Normative Behaviors vs Impairment

As a therapist, I am frequently asked by parents if what their teen is going through is normal or if they should be concerned. To be fair, coming to therapy for typical teenage changes is common and very helpful even if it is in the realm of normal. The safe space of the therapy office gives adolescents room to sort through their thoughts and feelings in a way that is not replicable with parents or friends. Having said that, there are times when concerns arise and it is important to have parents more involved. Typically what we look at is danger and impairment.  The following major areas come to mind that we will look at more in depth: suicide and self harm, substance use and behavioral issues.

Looking at depression and suicide for a second, I want to lay out some of the tools we have for identifying the level of danger, and what level of concern may be warranted. While it is common for adolescents to experience self harm thoughts or suicidal ideation during their formative years, it is important we always take their statements seriously and never minimize or downplay what they may be going through. 

First, we want to use the words suicide and self harm explicitly, not euphemisms or vague statements. For example, ‘Are you thinking of hurting yourself, killing yourself, or having suicidal thoughts?’ What we want to look for is the vague statements that teens make that point us in this direction. Comments like “I don’t want to be here anymore” or “I can’t keep doing this” are some examples. Next, we look for any plan or intent. These two tell us that the danger of harm has significantly increased passed ideation or thoughts alone. In the event that your child does endorse a plan and intent, stay with them, show them you are there to support them, and make a safety plan that involves someone staying with them until long term help can be obtained, typically hospitalization, partial hospitalization, or long term therapy.  

When looking at impairment or level of danger with substance use or behavioral issues, we look for major changes in grades, school attendance, suspensions, acting violently towards others, ability to take on responsibilities, and level of engagement with family and friends. With both of these areas of concern, I typically apply the saying “hurt people hurt people” as a means to gain empathy and compassion for teens who are lashing out at others through violence, stealing, being defiant in classes and at home, or using substances to hurt themselves, numb emotions or escape pain. In general, when teens feel their best and are getting adequate support for their emotional needs or trauma, behavioral challenges and dangerous substance use goes down. Because of this, approaching your child with empathy and understanding is a means to connect with them and begin the healing process. This does not mean that we are giving permission for dangerous behaviors, we are simply giving them a space to feel heard and seen without judgment so they can feel open to any help that is offered, on their own terms.  

I hope this article was helpful in identifying what might be some of the major concerns we look for regarding teen behaviors. In general, if you are unsure of whether to be worried about your child, feel free to reach out! It is almost always better to be proactive than reactive, and giving families tools for how to talk about difficult situations is a huge part of the therapy process. In all the above situations, increased parent involvement is a necessity for positive outcomes, and showing willingness to help and change alongside your child is a great way to model positive mental health.  

Best,

Ben Friday, LMFT #122263

Thrive Therapy & Counseling

Podcast Manager

916-287-3430