Podcast: Engaging With Closed-Off Kids & Teens

Jenn talks to Dr. Blaise Aguirre about how to have difficult conversations with kids and teens. Blaise suggests ways to approach difficult topics with children and adolescents, shares strategies to encourage your kids to open up to you, discusses navigating the complexities of growing up and gaining trust along the way, and answers audience questions about navigating tough talks at different stages of your child’s life.

Blaise Aguirre, MD, is a child and adolescent psychiatrist specializing in dialectical behavior therapy (DBT) and mentalization-based treatment (MBT) for borderline personality disorder and associated conditions. He is the founding medical director of McLean’s 3East continuum of care, an array of programs for teens that use DBT to target self-endangering behaviors as well as the symptoms of borderline personality disorder.

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Episode Transcript

Jenn: Welcome to Mindful Things.

The Mindful Things podcast is brought to you by the Deconstructing Stigma team at McLean Hospital. You can help us change attitudes about mental health by visiting deconstructingstigma.org. Now on to the show.

Hi folks. Good morning, good afternoon, good evening. Wherever you’re joining us from, whatever time you’re joining us at, whatever the weather looks like there, thank you so much for joining for our conversation about difficult conversations.

I’m Jenn Kearney. I’m a digital communications manager for McLean Hospital, and I am so excited to have Blaise Aguirre with me today.

And having difficult conversations is a monumental feat for any parent or caretaker, and that’s putting it lightly. But if you know how to handle these conversations well, you can actually better your bonds with your kids and set the tone that they can come to you with anything.

So for those reasons and so many more, is why I am thrilled to have Dr. Blaise Aguirre with me today to talk about all the ways to approach difficult topics with children and adolescents, strategies to encourage your kids to open up to you, and methods to talk to kids of any age about tough stuff.

So if you are unfamiliar with him, Blaise Aguirre, MD is a child and adolescent psychiatrist who specializes in dialectical behavior therapy, we call it DBT, and mentalization-based treatment, which we call MBT, for borderline personality disorder and associated conditions.

He is the Michael Hollander, PhD, Endowed Director and the founding medical director of McLean’s 3East continuum of care, which is an array of programs for teens that uses DBT to target self-endangering behaviors and the symptoms of borderline personality disorder.

So Blaise, it’s so nice to see you. Thank you so much for joining me today. I know that we’re going to get a lot of questions, but I want to get started with a nice broad one. What is the value behind having difficult conversations with our kids?

Blaise: So yeah, I’ve been thinking about this title ever since you sent it to me, and I thought, yeah, I can probably answer this more as a parent than as a psychiatrist. And, because I think a lot of the stuff that I was taught in psychiatry training is not necessarily something that I use as a parent.

And so I think that, now, so my answers will be definitely informed by what I’ve discovered clinically, but more what I’ve seen just as a parent of four teens and now four young adults.

So I think that there are many different kinds of conversations that you’re going to have with your kids. Some of them are going to be, you know, pretty easy, and you sort of think, okay, well, why are those easy?

Well, because the topics are maybe fun or maybe something that the child can deal with. But then there are going to be some very difficult conversations. And I often wonder why is it that parents don’t have those difficult conversations with their kids?

And often it has to do with the fear of the reaction that a child is going to have. So then what happens is that parents keep those discussions within themselves, and eventually it comes out, and often, unfortunately, it comes out at a time when things might not be going as well, and it’s often the wrong time to have that conversation.

So, from my perspective, the conversation’s probably going to be had at some point, and why delay, you know? So if the conversation has to be had, the reason, I think, is to not delay.

And the reason I don’t want to delay is because the more the delay, maybe the more the behavior continues, maybe the more the parent suffers in their mind, you know, worrying about having this conversation. Maybe the timing is wrong.

So I think it is better to have the conversation that you have to have sooner than later.

Jenn: I know that you’ve talked about timing, but are there better environments to initiate these conversations than others? And I know you’re a dad. You said you’re a dad of four, right?

Blaise: Yeah.

Jenn: Oh holy moly. So as a dad yourself, what approaches have you found to be successful in initiating these difficult conversations?

Blaise: I’ll tell you what hasn’t worked for me as a dad, and certainly even though I’m a child and adolescent psychiatrist, I fall into the same problems that many parents do, and that is, my kids do something that, you know, I’ve been worried about, and then I get really upset that they’ve done that thing.

And I’m maybe up late at night and I wait for them to come in, and I say, “Hey, you know, I told you I didn’t want you to be in, you know, after 12 o’clock,” or whatever it is.

And so what happens is, is that I am leading from a point of reaction at a time when I’m probably not at my best. I should, I probably ought to be sleeping. And maybe at a time when they’re not at their best.

So it’s a conversation that we need to have, but the problem is that if we have it at that time, when I’m vulnerable to my own emotions, when they’re vulnerable, that all that it’s going to do is it’s going to push us further apart.

So for me, the time to have those conversations is when I’m in a state of mind when I know what my purpose is, and that is to have this discussion, to not be punitive, to get my point across.

