Teenage niece would like therapy for DPD but parents not supportive.
February 21, 2019 5:27 PM   Subscribe

Help me advise my 15-year old niece on how to independently access mental health care in a mid-size Midwestern city.

My niece has been experiencing depersonalization and derealization for seven years. Last October, she worked up the courage to ask her parents for help. She said she was very interested in therapy. At first, her parents seemed supportive and said the right things, such as "We'll make a plan" and "I'll call about a therapist." However, with the exception of trying to figure out if her symptoms might actually be the effect of migraines, the promise of help has not been met. There's has only been silence.

After four months of her parents ignoring the issue with no explanation, my niece is afraid to ask them about it because she can't bear to endure another round of getting her hopes up only to have them dashed. Heartbreakingly, she said to me, "It's OK. I've been dealing with this since I was eight. I'll just wait until college to get therapy."

Is there any way my niece, a mature minor, can find a therapist independently? Are there services she could access for teenagers in her situation? She has told me she's not impressed with her school counselor and doesn't feel close to her family doctor. It doesn't seem right that she has to wait more than three years to get the help she needs now.

As a concerned aunt, I am in a delicate position. It isn't my place to tell her parents what they should do. (I've asked my niece if she'd like me to talk to them again, as I had done in October after she decided she wanted them to know about the DPD, and she said no). At the same time, I don't want to sit by and not do what I can to help her get the support she needs.
posted by prairiecatherine to Human Relations (8 answers total) 2 users marked this as a favorite
 
You and/or your niece could call the National Alliance on Mental Illness (NAMI), which offers a free HelpLine at 1-800-950-NAMI (6264) to provide information, referrals, and support for people living with a mental health condition, family members and caregivers, mental health providers, etc.

The NAMI online directory can also be searched for local NAMI organizations. A variety of additional resources are also listed at the MeFi Wiki ThereIsHelp page.
posted by Little Dawn at 6:09 PM on February 21, 2019 [2 favorites]


The laws about minors seeking treatment independently vary by state and it may be possible, it shouldn’t be a difficult thing to google. I agree that withholding mental health treatment could technically be a medical neglect children’s services call, but that really wouldn’t be my first suggestion based on what I see here because there are a lot of things you could try first.

Why doesn’t she want you to bring it up with her parents again? It seems like something you could explore further with her, and potentially get her to feel comfortable with. You haven’t mentioned her parents being strongly anti-mental health treatment. It may just be some fear-based avoidance that another gentle reminder would help them move past.

Even if she doesn’t feel close to her counselor or family doctor, maybe you could talk to her about getting them to help advocate... she can tell them about the full situation, or even just that she wants therapy with no details. If either of them are willing to reach out to her parents, it might help to hear an “expert” recommendation. Any teacher she trusts or feels somewhat ok about could also do this.

In general it does sound like she feels stuck...from what you’ve written here, she’s basically saying that she’s unwilling to do any of the things that might change the situation. No talking to them again, no talking to anyone who might talk to them, you can’t talk to them... not blaming her, feeling stuck is often part of the illness, PLUS, she’s a kid and getting healthcare shouldn’t be on her shoulders anyway. But it might help her if you talk through some of these fears with her. She doesn’t get a good vibe from the school counselor... ok, what’s the worst thing that could happen if you talk to her and it doesn’t go well? She has fears about handling disappointment if she asks her parents again and nothing happens? Well, clearly she managed that disappointment before, horrible as it was, and she’s a tough person who can handle it again. Just anything you can do to help reinforce how she can handle difficult things, and to plan how to attack the things that might not go according to plan.

Another resource might be Crisis Textline. You can text in to 741741 and have someone talk through things with you. I am a volunteer there and it’s mostly teens who use the service.

It means a lot that you are trying to support her, and there’s no one right thing to be doing in this. Just the fact that you’re there and concerned is a help, and one that not everyone has. You sound like a great aunt!
posted by sometamegazelle at 6:32 PM on February 21, 2019 [4 favorites]


To start with, Google the relevant state and minor mental health care consent. Or just call the nearest the nearest low income treatment center, because odds are, they're going to know.

There's a big red flag here, given that, according to Merck, "The disorder is usually triggered by severe stress, particularly emotional abuse or neglect during childhood, or other major stresses (such as experiencing or witnessing physical abuse)."

And her parents are blatantly neglecting/downplaying her mental health needs.

Thank you for helping her; I suspect she needs it.
posted by stormyteal at 7:07 PM on February 21, 2019 [5 favorites]


You could also consult with a family law attorney if you have questions about legal issues.

According to the Guttmacher Institute:
Laws in 20 states and the District of Columbia give minors the explicit authority to consent to outpatient mental health services.

