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Expert Q&A

	By Paul Coleman Psychologist Family Therapist

My 16-year-old daughter is in the hospital being treated for severe clinical depression. She has run away twice. She has inflicted self-injury and has had suicidal thoughts in the past. One of my concerns is she seems to glorify her running away and being in the hospital to her peers. Yesterday was her first day in the hospital and she didn't seem upset at all. I thought it would be traumatic for her. She wasn't crying and was acting very upbeat. She called and asked me to bring a couple of her belongings as if she thought she was on vacation or something. We've had a problem with her lying and making up things since she was 9 years old. She is lying to people now, saying things such as she smashed the whole side of her car, when all that happened is an ornament off the car came loose. They say she will be in the hospital for 3-5 days. Our concern is when she comes out, then what? She has been seeing a therapist since the first time she ran way and we go with her at times. How do we deal with this lying and deceiving behavior of hers?

It is hard for me to tell what precisely your daughter's issues are. Symptoms of running away and harming oneself suggest the possibility of a harsh home life or possibly a history of sexual assault. If there was any abuse or assault, she should be treated by a therapist familiar with Post-Traumatic Stress Disorder. A treatment approach known as EMDR is very successful for Traumatic Stress and you should seek a counselor trained in EMDR if trauma is an issue.

You should discuss with the hospital staff what their opinions are of your daughter and what should be done.

If there is no trauma and the household is stressful largely because of your daughter's disruptive actions, then you as a parent have to find a way to get more leverage than you have so far had.

I would suggest that therapy sessions not be primarily focused on restoring nurturance. Most parents resent having to be understanding and compassionate while their teenagers are getting away with behaviors that are certainly inappropriate and possibly dangerous. Parents can usually allow their softer emotions to emerge only after the more disruptive behaviors of the teen are brought under control.

Still, don't make the situation worse by attacking your child's character or by bringing up old issues. Keep to the here and now. Never label your child with words such as lazy, no-good, deadbeat, worthless, and so on. (Books such as "How to Say It to Your Kids!" will give you much advice on effective communication.) As such, your visits with the therapist should focus on defining clearly what the rules of the house are and what the consequences will be if those rules are not followed. Be open to suggestions by your teen, but remember, you are the boss.

The therapist should also help you to anticipate ways that your teen will try to get around the rules. (For example, your teen arrives home fifteen minutes past curfew. Should there be a punishment?) Running away should be followed by clear consequences that your teen is made aware of. I suggest the following--it is severe but can be effective. Next time she runs away, put all of her clothes in a safe place that she cannot get to. When she arrives home she is told she will get her belongings back if she does not run away for the next seven days. She must wash the clothes she has daily. If she refuses to wash the clothes she has, you will extend the time until she gets her clothes back. (Please discuss this with a counselor as you may need a lot of support during the seven days that your teen does not have access to all of her clothes.)

During this time, you can be open to discussions, but her clothes will not be returned until the seven days are up. If your teen runs away and is gone for more than 24 hours, file a missing person's report and place her photo all over the school and neighborhood.

Often, disruptive teens lose the affection of their parents because of their actions. Feeling unloved and alienated, these teens now connect more to friends who may further lead them into bad behavior. You need to reinstate affection and acts of caring. However, that is more easily done when you are in charge and do not feel like you are being blackmailed or intimidated by your child. (Be cautious about affection if your daughter was sexually molested. Discuss this with a therapist.) Teens may pull away from your hugs but try to give them anyway. Even a pat on the back will do.

Lastly, if the troublesome behavior seems more under control, try getting away for a day trip or an overnight trip with your daughter. Mother-daughter bonding can help reduce future problems."

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