And when they’re rested and when they’re in a better state so that they can have the conversation. So I tend to have them, you know, sort of mid-morning when things are calm rather than late at night, when maybe I’m being reactive and they’re being reactive.

Jenn: So, is there a certain age that we should start having these conversations? ‘Cause I know, you know, difficult conversations can be anything from your young adult saying, “Don’t get in the car with someone who’s been drinking,” versus the loss of a loved one, which could, that could happen at any age.

So, if they’re young, should we try to like, “sugarcoat” subjects for them, or what would be an approach depending on the age for these conversations?

Blaise: Yeah, I, well I, I know a parent who was never told anything as a child, and so what she has done now as a parent is that even from very, very early on, you know, as a, you know, she would speak to her two-year-old child and say, “You know, mommy feels this way.”

And, you know, the child doesn’t have the language, the emotional skills to be able to understand necessarily what the parent is saying. So I do think you have to think about your children from a developmental point of view. Meaning, you know, what is a child able to handle?

You know, it’s, you know, telling, you know, a child that Santa doesn’t exist, for example, or, you know, so that would be maybe more trivial, but, you know, you don’t want to necessarily take away the magic of childhood very early on.

But some parents might say, you know, “I don’t want to get into all this kind of nonsense about Santa and stuff like that. I’m going to tell my child, sort of, very early on.”

So you also have to think about the culture of the family. So you have to think about a couple of things. Is there a need to know?

So I mean, if there’s a difficult conversation like divorce or maybe a significant illness, maybe the child does need to know, and then how do you sit the child with enough supports to have that kind of discussion.

But there might be other conversations that could be difficult, like maybe a parent planning, changing jobs, and that there might be a sort of a financial impact, but that, things like that aren’t that certain.

Some parents say, “I need to tell my children everything all the time,” and ,you know, they might not be, that might not be the time to have the discussion. Talking to a seven-year-old not to get into a car if their friend has been drinking would be an unusual conversation to have.

Certainly if you’re noticing that in your child’s peer group, that is something that’s happening, that is a time to have that discussion. So I think it definitely matters on the child’s age and developmental stage and what they and their peers are doing.

Jenn: I know that you’ve mentioned support a few times. So, when following a tough conversation, what types of support do you recommend that kids can either pursue themselves or adults can help them enroll in?

Blaise: Yeah, the, for most children now, not for all children, but I mean, for most children, there typically tends to be at least one adult in their life that is, that the child would identify as supportive.

And it might not necessarily be the parent. It could be a grandparent, it could be an aunt, it could be a neighbor. And I think that if you’re going to have that difficult conversation, maybe you would let the, as a parent, you would let that support person know, “Hey, I’m going to have this difficult conversation. My child may reach out to you.”

It could be someone at school. And often those support people are often very willing to, you know, to be there for the child, if there is a conversation about loss, for instance, and the support person can be there.

I mean, I know it’ll sometimes worry the child, like, why is this, my, you know, “why is Grandma here? Why is my aunt here?” But, you know, it can sometimes help in those moments just to feel that there are people that the child trusts and know the child and can be validating to the child there with them.

So… now if you don’t have any support, I mean, I think that that would be really difficult for the child to have no one. But there’s often somebody, maybe it’s a coach, maybe it’s another sibling in the child’s life that can be a support.

Jenn: What do we do if our kids don’t want to talk? So, how do, can parents approach these kids that, for whatever reason, are just really reluctant to open up to their parents?

Blaise: You know, one of the things that I discovered, and maybe this was even with my own kids, was that I would jump very quickly to try to solve problems, and I would jump very quickly to try to tell the kid what to do.

Like, they would come to me with maybe a problem, and then I would say, “Okay, this is what you need to do.”

There was a, my kid had to make a, I mean, this is just a trivial example, but had to make this model plastic airplane, and, but what the, so I bought him one, and the kid, the school had insisted on balsa wood.

And so I bought him one and he said, “Wait a second, you know, you bought this wrong airplane.” And I said, “Well, look, I’ll call this school. I’ll tell them what’s what, I’ll, you know, I’ll take care of things. Don’t you worry about it.”

And he just said, “You know, I’m not going to talk to you. You’re not listening to me.” And the, but I would jump to problem solving. I mean, that’s something so trivial, but he shut down around that very thing, you know.

He just said, “Look, you know, you’re not listening to…” And when I said, “You know what, I’m going to start listening to you more, and if you need my help, I will be there to help you. And if you just want me to listen, I will just be there to listen.”

And once I started doing that, things started to change so much more, because we know what to do as parents, but we are not in their lives, and so we are approaching problem solving often through our parents’ eye, and most of us who are parents are fixers.

We want to fix everything. And it’s like, maybe the kid isn’t asking for fixing, maybe the kid is just asking for listening.

Jenn: I think that’s a really important point that you brought up because, you know, a parent’s instinct is that they want to solve their children’s problems for them.

So, do you think that there may be some reluctance to open up because they’re afraid that the parents will try to fix everything rather than just be a sounding board?

