Ashley was a thirteen year old girl who was brought to my office by her mother, Denise, who had concerns about Ashley’s mood and behavior. When I first met with them, Ashley and Denise would sit on opposite sides of the room from one another and could barely look at the other while speaking. When I asked what brought them into treatment, Denise told me that Ashley is “irritated all of the time” and “just wants to be left alone.”
Denise described a scenario in which she asked Ashley to clean her room over the course of three days. When she “finally couldn’t take it anymore and threatened to take Ashley’s phone if she didn’t comply,” Ashley began to yell, curse, cry, and kick her bedroom door so hard that it broke.
When I asked Ashley what made her so angry about this request, she said that she “doesn’t think anyone should tell her what to do” and that “her mom is just an annoying jerk who tries to control everything anyway.” After hearing this, Denise exploded and cried out, “Ashley is a selfish brat who has no regard for anyone else’s feelings but her own and has no idea what it is like to have to put up with her.”
Due to the tense nature of their relationship, I attempted to shift gears and asked Denise what she values or likes about her daughter. Denise struggled to answer with anything positive and instead said “Ashley used to be a nice girl, but I don’t even know who she is anymore.” This exasperation made me think that Ashley’s behavior was becoming her identity in the family, and had worn down her relationship with her mom.
Through assessing Ashley’s demeanor and her mom’s report, I soon identified Ashley’s symptoms as depression. Ashley was acting out her feelings in negative ways rather than expressing them verbally and coping appropriately. Denise also seemed to be struggling to understand her daughter’s behaviors. Frustrated by her disrespectful attitude, Denise would engage in childish arguments with Ashley.
In order to help improve the mother-child relationship so that Ashley could express her feelings more appropriately, I worked with the family towards learning communication skills through positive activities and exercises. At first, both Ashley and Denise seemed to have too much animosity toward one another to communicate well during therapy sessions.
In order to help them get on board with treatment, I explained that in order for things to get better they would need to connect in new and different ways so that they could experience one another outside of a tense argument. I truly believed that in order to help Ashley begin to access new coping skills, it would be necessary to rebuild attachment within the parent-child relationship, so that Ashley could turn to her mom for support in times of distress.
In addition to sessions focused on positive relationship interactions, I encouraged Denise to set clear boundaries with Ashley, and not to engage with her in a heated debate or argument. During sessions, I encouraged mom to disengage from conversations with Ashley if Ashley was not communicating in an appropriate way.
I helped both Ashley and Denise to use “I” statements when communicating their thoughts and feelings, in order to take away the blame from a conversation. During one session Ashley was able to tell her mom, “When I get home from school and have already had a terrible day, and I have to complete chores or other things, I feel overwhelmed and frustrated, because what I need when I walk in the door is a small break.”
After hearing this, Denise was able to say “I understand why you may feel tired after school, but I still have expectations for you that may need to be completed, but maybe we can discuss a way for you to take a break or have some time alone before completing chores.” In this way, Ashley and Denise were able to re-negotiate expectations so that Ashley’s emotional need was met before she had to complete a daily task.
Over time, through improving the parent-child relationship and increasing positive communication, Ashley and Denise felt more connected. Denise was able to recognize Ashley’s behavior as a way to express negative feelings rather than a definition of who Ashley is.
At the same time, Ashley was able to see her mom as a positive support, as someone who is interested in talking with her about her feelings rather than engaging in arguments or conflict. With greater trust in their relationship, Ashley began seek out her mom for appropriate problem solving and positive coping skills rather than engaging in negative, “acting out” behaviors.
Emily Katz, LCSW, is an experienced child and family therapist at Psych Choices of the Delaware Valley (Drexel Hill office). To make an appointment with Ms. Katz or one of our other clinicians, please use our Make An Appointment page or call the Intake Department at 610-626-8085, ext. 213.