When all members in a family unit are open to addressing any one of its member’s mental health issue, the chances of a favourable outcome improves considerably. This is especially true for teenagers who need their parents to believe in their struggle and support regular counselling sessions until their problem is resolved.
While this post is inspired by a real life case, all the specific details about every individual have been altered to maintain anonymity.
This story is about a 16 year old boy who contemplated jumping off from the 11th floor of his apartment block. But didn’t.
Addressing a Parental Nightmare
Couple of years ago, I was hastily summoned one day by my clinic’s receptionist. “Ma’am, you have an urgent referral from our paediatric psychiatrist.” I agreed to meet the family right away.
No sooner was I seated in my chair that Preeti and Anil burst into my chambers flanking a teenager with a tired, chaste expression. I offered my customary drink of water hoping it would help them relax and then asked what was it that was so urgent. Preeti spoke immediately- “Kabir attempted suicide.” Three pair of eyes swung to this boy who squirmed in his chair and gently shook his head. I encouraged for him to speak. “I just stood on my balcony ledge to see what it feels like to look down.” Anil started speaking but I held up my hand signalling for him to wait. “We will all get our turn.” I took the opportunity to explain that when I took on a minor client, I do meet the parents first to hear their concerns, but after that I am available ONLY to the client. Parents are welcome only for 15mins for the review sessions thereafter. That seemed to relax Kabir. He asked, “So I will be meeting you alone after this. Right?”. “Absolutely.” I assured him. Since I sensed his hesitation to speak before his parents, I asked him “Would you like to wait outside, till I hear what your parents have to say and then you and I can start?” He readily agreed and stepped out.
I invited Anil & Preeti to tell me all the details. Anil spoke immediately. “I can’t believe Kabir would do such a thing. Where did we go wrong?” I went on to share some data with both of them to consider. In general, 98% of people have considered self-harm at some time or the other (only as passing frivolous thoughts – something like “I got a bad grade again, so maybe its better to die than to face my parents.” Or ” Why did I steal my friend’s watch; I would rather die than explain this to my parents.”). But these kind of thoughts are momentary and pass on. Only 2% of people actually act upon their thought of self-harm. As they took in the information, Anil visibly relaxed and tears welled up rapidly in Preeti’s eyes. It was an immediate validation of how effective the counselling process can be in providing a safe space for someone to express their emotions without feeling judged. I was glad she felt secure enough to emote openly.
As I questioned and gathered data, I began to sense that I might be in presence of two genuinely devoted and scared parents who were clueless as to why their son would even think of trying such a thing. I didn’t pick up any signs of childhood trauma, abuse or extraordinary neglect in their narrative. I offered them some more relief by pointing out that just because their son had considered self harm, it was in no way a reflection on their parenting. When I asked them to be a part of regular review sessions with Kabir, they were very happy to agree.
After I spoke to his parents, it was Kabir’s turn to talk to me. He came in telling me how I had made him wait longer than I mentioned. “Sorry Kabir. But I had to get two worried adults off your hand.” I replied. He smiled immediately and we were on our way to establishing a rapport. He launched straight in and said, “This wasn’t the first time I thought of jumping you know.” I nodded empathetically. What followed was Kabir’s story in his own words. He corroborated his parent’s narrative about having a safe, loving home. Along with that was an open admission of his inner confusion. At all of 16, he wasn’t sure about his purpose in life and wondered often about the point of it ‘all’ ( ‘all’ being- going to school, passing exams, playing the same game with same friends, eating in front of TV everyday etc.). I was hearing existential angst in a young boy along with an age appropriate dilemma when one is individuating or forming an individual identity. In psychological parlance, Kabir was at Stage 5 of his life span, a stage of adolescence which is mostly about “Identity Vs Confusion.” (this is from the well known work of a developmental psychologist, Erik Eriksson, who is famous for his theory of 8 stages of psychosocial development during a person’s life span).
