How To Help A Self-Destructive Teenager

Amy: (We’re re-posting a couple of our Oldies But Goodies. This is one.)

Not too long ago I worked with an attractive family that demonstrated some of what Dave talked about in his “Disrupting a Family Pattern to Restore A Child” post (6/21). When I  say an “attractive family”, I’m referring to their outward, well-honed social appearance. In fact, some their behavior with each other turned out to be not so attractive.

They were referred to me by the fourteen-year old daughter’s pediatrician for “cutting”; she had been making small cuts–enough to draw blood, at times–in both forearms for  several years. She had been in Cognitive Behavioral Therapy  for over a year, with no change.

For our “Relationship Rhythms” readers not familiar with the whole “cutting” phenomenon, it’s an unfortunate self-mutilating behavior that has acquired near “fad” status in the U.S.  I don’t know if it’s “caught on” with teenage girls around the world. It’s a sad trend, but today’s post won’t be a cultural commentary, but rather a brief look at the role “cutting” played  within this family.

The Case: My first meeting included Dad, Peter, a local progressive politician, and  Mom , Laurie, a writer, along with their only daughter Frankie. Dad clearly presented himself as the “cool guy”, the understanding, hip Dad; but he was clearly in pain over his daughter’s self-mutilation. Early in the session, Mom appeared to be  the appointed scapegoat; she was identified by both Dad and their daughter as the “uptight” one, and daughter openly showed her disdain for her. Despite the daughter’s  cultivated toughness toward her mom,  some of her comments  inadvertently revealed her as a “softy” at heart.

Aside from the “cutting”,  both parents expressed concern over Frankie’s anger at her mother. Most of her cutting took place after a fight with her mother, or when the father was out-of-town. Dad described their ongoing battles, saying “They fight like sisters”. This told me a lot. Indeed, Frankie and Mom seemed trapped by their embattled relationship. And I assumed Frankie’s cutting to be a cry for help–not just for her, but for the family. They were in trouble.

Soon, the patterns that had revealed themselves in the early sessions became abundantly clear. Mom Laurie expressed herself reluctantly, almost apologetically, like she expected to be called out by her husband or daughter. When it came to parenting, she wanted more structure for their daughter, more accountability, in a good way. She had more of a “hands on” approach to parenting, which had been repeatedly discredited by her husband. Frankie picked up on, and magnified,  her Dad’s attitude.

In fact, Mother was right. Frankie was carrying burdens far too heavy for her little self. This child had a  kind of waif-like quality, with a delicate face and small frame. Father believed in granting their daughter an autonomy that exceeded her psychological and emotional development.  Frankie needed to “decide” almost everything for herself , including how much respect she had to show to her mother. Everything was negotiable.

Every time Dad, Mr.  Laid-Back Guy, talked about his wife, it carried some veiled criticism. He expressed himself in such a way as to sound sweet, but this was the proverbial knife-inside-the velvet glove-routine. So all of Mom’s ideas regarding their daughter–most of which were sane and helpful–were dismissed by the father as too this or too that. Frankie, sensitive young soul that she was, clearly found these tensions unbearable. Her cutting brought these tensions to the surface–and the family into therapy.

Strange as it might sound, the parents were largely ignorant of these patterns. They did not address them, or know how to address them, explicitly.  It’s almost always that way. Indeed, though these family tensions were palpable, they were also subtle, buried beneath the well-oiled social veneer of these well-meaning folks. My job was to bring these un-lovely patterns into the open so they could change.

The therapy lasted around six months with semi-regular meetings. The condensed version is that I began to challenge Dad’s rather smug dismissal of his wife, and support Laurie in her positions. This is not as easy as it sounds, since the family had been unconsciously practicing these patterns for quite a while.  In fact, part of Peter’s attraction for Laurie was how she admired him for what they both believed were his many wonderful attributes. That marriage clearly needed some updating. The therapy process helped them do this. There was a bit of (polite) kicking and screaming on the part of the father, but he gradually accepted an expanded, more complex–and more human–view of himself.

Without meaning this case to sound  too “neat”, Frankie’s cutting subsided within a few sessions. It recurred only once, briefly, after several months. Without ever making it explicit, Frankie’s cutting was re-cast as part of a troubled relationship pattern, with the  aggression of her self-mutilation directed at her mother.

The fact that Frankie’s cutting stopped rather quickly is not unusual,  in my experience It’s part of the power of introducing the subtle, powerful family dynamics that underly the child’s distress.  In this case, I think what happened is that Frankie felt relieved that someone was seeing what she was seeing, and understood the bind she was in. She was not free to love her mother openly: She absorbed her Dad’s powerful unconscious message, and acted as his spokeswoman; she would risk betraying her Dad–and the family script–if she were closer, and nicer, to her mom.   Not an easy road to walk for a teenager. And the therapy was not always smooth sailing; it took awhile for Frankie to absorb a new idea about her Mom. She fought it, though not quite as hard as her dad.

The last I heard from this family, Frankie was enjoying a better relationship with her mom, and the cutting had not resumed. Again, I’m not trying to oversimplify, but am rather presenting the bare bones of a rather common therapy experience. I think young people like Frankie are relieved to find an adult professional who understands the burden they bear, and the trap in which the family finds itself. I understand it’s difficult to escape those traps once we’ve been in them for a while. But experience has shown me, time and again, that with some honest commitment to self-exploration, those traps are possible to escape.