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Dr. Michael
Dr. Michael, Psychologist
Category: Mental Health
Satisfied Customers: 2177
Experience:  Licensed Ph.D. Clinical Health Psychology with 30 years of experience in private practive and as a clinical psychology university professor.
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We believe we raised a ‘helpless kid; she is 19, pregnant, and scared to succeed, be

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We believe we raised a ‘helpless kid;’ she is 19, pregnant, and scared to succeed, be it going to school, getting a good job or making it on her own. So much so that she won’t come out of her room. But is very smart, creative…. She has totally changed since graduating high school. Living at home, depressed, doing nothing to prepare for baby, but wants to keep it. Doesn't help at home or come around family much. What can we do?
Submitted: 5 years ago.
Category: Mental Health
Expert:  Dr. Michael replied 5 years ago.
Hello. I believe I can be of help to you with this issue.

Frankly, most 'counselors' or 'therapists' are not very helpful, so I'm not surprised the counselor didn't really connect with your daughter or have the skills to draw her in to meaningful therapy. there are about 20 'therapists' in my community and I'd only refer a friend or family member to 1 or 2 of them. It is time to try to drag her to family therapy and relatedly, another trial of individual therapy---it may take 3-4 therapists to find someone she can relate to. How? Well, your daughter is almost surely suffering from a combination of clinical depression and some significant personality disorder features. You describe a girl who has extremely low self-esteem, is highly insecure, dependent and emotionally immature. She has no clue how to lift herself up and out of this situation. You say you raised a helpless girl but probably, what you mean is that you look back on her upbringing and see that you "ran interference" for her a bit too much perhaps, or protected her from some of the normal frustrations and emotional insults kids have to learn to endure. But that is all 'water under the bridge' as they say.

If she is 'stuck' and you can't get any movement out of her, no matter what you've tried, the next step is to create a serious, credible emotional crisis in her mind. I think it is time to heavily confront your daughter and let her know that her current lifestyle cannot go on. You will probably have to use an (unrealistic but) credible threat that you fully intend to force her into a psychiatric hospitalization or institutional placement if she doesn't agree to see several more therapists until she finds one she can work with, and also, doesn't agree to family therapy. How to do this? You'd call your local mental health inpatient unit or community mental health center and find out more about steps to take to institute an involuntary hospitalization. Now, you won't of course, actually ACT on any of this information but you need to use all of the details you glean as part of a credible threat. You would get the names of specific psychiatrists or staff members and then sit down with your daughter and lay out the steps you "intend" to take to hospitalize her for depression. Lay out a detailed scenario---show you've done your homework---as this communicates credible intention on your part to follow through. You'd review the process with her, you'd drop the names of the doctors that might be involved, etc. So you need a credible threat to lay out before her, with the alternative being that she agrees to try therapy several more times if necessary. This means laying out a detailed hospitalization scenario.

If she has internet or cell phone access in her room and this is where she is spending her day, make it clear that this is 'going away' immediately and that in addition to therapy, she absolutely must agree to talk to vocational counselors at your regional vocational technical training school, community college or university about starting classes toward a career path. Set up an appointment for her and tell her she is going!. Let her know that you will help her and support her with child care if she decides to do this but ONLY if she does her share of the work. The point I'm making is that to get this girl moving, she has to feel severe, credible threat and emotional 'crisis' right now, otherwise, her current approach to life will continue. As it stands right now, you have to ask yourself, "exactly why shouldn't she sit in her room all day, do nothing, assume the life role of 'victim', when we have no influence, leverage and are basically, enabling her to do so? She is both miserable and comfortable."

In the least, you need to make her uncomfortable at this time and risk a stressful damaging upheaval in your relationship with her. What do you think?
Customer: replied 5 years ago.

Dr. Michael, thanks for your reply, this aligns closely with what we have been thinking.


On the therapist, can you tell us what credentials we are looking for (prescribing psychiatrists, masters level counselor, etc., there is a wide range) and any particular specialty? Also, should the family therapist be the same or different? In other words, are we looking for two different therapist?

Expert:  Dr. Michael replied 5 years ago.
You can find M.S. level marriage and family therapists who may be able to help with this aspect of the interventions you need; I'd just interview one or two in advance of bringing your daughter in to make sure you feel confident they can help. But for individual therapy with a resistive 19 year old? Another story----with M.S. level training, this means only about 1.5 years of graduate school, some of which was in actual therapy training, and an internship. So with your situation, you need someone quite experienced. The individual therapy you seek would be best accomplished by someone with specific skills and experience in what is called motivational interviewing. This is a preliminary therapy technique that runs a few sessions that is designed to move ambivalent and somewhat resistive clients from this position to a more engaged position; then, the therapists would use cognitive-behavioral or dialectical behavior methods or a newer therapy called acceptance and commitment therapy. It is the only empirically supported approach that is known to 'work', on average, for individuals who are ambivalent about therapy and change. Here, I think you want a clinical or counseling psychologist with a Ph.D. because they go to graduate school for 5 years, plus internship and typically, they have the 'time' in graduate school to learn a number of therapy modalities quite well. You can decide whether your daughter might get on best with a male or female psychologist. Some 19 year old girls can be more easily hooked in by a youngish woman role model, but others will be more likely to back for multiple sessions if the therapist is a younger male. You know your daughter best in terms of choosing the gender of the therapist.

I don't think a generic counselor or 'therapist' will do in this case because your daughter is likely resisting the idea of therapy altogether. I have been training therapists for over 25 years who already have their masters degrees (they came back for a Ph.D. program) as well as students who have a B.S. degree and go all the way through their Ph.D. Lots of these student have been doing therapy for quite a few years (social work, school psychology, mental health counseling, pastoral counseling, marriage and family therapy) and they are absolutely not 'better' or skilled in the specialized techniques I half-way expect they'd know, than relatively new therapists. It isn't because they aren't really smart (they are---we screen 130 applicants and take 5% only, each year). So, I find it amazing that many therapists don't know what they don't know, or claim they do a particular type of therapy but when you watch tapes of their sessions, they aren't actually doing remotely what they believe they are, or not doing it very well. This is why I caution you about perhaps needing to go through a couple more therapists until your daughter finds one she really relates to. So I would call around and ask what methods they use to get a 19 year old kid hooked in to therapy, who doesn't really want to be in therapy, and listen for their reference to these modalities of therapy. A clinical social worker with lots of experience, who references the therapy modalities I mention, and do so spontaneously during your screening conversation with them, could also be helpful.

Let me know if I can be of further help. Please click on the green Accept button at the bottom of the screen.
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