School Counselor Kryptonite

One of the best feelings as a school counselor is to have a student, with whom I have worked with for a long time, recognize that he or she needs help!  When a student finally gets that revelation, I hear angels sing, dark clouds open, and I feel like "super counselor."  That was the feeling I got the other day talking to a student who recognized that he/she needed to be in counseling for persistent sadness, lack of motivation in school, and issues at home.  The student asked great questions about the nature of the counseling relationship and seemed very positive that this could help him/her make progress. So, this is me, super counselor,  making great strides with a student!  I am in the groove!! To get the ball rolling on a referral, I have the student take home some paperwork and make additional arrangements to see the student.  I am so confident that this student will bring back the paperwork that I didn't think about it again until a few days later. Suddenly, I realize that no paperwork has been returned; therefore, set two was sent home.  However while I am waiting for the paperwork, the student has a meltdown and threatens to harm him/herself.  Immediately the parent is called in, the student is sent for a mental health evaluation, and a follow up letter is sent with the parent to report the results of the assessment.  Since the incident occurred the week before spring break, we allowed the parent some additional time to get back with us about the counselor visit.  Tick, tick, tick...no word from the parent.  Another week goes by and we leave copious phone calls and emails for the parent. Still, no word.  Again, the student comes in asking about counseling services and how it could not only could benefit the student, but the family as well.  Another round of messages are left for the parent with no reply.  Finally, the parent answers the phone and agrees to come back for a meeting!!  YAY!! Oh, don't get too excited because she misses the meeting and we call her again to reschedule.  The next day the parent pops in unannounced to talk to us, but guess what, we are out of the building. So, a  fourth round of calls are made and a meeting is set...SUCCESS!!

The Meeting

Hmmmm, a parent in denial.

When the parent finally makes it to the meeting, we begin to talk about the concerns of her child.  Throughout the meeting, the parent sat stone faced and replied, "I don't believe my child is suicidal." This is the point that I pull out all stops explaining mental illness onset, suicidal ideation, and chemical changes in the brain from depression (surely she will see the urgency).  Again, the parent stared blankly at me and said, "We all have stress and do you people think there has to be an illness for everything?" I explained that there is stress and then there is STRESS that may impact a student's quality of life.  The parent stopped me and curtly pointed out that she had to go. Next she said, "If I can make it through life so will my child...he/she will just have to tough it out!" Arrrghhh, this super counselor now faces her kryptonite, a parent in denial.

The Problem With Parental Denial

Parent in denial

There are many types of coping skills that we learn growing up; some good and some negative. Further, coping skills can be categorized as active or avoidant    One of the most pronounced coping skills, among parents, is the avoidant coping skill of denial.  Denial is the ability to believe that a problem doesn't exist or the ability to participate in behaviors that take one's mind off the issue like overworking, substance abuse, or constant distractions. Psychology Today found that denial is a "self security system" protecting parents from the impact of all the information going on around them.  It is a way to put uncomfortable or harmful information out of sight and out of mind. This denial by the parents can have a harmful impact on the their teen with mental illness. The Mayo Clinic found that people in denial typically refuse to acknowledge the issue; avoid facing facts; and minimize the consequences of a situation. In essence, a parent is unable to cope with the situation so they deny that it is occurring to them or their child. Could admitting a child has a mental health issue mean that the parents feel they will be exposed for doing something wrong?

During adolescence mental health issues like depression, schizophrenia, bipolar disorder, social anxiety disorder, eating disorders, obsessive compulsive disorder, and addiction can emerge. When teens suffer from mental illness, they may act unusual which makes others (students and adults) feel uncomfortable. Unfortunately, it is easy to treat teens different who seem to act strange which promotes stigma.  Clinicians have found that parents are often worried that if their student receives help for a mental disorder that they may be labeled as poor parents. In essence, the parent is contributing to the rule of the dysfunctional family known as "don't share family secrets". Also, parents may be fearful that if their child is diagnosed with a mental illness they will be negatively labeled and shunned by others. Since there is so much stigma associated with mental illness, the National Institute of Mental Health found that people wait ten years or more to get treatment after symptoms appear.

