(Note: As with all of these discussions, materiel changes have been made to the descriptions of the people being discussed in order to maintain strict privacy in accordance with all HIPPA and professional standards.)
When I met Nikki she had just been discharged from a local psychiatric hospital having experienced serious thoughts of suicide. She was a pretty, but clearly sad 16 year old young woman who admitted she had been struggling with depression for a number of months with more recent thoughts of killing herself. Her parents were concerned, available and admitted that they both came from families that were chaotic, distanced, and organized with lots of guilt as motivators. Nikki's parents were in their first marriage, having met in a self help group. I thought their mutual sensitivity a good sign They were appropriately concerned about their daughter's welfare and the frightening seriousness she had given to suicide.
In the course of the year that followed I have grown very fond of Nikki and her parents. We've explored both mom's and dad's families of origin, including one of Nikki's grandparent's financial boom and bust, leaving mom's family virtually desolate at the time of her father's (Nikki's maternal grandfather's) death. The issues of betrayal and rage that Nikki's mom grew up with were quite significant.
Nikki's dad also came from an emotionally challenging history, his parents having divorced and remarried to step parents with whom dad was cordial. Dad, however, was often caught in the ongoing friction between his biological parents that continued 30 years after the divorce. Nikki's parents willingly began coming for couple's sessions as well to deal with Nikki's hospitalization - a watershed event in their lives and with the family of origin challenges both brought to this marriage.
Nikki is a smart young woman and despite struggling mightily with her academics in the wake of time missed during her hospitalization and struggles with depression, she pulled out a very strong academic year. With a lot of support she asked for and received some latitude from her HS re: completing some assignments late. And yet, despite the accomplishments, she still struggled with feeling just OK (good was too high a bar) about her very significant accomplishments.
In addition to her academic strengths, she was very involved in sports spending many hours pursuing her expertise in gymnastics. She knew she was not destined for the Olympics and she was OK with that. But she enjoyed it and took her training and commitment to her team, coaches as well as her parents efforts on her behalf quite seriously. So when training resumed after a successful summer for the upcoming season, she resigned herself to the many hours per week required for training. But she worried.
Nikki was good at worrying and continued to struggle with just being happy despite her many strengths and accomplishments. So recently when she came in and voiced her concern about the upcoming academic load facing her, including a couple of AP classes, we began to explore what her motivation was to continue with gymnastics. She admitted it felt good to stay in shape, but added that there were certainly other ways to stay in shape that didn't require the degree of training and time that she had committed to. She hated to think that she'd be wasting the money her parents had already spent for her training and coaching. Her mom had been a pretty good gymnast when she was in high school and Nikki knew her parents both valued her extra curricular efforts. She worried about her "resume" for college, and that leaving gymnastics would take away from her chances for acceptance to a good college. (I'll spare you my rant about the pressure HS kids have these days, but trust me, I've got one.) She didn't want to let her coaches down who had been so supportive of her during her struggles last year. She had every reason to continue except her own desire to do so. Her motivation to continue was all based on factors other than her own. The theme of guilt ran strong as a motivator for her. She didn't know how she'd fit all of the needed time into the day or week to address both her academic and extra curricular load.
So I asked her what it would be like to consider dropping gymnastics - which she toyed with last year - again with her parents to see what their response would be. Communicating her concerns about how many hours there were in a day seemed a reasonable thing for her to do with them. They were supportive, concerned, available and she didn't have the seething resentment of her parents that some adolescents develop. She knew they were on her side, she just didn't want to disappoint them. She was unsure how to proceed.
In our next session, almost a year since her suicidal thoughts had taken root, Nikki came in and hesitantly but with confidence said she had finished with gymnastics. She spoke to her folks and to her coach and all were supportive of her. Never one for excitement or overstatement, I asked her how it felt and she said "OK."
"OK?, Not 'good?'" I asked. She let a small smile out and admitted that it was better than just OK. And then we talked about the role of guilt, the dangers of doing something for someone else's needs without doing it for one's own needs, and the importance of knowing when we were asking too much of ourselves. Nikki's confidence in herself is beginning to bloom. I suggested to her that she'd turned a corner in comparison to where she was a year ago when she didn't know how to communicate her needs and her parents were unsure what to listen to, or how hard to push her. She agreed, things were indeed different. So many of the things she worried about just hadn't come about. Her parents, her coach, all supported her decision to discontinue her athletics. I cautioned her in her fear of disappointing one of her teachers - she was changing out of one of the teacher's classes, but didn't want the teacher to feel bad. I suggested this was the virtually the same issue we'd been discussing - worrying about others' feelings instead of balancing her own needs. I could see the lights go on. She's learning how to find her voice, and I'm so proud of her.
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