Therapy or Not?

Q: My 15-year-old daughter has had issues of low self-esteem, especially in regard to academic and social issues at school.At home, she seems to feel more happy and relaxed. Because she is the oldest at home, she feels that she can teach her younger siblings things, which gives her more self-confidence.My husband and I try not to be critical of her, but it’s as if she has this negative inner voice that constantly questions herself.

She feels: a) that she is not religious enough; b) that she had more friends in the past, who no longer really associate with her; c) that she is not doing so well in school (high school is very pressured for her). Also, she is nervous a lot of the time.

I brought her to a therapist, and she just cried afterwards that she is sure that no one in her class goes to a therapist. She agreed to have a phone session with the therapist after this one session, doing me a “favor.”She opened upto the therapist during this phone call, and then cried that speaking about her feelings only made her feel depressed.

I don’t feel right to push her to go, but I don’t know what I can do to help her. We do live in a very right-wing Orthodox community, yet I know that there are other students in her school who go to counseling. Should I push her to go for counseling?

A: In theory, going for counseling should not be perceived as a “punishment for bad behavior.”However, anything that reminds us of our limitations can be uncomfortable.At times, parents may say to me that their children didn’t want to come to a family session that evening.This is no surprise, as no one likes to be reminded of what is lacking in them — or between them and family members. Discussing all types of emotions and what needs to be improved is not often easy. If participants do have progress to report, or see that improved awarenesshas improved the situation, they are very happy to come to sessions.

Psychotherapy can help make what is covert, overt.By a therapist focusing on destructive patterns in behavior, one can find alternate ways to respond — either through one’s thoughts, speech or actions. Your daughter seems to be too focused on self-pity at this point in her life to desire to move forward.

As I have not met with your daughter, I am not in a position to know whether it is helpful to push the agenda of counseling. Some clients need the push or positive reinforcement to take the first step to engage in counseling. Others will go grudgingly, and sabotage the therapy by being sure to arrive late, and behaving antagonistically towards their parents all week. In this second circumstance, pushing for counseling is counter-productive. A child’s refusal to talk for a few sessions of family therapy, however, is not necessarily a sign of failure. Just hearing how family members view each other (and her, as well), can be very therapeutic, as well as helpful. It is very rare that a participant in family therapy stays quiet for very long.

You can ask your daughter if she feels that the therapist herself possessed some degree of knowledge and understanding. (As she opened up her feelings to the therapist on the phone, I would guess that she felt this way.) You can ask if she would feel more comfortable if you would be with her during the actual session.You could ask if she would come on more of a consultation basis — where the therapist would give more of an outline of what to work on, anddo follow-up a month later. Her decision not to go right now doesn’t have tobe “all or nothing.” You yourself can have a session with the therapist, asking her what you can do to help your daughter.

Leaving the door open is the best policy.