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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 10627
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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20-yr old nephew living with us. High School education, low GPA, no work experience. His

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20-yr old nephew living with us. High School education, low GPA, no work experience. His Father died when he was 3, Mother alcoholic died he was 7-8. Lived with Grandmother and step-Grandfather from 3 yrs. Grandmother heavy smoker, so stayed in room alone. Became gamer. No bedtime limits. Grandparents provided sympathy excuses for him. Grandmother died he was 15. Lived with step-grandfather who gave love along with verbal abuse and criticism while still providing sympathy excuses. Home became filthy, unsanitary, unhealthy. Boy is depressed, lazy, talks in monotone, does not show emotion. How can we help him?

Dr. Z :

Hello I believe I can help you with your concern

Dr. Z :

Please give me a couple of minutes to read over your question carefully, so that I can better assist you

Dr. Z :

I am so sorry to hear about what your nephew has been through and for the symptoms he has been expressing, I can understand how this would distress you

Dr. Z :

It does appear that your nephew may have a Major Depressive Disorder or another type of disorder called Dysthymia, which is considered a more long term type of depressive disorder, but typically without the suicidal gestures or ideations.

Dr. Z :

I know that you want to get him help immediately, but this requires the combination therapy and psychotropic medication give the seriousness of his symptoms.

Dr. Z :

The best and most evidence type of therapy to help your nephew is called Cognitive Behavioral Therapy (CBT) as it is very effective in treating these symptoms you described. CBT has a premise that your symptoms are caused by negative thoughts, so if we change your thought process to be more positive and objective as well, then your symptoms will lessen.

Dr. Z :

So this link may help you, it contains a technique I use with patients called a thought record. It will help him keep track of any negative thoughts he has. He puts the negative thought on paper, the emotion accompanying, the evidence to support it, and the evidence against it. Then I want him to come up with an alternative thought for the situation (more objective and plausible). This will help him change his way of thinking to be able to think more positive and not automatically go to a negative type of thinking.

Dr. Z :

In addition, these two worksheets are very good at helping lessen depressive symptoms. It can help him focus on the big picture and the objective/positive thoughts and outcomes.

Dr. Z :

Also individuals with severe depression have a poor coping mechanism, so this worksheet will help him develop a better coping strategy to manage his symptoms better.

Dr. Z :

Individuals with a depressive disorder also may have low self-confidence, so this technique will help you replace any self-critical thoughts that you may have with more positive self-beliefs.

Dr. Z :

I would like to recommend these books as well

Dr. Z :

Now these techniques are very helpful, but the do not replace quality therapy with a therapist that specializes in CBT, so I would encourage you to seek that therapy for him. Therapy is a gradual process and accuse of his current low motivation, this is why I think that the use of an antidepressant is warranted to give faster results

Dr. Z :

The best antidepressant would be Lexapro at 10-20mg as it is the most effective antidepressant, fast acting, and has less side effects than the other antidepressants. Now this medication will start working in around 2-3 weeks with the maximum benefits being achieved in 8 weeks. This medication only lessens the symptoms, so it is not a cure, only therapy can cure him

Dr. Z :

In addition, he may be resistant to therapy so these books will help give you tactics and strategies to get him into treatment.

Dr. Z :

I see that you are online, do you have any questions or concerns?

Customer:

I believe you are correct that he does need therapy and will seek to provide that for him. For the immediate, since his step-grandfather died in July, we want to provide him with direction and some discipline in his life so that he might seek a 2-year college education and/or a job which he has never had. How firm can we be in giving him direction/advice. We are in our very early 60's and have raised 3 children all with college education and families of their own now. Want to give him a better perspective on life than his grandparents provided, but fear pushing him too far -- however, that may be why he has no direction -- he was never given much discipline -- he is a "good boy" with no alcohol or drug habits.

Dr. Z :

Well you mentioned that h was not the best student academically in high school because he had a low GPA, so I think enrolling him in a Community College is good, but only start out with 2-3 classes to let him adjust to college life and also try to provide him a tutor to help him succeed. Many young men who experience the abuse that he had from his step-father will develop depressive symptoms that will interfere with his education, so that could be why he struggled in high school. Therapy will help with this and gradually introducing him to college will help too so that he does not feel overwhelmed.

Dr. Z :

So the direction and discipline is a good idea since he is incapable of providing that for himself. Also a therapist will help provide him with direction as well and it possible that you as family members can go to a family therapy session once every 1-2 months so that everyone is on the same page to help your nephew

Customer:

Thank you. Then, we are thinking correctly on how to guide him through the next year? We will seek therapy as soon as we can get him settled with us instead of his traveling between family members. My tendency today is to be firm and keep him in one home instead of moving around. My tendency is to also provide a firm, but loving, hand in discipline as his behavior seems to be that of a 14-15 year old instead of a mature 20-year old. I feel that he needs to be provided with those upbringing values/tools that he does not have to reach maturity. Don't want to push him away from us though.

Dr. Z :

Yes so far your approach is very loving and caring, but also firm with appropriate discipline to help your nephew become a well functioning adult. An good tactic when giving discipline for someone of his age and maturity level is to give him choices so that he feels he is the one making the choice, this will help him feel more independent

Customer:

Excellent advice. Unlike taking in a 6-7 year old young boy with similar past, taking in a young man who should already be out in the world, but lacks the knowledge and experience to do so is tricky and we want to provide him with all the right tools to face his future, including direction. Thank you! Is there a way I can keep this transcript?

Dr. Z :

Exactly, it will be tricky at first but with the right tools I believe that your nephew will be able to succeed and become a healthy and well functioning adult. Well when you finish rating me, this chat will be sent as a link to your email, if it has not already, so you can always use it for future reference. In addition, this chat will be saved in your JA account under My Questions so you can always go back to it when you need to

Customer:

Thank you for your advice. Confirming that we are on the right path is helpful, along with the reading material and worksheets. We should be able to help him move forward without looking back and making excuses, and especially not using the sympathy excuse.

Dr. Z :

I agree I think the sympathy excuse, while valid given his history of emotional and verbal abuse, does not help him recover and heal. It also does not put him on a path to move forward, so I believe strongly that through this treatment plan your nephew will be able to move forward with his life because right now he is just stopped with no direction. You are a very loving family to be providing your nephew with these tools to help him succeed.

Customer:

Thank you, XXXXX XXXXX Appreciate your insight and advice! Have a nice afternoon.

Dr. Z :

You are most welcome and I wish you and your family all the best. My goal is to provide you with excellent service, so if you ever have any further questions or concerns please do not hesitate to contact me at anytime.

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