Blaise: What a lot of kids tell me is that the, you know, I’ve had this situation where parents will say, you know, “I don’t know what you’re going to get out of an interview with my kid, because they’re not going to say anything to you.”

And then they spend hours talking to me and the parents say, “Well, how did you do that?” And it’s, and in part it’s, it is that listening.

So I’ll ask the kid, “What was different about this conversation?” And they’ll say, “I thought that you were curious about what was going on for me. You didn’t seem certain, you didn’t seem judgmental, you didn’t seem accusatory.”

And I think that parents worry so much about their kids that how they come across in terms of listening can sound judgmental, can sound non-curious, can sound certain.

And I think that if you listen to your child and your, and reinforce your child for actually speaking about the things that are going on, slowly they will begin to open up a little bit, a little bit more.

But, and it’ll be gradual, and it’s just like, and then also just to say to the kid, “Hey, I really appreciate that you told me about that difficult thing, and let me know if I can help,” is a much better approach than “Let me tell you what’s going on,” and, “This is not good,” or, “This is not,” or, “This is bad,” or something like that.

Jenn: So, is there specific language or questions that a parent could ask that would help move the needle from being, “I’m overly helping” to just listening and being supportive?

Blaise: You know, I specifically use the language of, you know, first of all, that I want to hear more, it’s like, “Just, you know, just tell me more about what’s happening.”

But then, more specifically, reflect back to them to say, “Let me just make sure I got this right. You know, you were in class and the teacher asked you this and you felt that, you know, it was upsetting and then you got into it with the teacher and that was a really difficult situation. Did I get that right?”

So to reflect back to make sure that you’re understanding what your kid is telling you, and then that maybe a situation like that would’ve been difficult.

And then just recognize that that could have been difficult, but then very powerfully notice your desire to tell your child, “Well, you should never be disrespectful to your teachers,” or you know, “Who is the teacher to speak to you that way.” But just to say, “You know, is there something that I can do to help?”

Jenn: So, one thing that I have noticed is, like a lot of folks when they’re nervous, whether it’s a parent talking to a kid or a friend in a job interview, they talk a lot.

So, if a caretaker’s nervous, they might just make the conversation one-sided because they just will keep on rambling. So how can we actually help keep conversations as dialogues and not monologues?

Blaise: Yeah, I agree that I think that out of a lot of anxiety comes a lot of preaching, a lot of talking to, and you know, I’ve certainly noticed in, sometimes in family meetings when I’ve asked the kid to say, “Well, what did your parent just say,” they said, “I don’t know, I just tuned them out.”

And so this is where I think, you know, in the same way as I say don’t have those difficult conversations late at night when you’re emotionally dysregulated, check in with yourself as to the level of worry and anxiety that you’re bringing to the conversation.

If you tend to talk more, if you tend to get more anxious, then I think that checking in with yourself and saying, “I’m noticing I’m getting anxious. I’m noticing I’m not listening. I’m noticing I’m talking to.”

And then just, you know, you might even just say to your kid, “Hey, you know what? I realize I’m just talking a lot, and I don’t know if any of this is making sense, so maybe I’ll keep quiet and listen a little bit more.”

Reflect back to your child, you know, the, your failure in that moment. Children are so forgiving when their, when the parents admit that, you know, that they haven’t, that maybe haven’t listened, or maybe they’ve failed.

They can be so forgiving. Not always, but, and so they, I think they tend to appreciate that when you say that. And then, and notice your own worry, and then, you know, I think also for you to figure out what your worry is about, so, mm-hm.

Jenn: Do you have any advice for making everybody involved in a difficult conversation feel as comfortable as possible, or is it something that, depending on the topic, is it actually even possible?

Blaise: I, here’s the thing is I, I worry a little bit about making everyone as comfortable as possible because people might be on exactly opposite sides of a discussion, and so making one person comfortable might make another person very, very uncomfortable, and vice versa.

And the way I preface this is that, you know, I will recognize that I think that, for me, that this is going to be a difficult discussion.

Now, sometimes the kids surprise me and say, you know, I know, I remember there was a time when parents were going to announce to their kid that they were, you know, going to separate, and the kid said, “Oh my God, it’s about time. It’s been about five years. I knew this all along.”

So sometimes you can say, “Well, okay, maybe the kid was much more aware of a discussion.” But if it is going to be, like, a difficult conversation, to then just say, “This is going to be a difficult conversation, and what I don’t want this to be is a fight. What I don’t want this to be is a yelling match.

So let’s accept that as a ground rule that we have to have this difficult conversation. If we notice that we’re getting upset, why don’t we take a five or 10 minute break and then come back, but you have to come back. All of us have to come back.”

And it’s not so much about comfort, but it’s about effectiveness. It’s about dealing with dignity and with effectiveness through a difficult situation without necessarily blowing up. But I don’t know that it’s neither necessary nor essential to have people feel comfortable.

And by the way, the other thing is this. When kids are able to have these difficult conversations with parents and vice versa, one of the things it teaches them is that they can have difficult conversations, ‘cause there are going to be other difficult conversations.

