By Emily Kline, PhD
One of the most fraught topics for teens and young adults to negotiate with their parents is whether to take medications for mental health problems. Often, parents play the role of pushing for medicines while youth question whether the medicine is truly necessary or effective. This can easily escalate into a power struggle in which parents feel like they can’t trust their kids to make good decisions while youth resent their parents’ intrusive and controlling behavior. This dynamic is awful for everyone involved, and it can go on for years.
As a specialist in adolescent and young adult mental illness, I think I’m pretty good at talking with my clients about medication decisions. I want to hear their concerns, and I have total sympathy for the fact that many medications are only partially effective for managing mental illness symptoms while sometimes causing embarrassing or disabling side effects.
The pros and cons of taking psychiatric medications are unique to each individual. Some people find that medications are incredibly helpful, and cause no side effects, while others feel that their medication yields few benefits and a lot of costs.
Usually, young people actually want to talk about these dilemmas, so long as their parent is truly seeking to understand without casting judgment or pushing an agenda.
To navigate these conversations, I ask about clients’ past experiences, their treatment goals, their cultural beliefs and values around medication, and their preferences. To be honest, my clients usually wind up wanting to give medication a try. They want their best shot at relief from painful symptoms like mood swings, hearing voices and panic attacks.
Many of the techniques I use derive from a communication style used by health professionals called “motivational interviewing” (MI). MI is based on the idea that the best way to influence another person’s behavior is by creating space for them to make their own decisions. The core aspects of MI include asking open ended questions, listening carefully and repeating back what you heard.
Since MI is shown to be effective when professionals use it to talk to clients about difficult topics, like substance use and medication adherence, I started to wonder: wouldn’t parents love to learn these skills? With funding from the National Institute of Mental Health and in collaboration with the Massachusetts Department of Mental Health, I’m developing and testing an online curriculum that teaches parents to use MI-derived communication techniques.
Rather than engage in the power struggle over medications, take a deep breath and try to get curious instead. “Help me understand how you feel about medication” is a good place to start. If your child makes statements that you know or suspect are not based in facts, let it go. Don’t try to win the medication debate; win the moment by showing your child that you value their perspective and your relationship with them. Repeat back the gist of what you heard, without adding your own spin, and then ask, “did I leave anything out?” and finally, “so what do you think you’ll do next?” Try to listen and understand your child’s perspective before offering your own.
It can be hard for parents to admit how little control they have when the stakes are so high. The consequences of medication non-adherence can be serious, leading to symptom relapse or even hospitalization. Parents often feel like they ought to be able to force their child to take medications, but the truth is, parents of teens and young adults with mental illness often have little leverage.
If your teen or young adult child doesn’t want to take medicine, what are you going to do? Threatening to kick them out of your house, withdrawing love and affection or using rewards and punishments to enforce rules that they don’t agree with can cause conflict and damage relationships during a vulnerable time. If you sense a crisis is around the corner, prioritize making time for an honest conversation. Acknowledge that the choice is up to them, work to understand what’s motivating their behavior, and respectfully give your own opinion or advice.
In order to use their best judgment, people need to feel that they are in control of their own destinies. The last thing parents want is to tempt their children into proving them wrong. Declaring defeat in the medication tug-of-war is not giving up on your child, but allowing them to be in the driver’s seat of their own recovery. Once parents accept that it’s not really their decision to make, they might be surprised by the wisdom of their kids’ choices.
Dr. Emily Kline is an assistant professor of psychology in the Department of Psychiatry at Beth Israel Deaconess Medical Center and Harvard Medical School. Her current research focuses on communication skills training for parents and caregivers of youth with emerging mental health difficulties.
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