@stressedteenager
Have namechanged for this as DC know my current nick.
Nicola, I really enjoyed Blame My Brain, great book, and it's been useful for both my teen and upcoming teen.
The question essentially is how you can convince a reluctant teen to start CBT if this has been urgently recommended by a psychiatrist.
DD1 has been suffering what we think are psychosomatic symptoms since starting secondary school (and puberty). She's now 16. She's easily missing 20% of lessons because of stomach aches, exhaustion, headaches etc. We live in a country where academic selection is compulsory, so she's in a traditional grammar school. Academically she's coping fine - in fact she'd find it more frustrating in a less academic setting and is happy with her friends - but she puts herself under huge pressure to do well, while also being very scatty and disorganised. She gets outraged by any perceived injustice, whether among her friends, from teachers or on a global scale. The two family members she was closest two apart from DH and me have died in the last three years - one of them violently. And she's coming to terms with coming out as gay, which we're trying to support her through, but it's been a rocky road at school. That's a lot for one teenager to cope with. A psychiatric evaluation (which we had to coax her into) confirmed that it was not physical, and recommended a course of CBT - but she's refusing. She also won't do yoga or any sort of relaxation techniques (eg I have a Jacobsen CD at home). I'm really worried she's going to stress herself out to the point of a breakdown - she's just started the equivalent of A-levels and the pressure will only get greater. As part of the evaluation she had an IQ test, which found that she scored very highly for logical thinking and very low for working memory: a disparity of nearly 40 points. Any suggestions?
Hi. Gosh, your daughter has some big and difficult things to deal with. But she has very supportive parents, which will be a hugely important factor in helping her through this tough period and the two traumatic bereavements she has had to face. I'm interested in why she is resisting CBT. Is this because she had been hoping that the stomach aches etc had a "physical" cause? (As someone who suffered those symptoms, I identify with that hope.) If this is the case, she needs to understand that "psychological" does not mean "imaginary" – they are physical symptoms, stemming from chemicals and pathways in the brain, and require help to sort them out. I spent a lot of my childhood suffering stomach-aches, headaches, nausea and insomnia and wish CBT had been around then – instead of which, I was, appallingly, given sedatives.
I have two points I'd like to make. First, it's highly likely that the poor working memory score is because she is under stress. When we are stressed, some of our working memory and "brain power" is occupied by that stress, and we cannot perform as well. So, it's important, I think, for her to see that the stress is likely to hamper her academic performance – and this may give her a powerful motivation to tackle the problem. Obviously, you need to be a little careful how you phrase this, so as not to make her more stressed, but she’s a bright girl and should be able to see that too much stress will make it harder for her to achieve her goals.
Secondly, I suggest that you offer her a real choice, which will give her some control. The choice is either to get professional help to control her stress or to tackle it proactively herself. I think that once the choice has been offered, it would be a good idea to back away for a week, and see what decision she makes after researching for herself what her options are. The Teenage Guide to Stress gives lots of suggestions about this. You mentioned that she's resisting things such as yoga – I suspect this is because she needs to find some ideas herself and feel a sense of control and choice. You are being so supportive but I wonder if there's a way of empowering her to use her very clever brain to help herself. She needs to understand that every human is vulnerable and that she is not showing weakness for needing help. I made myself ill at various times in my adolescence and twenties, because I didn't look after myself, and I remember resisting other people's suggestions.
One final point: it sounds to me as though she takes life very seriously indeed (for understandable reasons) and maybe has forgotten to build pleasure into her life. We need a bit of pleasure every day, some way to let off steam, whether by having a laugh with friends, walking on a beach, or having a long bath while reading a book or magazine. We should not feel guilty about having fun and relaxation – it's an important part of looking after our health.
I wish your daughter the very best. She is welcome to email me if she would like me to explain anything I've said.