Do’s and Don’ts of Empowering Emerging Adult Children

We all want our kids to ultimately take over the running of their daily lives. We want them to soar out on their own and thrive as adults whom we trust and respect. We hope they evolve into responsible adults, capable of solving their own life problems without constant parental supervision. But all too often, parents are inadvertently undermining the confidence and opportunity to gain experience that lead to autonomy in adult children. Parents “helicopter.” Parents control. Parents criticize and thus dishearten teens and young adults instead of encourage and empower them.

When parents undermine, it occurs accidentally, born out of attempts to teach, guide, and support. But what’s the difference between useful guidance and clipping your young adult’s wings? Consider the following Do’s and Don’ts for empowering your young adult to soar independently. 

Don’t: Say, “You’re doing it wrong.”
Parents often want to share their experience with budding young adult children. You may watch and observe your child making obvious mistakes, However, saying, “You’re doing it wrong,” is likely to crush your adult child’s confidence and stop her dead in her tracks. Or worse, if you hurt her feelings, she might shut you out and refuse to listen to your advice in the future.
Do: Say, “Can I tell you what has worked for me?”
Instead of pointing out that your adult daughter is “wrong,” try telling her about your experiences. Say, “Can I tell you what I have experienced and what I learned?” Explain what your situation was, how you made mistakes (or succeeded) and then why her current situation made you decide to share the personal history. And then step back and allow her to make decisions on her own.

Don’t: Criticize
You might feel tempted to offer your emerging adult child feedback, but tread lightly. Giving your opinion is only helpful when the listener is open to hearing it. Because you’re the parent, your opinions carry an emotional heft that is likely absent when the feedback comes from a third party. As the parent, your comments have a higher likelihood of resulting in hurt feelings and thus proving counterproductive. Maybe you’re just not the right person to offer a critique.
Do: Praise and give constructive feedback
Instead of pointing out your criticisms, try focusing on praise. Tell your emerging adult what he does well. Doing so helps encourage him to do more of his best. If you can’t keep quiet when you see an area in need of improvement, take care to give your criticism the kindest, most constructive fashion. Your emerging adult wants your approval. So make sure your admiration and affection show. 

Don’t: Offer unsolicited advice
Your emerging adult needs mentors and parents, but those roles are often divided into multiple relationships. Because you are Mom or Dad, you may not also be the best person to provide sage advice. Why? Your child knows you have a vested interest in the outcome, so you’re not objective. 
Do: Ask permission to share your opinion
When it’s time to give advice, shift into advisor and student roles by explicitly requesting permission. Doing so will increase the likelihood your adult child will listen to the wisdom you offer with an open mind rather than dismiss you as a biased family member with an emotional agenda.

Don’t: Take over
Sometimes emerging adults children seek out the help of their parents. When they come to you, make sure you help in just the right way. You probably spent years running your adult child’s life. Remember, now it’s his turn. Let him drive. Taking the wheel and controlling the situation robs your adult child of the opportunity to learn and practice under your wise tutelage. 
Do: Support and offer to share your experienced opinion and guidance
If you’re fortunate enough to function as an advisor to your adult child, be a teacher instead of a controlling boss. Instead of usurping power, give the power to your budding adult. Let him steer and position yourself squarely in the passenger seat. Remember, you know how to run your life. Let him learn how to run his.

Don’t: Threaten punishments if your emerging adult child refuses to cooperate.
Teaching your kids through the use of punishments should be a thing of the past by the time you reach the young adult years. Your young adult child must function in the world of adults day to day. She has to accept the natural consequences as her teachers, not worry about whether Mom and Dad will ground her when she gets home.
Do: Explain the rules and how you can (or cannot) support his or her choices.
Instead of punishments, parents of adult children help best when they make offers of support that come with clear expectations and rules. Say, “I can give you a loan for $700, but I expect to be paid back in 6 months. If that’s not enough money to meet your need, I can’t give you any more.” Making rules and allowing your adult child to operate within the rules or deal with the consequences of non-compliance will make things work more like the real world and prepare them to succeed..