They will be parents too. They will be in other situations, they will be in an employment situation, and it’s okay, you know, not to treat their kids too much with kid gloves.

Jenn: I do want to address the other side of the coin, which would be, instead of a parent, guardian, et cetera, approaching a kid to talk about a difficult subject, if our kids come to us to talk about difficult things.

Does the same, you know, making, trying to make people comfortable, acknowledging that discomfort, et cetera, does that advice still apply, or are there any other methods for keeping our emotions in check?

Because I can imagine, depending on what they’re coming to us with, it can be really hard to keep a poker face.

Blaise: Right, and I don’t know that you should necessarily keep a poker face. Sometimes, you know, one of the things that some of my patients have told me is that their parents are so robotic.

You know, that all they do is they keep this poker face and do they actually have emotions, you know? And I think that authentic responses are key. It may not feel right in the moment or it may, you may worry that it’s going to dysregulate your kid, but you know that you can have strong emotions and that you can get through those emotions.

That’s a much more powerful life lesson than you’re a robot. Now, there are certain things, you know, maybe it has to do with who the person’s dating, the drugs that they’re using, something like that, that, you know, it can be a difficult situation, and you may or may not suspect, and then you will have the reaction that you do.

And you might just say, “Wow, this is really tough. I just need, like, a few moments. Can I, you know, just, can we get back to this?” There are other situations where, I mean, sometimes it has had to do with, well, it could be anything.

I mean, gender or sexual identity or life partner or refusal to go to college or something like that, that just takes a parent completely by surprise.

And, you know, I would just be grateful that my kid is actually coming to me with this thing, and I would also say, “Hey, listen, I really want to hear you out, but, you know, I just need to, you know, take a few moments to, maybe even a day, but I promise I’ll get back to you.”

And I would just recognize, you know, how grateful I’d be that the child who has been struggling with something is coming and telling me something.

Jenn: How would, can we as parents, educators, adults, listen to young people without personalizing what we’re hearing?

I know I’ve… I’m a child, I’m a child of parents. I have heard many times, “When I was age, ABC, XYZ,” and personalization is a way that you can feel like you’re connecting with someone, but it can also make you feel really disconnected at the same time.

Blaise: Yeah, I did that a few times and my kids pointed out like, “Oh, so you smoked weed once? Okay, were you on Snapchat? Were you on, you know, Instagram? Did people take pictures?”

I think, you know, we forget that we’re individuals and that each of our experiences are completely different. I mean, our children are not ourselves. They are shaped by their genetics, which includes some of our genes, by their experiences, meaning their friends and what their friends are doing, by their time in history, you know, with social media and other things.

And so to equate, you know, what we experience to what they experience does them a disservice. It robs them of an opportunity to explain or to talk about what they’re going through.

You know, I used to tease my dad. I’d say, you know, “So what was it like, you know, riding the old horses around back in the day before cars,” you know? And, but, you know, we would joke about stuff like that, but it’s like, you know, the times are different.

And I think it like, “Wow, let me tell you what I did, let me tell you what happened to me,” it, you know, it robs you of an opportunity to listen and it robs them of an opportunity to say what they’re going through in their time, given who they are and their experience.

Jenn: Do you think that same principle would apply then to, if we have more than one kid, talking to them each individually about difficult subjects, because it seems like the gist of this is that you want to make this a unique, personalized experience for them.

Blaise: Yeah, you know, the great child analyst Winnicott said, “No two children are raised by the same two parents.” Meaning that, first of all, children are different, and that you are different.

You know, you, as a parent of one child will be different than you as a parent of two children, so that things will change, you know, over time. And you might have a child who’s very emotionally sensitive, and then other children who are just like, “Whatever,” you know?

So if I, you know, my kids who like to play sport, for one of them, I’d say, maybe they’re playing soccer or something, you know, “Get up, come on, push yourself.” And they’ll say, “Yeah,” they’re going to do that.

And the other one will get really upset and say, “Oh, you’re not being nice to me,” or something like that. So children are just different, and to recognize those differences and individualize.

Now, I mean, there might be some situations, you know, saying, “Hey,” you know, “we’re packing up and we’re moving to Seattle or something,” and, you know, that’s a family discussion that has to happen, and that could be very difficult for all the kids because of schools and friends and stuff like that.

But maybe that would be a time to have a family discussion. But I would try to individualize it to the extent that I can, knowing your own sensitivities and knowing your child’s sensitivities.

Jenn: So, with the recognition of there being sensitivities all around, do you have any tips around successfully validating young people who are sharing negative feelings about us as being their parents or caretakers?

I understand it hurts to hear criticism, but if we’re reacting poorly, couldn’t it just further splinter our relationship with our kids?

Blaise: Yeah, yeah, so it’s painful as a therapist or as a parent to be attacked by either you, the, you know, the patients you’re taking care of or the children that you’re trying to raise.

Two things about that. There can sometimes be a kernel of truth, a tiny kernel of truth in what they’re saying, and I sometimes try to pick up on what is going on rather than specific content.

