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Showing posts with label adolescence. Show all posts
Showing posts with label adolescence. Show all posts

Tuesday, January 25, 2011

Life Stages in Mother-Daughter Relationships

In a prior blog post, I wrote about Ambivalence and Codependence in Mother-Daughter Relationships. That blog post presented the complex nature of mother-daughter relationships when there are problems with enmeshment. At this point, I would like to return to the topic of mother-daughter relationships to step back and look at these relationships over the course of the various life stages that mothers and daughters go through.

Life Stages in Mother-Daughter Relationships

Mother-Daughter Relationships - Early Bonding:
There is no doubt that, in general, fathers are more involved with their children than they were a generation ago, which is encouraging. But the primary parental relationship for most girls and women remains the mother-daughter relationship.

During the 1940s and earlier, people believed that babies were born as blank screens, but we now know that from early infancy we're biologically "hard wired" for attachment. That means that infants seek warmth and comfort from Day One: the warmth and scent of her mother's skin, the comfort of her mother's breast, and the sound of her mother's voice. When bonding goes well between mother and infant, the baby feels a secure attachment to her mother. This secure attachment between mother and child makes it more likely, all other things being equal, that the child will develop healthy relationships later on in life.

Under optimal conditions during infancy, the baby and mother are also bonded through the mother's loving gaze. The baby sees herself in the mother's eyes and feels the mother's love. The mother, in turn, sees how comforted the baby feels being mirrored in the mother's eyes and this is comforting to the mother as well. This interaction provides a positive feedback loop between mother and child and reinforces this bond.

Mother and Daughter Relationships - From Early Years (18 months to age 5):
At around the age of 18-24 months, babies begin to learn to separate from their mothers for short periods of time. Margaret Mahler referred to the "separation/individuation" phase when, under optimal circumstances, babies learn that their mothers continue to exist even when they are out of sight. This is also the time when babies begin to assert some of their autonomy by saying, "No!" If the mother is patient and recognizes this as a normal stage of development, babies gradually outgrow this sometimes difficult stage.

From about the age of four or five, most daughters idealize their mothers. They often find their mothers to be attractive and glamorous. At this stage, many girls want to mimic their mothers by putting on the their mothers' makeup or playing dress-up with "mommy's clothes." They often think of their mothers as beautiful and all-knowing.

Some daughters have a hard time separating from their mothers when it's time to start school (this occurs with sons as well sometimes). It's their first time away from the security they feel with their mother to be in a new and strange environment with a stranger (the teacher) who is now in charge. Most of the time, young girls are able to make this adjustment, and the mother remains their primary attachment figure.

Mother-Daughter Relationships - During the Daughter's Adolescence:
While mothers are idealized when children are four or five years old, teenagers often see their mothers as being old fashioned or "out of it." This is another stage where children are learning to separate themselves emotionally from their mothers.

This stage can be bewildering to mothers who often say, "What happened to my relationship with my daughter?" This is a time when teens bond with their peer group, and a friend's advice or opinion is often valued more than a mother's.

Tension and conflict during this period of time can be managed if both mothers and daughters accept and respect each other rather than viewing each other as the enemy. Since they're the adults, mothers have a greater onus for being understanding and fostering good relationships with their daughters. However, daughters must also learn to be open and respectful towards their mothers. Mothers need to learn to allow their daughters an age-appropriate degree of autonomy, but mothers must also provide guidance and support while setting boundaries for their daughters. Daughters will often test these boundaries, but this is also a normal part of adolescence.

Mother-Daughter Relationships - Daughters in Their 20s and 30s:
During their 20s, daughters are no longer teenagers, but some of them, depending upon their level of maturity, might not feel like adults yet. Prior to the 1990s, many daughters were able to go out on their own and live independently after college because apartments were more affordable. Now, with fewer rent stabilized and moderate income housing, many daughters continue to live at home for longer periods of time, depending upon their parents for longer as compared to prior generations.

During their 20s, many daughters often realize that their mothers are fallible and they don't always have all of the answers. During this period, many of them are being challenged by career choices and choosing a mate. Often, they're learning how to distinguish themselves from their mothers while attempting to maintain a bond with them.