Dr. Deuter is a psychiatrist who specializes in the care of emerging adults.

I’m Sorry, The Doctor Is Not Taking New Patients At This Time: The Sad Truth About the Overloaded Mental Healthcare System

I recently saw this article: http://ow.ly/CPei8 associated with the tagline, “Just Try Getting an Appointment With a Psychiatrist.” The link connects to a research study in which investigators phoned psychiatrists’ offices in 3 major cities attempting to set a new patient appointment, and they were only successful in getting an appointment about 20% of the time. Although I don’t live in one of the cities where the study took place, the findings appear consistent with what I would expect here in San Antonio. And I’m sad to admit, I’m a member of the 80% of psychiatrists who cannot take on a new patient.

The 20% accepting new patients are probably newer to practice, or seeing patients for the dreaded 7 minute appointments that have become the norm in primary care. Listening and understanding requires spending more time with each patient, less time means relying on overly simplistic checklists to categorize our patients’ experiences. But there is a clear downside to spending 20, 30, 45, or even 60 minutes with each person in my care: my practice remains small. The total number of patient care contacts would be much higher if each patient was seen for only a few minutes and follow-ups were months instead of weeks away. 

Advocates estimate that one in four of us suffers from a mental disorder https://twitter.com/MarkOneinFour, with many of the most severely ill unable to access care. Even professionals cannot get appointments for those with the greatest need. Just this week I tried to facilitate getting an appointment with a child psychiatrist for the 8-year-old daughter of one of my adult patients. The child had been receiving treatment until her doctor retired. The clinic were she was receiving care, probably the largest children’s mental health care clinic in the city, informed me that they were “unable to accommodate new patients at this time.” Another family looking for a child psychiatrist was told it would be at least a six-month wait. Desperate, parents call the primary care doctor. Although it’s difficult to get an appointment even with the pediatrician (two weeks is now standard for a mental health crisis situation), at least they can see a physician.

But seeing the primary care doctor isn’t ideal either. Two weeks in crisis is not a reasonable time frame. And then their doctor may only spend 7 minutes in the room (sometimes 3 minutes). Or the appointment might be made with the PA instead of the physician, often a surprise to patients when they arrive expecting to see the physician. 7 minutes with the primary care doctor can only offer one kind of treatment for mental health issues: prescription medications. But some patients need treatments other than meds. 

Primary care is overwhelmed, too, not just for the treatment of mental illness, but for the care of general health as well. I have patients asking me to write prescriptions for their blood pressure medicine because they cannot get them filled reliably in the overloaded primary care system. They can’t get through to a person on the phone when its time for an appointment or a medication refill. 

All my doctor friends look exhausted, usually sporting dark circles under tired eyes and chugging coffee to keep up. We all want to provide excellent care, but there are only twenty-four hours in each doctor’s day. Every additional slice in the pie of time comes from somewhere- shortening appointment times, shaving off hours of valuable sleep, cutting in to family time… The system needs more physicians, but training doctors adequately takes many years. Physician extenders like PA’s and RNP’s can help expand access, but have far less training and they seem to be getting thrown into the pool to function as physicians, taking on a percentage of all patients in a practice, not necessarily the most straight forward cases. 

What’s the solution? Many opinions are offered, but as a doctor, I don’t think there’s an end in sight.

Show Your Love by Taking Care of Your Health

Do you worry that self-care is selfish? If you take a sick day off from work, do you feel guilty? Consider the issue from another perspective: Taking care of yourself is a way of showing love for your family. Here are ways to love your family by taking care of you:

1.     If you are sick or injured, rest. Pushing yourself to the brink when your reserve is low will result in prolonged symptoms, burdening your loved ones in the end. You might think you’re being helpful by overdoing it, but taking care of yourself is a better approach.

2.     Schedule your annual check-up. Regular health maintenance prevents you from getting sick. See your primary care doctor, get any recommended screening tests, and make sure your health is ship shape.

3.     Exercise. The research on exercise is strong. If you want to live longer, stave off Alzheimer’s and cardiac disease, and thrive into your golden years, regular exercise is the single most important thing you can do for yourself (and the people you love most).