Now, if somebody becomes, frankly, attacking, you know, “You’re the most terrible parent that ever existed,” you know, it’s very, it would be very hard for me to have a discussion under those circumstances, feeling attacked.

And what I would like, typically that kind of statement would happen under the circumstance of deep emotionality.

And then, what I, so what I think that I would do in those circumstances is say, “Listen, you know, we got off on the wrong foot. I really want to be of help to you, I want to be able to listen to you, but I didn’t.

You know, something got in the way, and it was painful for you to, you know, it was painful when I heard you say that I’m the worst parent ever. And I want to be a better parent. I don’t wake up in the morning thinking, ‘how am I going to be a bad parent today?’

But clearly something didn’t work, so can we start again? Can we try again, and then, and can we do so, I, you know, neither of us attack the other person, just listening. How is it that you’re finding that the way I’m parenting you isn’t helpful to you?” So.

Jenn: My next question for you is actually two-pronged. I’m curious about what parents have expressed to you as being the important conversations that they find the most challenging, or they’re the most avoidant about.

And, as a parent, which important conversations have you found to be most challenging, and have either considered avoiding or avoided all together?

Blaise: Yeah, okay. So I think questions of illness, either physical illness or mental illness, especially if they’re pretty significant, you know, maybe the diagnosis of a terminal illness, sharing the diagnosis of a terminal illness.

Maybe a divorce that, or a separation that the kid wasn’t anticipating, a loss of a job, you know, and a sudden change in the family’s financial situation, you know, the insistence that a kid go into, maybe longer term treatment, say at a residential treatment center, those kinds of things.

But then there’s other kinds of things like, you know, maybe the parent doesn’t like the child’s romantic partner, the group of friends, drug use. Those are the kinds of conversations that I think parents have had a difficult time having with their kids.

And often those are the ones where they come to us and say, “How do I have this conversation with my kid?”

And I think it gets back to one of the earlier questions that you asked, you know, like, delaying it too, too much, now the parent is in their head like, “How am I going to do this,” and worry, worry, worry, and they anticipate a reaction which sometimes doesn’t happen, and which sometimes does.

You know, because I, you know, I suppose for me, because I had, I had many parents tell me about the difficulties in their conversations that they were having, and I would coach them on how to have them, I realized early on that I couldn’t tell, coach parents in having these difficult conversations without myself doing the very same thing.

I’m never going to recommend something that I wouldn’t do myself. So very early on, I just decided I would have those difficult conversations as soon as necessary.

And I, you know, so for me, it wasn’t so much not having them or delaying them for long periods of time, but having them at a time when, you know, I was regulated and my child seemed regulated, you know.

So I, you know, I remember waking up one morning and saying, “Hey, you know, I think we have to start talking about drinking and partying.

You know, you’re at the age where I know you’ll go to parties, and I know, even though you’re not legally allowed to drink, people will bring in alcohol, so let’s just talk about it. Let’s just talk about what happens if things go badly.”

Because I’ve seen the other side of it, where, you know, as I say, a parent is up late at night and the kid comes home, they’ve had something to drink and, “Oh, this is terrible, and you’re grounded for the rest of your life.”

And, you know, stuff like that, which never works by the way, because it’s not true that they’re going to get grounded for the rest of their life, and that’s just one of those emotional statements that you feel like saying.

Jenn: I know that you obviously, as a parent, you know your kids almost better than they know themselves at times.

How do you know when they’re actually feeling the most emotionally regulated? Are there any patterns or behaviors that a parent could pick up on so they know when to address those difficult topics?

Blaise: You know, so, just as a general rule, and I know that this is true for me, and I know it’s true for a lot of emotionally sensitive people, that as the day goes on, and as you accumulate more and more, kind of, exhausting events, work, and other interactions, et cetera, we tend, you know, tend to, for most people, not all, but for most people tend to be more difficult at night as a general rule.

The, I try to pay attention to deviations in normal behavior. So, for instance, let’s just say that the child is a very chatty child and all of a sudden has stopped talking.

I would then, I would just notice that, I would say, and I would probably do it earlier in the day because you might not be getting any other clues from your kid as to what’s going on, would say, “Hey, you know, you used to come home and, like, I don’t know, you’d tell me everything that was going on, and I just see the last four or five days, you haven’t said anything, you know. Tell me what’s going on.”

You know, if there are other changes in other kinds of behaviors. Anything that leads to anything dramatic, I sort of would cue in on. But how do you know that your child’s in a state to be able to have that a discussion?

You know, if you don’t know, if you just can’t read your child because they’re not giving you enough clues, I would just say, “Hey, you know, I really want to talk about drinking and partying.”

Maybe I would say, I don’t know, do it on a Saturday morning. If they then explode, which is why a lot of parents don’t want to have those conversations, you know, probably not the right time.

However, you’ve broached the subject and you say, “Look, this doesn’t sound like it’s the right time, but we have to have this discussion. And I’m happy for you to let me know when you’re ready to have that conversation. Do you need like an hour? Do you need two hours? But we really need to, this is a conversation that needs to be had.”

