But My Kid is Depressed!

How can parents implement consequences when a child is depressed, not defiant? Sarah and Dr. Vaughn discuss the importance of consequences and rules ESPECIALLY when a child is suffering with a mental health issue.

Full Transcript Below:

Sarah: Today we are going to talk about, a topic that parents bring up in parent coaching that is oftentimes a hindrance to effectiveness of parent coaching as a whole.

Stephanie: That sounds really fancy.

Sarah: Yeah basically what I’m saying is parents sometimes have difficulty implementing the plans that we talk about in our parent coaching sessions because “their kid is depressed”.

Stephanie: Yeah, so what you are referring to is the parents that think that a behavior plan is a big bad meanie, scary monster plan.

Sarah: Right, and, you know, I find one of the barriers to working with a parent that has this philosophy is that I spend more time trying to sell them on the plan and doing the interventions that I think would be beneficial and it just kind of keeps us from moving forward.

Stephanie: Yes, and that wastes valuable time. It is nice whenever we have someone who understands the plan, or the reason behind the plan, and it’s not to make a depressed kid more depressed, or punish a depressed kid, and sometimes I’d say and maybe half the time we get people that have the misconception that if I give my kid consequences, then I’m not taking their mood disorder into account, I’m not taking into account that they have anxiety or depression or that they self-harm and are suicidal.

Sarah: Right, like I’m the jerk that’s taking away my kids social media when it is the only place that they have to talk to their friends because they’ve got a mental health issue.

Stephanie: Right, and so our purpose is to clarify we’re well aware, aren’t we? Of the fact that kids are depressed and kids that are depressed actually need more structure than kids that are doing okay. And we look at the structure as kind of being like when they were little, when my kids were little they had a little a little play area that put a pen, you know, put around, a little pig pen almost and they would play together and then you know you could broaden it out depending on how old they were and then you could start outing up those little kid gates between the living room and the staircase or something and then as they get older then you move them out. But, based on their developmental level we had to put barriers around things that would be harmful for them. Same kind of idea when you got a kid who’s depressed, at risk in some way, we’ve got to make sure we put those barriers in place. And you know, you’d think by giving them kids when they were little, and you’re going to have your own here soon.

Sarah: Yes.

Stephanie: You get them on a schedule and it’s a sleep schedule, a lot of times it’s an eat schedule at some point and our depressed and anxious kids that we treat are the same in that way.

Sarah: Right, you know speaking about anxiety disorders for a minute, a lot of times treatment for that seems more harsh than treatment for depression, because you know, at our practice we try to use what’s most empirically validated treatment from working with inputting exposure to anxiety producing stimuli, a.k.a the things that make us anxious or what’s actually going to get us over the fear of x, y, and z.

Stephanie: Right.

Sarah: Yeah, pretty barbaric if you think about it.

Stephanie: Training new therapists, when we teach them that doing exposure treatment, how harsh it can seem, it’s scary for them also. So it’s not just parents who are afraid of making kids worse, therapists who are trained in exposure based techniques are also afraid of making things worse. And the truth is it does make things worse in the short-term and there’s a whole thing called an extinction burst where the behavior gets worse before it gives up but in order to get past it we’ve got to go through it, we can’t go around it. And, these kids have got to have those parameters, the boundaries as they say, the gates, to help them do the best that they can possibly do when they’re prone to depression or anxiety. What does that mean on a practical level? Like this all sounds real good, but what does that mean on a practical level?

Sarah: You know, I mean I’m trying to think of some of the sticking points that I’ve had with parents that have persevered on, but you know my kid got, x, y, and z diagnosis. And, you know, I think one of the first ones that comes to mind is making them go to school everyday because, you know, school for a lot of our adolescents can be code, triggering, it can be highly anxiety provoking and very…

Stephanie: Unpleasant, dysregulating.