During their 30s, many daughters are starting to come into their own with regard to career and their own family. Under ideal circumstances, they are less emotionally and financially dependent on their mothers. They often realize that their ideas differ from their mothers with regard to certain values. At this point, if they are in committed relationships with a significant others, under optimal circumstances, daughters are learning to put their partners first. This can create tension in the mother-daughter relationship, unless mothers understand that this is a normal part of development.

Mother-Daughter Relationships - 40s and Beyond:
Although there are many sons who help to take care of their elderly mothers, traditionally, for better or worse, it has been the daughter's responsibility to take care of elderly parents. For many women, who are "sandwiched" between their own families and their parents, this can be very challenging. During this time, daughters and mothers start to come to terms with the fact that mothers are aging and have more years behind them than ahead. How well they deal with this is often dependent upon how well their relationship has developed until this point.

Life Stages in Mother-Daughter Relationships

This is also often a time when mothers and daughters let go of old resentments in light of the fact that mothers are elderly at this point and time might be short for reconciliation. Under most circumstances, daughters often develop a different perspective of what's important, especially if they now have their own children and they understand better what their mothers went through with them.

In future blog posts, I will continue to explore mother-daughter relationships.

About Me
I am a New York City psychotherapist, hypnotherapist, Somatic Experiencing therapist, and EMDR therapist. I work with individuals and couples.

As a psychotherapist, I have helped many mothers and daughters, individually and together, to improve their relationships.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist

To set up a consultation, call me at (917) 742-2624 during regular business hours or email me.




Thursday, March 25, 2010

Adolescent Depression Among 18 Year Olds: Child or Adult?

Adolescent Depression Among 18 Year Olds: Child or Adult?


Adolescent Depression Among 18 Year Olds:  Child or Adult?
Over the years, I've seen a number of parents who come to psychotherapy to deal with their own fear, frustration, and anxiety related to an 18 year old daughter or son who refuses to get help for depression. With regard to mental health decisions, in New York State, we consider an 18 year old to be an adult who can make his or her own decisions about getting mental health treatment. A concerned parent, who is worried about the welfare of his or her child, cannot force an 18 year old to get help if the teen doesn't want it. This raises a lot of complicated issues:

  • Even though the law considers an 18 year old to be an adult with regard to participating in mental health treatment, does an 18 year old always have the psychological maturity and judgment needed to make this decision?
  • Given all the hormonal and psychological changes that go on during adolescence, does an 18 year old always know what's in his or her best interests regarding psychological health?
  • How does teenage rebellion against parents and authority figures factor into this issue?
  • How does the depression itself affect an 18 year old's ability to make sound decisions for him or herself in this situation?
What is Adolescent Depression?


What is Adolescent Depression?
Adolescent depression is a psychological disorder that occurs during teenage years with symptoms of persistent sadness, loss of interest in his or her usual activities, loss of self worth, and discouragement. In many cases, teens will start to isolate themselves from family and friends. In some cases, teens might turn to alcohol or drugs to self medicate their depression. In more severe cases, teens might make impulsive attempts or gestures to commit suicide. There might be other symptoms from other psychological disorders such as anxiety, anorexia, bulimia, compulsive overeating, self mutilating, hair pulling, and other similar symptoms. See below (What Are the Symptoms of Adolescent Depression?)

What Causes of Adolescent Depression?


What Causes Adolescent Depression?
Depression during adolescence is not unusual. Some of the causes of depression in teens might be:
  • hormonal changes that occur during adolescence
  • stress associated with the normal process of maturing and developmental change
  • a reaction to a disturbing event: the death of a friend or loved one, the breakup of a relationship, problems at school, and other similar issues

Teens who are Most Vulnerable to Depression:


Teens Who Are Most Vulnerable to Depression
  • have low self esteem
  • are highly critical of themselves
  • have little sense of control over stressful events that occur to them
  • have been sexually, physically or emotionally abused or emotionally neglected
  • often come from a family with a history of depression
  • often have poor social skills
  • often feel that they don't "fit in" with their peer group
  • have an unstable home life
  • often have parents who are divorced
  • experience the loss of a parent

What are the Symptoms of Adolescent Depression?