So if they’re ready, fine, if they’re not ready, then let, then I would say to them, “You tell me when then, but we have to have it.” And say, you know, it has to be before the end of the weekend or something like that.

Jenn: So if a parent is considering getting ready to have a difficult conversation with their kid, how can we actually prepare to have that chat, and what are some things that we could do in advance of that conversation?

Blaise: Okay, so a couple of things to this one. There’s a DBT skill which we call the Cope Ahead Skill, and what we do in the Cope Ahead Skill is we anticipate the worst possible outcome, the worst possible realistic outcome.

It’s not like the child, the, you know, 10-year-old child is saying, you know, “I’m packing my bags and, you know, moving to Washington,” or something. It would just realistically, what is the worst thing that could happen?

And often, the worst thing that can happen is a big emotional upset. And so it’s a little bit like doing, you know, like coping ahead for that situation, imagining that situation, the worst situation.

Because if it’s anything less than the worst, then you’ve got it, because you’ve coped for the worst, and if everything works out, well, that’s fine. If there’s anything in between that, well, you’ve coped for the worst.

The second thing is to, you know, do your own, and this is where the practice of mindfulness for me comes in. It’s like, pay attention to how am I doing right now? Am I in a listening state? Am I making assumptions about my child’s behavior? Am I judging my child’s behavior?

Because if I bring those qualities into that conversation, it’s unlikely to go well. So I set the intention of listening, of being curious, of being nonjudgmental.

And so if I’m not in that state, then I wouldn’t, you know, go and have that conversation. Maybe I go for a bit of a walk just to calm down, make a nice cup of Earl Grey tea and, you know, decaf if it’s later in the afternoon, so.

Jenn: We’ve had several audience members express that they have teens that have just completely shut down speaking to them, even if it’s just small talk, which I was there, I’ve done that before, I’m sorry.

It’s really difficult for a parent not want to just throw their hands up in the air and just say, “Forget it. I hope this works itself out.” So at what point do parents, kids, or both want to talk to therapists about this kind of behavior?

Blaise: You know, for kids who just will not talk to their parents, you know, I have found that for many of those kids, for example, as a therapist, that I can have lots of discussions about that, about what’s going on for them.

So they think, “Okay, what is going on that they can talk to me, but they cannot talk to their therapist?”

Now, sometimes you just want to talk to your therapist, you know, but that complete shutting down, it can be really confusing, because it would be easy, much easier to say, “You’re a judgmental person, and until you stop judging me, I’m not going to talk to you.”

So, but they’re not even telling you what’s going on. I think that in those situations, it just is such a sad situation for me. I mean, the idea that a kid wouldn’t speak to their parent is just so sad, and I think I would’ve just expressed my own sadness.

I’d say, “You know, we had this relationship and now we don’t, and that has really made me so sad. And I’m worried that there’s stuff going on in your life that you have a hard time talking about, maybe we can find a therapist.

But I’m really worried that I’m doing something that is interfering with your ability to talk to me, and I really want to change that.” And, you know, I always spoke to my mom, but I often didn’t speak to my dad, because my mom was so open and listening and my dad was so judgmental. And, but he wasn’t even curious about why I wouldn’t talk to him. You know, it took years, you know, 50 years before. Now we get along much better. But it is, you know, it is that.

So I think to observe the change, to notice it, to be saddened by it, and then to say, “You know, if there is something about how we are doing things, let’s, I’d love to know. I’d love to know more. I’d love to know what it is.”

And then be open to discuss. And, you know, “Every time I date someone, you know, you’re just critical of the person I’m dating. You know, I experimented with drugs and you, you know, you said I was going to, you know, never succeed in life,” et cetera.

I…whatever the conversation is. So something that maybe you’ve said. And you might not even be aware of what you’ve said as a parent, and just be open to listening.

Jenn: I want to address that there is the other side of the coin, where if kids are perceiving that their parents are being hard on them by talking about this tough stuff, there’s some children that are just hard on themselves anyway, whether it’s grades, sports, social life.

It’s hard to watch a kid struggle through all of these things, but how can a parent approach helping their kids when their kids are just beating themselves up?

Blaise: Yeah, no, I see this a lot, and then the problem is, is that an internalization of those criticisms as true. You know, “You’re lazy, you’re not trying hard enough,” those kinds of things.

The, you know, people learn through repetition, and so if there’s some kind of repetitive message that a child is getting, eventually over time, they’re going to absorb that message, and it’ll be integrated in their sense of who they are.

And I think, and you know, certainly in the days before, years before I did dialectical behavior therapy, I would sometimes think that my patients weren’t trying hard enough, that they were being lazy, that they were being, you know, manipulative or attention-seeking, without recognizing that, at any given point in time, a person is doing the very best that they can, given who they are, given their genetics, given their biology.

And so if, you know, I mean, you might not think that the criticism or the recommendations that you’re giving your child are harsh or critical or judgmental, maybe you don’t see it that way.

But you could, you know, one thing that you could say to your child is, “Is what I say to you helpful? Does it help you get unstuck? Does it expand you or does it shut you down even further? And because I, you know, that’s not my goal.”