Sarah: Yeah, for both the parent and the adolescent to get their kid to go to school. And it can seem really harsh when parents are just dumping their kids off at school, when in fact that is what we recommend doing if going to school is anxiety provoking. Not to mention it’s against the law not to have your kid go to school.

Stephanie: Right, and we usually will use that as a motivating factor when we’re talking to both adolescents are parents. That you know, it is against the law to not send your kid to school just because they’re anxious or depressed and it may seem like a good idea. And I could totally see how it would seem like a good idea if I hadn’t had the training that I had where your kid is just really anxious that day or is just really feeling depressed. It’s like, well why not just let them not go today isn’t it, isn’t depression a serious illness just like the flu. Yes, absolutely it is and the treatment is totally different, so if you use the wrong medicine on a sickness, you know an illness, a physical illness, you risk making that illness worse. So, it’s the same with these mental illnesses like depression or anxiety, if we’re using the wrong treatment, then we are going to make the problem worse and the wrong treatment looks like letting them stay home, letting them sleep in, letting them curl up in a ball and put the covers over their head and avoid the world. The actual treatment would be to do the things that they don’t want to do and that goes for both depression and anxiety and that means that as a parent you have to be the bad guy sometimes.

Sarah: Yeah, and I don’t want parents to misunderstand, I mean, we get that you have your kids best interest at heart, and you love your kid more than anything, and you see them suffering and you don’t want to suffer anymore. And, removing them from situations that cause them to feel stressed is very reinforcing for parents, and for kids. So, what we’re asking we know is not easy to do, it’s just one of those tough things like Dr. Vaughn said, you just got to work through it to get past it.

Stephanie: Right, and I think if parents could see how they’re behavior in the moment impacts their kid long term, they wouldn’t let them skip school when they’re depressed, the problem is you don’t see it immediately it’s a delayed outcome. So the treatment for depression, one of the main empirically validated, that means research supported treatments is behavioral activation, behavioral activation is a fancy term for you know, getting up and getting moving and doing the things that you need to do, whether that’s taking a shower and you know, eating and going to school and going to work and exercising. That’s activating, behavioral activation, and so for your child that means going to school. And that doesn’t mean they’re going to necessarily like it. Which goes back to the bad guy thing. And many parents have a problem with being the bad guy, or being viewed as the bad guy by their kids when their kids are depressed. They feel some sense of responsibility like this is my fault that my kids this distressed, it’s my fault that my kids suicidal. And, if nobody’s ever told you, this is what I always say, if nobody’s ever told you, it is not your fault that your child is suicidal or had depression. There is, the contribution of the environment and then there’s the contribution of the biology, you know the inborn stuff the kid has already. There are things that you can do to make it better and that’s part of why we’re here isn’t it.

Sarah: It is why we’re here, to help you, help your child make things better. And I will play the harsh side of things just for a minute, because I think you said it to a family once and I think it’s been one of the most impactful things that I have been able to say to families since I heard you say it, is you know the short term benefit of rescuing or saving your kid from doing something that is going to cause them distress in the short term is more for the parent than it is for the kid. And I will use the s-word because you used it and I think it just makes sense, it’s selfish. No you did not get your kid necessarily to where they are today, but now that you’re in this position you are the one that’s responsible for helping them move past it.

Stephanie: Right, yes exactly and I think parents can sometimes, and we all I guess can sometimes not see how the thing that we’re doing is necessarily for us and not for the benefit of the kid. Because in the short term the kid seems to be relieved and they say thank you and I appreciate you so much and then we feel good and that we’re a good person, we’re a good parent and that whatever. And the long term is that we are actually doing damage and so if you are willing to trade your short term payoff of being seen as the nice parent or good friend, whatever if you’re willing to trade that for the life of your child sometimes. I mean, I’ll even go that far, sometimes it’s that important to trade that, like it doesn’t matter if you see me as being nice or fair or a good mom, what matters is you being alive and being healthy and happy whether it’s related to me or not. Because one day maybe you grow up, you go out, form your own household and never speak to me again, maybe but you make that choice when you’re grown and I’m going to make sure I do everything that I can so that I provide you with the environment so that you can survive, be happy, healthy and have your own family one day, maybe.

