Our second family makeover deals with a teenager who is experiencing a very difficult time. Through this particular situation we will focus on issues such as: how to deal with teenage depression, how to set clear boundaries for your teenager, how to handle drastic changes in the family dynamic (such as a parent suddenly not being present), the source of dating and peer group problems, and how to approach rebellious or self-destructive behavior.
In my first meeting with Cherie and Maddy, I found a teenager who was depressed and very much in crisis, a family dealing with the father’s absence and a very strained relationship between mother and daughter… all of this led to Maddy acting out in disrespectful and self-destructive ways at home and in school.
The First Visit
When Cherie brought 13-year-old Maddy in for her well-child visit, I immediately knew that the appointment was going to be a long one. When I opened the exam room door, I found the mother and daughter fighting. It appeared as though Maddy was winning because her mother was in tears.
“Dr. Meeker” her mother began, “Please do something with Maddy. She’s out of control. She won’t listen to me. I just found out she’s been cutting her arms and her friends are getting her into a whole lot of trouble.”
Maddy piped up, “That’s not true. You just don’t like any of my friends because they don’t get straight A’s and they don’t dress like you think they should. They’re nice! And besides, if I cut, it’s none of your business.”
Fortunately, I knew Maddy, so I skipped the cordial hellos and jumped right into the conversation. “Maddy” I said, “Are you cutting?”
She looked at her mother then down at the floor and responded, “Yes, a little,”
Cherie sat next to her and cried. “I just don’t understand,” she said. “Why would she do something like that??”
“So Maddy, why are you cutting yourself?” I asked her this as I walked to the exam table and patted the top, indicating I wanted her to jump up on the table. She complied and I grabbed her arm and gently rolled up her sleeve. Both of her arms were covered with multiple superficial scars… My heart sank.
“Oh Maddy” I said. “This makes me so sad.” I looked at her and she looked away, not really knowing what to say.
“It just, I guess, kinda makes me feel better. I don’t know. I do it when I’m mad. I get mad at my mom and my dad and I get mad at myself. I’m just stupid, ‘ya know.”
“No, I don’t know,” I said. “I’ve known you for a long time and I know that you’re not stupid. As a matter of fact, I’ve had conversations with you that I often have with adults, so I know that you are very smart. What do you mean by stupid?”
“I just don’t like myself.” Maddy said.
Her mother cried harder.
“How long have you not liked yourself very much?” I asked.
“I dunno…ever since last summer.” Maddy explained, “It got bad when my boyfriend broke up with me.”
“Oh, what a blessing that was!” her mother cheered. “Tell her, Maddy. He is now in prison. He was a terrible influence on you!”
I looked back at Maddy and she was clearly upset at her mother, but couldn’t deny the claim. Her 17-year-old ex-boyfriend was now in prison.
After we all chatted for 45 mins, I learned that Maddy’s father had taken a job overseas working on an electrical plant. He worked for three months, came home for six weeks and then returned again. Maddy said she missed him, but overall was “glad” he was gone because she “didn’t get along with him either.”
I explained to Maddy and her mother that we needed to work hard on some stuff, but before they returned in a week, I needed them to specifically do three things: First, I wanted Maddy to keep a “mad journal.” In the journal, I wanted her to write anything that she wanted when she was angry. She had a real artistic flair, so I told her to draw images and to use color in her writing.
Second, I told her mother that I wanted her to take Maddy out to dinner or to have a special dinner at home with just the two of them every week. During the dinner, they could not argue or talk about anything difficult. It didn’t have to be long, but the purpose of the dinner was to be together… even if they didn’t speak.
Third, I needed Maddy to agree to it.
Fortunately, the two of them complied with my plans. I told them to return in a week.
The Second Visit
When Maddy and her mother came back to see me, it was clear that the two of them were still on rough terms. I could hear them arguing outside the exam room.
“So” I said cheerfully, “How are you two today?”
“Good.” Maddy chirped. She seemed to be in a better mood than her mother.
“Maddy, what do you mean by ‘good? ’” I asked.
“Well, Mom and I didn’t fight as much this week and she left me alone more than she usually does. I mean, she didn’t pick any fights with me.” Maddy reported.
I turned to Cherie. “What do you say, Cherie? Did this week go any better?”
“Ugh. I don’t know. She’s impossible. I ask her friends over, but she complains that I don’t like them. She wants to wear obscene clothes to school and when I tell her ‘no’ she yells at me and slams the door to her room. I can’t seem to do anything that makes her happy.” Cherie said.
“Tell me about dinner. Did you have dinners together?” I asked.
They looked at one another. “Yes” Maddy said. “We did. It was weird. I mean, do we have to keep doing that?”
“I tried Dr. Meeker,” explained Cherie, “I really did. I took Maddy to her favorite restaurant and she spoke three words to me. She hates me. I want to do anything I can for her. I listen. I know she’s smart and I tell her that all the time. I ask her how she’s doing, what she likes at school, what she wants to do when she’s older and she just glares at me like I have three heads. She can’t stand me. I just wish she’d tell me what she wants me to do and I’d do it.”
“Maddy” I started, “Here’s the deal. Your mother loves you a lot. You can see that. The problem is that she can’t see what’s inside your head and she also can’t see the feelings inside your heart. So, can you help her out a little?”
“Well, she should know what I think and feel, after all, she’s my Mom.” Maddy continued, “And she was a kid once, why doesn’t she get it? Why doesn’t she get me? She’s supposed to!”
I explained to Maddy that sometimes parents love their children “sideways.” Meaning that the love doesn’t come out the way children think it should, so they just assume that the parents don’t love them. I asked Maddy to tell her mother what made her feel more loved. Was it not snarling at her friends’ clothes? Was it asking certain questions or was it helping her with homework?
Maddy started to cry. I waited until she settled down and she spoke. “Well” she sniffled, “my Mom tries too hard. She always seems so suspicious of me and that makes me feel like I’m a bad kid.”
“What is your mother suspicious about?” I asked.
“She thinks I’m going to run away or get in trouble or do something bad to myself.” She responded.
“Well” I asked. “Should she worry about those?”
Maddy was startled by my question. She didn’t know what to say because she realized that her mother was right. Her mother did have a right to worry because Maddy was trying to hurt herself.
Over the next few weeks Maddy and her mother came to realize that much of Maddy’s behavior stemmed from two things: missing her father and feeling rejected by her boyfriend.
Her “bad moods” as she described them, began shortly after her father left and her cutting began after her boyfriend broke up with her. So, why did she take everything out on her mother? Because that’s what sad kids do. She couldn’t be angry with her father because she wanted to make sure that her time with him at home was pleasant and she believed that if she were a “better” girlfriend, her boyfriend wouldn’t have broken up with her. When children hurt, they often turn the anger inward on themselves because they believe that they are responsible for many bad events. In short, the breakup triggered her desire to punish herself and this led to her cutting.
“Here’s what I’d like you to do Maddy.” I told her. “I want you to write a letter to your father, but I don’t want you to send it. Tell him why you miss him. Tell him what it feels like to be left behind. If you feel that he should be staying home, tell him that. Write whatever you want because no one, including your mother, can read the letter.
When I was alone with her mother, I said, “Cherie, I want you to do something as well. I want you to stop asking Maddy what you should do. Don’t let her know how much her behavior upsets you. When she sees you tangled in knots over something she says or does, it actually makes her feel frightened. She doesn’t want to feel like she has that much power in your life, because it makes her believe that she’s too much for you to handle. And that makes her feel very insecure. Can you try that?” Cherie agreed to try.