Originally published in The Ottawa Citizen December 4, 2001

Erica (not her real name),16 years old, dropped in to the high school clinic. She announced she had been having bouts of depression for about a year since beginning high school. Her parents were arguing daily and she feared they were heading for a divorce. She felt powerless to stop them.

She said her father was critical about her work and that her best efforts were never good enough. She felt she could not approach her parents about her depression because she feared they would be disappointed with her. Her school performance was declining. It was clear she was depressed.

She raised an additional problem she was having with her boyfriend of two months. She said he cared for her and “is in tune with my moods and feelings.” The problem was that he asked her to have sex with him for his birthday. She initially agreed but was now having reservations. I asked her to consider the positives and negatives of agreeing to his request. She admitted there were more negatives but that she was afraid of saying “no” to people.

There is a useful set of concepts I introduce to my patients that can provide the tools necessary to deal with inter-personal problems.

The first deals with the concept of the “true” versus “false” self. The true self usually can discern right from wrong. We sometimes refer to this as the alarm bell that goes off in our head. When we ignore this alarm, we do so at our own peril. People who follow this inner voice tend to respect They become more self-confident and self-reliant. They are not afraid to say “no.” The false self is best described as following a path or decision contrary to doing the right thing. The person directs anger inward. They know what they are doing is wrong but they follow through with it anyway. They lose respect for themselves. They have a difficult time saying “no.”

The second focuses upon two straightforward statements, the Two Rules as I call them: “It is not that people say but rather how they act that reveals their true intent,” and “People always do things for a reason”. There are some issues to keep in mind before solutions are offered. A good, trusting relationship must exist to be effective when treating adolescents. This may take weeks or months to develop. It is an investment in time with huge dividends.

We have a natural tendency to offer suggestions to help them. However, teens will listen when they ask for your opinion. Before offering it, let them know they may not get the answer they are expecting. Let them again decide whether they want to hear what you want to say to them. You have
given them an “out.”

Usually at this point of the process, they are curious to know what it is you might say to upset them. However, they rarely become upset because of how the lead-up was presented.

In this particular situation, although the solution is obvious, some adolescent patients may chafe at someone telling them what to do. In Erica’s case, she was terrified her boyfriend would dump her. She had little in the way of support from her parents. Her father was distant and not providing the emotional support and stability that she needed.

Erica went through this exercise in detail. Why would her boyfriend dump her because she refused to have sex with him for his birthday! He claimed to love her. He was in tune with her feelings. But then why did his actions betray his claims? Was he not objectifying her? What was his real intent? She also knew the right thing to do was not to have sex with him. But she loved him. Needless to say, she admitted to being very confused.

After much deliberation she decided against being a birthday present. He promptly dumped her. Initially upset, she saw her decision as correct. In fact, her boyfriend made many overtures to resuming the relationship. She felt better because she did not compromise herself and had some measure of control of her life. She was able to apply the Two Rules and determine motive. She
could then listen to her true self and be comfortable with her decision.

This method is not a panacea for all adolescent ills. It has served well in helping many adolescents. Erica, now 21 years old, is in university. She is happy and in a stable relationship. She cringes when she thinks about what she actually contemplated doing six years ago.

One of the great joys of adolescent practice is when one is able to have a positive influence upon them. Once they trust your judgment and counsel, the ability to affect positive change in their lives improves dramatically. Certain relationships can make all the difference.

[Originally published in the Ottawa Citizen]