According to the 5th psychosocial developmental stage which is between the ages of 12-18 years, one faces the challenge of developing his or her sense of self and identity, apart from their familiar environment. So Kabir too was trying to examine his beliefs and limits (and perhaps had gone overboard in the process). I saved psycho-education ( sharing knowledge based on hard evidence or research in a counselling session) for later and assured him that we will examine all his thoughts in minute details in the coming sessions. For now, he had to learn more about pin pointing his real feelings followed by a strategy to manage them. He shared he had been put on medication by the psychiatrist he has met before. I assured him that the best results in his case might came from a combination of medication and counselling. Medication for biochemical support and counselling for ‘thought reformation’ and ‘behaviour change’. I called his parents back to reinforce weekly sessions till Kabir’s condition stabilised. He was to stay under adult supervision constantly till we had a better sense of how things were shaping up with him. His parents agreed to take turns to watch over him.
Road to Recovery
With the onset of weekly sessions, Kabir and I delved into many teenage issues one by one. How to understand one’s true feelings and communicate better. How the life skill of Assertiveness (ability to express your own or other people’s needs in a calm & effective manner) helps the transmission and sharing of ideas. What are good Boundaries (psychological limit that marks the distinction between acceptable and hurtful behaviours) and how important it is to practice them. Once he trusted me, Kabir became more open and talkative. I also discovered he had a natural athletic ability. I planned to leverage that for speeding up his recovery. It is a well known fact that regular physical exercise helps human body to release feel good chemicals called endorphins. These endorphins work with the brain receptors to reduce negative feelings. Kabir jumped for joy when we started planning his workout time instead of discussing his academic performance at school- which was not a point of parallel concern to me but it was for him.
Kabir’s parents didn’t not miss a single review session and were supportive of every healthy change I suggested. They enlisted him for a competitive sport of his interest and figured out how to drop and pick him up. They started switching the TV off and sitting down for meals together. Over months, the family conversations slowly improved from being awkward to free flowing. As Kabir got better at communicating, his parents got better at showing affection and holding space around him unconditionally. Preeti and Anil needed some handholding in between to manage parallel issues at home. I kept Kabir informed every time I spoke to his parents in his absence to keep his trust. He was only too happy to give me the permission as the quality of his home life was improving in leaps and bounds.
A few months into counselling, Kabir had a request one day, “Please ask my parents to leave me alone for sometime on my own.” I smiled inwardly. It was a good sign that he wanted to be free of so much parental attention. Our work together had helped to increased his self awareness and the existential angst he felt before was healing. I took time to reply, “For that to happen, you have to show them that they can trust you first.” We discussed his future course of actions accordingly. After 4-5 months of Cognitive Behaviour Therapy, Kabir had realised where his thinking had gone off track. He was ready to move on. In the next review session, we discussed graded exposure (in small chunks of time) to unsupervised time. Kabir grabbed the opportunity to apologise to his parents in my presence, for what he had put them through inadvertently. The poignant moment that followed is one that will always remind me why I love my work – Anil held both of them in a hug with teary eyes. Here was a family that had come closer during the crisis and bonded more than ever before.
Sometimes youngsters like Kabir (even adults) can feel unhappy and despondent for no apparent reason. While there may be subjective causes layered in the human subconscious, it could also be mere existential confusion. Only enhanced self-awareness and genuine appreciation of being ‘worthy’ allows the truth to surface. One needs to give themselves permission to seek an experienced handholding this stage requires.
Kabir made good use of his new found freedom and physical prowess. He qualified for many state and national level competitions one after another only to win accolades. I also taught him NLP (Neuro-Linguistic Programming) techniques to help him visualise and chase his goals. It was very satisfying to see this bright, sincere boy move from a state of confusion to clarity and purpose in a few months. I first moved him to bi-weekly and later to monthly sessions for support till he was off his medications.
And when the day came for the ‘closure’ of counselling sessions, I am proud to say that Kabir was doing great and didn’t need sessions anymore. He was focussed, happy and future ready. This case was a validation of my belief that families don’t have to be perfect- they only have to be willing and loving to rally together in the face of any difficulty- to WIN!!
Paintings: ‘Family’ and ‘Looking Down’ by Sahana Shanavas
Photo: ‘Pang Plains’ by Thomas Job