Mental Health Stigma

Adolescent mental illness stigma is not something new. In fact, the other night the Animal Planet Channel featured a show about wild children raised by animals.  Each child had a traumatic experience and during that time were exposed to animal behavior. In order to cope with the abuse suffered by the children, they assumed the behaviors of animals. These behaviors made neighbors feel uncomfortable and often afraid.  The immediate response was to capture and imprison the child to keep the public safe.  This fear or stigma was responsible for turning them from wild children to wild adults.  One story was about the wild Chicken Boy of Fiji. At the age of 18 months, his parents put him under the house with the chickens because they thought he had an evil spirit. At the age of four, he was unable to speak, he pecked at his food, and his hands were curved like the claws of a chicken. At the age of eight, he was captured walking down the street and he was taken to a home where he was tethered with sheets to the wall. Because he did not know how to communicate, he was beaten and mistreated for his behavior over the next 20 years.  The cultural stigma of believing this young boy was evil prevented him from receiving much needed treatment.
Chicken Boy of Fiji

Ten Ways To Deal With Parental Denial and Encourage Early Mental Health Intervention

You may have experienced parental denial and stigma when you have tried to advocate for a student with mental illness. It truly can be frustrating and difficult to show that the teen needs to get treatment early.  Here are some suggestions when you face these challenging parents:

1. In an article by Sommers-Flanagan and Bagley (2011), they outlined some skills that counselors should use when working with difficult parents.  One practice they outlined was the use of radical acceptance or the ability to accept the parents as they are and tell them that your purpose is to help them make positive changes.  If a parent says he or she does not believe that his or her child needs to see a counselor, you may say something like, "Thank you for being honest with me about your feelings regarding outside counseling. A lot of parents feel that outside counseling is not necessary or can be intrusive." This shows the parent that as a professional you affirm that you are open to his or her beliefs which can establish a trusting relationship.

2.  Another skill suggested by Sommers-Flanagan and Bagley is collaboration. Collaboration requires the school counselor to come from a place of not acting as the "expert" and is willing to include the parent as an equal partner.

3.  In addition to acceptance and collaboration, Sommers-Flanagan and Bagley feel that school counselors should validate the parents' feelings of uncertainty and compliment them on their willingness to talk about the issue.

4.  A fourth skill recommended by Sommers-Flanagan and Bagley is joining. Joining includes showing that the school counselor is on the same side of the parents so one can  provide educational interventions. Part of this intervention is to educate parents on mental health and how it is just as important as physical health.  Explain to parents that the brain is an organ, like the heart, and it can get sick. Parents would not hesitate to take their child to the doctor if they were having physical symptoms like heart palpitations, rapid breathing, or fainting.

5.  Empathize with parents about their concerns and fears on getting their child help.  The parent that I met with was concerned that her child would be labeled as mentally ill and not able to get a job.

6.  Be patient with the parent(s). Remember you may not be able to convince parents to get their child help in one meeting.  It may take time to show parents that their child can benefit from outside help.

7.  Provide resources on mental illness symptoms and negative consequences.  Show parents the potential costs for students if their symptoms are allowed to continue into adulthood. See the stages of mental illness below as a resource.

Source: Mental Health America

8.  Show parents that it is important to treat mental illness early especially before students go to college. Although symptoms may ease when students start college, clinicians found that these symptoms return with severity within six years. Therefore, it is imperative that parents prepare students to become independent within the months prior to college.

Managing a Mental Health Condition in College

9. Continue to help the student.  The best thing to do as a school counselor is to be available for the student and provide a safe place for the student to come and talk.

10. Participate in mental health awareness in May to help bring awareness to stigma.

Also, think about continuing the campaign in the fall by promoting National Day Without Stigma in October. 

Additional Resources:

Active Minds
NAMI
Suggestions for Educators
Mental Health Resources