And just because something worked for you, you know, I mean, I have a, somebody who’s, you know, grand, their grandparent was in the army and sort of was a staff sergeant with this person’s dad, and, you know, and the dad said, “Yeah, I just got up every morning, and I just did what I had to do in a very militaristic style.”

Well, that worked for that person, but it might not for this person. So when he, when this dad tried it with this patient, it didn’t work.

And so paying attention like, “Wow, this is not working. It’s actually distancing us rather than getting us closer together.” And notice that distancing because you don’t want distancing from your kids.

Jenn: I know one of the things that you have addressed in the previous question was about for kids that are more internalizing their behaviors and shutting out other folks.

We had someone write in saying that their college-age son doesn’t leave the house. He’s actually been home for four years, has cut off all of his friends, is on medication and in therapy, but what can they do as a parent to engage with him and vice versa, because he’s just not talking to them.

Blaise: From a DBT perspective, we often think about what’s reinforcing, so what keeps any behavior going?

Often, you know, when children are really, really shut down in the way that this person described, there’s something very, it feels very, very safe about the world, you know, not leaving the house, being taken care of and being provided for.

Obviously the other side of it is that they won’t then learn how to do for themselves, and that would be a very difficult way to intervene, because four years of a practiced behavior, you know, to undo it all of a sudden, would be hard.

I mean, it would be very abrupt. I think that what I would, if I could get a better sense from the kid and maybe even have a family discussion or do a family meeting with a therapist to say, “What is it about being at home so much that is so reinforcing?”

And, you know, if it is a sense of safety, then what is it about the world that is unsafe? And are there things that we can do to make, you know, to sort of challenge the false thoughts, if there are some false thoughts.

And, you know, but then I would also work on reinforcing the child leaving the house, maybe half an hour, maybe one hour a day, you know, through something that the child wants. I would also start thinking about not rewarding the behavior of staying at home in some way.

But that’s a very complicated situation. I’d probably, you know, it would need a lot of very careful analysis and assessment of the child to really fully understand all the motivations for staying at home for four years. That’s a really difficult situation, and my heart goes out to this family.

Jenn: I know one of the things thematically that we’ve addressed throughout the last hour is just being realistic about teen behavior. I know as much as we don’t want our kids to be drinking or having sex, it’s, you know, they’re bound to happen, and we want them to make the best decisions in those moments.

So how do we actually suggest, or rather, how do you suggest expressing these concerns to our kids about being responsible about sex, drugs, et cetera, without being the overbearing lecturing parent?

Blaise: You know, there was a very interesting study in Holland, and Holland tends to have the lowest rate of teen pregnancy anywhere in the Western world.

And one of the things that happens is that, this is just an example, is that parents allow for their children to have their romantic partners stay with them in their house, you know, under certain circumstances. Not that somebody can, “Okay, this is my new girlfriend,” “This is my new boyfriend,” like every three days.

But just like, you know, and they have open discussions about this. Now, if we’re trying to, so, for example, tackle teen pregnancy, it’s a really interesting idea.

How does that happen in parties, because, you know, they realize that they said, whether you talk to your children about sex or not, children are having sex.

I mean, and by children, I mean our kids under 18. I mean it’s, to deny that that is something that’s happening for many kids, it’s just a, you know, is a delusion.

So to have that discussion about “How are you respectful,” “How are you compassionate,” “How are you thoughtful about sex?”

Now, they may not necessarily want to talk about it with you, but if you, you know, I mean, I had a parent that said, “I just told my kid that he could, he had to stop having sex.” I said, “What happened?” He says, “Well, he stops having sex.” I said, “That’s remarkable.”

And then his mom came in the next week and said, “That’s not what happened.” She said, “You can’t have sex.” He told her, “I won’t have sex,” and then he was at the girlfriend’s house having sex.

So it, the idea that, you know, you can, that you can shut the conversation down is not useful, because that’s not the way that teens work, and I think it’s, like, having an open conversation.

Now, there are also many, many teens who aren’t having sex and who aren’t doing drugs, and that their issues are school avoidance or, you know, or who are being bullied or other things like that. It’s not just about sex and drugs.

There are other difficult conversations that that need to be had, and, but it’s just like a general openness to any of these conversations, and not to get, you know, too preachy and judgmental about them.

Jenn: I think when it comes to these conversations, it’s also important to recognize…

I know you had addressed previously that you felt more comfortable talking to your mom for so many years, and I’m sure that, in the background, your mom was enrolling your dad in a lot of stuff without making you feel like you were alienated or betrayed, or like your trust was broken with her.

Do you have any advice for how parents who are kind of that solo communicator with their kid enroll the other parent and help them stay in the know?

Blaise: You know, one of the things I’ve seen is that, you know, sparks fly much more when the parent and the child are in a very antagonistic situation. And then sometimes they’ll say, “Oh, wow. They seem to be able to talk more to their other parent.”

