for names of professionals to whom THEY have referred in the past.
2. As an initial step, go and meet the professional YOURSELF!  Assess the “goodness of fit” between this professional and your son.  You know your son well.  Ask this professional to help you develop a plan of how to get your “treatment resistant” son to meet with him or her. Use this meeting to assess whether or not YOU could talk with this therapist about your son’s situation.  Will the therapist include you in his/her treatment of your son?  This is CRITICAL!  Remember this:  “When all the key adults in a child’s (or teenager’s) life are on the same page, the child (or teenager) can’t help but grow in the direction of that coordinated adult-communication.”
3. Develop a “short-term” plan as a way of getting your son to meet with the professional.  You are the parent!  You are in charge.  Require that your son meets with this professional for a few meetings.  Make a deal with your son.  Contract with your son for up to six sessions with a professional (by then, the professional should have been able to make some inroads with your son and may also have some useful ways to help you in your parenting role).  Require that your son try it for some limited number of sessions – limited, but enough to get a “therapeutic process” started.  Agree to review the situation after the “initial contract.”  (Ask your son, “For what would you be willing to do this?”  In real life, a meaningful contract involves something of “equal value” flowing BOTH WAYS.)
4. If your son STILL will not go, then YOU go to an adolescent-friendly therapist to work on maximizing YOUR OWN parenting strategies targeted on helping your son.
5. Ask your pediatrician for help in this situation.  While your son may not listen to you, he may listen to HIS doctor.  (There may be other adults, such as teachers and coaches, who have a certain amount of leverage with your son.  These other “key adults” may be open to working with you to get your son to work on these problems.  If possible, schedule a time to meet or talk with this other key adult and ask him or her to help.)
6. Talk with your son about the implications of NOT addressing these problems.  Do some emotional, social and behavioral “forecasting.”  Help your son see the advantages of getting some “coaching” in his personal life.
7. Mostly, do NOT give up!  If you continue to observe that your son is struggling in emotional, social or behavioral ways, keep talking about it.  Find the resources you need to help you and him to deal with the situation more effectively.

David L. Gleason, Psy.D.