Sarah: Maybe I’m on my soapbox right now but

Sarah: No that’s good, I mean you know, this is going to sound very cheesy and cliché but we actually do hear adolescents end up thanking their parents for being tough on them and going through parent coaching and setting limits, you know I’m not going to tell you it happens every time because it doesn’t but we have seen it happen and I’m sure we can all think back to things our parents said when we were a child that we did not understand back then, but looking back it’s like okay, I hated it in the moment but I’m thankful they’ve done it.

Stephanie: Yes.

Sarah: That’s how I look at all of this.

Stephanie: Yes, for a lot of these kids limits and consequences mean caring.

Sarah: They do.

Stephanie: You know, that’s what they see as caring, and I know, you and I both know, we’ve worked on both sides with parents and on the adolescent side, you know, I’ve heard them say and talk about their friends or people that they know and describe how this other parent doesn’t really care that much about their kid because they’re not setting the same limits, they’re not following through. And when you don’t follow through on the consequences it’s sort of like you find them a burden, you know like they’re too much to handle. And that’s scary for a kid, to think that the big bad scary world is out there that the parents are supposed to be able to fend off and protect them from but they can’t even set a limit and protect themselves from the kid. And so the kid has to sit with that and make meaning out of that, and I used to tell my kids when they were little, and they would have a little fit, don’t worry, I’m going to handle this, I’m going to, I’m not going to let you treat me like I’m, I’m not going to let you talk to me like that, I’m going to handle this. And they’re sort of a strange calm that comes over, that would come over their face at the time and I don’t think we lose that. I think we do need to have some idea that we have, there’s a limit to what we can do. And, especially for kids.

Sarah: Yes, absolutely.

Stephanie: So Sarah, back to the idea that but, Sarah, but, but my kid is really depressed so I need you to validate that.

Sarah: I would say, yeah your kid is depressed, I’m glad that you’re here because that’s what we work on and the tactics and strategies that I’m going to teach you in parent coaching are going to help your kid feel less depressed or anxious or fill in the blank.

Stephanie: Yes, and the very first thing that you may implement could cause them more immediate distress, just like when you skid you knee when you’re a kid and then they try and put that alcohol or hydrogen…your mom was probably nicer than my mom because I’m older than you they didn’t anything but salt and vinegar back then.

Sarah: Like an elbow grease.

Stephanie: Yeah they put the stuff on and it’s like because it burns that means it’s working. And it’s the same a lot of times with these consequences, because they don’t like it, it actually suggests that it’s working and it’s not forever.

Sarah: It’s not forever, and usually the more dedicated and diligent a parent can be the shorter amount of time that they’re going to have to be as stringent and on their kids before change occurs, it’s the wishy, washy or half-hearted attempts that keep families stuck.

Stephanie: Yeah, your so right. It’s really not the parents that just let their kids do whatever that’s the biggest problem it’s the one’s that partially do, they partially put limits from time to time and/or when the kid pushes and pushes and pushes then they give in. And only when the child says but I’m really depressed or I want to kill myself, do they give in then, so then it says. What that says is, I don’t take you seriously unless you’re going to kill yourself.

Sarah: Right, which is a very dangerous message to send to your kid.

Stephanie: Right, yes. So, I would say the podcast to listen to in addition to this one is the electronics one because I think the hardest thing for parents is taking those electronics away. It really is, they can do all kinds of things but taking those electronics away when quote, everybody else has got them, taking away Instagram or taking away Snapchat when everybody else has got it and that’s how the kids communicate these days that’s the biggest barrier. I would listen to the electronics podcast as well.

Sarah: Yes, it’s definitely a tough one to implement with parents, especially those that are the bleeding hearts for their kids, and don’t want to cause any harm.