So without necessarily the parent being the parent that the child goes to being the moderator or being the, you know, the balance between these two people, I would, as the parent who is able to get along with the child, you know, share with the other parent…

Okay, for instance, “I just listen,” or, “I,” you know, “I’m curious,” or, “I’m not judgmental.” And I think… now that doesn’t mean to say that you have to be somebody who just caves to everything that your child wants, you know, but, and, and actually, you know, many of the parents who are just listening parents don’t necessarily agree with the child’s behavior.

Like, okay, staying up late at night or anything like that, you know, maybe going to parties. But it’s the approach to how they say no that is the useful one.

Not, you know, like one parent, “Ah, you just can’t do this, and I don’t like your friends and you guys are all drinking all the time,” you know, versus saying, “Okay, so tell me more about these friends.

What is, you know, tell me more about how you engage with them. Let’s invite some of your friends over so I can get to meet them. You know, I don’t like you drinking at night, and especially if you’re drinking and you have school the next day,” you know.

So it’s not that the children are often surprised by their parents’ values, and not even that the parents maybe have the same value, but it’s that approach about how do you say no in such a way that the child looks forward to hearing the no in a sort of a diplomacy, rather than saying, “Oh, here he goes again, preaching about when he was a kid, et cetera.”

Jenn: You know, one of the things that’s really difficult to talk about with kids, and we’ve alluded to this already, is getting them enrolled in therapy or engaging with a mental health specialist.

Do you have advice for engaging these kids who are technically still under our guardianship, so we could force them into it, but we’d rather have them be interested in seeking mental health treatment. Any tips for parents on that?

Blaise: Well, I can say this, that there have been many kids who, when they come to our form of treatment, DBT, generally by the time they get to our form of treatments, it’s because other treatments haven’t worked.

So when I, you know, so then they say, “Oh, here we go again. They’re recommending therapy. I’ve been in therapy before. I talk about my problems, nothing ever changes.” So, first of all, is to differentiate between different types of therapy.

If I wanted to learn how to rock climb but somebody sends me to basketball camp, I’m not going to learn how to rock climb. But if that’s what I want to do, I want to go to a rock climbing camp.

So if somebody says, “I’ve got difficult emotions, I want to learn how to regulate those emotions. I have difficult relationships, I want to learn how to regulate,” then go to a therapy that does those things.

Somebody says, “I’ve got ADHD, I want a therapy for ADHD,” well, that might be more medication. “I have bipolar,” then…So you, so not one size fits all.

It’s not like, “Oh, we’re going to send you to a therapist,” and then another therapist and another therapist. How do they differentiate? How do they, you know, how does it make sense for the child to say yes, you know, by mapping the therapist’s skillset to what the child is asking for?

So you could say, you know, to your child, it’s like, “Okay, maybe some, you know, just simply going and talking about your problems hasn’t helped. For a lot of people it can help, but maybe for you it hasn’t.

But I realize it’s because we weren’t addressing the thing that you were talking about, which is how to control your emotions, in which case, oh, we have a therapy that is for controlling emotions.”

So mapping what, you know, the kid is asking for with the patient, the therapist’s skillset.

Jenn: Any resources that you can think of that would be beneficial for parents, educators, any folks tuning in, to help them learn more about initiating and navigating difficult conversations?

Blaise: The, there’s, I haven’t actually found a singular site that is, that has been useful.

One of the things that we have found very helpful at 3East, my program that does dialectical behavior therapy is that there’s a, the National Education Alliance for Borderline Personality Disorder has this program called Family Connections, and that is parents helping other parents.

And one of the things that I like about this Family Connections model is that for a lot of parents, they can think, “Oh my God,” you know, “here’s the therapist telling me what to do.” But families helping other families seems to work really, really well.

Now, and so the Family Connections model for kids who are emotionally ultrasensitive seems to have worked really well for those parents. I just don’t know if there are, you know, that kind of equivalent for families whose maybe kids don’t have as severe a problem.

But certainly if you have a kid who is maybe really struggling with suicidality or with strong emotions, maybe some self-injury, destructive behavior, and there’s really suffering, that a program like Family Connections would be useful.

Jenn: Well, Blaise, I think this is a really good way to wrap up the conversation. I just want to say thank you so much for joining me. I think it’s just, it’s so remarkable how you’ve made a subject like difficult conversations seem so easy and so approachable just based on your speaking style, your knowledge, your engagement.

So, just thank you so much for joining me to talk all about this. And if anybody is tuning in, thank you for joining, and this actually concludes our session about difficult conversations.

Until next time, be nice to one another, but most importantly, be nice to yourself. Thanks again, Blaise. Have a great day everyone.

Blaise: Thank you, okay, bye-bye.

Jenn: Thanks for tuning in to Mindful Things! Please subscribe to us and rate us on iTunes, Spotify, or wherever you listen to podcasts.

Don’t forget, mental health is everyone’s responsibility. If you or a loved one are in crisis, the Samaritans are available 24 hours a day at 877.870.4673. Again, that’s 877.870.4673.

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The McLean Hospital podcast Mindful Things is intended to provide general information and to help listeners learn about mental health, educational opportunities, and research initiatives. This podcast is not an attempt to practice medicine or to provide specific medical advice.

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