QUESTION: My daughter (who is 15) has been unhappy since last September which seems to have started when her two friends betrayed her by siding with another girl and excluding her. Earlier this year she told me that she was feeling very low and that she had been cutting herself. We took her to the GP and she was assessed by a psychiatrist who put her on medication and we also arranged counselling for her at a specialist service.

So far she has had three sessions but she is not participating very well. Her therapist says she has connected with her just very slightly and it has been baby steps. My daughter says she does not like the therapy and talking to a “stranger”, though she does talk to us about her feelings at home.

She has not attended school for about three months now and her life is pretty much on hold. She is sitting her Junior Cert exams as she needs to do this to progress to transition year though we are not at all concerned about her results. Previously, she had been a very high achiever in school and pushed herself hard though she could be nervous at exams. We are trying to keep some normality in her life. The school is helping as best it can by keeping her up to date with projects that need to be submitted for the exams.

We have tried to create a good routine at home for her. She goes to her dad’s office about three days a week to study for a few hours, she loves to cook with me and we got her involved in tennis which she likes. We try to help her keep in touch with friends (though they are all busy with exams) . We even got her a dog and she walks the beach with us and the dog, and the dog has become her companion which has really helped.

Generally she is fine until real life kicks in when she has to go to school. Then she says she can’t cope. To be honest, she would be quite happy to be left watching box sets and eating ice cream. We have indulged her a lot under the circumstances. She kind of has us over a barrel – we are afraid to push things too much with her in case she harms herself or express suicidal thoughts. Any advice on helping her would be gratefully appreciated. How can we help her be more engaged and make better progress in her therapy?

ANSWER:
Sparked by feeling excluded by her friends, it sounds like your daughter has got caught into a pattern of depression and self-harming which has caused her to opt out for the moment from the stresses of school life.

Reading your email, it strikes me that you have done a lot of the right things to help her, such as seeking professional help, being there to listen and support her, building a supportive home environment with a good daily routine (for example, study, cooking and dog walking).

However, helping a young person recover from a mental health crisis can take a lot of time and patience, and requires a mixture of accepting support and gentle encouragement to move on.

Have a period of rehabilitation and recovery
See the summer as a period of recovery for your daughter with the long-term goal of her starting back to school in September. Try to reach a positive shared understanding with her about the reasons for her mental crisis and what needs to happen for her to recover.

For example, you could say that her “mental health had a big setback last year – that this is common for a lot of teens – but now you are going to take the summer to recover and then get back on track in school in the autumn.” You don’t want her to buy into the idea of her being stuck into a “mental illness” and being unable to make progress.

Agree short- and long-term goals with her
Try to get her to come up with goals for her recovery – “What do you need to do to get back on track? What has helped so far? What is she doing already to cope?”

Focus both on long-term goals (what does she want for her life?) as well as the short- and medium-term steps she needs to take to get there (what projects over the summer would help her feel more comfortable starting school in September?)

While as parent you might have to apply some gentle pressure and encouragement, the more you can get her to come up with goals and take the lead in her recovery, the better. You want to empower her to take the steps she needs.

Use professional therapy
Therapy and counselling can be an important part of a young person’s recovery from a mental health crisis, though you have to make sure it works for the young person.

It is important to help your daughter persist to a degree in the sessions but take careful note if she is not making a “connection” with the therapist nor making progress.

Remember that different types of therapy work for different people – it can be practical and focused on behavioural goals or more expressive and involve high personal disclosure; it can also be done individually with the young person or be delivered in groups or involve the parents directly in a family-based approach.

Maybe arrange a meeting to review progress with the therapist and discuss how things can be improved.

Focus on positive mental health
As well as formal therapy, lots of other personal development experiences could help your daughter’s recovery such as being involved in courses, projects or trips offered via sports, youth, church or community groups.

These could help her increase her confidence, learn new coping skills and meet a supportive group of young people and adults, while having the advantage of being non-stigmatised but just as potentially beneficial to her mental health.

Check out what might be available over the summer via the many services such as www.foroige.ie or the scouts (www.scouts.ie) or church groups (eg Meitheal programme www.marianella.ie/meitheal).

Dr. John Sharry, The Irish Times, June 2013. John writes inThe Irish Times Health Plus every Tuesday
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