The Patient Who Made Me Question Everything
"I want your kids to hear and accept your advice. This is how to get there."
Posted February 1, 2023 | Reviewed by Vanessa Lancaster
- Sometimes, people don't want help, but their families do.
- Family members can learn skills to communicate more effectively with adolescents about issues from suicidal thinking to college applications.
- We can't control other people's behavior, but we can help them make good decisions by showing curiosity and respect.
In my final year of training to be a psychologist, I was assigned a really challenging case at a clinic for young people experiencing psychosis. Jack was on a mental health leave from college. He wouldn’t eat, bathe, or see his friends.
His parents suspected that paranoid delusions consumed his mind. Jack came to see me twice. He seemed hesitant, but I thought we were making slow progress at getting to know each other and building trust. Then he missed a session.
The next week, Jack no-showed again; this time, his dad surprised me by coming in Jack’s place. I led him into my office, and he shook his head sadly. “He won’t come,” the father said. “He doesn’t want to talk to you. I just wanted to say… thank you for trying.”
We sat in silence for a few minutes. The seconds ticked by painfully. I must have tried to say something reassuring. But it felt pointless. Years of classes and supervised practice had prepared me to work with Jack and help him to understand his own emotions, thoughts, and behaviors. But Jack did not want to talk to me.
Jack’s father had already read the pamphlets about psychosis and spent late nights Googling the problem. He knew that his son needed to meet with a therapist. He had spent months waiting for a spot to open for his son at the clinic, rallying hope around the idea that help was on the way. But he couldn’t force his son to meet with me.
The Limits of My Influence
That experience—my failure to help Jack and the weight of his father’s grief—shaped my career. Psychologists know a lot about how to talk to people who are struggling with ambivalence about their behaviors: whether to cut back on drinking, for instance, or whether to take a medication.
Decades of research have shown that when we use a therapeutic practice called motivational interviewing, people are much more open to making these positive changes. But in that moment, I couldn’t use any of those skills because I didn’t have access to the person at the center of everyone’s concern. I only had access to his father. But an idea took root: Jack’s dad might be able to use motivational interviewing to talk to Jack about attending therapy.
Even under the best circumstances, when someone is struggling with serious mental health or substance use issues, I typically only see them for 50 minutes once a week. I know I play an important role in my patients’ lives, but let’s be honest: 50 minutes is 0.4 percent of a person’s week. The other six days and 23 hours, they are kind of on their own.
But most young people are not truly alone; almost all my patients live with a supportive friend or family member who interacts with them throughout the day. These folks—typically family members, often parents—do the real heavy lifting of encouraging their loved ones to eat healthy foods, take walks, get regular sleep, and engage in other activities that will make recovery possible. Jack’s dad was a good example: I felt helpless because I couldn’t talk to Jack, yet his dad was stuck at home with him all the time, also feeling helpless.
Motivational Interviewing for Loved Ones
That fateful session, when I sat in silence with Jack’s father, was eight years ago. In the meantime, I created a brief coaching program for parents and other non-professionals who wanted to learn how to use motivational interviewing with the young people in their lives. I enrolled 130 families in research studies to test the effects of the training, and I got feedback from hundreds more who generously shared their insights and experiences with me.
I found that parents from diverse backgrounds whose adolescent and young adult children struggled with everything from college applications to suicidal thoughts were profoundly grateful to learn these skills. They told me that they were able to use them right away—sometimes minutes after logging off from a training session. Parents reported significantly less stress and more confidence after learning the skills. Compared to those who were randomly assigned to a waitlist, families who got the training had significantly reduced conflict and burnout.
So, what are the magic words that helped these families? Unfortunately, there is no button that gets kids to listen. But here’s the main idea: We cannot control other people. Influence flows from relationship, and relationship flows from respect. So, if you want your kids to listen to you—especially about stressful topics like drugs, school, and being safe—you must convey curiosity about the person your child is becoming, interest in their perspective, confidence in their judgment, and respect for their autonomy.
Those are abstract concepts, but they can be conveyed through simple, specific behaviors: reflective listening, asking questions, and offering your own advice thoughtfully and sparingly. For instance, if a teen says, “I hate school,” our instinct is to rush in with reassurance (“But you are so good at math!”) or solutions (“Let’s meet with the principal and discuss dropping a course”). But we can be so much more effective by reflecting on what we hear (“School has been tough for you lately”) or eliciting more information (“What makes you say that?”).
The better we understand other people’s dilemmas, the more helpful our advice will be. Sometimes, kids don’t even need our advice or intervention: Simply having a calm, nonjudgmental sounding board is enough for them to feel better or problem-solve on their own.
Believe me. I want your kids to hear and accept your advice. This is how to get there.
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Miller, W. R., & Rollnick, S. (2012). Motivational interviewing: Helping people change. Guilford press.
Kline, E. R., Thibeau, H., Davis, B. J., Fenley, A., Sanders, A. S., Ipekci, B., ... & Keshavan, M. S. (2022). Motivational interviewing for loved ones: Randomized controlled trial of brief training for first episode psychosis caregivers. Schizophrenia Research, 250, 43-49.