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How to set boundaries with mental illness

How to set boundaries with mental illness

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How to set boundaries with mental illness

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My 17 year old daughter has suffered from depression and anxiety for several years and has been to several psychologists over the years and has been on medication for over a year.  It has been just her and I since she was 18 months old as her father had major alcohol and drug issues (probable mental health issues being self medicated) which ended with his sudden death late last year. She always had regular if somewhat complicated contact with him. She is in her final year at school and has had a lot to deal with this past year. My problem is she is sabotaging herself with school and life in general. I have tried everything I can think of to help including conventional and not so conventional therapies. any time now I try to discuss my concerns with her she will state that it is because she is “obviously unwell” and “feels like s**t” and wants to hurt herself. It is as if she has taken herself hostage and if I say the wrong thing she threatens to hurt the hostage. I have tried everything from psychologists/ psychiatrists, medication, hypnosis, massage, chiropractic, meditation, anxiety blankets, everything but she refuses to even entertain simple strategies such as exercise or eating healthier expecting meds to act as a magic wand to make her feel better. The trouble is she also expects to get the marks for university and go to uni next year. I have been told I should stop doing so much for her and she may then understand the natural consequences of her actions (or lack of actions) but she has a way of twisting my concerns to make me the villain “nothing I do is ever good enough” is a common accusation made against me when all I want her to do is pick up her dirty clothes or do her chores (nothing too strenuous). I have been cutting her some slack because of exams but I think she may be taking advantage of me because she hasn’t been studying or doing the limited chores that I really rely on her to do and can’t pick up myself, she also tells lies about having done things (such as feeding the dogs in the morning when I am at work when there is proof that she hasn’t and she is totally unapologetic) I don’t know how to get her to help herself even a little bit and I have run out of ways to help. Is there such a thing as too much support? At what point can you pull back a bit and how do you do it without being made to feel like you are making things worse/ harder for them? What sort of consequences are reasonable? I really don’t know what to do. Any suggestions would be great.  

 

Thanks so much for your post. I am struck by how much perseverance you have shown in trying all these different approaches and services for your daughter, and by how much effort and care you have devoted to supporting her. 

It must be difficult that despite this, she is still experiencing difficulties, and that she is responding in ways which feel counterproductive. It is understandable that you are feeling at a loss of what to do, and are perhaps also feeling frustrated.

When all the things you’re trying feel like they aren’t helping, sometimes that is a sign that it is time to pull back a little, or try a different approach. This can be scary - you clearly want what’s best for your daughter and want her to succeed and to thrive, and it can feel like by reducing the support you offer this could set her back. 

However, at the moment it sounds like the more you try to support her, the more she fights against it by responding to conversations with distress or hostility.

By taking on less of the responsibility for your daughter, this provides space for her to begin to take ownership and responsibility for her decisions. It might be helpful to think about it less as not supporting her, and more about encouraging her independence. 

With any change you make, it can help to be transparent about why you’re changing her behaviour, with the focus on letting her know that you do care about her and want what’s best. An example of this would be saying “It seems like the approach I’ve been taking, of trying to give you suggestions about what might help you feel better isn’t working - it just irritates you. So, I’m going to stop doing that, but if you ever want to talk about how you’re feeling and share ideas of what might help, I’m here.” Of course, this should be adjusted based on what feels right to you - you might not be ready to take such a big step, and might want to start with a more specific area - for instance, deciding not to comment on her diet even if you can see that what she is eating isn’t ideal. 

When it comes to consequences, I’d also recommend starting small. Big changes can be overwhelming, both for you and for her, so sometimes just starting with a little change allows you to see what impact it might have, and help guide your next steps. Think about something small that you currently would address with your daughter, that you might be able to let go of. For instance, this might mean if she does not pick up her dirty clothes, they don’t get washed.

It’s also okay to have a boundary about talk of self-harm or suicide - if she tells you she is currently at risk of harming herself or suicide, and is not willing or able to discuss with you ways she can keep safe, then you may need to speak with her doctor or contact a crisis service for advice. Being consistent and clear about this boundary is important, as is communicating the reason why - her safety is very important to you, and sometimes keeping her safe means involving professionals when she is not able to manage her safety. 

I find myself wondering about the impact that losing her father has had on your daughter. The sudden death of a family member can have a big impact on anyone, but particularly when the relationship has been complex, this can result in emotions and reactions that can be quite challenging to manage. From what you’ve written she may not be open to seeing a psychologist or counsellor about this right now, but letting her know that this is an option if she ever does want to talk about her father or the impact of his sudden death may be helpful. You may have already done this, but I wanted to mention in case you hadn’t - counselling for grief and loss can sometimes be quite different to therapy for depression and anxiety, and even if she’s not ready for that, it lets her know that her grief is valid.

I would also encourage you to consider counselling or therapy for yourself - you’ve been putting a lot of energy into looking after your daughter, and are in a challenging situation. It’s important that you are also supported and given space to think about your own needs. This could also provide more in depth guidance about how to approach things with your daughter, as well as help you identify steps you can take to look after your own wellbeing. 

Best wishes,

Linda

 

Linda is a psychologist experienced in working with people across the lifespan, including teenagers and their families ,in a variety of settings, and is ReachOut's Clinical Lead.

 

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Community Manager

Re: How to set boundaries with mental illness

Hi @Anxietyprincess  -  I just wanted to let you know that our resident psychologist Linda has also answered your question - I hope you find this helpful. Thinking of you and your daughter. 

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Casual scribe

Re: How to set boundaries with mental illness

Thank you so much Linda for your response. 

My daughter had an appointment with a psychiatrist who diagnosed her with ADHD, stopped her antidepressants and put her on ADHD medication. We were both a bit stunned because this was not a problem we had even considered but it seems to have made a big impact on her in a good way. She is currently being a lot kinder to herself and whilst there is a way to go she is at least trying now to help herself. There is a clarity around her thought processes now which was not there before. The self sabotage seems to have eased.

We both have psychologists that assist us however services are limited in our area and it can sometimes be months between appointments and often it is impossible to get help when it is most needed. My daughter doesn’t find her psychologist as helpful as she’d like but changing psychologists may mean an extended wait. He is aware of the circumstances around her father, I’m not sure how he is approaching it though.

I’m hopeful that an accurate diagnosis can target treatments and therapies that feel like a better fit for my daughter so she can achieve her potential and thrive. No one likes to see their child suffering.

Thanks again for your support and advice