What Are the Symptoms of Adolescent Depression?
  • acting out behavior (misbehaving in school, acting defiant with parents)
  • changes in appetite (either increase or decrease)
  • criminal behavior (shoplifting, alcohol or drug abuse, selling drugs, etc)
  • persistent sadness
  • irritable mood
  • difficulty concentrating
  • difficulty making decisions
  • problems with memory
  • sleep problems (either problems with insomnia, excessive sleeping or day time sleepiness)
  • excessively irresponsible behavior
  • excessive guilt
  • problems in school, including failing grades, fighting with teachers or other students, cutting classes, etc.
  • thoughts about suicide, making plans to commit suicide or actual suicide attempts
  • substance abuse or other forms of addictive behavior (gambling, acting out sexually)
  • excessive worry or preoccupation about death
  • significant weight change (either gaining or losing)
Is it Depression or Something Else?
Depression is difficult to diagnose in teens due to hormonal and other developmental changes that go on during this phase of life. Some of the above symptoms are just a normal part of being a teen and do not necessarily mean that your teen is depressed. A psychotherapist or psychiatrist, who specializes in working with teens, should be consulted to make a differential diagnosis. Also, it's a good idea to consult with your medical doctor to rule out any medical causes. A doctor who is knowledgeable about substance abuse can also rule out alcohol or drug abuse.

Depression Before and After Age 18:
Prior to the age of 18, as a parent, you can make the decision as to whether or not your child gets help. It's always better to include teens in on the decision making process, if you can, rather than trying to force them to get help. Also, when teens become involved in criminal activity, the court can mandate that they attend treatment and will often monitor their compliance in treatment.

But when teens turn 18, getting them into treatment for depression can be a thorny issue, if they are either afraid to get into treatment, they feel stigmatized, or they refuse to participate in treatment as part of their rebellion towards you.

What to Do If Your 18 Year Old Refuses to Get Help:
Recognize that, ultimately, as scary as this might be, in most cases, the decision is up to your 18 year old. But there are some steps that you can take to help your 18 year old to get help:

Normalize What Your Child is Feeling
As previously mentioned, it's not unusual for teens to be depressed. Your 18 year old might feel that he or she is the only one who is going through depression. This can be especially painful because teens often have a strong need to "fit in" with their peer group. If they think that what they're going through is "weird" or "crazy," it would be helpful for them to know that they're not alone.

Provide Your Child with Psychoeducational Material about Depression
Organizations like NAMI (http://www.NAMI.org) have websites that provide psychoeducational information about depression. So, even if your 18 year old won't listen to you, he or she might be more receptive to information that is online.

Elicit the Help of Someone Close to Your 18 Year Old
During the adolescent phase of growing up, teens are striving to have some degree of autonomy and control. This often translates into alternating behavior of over dependence and rebellion towards parents and authority figures. An 18 year old's decision not to participate in mental health treatment for depression can be adversely affected by his or her need to feel autonomous and independent from parents. So, even though you might be the one who is most familiar with what's going on with your teen, you might not be the one that he or she will listen to about this. In many cases, it's helpful to find someone who has some influence with your teenager--that might be an older sibling, an aunt or uncle, your child's medical doctor, or a coach. They might be more persuasive than you.

Try Not to Get into a Power Struggle with Your 18 Year Old
If your 18 year old refuses to get help for depression, your inclination might be to feel angry and frustrated. You might see all the signs and symptoms of depression and know that you have better judgment with regard to your teen getting help. However, aside from emergency situations, if you try to force, rather than persuade, your teen to get help, your teen might dig in his or her heels about this, making it less likely that he or she will get help.

What About Suicidal Thoughts, Intention, Plan or Attempt?
If your teen is talking about suicide, you need to consult with a psychiatrist who specializes in working with teens immediately. Teens can be impulsive and events that might seem insignificant to you can often be emotionally overwhelming for a teen. When teens are impulsive, often, there is no forethought about suicide--they make the attempt.

If your teen has actually made an attempt, of course, you need to call 911 immediately. If your 18 year old is taken to the emergency room for a psychiatric evaluation following a suicidal attempt or gesture, the psychiatrists can hold him or her for up to 72 hours or more if they feel that your child will be a risk to him or herself or others.

Hopefully, as a parent of a teen, you will never be faced with adolescent depression in your child. But if you are, aside from getting your teen help, the family might need family counseling and you might need your own psychotherapy to cope with this ordeal.

I am a NYC licensed psychotherapist, hypnotherapist and EMDR therapist who works with individual adults as well as couples.

To find out more about more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist

To set up a consultation, call me at (917) 742-2624 or email me