No state explicitly requires parental consent or notification for any of these services.
posted by Little Dawn at 8:22 PM on February 21, 2019 [1 favorite]


Honestly, there are so many reasons she could be getting silence. Trouble finding a therapist taking new patients. Having a hard time navigating insurance and what’s in network. Just getting overwhelmed by the holidays and the beginning of the year! I think it would be a good thing for you to model for her that instead of making assumptions about what’s going on, it’s best to just have a conversation. You could offer to check in with her parents for her, or help give her some words for doing so herself. If you are up for it, I would approach them and say “Niece talked to me about getting a therapist. How can I help make that happen? I would be happy to [whatever help you are comfortable offering.]”

From what you have written here, I don’t think there’s a reason to jump to her needing to pursue it without their support. Saying the right things and not following through is a heartbreakingly common part of being a parent to a teenager. Life can get in the way, and if there hasn’t been ongoing conversation about something it’s easy to start thinking it must not be that important.

She may be mature for 15, but honestly the mature thing to do in this situation is do the scary thing and ask them what’s up. She should let them know this was heartbreaking and that she is ready to pursue it on her own. From the sounds of it, she doesn’t need to do this behind their backs. Mental illness is hard and isolating and it lies to you and says that’s the way it has to be. Help her not cut off her support network before she even tries. I know it will take courage, but she doesn’t need to break her own heart.
posted by stoneweaver at 10:58 PM on February 21, 2019 [4 favorites]


One thing to bear in mind is that it's potentially really, really hard for the kid who is inside this kind of dynamic to challenge it from within. I had some serious mental health issues as a teenager and my parents were very resistant to the idea of me seeking treatment for those issues.

It was a frosty, abusive household to grow up in and I'd deeply internalised the idea that pleasing the difficult people who had so much power over me was way more important than getting help for myself because they had the ability to make my life utterly miserable in subtle, immediate, emotionally abusive ways and the idea of being less mentally ill seemed really abstract and unachievable in comparison.

So I didn't push very hard, and I didn't keep asking when it was clear they were very uncomfortable and unhappy with the idea. I made them believe that it wasn't a big deal and I would be okay without it because it was easier to deal with the fallout from that than to try to bear their pointed disappointment and discomfort on top of the severe depression I was already trying to deal with without any meaningful resources.

I brought this up with my surviving parent recently and she told me she believed it was very much my fault I didn't receive adequate mental healthcare as a teenager because I failed to advocate for myself hard enough and didn't select the one correct safe adult in the extended family to confide in (because at that point I didn't believe any adults were safe or trustworthy on the subject).

From my perspective, it was very much her & my dad's fault that I didn't receive mental healthcare as a teenager and I consider this medical neglect of a minor in retrospect, but there was no way I could explain this to her in a way that would make her actually understand that the reason I didn't feel able to advocate for myself was because of the culture of shame, silencing and fear that she and my dad built their house on. I'm now nearly 30, have done a ton of therapy, and I still can't communicate well enough with this parent to make her understand that it wasn't my job to advocate for myself that hard, nor was it my fault that I couldn't.

It's so great that your niece has an adult who's on her side, but bear in mind that the reasons why she doesn't feel safe pushing this until she's in college (this was also what I did as soon as I got out of my parents' house) may be extremely deep-seated. On the off-chance that her parents are as difficult and emotionally abusive as mine were (and this sounds plausible if she's had dissociative symptoms since an early age, which was also true for me, though obviously I know nothing about her family or how her parents have raised her), one supportive adult on the outside may not be enough to overcome intense feelings of needing not to make a huge deal out of this right now because it doesn't feel safe enough at home to do so.
posted by terretu at 11:48 PM on February 21, 2019 [17 favorites]


I do not know this teen, I do not know these parents.. I have no siblings. But if there is only silence and not emotional/physical abuse. I suggest she asks again, Maybe with you or allowing you to ask for her. Sometimes parents have their own drama and things get pushed aside, sometimes, they may delay because they don't understand the issue or sometimes they just forget.
I would not doubt her on school counselors. I know their may be some great ones out there..I have just never seen them, nor have my daughters run into any during their terms in high school/college.

I do have a matter of fact attitude and I'm not great on slinging fluff to make people feel better so I suspect heavily, in your shoes, I would just ask them myself how she was doing, (to get their view) and then ask what plans were being done to get her treatment for the issues she has raised before. Ask them if the need help.

Then, if they blow it off. I would start looking for other options.
posted by ReiFlinx at 2:58 AM on February 22, 2019 [2 favorites]


Thank you so much to everybody who responded to my question. Your answers provided perspective, support, empathy, practical advice, and much to consider. In response to sometamegazelle's question about the parents' attitude to therapy, I would say that it is ambivalent at best. Based on what I've heard and observed, one of the parents in particular seems to see therapy as something for self-indulgent people who don't have "real" problems or any legitimate reason to seek this help. In other words, if you are from a comfortable home, making good grades, appear to be externally fine, and have not experienced extreme trauma, then you are not really entitled to therapy.
posted by prairiecatherine at 10:17 AM on February 25, 2019


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