4.     Keep the vices to a minimum. Don’t smoke, limit drinking to moderate amounts or none at all, and avoid any vices that threaten your long term health and wellbeing.

5.     Mind your mood. Depression and anxiety are extremely common. Even in milder forms, mood problems take a toll on your ability to live a healthy, fulfilling life. If you’re experiencing changes in your mood, it’s best for every one if you go talk to a professional about it.

6.     Eat a healthy diet. The best advice for a healthy diet: Load up on the fruits and vegetables. Whatever your philosophies about food, no one can deny that whole fruits and veggies are the world’s most perfect health foods. Take care of yourself and show your love by getting lots of these goodies everyday.

7.     Talk it out. Work through conflicts by discussing them. Most conflicts come from misunderstandings, so having the courage to talk things through can clear them up. You’ll feel better, and so will your loved one.

8.     Keep in touch. Relationships are important. Stay connected to the people in your life.

Why I Can’t Treat My Friend’s Teenage Daughter

Last week during a supervision session with a psychiatry resident, my text message alert interrupted. The text was from a friend. She said her teenage daughter has been acting-out- breaking curfew and being disrespectful. She knows I work with teens and young adults, and asked if I could evaluate the teenager for depression.

After glancing at the text, I asked the resident, “Why can’t I treat my friend’s teenage daughter?”

Tentative, he guessed, “Boundaries?”

My thought had been: It would almost certainly ruin a good friendship.

Medical care relationships might successfully comingle with friendships. (Might.) But psychological therapies are different. How could I forget if I heard of my friend’s unhealthy behavior in the family from her daughter? And sitting down with my friend saying, “I think you need to learn to talk to your daughter differently,” would not only prove unwelcomed, the advice would likely be ignored. When friends offer unwanted advice, who listens?

The contract with a treatment professional is different. People walk in the door and risk telling their problems to a stranger, hoping to receive sage guidance or sound medical interventions. They walk in the door ready to listen. Friends don’t.

The resident was right. It was an issue of boundaries. Boundaries are a vital part of mental health relationships. But the problem with boundaries is that many people seem confused about what they are. Not just friends who need advice on parenting, even treatment professionals struggle to define “boundaries.”

Recently I was speaking to a colleague who said she couldn’t speak honestly about her own mental health history in public because: “boundaries.” I told her I didn’t think boundaries equated simply to privacy.

Or other professionals will use the word exclusively regarding physical contact with patients or clients by therapists. “I can’t make physical contact with them. I need to have boundaries.” But I know some wonderful, ethical, well-boundaried therapists who regularly hug their clients.

As I began to discuss boundaries with the resident, he referenced both of the above interpretations. He said, “You probably shouldn’t treat her daughter because your friend knows personal information about your life. And you probably hug your friends, you wouldn’t do that with patients.” But I didn’t think he had it quite right. I’m a pretty open book. Nothing my friend knows about me would necessarily have to be hidden from patient families. And I’ve been known to hug a patient now and then, if they ask and it feels appropriate.

I offered him another definition of boundaries:

Boundaries are rules in relationships. Fences. Necessary because, as the saying goes, “Good fences make good neighbors.”

All relationships have boundaries, not just mental health care relationships. Marriages, parent-child, and even fellow PTA members follow a set of rules (often unspoken) regarding the rules of engagement. The rules help us understand what is okay, and what is not, in each relationship. When those rules are broken, conflict, hurt feelings, and misunderstandings result.

If someone is my personal friend, our relationship has different rules than the relationships I have with my patients and their families. My friends listen to my problems, come to my house, and have my home phone number. My patients do not. However, my patients hold a privileged position of a different kind. They are guaranteed my full attention during their scheduled time, no matter whether I am having a bad day, feeling tired, or having a problem of my own. Friends have to take the good and the bad. Patients’ needs take priority over mine.

So, no, I cannot evaluate a friend’s teenage daughter for depression. But I’m sure I can give her the name of a terrific colleague who can.